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Of the several sections we can only briefly speak. Almost

every chapter has been extensively altered, none more sothan the first one, on Diseases of Bone; the question ofinflammation of bone being discussed with much ability.Diseases of the Heart receive very full discussion, as alsodo the Diseases of the Arteries, to which Dr. Moxon isknown to have paid much attention. " Arterio-capillaryfibrosis" meets, it is to be remarked, with little favour. Anexcellent description is given of the pathological anatomyof the brain and cord; which, although brief, is by far thebest that exists in an English work, the results of the mostrecent observations being incorporated in the description.The chapter on Diseases of the Lungs has been revised, aswe said, by Dr. Wilks, and it contains an excellent accountof the morbid changes which underlie phthisis, the severalviews of their pathological character being stated with

great clearness and impartiality.The account of the Morbid Anatomy of the Stomach

embraces an interesting discussion of the pathology ofgastric ulcer. The view is rejected as unsatisfactory whichascribes its origin to the action of the gastric juice on anarea in which an accidental arrest of circulation has taken

place. Indeed, Pavy’s explanation of the absence of self-digestion-that the circulating alkaline fluid neutralisesthe effect of the blood-is regarded as insufficient. The

authors are inclined to attribute the occurrence of theulcers to nervous influence, and to associate them with

simple ulcers of the cornea.In the description of Changes in the Liver, the mode of

origin of hepatic abscess is considered at length. The

theory of the mechanical action of embola in causingsecondary abscess, on which stress has been laid, is doubted,and they are ascribed to the irritating quality of the clotfrom the inflamed region setting up a similar morbid actionin the liver tissue.A very good account is given of the Morbid Anatomy of

the Kidneys. The identity of most forms of acute Bright’sdisease is strongly insisted upon; the various states of

kidney representing the several stages of the affection.The authors have themselves met with no facts to suggestthat a contracted kidney may be the ultimate stage of anacute inflammation.

. The final section contains, besides the description of theassociation of diseased states, some excellent suggestionson the points to observe in making a post-mortem ex-amination.

THE

OUTBREAK OF ENTERIC FEVER AT MÜLLER’SORPHANAGE, ASHLEY DOWN, BRISTOL.

WE regret to state that the outbreak at Mr. Muller’s

Orphan Asylum near Bristol has assumed serious pro-

portions ; no less than 500 children being affected, of whomtwelve have died, whilst others remain in a precarious con-dition, but no fresh cases have occurred during the last fewdays.The asylum consists of five large separate buildings,

and nearly 2000 children are maintained in them. The

management of this huge establishment rests entirely withMr. Miiller, there being no committee, nor are any of theusual means of raising funds employed, Mr. Muller relyingentirely on the efficacy of prayer to replenish his exchequerwhen it falls low. The buildings are well constructed, wellventilated, and are connected with the Bristol system ofsewage. The water-supply of the establishment is takenfrom wells situated on the premises; the water is good, andthe city analyst, Mr. Stoddart, reports it free from organicimpurities. The water has been again analysed since theoutbreak, with the same result. From a visit we paid to

the asylum some few years ago, we can bear witness tothe excellence of the domestic management, and the happyand contented appearance of the children.For the details of the present outbreak we are indebted

to Dr. Davies, the medical officer of health for the city ofBristol, who has most kindly furnished us with an accountof the outbreak, so far as he has been officially connected.with it.The first notice received by Dr. Davies of the occurrence

of the outbreak was on the 26th of July, when the local-registrar returned five deaths from fever and one fromhaemorrhage, which, on subsequent inquiry, proved to havebeen a case of typhoid, as having occurred at the asylum.Dr. Davies at once visited the orphanage, and obtained thefollowing information. The disease commenced on the 24thof June. At first nearly 30 sickened, and these cases weresevere. The disease was entirely confined to houses 2 and 5.Dr. Davies suspected the water-supply obtained from thewells on the premises, but failed to establish any proofof their bavinf been contaminated. He then inauiredabout the milk. supply, but as the same milk was used in allthe five houses, and only the inmates of 5 to 2 were attacked;..that source of infection was eliminated. Dr. Davies, how-ever, persevered in his inquiry, and presently learnt thatthe children were in the habit of playing in a picturesque-dingle situated near the asylum, at the bottom of whichruns a small stream of water fed by ditches containing the’sewage of the several private houses on Ashley Down. Dr..Davies also learnt that fever has recently prevailed in thesehouses. The children, it appears, were in the habit odrinking the water when out for their afternoon rambles.Dr. Davies believes this to have been the original source ofthe mischief, and we quite agree with him, but we thinkthat the subsequent extension of the disease in buildingsNos. 5 and 2, and the strict limitation of the fever to thesehouses points to some local defect in their sanitaryarrangements ; unless, of course, it can be shown that theinmates of these two houses alone had access to the con.taminated water of the valley. What we think most likely toprove the case is that a certain number of children in house2 and 5 received on a given day a dose of specifically con-taminated water, and subsequently sickened with entericfever. The disease thus introduced into the houses spread,owing to local sanitary defects in the buildings themselves,and as these defects were probably limited to these twobuildings, the fever was not introduced into the other blocks.The preventive measures that have been adopted by Dr.

Davies are admirable, and will no doubt prove sufficient tocheck the extension of the disease in other quarters of theneighbourhood. With regard to the polluted streams thathave caused the mischief. Dr. Davies, some months back,served notices on the owners of the houses on Ashley Downto abate the nuisance ; but it was found that Ashley Downand its watershed lie above Bristol, in a separate sanitarydistrict. The Bristol sewers are constructed onlv for theparliamentary borough of Bristol, and cannot take thesewage of outlying districts on a higher level, the resultbeing that the sewage of the rapidly increasing suburbandistricts round Ashley Down is discharged into the openstreams which pass through the town of Bristol to dis-charge itself into the harbour ! To remedy this condition,Dr. Davies suggests that the sanitary authority of the dis-trict should be made coextensive with the watershed. Itaffords another instance of the absurdity of the presentsystem of artificially dividing our sanitary authorities intourban and rural, when the interests of both are in so manycases idential.

In conclusion, we would comment on the extraordinaryfact that, although enteric fever had been spreading rapidlyin the orphanage for more than a month and 500 cases hadsickened, no official intimation had been sent to the medicalofficer of health of the district, who did not learn of theoutbreak till no less than five deaths had been reported by,

the registrar. This omission of a plain and obvious duty,

might have been followed by most disastrous consequences, to the city of Bristol. We desire to express our sympathy’ with Mr. Muller during this trying time, and we sincerely. hope that the public attention which has been drawn toL this useful institution by the occurrence of the outbreakI will secure for it increased support, and that Mr. Muller! will be able to carry on his good work even more success-I fully than before.