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day there remained only a small superficial ulcer. Redwash was applied, and by the thirty-third day the woundhad quite healed. There had been no suppuration through-out.CASE 7. Removal of a Scirrhous Tumour of the Breast.-The

patient was thirty-eight years old. The breast was removedby means of an elliptical incision. The dressings employedwere the ordinary antiseptic ones. By the seventh day theedges of the skin had separated, but there was no suppu-ration, only a serous discharge. On the twenty-sixth dayno more than a superficial ulcer remained. There had beenno putrefactive suppuration. The patient was dischargedon the forty-first day.CASE 8. Removal of a Fatty Tumour over the Deltoid.-

In this case the tumour was removed antiseptically by asimple straight incision. The ends of the incision adhered,but by the fourth day the centre gaped, the skin aroundbeing tense and erythematous. Pressure squeezed out afew small clots, not putrefied. By the twenty-third daythe wound had healed without any suppuration or spreadingof the blush.CASE 9. Wound of Wrist-joint.-Whilst working at a

rope factory, the right wrist of the patient, a youth of six-teen, was caught in a roll of hemp, and sustained a woundreaching from the inner edge of the radius at the back,round the ulna to the styloid process of the radius in front,cutting through the skin; dividing the superficial extensortendons, and opening the wrist-joint in the situation of thecuneiform bone. The finger could be readily passed intothe joint. The usual antiseptic dressings were employed. Onthe twenty-ninth day there had been no suppuration. Theonly traces of the wound were two small ulcers. Therewas tolerably free extension and flexion of the wrist andfingers.CASE 10. Popliteal Aneurism.-The patient was twenty-

six years old. Pressure with Signorini’s and Carte’s tourni-quets was kept up with very little benefit for thirty-onedays, when it could no longer be borne. Then the femoralartery was tied antiseptically in Scarpa’s triangle. In

twenty-one days the wound had entirely healed without theslightest trace of suppuration.

NORFOLK AND NORWICH HOSPITAL.CASES OF STONE IN THE BLADDER.

(Under the care of Mr. NICHOLS and Mr. CADGE.)THREE cases of stone were submitted to operation on the

18th inst.CASE 1.—A woman, aged forty-four, who had passed

small calculi formerly, and who had suffered the usual sym-ptoms for some time. Mr. Nichols dilated the urethra

slowly with a three-branched instrument sufficiently toadmit his forefinger. Having ascertained the size andsituation of the stone, forceps were introduced, and a stonemeasuring an inch and a quarter by three-quarters of aninch, and weighing three drachms, was carefully extracted.Five days afterwards the patient could retain her water fortwo hours, and seemed recovering well.CASE 2.-A man, aged sixty, was cut laterally by Mr.

Cadge. The symptoms were moderately severe, but it wasthought the amount of stone and the general condition ofthe patient made lithotomy preferable to lithotrity. Theprostate was rather large, and the forefinger could scarcelyreach the bladder. Four calculi, composed of lithic acid, andweighing five drachms and a half, were easily removed.They broke during extraction. The bladder was carefullysyringed, and a silver tube, which Mr. Cadge prefers to thethick gum-elastic one, introduced. Scarcely a tablespoonfulof blood was lost, and now, after five days, the patient isrecovering.

CASE 3.-A man, aged sixty-four, was next operated onby Mr. Cadge, by median lithotomy. He was a thin man,and the symptoms were not acute. The lithotrite readilyseized a stone, which measured nearly an inch; but as therewere more than one, and as the patient was very timid andnervous, Mr. Cadge preferred the more complete and speedytreatment by cutting. The case was especially favourablefor median lithotomy. The operation was quick and easy;very little blood indeed was lost. Three small, flat, lithic-acid stones were removed, which weighed three drachmsand thirty grains. A tube was introduced. Twenty-four

hours afterwards the tube was removed, and from this timeall the urine passed by the urethra. Now, on the fifth day,he can retain his water seven or eight hours, and then makeit in a full stream. The wound seems closed, and is onlymarked by a line. This case was the thousandth cut inthis hospital.

’

THE

ANNUAL REPORT OF THE POOR-LAW BOARD.

