816

My experience as a medical officer of health has taught methat the perfect system of house-to-house visitation, &c.,which is common in the large municipal and other combinedauthorities, is wanting in the smaller urban ones, and it wasonly by the death certificates and other casual means thatone could get what was at any time but a very moderateamount of information as to the presence of disease ; ittherefore seemed to me but proper that the causes of theabsence of children from school might be of great use to oursanitary authority.For some months past measles and scarlet fever have been

prevalent here ; and, according to the school-attendanceofficers’ report, children were staying at home for thesereasons. I then suggested to our School Board the advi-sability of acquainting the Sanitary Authority with all casesof infectious disease. This they resolved to do. Theepidemic of measles, however, spreading considerably, wethought it necessary to close our central infant school fromOctober 24th to November lOth, and I send you theresults :-

Average attendance previous to epidemic ......... 270" " at time of closure ............ 142

., " when reopened ............ 199Present average attendance .................. 214No. of families reported to Sanitary Auth. before closing 74

" " during the time closed 14

" " after re-opening ... 3

I would suggest that in all the smaller urban districtswhere a School Board exists the school-attendance officershould also be appointed inspector of nuisances, for he hasa knowledge of circumstances connected with parents andchildren which no other official can possess, and if they areabsent from school he immediately ascertains the cause, andcould then deal with it as ordered; and in addition to thisimprovement in sanitary work, one officer would do thework two are now required for, which would be no doubt astrong recommendation in favour of such a course.

Unless some such plan is adopted I fear large schools,massing together numbers of children, will become not onlycentres of instruction, but foci of disease.

I am, Sir, yours, &c.,WILLIAM HENRY ELLIS, M.R.C.S.E.,

Surgeon to the Saltaire Infirmary, and late M.O.H for theShipley and Windhill districts.

Shipley Hall, Yorkshire, Nov. 28th, 1879.

WILLIAM HENRY ELLIS, M.R.C.S.E.,Surgeon to the Saltaire Infirmary, and late M.O.H for the

Shipley and Windhill districts.

"TRAUMATIC ORIGIN OF COLD ABSCESS."To the Editor of THE LANCET.

SIR,-In your review of my paper on the " TraumaticOrigin of Cold Abscess," in THE LANCET of Oct. 25th, youtake exception to the description of one of my cases, inwhich I state " that the digitation of the serratus magnusmuscle at the eighth or ninth rib had been torn from itsattachment." " ’

Your reviewer says, " As this muscle is not fixed to theninth rib, and as it ought never to be a matter of doubt whichrib is exposed in a wound,l and as this discovery was onlymade after a very free opening of an abscess which hadbeen forming for some months and had burrowed extensively,we must hesitate to accept evidence so obviously imperfect."By referring to Winslow’s Anatomy, 5th edition, trans-

lated by Douglass, p. 176, sec. 161; Quain, 7th Englishedition, vol. i., p. 207; Erasmus Wilson, 4th Americanedition, p. 226; Leidy’s Human Anatomy, p. 202; Bour-gery and Jacobs’ Anatomy, translated by P. C. Comstock,plate 7 and description ; Dunglison’s Dictionary, 6thedition, p. 680, you will find that each of these authorsstate that the serratus magnus muscle frequently has anattachment to the ninth rib.As the patient referred to was in a very critical condition

at the time of the operation, I did not of course make a par-ticular examination to ascertain the exact point of rupture,as it was of no importance whether the rupture was fromthe eighth or ninth rib.The source of the abscess was discovered, when we found

that there had been a rupture of the muscle, and by givingfree exit to the pus a most valuable life was saved.Had the discovery been made at an earlier period, and

1 The italics are mire.

the same treatment adopted, he might have been saved manymonths of suffering with its attending dangers of pyaemia.

I am, Sir, yours, &c.,New York, Nov. loth, 1879. LEWIS A. SAYRE, M.D.

No doubt the serratus magnus may occasionally beattached to the ninth rib, but the occurrence is so unusualthat it is not mentioned by Ellis, Gray, or Heath. Thatdoes not affect our criticism. The want of accuracy in not

observing the precise rib affected may possibly have ex-tended to other particulars. If Dr. Sayre counted the ribhe ought to have been able to decide which it was. If hedid not count, he was not justified in giving it any numberat all. Be that as it may, we maintain that Dr. Sayre sig-nally fails to establish his proposition. He has furnishedno proof whatever that the detachment of the muscle wasthe cause rather than the result of the abscess.-ED. L.

ours, &c.,

LEWIS A. SAYRE, M.D.

ARMY MEDICAL DEPARTMENT.To the Editor of THE LANCET.

SIR, -Your excellent article on Honours to Medical Officers,in THE LANCET of the 27th September, 1879, is opportune,seeing that another delay has occurred in the issue of thelong-expected Warrant; and it is to be hoped that before itis too late Colonel Stanley will see the necessity as well asthe justice of redressing the complaints to which you soforcibly refer, and which have always been and will continueto be standing grievances so long as they remain unre.dressed.The authorities may rest assured that nothing less than a

complete reversal of the policy hitherto pursued towards theMedical Department will attract a sufficient number of ablecandidates and satisfy the legitimate aspirations of its mem-bers. Why, it may be asked, should honorary or titularrank be withheld from the medical officer who has numbersof men under him, while the paymaster has a military rankand title, and not a single man under his command ? Surelythis is a singular anomaly. Titular rank should be grantedto medical officers as in other armies ; relative rank havingno meaning to the uninitiated, and, except in the matter ofchoice of quarters, being perfectly worthless to the possessor.Seeing that medical officers hold command in the ArmyHospital Corps, in station hospitals, &c., that their dutiesin the field necessitate their being under fire, and that,although not so much exposed to danger in that respect astheir so-called combatant brethren, yet the losses amongthem from all causes in recent campaigns (great and

L small) have been found to be much greater than among the1 latter, I think it may be fairly conceded that something> more than the bait of increased pay must be held out before> the medical branch of the army will attract recruits.

Change the designation of the department in some suchway as the committee appointed to inquire into the subject

e recommended, grant titular rank as in other armies, and leta fair proportion of honours and rewards be bestowed ony medical officers, and the British medical man will be found1 no more exigent than others. But so long as the military

authorities choose to evade this part of the question, a; Warrant which merely " increases pay and improves pen-

sion " will not be accepted " as a universal panacea for all:- grievances," however powerful the financial lever may bein other respects, and the British taxpayer will be obligeda to put his hand into his pocket in vain to provide an efficient’- and contented medical service.:, I am, Sir, your obedient servant,11 India, October 31st, 1879. Z.

THE CASES OF TYPHOID FEVER ATTHE CHESTER ASYLUM.

(From a Correspondent.)

THE cause of the outbreak of typhoid fever at the UptonLunatic Asylum, near Chester, has now been discovered.It is due to the total failure of the new drainage systemwhich was completed last July at very great cost. The LocalGovernment Board have sent down an engineer during theweek in response to Dr. Davidson’s suggestion, and on the