1165EPIDEMIOLOGICAL SOCIETY.-REVIEWS.

under the head of rigid bodies. Version illustrated this.-Dr. CHAMPNEYS pointed out the importance of accurateknowledge of mechanics in practice-for instance, in thedelivery of the head. The head is born by a movement ofextension with advance. If the advance is forgotten andextension artificially produced, the larger fronto-occipitalinstead of the smaller suboccipito-frontal circumference dis-tends the vulva and the perineum is unduly stretched. Hewas convinced that laceration often occurred from thiscause. The words revolution and rotation were familiar toall, and were most useful for teaching purposes; a wheelrotates round its axle-tree, the moon revolves round theearth and also rotates. Viscosity could hardly be denied inthe face of the various forms of expression of more mobileparts or their retardation, and the foetus could not, there-fore, be regarded simply as a series of rigid levers.-Dr.M. DUNCAN, in reply, endorsed Dr. Champneys’ remarks,and stated that the movement as described in the paper hadbeen so described by all previous good observers, and that hisdescriptions were not innovations, as Dr. Galabin implied.

EPIDEMIOLOGICAL SOCIETY.

A MEETING of this Society was held on June llth, Dr.Buchanan, F. R. S., in the chair.A paper entitled "Some Observations on the Etiology of

Diphtheria" was read by Dr. H. FRANKLIN PARSONS, ofwhich the following is an abstract. The author sought tobring together the principal known facts concerning thecausation of diphtheria, with some of the hypotheses whichhave been propounded towards the solution of this hithertounsolved problem, supplementing them by a few observationsof his own. Diphtheria, though the name is modern, hasbeen known from early times. Until the middle of thepresent century it had, however, for nearly 100 years beenmet with in this country only in the form of sporadic casesand limited outbreaks. Appearing in several parts of thecountry in 1855, the disease rapidly increased until in 1859it caused a mortality of 53 per 100,000; the death-rate thendeclined, with the exception of a second lesser rise in 1863,to 12 per 100,000 in 1867, about which figure it has keptconstant ever since, latterly showing a tendency to rise.A diagram was shown in which the curve of the death-rate from diphtheria during the past thirty years wasshown and compared with those from scarlet fever and"fever," both of which, exhibiting large fluctuationsin the first half of the period, had steadily declined in thesecond half, doubtless owing to the operation of the PublicHealth Acts and the growth of public opinion as to the im-portance of preventive precautions. The Registrar-General’sremarks were quoted as to the probably large number ofdeaths from diphtheria which are returned under the head-ings of "croup" and "quinsy.’ The mortality from diph-theria, like that from scarlet fever, is greatest in the fourthquarter of the year, and between the ages of one and five;but, unlike scarlet fever, it is more fatal to females than tomales, and in rurl districts than in towns. These pointswere illustrated by tables. Of the modes in which diph-theria may be supposed to originate, infection from a previouscase is perhaps the only one which is certainly established.Examples taken from the author’s experience were adduced.The susceptibility to the disease varies greatly among dif-ferent people, often being great in particular families. Thedisease is infectious in an early stage, before its charactersare pronounced, and also after apparent recovery. Theinfection also attaches itself with persistence to houses,and may be conveyed by persons living in an infected airwho have not themselves suffered from the disease. Theattendance of children at school is a frequent channel bywhich the disease is spread, and there is reason to believethat it may be propagated from cases of sore-throat of amild character, such as frequently are prevalent at the timeof diphtheria outbreaks, but which do not themselves presentthe typical features of the disease. The infectious natureof the disease is also shown by the good effects which havefollowed well-considered and carefully executed measures ofisolation and disinfection. Cases were quoted showing thelength of the incubation period to be from two to five days.The hypotheses of the conveyance of the infection by thewind and by milk were touched upon. Granting the in-fectious nature of diphtheria, and the difficulties in the wayof tracking it, arising from latent cases, &.;., it must still be