THE annual Report of the Poor-law Board contains theusual statistics as to the numbers of paupers relieved, andthe cost of relieving them. Except in the metropolis, thenumbers have not decreased, and the expenditure, as com-pared with ten years ago, has increased out of all propor-tion to the numbers. This is due to a general augmentationof the scale of relief, to better accommodation for andmore liberal treatment of the sick, to some rise in the

price of provisions, and to increased salaries to the officersengaged in the administration of the law. The metropolishas incurred an expenditure of nearly a million and a halfunder the Metropolitan Poor Bill, and over half a millionhas been expended on the improvement of workhouses

throughout the country ; and, as there are but few able-bodied inmates, it may safely be presumed that the sickwill be chiefly benefited by this expenditure.For the first time the Poor-law Board have instituted an

inquiry into the administration of out-door relief, and al-

though the prohibitory orders of the board appear to begenerally observed, there is enough evidence to show thata great reform in this department is absolutely required.Mr. Wodehouse, in his report on the metropolis, points outthe demoralising effect of insufficient inquiries, and mentionsthe practice of assuming that the poor reveal only half theirearnings. He points out the impossibility of either guard-ians or relieving officers arriving independently at the truth,but says more might be done by more frequent visitation.Mr. Farnall could not discover that the visits of the re-lieving officers were systematically or periodically made, andas they each have districts averaging 24,618 acres, and 620paupers to look after, it is not by any means clear that thevisitation is as frequent as is desirable. For the first timealso the Poor-law Board has ordered a report on out-doormedical relief. Mr. Farnall reports a considerable numberof instances in which the regulations of the Poor-lawBoard are violated without any obvious reason, and althoughhe does not advise the board to disturb the rules whichnow govern the administration of medical relief, he recom-mends that it be incumbent on every board of guardians toestablish a sufficient number of dispensaries in each union,and to provide them with competent dispensers and suffi-cient medicines of the best quality, and further, that theguardians should supply all the drugs for the sick poor inall the workhouses. Mr. Peel has gone more closely into thesubject. He finds the books are kept very irregularly, andthat doctors’ orders for wine are regarded as forms of ad-ditional relief, and that in no case would it have beenproper to replace those orders by medicine. He says that,notwithstanding some defects in the administration ofmedical relief, the paupers are better off than the inde-pendent poor; and whilst the latter may be neglected, theformer can scarcely be so without the medical officer beingeither reprimanded or dismissed. Mr. Peel says that manyof the salaries are undoubtedly too low, and he also re-

commends the supply of expensive medicines by the

guardians should be made compulsory. Mr. Peel statesthat it would be practicable to establish dispensaries, notonly in all large towns, but in the thinly populated and

! extensive rural unions. In the latter the medical stations. would require to be more numerous than in towns. He, observes that, besides the cost, it might be contended that

the establishment of dispensaries might act to the prejudice, of medical clubs, and so increase pauperism and discourage. habits of independence. But, on the other hand, he thinks

they would secure to the sick poor a more rapid and better’ supply of medicine., and would tend to raise the remunera-

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tion of the medical officers, and remove from them anytemptation to prescribe medicine insufficient alike in

quantity and quality. Mr. Basil Cane strongly points outthe inconsistencies of medical officers as regards the order-ing of extras, and says that in some cases the guardiansare not only embarrassed, but absolutely foiled in their at-tempts to administer relief economically by the liberalityof medical officers in respect of extras. He also points outmany important evils connected with the supply of theseextras, and he concludes that they transfer a large propor-tion of out-relief from responsible to irresponsible hands, andthat they effect a minimum benefit at a maximum expendi-ture. He recommends the establishment of dispensarieswith relief stores attached, as affording the best prospectof remedy. He recommends that the relief room in villagesshould be used as a dispensary, and thinks that if therewere a dispenser who attended each daily at a certain hour,the poor would be more promptly and effectually relieved,and many of the evils incidental to 11 doctors’ orders" wouldbe avoided.

It is really refreshing to find that these recommendationshave at length penetrated within the precincts of the Poor-law Board. The evils of the existing arrangements havebeen long and systematically pointed out in this journal,and have been as systematically ignored at Gwydyr House.The Poor-law Board has now no excuse. All the inspectorshave endorsed our complaints and the propriety of the re-medies we have advocated, and it only remains for thePresident to urge their adoption by the guardians, who, wedoubt not, would listen to his representations on the matter.We shall look forward to a circular letter on the subjectwith great interest.

Considerable progress has been made in the establish-ment of dispensaries in the metropolis. Fifty-eight areeither ready or in contemplation ; twenty-three are at work.The dispensaries are generally within a mile of the homesof the most distant patients. The Board finds the guard-ians give their assent readily as soon as the objects to beattained are fairly placed before them, thereby provingthat the real delay in their establishment rests primarilywith the Poor-law Board. In the country nine dispensarieshave been formed, including some for workhouses.

It is gratifying to find that the Superannuation Act hasalready been acted upon. Four medical officers have retiredon allowances somewhat exceeding half their salaries. Andit speaks volumes for the generally satisfactory way inwhich the medical officers have performed their duties whenit is found that, of 3950 medical officers, only one has beendismissed for neglect of duty.On the whole, we hope we may regard the issue of the

present Report as a turning point in the medical treatmentof the sick poor, and as indicative of the prospect of bettertimes for the medical officers.

