889HEALTH OF ENGLISH AND SCOTCH TOWNS.

in limb; five grains of quinine given,-9th: Spent a restlessnight; no special complaint, however, of pain or troubleanywhere ; temperature in the morning still high, 101°; legdressed; wounds free from discharge; no tension in limb;swelling still satisfactorily decreasing. During the dayrestlessness increased, and in spite of frequent doses ofquinine the temperature rose in the evening to 103°.-10th :Had passed an unsatisfactory night ; while tossing aboutpatient had jerked the leg somehow, acute pain followedfrom which relief was only obtained by a sleeping draught.In the morning the dressings were changed ; swelling had Ioccurred in the lower parts of the leg and around the ankle. IfCirculation and sensation in foot, however, were perfect. Torelieve the slight tension of skin the wound over fibula wasextended about one inch, above and below. The cuts madebled freely ; the wounds were dressed with carbolic oil, a layerof salicylic wool was wrapped round the limb, and an anti-septic bandage applied over all. Splint dispensed with.Limb felt more comfortable after dressing, but the patient’sgeneral condition was most discouraging. Temperaturethroughout the day continued about 103°, skin dry and hot,no other svmptom being present, however, save marked rest-lessness. Quinine and stimulants given freely, with opiates.-llth: Durmg the first part of the night the patient had beenrestless, but towards midnight pain left the limb, and heslept well till morning. At 8 A. M. the left knee joint andlower part of thigh were much swollen, and skin thereofhad a peculiar livid colour. On opening the dressings thewhole leg was found cold, and in a state of completegangrene. Patient’s breath had a marked gangrenous odour.No attempt at a line of demarcation was perceptible in thethigh. Temperature 103°. Amputation was at once per-formed in the upper third of the thigh. Dr. Rennie, who wascalled in consultation, operated. Patient rallied successfullyfrom shock. The evening temperature rose again to 102°.—12th : More or less delirious all night. In the morning theintellect perfectly clear. Temperature 103°, pulse 140. Coldperspirations. On removal of the dressings the flaps werefound gangrenous. Patient passed the day perfectly freefrom pain, intellect unclouded, and spirits marvellouslycheerful, though fully informed of his condition. Lostconsciousness only about an hour before death, whichoccurred early in the morning of the 13th.Remarks,-With such a history as the above before one,

the question is naturally asked, Was this a case in which alife was sacrificed in a mistaken zeal to save a limb ? Fortwo days and a half progress towards recovery was all thatcould be desired ; the wounds were perfectly antiseptic, andthe effused blood was being rapidly absorbed ; fever thenoccurred. The patient’s constitution was unfortunately nota good one. Previously stationed on the West Coast ofAfrica, Lieutenant Huobard had suffered severely frommalarial fever, been invalided home on that account, andhad left the Naval Hospital but a few weeks when he startedfor the China station, eleven months ago. For the firstthirty-six hours of the fever the injured limb continued ap-parently to make satisfactory progress ; acute pain thenoccurred from some sudden movement on the patient’s part.On the following morning a suspicious increase of swellingaround the ankle was noted. The most serious view of thecase was taken, and the question of the patient’s chancesfor life was discussed. With the grave constitutional dis-turbance present, and no signs of failure of circulation inthe injured limb, both Dr. Lory and myself were agreed thatamputation at that moment would be unwise and unjustifi-able. Relief of all tension in the limb, and efforts to reducefever, were the measures adopted. Perhaps we were wrong,but of that I am yet in doubt. The waste products pouredinto the blood by lymphatics from the injured limb would,of course, supply fuel for the fever flame, but the repairof a thigh stump also calls for active tissue changes, andthese, plus the depression to the system from the hockof the operation, could scarcely result in abatement offever. In spite of all endeavours, however, the high fevercontinued, and this, with the accompanying rapid circula-tion, soon proved too much for the injured limb. Duringthe night of the lOth venous return was blocked, and avery few hours with such high temperature sufficed tobring about the state of affaIrs found on the morningof the llth. The amputation then performed I admit washopeless and a questionable proceedmg, but by securingto the patient comfort during the remaining forty hoursof his life, the end, I think, justified the deed.