admitted that outbreaks are frequently met with whichcannot be traced to an antecedent case-more so than withsmall-pox or scarlet fever; and hence it is probable that thedisease may arise de novo. Diphtheria and scarlet fever areoften closely associated, and the one disease has often

appeared to have been contracted from the other. Instancesfrom the author’s experience were given, and the nature ofthe connexion between the two diseases was discussed. Theone disease is not protective against the other, nor is oneattack of diphtheria protective against the other. Diph-theria, moreover, may arise as an intercurrent affection inthe course of other diseases, as measles, enteric fever, anderysipelas. It would seem therefore that diphtheria shouldbe classed in an intermediate position between the specificzymotics and the common local inflammatory diseases, likeerysipelas and puerperal fever, which may arise otherwisethan from specific infection, but which propagate themselvesreadily by infection under appropriate conditions. It isknown that diphtheria can be imparted to the loweranimals; but are there diseases of the lower animalsdiffering in appearance from diphtheria which may becapable of giving rise to that disease in the humansubject? Tnis question, still unsolved, is of especialimportance in reference to milk, a number of outbreaks ofdiphtheria having been observed to follow the distributionof a particular supply of milk, though no opportunity of con-tamination with specific infection could be traced. " Garget,"suggested by Mr. Power in reporting on the Kilburn epi-demic in 1878, and foot and mouth disease were referredto. Many authorities consider diphtheria to occur most fre.quently on a wet, retentive soil; others that it occurs in-differently on soils of various nature. Some consider it toprefer low, damp situations; others high, bleak, exposed sites.The author had not been able to attribute influence to any par-ticular soil or situation, having met with the disease on clay,sand, limestone and slate, on high chalk downs and in the fens.Can diphtheria be caused or propagated by insanitary condi-tions ? Judging from statistics it cannot, for the death-ratefromthe disease is higher in healthy rural districts than in the mostunhealthy towns ; nor has it fallen, as is the case in fever,in consequence of the sanitary amelioration of recent years.On the other hand, in practice it is often found that in-sanitary conditions are often present in houses in whichdiphtheria has broken out, and the author had an impressionthat insanitary conditions, such as the inhalation of drainair and putrid effluvia, overcrowding and dampness, were notwithout influence upon the occurrence and course of thedisease. The cause of the disease had at different timesbeen sought for in various low vegetable organisms, as

fungi, especially the oydium albicans. More receutly Oerteland other German observers had ftjund a micrococcusabundantly developed in the affected mucous membrane.It seemed probable that the immediate cause of the diseasewould ultimately be found to be some low organism which,while capable of passing its existence outside the humanbody and perhaps habitually doing so, could, nevertheless,under certain circumstances take on a parasitic habit andacquire toxic properties. In the discussion which followedMr. Buchanan, Dr. Murray, Dr. Squire, Dr. Thorne Thorne,Dr. Pringle, and others took part.

Reviews and Notices of Books.Memoirs of Life and Work. By CHARLES J. B. WILLIAMS,

M.D., F.R.S., Physician Extraordinary to H.M. theQueen, &e. London : Smith, Elder, and Co. 1884.

THE memoirs of any man who has been connected with themedical profession for nearly sixty-five years could not bealtogether devoid of interest, but the memorials of one whohas, in addition, been an energetic and eminent author,teacher, investigator, and physician must abound inincidents of social, scientific, and historical importance.From boyhood to old age Dr. C. J. B. Williams has had adistinguished career. When we contrast the conditions of

social, political, and medical life sixty-four years ago, whenDr. Williams entered upon his medical studies at Edinburgh,with those under which we now live, it is difficult to conceivethat any single life could have known them all. Ic is strangeto read the record of the recollections of one still living who

1166 REVIEWS AND NOTICES OF BOOKS.

studied under John Thomson, Hope the chemist, Monrotertius, Barclay and Lizars in Edinburgh; Magendie,Dupuytren, Laennec, Broussais, Andral and Larry in Paris,Charles Bell, Shaw, Abernethy, Astley Cooper, Brodie, andGreen, in London; and who began the study of medicineseventeen yeare before the Univer3ity of London was founded,and retired from the active practice of his profession oolynine years ago. The mention of these names and eventsrecalls all the changes, discoveries, inventions, and improve-ments that characterise modern medicine.

