528

Humphry in Addenbrooke’s Hospital. W. M-——, male, agedfive months, was admitted on Sept. 1st, 188G. He was thin,pale, and weakly, with a’somewhat imbecile expression, buttaking notice of things around: the tongue was too largeat birth, and had been gradually increasing in size eversince; the child took the breast with difficulty, andhad latterly been fed on milk-sop. The mouth was alwayswide open; the tongue freely protruded, curving abruptlydownwards from the tightness of the frsenum, with markeddrooping and eversion of the lower lip : the protruded partwas an inch and a quarter long in the middle line, and an inchand a half broad at the base, and quite symmetrically enlargedin all its dimensions, the edges being thick and rounded, the tipbroad, truncate, and slightly bifid. The tongue could just becontained within the mouth, with evident discomfort; therewas wide dilatation of the nostrils and marked bulging ofthe submaxillary region; saliva freely dribbled from themouth, and there was an eczematous eruption about the chinand lips; the submaxillary glands appeared to be slightlyenlarged on both sides. The protruded part of the tonguepresented two deep antero-posterior furrows, parallel withthe edges of the tongue and meeting just behind the tip ;within the furrows the dorsum was convex from before back-wards and from side to side, and coated with brown fur. Theedges were clean and superficially ulcerated here and there;the papillae were everywhere enlarged, and scattered thicklyand irregularly over the anterior part of the dorsum and toa less extent over the under surface were numerons, pale,translucent, lymphatic cysts, from the size of a millet-seeddownwards; the whole tongue was moist, and nowhere crackedor dry. There was no evidence of glossitis, nor hoemorrhagesin the mucosa; there were no teeth, no deformity of thelower jaw, no evidence of lymphangiectasis of any descrip-tion elsewhere, nor any deformities. There was no history ofmental disease, or deformities, or struma in the family.The child died suddenly after being in the hospital a week,with atemperature, irregular before, suddenly rising to 108" F.There was a little difficulty in swallowing, but no interferencewith respiration. A portion of the posterior part of the ’,dorsum, where the disease was least advanced, was examinedmicroscopically. The papillae were much and irregularlyenlarged, more vascular, and covered with a thick layerof cuticular cells superficially. The submucous lymphaticswere enlarged here and there, and the lymph canalicularsystem of the muscle-bundles was especially dilated, butno defined cysts or haemorrhages were seen.Mr. WHERRY described and exhibited a case of remarkable

Power of Retraction of the Tongue. The organ could becompletely pushed up behind the soft palate and uvula, andthe tip could be made to touch, with precision, any part of Ithe post-nasal region.Communication of Dipkthel’ia.--Dr. ANNINGSON described

three special epidemics and several isolated cases of diph-theria which had occurred in his experience. The formerillustrated very well the tendency of diphtheria poison tocling to localities and reappear at certain periods withspecial force, as well as the influence of school assemblagein favouring the spread of the disease. One interestingfeature was the sudden explosion of the disease, after a

period of quiescence, among the girls attending school, whilethe boys, with one exception, escaped; and his case was ex-plained by his having been exposed out of school hours to thesame influence as the girls. Dr. Anningson also related someapparently unexplained cases of diphtheria in lonely de-tached houses, which afterwards could be traced to rainwater used for drinking which had been contaminated bythe droppings of domestic birds; also an instance where theconverse seemed to have occurred in the infection of poolsby human discharges.

ROYAL LONDON OPHTHALMIC HOSPITAL. - Theannual general meeting of the supporters of this institutionwas held on the 8th inst. The report stated that the hospitalhad in the past year afforded reliet to 28,260 persons, the in-patients numbering 2049 and the out-patients 26,211. Thetotal receipts for the year, including legacies, amounted to.66939, a sum which more than met the expenditure.PRESENTATION.-The Committee of the Monk-

wearmouth and Southwick Dispensary have presentedDr. Bruce Low with an illuminated address, he havingbeen appointed a surgeon for the Sunderland Infirmary, andconsequently having resigned his connexion with theMonkwearmouth institution.

