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root which was damaged if, as seems likely, the sympatheticparalysis was not due to a division of the cervical sympatheticcord.

It is by no means uncommon in our experience fora ballet to be found with its wrong end foremost, so to

speak, and this even at the very end of a long track whichappears to have been inflicted by a direct, not ricochet, shot.Sometimes, but not always, a possible explanation of theturning of the bullet has been given by the fact that it hastouched a bone in its course.Complete transverse penetration of the head or face is by

no means rare, and, as in penetrating wounds in other parts ofthe body, it is often astonishing what slight damage has beendone. In one case the bullet entered just upon the externalauditory meatus on the right side and emerged through theexternal angular process of the frontal bone on the left side.The patient was absolutely blind in the left eye and theretina was one mass of hemorrhage. Despite the violentlyseptic character of the entrance wound on admission the manis now making excellent progress in every respect and pre-sents about the best instance we have had of the extra-

ordinary way in which nerves will recover which apparentlywere completely shattered. The second and the third divisionsof the fifth nerve on the right-hand side were completelyparalysed both as to motion and sensation. The ocularmuscles of the right-hand side were paralytic, butthey, too, have recovered, and even the optic nerve, whichwas so much damaged as to cause very well-marked opticneuritis, is also recovering.We have had quite a large number of bad cases of

haemorrhoids. Whether they are caused by riding-foralmost all the patients have been mounted troops-or by the unnatural stress upon the rectal eliminatingapparatus we are not sure, but it is a fact that most people’salimentary canal in these parts varies in a most unaccount-able manner between the states of diarrhoea and intestinalobstruction.A young officer came into this hospital the other day with

eight wounds. One bullet had perforated his lumbar regionand another had perforated his thigh. In neither case did anyharm result. A piece of shell had blown a piece out of theinner aspect of both thighs and three pieces off the bottomof his scrotum, while a third bullet had lodged in the cruro-scrotal fold, whence it dropped out as he was standing upto be examined. He has left the hospital in no way theworse, apparently, for his narrow escapes. Another mostextraordinary case was that of a man in whom a bulletentered the right thigh on the inner aspect about two inchesbelow the cruro-scrotal fold. The leg was skiagraphed, butnothing could be seen of the bullet. An abscess developedin the other thigh at about a symmetrical position to theentrance wound. It was incised and the bullet was found, andthe finger could then retrace the track of the bullet acrossthe front of the bodies of the two pubic bones to the woundof entrance.A man was shot while his right hand was hanging in front

of his abdomen, the bullet tunnelling the radius withoutdoing any harm, and then piercing the abdominal wall twoinches above the middle of Poupart’s ligament it emergedthrough the middle of the dorsum ilii. When admitted intothe hospital he presented no abdominal symptoms whatever,but we kept him in bed and on restricted diet so as to be onthe safe side, for I had seen at Wynberg a similar case inwhich a couple of weeks after the receipt of the wound ahard tender swelling developed in the right iliac fossa,which, as there was considerable pyrexia, was taken to be anabscess. It was incised and proved to be a large hasmatoma.Our patient also was not long before he developeda swelling in the caecal region. This swelling was

neither tender nor painful, nor was his alimentary canal inany way upset. He developed a high temperature every night,but we had great difficulty in persuading him that he was illand in getting him to let us do anything. On incision theswelling proved to be a huge fascal abscess, and for two days allhis foeces poured out through the incision. This distressingsymptom suddenly ceased and the wound proceeded straightaway to heal up in a most rapid and satisfactory manner.We have had three or four other instances of perforationsthrough the iliac and coecaleregion that have presented nosymptoms at all. In another case the man was shot throughthe pelvic bones lower down ; the entrance wound wasbehind, just two inches below the posterior superior spineand two inches to the left of the middle line, and the exitwound was just to the right of the middle line in front underor through the edge of the descending ramus of the

pubes. There was no sign whatever of damage to thebones, the alimentary canal, the blood-vessels, the peri-toneum, or the bladder, but only sufficient damage tothe cords of the sacral plexus to cause paresis ofthe gastrocnemii, and an area of anaesthesia over theheel indicates, I take it, damage to the first sacralnerve. The anaesthetic area shortly became bypeiasstheticand is now rapidly returning to normal.Even before we left England such a large number of

perforating wounds of the trunk and head, to saynothing of the limbs, without any permanent damagehad been recorded in the medical journals that I takeit that you have no desire to hear repeated again allthese miracles. Every train-load brings us fresh instancesof them. In the last, for instance, was a man in whom the

bullet entered behind the middle of one clavicle and emergedthrough the opposite groin. One thing which I have notseen noted in the medical journals, but which is being bornein upon us more and more, is the rapidity with which theeffects of general anesthetics pass off in this climate. Per-haps it is due to the skill of our anaisthetists, but the factremains that it is much rarer to see any vomiting or nauseaafter operations out here than it is at home, and the rule isto find the patient so well that within an hour of his beingput back to bed he is asking to be allowed to smoke or evento get up.Deelfontein, May 7th.

