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Notes, Short Comments, and Answers to

Correspondents.A GIGANTIC INNKEEPER.

OUR Newcastle-on-Tyne correspondent sends us some particulars as toMr. William Campbell, landlord of the "Duke of Wellington," in histown. Campbell boasts of being the largest subject in Her Majesty’srealms, standing 6 feet 4 inches in height, and weighing over 52 stones.He measures round the shoulders 96 inches, round the waist 85 inches,and round the calf of the leg 35 inches. He was born in Glasgow in1856, and has not quite attained his twenty-second year; was one ofa family of seven children, none of whom besides himself are of morethan ordinary proportions. His father was of average weight, althoughhe stood 6 feet 2 inches high; his mother was rather under the aver-age height and weight of women. Campbell stated that from birth hewas remarkably stout, and that at nine months old he weighed 4 stones,at ten years of age he weighed 18 stones, and he has gone on increasingsince then, and it is with difficulty he keeps at his present weight.He was brought up as a printer, but was compelled from his extra-ordinary size to give up his occupation. Our correspondent foundCampbell to be an intelligent and agreeable young man, having goodhealth as a rule, but on his visit suffering from the effects of cold andslight erysipelatous affection of the leg. His powers of locomotionwhen well were considerable, taking into account his huge bulk ; hisappetite was not more than an average one, and, although not anabstainer, he was moderate in his use of alcoholic drinks. He ad-mitted to our correspondent that he was a great smoker, which, inour correspondent’s opinion, might account for a weak and ratherirregnlar cardiac action observed on auscultation; and our correspond-ent is further of opinion that Mr. Campbell’s present occupation, how-ever it may add to his weight and popularity, is scarcely likely to beconducive to his health and longevity.

Mr. A. Dunbar Walker is thanked. An article was already in type.

DEATH FROM CHLOROFORM INHALATION.

To the Editor of THE LANCET.

SIR,—A death from chloroform took place at this hospital on Thursday,the 7th of February.The patient, an apparently healthy man, was admitted on Saturday,

Jan. 26th, under Dr. Campbell, suffering from an injury to the right eye-ball. Extirpation was determined on, and chloroform administered,Skinner’s inhaler being used. The administration was commenced withrather less than a drachm of chloroform, the patient inhaling it quietlyfor three or four minutes. The stage of excitement was then entered,lasting two or three minutes, during which the patient struggled vio-lently. Then he again became quiet; the conjunctiva became insensibleto the touch ; the pupil was contracted; muscular relaxation was notcomplete; the jaws were firmly clenched ; breathing was going on well ;the pulse was good. (I should mention that on listening over the heartbefore commencing the administration, the sounds were clear, and theheart acting powerfully.) At this stage the inhaler was withdrawn,about three drachms of chloroform having been used in from eight toten minutes. The operation was commenced. The wire speculum wasbeing introduced between the lids, when the breathing ceased; thepulse was going at that time. The chest was immediately compressed ;but the pulse, again felt in one or two seconds, had stopped. Artificialrespiration by Silvester’s and also by Sayre’s method was kept up forhalf an hour; and although the patient breathed a few times spon-taneously afterwards, the pulse or heart-beat was not again felt. Gal-vanism, inversion, dashing of iced-water on the face and chest, and ice inthe rectum were tried.The post-mortem examination, made by Dr. Davidson, Physician to

the Royal Infirmary, Liverpool, showed :-Heart weighed twelve ounces;left ventricle contained two drachms of fiuid blood ; right ventricle anequal amount, also fluid ; muscular substance flaccid (microscope showedcommencing fatty change). Lungs emphysematous ; no marked con-gestion ; considerable amount of frothy serum on section. Kidneys in-tensely congested, like scarlatinal kidneys ; slight granular change.Liver much congested ; healthy. Brain : Veins full; considerable vin-crease of subarachnoid fluid; marked congestion of cerebral veins onsection. I am, Sir, yours &c.,Northern Hospital, Liverpool, B. HUGHES JONES, L.R.C.P.,

Feb. 13th, 1878. House-Physician.M.D.-It would be impossible to grant permanent appointments undertwenty years’ service, as it would open a door to much scheming ; norcan we recommend the adoption of a local medical corps in India inlieu of the present system.