. Foochow, Sept. 18tb, 1884.

THE DESTRUCTION OF CHRISTIANSBORGPALACE.

REPLY OF THE KING OF DENMARK TO THE ADDRESS BYTHE ENGLISH, SCOTTISH, AND IRISH MEMBERS OF

THE INTERNATIONAL MEDICAL CONGRESS.

THE following letter has been sent to us for publication :-British Legation, Copenhagen, November 3rd, 1884.

SIR,-I beg to inform you that the King was graciouslypleased to receive me to-day in private audience for thepurpose of delivering to His Majesty the address, signed bythe English, Scottish, and Irish members of the InternationalMedical Congress recently assembled here, expressing theirprofound regret at the loss sustained by His Majesty andDenmark in the destruction of ChristiaDsborg Palace on the3rd ult. The King seemed fully to appreciate this gracefultribute of sympathy, and commanded me to convey to itsauthors his "heartfelt thanks."

I am, Sir, your most obedient humble servant,

I Henry Morris, Esq. Her Majesty’s Chargé d’Affaires.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

, In twenty-eight of the largest English towns 5784 birthsI

and 3569 deaths were registered during the week ending. the 8th inst. The annual death-rate in these towns,.

which had been equal to 20’9 and 20’6 per 1000 in the two, preceding weeks, rose last week to 21-3. The lowest rates,

last week were 166 in Birkenhead, 17’1 in Brighton, 18 v: in Portsmouth, and 18’3 in Birmingham. The rates in the: other towns ranged upwards to 25 in Newcastle-upon--: Tyne, 26’0 in Liverpool, 27-4 in Cardiff, and 31-5 in- Preston. The deaths referred to the principal zymotic,

diseases in the twenty-eight towns, which had been 390.

and 379 in the two previous weeks, rose again to 392 lastweek; they included 82 from scarlet fever, 79 from measles,73 from diarrhoea, 60 from "fever" (principally enteric), 26

: from diphtheria, and 23 from small-pox. No death from any.

of these diseases was returned last week in Brighton, whereas,

they caused the highest death-rates in Bolton, Preston, and.

Cardiff. The greatest mortality from measles was recorded: in Bolton, Preston, and Cardiff ; from scarlet fever in Sun-; derland, Sheffield, and N ewcastle- upon- Ty ne; from whooping-

cough in Bradford and Leeds; and from " fever’’ in Leeds,-

Derby, and Blackburn. The 26 deaths from diphtheria inthe twenty-eight towns included 17 in London, 3 in Liver-pool, 2 in Portsmouth, and 2 in Newcastle-upon-Tyne.,

Small-pox caused 22 deaths in London (exclusive of 7London cases registered outside Registration London), and

.

1 in Sunderland. The number of small-pox patients in. the metropolitan asylum hospitals, hospital ships, and

, camps, which had been 596 and 580 on the two preceding. Saturdays, rose to 675 at the end of last week ; the admittedcases, which had been 173 and 101 in the two previous weeksa,rose to 233 last week. The Highgate Small-pox Hospital

’

contained 30 patients on Saturday last, 18 new cases

having been admitted during the week. The deaths re-, ferred to diseases of the respiratory organs in London,,

which bad steadily increased in the seven preceding weeksfrom 159 to 348, further rose last week to 357, but were 7&below the corrected weekly average. The causes of 91,

, or 2’6 per cent., of the deaths in the twenty-eight towns lastweek were not certified either by a registered medical practi-tioner or by a coroner. All the causes of death were dulycertified in Brighton, Bradford, Sunderland, and in threesmaller towns. The largest proportions of uncertified deathswere recorded in Norwich, Halifax, and Wolverhampton.

HEALTH OF SCOTCH TOWNS.

, The annual rate of mortality in the eight Scotch town,which had been 21’4 and 22’5 per 1000 in the two precedingweeks, further rose to 22’6 in the week ending the 8th inst. ;

. this rate was 1, 3 above the mean rate during the same, week in the twenty-eight large English towns. The rates

in the /Scotch towns last week ranged from 13’4 and 14’1in Perth and Leith, to 25’5 in Glasgow and 28’5 in Aberdeen.