492 BEDFORD INFIRMARY.-SURGICAL FEES.

in the position of the direct cerebellar or crossed

pyramidal tract of the left side, and also around the

posterior root; at higher levels these patches increased insize, the direct cerebellar tract being extensively diseased, andthe crossed pyramidal tract slightly so. In the upper dorsal

region the antero-lateral tract was also affected, and thecells in Clarke’s column were diminished in number. In the

cervical region there was a trace of degeneration in the

opposite antero-lateral tract and also in the posterior columnof the same side. Degenerated fibres were also found inboth ventral and dorsal nerve roots along the cord. In themedulla and pons the degenerated tracts could be tracedupwards until they apparently merged in the restiform body ;but scattered patches of degeneration were found at thelevel of the sixth, seventh, and eighth nuclei. The case, itwill be seen, is interesting and important. It is believed byDr. Campbell to prove the existence of downward conductingpaths from the cerebellum in the cord. An examination for

upward paths from the diseased cerebellar hemisphere doesnot seem to have been made, and in a case from which suchimportant deductions are made an examination of bothinternal capsules as well as of the cortex would certainlyhave been desirable. Considering the conditions found postmortem it would also be interesting to know what had beenthe state of the knee-jerks.

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BEDFORD INFIRMARY.

WE are glad to observe that at the annual meeting of thegovernors of the Bedford General Infirmary, held on the12th inst., the committee of management recommended thatthe election of the house surgeon should be placed in thehands of the committee. Hitherto it has been the custom forthe whole body of governors to take part in such elections-asystem which not only involves much personal canvassing, butis not always conducive to a right selection. At the meetingone of the governors made a strong appeal for the retention ofthe old plan which had existed for "ninety years " but we canhardly think that his arguments are likely to prevail. The

number of such institutions where the paid officers are sub-ject to election at the hands of the whole governing body isconstantly diminishing, it being felt that a select committeeis in a far better position to weigh the qualifications of can-didates judicially and impartially than the large body ofsubscribers, whose votes may be obtained by personalappeals. It is also proposed that the house surgeon shallhold office for one year and be eligible for re-election, hiswhole tenure not to exceed three years.

SURGICAL FEES.

ON Monday morning last, at the Clerkenwell County Court,before his Honour Mr. Meadows White and a jury, a case-"Browne v.: Cowan "-was decided of considerable interestto many in the profession. The case was one of those dis-

tressing ones, where an over-distended bladder due to

prostatic disease had long existed without treatment. Mr.Reid of Canonbury saw the case and at once realised itsimportance and gravity, and recommended it to the care ofMr. Buckston Browne. The patient was emaciated, seventyyears of age, and worn with constant and painful micturi-tion. He was assiduously attended, at first four times daily,and the bladder very gradually emptied. The late Sir AndrewClark was called into consultation and every care and pre-caution exercised ; but, as had been feared from the first,the patient gradually sank and died in fifteen days. The

friends desired to know the fees and were told thirty guineas,being at the rate of two guineas a day, and two guineas forthe consultation with Sir Andrew Claik. During the illnessno complaint was made, and afterwards no plea of povertywas brought forward. Immediately upon hearing what thefees were the representatives of the patient wrote to say

that they considered them excessive and offered fifteen

guineas, and, if this sum was not accepted, declinedfurther correspondence, and enclosed the name and"

address of their solicitor. This offer was absolutelyrefused, and later on, through the solicitor, 20 guineas.were proposed, and as definitely declined. Finally, the case-was brought into court. After paying a graceful tribute to.

the hard work and generosity of the medical profession, his<

honour told the jury that in his opinion it ought never tohave been necessary to bring such a case forward ; but thatMr. Buckston Browne had no alternative but to bring thematter before them. He thought that if 50 guineas hadbeen charged, such a sum would not have been outsidethe mark. The jury found for the plaintiff for the fullamount, and all costs to be paid by the defendant.

SANITATION AND MIDDLE-CLASS DWELLINGS.

THE Croydon County Council have lately instituted a suitagainst a builder for having used bad mortar in the constructionof certain houses at Thornton-heath. It was stated in evidenceby Mr. J. Birch, building inspector to the corporation, that.the mortar employed, instead of consisting of sand and lime,was made of garden mould and lime. Corroborative evidencewas given by the borough surveyor, Mr. Thomas Walker, who<added that the bricks also were of the most inferior descrip-tion, so that "dampness would come through as readily as,through a piece of blotting-paper." Although warned, the-foreman continued to employ the same materials. The

defendant was fined :E3 3s. and ;E2 9s. 6d. costs, or in default,

twenty-one days’ imprisonment.