Participator in most of the principal events affecting themedical profession for nearly sixty years, Dr. Williams hascontribute! largely to the advancement of the science andart of medicine and to the elevation of its practitioners. A

glance at the headings of some chapters of the memoirswill suffice to show what Dr. Williams’ share has been :

Chapter xv., "Professorship of Medicine in UniversityCollege." Chapter xx., " R form in the Ct)lleg.3 of Phy-sicians." Chapter xxi., "Foundation of the Hispital forConsumption." Chapter xxv., "Formation of the Patho-logical Society." Chapter xxxi., "New Svdenham Society."Chapterxli., "The Clinical Society," &e. In all these mattersDr. Williams took a leadin- part in addition to his publicand private duties as a teacher, author, and practisingphysician.The interest of these memoirs is manifold, being per-

sonal, political, educational, literary, historical, ethical,and polemical. These varied interests will affect differentreaders differently. Speaking for ourselves, we prefer to Iregard Dr. Williams as a teacher, physician, and medicalpolitician. The polemical parts might, with advantige, havebeen pruned.On the subject of lectures, for instance, Dr. WLlliams, after I,

stating he never missed a clinical lecture as a student, says : I,Much has been said against teaching by lectures ; some de- clare that they learn better from their own reading than fromany ex cathedrâ address. My experience is different. Inthe case of subjects admitting of demonstration, by experi-ments or by appeals to the senses, in drawing" blackboardillustrations, and such objective aids, it can hardly be dis-puted that lectures teach better than books. Bat even inmore didactic topics I have always been able to learn morereadily from a well-delivered lecture than from reading thesame matter in a book. The liviag words of a clear speakerarrest the attention and command the thoughts more thanihe same words read in a book. I found lectures useful, noto11y in the amount of information which they conveyed, butalso as a mental exercise, suggestive of thoughts beyond thewords of the lecturer, and not always in accordance withthem. I was, therefore, more assiduous than most studentsin attendance on lectures, even beyond those prescribed inthe usual curriculum (p. 12).Many other instructive passages might be quoted on edu-

cational matters, and it is impossible to read Dr. Williams’sremarks on reform at the College of Physicians withoutfeeling that a great medical politician was lost in the suc-cessful physician. ---

The Action of Saline Cathartics. By MATTHEW HAY,M.D. With Woodcuts and Lithograph. Edinburgh :Maclachlan and Stewart. London : Simpkin, Marshall,and Co. 1884.

THIS memoir was originally presented to the Medical

Faculty of the University of Eiiaburgh as a graduationthesis for the Doctorate, and gained for its author a

gold medal and also the Goodjir Memorial Prize. Itwas subsequently published, with a few alterations andadditions, in Vols. XVI. and XVII. of the Journal ofAnatomy and Physiology, and the present publication is averbatim reprint from that journal. It i.,; needless for us to

say anything concerning the merits of this proiucion. It

deserves to be read by every member of our profession. Avery important item in the work is the admirable summaryof the results of the author’s investigation ; this consists of aseries of thirty-nine propositions or articles. We may indi-cate some of the more important conclusions :-A salinepurgative always excites more or less secretion from the

alimentary canal, depending on the amount of the salt andthe strength of its solution, and varying with the nature ofthe salt. The low diffasibility of the salt impedes theabsorption of the secreted flaid. Between stimulatedsecretion on the one hand and impeded absorption on theother, there is an accumulation of fluid in the canal.