Reviews and Notices of Books.A. Treatise on the Principles and Practice of Medicine. By

AUSTIN FLINT, M.D., LL.D. Sixth Edition, revised andlargely re-written by the Author, assisted by WILLIAMH. WELCH, M.D., and AUSTIN FLINT, M.D., LL.D. London:J. and A. Churchill. 1886.

A NEW edition of a work of such established reputation asFlint’s "Medicine" needs but few words to commend it to

notice; but to this sixth edition there attaches a melancholyinterest in the fact that its preparation occupied the mindof its learned and much-lamented author during the closingyears of his life. It may therefore in truth be said to

embody the fruit of his labours in clinical medicine, ripenedby the experience of a long life devoted to its pursuit. Thevolume has further been revised by the author’s son, thewell-known Professor of Physiology in the Bellevue Hos-pital Medical College, and by Dr. Welch, Professor of Patho-logy in the Johns Hopkins University. A comparison of thisedition with the preceding, which was published in 1881,’serves to illustrate in a striking manner the remark-able advances made, especially in pathology, during thepast five years, necessitating in many chapters an entirerecasting of the text, with numerous additions in thestatements of observed facts. Dr. Welch’s assistance inthese chapters has been invaluable, with the resultthat the reader will find a clear and succinct accountof our present knowledge upon the etiology of disease andthe nature of morbid processes which no other text-book ofmedicine supplies. Amongst the additions to the volumemay be noticed the articles on Infectious Tumours, SyphiliticDisease of the Lungs, Cerebral Syphilis, Spastic CerebralParalysis of Children, Hereditary Ataxia, Myxcedema (which,by the way, is omitted from the index), Multiple Neuritis(where, however, we miss any reference to the recent andrapidly accumulating evidence of the influence of alcoholismin its causation), and the General Pathology of Fever; butthis enumeration does not nearly cover all the additionsand alterations in the text of the work. If we were to

single out, where all is of such good quality, any chaptersas especially noteworthy, we should have little hesitation inpointing to those upon Diseases of the Lungs and theHeart, for these were subjects to which Dr. Flint paid special

attention. His well-known views upon the constitutionalnature of pneumonia, or as he terms it " pneumonitis," orpreferably " pneumonic fever," promulgated many yearsago, have received striking confirmation in Friedlander’sdiscovery of the "pneumococcus," although it is pointedout that the evidence of this being the specific organism isas yet inconclusive. The article on Pulmonary Phthisisis notable for the sagacious remarks upon treatment,especially upon the momentous question which is pressedupon the physician as to advice respecting the patientseeking a change of climate. In the chapter uponValvular Disease of the Heart the significance of thevarious murmurs is most clearly set forth. The sectiondevoted to Diseases of the Hasmopoietic Organs contains anexcellent account of pernicious anosmia, in connexion withwhich it may be remarked that "more than twenty-fiveyears ago" Dr. Flint pointed out the dependence of certainfatal cases of anaemia upon degeneration of the gastro-intestinal glands, which Dr. Fenwick in this countryconfirmed many years subsequently. But it is not neces-

sary to adduce evidence of the care or labour expendedon the work; it speaks for itself, and will remain as apermanent testimony to the great abilities of its author.We cannot, however, refrain from quoting a passagefrom the preface contributed by his son, for it affords

1 THE LANCET, vol. ii. 1881, p. 134.

529

some insight into his immense industry and capacity forwork, that may be taken as an example worthy to befollowed

