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the cases of menstruation in pregnancy, and excluding casesof irregular haemorrhage, he believed the source of the bloodto be the decidua vera, as in ordinary menstruations, the un-usual condition in such cases being the absence of adhesion ofthe two membranes, the decidua vera and decidua reflexa.The decidual chamber may, in other words, persist to a laterperiod than usual, in which case there is no difficulty in ac-counting for the exudation of blood from within it, and itsappearance externally.Mr. ROBERT ELLis read a paper

ON ANESTHESIA BY MIXED VAPOURS.

In opening this subject Mr. Ellis said it would be taken forgranted that the administration of mixed anaesthetic vapourspossessed certain advantages over that of pure chloroform,counteracting the depression produced by the latter agent, andgiving great security to the anaesthetic art. But the difficultyconsisted in the due application of these vapours, and up tothis time the anaesthetic fluids had been simply mixed together,and their resulting vapours administered. It was then shownthat the whole theory of anxsthetic mixtures, and especiallyof those recommended by the Chloroform Committee, was basedon an error; this being the idea that the vapours of each fluidwould rise from the mixture in the same proportions as thoseof its constituents. A large number of experiments weredetailed, the object of which was to prove in the clearest pos-sible manner that this notion was wrong from the commence-ment. Anaesthetic mixtures were shown to give off theirrespective constituents in vapour as nearly as possible in theorder indicated by their boiling points. Thus ether came offin largest quantity, and alcohol in the least; and it was foundthat it was not possible to construct any formula for an anaes-thetic mixture which would give off a definite and unvaryingconstitution of vapour from first to last. The patient con- isequently would be inhaling a mixture of vapours of differentcharacter at each moment of evaporation, and no reliancecould thus be placed upon these compounds. The author,therefore, denounced the whole practice and theory of anaes-thetic mixtures in the fluid form as uncertain in their effects,and not to be depended upon for practical employment. Mr.Ellis, however, believing in the great value of a true system ofanaesthesia by mixed vapours, was led to the discovery of asimple means by which this anxsthetic method might becarried out in practice. In the instruments exhibited to theSociety the following principles were completely carried out:-

1st. The anaesthetic fluids were evaporated in distinct andseparate chambers, and their vapours were combined in an air-chamber on their way into the lungs.

xnd. The proportions of each vapour were regulated by amost simple mechanical contrivance.

3rd. It was impossible to give an over-dose of either etheror chloroform in consequence of the peculiar adjustment of thereceptacles for those fluids.Without entering into the details of construction of these

inhalers, the author drew attention to two very important fea-tures in his invention, which he believed likely to influencefor good all future forms of chloroform instruments. The firstof these was the method of only liberating a certain numberof minims per minute of chloroform or ether. This was effectedby an adaptation of the self-acting law of capillary attraction.And the other was the powerful evaporating surface of a frilleddescription, by which he could saturate the inspired air withthe powerfully stimulant vapour of alcohol. He estimated ata high rate the value and importance of these adjustments,and invited the close attention of the meeting to their excellentperformance. The fluids employed by the author were purechloroform, ether, and alcohol ; and so great was their economyof use that, in anaesthesia for such an operation as ovariotomy,extending over half an hour, scarcely two drachms of chloro-form were used-an allowance of less than four minims perminute, or only three quarters per cent. of chloroform in theinspired air. In midwifery practice, in which the authorclaimed for his system many special advantages, he seldomused more than from sixty to ninety minims of chloroform perhour.

Dr. SA-NS0,M thought the observations of the author mostvaluable, as urging upon the attention of the profession thenecessity of a proper dilution of chloroform. From his ownexperience he was assured that by the ordinary rough meansadopted to administer chloroform it was common to allow anatmosphere of from ten to thirteen per cent. to be inspired.Dr. Sansom explained his theory of narcotism, especially theaction of narcotics upon the calibre of the arteries. A typical

anaesthetic would be one which would not, on the one hand,like chloroform, rapidly abrogate the functions of the sympa-thetic and paralyse the heart, nor, on the other hand, " over-stimulate "-i. e., by contracting the arteries, throw a largevolume of blood upon the venous system. Chloroform actedbest when freely diluted, but, unlike the author, Dr. Sansomconsidered that this dilution could be effected without specialapparatus. Ether was ineffectual for dilution, because, fromits volatility, it nearly all evaporated away from its mixturewith chloroform; and its excitant as well as nauseating pro-perties were objectionable. But from great numbers of expe-riments (many of which Dr. Sansom detailed), he was con-vinced that in chloroform diluted with an equal bulk of abso-lute alcohol we have an excellent anxsthetic, which gives off aproportion of chloroform vapour in a given time almost exactlyhalf of that which is given off by chloroform pure and simple.As to Mr. Ellis’s instrument, though most ingenious, he thought,as anaesthetics were for the many and not for the few, we shouldrecommend such a process as will render anaesthesia safe, andbe encumbered as little as possible with mechanical complica-tions.Mr. ELLIS, in reply, stated that he could scarcely sufficiently