Mr. A. Millar.-The word is derived from the Greek, &pgr;&lgr;&agr;&xgr;, or &pgr;&lgr;&agr;&kgr;ous,a cake.

VARIOLA AND VARICELLA.To the Editor of THE LANCET.

SIR,—The following extract, in reference to Dr. Alderson’s letter inyour issue of the 9th inst., will doubtless interest him : "Varicella isa slight febrile disease, accompanied by an eruption of vesicles, not pre-ceded by papules, but they have a slight central depression; they donot proceed to suppuration, but dry up, and they appear irregularly, sothat they may be seen in all their stages on the same part of the body atthe same time; and, moreover, it differs from small-pox by there beingno preceding pain in the back."-Yours truly,

J. HENRY MORTON, L.R.C.P., &C.New Brompton, Kent, Feb. 16th, 1878.

" ARMY CLOTHING INFECTION."IN answer to several inquiries, we would state that the objection takenonly applies to contractors in so far as they may send the clothes outto the houses of the workpeople. If wholesale contractors confinethemselves to making clothes within their factories, and if in thesupervision of these workshops they exercise the same precautions aswill, we trust, be ultimately adopted at the Pimlico Army ClothingDepôt, then we see no reason why some of the clothing should notcontinue to be made by private firms-at least so far as the sanitaryphase of the question is concerned.

Mr. Dacnlop is thanked ; but we do not think it desirable or considerateto the possible sufferer to publish predictions so alarming, more espe-cially as the vaticination may not be fulfilled.

REJECTIONS AT THE COLLEGE OF SURGEONS.To the Editor of THE LANCET.

SIR,—I heartily concur with your correspondent, "Deltoid," in be-lieving that the large number of rejections at the primary examinationof the College is due to the " unfairness of the written examination."But from a close study of the examination, both written and viva voce,so far from being surprised at the number of rejections, I am only sur-prised that so many men pass.In discussing such an examination, it appears to me there are two

main points to be considered-first, the object for which the examina-tion is held; second, the manner in which that object is carried out.With regard to the first question, I suppose there can be no doubt thatthe real object of the anatomical examination of the College is to dis-cover whether those examined know enough anatomy and physiology toenable them to practise their profession with safety to the community- aIf this be admitted, the minimum amount of knowledge which can beaccepted should be definitely settled, and men should be examined upto and about this point, but not continually beyond it. I do not thinkit would be found very difficult to decide generally what is essential andwhat is not essential to be known. For instance, speaking roughly, onemight say, in anatomy, the main characters of the bones, but not theirminute characters ; the rough attachments of the muscles, and theiractions; the course, relations, and branches of the main arteries; thecourse of the main veins ; the course and distribution of the main nerves ,the position and rough relations of the viscera; the outline anatomy ofthe brain, eye, ear, nose, mouth, &c. And in physiology, the theory andmain facts of the circulation, respiration, digestion, absorption, secretion,of the nervous system, of generation (but not of development); and justso much minute anatomy as shall enable the student to understandthese subjects (which is very little). One can hardly believe that a moreprofound knowledge than this is necessary or even advisable for studentswhose time of study is very limited. With regard to the second ques-tion, how the object of the examination is carried out, the impression Ihave gained would lead me to believe that the true object of the exami-nation has been completely lost sight of. As at present conducted, it isfar too capricious, far too extended, too minute. Men are liable to beexamined equally upon the roughest and the most minute subjects.They are expected to know the chemical composition of almost all thefluids of the body-not the chief ingredient of the saliva, bile, &c., butthe relative quantities of water, of salts, of epithelium and mucus, andof the principal agent in these fluids. They are expected not only torecognise the simple tissues under the microscope, but elaborately pre-pared specimens of tissues and organs, and even to give a careful accountof the minute structure of numberless things, the very existence ofwhich they only know of by hearsay. They must know the diameter ofblood-corpuscles, of capillaries, of lung vesicles, of Malpighian bodies inkidney and spleen, of liver-cells, &c. They must be able to give theexact attachment of all the larger and of many of the smaller muscles ;must know every point of all the large and of most of the small bones ;must be able to describe from memory the carpal and tarsal bones, dis-tinguish carpal, metacarpal, and metatarsal bones from one another,and even be able to separate those of the right side from those of theleft-with many of them a mere trick, forgotten as soon as learnt. Inphysiology they are closely examined on all the subjects I have namedabove, and to these is being gradually added development. It will,.doubtless, be said that a man will pass with far less knowledge thanthis. If less be necessary, why continually examine on more? I haveheard men questioned on the nerve-plexuses of the intestines; on thedifference between Auerbach’s and Meissner’s plexus ; on the minutestructure of touch-corpuscles, end-bulbs, Pacinian bodies; on the ab-sorption of oxygen by the muscles ; on the development of blood-corpuscles ; on the course of the Vidian nerve; the course and distributionof the auricular branches of the pneumogastric and glosso-pharyngealnerves ; the relations of the mylo-hyoid, hyo-glossus, and other muscles ;and on a hundred other such subjects. At the end of a year and a half,or even less, from the time of entering the dissecting-room, students areexpected to be well versed in all this anatomy, physiology, and his-tology. If they fail to reach the required standard of knowledge, theyare rejected for three, four, or even six months, and by thus much is thetime of their hospital study often curtailed. I have been told thatlonger time should be devoted to the study of these subjects-anotheryear, for example ; and, again, that were it not for the severity of this

