265ACTION AGAINST A DENTIST FOR MALI’TtANT9.

It is not so very long since we heard a good deal about theenre of epilepsy by correcting errors of refraction, but nowmost physicians are satisfied that however much such cor-rection may relieve the epileptic, it very rarely, if ever, issufficient to abolish his fits. Probably the same is true

of all peripheral disturbances. The sooner it is clearlyrecognised that epilepsy depends upon some morbid condition ’,of the nervous centres the more likely are therapeutic dimeasures to be crowned with that success which is at once ’

the aim of the physician and the desire of the patients.

ACTION AGAINST A DENTIST FOR MALPRAXIS.

ACTIONS brought against dentists to recover damages foralleged avoidable injury during an operation are by no meansuncommon and are exceedingly difficult to adjudicate upon.Such a one occurred recently at Manchester, the plaintiffalleging that by the negligence of the defendant’s operatorhe suffered from haemorrhage to such an extent that he hadto be attended by a medical man. Another dentist subse-

quently extracted a piece of the fang which had been left inthe gum. It was contended for the defendant that the bleed-

iag was due to a predisposition on the part of the plaintiffto hemorrhage. The plaintiff was awarded E15 damages.From the meagre report in our hands it is impossible to giveany definite opinion on this particular case, but the operationevidently was not a success as one fang was left, though thismight have been the fault of the patient. Hemorrhage isthe most frequent of all the casualties, and they are many,that may arise from tooth extraction, and cases occur fromtime to time even in the hands of the most skilful operators.Many cases have been recorded where death has occurredfrom loss of blood after the extraction of a tooth in those

,6uffeHng from hemophilia, and in some where there has beenno history of this condition. In cases of hsemopbilia certainprecautions should always be taken-but how often is the

operator informed of the fact ?-such as the internal adminis-tration of gallic acid for a few weeks prior to the operation as6uggested by Mr. Smith Turner, and the plugging of thesocket after the extraction.

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THE TESTICLES IN AGED PERSONS.

IN an interesting paper on the structural changes observed z,in the testicles of aged persons, which appears in therecently issued number of the Journal of Anatomy and ’

PAyAology, Dr. Joseph Griffiths of Cambridge gives the IfMiowiag results of his observations : In the testicles of ’

the aged two distinct stages may be recognised in the I

process of involution or decay to which they are liable.Either of these may be apparent although the organs maypresent their usual appearance and nearly natural size.In the one the epithelium of the seminal tubules andalso that of the tubules of the globus major of the

epididymis undergoes more or less complete fatty de- digeneration and partly disappears; the tunica propria I,of the tubules of the testicle becomes somewhat thickened,but the intervening inter-tubular connective tissue remainspractically unaltered. In the epididymis the muscularcvall of the tubule is replaced by fibrous connective tissue,and the inter-tubular connective tissue is increased, denseand fibrous. In the other, or second, stage the seminaltubules are much reduced in size, the epithelium havingin great part disappeared, leaving only, in many instances,a single layer of long, tapering, columnar cells, liningand filling the tubule, the central spermatozoa-producingcells having completely disappeared, whilst the tunica

propria is greatly thickened from proliferation of its ownconnective-tissue cells and the formation of a fibrous matrix.The inter-tubular connective tissue is in this second stagerelatively increased, owing perhaps to the diminution in

the size of the seminal tubules, but it still remains of loose

texture and contains, as in the normal condition, manyconnective-tissue cells. The epididynua shows no other

changes than those incident to the first stage. Besides theabove there is a third change, which is more partial andmuch resembles the result of the infiammatory process. It

is usually observed in the small or shrunken testicles of oldmen and afreets both organs. In the altered patches theseminal tubules, in the majority of instances, are completelytransformed into fibrous rods or cords ; but in some therestill remain in the central fissure that represents the originallumen traces of epithelial cells derived from the degeneratedcells of the seminal tubules. The inter-tubular connectivetissue is increased in amount and converted into a densefibrous variety.

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THE HEALTH OF ITALY.

