ASYLUMS BOARD HOSPITAL STATISTICS

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DENAEYER’S PEPTONATE OF IRON (STERILISED).(THE DENAEYER’S PEPTONES COMPANY, L)MITEt), 118, BISHOPSGATE.

STREET WITHIN.)In this preparation Denaeyer’s peptone of meat is com-

bined with ferric hydrate, a neutral brownish red solutionbeing thereby produced. Both peptone and iron are easilyfound by analysis, and each is in a condition well suited fordigestion and absorption. This is shown by the curiousfact that weak acids cause a precipitate, which is againdissolved in an alkaline medium.

MURRAY’S FLUID MAGNK8IA.

(SIR JAMES MURRAY & SON, DUBLIN.)Each fluid ounce of this preparation contains seven grains

and a half of carbonate of magnesium, equal to thirteengrains of bicarbonate. We found nothing else, except freecarbonic acid and a trace of bicarbonate of sodium. Thefluid is perfectly bright, and, being entirely free from im-purity, is a mildly aperient medicine and a valuable antacid.

STOWER’S LIME-JUICE CORDIAL.

(A. RIDDLE & CO., 38, COMMERCIAL-STREET, E.)A genuine preparation of lime-juice. We find no trace of

any acid, except the citric acid proper to the fruit, and nometallic contamination. It is excellent in flavour, and per-tectly bright.

GINGER BEER IN CASK.

(CLAYTON BROS., RUTLAND-STREET, PIMLICO.)

Old-fashioned ginger beer, when well made and drunkfrom the cask, is, after all, one of the best of modern

temperance drinks. Not the least important thing aboutit is that everybody knows how it is made and of what itconsists, so that it is a drink which may be indulged in with ’,confidence. We find this ginger beer excellent in all respects. ’,It is evidently prepared with great care from the very bestiormula. It possesses a sparkle in degree like that of bottledale, and has an agreeable flavour characteristic of an in-fusion of fine ginger. We found a very slight trace ofalcohol as an inevitable constituent, but scarcely to be de-tected from the specific gravity of the distilled liquor,although shown to be present by the well-known delicateiodoform test. Solid matter, dried at 100° C., chiefly sugar,8’37 per cent.; metallic contamination, none. We can recom-mend the ginger beer either as a temperance or summer drink.

ASYLUMS BOARD HOSPITAL STATISTICS.

FOR the past four years a volume of reports by theStatistical Committee and the medical superintendents of thehospitals, asylums, and training ships of the MetropolitanAsylums Board has been issued, and the volume for 1889is compiled in a manner which shows that this series isintended to be increasingly of interest and value to thoseconcerned with the subjects with which it deals. A set ofadmirable maps is included in the last volume, indicating thelocalities from which the patients suffering from the severaldiseases which came under isolation were removed ; and atable is also given showing the districts in which infectiousdiseases were notified between Oct. 30th, when the Notifi-cation Act came into operation, and Dec. 29th, 1889. Inall, 6042 cases were notified, and the causes were as follows:Scarlet fever, 3301 ; diphtheria, 981 ; erysipelas, 808 ;enteric fever, 683 ; membranous croup, 142 ; undefined"fever," 54; puerperal fever, 43; typhus, 17; small-pox,8 ; relapsing fever, 8 ; "cholera," by which choleraic diar-rhoea must be intended, 1. It is much to be hoped that themaps will next year be utilised to show the distribution ofthe notified diseases over the metropolis, for this has farmore interest to the public at large and to the medical pro-fession than any mere localisation based on removal to aspecial group of hospitals. To this extent the MetropolitanAsylums Board would do well to act as a central autho-rity, unless, indeed, they know that this will be an annualduty which the London County Council intend to under-take.

Since October, 1888, diphtheria has been received intothe hospitals of the Asylums Board, and during 1889 thenumber of admissions was 772 ; and the map, showingwhence the cases admitted were mostly derived during 1889,shows two main groups-one extending from Stepneythrough St. George’s-in-the-East and Wbitechapel intoBethnal-green, and the other being in the northern half ofKensington and of Paddington. But this affords, of course,no definite notion as to the localisation of the diseasegenerally over the metropolis ; it points rather to the areaswhere cases occurred which could not, with reasonablesafety, be isolated in their own homes. On this subjectof diphtheria the Committee report that. in view oftheir attention having been drawn by Mr. Sweetingto an increased prevalence of throat illness amongstscarlet fever cases since the reception of diphtheriapatients into neighbouring hospitals, special care isbeing taken to learn whether any influence resultsfrom the aggregation together of persons suffering fromdiphtheria. Dr. Gayton gives a list bearing on this point,from which it will be seen that in the North-WesternHospital there were during the year 790 cases of scarletfever and 144 of diphtheria ; that of the scarlet feverpatients eleven had diphtheria complications at periodsvarying from one week to eight weeks after admission;and that nine of the eleven died. Six of the staff also con-tracted the disease. So also in the Western Hospital Mr.Sweeting found that with 905 scarlet fever and 130 diph-theria admissions, no less than 27 of the former developedsymptoms of diphtheritic throat illness, and that 18 of thesedied. Two of the staff had diphtheria and 5 suffered fromtonsillitis. According to Dr. MaeCombie’s experience inthe South-Eastern Hospital, where there were 1464 cases ofscarlet fever and 89 of diphtheria patients, 7 scarlet feverpatients exhibited the diphtheritic membrane in the faucesin the acute stage, and diphtheria or membranous laryngitiswas a sequela in 19 convalescents. As to the diphtheriasequela, it appears to have occurred in all the scarlet-feverwards but two; there was no known causal relation betweenthe cases, and no sanitary defects could be found to accountfor the occurrences. Dr. Bruce also records the occurrenceof diphtheria in 15 cases, of which 4 died, and of "croup"in 5 cases, all ending fatally. As regards this amount ofdiphtheria amongst scarlet-fever patients, it would be in-teresting to know to what extent the percentage of suchcomplications during 1889 differed from that which tookplace before the systematic isolation of diphtheria in thesehospitals was undertaken. And it is very certain, to usethe words which the Committee quote from their latemedical officer Mr. Sweeting, that the whole question is"one calling for immediate skilled scientific inquiry."

ETHER v. CHLOROFORM.To the Editors of THE LANCET.

SIRS,—The subject of anaesthetics is of such importanceto surgeons that every detail in its administration must becriticised and discussed as thoroughly as possible. In yourlast issue Mr. Nance in a very practical letter writes,among other things, of the use of Clover’s inhaler. Myown experience, after five years of surgical hospital resi-dence, leads me to think unfavourably of that form ofinhaler. In producing anaesthesia with it, the patientbreathes and rebreathes his own exhaled air. Even if theair in the bag is constantly changed one frequently noticesthe marked cyanosis of the patient, denoting carbonic acidasphyxia as well as etherisation. This has been veryforcibly impressed on me lately by a case of operation forintestinal obstruction, where the ether was given in aClover’s inhaler, with a free admixture of air. Towardsthe end of the operation there was marked cyanosis, andafter partially recovering the patient died. It is but fairto state that the patient was sixty-three years of age, thatthe anæsthesia lasted rather over an hour, and that thepulse before the operation, although fair, was somewhatirregular. Allowing for all these factors, the opinion of theanaesthetist that the constructive fault of the inhaler con-tributed in no slight degree in causing death was concurredin by those present at the operation.

I am, Sirs, faithfully yours,Bradford, July 7th, 1890. WM. HORROCKS, F.R.C.S.WM. HORROCKS, F.R.C.S.