examination the profession would be flooded with men. To the first ofthese statements I would reply, why do you want to waste another yearof a student’s time in the acquirement of knowledge which is forgottenalmost as soon as learned, and much of which would be useless even ifrememoered? To the second the reply is evident: this is not the barrierby which a man should be kept out of the profession. The preliminaryexamination should thoroughly test his general education, and, if neces-sary, stop him at the outset. The surgical examination should be muchmore searching in its character, and should ascertain certainly thatevery man who presents himself is really and truly competent to practisehis profession. Yours obediently,Feb. llth, 1878. SIGMA.

298

Mr. Wm. Robert Smith.—We are opposed to all printed letters, circulars, G. II. 1J{., (Liverpool.)—Returns of the mortality in the famine-strioken&c., from medical men to the public and even to acknowledged districts of India have not been issued. We believe, however, it is thepatients. The letter in question is described as a private communica- intention of the Government of Bombay and the authorities of Mysoretion ; but by our correspondent’s statement it seems to have been dis- to have a census taken with the view of ascertaining as far as possibletributed very freely. Any statement of the sort should have been the real loss of life arising from the famine in those territories.made orally to individual patients. It was not right in a practitionerto wrest the letter from its privacy, and publish it without giving the THE CORONER’S COURT AND PUBLIC MORTUARIES.

writer an opportunity of explaining the circumstances under which it Tu the Editor of THE LANCET.was written. SIR,—A short time since there appeared in THE LANCET a notice of

P. T. E. should consult the well-known works on Physiology, which are, the new mortuary and Coroner’s Court which has recently been erecteddoubtless, within his reach. in the City. It was there called the first of its kind, and spoken of in

high terms. Considerable commendation was also bestowed upon thoseCOLONIAL DEGREES. by whom it had been erected. It is not my intention to dispute these

To the Editor of THE LANCET. latter points. Doubtless both were true and well deserved. But I demur

SIR,—I have been requested to forward for insertion in your journal to the statement that the then noticed mortuary and Coroner’s Courtthe minutes of a meeting held in Birmingham yesterday. Among those were the first of their kind in the metropolis.who were present were the following :-Dr. Bodington, Kingswinford ; The writer of the notice seems to have been quite unaware that forDr. Shuttleworth, Lancaster; Dr. Hickinbotham, Birmingham; Dr. several years past the parish of Islington has possessed a similar insti.Hitchman, Liverpool; Dr. Hardwicke, Sheffield ; Dr. Lee Strathy, Bir- tution. Personally I can speak highly of the immense convenience ofmingham; Dr. Ashburton Thompson, London; Dr. Annie Barker, this building. The post-mortem room is airy and large, with a goodBirmingham ; Dr. Saul, Lancaster; Dr. Bayley, Stourbridge. supply of water. There are full appliances and plenty of room for car.It was proposed by Dr. Hardwicke, and seconded by Dr. Shuttleworth, rying on three or four examinations at the same time. It must not beThat Dr. Bodington take the chair." Carried unanimously.

