1235

of disiniecting a closet does not amount to more thana penny a week. The patentee is Geo. H. King, Ashmore-road, Paddington.

Analytical Records.CADBURY’S COCOA.

(CADBURY BROS.). MESSRS. CADBURY maintain the fame they have so long

enjoyed. The cocoa examined by us was very soluble inwater, contained no starch or other foreign ingredient, andonly 20’5 per cent. of fat. In other words, it was of

excellent quality, easily digestible, and not too rich.

SAINT MARCO LITHIA WATER.

(HEARON, SQUIRE, AND FRANCIS, 5, COLEMAN-STREET, LONDON.)This natural water is recommended as useful in gout,

rheumatism, stone, &c. It is drawn from springs on

the Marucheto Estate, Tuscany, and is, we are informed,held in high estimation in Italy. The published analysisby Professor V. Amoroso shows in English figures 154grains per gallon of mineral compounds, including 2’52

grains of carbonate of lithium. The rest consists mainly ofthe sulphates, chlorides, and carbonates of calcium, mag-nesium, sodium, potassium, iron, and manganese. Wefound 172 grains per gallon in the sample we examined, andverified the presence of lithium. Certainly the water isinteresting, and deserves a careful trial in this country. It

is slightly saline in taste, and is not too strong to be usedat the table.

CARNABYN.

(HOOPER & CO., 55, GROSVENOR-STREET, LONDON.)We can best describe this preparation by saying that it

suggests port wine and the extracts of meat and malt, butwe cannot profess to describe its exact composition. It is

certainly a very powerful nutrient stimulant, and will insuitable cases be very valuable. It is perfectly clear andtastes somewhat like a very fruity and somewhat sweetport. Its alcoholic strength is high-namely, 16’46 percent., by weight equal to 35’47 of proof spirit. It yielded14’2 parts in 100 volumes of solid residue, and 0’5 of ashcontaining phosphates. Every physician will see the properand avoid the improper uses to which such a wine maybe put.THE STRETTON HILLS MINERAL WATER COMPANY, SALOP.We have received from this company samples of various

aerated beverages made from the water of the Crom DaleSpring. This water is evidently very pure, for the so-calledsoda-water only contained eight grains per gallon of solidmatter and no trace of organic matter. Of the seltzer,potash, and table waters there is not much to remark exceptthat the seltzer contained 10’02 and the potash 2’7 grainsof salt in the 10 oz. bottle. The ginger ale did not strikeus as quite satisfactory, for the evaporated residue ex-

tracted with ether left an acrid, burning taste on the tongue.No lead or other heavy metal was found in any case.

A COMPLIMENTARY DINNER.-On Tuesday even-ing, at the Leeds Club, Albion-place, Mr. C. G. Wheel-house, F.R.C.S., was, on the occasion of his leaving thatcity, entertained at dinner by the Board of the GeneralInfirmary, the medical officers of the various local institu-tions, and other medical friends. Mr. R. Benson Jowitt,Chairman of the Infirmary Board, presided. The chairman,in proposing the toast of " The Guest of the Evening,"referred to Mr. Wheelhouse’s long connexion with the In-firmary, and to the valuable assistance he had rendered it,not only as a surgeon, but in its management. Mr. Wheel-house, in returning thanks, expressed his appreciation ofthe compliment paid to him.

THE PATHOLOGY OF CHOREA.To the Editors of THE LANCET.

SIRS,—Might I crave a little space in order to point outan error into which Dr. Garrod has fallen in his criticism of

my letter on the above subject? In that letter I say :"Rheumatism is essentially a disease of the motor apparatus.Chorea is essentially a disease of the motor centres. In thisbroad pathological statement we have the clue to the

explanation of the fact that chorea is common in rheumaticsubjects." Referring to this, Dr. Garrod says that if this wereso "we might surely expect a similar association of choreawith gout and rheumatoid arthritis in spite of therarity ofthesemaladies in early life." In this criticism Dr. Garrod ignores(no doubt unwittingly) a very important part of my letter,for in the latter part of the paragraph to which he refers itis stated in the most explicit manner that chorea is mostcommon in females and in young people, and that " therheumatic constitution is by no means necessary to theproduction of chorea. Youth and sex are more importantpredisposing agencies." Chorea is essentially a disease ofyouth, the vast majority of cases occurring between theages of seven and fourteen. Causes which excite it thendo not excite it in adult life. Gout and rheumatoidarthritis are not possible causes, because they do not occurduring the age of liability to chorea; rheumatism is apossible cause, because it does occur during that age.

In discussing the question of the relationship of rheu-matism and chorea it must ever be borne in mind that thecases of chorea in which this relationship exists are, afterall, only a minority. In the majority there is no suchrelationship, and the choreic symptoms have in them to beexplained without reference to any of the changes asso-ciated with the rheumatic process. To advance one

hypothesis for the explanation of the rheumatic cases, andanother for the non-rheumatic, is to advance two hypo-theses in explanation of one set of phenomena. In sciencethat is scarcely admissible.

I am, Sirs, your obedient servant,Cadogan-place, Dec. 7th, 1889. T. J. MACLAGAN.T. J. MACLAGAN.

OPERATIVE TREATMENT OF FLAT-FOOT.To the Editors of THE LANCET.

SIRS,—In your issue of Dec. 7th, Mr. T. S. Ellis of

Gloucester comments adversely upon osteoplastic operationsfor the cure of flat-foot, holding osteotomies for this con-dition "to be unwarranted, because unnecessary." I amwell acquainted with Mr. Ellis’s views-and I think themadmirable-on the restoration of deformed regions by theenergetic renewal of abeyant motor functions; and in thetreatment of such conditions as lateral curvature of thespine I conceive no better principle of treatment can beenunciated. But when this principle is applied to thetreatment of such deformities as extreme knock-knee andflat-foot, as Mr. Ellis urges it should be in his publishedwritings, I can but fear that it will suffer in reputation byits extension to a group of conditions wholly different fromthose where its advantages have been indubitably proved.The group to which the principle is properly applicableincludes all cases of deformity not dependent upon actualalteration in the shapes of bones. On the other hand, inthat group of cases where bony surfaces are profoundlyaltered in their shape or direction, the principle in questionmust certainly give place to that of plastic renovation ; forthough I would not deny to the former method the pos-sibility of effecting a cure after long and laborious use, yetsuch a result, as compared with the early and satisfactoryoutcome of a radical operation, cannot escape condemnationas an undue procrastination of recovery. In hospital prac-tice this element of time cannot be left out of account ; itis of the greatest importance to the disabled patient and tothose dependent upon him that he should be restored tousefulness by the most rapid means compatible with safety.And on this last issue, with the statistics of aseptic osteo-tomy before me, I can but express surprise that Mr. Ellisshould now feel any doubt as to the " justifiable " nature ofsuch operations.

I am, Sirs, yours obediently,Manchester, Dec. 10th, 1889. ARTHUR W. HARE.ARTHUR W. HARE.