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not altogether due to novelty. "The dressing of the playwas effective, the scenery was. good, and there was spiritin the acting," and "the audience, judged by their atten-tion, felt a real concern in the development and the incidentsof the play." It is pleasant to know how cheerfully andsuccessfully these poor folks struggle against the limitationsbrought about by their affliction, but for all that this silentHamlet must have seemed to the visitor who could hear and

speak a pathetic spectacle. -

THE JACKSONIAN PRIZE.

THE Jacksonian Prize of the Royal College of Surgeons of’England has been awarded by the council of the Collegeto Mr. McAdam Eccles, M.S. Lond., F.R.C.S. Eng., for hisdissertation on "The Pathology, Diagnosis, and Treatmentof the Diseases caused by and connected with ImperfectDescent of the Testicle."

___

PUERPERAL INSANITY.

DR. ARTHUR C. JELLY of Boston has published in theBoston Medical and Surgical Journal of March 21st an

important article on puerperal insanity based upon themedical records of 250 cases of puerperal mental disturbanceobserved during the years 1872-1900. After referring to thegreat anxiety and suffering which are caused by puerperalinsanity when a young mother becomes suddenly maniacalafter the birth of her first child and requires to be sent to an-asylum he directs attention to the possibility of prevention.Of the 250 cases referred to above as suffering from puerperalmental disturbance, in 200 the disorder was sufficientlygrave to constitute insanity and to require asylum treat-ment. Cases of the insanity of pregnancy or of lactationwere not included, the term puerperal insanity being, some-what artificially, restricted to those who became insane

within six weeks after childbirth. From an etiological pointof view two distinct groups were recognised. In the first

group the causes were septic infection and exhaustion, com-plicated in some cases with auto-intoxication. In the

second group a psychopathic predisposition existed and theordinary stresses of the puerperal state were sufficient to Icause it to manifest itself in the form of insanity ; thepuerperal state opened the door and thus the psychosis was,as described by Kraepelin, liberated (auagelöst). Insanity issaid to occur once in 460 deliveries. In asylums for theinsane from 7 to 9 per cent. of all the female admissions arecases of puerperal insanity. The insanities of pregnancyand of lactation claim each about one-half of the number- of victims of puerperal insanity. Dr. Jelly finds a history ofinsanity, epilepsy, or cerebral disease in one-third of all hiscases. Alcoholism also plays an important part, whether itis present as a hereditary taint or as a personally acquiredvice. Some patients are liable during the pains and suffer.ing of childbirth to suffer from suddenly-developed delirious’troubles, but these rapidly pass away when delivery has takenplace. In such cases a predisposition to epilepsy or pro-found hysteria often exists in the background (Kraepelin).Illegitimacy is a predisposing cause of puerperal insanity,the latter being twice as common after illegitimate as com-pared with legitimate births. Cases of puerperal insanity ofseptic origin have shown a tendency to decline in the lastthree decades owing to the stricter and wider adoption ofantiseptic principles. Thus in the Philadelphia MaternityHospital 99 cases of puerperal insanity of septic originwere admitted from 1867 to 1877, while from 1887 to 1897the numbers had fallen to 20, ’’ the latter period beingmarked by the introduction of stricter antiseptic measuresin obstetric practice in Philadelphia." In Boston there has

been a decrease in the ratio of puerperal to total labour

cases, it being 6-4 per cent. in 1872 to 1880, 4 6 per cent. in1880 to 1890, and 3-7 per cent. in 1890 to 1900. The more acute

septic cases are of short duration and end in death. Others

improve after removal of the sources of sepsis, but completerecovery occurs in only a few. The average duration of

puerperal insanity is eight months. In some cases where there

is marked cerebral exhaustion the patients live only a few daysand where recovery takes place the process is slower than inseptic cases. Of Dr. Jelly’s 200 cases of puerperal insanity30 had had more than one attack. " One woman was

admitted to a hospital for the insane in 1870 with her firstattack and in 1899 in her seventeenth attack." In 20

patients some form of mental defect or disorder had existedbefore pregnancy, thus, one had general paralysis, threeepilepsy, three imbecility, three dementia prascox, fivedelusional insanity, and five secondary dementia. The pro-

gnosis as to recovery from a first attack was good (from 75 to80 per cent.), but the tendency to recurrence was strongand the prognosis was bad after a second or third attack.Treatment consisted in keeping the bowels open, dailycatheterisation of the bladder, rest with abundant goodfood, alcohol and hypnotics in moderate amount so as tosecure sleep, and careful guarding against suicide. Hometreatment was seldom satisfactory.