" imagined that the use of this is limited to inquest cases. Private post.Proposed by Dr. Shuttleworth, and seconded by Dr. Saul, That an mortem examinations may be made here, and thus the inconvenienceAssociation be formed, consisting of registered practitioners possessing and mess of making them in private houses are avoided. The dead-houseloreign or colonial degrees in Medicine and Surgery." Carried una- itself is also a large room, well suited to its purpose. This also is opennimously. Hickinbotham, and seconded by Dr. Hitchman, "That

to the use of the public as a depository for bodies between the time ofProposed by Dr. Hickinbotham, and seconded by Dr. Hitchman, That death and burial. The advantage of this in infectious cases needs not tothe objects of such Association be the promotion of the professional in- be pointed out.terests of such graduates, amendment of the consideration Carried Coming now to the rooms devoted to the use of the coroner. Up toclaims to recognition in any amendment of the Medical Acts." Carried the present time the actual inquest-room has been too small. This is,

Dr. Bodington was afterwards elected President of the Association ; however, now obviated, and a handsome, spacious, and lofty hn hasand Dr. Hardwicke, Honorary Secretary and Treasurer. been erected The witnesses are accommodated with a room, in which

It was proposed, seconded, and carried unanimously, that the Com- they can wait. It appears to me that some praise is due to those bymittee be composed, of the President, the Secretary, and Drs. Shuttle- whose agency these conveniences have been provided. The suggestionworth (Lancaster), and Plomley (Maidstone). was originally thatof Dr. Hardwicke, the present coroner. It wasLetters of apology for non-attendance were read by the President from owing to his representations that the Islington vestry determined toDrs. Gayton, Llewellyn Thomas, A. Duncan, and Sophia Jex-Blake erect the builclings above roughly described. Thanks are therefore due

London), Dr. Broom (Clifton), Dr. Macdonald (Cupar Fife) and Dr. to that gentleman. It is surely but just also that the vestry shouldPlomley (Maidstone). receive full credit for their liberal action, and I trust that by the insertion

I remain, Sir, yours truly, of this letter at least you will make some recognition of that liberality.H. J. HARDWICKE I am quite conscious that the description I have given is only a rough

Hon. Sec., Foreign Graduates’ Association. one. I am naturally more interested in the room devoted to the post.Sheffield, Feb 20th 1878 mortem examinations. The great convenience to the public was, how.ever, sufficiently evident last Wednesday. On that day there were nine

P.S.-A Committee meeting was subsequently held at the Queen’s s inquests on bodies sent from different portions of the surrounding dis-Hotel. trict. In times now happily past, as far as Islington is concerned, these

UTERINE POLYPI. would have necessitated the summoning of a similar number of juries toDR. G. H. KIDD exhibited last week before the Surgical Society of Ire- a similar number of public-houses. Doubtless there would have been

land a specimen of polypi of the uterus, which he had removed from a no objection to this on the part of the nine publicans but, as a set-offto this over a hundred British taxpayers would have had their just in.

woman aged twenty-five. They were six in number, and the case is, dignation stirred at being required to devote some of their time.to thebesides, remarkable, inasmuch as a sister of the patient, eleven years service of the country. We must also not forget the extra work entailedago, had twenty-nine uterine polypi removed at four different opera- on the coroner. As matters now are, one jury is found to suffice fortions. all nine cases ; the bodies to be viewed are, so to speak, in the next

.

room, and the coroner saves a quantity of valuable time. By thwMedicus.—1. Nothing has been done in Parliament in the matter at means, therefore, the county is saved considerable expense. Nowtbatpresent.-2. Only if properly registered. such institutions are erected, one almost wonders why we were so long

without them.I have now pointed out some of the advantages we in this parish haveAORTIC ANEURISM : CAUSE OF ACCENTUATION OF gained from the erection of a Coroner’s Court and mortuary. 1 may,

SECOND SOUND IN AORTIC AREA. therefore, be permitted to indicate one or two points at which improve.To the Editor of THE LANCET ments may still be made. Might there not be a supply of warm water in

To the Editor of THE LANCET.

the post-mortem room . Would not the whole building be better warmedSIR,—On reference to medical works and medical friends of expe- by a system of hot-water pipes in preference to open fireplaces! Tte

rience, I cannot find any satisfactory reason for the production of the evil of these last, which, of course, only exist in the Court and nztnussabove phenomenon. I hold a theory respecting it, which I believe to be rooms, is that near them the place is too hot, while they scarcely act atnew and explanatory of it. If to your knowledge it be not a new theory, all at a distance. The advantage of such change in this direction, as in-there will be no necessity to publish this letter; but, if otherwise, a dicated above, would be that the hot water would be available for theshort space in THE LANCET will much oblige. double purpose of warming the building and providing what is arealMy theory is simply this : Given an aortic aneurism ; the onward necessity in the post-mortem room.