" The basis of the work is an unbroken series of recordsof cases in private practice and in hospitals, begun in 1833and continued for more than half a century, covering 16,920foliopagesof manuscript, written with the author’s ownhand.These records embrace carefully written histories of cases inall departments of practical medicine, observed under variedconditions of life, climate, and general surroundings. Soldiersin camp and barracks ; the rich and the poor; those affectedwith diseases incident to lives of ease and luxury, andpaupers in hospitals; the pioneers of Western New Yorkand the inhabitants of the metropolis; patients in thewards of the almshouse and hospitals of Buffalo, of theMarine Hospital in Louisville, Kentucky, the great CharityHospital in New Orleans, Louisiana, the Bellevue Hospital,the Charity Hospital, the dispensaries and similar institu-tions in the city of New York; cases observed in theexperience of a quarter of a century as a general practitioner,and of more than another quarter of a century as a consultingphysician, including the epidemics which have occurredin this country within the last fifty years,-the experiencederived from these various sources of observation, carefullyrecorded, studied, and analysed, was finally used in the

composition of this treatise, the first edition of whichappeared in 1866."America may well be proud of having produced a man I

whose indefatigable industry and gifts of genius have doneso much to advance medicine; and all English-readingstudents must be grateful for the work he has left behindhim. It has few equals either in point of literary excel-lence or scientific learning, and no one can fail to studyits pages without being struck by the lucidity and

accuracy that characterise them. It is qualities such asthese which render it so valuable for its purpose, and giveit a foremost place among the text-books of this gene-ration.

Anatomy and Physiology in Character. By FURNEAUXJORDAN, F.R.C.S. London: Kegan Paul, Trench, and Co.1887.

ATTEMPTS to connect physiological appearances with acertain stamp of character are as old as Aristotle and Plato.Mr. Jordan, in his recently published work, seeks to establishthe connexion on a scientific basis. In the preface heapologises for the "unpleasant and clumsy epithets of 1shrewish and non-shrewish," which he uses for want of ’better terms. His attention some time ago was drawn to Ithe physical conformation of women in hospital suffering 1

from ill-usage at the hands of their husbands. Thepeculiarities common to them all were a clear skin, oftenpink, scanty hair growth both on the head and eyebrows,and convexity of the spine, more or less marked. Friendsand neighbours said or hinted that these women had

"sharp tongues in their heads." Mr. Jordan eventually dis-covered that these peculiarities in connexion with a shrewishcharacter were not confined to one sex, and he classes menand women under the two heads of "shrews and non-shrews." Some of us may be inclined to doubt the truthof Mr. Jordan’s deduction, remembering cases of decidedshrewishness in persons of markedly pigmented skin andthick hair growth, and an absence of the same in the typecalled by him " shrews." After three chapters devoted tothe character of the shrew and non-shrew, male and female,there is an account of the differences of skin, hair, andbones to be found in these two classes. In the shrews thedorsal curve is of excessive length, not infrequently reach-ing even below the waist. This curve affects the positionof the head, and throws it forward. " The antero-posteriordiameter of the thorax is relatively increased; henceits cavity from breast-bone to spine is deeper. In

the non-shrewish skeletons the long transverse is ex-

ceedingly marked ; it would seem as if the thorax were

endeavouring to throw itself back and embrace the spinalcolumn. This backward tendency of the spine has onestriking result-the curves of the thorax posteriorly oneach side of the spine lie at a level distinctly posterior tothe most prominent portions of the vertebral bones, so that,looked at from behind, the spine, even at its dorsal curve, isseen to lie on an actual hollow between the two shoulders."Mr. Jordan lays some stress on the fact that in shrewishmen and women the skin is clear, transparent, and pig-mentless, often accompanying very pretty features. Thenails are inclined to be thin and weak, easily bent or

torn, the hair thin and scanty, the eyebrows especiallybeing poor and uneven. That marriages should ever be

arranged by a mutual choice of shrews with shrewsand non-shrews with non-shrews appears to be very hypo-thetical ; still, Mr. Jordan is not without some hope thal.future years may bring such a result. The characters ofshrews and non-shrews may be summed up in a fewwords. Shrews are superficial, restless, consequential ;having no deep sympathies, affections, passions, or emo-tions ; nearly always moral, not from an inherent sense ofduty, but from the desire to be considered respectable. Theyare apt to be discontented at home, but to shine in