THE ADMINISTRATION OF SALT SOLUTIONAFTER H&AElig;MORRHAGE.

IN the Allgemeine Wiener Medicinische Zeitung Dr. Warmandraws attention to a new method which he has employed forthe administration of salt solution after severe heamor-

rhage. This is usually accomplished by injecting the solu-tion into a vein, but this method has many disadvantages,especially in private practice : the solution has to be care-

fully sterilised, by which much time is lost, the specialapparatus required is frequently not at hand, and it is oftenvery difficult in severe cases to find and open the vein.Dr. Warman, therefore, in a case in which there was.

alarming haemorrhage after abortion, adopted the plan ofinjecting about a litre of water, to which a teaspoonfulof ordinary salt had been added, into the rectum by means.of an ordinary enema syringe. In order to prevent, if’

possible, an action of the bowels, the fluid was only allowedto enter very slowly. The result, as Dr. Warman expressesit, surpassed all expectations : within a few minutes the-,

patient had a slight rigor, the pulse, which before could notbe felt, was distinctly perceptible at the wrist, the respiration.became deeper and the patient made a good recovery.Encouraged by this result Dr. Warman has since tried this-treatment in twenty-six other cases, and always with success..The rectal method has considerable advantages over intra-venous injection, as the solution is easily prepared and nospecial apparatus or skill is necessary. Dr. Warman thinks,that the fluid is entirely absorbed in less than five minutes..He points out that one great danger which is apt to occur inthe venous method-namely, over diluting the blood and so.destroying the red blood-corpuscles-is quite absent from his.method. The chief disadvantage in the rectal method is that.in some cases, when the patient is completely unconscious,the sphincter ani does not act properly, and the fluidis not retained in the bowel and immediately runs out.

According to Dr. Warman’s experience, however, this has.only occurred when the h&aelig;morrhage has been less severe;. r.but when much blood had been lost the absorption was soapid that no difficulty was experienced. The quantity &3

493THE SOUTHAMPTON CORONER ON UNQUALIFIED ASSISTANTS.

- solution usually employed was between one and two litres,and all the cases treated were obstetrical ones ; but Dr.

’Warman believes that this method of treatment would be

equally serviceable in other classes of cases, but not in entericfever, when he thinks that there would be considerable dangerof removing the scabs from the ulcers.

INTERNATIONAL MEDICAL CONGRESS IN ROME.

WE learn that the South-Eastern Railway Company, inconjunction with the French and Italian railways concerned,will issue to members and their families attending theEleventh International Medical Congress in Rome, March 29thto April 5th, 1894, special through return tickets to Rome fromCharing-cross and Cannon-street stations at practically asingle fare for the double journey, either vii Boulogne orCalais, Paris, and Modane or Vintimille. These specialtickets, which will be available for the return journey lip toMay 10th, will be issued to each traveller only on presenta-tion of his personal letter of invitation.

THE DIFFUSION OF SMALL-POX.

THE records of small-pox prevalence last week in the greattowns of England and Wales show a distinct decrease of thedisease. In London 17 cases were admitted to hospital ; nodeath was recorded; and 78 persons remained under treat-ment on Feb. 18th, a number identical with that of a weekearlier, 62 cases being on the river, and 16 at Highgate Small-pox Hospital. West Ham had 14 cases, with one death ;New Swindon and Bristol 4 cases each ; Walsall 6 cases, afurther decrease continued during four successive weeks;Birmingham 48 cases, a little over 5 per cent. of the precedingweek, 7 deaths being registered ; Aston Manor 8 cases ; Man-chester 3 cases, following one a week earlier ; Oldham 9 cases,and Bradford only 3 new attacks, with 2 deaths. Severalother towns had cases numbering from one to three.

THE SOUTHAMPTON CORONER ON UNQUALIFIEDASSISTANTS.