YEAR by year the statistical reports issued by the ItalianGovernment are gaining in method, in fulness and in scien-tific precision, and those for which the department of PublicHealth is responsible are a conspicuous illustration in point.One drawback, however, is common to the whole series, andthat is the lateness of their appearance. For instance, we arenot allowed to know the mortality returns of the first half of1892 till July of 1893. Still, compared with the old per-functory system, now happily superseded, the superior accu-racy and comprehensiveness of the new are worth waiting for,with which consolation we must be content and hope for theyet further improvement by which the subject-matter dealtwith shall savour less of "ancient history." From a return

which we owe to the Public Health Department we can nowgive the number of deaths from infectious diseases in eachprovince of the kingdom from Jan. 1st to June 30th, 1892.These, all told, were 426,604-far too high a figure for apopulation of 30,200,000. This is a notable rise on thenumber of deaths for the corresponding six months of 1891,which was 402,479. Special causes, however, are cited toexplain this difference between the two semesters-a differ-ence which, as will be seenfrom the subjoined table, was mostmarked in January and February of each year :-

dumber of deaths.

Months. 18n i . 1892.

January......... 79942 ...... 91.689February......... 73.548 ...... 82.208March......... 73.136 ...... 79,314April......... 66 742 ...... 61,254May ......... 55 592 ...... 57,381June ......... 54,040 ...... 54,758

The principal causes of the severe mortality registered in thefirst months of 1892 were the diffusion and the gravity of theinfluenza epidemic. In fact, owing to this malady there diedin the first semester of 1892 no fewer than 19,508 individuals,whilst in the corresponding period of 1891 the deaths due tothe same cause were only 118. On the other hand, therewas a great diminution of the mortality from other in-

fectious maladies in the first half of 1892 as comparedwith that of 1891. We cannot transcribe the parallelcolumns given in the official return before us for the two

years, but we may select a few prominent heads, as, for

instance, that of small-pox, which for the first half of 1892numbered 659 victims, as against 1360 for the correspondinghalf of 1891. Measles in the former period caused 6458 deathsand in the latter 11,430 ; erysipelas 1756 in the one and 2110in the other; miliary fever 98, as against 144, and typhoidfever 5105, as against 6792. The deduction from these figuresis the eminently satisfactory one that in preventable zymoticdisease the effect of improved hygiene and sanitary precau-tions is steadily making itself felt. Malaria, in spite of allthat has been done for its etiology, its pathognomonic signs(particularly in the circulation) and its treatment, remains apretty "constant quantity" so far as its victims are con-cerned-the deaths from it in the first half of 1891 having

266 THE EPIDE1BUOLOGTCATJ SOCIETY OF LONDON

been 4882, as against 4973 in the corresponding halfof 1892. Thanks to tho Istituto Anti-rabhico of Milan,where the Pasteur method is practised with a care

and Rkill hardly inferior, if at all, to that of the

parent institution, deaths from hydrophobia aro yearby year diminishing in the Italian peninsula—23 being thenumber of victims from the fell disease in the first Homesterof 1892 and 49 in the corresponding six months of 1891.These results are still more apparent on a comparison of thelast five years with each other-that is, from 1887 to 1892-and clearly prove that, thanks to her independence and unity,Italy has now fallen into line with other civilised nations andis beginning to enjoy the advantages of more enlightenedinstitutions, especially in the all-important department of thesal?ts,v6pitli. -

THE EPIDEMIOLOGICAL SOCIETY OF LONDON.

A DINNER of this society was held on Friday, July 14th, atLimmer’s Hotel, the President, Dr. Payne, being in the chair,supported by Sir George Buchanan, Sir William Moore, SirBenjamin Richardson, Dr. Dickson and numerous other

members of the society; whilst Dr. Wilks, Sir Dyce Duck-worth and Dr. Pye-Smith were amongst the guests. Afterthe usual loyal and patriotic toasts, that of "The PublicHealth Service, " including the Medical Department of theLocal Government Board and the County and Urban MedicalOfficers of Health, was proposed by Sir Benjamin Richard-son and responded to by Dr. Franklin Parsons, Mr. ShirleyMurphy and Dr. Newsholme. Sir George Buchanan pro-posed "The Visitors." In introducing the toast of the

evening, "The Epidemiological Society," the President gavea short sketch of the history of the society and the rise of theEnglish School of Epidemiology. Beginning with the workof John Caius on the sweating sickness this school had beendeveloped by the labours of Morton, Willis and Sydenham inthe seventeenth century, and of other great observersin the last and the present century. The origin of the modernscience of medical statistics was traced to the London Billsof Mortality, compiled by the humble labours of old womenand the parish clerks. The Epidemiological Society itself,founded in 1850, had in early days done good service bypressing upon the Government the importance of sanitaryreform in relation to the prevention of cholera, to vaccinationand to other subjects, and amongst minor matters first startedthe scheme of a nomenclature of diseases, since carried out

by the Royal College of Physicians. It had attracted contri-

butions from all parts of the world and received cordial

recognition from continental authorities, whilst now, after

forty-three years of work, its Transactions showed no fallingoff in interest or importance.