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THE CHARING-CROSS HOSPITAL EXHIBITSAT EARL’S COURT.

THE Appeal Committee of Charing-cross Hospital haveorganised an interesting exhibit at the entrance of the OldEnglish Village which is one of the most attractive featuresof the Woman’s Exhibition held this year at Earl’s Court.Outside there are tents fitted up for field ambulance work

and dummy figures representing wounded soldiers so as toillustrate the ingenious devices by which dressings andsplints are extemporised out of anything that may be foundon the battle-field, from a broken rifle to the bark.of a tree.Within the building there are several compartments, thelargest being a surgical ward with eight beds differing instructure and suited for various special purposes. Thus onebed is provided with electric light so as to facilitate examina-tions with the ophthalmoscope, while a system of rubber tubesenables water to circulate round the head of the patient andthus replaces the more clumsy ice-bag. The Gorham bedattracts much attention. With no great muscular effort, butby merely turning a small wheel, the patient may be raisedin almost any position or lifted several inches above themattress while the sheets are being changed, the body beingsuspended on canvas bands stretched across a moveable ironframework. Other beds are provided with special apparatusfor fractured thighs and legs, and for abdominal injuries, &c.The combined bed-table and locker used is also veryingenious. These beds stand on Messrs. Geary, Walker, andCo’s. patent anhydrous flooring. An asphalt foundation islaid first, then a thin layer of wood, and on this are placedoak blocks. Between the blocks a thin partition of an

asphalt composition is sufficiently elastic to allow for

expansion and thus the risk of cracks or of bulgingis met. In the centre a Pridgin Teale fireplace ensures

a more perfect consumption of coal, consequently pro-ducing more heat, less smoke, and not requiring so

much attention as is usually the case. The fan windowsdevised by Mr. Robert Adams should be carefully examined.Instead of the ugly side projections to which architects sostrongly object, when the top of the window is made to openinwards the side draws out a light metallic fan which whenunfolded prevents the air escaping otherwise than from thetop. Thus directed it must strike the ceiling, whenceit is diffused over the ward without causing any sharpdraughts. Apart from this the large window-panes can beraised by merely removing a small bolt and then twistedright round by means of a central pivot. Thus the externalsurface of the glass can be brought inside and cleanedThis contrivance would be just as useful in private housesas in hospitals and would put an end to the difficultyand danger of window-cleaning. Messrs. Burroughs andWellcome exhibit a ward medicine case, not unlike a brief

bag, which contains a variety of useful things in a smallcompass.

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Next to the ward there is a model operating-room. Inthe centre to give a good light the wall and ceiling on thenorthern side are of ground glass. Between this groundglass and a second outer and plain glass covering built forprotection there is an electric heating apparatus. This is

important, as otherwise the wide glass expanse would chillthe air of the operating-room. Inside there are hot-air coilsand ventilators. Needless to say, that all surfaces are abso-

lutely smooth and air-tight and that there are no cornersor ledges. The water for sterilising the instruments is heatedby electricity at a cost of less than a penny per hour.Mr. George B. Davis, sanitary engineer, provides the closets,the baths, and a running-stream lavatory for the operatingsurgeons, with a shampoo for sluicing the arms. The

ledges of this and other lavatories and sinks all slanttowards the basins, so that no water or soapsuds can stagnateon the borders. Glass, gun metal, and enamelled hardwarealone are employed, and the connexions with the piping arenot soldered but established by means of "union " screws, sothat the lavatory can be readily removed to any other place.Underneath the waste water discharges into an open channeland the connexion of this channel with the drain-pipe canbe plugged up and completely cut off. For the bath, whichis in another room, the water enters all round the sides fromthe rim, so that the bath can be washed out before it is used.The delivery is so abundant that the bath can be filled inthree-quarters of a minute and it can also be emptied withequal promptitude. All the fittings are of good gun-metal,and the towel-horse being of hot-water tubing the linen isduly heated and kept warm. At the sink the grid is so madethat the bed-pans are placed on end, so that the water-jetis discharged in the centre and thoroughly flushes them out.To return to the operating-room, it is provided with

Dr. Isaac’s electric search-light, which is af6ged to the fore-head in the same manner as a pair of spectacles and is usefulfor examining the throat or for speculum work. Messrs.S. Maw, Son, and Thompson provide all the surgical instru-ments and also an air-tight and dust-proof brass and glassinstrument-cabinet. In a case of similar construction the

aseptic bandages are kept. The flooring is made of theterrazo mosaic supplied by the Artistic Tile Company. Thisconsists of fragments of marble set in cement. Being i

liquid when applied it can with great facility be rounded offat the corners so as to prevent the forming of angles wherethe wall joins the floor. When dry it is hard and imper-meable. The same firm exhibits a table such as is usedat the Pasteur Institute. It is made of volcanic lava,and is so hard that it can only be cut with a diamond saw.The strongest acids produce no effect upon it and thereforeit is considered best adapted as being absolutely non-absorbent. In the operating - room there are asepticirrigators by which water can be brought to the operatingtable. It comes direct from the main to a nickle-platedcylinder on a wrought metal stand, containing a sufficientnumber of Pasteur-Chamberland filtering bougies to ensurea constant current of water. To this cylinder a long india-rubber tube is fixed and the water can thus be broughtwherever needed. Throughout the building the Pasteur-Chamberland filter is employed.Another room is devoted entirely to Roentgen ray

apparatus. Dr. Mackenzie Davidson, the medical officer incharge of the x-ray room at Charing-cross Hospital, shows anew zoditory mercury break which can be made to work

satisfactorily with any voltage. Here there are many photo-graphs taken from different points of view and combinedwith the aid of a stereoscope so as to prevent distortion.Then there are various methods of generating the currentsrequired for x-ray work and there is also a portable apparatusfor field ambulances.