Purgation will not ensue if water be withheld from thediet for one or two days previous to the administratioaof the salt in a concentrated form. The absence of purga-tion is not due to the wa.nt of water in the alimentarycanal, but to its deficiency in the blood. The salt is absorbedwith extreme slowness by the stom-ich of the cat. Thesecretion excited in the intestines is prob!l.bly a true succusentericusi, resembling the secretion obtained by Moreau afterdivision of the mesenteric nerves. When the salt is admi-nistered in the usual manner, it appears, in the case of the

sulphate of magnesia and sulphate of soda, to become splitup in the small intestine, the acid being more rapidly absorbedthan the base. A portion of the absorbed acid shortly after-wards returns to the intestines. The salt does not purgewhen injected into the blood, and excites no intestinal

secretion ; nor does it purge when injected subcutaneously,unless in virtue of its causing local irritation of the abdominalsubcutaneous tissue, which acts reflexly on the intestine@,dilating their bloodvessels, and perhaps stimulating theirmuscular movements. The sulphate of soda exhibits nopoisonous action when injected into the circulation. The

sulphate of magnesia is, on the other hand, powerfully toxicwhen so injected, paralysing first the respiration, and after-wards the heart, and abolishing sensation or paralysing thesensori-motor reflex centres. Both salts administered in theusual manner produce a gradual but well-marked increasein the tension of the pulse. The salt reduces the absoluteamount of heat in the body, though it has no marked specificaction in lowering the internal temperature.

Good Remedies out offashion. By CHARLES J. HARE, M. D.,F. R. C. P.

THIS brief address commends itself as a well-timed and

strong appeal to the medical profession not to desertcertain ramedies which in the past have yielded valuableresults in the treatment of disease. It is urged thatthe pendulum has swung too far in the opposite direc.tion. There can be no doubt that bleeding, emetics, andfree purgation are resorted to but raraly nowadays ; and thequestion arises whether a more frequent trial of such remediesin appropriate cases would not be of benefit both to the

patient and the doctor-to the former by a more rapid re-storation to health, or it may be relief from impendingdanger, and to the latter by enlarging his views as to thescientific methods of dealing with "debility." We canheartily recommend all our medical readers to peruse thisexcellent address, which is couched in plain language ofscientific moderation.

THE SMALL-POX CAMP AT DARENTH.-The sanitaryauthority at Dartford has made representations to the LocalG tvernment Board to the effect that the arrangements of theMetropolitan Asylums Board for the conduct and manage-ment of their camp for emall-pox patients at Darenth are sodefective as to render the camp a source of danger to thelocality. As the treatment of so many patients at this camphas been undertaken by the managers with the consent ofthe Local Government Board, it is believed that an inquiryin’.o the allegations will be instituted.

1167THE ELECTION AT THE COLLEGE OF SURGEONS. ; ’I

THE LANCET.

LONDON: SATURDAY, JUNE 28, 1884.

ON Thursday next the election will take place of five Imembers of the Counc 1 of the Royal College of Surgeons ofEngland. Seldom, if ever, have thera been so many

vacancies or so many candidates; never before has an elec-tion had so much significance, and yet the prospect seems toexcite but little general interest. We say" seems, because inreality most of the Fellows who are likely to vote are deeplymoved and sternly in earnest. A distinct issue has beenraised, and there can be no contentment or peace till thisissue is settled in accordance with the principles of rightand liberty. Over two hundred of the Fellows have pledgedthemselves to an opinion that all the members of the bodycorporate should be invested with a larger share in themanagement of the College, while a majority of the Councilhas expressed an equally deliberate opinion to the effectthat it is not desirable to disturb the existing order of thingsunder which the entire government and management of the

College are left to the unfettered will of twenty-four membtrsof the Corporation. Thus the matter stands ; on the oneside is a majority of eighteen thousand members of the bodycorporate, and on the other a majority of four-and-twentymembers. The ultimate result is certain, but the Fellows

may do much to expedite its attainment by electing to theCouncil those who are not only in favour of Collegiate reform,but may be depended upon to retain the courage of theirconvictions within the Council. Strength of character is

therefore a greater desideratum in a candidate than a pro-fusion of pledges, for it cannot b3 forgotten that some ofthose who afterwards became the most conspicuous obstruc-tives in the Council were, previous to their election, notoriomfor the extremely sweeping and even extravagant characte]of their notions of reform. Indeed it has happened to manmembers of the Council to find it convenient or agreeable tcrenounce their pre-electoral political creed.At present it is only possible for the Fellows to proteci