,blood-stream fills the lumen of the vessel on the proximal side of the There can be no doubt that there are immense advantages in beiuganeurism; on reaching its dilated sac, this stream splits up into a radia- able to hold so many inquests in one place and at one time. But thereting, and on section somewhat fan shaped, mass. The central portion of is one class of witnesses who may be considerably inconvenienced by so

this, meeting with no abnormal resistance, passes on through the corre- doing. I refer to the medical witnesses, by far the most important ofsponding lumen of the vessel on the distal side of the aneurism, whilst course. It is rather hard on a medical man to be summoned to attedthe circumferential portion (in the sac) is reflected against the sides of an inquest at a certain time, and to find on his arrival that the timethe aneurismal walls, "forming eddies travelling in the direction of the stated in his summons is that at which the coroner intends to hear theheart." Two opposite forces thus meet at the point of junction between first of a series of cases, in which series the particular case to which tethe proximal vessel and the beginning of the sac; this causes resistance witness has been summoned may be the last. It will easily be seen thatto the onward blood-flow at this point, resulting in a recoil of the blood the best part of a day may thus be spent in doing nothing for the smallon the aortic semilunar valves, and hence the accentuation. sum of perhaps one guinea. It would surely be better to allow an aver-

Your obedient servant, age of fifteen minutes for each case, and to summon the witnessesUniversity, Edinburgh, Feb. 2nd, 1878. THEODOR LINDE, D.Sc. accordingly. At present I have certainly had no reason to complain. On

Wednesday last my case was taken first ; but I cannot conceal fromDr. Aldridge, (Southampton.)-Most museum assistants can make plaster myself that at any future time my fate may be that of my medicalmodels. For models in wax, apply to Mr. Towne, the Museum, Guy’s friends whom I left waiting their turn.

.

Hospital, S.E. I remain, Sir, yours &c.,Hospital, W. HENRY KFSTFVBN.Mr. Henry Messenger.-It is difficult to strike an average. Probably Tnfnell-park-road, Holloway, Feb. 18th, 1878.

3s. 6d. per head. Many Societies are raising their amount to 5s. and gh,. James Brandreth.—We cannot supply the information required, oreven more.

approve the suggestion.MUSCÆ V O L I T A N T E S. Dr. R. Scott Orr, (Glasgow.)-Thanks. Next week.

To the Editor of THE LANCET. "DIABETES."

SIR,—Can any of your readers kindly suggest a remedy for the cure oralleviation of muscse, which harass me greatly? An ophthalmoscopic To the Editor of THE LANCET.examination has proved the eyes free from disease ; and as I have tried SIR,—If the writer of the article on " Diabetes," p. 248, in your lastmost remedies without deriving any benefit, I shall be truly thankful to issue, will look at the British and Foreign Medico-Chirurgical Review,hear of anything likely to relieve this most annoying complaint. vol. xlvi., pp. 551-2, he will see reason for modifying (or supplementing)

Yours &c., his statement relating to Dr. Thos. Willis.-Yours &c.,Feb. 6th, 1878. M.R.C.S. Hastings, Feb. 18th, 1878. W. A. GREENHILL, M.D. Oxon.

299

STATISTICS OF SECON DARY HÆMORRHAGE. MEDICAL REMUNERATION.THE Guy’s Hospital Gazette for January contains a statistical report, To the Editor of THE LANCET.prepared by Mr. John Poland, of the number of cases of secondary SIR,—In connexion with a case noticed in your issue of Feb. 2nd,.