society, of which they often form very useful members.Non-shrews cannot precisely be described as the direct

antithesis, but they have deep emotions, sympathies, affec-tions, and passions. Non-shrews are more easily led intocrime, owing to their defper feelings. It is not incompa-tible with non-shrewishness to shine in society or to bevoluble and passionate, since a shrewish person does notfeel deeply enough to be really angry. Mr. Jordan

expresses a hope that more attention will be paid in future3 years to physiology in connexion with the training ofchildren and the development of character. The closing

chapters are devoted to the shrewish character in connexionwith literary work and the influence apparent in many

y- standard books. ___________

Alexander Wood, M.D., F.R.C.P.E., g’c.: a Sketch of HisLife and Work. By the Rev. THOMAS BROWN, F.R.S.E.(his Brother-in-law). Pp. 203. Edinburgh : Macniven.1886.

To the personal friends of the late Dr. Alexander Woodthis book cannot fail to be acceptable as furnishing themwith a record of his many kindly and estimable qualities,and of the zealous manner in which he worked to advancethe interests of his profession and to promote any publicphilanthropic and Christian work. It will also prove interest-ing to many of the older alumni of the university and medicalschools, as it contains some reminiscences of Edinburgh asit was sixty years ago, and of the professors and teachersabout that period. But we regret to add that it is open tothe objection which may be brought against most of thebiographies written by near relatives, that it takes a verypartial and one-sided view of the work done by the subjectof the memoir. A reader of the present volume might fairlyrise from its perusal with the impression that almost all thework done in Scotland during the last half-century toimprove the science of medicine and the status of the pro-fession had originated with, and been carried through mainlyby, Dr. Wood. In fact, there is scarcely, from the beginningto the end of the book, any mention of the work done byany other member of the profession. This is much to be

regretted, as it cannot fail to produce an unpleasant impres-sion that his biographer is claiming for him an amount ofinfluence which he did not exercise. Dr. Wood’s many goodqualities and zealous work were sufficient to ensure himdistinction and respect without the labours of others beingof necessity ignored. The volume is remarkably well broughtout, and contains two portraits of Dr, Wood--in middle lifeand in his later years.

THE PRISON DENS OF ENGLAND.

THE LANCET.

LONDON: SATURDAY, MARCH 12, 1887.

THE Committee appointed to inquire into the accommo-dation for prisoners in court-houses and other places whilewaiting for trial at assizes and sessions have now issued

their report, and the particulars contained therein confirmin the fullest manner the grave charges which THE LANCEThas from time to time brought against the existing arrange-ments, and proves that, so far from such complaints beingexaggerated, as has been repeatedly affirmed, the accusationhas actually fallen far short of the reality. Those onlywhose duty it has been to visit the court-houses and otherplaces where prisoners are detained whilst waiting fortrial could have been prepared for the statement of the

committee, that "in very few everything that can be

expected is to be found," but many, " on the contrary, areas bad as well can be." Of these they go on to say " thatnearly every requisite of humanity, and even of commondecency, is wanting; and scenes still take place whichit might reasonably have been hoped belonged to fifty ora hundred years ago." When the details on which thisstatement is based become known to the people of England,a feeling of disgust and mistrust will be aroused, which willfall heavily on those who have sturdily maintained theperfectability of our prison system : disgust that suchabominations are permitted; mistrust lest the much-praisedmanagement of the gaols be in reality as defective as thatof the court-houses. With regard to this latter point our

opinion has been frequently expressed, and it is well knownthat we do not view with approbation the treatment indis-

criminately adopted for all prisoners after trial under theprovisions of the new Prisons Act.But to return to the arrangements provided for those who

are not yet proved guilty. In the first place, one wouldimagine that, in England at least, there would be neitherwant of ventilation nor of decent closet and urinal accom-