themselves against this form of apostasy by voting fo]

those candidates only whose stability of character has beerrested, and who have shown that they possess that morastrength which can resist the lulling influence of the charm!of office. Many of the candidates for the ensuing electiorare certainly proof against such allurements, and are notlikely to have their heads turned by a little brief authority.For instance, the bold stand which Mr. OLIVER PEMBEBTOrmade some years ago against the admission of homaeopathist!into the Birmingham Institute stamped him as a man 0:strong convictions and singular courage. Some of the othe:

candidates have also given proofs of a zealous public spiritIt is to such as these that the Fellows and Members aliki

must look for the faithful fulfilment of the programmeof enfranchisement and reform. There are, as we havi

previously announced, nine candidates for the five vacanciesIn the order of their seniority of Fellows they are as followMr. RICHARD BARWELL, 1853 ; Mr. WILLIAM ALLINGHAM1857; Mr. GEORGE LAWSON, 1857; Mr. T. SMITH, 1858

Mr. BERKELEY HILL, 1859; Mr. A. DURHAM, 1860; Mr.F. J. GANT, 1861 ; Mr. GEORGE COWELL, 1867 ; Mr. OLIVERFEMBERTON, 1878. All have declared themselves more or less

explicitly in favour of some reasonable reforms. It is for the

Fellows to select those whom they believe will most faithfullyand consistently endeavour to realise these good intentions.

FAITHFUL to its promises, the Government put the

Medical Act Amendment Bill down for second reading atthe morning sitting on Tuesday last. Mr. MUNDELLA

moved the second reading in a powerful speech, in which heclearly set forth the objects of the measure; and he wassupported by Sir LYON PLAY FAIR, who gave his heartysupport to the scheme of the Government. Such supporthas an especial value ; for not only must the personalopinion of Sir LYON PLAYFAIR on such a subject have greatweight in the House of Commons, but he is also recognisedas expressing the views of the Scotch universities. The

debate was continued by Colonel KING-HARMAN, Mr.

BRYCE, Mr. GIBSON, and Mr. J. CAMPBELL ; and eventuallythe Bill was talked out by Mr. GRAY, who appeared to takethis step in the interest of the Irish apothecaries.Although we should prefer to have been able to report

the second reading of the measure, we cannot express

disappointment at the present position of affairs; the

discussion showed that the Bill is considered by nearlyall parties as a necessary and first settlement of the

question, and we may be sure that the Government

will urge on the measure with all possible speed. The

debate on the second reading we may consider as virtuallyover, and the issue of the vote upon it we wait with the

utmost confidence. But although we may confidently anti., cipate the second reading of the Bill, it is clear that an

attempt will be made to introduce an important alteration, in itin Committee. If passed as at present drafted, every, student will have to pass an examination in medicine, sur-I gery, and midwifery conducted by the Divisional Board

: before he is entitled to be placed on the Register andr to practise. It will be proposed that graduates of the

r Scoteh universities and other bodies granting higherdegrees" shall be exempted from this minimum examina.

; tion, and in place of it the Divisional Boards will be

r authorised to send assessors to such examining bodies

ito ensure that the standard of examination is main-

Itained sufficiently high. We trust such amendments will9 not be pressed. We believe the Scotch universities, andisimilar bodies, will be wise in submitting their graduates tobany reasonable State examination, the cost and the trouble

of passing which will, to such men, be very slight. We

t believe that the English universities have not asked for anys such privileges for their graduates, and the advantage ofE having one single qualifying examination for each divisionr of the kingdom is so enormous that it should not be sacri-. ficed to matters of sentiment, or lightly waived in favour ofa schemes which are more complicated and afford less grounda for assurance that the prime essential of a qualifying exami-e nation is obtained.. The Government deserves the hearty, thorough, and prac-: tical support of the profession in thus pressing on this measure, of reform. It will be nothing short of a di-aster should the; end we so much desire not be reached now that it seems so