hæmorrhage after amputation during the last ten years m Guy Hos- and the correspondence which has taken place lately, principally in non-

pital. The following forms the conclusion of Mr. Rolands valuable

professiontl journals, on the subject of medical remuneration, I would

paper "Total :- number of amputations during the ten years, 543 ; of these wish to call the attention of the medical profession generally to this

there were 73 deaths within a few hours or the first few days, and are question. Though a matter, strictly speaking, not scientific nor profes-not included in the following figures, because in them the efficiency of sional, and therefore one hardly suited to your columns, yet it is one ofthe mode of arresting hæmorrhage could not have been fairly tested, vital importance to both scientific and medical men.with the exception of acupressure; 64 cases in which silk ligature was In addition to the enormous amount of talent, energy, and pecuniaryemployed, and among them 5 cases of secondary hfcmorrhage, 1 inevery 12,8, or 7-812 per cent. aid given annually to our public hospitals and institutions by medical" 19 of acupressure, in 6 of these there was secondary hæmorrhage; men throughout the country, the younger members of the profession in

1 in every 31 cases, or 32’63 per cent. London and in the country towns and districts, many elderly ones as" 355 of torsion, in 14 of these there was secondary hemorrhage; well, do work gratuitously in private practice, independently of services.1 in every 25.3, or 366 per cent. they may render to public charities unremunerated. Now, although" 31 of earbolised-gut ligature, 2 cases of secondary haemorrhage; this is done freely and willingly enough by most of them, it is almost

compulsory, through custom, for obvious reasons. Granted that there- .The above cases were collected after an examination of the Sur- are many whom peruse this who will not give another thought to it-forgical Clinical Reports and Post-mortem Records. They show a some- they are now past feeling the weight of the abuse which this letter iswhat greater frequency of occurrence of secondary hæmorrhage after endeavouring to rectify,-yet there are hundreds on whom this pressure.amputation than what is generally stated to occur. Here every case is very great scores of talented young practitioners in London and theof secondary hæmorrhage has been included ; those cases in which the provinces, who are possessed of the highest honours which it is possiblepatients afterwards recovered, as well as those in which they died as to obtain in their profession, and others who do work enough to merit aan immediate result of the hæmorrhage; whereas in many of the sta- handsome annual income, and who yet can scarcely pay for their boardtistics that have been published only those cases are included in and lodging and incidental expenses by what they receive from theirwhich the patient succumbed immediately, or soon after the occur- professional sources. That there is something radically wrong here isrence of the hæmorrhage. There are other fallacies in the above sta- evident, and the abuses of charitable medical aid in private practicetistics. must be rooted out, otherwise it will be impossible for any man to enterIn the first place, for comparison, we should have corresponding the profession eventually who is not possessed of considerable privatenumbers, and the same sort of amputations in each case ; and, of means. The question then arises, When and how is this to be done?

course, as great a number as possible, and the patients under similar Commence at once. How? By various means, which I shall not here-conditions. directly indicate, but will endeavour to show how much abuse exists." Secondly, in respect to the old silk ligature. Secondary heemor- Supposing the Manchester Medico-Ethical Association’s code be takenrhage at that time was not at all uncommon, so that probably only the as an example of the rate of fees obtaining in general medical practicevery worst cases were recorded ; therefore we should have had a still in England-and I merely give this instance because no other occurs to

larger proportion of cases than the above.. in the cases of car- me at the moment,-in which the ordinary visits range from 2s. 6d. to-Also the frequency of secondary hæmorrhage in the cases of car- 7s. 6d., mileage from Is. 6d. to 2s. 6d., detention per hour 2s. 6d. to 7s. 6d-bolised catgut is great, because in most of using this form of lorsion (I must here add that for the above seale I am indebted to Iota,was used on account of the impossibility of using or failure of torsion M.R.C.S.," taken from The Times of January 15th, 1878),-providingfrom a diseased state of the arteries &c. this scale be correct, and taking into consideration that Manchester is

Mr. Murdock should write to the Dean of one of the London medical one of the wealthiest cities in the kingdom, I say that these fees,

schools. are simply disgraceful-nay, taking them as a fair sample of fees.

VOTING IN CONVOCATION. throughout the country, they are disreputable for this one of the

To the Editor of THE LANCET. ’

richest countries in the world. By these terms I wish it to be distinctlyTo the Editor of THE LANCET. understood that I do not in any way reflect on the compilers of theSIR,—I have read with interest the article in THE LANCET of Saturday above scale ; but I say that it is hardly credible that inhabitants of so

last, entitled " The Vote on the Admission of Women at the University rich a country are content to offer their medical advisers such beggarlyof London." In it there is a reference to the advisability of giving gra- remuneration. Supposing, for example, that fees began where theseduates a less inconvenient way of recording their votes at the meetings left off-viz., from 7s. 6d.,—they would then only approximate those ob--of Convocation. Residing as I do nearly a day’s journey from the metro- tained in many rising communities beyond our own shores. When thepolis, the subject is one in which I feel considerable interest. The loss "rank and file" of art and science in a rich country are paid like this, it