modation ; yet in Derby we find as many as twentyprisoners at a time crowded into a room only 18 ft. by 9 ft. ;at Ipswich, twenty to thirty in a room of 11 ft. 10 in. by5 ft. 2 in. by 6 ft. 3 in.; and at Oxford, twelve in a room 9 ft.by 8 ft. 6 in. In some of these rooms there is no separationof adults and children, of convicted and unconvicted ! In

some of the places, however, where separation is attempted,torture is superadded to confinement, and men and womenare bolted for many consecutive hours, sometimes days, indens hardly larger than ordinary clothes-cupboards. Thus

at the Central Criminal Court the dens are 2 ft. 6 in. by3ft.; at Marlborough, 2 ft. by 2 ft. 4 in. ; Gloucester,2 ft. 1 in. by 2 ft. 4 in. In these last the Committee inform

us that prisoners have been conlined six days consecutively.As regards the sanitary arrangements, in many cases theoffices of nature, if performed at all, must be performedin the presence of spectators; at Hereford there is an earth-

closet, without a screen, in the one room occupied by theprisoners and the warders. Happy those who are provided

with pails in their cupboards. At Marlborough there is oneroom with a number of boxes in it. " Sawdust is used to

cover the excreta ; the stench is sometimes very bad." At

Petwortb, with sometimes twenty-two prisoners in one

room, the only accommodation is a bucket behind a screen.In important townp, such as Carlisle, Derby, Newcastle, andOxford, there is no watercloset, privy, or accommoda-

tion of any sort. After such a confession as to the pro-

visions for ordinary decency, we are not surprised to

learn that the arrangements for lighting and heating areextremely defective. Some places are, indeed, providedwith hot-water pipes and gas-burners, but in this ce theprisoners seem to be worse off than without them, for

owing to the minute cubic space allotted in these dens, theatmosphere speedily becomes close and overheated, whilstthe heat causes rapid decomposition of the contents of thepails and the sawdust-covered excreta, so that after a fewhours the etHuvium becomes unbearable and the air foul and

poisonous. In other places no attempt is made to warm

the buildings, so that in winter the temperature sinks

often to 40° F., and that with damp and unprotectedstone floors. These insanitary conditions explain in partthe high relative death-rate from pneumonia, which wehave often pointed out as characteristic of prison bills

of mortality, though no doubt the plank bed and defi-

cient dietary of the convicted prisoner give the final

stroke. In some places the gaslight is placed outside

the cell, so that the prisoner remains in partial darknessand gloom, sometimes for many days together. Even

in these wretched holes one would think some provisionwould be made for the physical rest of the prisoner,yet we learn that in the prisons where seats are providedthey are mostly of stone and brick, cold and damp, and conse-quently injurious if used continuously; but in most instancesno seats are provided, and the wretched prisoners have eitherto stand like cattle in railway trucks, or squat like negroesbetween the decks of a slaver. So much for the physicalaspect, but the moral is quite as revolting; one would thinkthe matter of the separation of the sexes is a question thatwould hardly be open for discussion, and yet " this elemen-tary requisite of decency " is not invariably provided for. Wealways understood that the separation of prisoners was oneof the most important points attended to under our per-fected criminal laws. Fancy the fate of a young servant

girl, arrested on suspicion for some small theft-erroneously,perhaps,-kept in contact for many hours with abandonedmen and women. Lucky for her if chance isolates her inthe two-foot cupboard! Sdrely the reasons that separatetried prisoners from each other hold with greater force inthe case of the unconvicted.

Only a few years have passed since THE LANCET com.mented upon the treatment of an unfortunate unconvicted

prisoner who died at Winchester, after repeated journeysto and from Southampton, where he was exposed to many ofthe evils at present commented on. At the time we were

assured that our statements were unwarranted, and ourconclusions false; but the present picture is a hundredfolddarker than we then dared to think even possible. Then the

officials declared that the arrangements were perfect; now itis clearly shown how defective in many cases they really are.As it has been proved with regard to our court-houses, so we