SOOT AND TERRESTRIAL AND COSMIC DUST.

IF complexity of composition frees a substance from

reproach at all that substance should be soot, for recentmicro-spectroscopic analyses have shown that it contains anextraordinary number of metallic elements. Thus chimneysoot was found to contain, besides iron and calcium, nickel,manganese, copper, and silver. The soot from laundriesseems to contain more elements than that from the kitchenor bedroom chimney, doubtless on account of the more com-plete combustion of the fuel in the laundry fire. Flue dust,besides containing the more or less common metals such aslead, silver, and copper, contains also nickel and manganeseand even rubidium, gallium, indium, and thallium. Gallium

appears to occur in all kinds of dusts and soots. Some dustsare clearly of terrestrial origin while others are undoubtedlyof cosmic origin. Nickel occurs both in the dust from the

clouds (or the dirt in the rain) and in soot, so that its

presence in the former is not necessarily an indication of itscosmic origin. The dust which fell upon the earth in

November, 1897, yielded a deposit identical with meteoricdust and was magnetic. The dust examined fell on a

perfectly calm fine night and there was no rain for upwardsof 24 hours. Its composition was totally unlike that ofvolcanic dust and flue dust from various industrial processes.It was therefore of meteoric origin. It has not hitherto been

suggested that when London was in the throes of one of itsdarkest fogs it was bathed in an atmosphere of rich andrare metallic elements. But such would seem to be the

case according to micro-spectroscopic methods. It should be

remembered, however, that these methods discover the mostinfinitesimal quantities; indeed, it may be but a few

molecules..

THE springomeefing of the Medico-Psychological Associa-tion will be held at the Essex County Asylum at Brentwoodon Wednesday, April 24th. From 11.30 A.M. to 1 P.M.

there will be an inspection of the asylum and grounds,followed by luncheon on the invitation of Dr. G. Amsden,the medical superintendent of the asylum. At the generalmeeting, which will take place at 2.45 P.M., Dr. RobertJones will communicate a paper on " How should the subjectof Insanity be taught to the Medical Student?" " and Dr.Arthur H. Spicer will deal with ’’ A Case of SpontaneousFracture," In the evening the members will dine at theCafé Monico, Piccadilly-circus.

THE death is announced, on April 13th, of Mr. GeorgeFleming, C.B., LL.D., F.R.C.V.S., late Principal Veterinary

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Surgeon to the army. He was born in 1833, served throughthe Crimea and on the North China Expedition, and wasfive times President of the Royal Veterinary College. A

pathetic circumstance connected with his death is that he

died suddenly on the second day after the wedding of hisonly surviving daughter to Mr. N. S. Manning, F.R.C.S. Irel.,of Combe Martin.

-

. ITHE KING has graciously consented to act as patron

Iof the Prince of Wales’s Hospital Fund for London, andHis Royal Highness the Duke of Cornwall and York has

expressed his pleasure in accepting the office of Presidentin the place of His Majesty the King. His Majesty hasintimated that in his capacity as patron he will continue towatch over the work of the Fund with the same deep interesas hitherto.

-

THE KING, who as Prince of Wales has been President ofthe Society of Arts since 1863, has now graciously accededto the request of the society and has consented to becomeits patron. His Majesty has also permitted the society tocontinue the use of his profile on the medals of the society.

THERE was a small gathering of the members of the

Metropolitan Counties Branch of the British Medical Asso-ciation at Exeter Hall on April 3rd, when the meetingapproved of the principles embodied in the provisionalreport of the Constitutional Committee.

THE King has been graciously pleased to grant his

patronage to the Royal General Dispensary, Bartholomew’s-close, E.C. His Majesty has also consented to continue hispatronage to the Hospital for Consumption and Diseases ofthe Chest, Brompton. -

THE second annual meeting of the American Congress ofTuberculosis will be held at the Grand Central Palace, NewYork, on May 15th and 16th, in joint session with the

Medico-Legal Society of New York.

NOTICE has been received at the Colonial Office, dated

I

April10lih, 1901, that 10 days’ quarantine have been imposedat Cyprus against Egypt in consequence of bubonic plague.

THE King has appointed Dr. William Thomas Prout

(Colonial Sargeon) to be an Official Member of the

Legislative Council of the Colony of Sierra Leone.

DR. H. D. ROLLESTON is starting for Pretoria to replaceDr. J. W. Washbourn for six months as senior physician tothe Imperial Yeomanry Hospital.