. of time and the expenses entailed by such a journey are, I have no is not to be wondered at that even the " field officers," so to speak, do,doubt, serious obstacles in the way of the attendance of the majority of rarely attain competence until late in life, and that continually we aregraduates residing in the provinces. However anxious one may feel called upon to contribute to the widow and family of some brotherabout the doings of Convocation, yet these two sacrifices are amply practitioner smitten down while at his post on unpaid duty. As long assufficient to prevent the recording of a vote. Surely it would be to the general practitioners continue to visit patients for 3s. 6d., or drive longadvantage of the University to cultivate, and if possible maintain, the journeys at 2s. 6d. per mile, so long will the public value their profes-affection of its members, and to foster more than a passing interest in sional worth at that rate, and treat them like petty tradesmen by askingits affairs. Such an object, I think, would certainly be favoured by the for items in accounts.introduction of the proxy vote. Then the printed form of resolutions for I could say much more on this subject, and am willing to do so shouldproposal at meetings of Convocation, instead of being at once consigned, occasion arise. Your obedient servant,without perusal, to the waste-paper basket-which I fear they too often A TRAVELLING MEMBER OF THEare at present,—would stand a better chance of being carefully scru- February, 1878. PROFESSION.tinised, and at the proper time voted for or against.

I trust your article may attract the attention of other provincial gra- Inquirens.—The new-comer would do wisely to call upon the practi-duates, and that something may be done to bring about this much tioners resident in the locality.needed reform. Faithfully yours,Bradford, Yorks, Feb. 13th, 1878. JOHN ApPLEYARD. THE TELEPHONE.

To the Editor of THE LANCET.THE RECEPTION OF NON-PAUPER PATIENTS INTO POOR- SIR,—I observe in your issue of Feb. 9th two letters from correspond-LAW HOSPITALS. ents, suggesting the possibility of applying the telephonic principle to

To the Editor of THE LANCET. stethoscopes. These gentlemen appear to suggest the electric telephoneSIR,—Being the sole medical guardian of the Stepney Union, my in auscultation. Previously to the above date I had furnished Messrs.

opinion is often necessary on various questions which come before our Arnold and Sons, in West Smithfield, with a plan for a telephonic stetho--Board. scope, which consists simply of an ordinary wooden stethoscope, withAn outbreak of variola in Limehouse has raised the question, On whom a membranous tympanum at each end, connected by a tense thread.

devolves the care of non-pauper cases-whether on the guardians or on Such an instrument suggested to my mind the possibility of a com-the Board of Works ? It appears that during the present and a previous promise between mediate and immediate auscultation, as the ear isoutbreak the guardians have permitted their officers, on the score of in close apposition to the upper of the two vibrating tympana, while theeconomy, to take charge of both pauper and non-pauper cases, including lower tympanum may be close to, or on, the surface it is intended to.their removal to hospitals. There are some of the guardians, however, auscultate.

who, with myself, consider that all the non-pauper cases should be I have received the instrument from the makers, but have not yettaken charge of by the Board of Works, as the proper sanitary authority, sufficiently tested its comparative merits. Should it appear to myselfand because the risk of pauperising would be less if dealt with by them and others to intensify sound, I shall take the liberty of communicatingthan by us. Your opinion on the above would greatly oblige, the result to your journal. Yours faithfully,

Your obedient servant, Canonbury, N., Feb. 12th, 1878. A. M.Shadwell, Feb. 13th 1878. H.. SARGENT M.D.