THE attendance of an unqualified assistant in a case ofsudden death at Southampton-that of William Harding,aged twenty-eight, a dock labourer, a steady young man-ledthe coroner, Mr. W. Coxwell, to comment on medical prac-titioners employing unqualified assistants, saying that it

lowered the profession and was a wrong practice, and thatnot one penny could be recovered for their services. The

practitioner, whose assistant had attended, retorted that suchassistants were employed throughout the country, that it

was not illegal, and that medical men could not afford topay qualified men. This sharp passage of arguments putsinto a small compass a good deal of truth on which we havenot leisure at present to comment, but which we commendto all concerned-not least to practitioners and to those ill-advised young men who drift into the chronic position ofunqualified assistants.

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HYDATID CYST IN THE PAROTID REGION.

AN interesting and rare case was recently shown beforehe Soci&eacute;t&eacute; de Medecine et de Chirurgie de Bordeaux byDr. Pi&eacute;chaud.1 It occurred in a child aged twelve, who hadhad for some months a swelling in the right parotid region.The tumour was the size of a large orange, flattened, sessile,.and adherent to the deeper structures, with marked fluctua-tion. It had caused a considerable amount of pressure in the

neighbouring parts; the arch of the palate was depressed;there was difficulty in moving the under jaw; and in the regionof the right tonsil there was a prominent projection, soft andfluctuating, resembling the external swelling, of which it

1 Journal de M&eacute;decine de Bordeaux, Feb. 4th, 1894.

was manifestly a part. On placing the patient in a

suitable light it was demonstrated that this enormous tumourwas semi-transparent, and by means of palpation, made atthe same time from within the mouth and in the parotidregion, fluctuation was found to be so distinct that theexistence of a single encysted mass of fluid was placed beyonddoubt. After having dismissed neoplastic growths whichmight be found in that region as improbable, Dr. Pi&eacute;chaudcanie to the conclusion that it was a hydatid cyst, but inorder to corroborate his diagnosis he sent to Professor Auch&eacute;,for examination, some of the liquid which had been removedby an exploratory puncture. This liquid exhibited the

following characteristics : the amount was six cubic centi-

metres ; it was clear, the specific gravity was 1006, and onstanding it yielded no deposit. In reaction it was faintlyalkaline. Not a trace of albumen could be obtained, butthere was a considerable quantity of salt (5 grammes in 1000).On microscopical examination no cellular elements could beseen, and no crystals. Although special search was made,no scolices or hooklets could be found, but, consideringthat the fluid was drawn off with an exploring needie only,this was not a matter for surprise. Cultures were also madeof the fluid in various nutrient media, but no growth resulted.The diagnosis of hydatid cyst was supported by this examina-tion, so far as it goes ; but the further course of the case hasnot yet been recorded.

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SCHOOL ATHLETICS IN RELATION TO MENTALTRAINING.

THE mere circumstance that discussion has long been andstill is active in seeking to define the true position of physicalexercise in relation to mental training should suffice to provethe essential nature of the connexion which binds togetherthese diverse methods of education. Each is in its own placeindispensable, and this fact happily is in a greater or lessdegree recognised in every school curriculum, even the mosthumble. The reason is not difficult to find when we con-sider how closely and inseparably associated is the health ofthe mind with that of the body. It is not in the nature of

things that we should be capable of sustained and vigorousmental activity unless due provision be made for the purifica-tion and nutrition of tissue, including that of the brain, bymeans of an active blood circulation. The relation between thelatter and muscular energy requires no explanation. It is true

that bodily activity does not confer mental power or evenencourage mental exertion. It is also true that exceptionalpowers of mind have displayed themselves in persons physi-cally weak; but neither of these admissions affects our presentargument, which maintains the certain advantage resultingto all mental processes, ordinary or exceptional, from thatwhich promotes the health of their nidus in the brain. Afurther benefit conferred by physical training is its influenceupon character. A host of mushroom frailties, vices, and foiblesbreak down in presence of such vigorous growths as the resolu-tion, the endurance, and the manly self-reliance engendered bya habit of orderly and energetic action, Justice, fairness, andfellow-feeling are developed by the same wholesome training,and thus many a boy at school acquires almost unconsciouslythat living force of character without which intellect isbut a brittle gem. For obvious reasons our public schoolshave taken a leading part in promoting physical education inthis country. The pupils trained in them are, in very many

, cases, resident, and the consequent responsibility for theirj bodily health imposed upon teachers who act in loco parentis, . has no doubt had to do with the formation of a compulsory

system of exercise. Administered with due regard to indi-l vidual fitness or unfitness, we regard this arrangement ast beneficial, and we welcome the development of a similar,- though naturally somewhat less stringent, method in the

management of day-schools throughout the country. Into