forcibly dwell on the fact that the fluid anaesthetic mixturesgave off uncertain and varying compositions of vapour-a factclearly demonstrated by many of the experiments he had de-tailed, and that, therefore, they were not to be relied upon.Especially in midwifery practice this grave error, in consequenceof the duration of inhalation, was most manifested. He couldby no means agree in the remarks of Dr. Sansom as to adminis-tering as high a per-centage of chloroform as four per cent.He was, by his system, perfectly well able to obtain speedy,and to sustain prolonged, anaesthesia with an allowance ofbarely one per cent., the security and well-doing of the patientbeing, in his opinion, in exact proportion to the diminution ofthe dose of chloroform. The vapours of ether and alcoholmixed with it seemed in an extraordinary manner to enhancethe activity of the chloroform, and safely to sustain its force.He begged in conclusion to exhibit to the Society a perfectlynew form of his inhaler. This instrument he had especiallydesigned for his use in midwifery. It was simple in construc-tion, and of equal safety in use with the more powerful in-haler. Its principal feature was a beautiful little reservoir forchloroform, which, acting on the principle already alluded to,dropped that fluid over an evaporating surface, at any rateper cent. desired by the operator. The instrument was thuseffectually protected against an overdose.

Dr. BATTYE read a paper onAN EXAMINATION OF CERTAIN UTERINE AFFECTIONS IN THEIR

RELATION TO PHTHISIS PULMONALIS; WITH CASES.The author’s attention to this subject had extended over four-teen years, during which time he had collected numerous ex-amples of various forms of uterine leucorrhoea coexisting withaffections of the lungs. He brought eleven cases before theSociety, minutely describing the symptoms and terminationof each. It was shown that as soon as the leucorrhcea wascured or relieved, the chest-symptoms also either entirely dis-appear or lessened in extent and force. He strongly urgedearly special attention during the treatment of phthisis touterine discharges when present, as such caused a constantdrain on the constitution. As to treatment, lie seldom usedlocal remedies, but trusted to acids, vegetable bitters, andcod-liver oil. The salts of iron were found by him to Le very

valuable in the chronic forms, having a special e3’ect on thelung condition as well as on the uterine discharge.

Reviews and Notices of Books.lt’Tedical Report of the Campaign carried on against the Taepings

’ ly Gordon’s Anglo-Chinese Continpcnt in 1863-64. ByAssistant-Surgeon A. MOFFITT, 67th Regiment.Two years ago the fanatical insurgents known to us as

; Taepings were making themselves extremely formidable to theImperial Government of China, and threatened by their de-vastations to put an end to all internal and foreign commerce

in the provinces where they had established their authority.With a view to aid the Imperial Government in putting a

. stop to the alarming progress of the insurgents, Major (nowLieut.-Colonel) Gordon, C.B., of the Royal Engineers, was

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authorised to enter the service of the Emperor of China, toraise, organise, and command a disciplined force of Chinesetroops to aid the Imperial forces in suppressing this formidablebody of merciless fanatics.

It will be in the recollection of our readers that completesuccess attended this measure. In a series of brilliant opera-tions, in which Colonel Gordon displayed great military capa-city and genius, the object was effected. The little forceunder his command fought many severe actions, and finallyexpelled the rebels from the province of Kiang-too. Assistant-

Surgeon Moffitt, of H.M. 67th Regiment, was placed at thehead of the small medical department of the force, and theReport under notice is a brief and modest record of the servicesit rendered.

Dr. Moffitt, after a short description of the organisation ofthe force and the topography of the province in which theoperations were conducted, gives an account first of the dis-eases from which the force suffered, and then a classified

history of the wounds received in action.The force consisted of 3000 Chinese and 120 foreigners. The

admissions from all diseases amounted to 4166, and the deathsto 87. As might have been expected in such a locality, six-sevenths of the whole admissions, and over eleven-twelfths ofthe whole deaths, arose from miasmatic diseases; while theimmunity from tuberculous, scrofulous, and hepatic and otherconstitutional and local affections, is unprecedented in anycountry and among any people."

Dr. Moffitt gives some interesting details of opium diarrhoea.,which he " found to be a most troublesome affection to dealwith." This is of course the disease of opium smokers; inthem it appears to come on every summer, and continues

through the hot weather, or until it proves fatal. Dr. Moffitt,from his extensive observation, looks upon death from thisform of diarrhœa, " as the end to which all persons who indulgein the pernicious practice of opium-smoking must come sooneror later." The disease is attended with little pain, and nofever. " Its prominent symptoms are looseness of the bowels,bad appetite, loathing of food, white tongue, depression ofspirits, sallow skin, hollow cheeks, and sunken eyes, withwasting of tissue and general debility." In treatment, thedifficulty is to get the patient to give up the practice of smok-ing. If this can be done sufficiently early in the disease, Dr.Moffitt found that " Dover’s powder and tonics were of muchservice. " He found it necessary to give opium by the mouthfor some time after smoking was left off.