ATTACKS ON THE LONDON HOSPITAL.

IT is poor employment to make cheap newspaper attackson the management of a hospital which works in the poorestpart of London and under the strain of a constant and heavydisproportion between the number it has to cater for and themeans supplied to it. We are not disposed to be blindapologists for any hospital, not even for this institution thatis so handicapped in these hard times when criticism is moreactive than charity. Neither are we disposed to attach anyimportance to such attacks as those contained in the seriesof papers which have lately appeared in the Pall MallGazette headed, "The Truth about the London Hospital,by our Special Commissioner. " It is. for the authorities ofthe London Hospital to consider what kind of notice, if

any, such attacks deserve. It seems to us that there

should be some legal protection to hospitals as well as

individuals from criticism so irresponsible and one sided.In the meantime we advise all really charitable friends of thisgreat institution to disregard such detraction. We are quite

: prepared to believe that nurses at the London Hospitalharesome grievances. By all means let them be temperately m

! rcasonably stated and redressed; but the articles on whici,, we are commenting do not seem to be reasonable and ten.. perate statements and we have to set against them the far:i that according to the finding of the council of the Hospital, Sunday Fund the London Hospital is well administered and

that on this very question of nursing the following judgmentadelivered by the Lords’ Committee in their responsible report:"The figures given show that while the strength of the

nnrsing staff on duty by day at one of the great hospital(the London being taken as an example) is fully sufficient fotthe needs of the sick, by night the strength is somewhatshort, the deficiency being, however, such as would beremedied by a trifling increase in the number of nurses ?the establishment. The demand for an increase in the

nursing staff is, in fact, made in the interest rather of thenurses themselves, in order to secure shorter hours of dutyand longer holidays, than of the patients. There was littleevidence that the patients suffered from insufficient nursing,while on the contrary abundant testimony was forthcomingof the admirable care and attention bestowed on them and ofthe spirit of self-sacrificing zeal which animated the nurses."

A NUISANCE CAUSED BY A DUST DESTRUCTOR

A CORRESPONDENT has directed our attention to theexistence of a nuisance arising from the shaft of a dust andrefuse destructor situated near the end of Waterloo Bridgeon the Surrey side. When the wind is in a certain quarterhe complains.that the smoke passes over a certain street anddeposits a copious quantity of refuse, a specimen of whichhas been submitted to us. It appears to consist of ordinaryhouse refuse and dust, which it is the duty of the dustcollector to take away. Doubtless it is carried mechanicalJyup the shaft into the air by the draught induced by the heatof the furnace below ; but surely some provision could bemade to obviate at least the mechanical emanation of

particles into the air in this objectionable manner. A wire

caging over the top of the shaft, so as to screen the smoke,as it were, might answer. Our correspondent suggests t6eadoption of long underground flues. We commend this

grievance to the notice of the authorities, who will doubt.less take the necessary remedial measures when they learn ofthe existing evil.

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THE ABUSE OF PISTOLS.

WE have over and over again called attention in the

columns of THE LANCET to the utterly inefficient regulationswhich at present prevail with regard to the sale and use ofrevolvers and other forms of the small firearms known as

"pistols." The loss of life and injury that have been

caused in consequence of their almost unrestricted sale an

employment have been very great and, we feel inclined t

add, very preventable. We are glad therefore to see

that the Home Secretary has introduced a Bill under

which the following new regulations are proposed :-No boy or girl under eighteen may carry a pistol, and na

persons may sell pistols to them. Pistols may only be soldby gunsmiths or pawnbrokers, who must obtain a ls, licecwfrom the local authority. Pistols sold must bear a distinctivemark, and particulars of the sale must be entered in a

register. They may only be sold to holders of licences, andthe Inland Revenue Board may authorise licensed vendors of

pistols to sell gun or game licences. No persons maycarry loaded pistols in a place of public resort without

special permission. Penalties under the Act may be recoveredon the information of a police constable. Persons releasefrom penal servitude are under a special restriction; whole-sale dealers are exempted from the Act ; and importers ofpistols have to furnish particulars to the officers of Customs