THE TWENTY-FIFTH ANNUAL REPORT OF THE

COMMISSIONERS IN LUNACY.

THIS Report, which has recently appeared, contains, asusual, a catalogue of fractured ribs and other injuries, allplainly indicative of inefficient or insufficient supervision.We took occasion to animadvert strongly last year on the un-satisfactory nature of these reports, in that the Commis-sioners, having the power to inquire into alleged acts ofcarelessness and cruelty, have no power whatever to enforcethe law as regards those who commit them. But inasmuch

as, in the working of the Local Government Board Act, wemay fairly hope for a better state of things, it will suffice,on this occasion, to place before our readers, as succinctlyas possible, the matériel of the Report.At the beginning of the current year, a total of 56,755

lunatics existed in England and Wales, 50,301 of whomwere paupers and 6154 under private and other manage-ments, these numbers representing an increase of 2042 ascompared with the previous year. The ratio per 1000 ofthe total number of lunatics, idiots, and persons of unsoundmind to the population still shows a progressive advance,

having increased from 1’86 in 1859 to 2’49 per cent. in 1871.There are now established in England and Wales 176asylums, hospitals, and licensed houses, of which 50 are countyandborough asvlums,16 registered hospitals, 4 state asylums,41 metropolitan licensed houses, and 65 provincial licensedhouses. The Report recites that there is still a deficiencyin the number of medical officers in some of the countyand borough asylums, and that the wages of nurses andinferior officers are on too low a scale to secure and retain

competent servants. Middlesex is again reproved for theinadequacy of the accommodation provided, and the pennywise and pound foolish doctrine is again charmingly ex-emplified inasmuch as no less then 906 Middlesex pauperlunatics are distributed in county or borough asylums orlicensed houses, costing from half to two-thirds more thanat Colney Hatch or Hanwell. The county asylum at

Cambridge had, at the time of the last official visit, butone medical officer; and it appears that during the absenceof that gentleman 11 own a fortnight’s holiday, a patientthrust her face into the fire, and narrowly escaped self-destruction." At Lancaster the authorities decline to

provide a medical officer for a detached block of buildingsthat accommodate 140 patients, although proper quartersexist, in accordance with the recommendations of the com-missioners. " Three male patients died last year in Hanwellwith fractured ribs, and marks of violence on their persons";and there was a death from scalding at Colney Hatch" attributed to carelessness on the part of the nurses incharge." Suffolk and Hull are deficient in asylum accom-modation, and new buildings have recently been erectedat Worcester, near Beverley, at Wadely-park (for the

county of York), and at Ipswich. The total weekly costper head in county asylums appears to be 9s. 5 1/8d. TheCommissioners report that a great improvement has takenplace in the system of performing post-mortem examina-tions, and that in nine asylums-i.e., at Carmarthen,Cumberland, Rainhill, Hanwell, Warwick, Worcester, theWest Riding, York, and the City of London-autopsieswere made in the proportion of 91 per cent. Inthe matter of borough asylums, it appears that Maid-stone and other Kentish boroughs, as well as Portsmouthand Southampton, have still no provision for pa,uperlunatics. As to hospitals, the management at Lincoln iscriticised uufavonrably. The Royal Albert Asylum foridiots and imbeciles of the seven northern counties was

registered as a hospital last year, and will supply a wantthat has long been felt in that district. The Royal IndiaAsylum has been opened near Ealing-common, and the in-sane soldiers of the Indian army are now located there, itbeing found necessary for sanitary reasons to remove themfrom Pembroke House, Hackney. The army patients atFort Pitt were removed to Netley in July of last year.There seems to be little or nothing worthy of note in con-nexion with the metropolitan asylums, though we cannot butobserve that an unnecessary amount of caution appears to beobserved in the style of criticism adopted with reference tothese establishments. At the beginning of the currentyear there were 12, 161 insane persons in workhouses, thesenumbers including those located in the Metropolitan Dis-trict Asylum at Leavesden and Caterham. An attendantin the Medway Union Workhouse was charged with sevendistinct acts of cruelty to patients, but the result of officialcircumlocution was simple dismissal, without punishmentof any sort or kind. There were at the beginning of theyear 392 private patients under single care, and three casesof lunatics under illegal charge are specially noticed in theReport, the facts recorded in one case showing very de-cidedly that truth is stranger than fiction.In reviewing this Report we have for several reasons con-

fined ourselves to a simple summary of the facts containedtherein, and these facts may most decidedly point a moral,as well as adorn a tale. We abstain from criticism (1) be-cause no sophistry is required to show the need of change inthe organisation and working of this Commission; (2) be-cause the Local Government Board Act will shortly takethe matter in hand; and (3) because we believe that thisBoard cannot but apply to Parliament for plenary powersto remedy the abuses that now exist, and that the Com-missioners expose, but cannot cure.