Finally, Messrs. Thomas Bradford and Co. have fitted up asmall, compact laundry which is not worked by steam

power. A spraying grid used in conjunction with the

soaking tank is new. It is worked with the aid of a hose andreduces the necessity of handling the dirty linen to aminimum. Two small fires suffice to do all the washing,drying, and ironing.

Altogether this exhibition is very compact and containsmany things of considerable technical interest in a verysmall space ; moreover, the general public cannot fail to beimpressed and interested when they see the scientific carethat is bestowed on hospital patients. It is to be hoped thatthis exhibition will awaken sympathy and increase the

1subscriptions needed for the continuation of the good work (done at Charing-cross and other hospitals. ,.

NOTES FROM INDIA.

(FROM OUR SPECIAL CORRESPONDENT.)

The 6%<M in Plague Policy.-The Prorrress of the

,Epidevbic.-Tlte Request for a Plague Expert.-TlteSer2cna Treatment of Plague.AN extraordinary change of policy has been gradually

adopted by the plague authorities. Whereas formerly deten.tion of travellers with quarantine and thorough disinfection,isolation of the sick in hospital and segregation in camp ofthose who had been in contact with them, eviction fromdwellings with formation of health camps, and disinfectionhere, there, and everywhere were actively practised one findsthat one by one these measures have been graduallyrelinquished. During the past week it has been notifiedthat disinfection of native passengers to Naini Tal will berestricted to the soiled linen and dirty blankets of third-classpassengers who have travelled from a plague-infected district.The epidemic wave is gradually falling. The deaths from

plague throughout India last week fell to 2498 comparedwith the 3365 deaths for the week previous. It is improvingin Bombay city and also in Karachi, and it is markedly lessin Caleatta and the Bengal Presidency. An improvement isalso reported from Aden. Bombay city has still a mortalityat the rate of over 130 per 1000 per annum, and whilehaving 1400 deaths above the average returns but 448 deathsfrom plague. While plague is thus improving the numberson famine relief unfortunately continue to increase. Thegrand total is now over 5 500,000. The Central Provincesand the Bombay Native States show the largest increases thisweek.

I understand that considerably more than a month agothe New South Wales Government asked the Government ofIndia for the services of a plague expert, but so much timehaving elapsed since the request they now intimate that theydo not require the services-of a plague expert from India.An advocate for the serum treatment of plague after the

method of Professor Lustig has appeared in the person ofDr. A. Meyr of the Bombay Municipal Laboratory. In a paperread before the Medical and Physical Society he reviewed theresults obtained when the patients were selected for treat-ment and since then when they have been taken alternatelyas they were admitted. His figures must be doubted on twogrounds-viz., that patients of the later days of diseaseand moribund and mild cases were excluded. Since May,1899, some 361 patients were treated, with a recovery rate of33’8 per cent. The report says that an equal number with-out the serum treatment only gave a recovery rate of 21’2 percent. There must here be an obvious fallacy, because with.out the exclusion of any cases this has been hitherto theaverage ’recovery rate of all admissions. 33 per cent., or

thereabouts, die within 24 hours. It is clear, therefore, thatthe exclusion of moribund cases and cases in the later daysof disease must considerably improve the recovery rate of theremainder. In fact, exclusion of such cases at once raisesthe recovery rate 12 or 15 per cent., if not more. If Dr. Meyrcould show a real improvement of 12 per cent. it would cer-tainly indicate some promise of future success, but to holdup an improvement of only 12 per cent. after deduction ofserious cases over the rate which ruled at the hospitals forall admissions is not very satisfactory. The original Chineseserum was obtained by injecting the horse with livingand virulent cultures. This method was thought tobe dangerous and was abandoned. Latterly a modifiedpractice has been adopted in Paris. This consists ofinjecting first of all dead cultures and afterwards livingand virulent ones. Serum after this method was used inOporto and was said to have proved very successful, but hereagain the same errors were repeated in that similar caseswere not taken for comparison. Under these circum-stances it is impossible to place faith in the returns

notwithstanding that the mortality under the serum

treatment is reported to have been five times less than thatof cases treated without it. It is very evident that themethod of Lustig which has been tried in Bombay falls farbehind that which has apparently proved so successful atOporto. If Lustig’s serum possesses any value greatalteration must be made in its preparation in order to renderit more potent.May 3rd.