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grounds that they had not been increased for50 years, that the cost of living had greatlyincreased, that travelling expenses were higher,and that recent legislation had almost doubled thework. The matter will be considered at a specialmeeting of the board.

PARIS.(FROM OUR OWN CORRESPONDENT.)

Emetine in Acute Respiratory Affections of Children.M. Mery has reported to the Societe Medicale des

Hôpitaux a series of cases which seem to make itclear to him that emetine injected in doses of1 cgm. at the age of 1 year, rising proportionatelyup to 4 cgm. in the adult, lowers the temperature,renders the secretions fluid, rapidly lessens conges-tion of the lungs, and has no weakening action.These injections have been renewed for severaldays running in cases of broncho-pneumonia,pneumonia, and capillary bronchitis, without anyuntoward happening.

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The Sigaut Prize.The Secretaire Perpetuel of the Académie de

Medecine has been authorised to accept in thename of the academy a legacy from Dr. M. Sigautof 8000 francs, the interest to be used to establisha prize to be known as the Dr. Max Sigaut prize.It is to be awarded every two years for the bestmemoir on early diagnosis and the best treatmentin cancer of the digestive tract.

The Soldier’s Wine Ration.At the Paris Academy of Medicine M. Vidal

has asked for a resolution demanding the regulardistribution as far as possible to all soldierswith the colours, whether in garrison or at the

front, of a hygienic beverage-wine, cider, or beer-during meals. Professor Landouzy called attentionto the fact that for a long time he had pointed outthe defects of the alimentary ration of the Frenchsoldier, a ration which was calculated the same forall arms without allowing for the differing needs ofmen of different weight, a ration which comprisestoo much meat and not enough carbohydrates.The addition of a suitable proportion of wine to thedaily ration appeared to him an excellent method toequalise the insufficiency and the defects in com-position of the existing ration.

Typhoid Statistics of the Army.Statistics indicate that the sanitary condition of

the French army is particularly satisfactory. No epi-demics have appeared, thanks to the knowledge andstrict application of the fixed laws of hygiene. If afew isolated cases of typhoid fever appear it is becausethose who are attacked have not been protected byvaccination, or have been vaccinated in an unsatis-factory manner as to quantity or method of applica-’tion. In the early months of the war, moreover,since preventive vaccination had not yet been madegeneral, and numerous cases were presenting them-selves in the infectious hospitals, it was thoughtthat cases of typhoid fever had been found in thosewho had been vaccinated. This was not so. Thesecases have been found to be paratyphus, and theyare the result of a microbe entirely different fromthat of typhoid fever. Sometimes typhus feverhas been confused with typhoid or paratyphoidfever, and against typhus fever no vaccine has beenfound, but this fever seems to have largely dis-

appeared from the western front in the presentwar, and no case of it has been seen in Franceaccording to official figures, though individualaccounts do not agree here.

Correspondence."Audi alteram partem."

AMPUTATIONS FOR GANGRENE.To the Editor of THE LANCET.

SIR,-Among the many difficult problems whichsurgeons have been confronted with in this warnone are of greater importance than the bestmethods of amputation in cases of sloughing andcellulitis or actual spreading gangrene. Someauthorities have lately revived the ancient practiceof cutting the limb straight through, leaving noflaps whatever. We have recently had some ofthese cases at Exeter and the results are veryunsatisfactory, necessitating tedious skin grafting,leaving at best a poor unsound stump, or actualre-amputation. I hesitate to veto or condemn apractice which has been advised by leading men.But I fearlessly assert that this amputation, if doneat all, should be reserved only for pronounced casesof spreading gaseous gangrene. I have reason tobelieve it has been performed for other conditions,when I can hardly believe it is ever needful.The drainage of septic serum from a swollen and

enormously cedematous limb is effected very per-fectly if the flaps are left open. I have had experi-ence of this and speak confidently. The amputationshould be done well away from the damaged parts.In cases of gunshot injury, crushes, and the like,the damage to the soft parts extends much higherthan is apparent. Many disastrous results are dueto the anxiety of the surgeon to preserve partswhich appear to him sound. The flaps should becut thick, with substantial muscular bases, to pre-serve the nutrient vessels. And it is of specialimportance that the soft parts be well retractedand the bone sawn high up. The shrinkage inthese cases is remarkable, and very apt to leadto after-protrusion of bone. The sutures shouldbe passed and knotted at the ends, but not tied,and the stump wrapped in warm fomentationsof boric or saline fluid, often renewed. Elevationof the stump should be adopted if possible. The

drainage of serum is copious and immense. The

flaps shrink markedly. Should the patient survivethe cut surfaces will

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glaze," and the sutures canthen be tied. Even if parts of the flaps slough,there is still some covering from which subsequenthealing may ensue. I have no hesitation in recom-mending this practice.

All allowance must be made for the difficulties ofamputations done in haste, perhaps in danger, andby a surgeon embarrassed by crowds of woundedmen. But I believe the main . recommendationof the operation of

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Antyllus " is the ease of itsperformance. And though this somewhat pre-historic surgery may be justifiable, say, for a ship’scarpenter acting in emergency, it can hardly beadvised to a modern surgeon unless under themost exceptional circumstances. I write in no

carping or critical spirit. The matter is a veryserious one. It must be remembered that our

younger surgeons at the front have not experienceto guide them; they are largely guided by whatthey read. The subject is eminently one for a pro-nouncement by the consultants on active service.We are all anxious to spare the brave men fightingfor our existence all needless suffering.

I am, Sir, yours faithfully,f

July 30th, 1915.A. MARMADUKE SHEILD,

Consulting Surgeon to St. George’s Hospital.