Every=thing relating to cholera has an absorbing interest atthe present time. The disease has been known to the Chinesefor centuries, under the name of " Shu-ping" (low sickness, orfatal disease); and Dr. Moffitt states that it clings to the banksof the great Yang-tszn river, and, as is well known, severelyscourged the force under Lord Gough after the capture of Chin-Kinny-Foo, on that river. At Nankin it has been known for

centuries; but, according to our author, has never visited thegreat city of Loochow, which is only thirty miles inland fromthe great river. It seems to be even more fatal to Chinamenthan to Europeans : they succumb to it rapidly.Many 01 the surgical details given in this Report are full oi

interest to military surgeons. So great was the reputation ofDr. Moffitt as a successful operator and surgeon, that the

Viceroy of the province, when General Yang, commanding sdivision of the Imperial army, was wounded in the chest andgiven up for lost by his countrymen, applied to Dr. Moffitt foraid. The General was successfully treated. Our readers shouldmark the result. "The case coming under the immediatenotice of the Viceroy of the province, he took much interesiin it, made a special report of it to his own Government, anchas since been trying to obtain as his own medical attendania Chinese physician educated in Edinburgh, now practising iiCanton."

It is impossible to over-estimate the good done by Dr. Mof&tt

not only to the force in which he served with so much distinc-tion, but to the reputation of his profession and country. Wetrust that some recognition of this officer’s services will bevouchsafed; for we have reason to know that the gallant com-mander of the force is more than ready to testify that the con-fidence felt by all ranks in the surgical skill of Dr. Moffitt wasof signal service in nerving their minds for enterprise, how-ever hazardous. It will not be creditable to those in authorityif Assistant-Surgeon MoffiGt is left to find his reward in theapprobation of his own conscience.

NURSING IN HOSPITALS.To the Editor of THE LANCET.

SIR,—Before censuring anyone for an alleged statement, itis right to be accurately informed both of what was actuallysaid and of the circumstances under which the statement wasmade.With two exceptions (reduced to one by the resignation of

Dr. Patrick Stewart prior to the meeting of the court), theentire medical staff of the Middlesex Hospital desired, on theground of its superiority, to see introduced a system of nursingby paid nurses supervised by ladies, in the place of the oldsisters under a lady superintendent.At a court specially summoned to consider the question, the

shortcomings of the system now working, stated in the Reportof the Medical Committee, were denied by some governors;and it was objected that ladies, on account of their refinementand less bodily strength, were unfit for hospital work. Incorroboration of the Medical Committee’s report, I mentionedseveral defects in ward-economy which, although individuallyof little moment, yet collectively greatly concerned the com-fort of the patients and the sanitary state of the wards; andI endeavoured to show that, by virtue of their refinement, ladieswere eminently qualified to remedy these defects, while theirpresence was also calculated to check the feeing which therewas reason to fear some parts of the hospital were not freefrom. I did not " discredit all the hospitals in London," northeir nurses (I know individual sisters and nurses whose prin-ciples and attention to their patients it would be hard to equaland impossible to surpass); but I maintained that the systemexisting in our hospital produced a less good average than thatdesired by the medical staff. Neither did I say that " theLondon Hospital nurses desert their duties, and are not to beruled;" but, after citing the invaluable assistance rendered byladies in the Eastern hospitals during the Crimean campaignin proof of their particular aptitude for hospital work, I men-tioned, as an additional example of what ladies may do inhospitals, the good influence which I had been informed (andmy information seemed to be substantially confirmed by yourarticle of the previous Saturday) had resulted from the acces-sion of a lady in the cholera wards of the London Hospital, incheering and encouraging the nurses to renewed exertion at atime when they were well-nigh overwhelmed by their incessantlabours. If in this I have been misinformed, and any wordsof mine have given pain to the nurses and ladies engaged inthis heroic struggle, I deeply regret them.

Mr. Shaw Stuart is so well able to justify his statementsthat I shall leave your comments on them unnoticed, exceptto say that I did not hear him relate" stories of indecency,"&c.; but, in proof of the want of sufficient surveillance, hereferred to an instance of gross disorder which had during thepast year been brought under the notice of the Weekly Board.I may add that the Board dealt summarily with the offenders.The incrimination conveyed in your culminating observation,

"a member of the staff, not satisfied with this," is simplygratuitous, as my remarks preceded those of Mr. Stuart.

I am, Sir, yours &c.,London, August 6th, 1866. J. W. HTLKE.

SUBSCRIPTIONS amounting to £3000 were receivedup to Wednesday night by the Mansion-house Relief Committee.A grant was made by the committee of £200 to the Poplarand South Bromley Cholera Fund, and £50 to that of Mile-endNew Town. A suggestion has been made that the Bishop ofLondon’s Fund and all similar ones should be merged in the

Mansion-house Committee.

J. W. HULKE.