WoRKHousE DIETARY.-A man who has beenan inmate of Withington Workhouse since August, 1899, hasmade a practical protest against the new dietary order of theLocal Government Board by throwing his breakfast throughthe doorway and refusing to do any work. He said that itwas on account of his health and the insufficiency of thefood. On the day of his protest it consisted of one and ahalf pints of porridge, one and a half ounces of treacle, andtwo ounces of bread. In addition to the breakfast the paupers,it was explained, if well behaved, had a lunch of breadand cheese. The medical officer of the workhousesaid that the man was quite fit to go on the newdiet and to do the work allotted to him. Some con-

versation took place at the county police-court, andthe prisoner informed Mr. Yates, the magistrate, that"they give you eight ounces of bread in prison and thatthe porridge is very thin and really gruel and ’’ not muchgood." The medical officer said that " the prisoner seemedto have been put forward as a test case against the newdiet." In sentencing the man to seven days’ imprisonmentwith hard labour Mr. Yates said " he would now be able tocompare the two diets."

THE REPORT ON ANÆSTHETICS ISSUEDBY THE BRITISH MEDICAL ASSOCIA-TION AND "THE LANCET" CLINICAL

REPORT ON ANÆSTHETICS.

11.1

THE sections in the report of the British Medical Associa-tion dealing with the methods employed, although of interest,afford no finality in the conclusions which they express. It

is pointed out both in this report and in that of THE LANCETthat the methods classified under one name may be widelydifferent in their actual technique. A towel or piece of lintemployed as a means of exhibiting chloroform may in

dexterous hands be tolerably safe, but when used in sucha way as to allow a high percentage vapour of chloroformwith excessive exclusion of air it must result in death. Thematerial upon which the committee of the British MedicalAssociation had to work appears to have been too inexact forthem to obtain any very definite results, but some usefulinformation is still to be gleaned from the sections. Thus,although they state that the lint method gives a high danger-rate, higher than the towel method, yet the study of thecases compels the belief that practically all the recordedcases of chloroform administration were those grouped underthe general heading of ’’

open method," and that as therewere so few figures dealing with any method based uponmeasured quantities of the anesthetic used no basis forcomparison is afforded. If this contention is correctthe figures (pp. 95-96) are really merely those of variousmethods, perhaps some superior to others, still all ofthem examples of non-regulated chloroformisation. Theseplans were adopted by a large number of persons someof whom were experts, so that it appears probable thatthe results obtained constituted a resultant of opposite forces.-the careful and the careless chloroformisation.The two reports emphasise how persistent are the old

methods—the "slapdash" methods, as they have beentermed. The actual variety of the "open method" "

employed is thus shown to be of less importance than theindividual skill of the person carrying it out. Certain it is,that we possess no statistics which prove the safety or theconverse of the " open method," or of the method in which aregulating inhaler is employed. The appendix to the BritishMedical Association report gives a small number of cases(1521) in which a semi-closed method (the Hyderabad cone),was followed with a death-rate of nil and a low danger-rate,but here obviously the surgeon in charge took the utmost careto avoid an overdose. Moreover the plan adopted was to pourmeasured quantities of the chloroform into the cone at statedintervals, thus giving a certain degree of regulation of dosage,by this method. These cases are too few for comparisonwith the towel, lint, or Skinner mask cases. All methodsused for the exhibition of chloroform taken together accord-ing to the British Medical Association report, give a compli-cation-rate of 3’27 per cent. to the total number of cases, a .danger-rate of 1’032 per cent., and one death in 744 cases ;the towel method gives a complication-rate of 3’92 per cent., adanger-rate of 1-41 per cent., and one death in 888 cases, andthe lint method gives a complication-rate of 2 14 per cent., a,danger-rate of 0’59 per cent., but one death in 542 cases,showing that although the cases of danger were few they.were extremely grave when they did occur. The regulatingmethod suggested by Dr. Junker and sometimes recordedunder other names was only recorded in 411 instances,but although these showed a favourable record it would beuseless to base any arguments upon so slender a foundation.Indeed, the experience of the past years has shown thetendency there is for an observer after the careful useof one method subsequently to regard his success as neces-sarily a proof of the value and safety of his plan. Thegood results are usually due less to such a cause than to theexpertness acquired by conscientious employment of a routinemethod.

It would not only be tedious, but quite useless, to considermethods in the case of other anaesthetics than chloroform.We may, however, remark that the committee call attention,and we think rightly, to the fact that when mixtures

1 Article I. was published in THE LANCET of March 30th, 1901, p. 961.