CEREBRO-SPINAL FEVER IN DUNDEE.*. Our correspondent is unquestionably right in the view he takes on To the Editor of THE LANCET.the subject in question. On the 20th January, 1877, the Local Govern-ment Board addressed a letter to the metropolitan vestries and district SIR,-In Dr. Maclagan’s letter in your journal of the 9th inst., as tothe occurrence of cerebro-spinal fever in Dundee, there is nothing men.Boards of Works on this subject, from which we quote the following tioned which would allow one to say that the cases are other thansentence : The Board cannot too distinctly point out that the hos- typhus fever. The mere presence of vomiting does not make a case ofpitals provided for the reception of cases of small-pox by the Metro- cerebro-spinal fever ; and in the absence of definite statements as to the

age of the patients, the mortality and the post-mortem appearances, onepolitan Asylums Board are essentially intended to meet the require- cannot believe that Dr. Maclagan is dealing with a disorder " new toments of the destitute class, and that the admission into these hos- our hospital records." Typhus fever is not uncommon in Dundee, and.pitals of persons not in need of poor relief is altogether exceptional, the symptoms enumerated correspond so closely with those of typhusand only allowable upon conditions (1) that the individual case is one that until one hears that the well-marked symptoms of cerebro-spinalof emergency, and (2) that there is sufficient accommodation for the fever are present in the cases observed by Dr. Maclagan—symptomspatient without infringing upon the space required for paupers."— which clearly differentiate the two disorders,-one will be justified in,

thinking he has only typhus to deal with-Yours obediently,ED. L. St. Thomas’s Hospital, Feb. llth, 1878. FRANK T. TWINING.

300

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

THE following were the questions submitted to the candidates at thewritten portion of the examination for the Dental diploma on the8th inst. :-

Anatomy and Physiology.1. Describe the Eustachian tube, its relations to surrounding parts,

and its functions.2. Describe the acts of mastication and deglutition, mentioning the

muscles concerned therein, and the nerve-centres by which thesemuscles are controlled.

Pathology and Surgery.1. Describe the process of separation of a sequestrum in necrosis of

the lower jaw, and the mode in which repa,ir is effected.2. Describe the characteristics of the chief forms of ulcer affecting

various parts of the mouth, and their treatment.Dental Anatomy and Physiology.

1. Describe, in relation to human and comparative anatomy, the chiefmethods by which teeth are fixed in their place, and give examples.

2. Mention the changes which the lower jaw undergoes during thedevelopment of the teeth from birth to puberty, and account for itselongation backwards.

3. Describe the structure of the tooth-pulp in its earliest stages offormation, and in the adult tooth.

Dental Surgery and Pathology.1. Describe and give the reasons for the manner in which the opera-

tion of extraction should be performed on different teeth, and mentionthe chief reasons which may necessitate the operation.

2. State the symptoms, sequelæ, and treatment of dental periostitis,and explain in what respects they differ from those of inflammation ofthe dental pulp.

3. Enumerate the different irregularities in position which the in-ferior dentes sapientife may exhibit. State the symptoms which suchirregularities occasion, and what treatment you would adopt.

H. E. D. -Dr. Dickinson’s paper "On the Changes in the NervousSystem associated with Diabetes" appeared in the Medical and Chirur-gical Society’s Transactions, 1870.

ERRATA.-In the obituary notice of Dr. Blundell, page S55, 2nd column,line 16 from bottom, for "August, 1828," read August, 1825.-In Dr.M’Calman’s letter, on page 259, the word " How" in the seventh linefrom the end should be omitted, and "when it is fairly aroused"should conclude the sentence.

COMMUNICATIONS, LETTERS, &c., have been received from—Mr. Erichsen,London ; Mr. llaunder ; Dr. Fothergill, London ; Dr. Eben. Watson ;The Duke of Westminster, London ; Mr. Haviland, Northampton;Mr. A. L. Jones, London; Mr. Morton, New Brompton ; Mr. Murdock,Pennsylvania ; Mr. Anderson, Nottingham; Mr. Phelps, Freshwater;Mr. Adams, Rippingale ; Mr. Walter, Dover; Mr. Symns, Snares-

brook ; Mr. Thomas, Bristol; Mr. Dunlop, Farnham; Dr. Newham,Winslow; Mr. Dowdeswell, Wimbledon ; Mr. Clippingale, London ;Dr. O’Neill, Punjaub ; Mr. Snell, London ; Dr. MaePItchie, Hunting-don ; Dr. Godson, London; Dr. Greenhill, Hastings ; Dr. M’Calman,East Ilsley; Dr. Dudfield, Kensington ; Mr. T. Jones, Manchester;Mr. Gorham, Yoxford ; Mr. Nixon, London ; Mr. Grosholz, Aberdovey ;Mr. Brown, Northallerton ; Mr. Walmsley, Salford; Dr. Hitchcock,Lewisham ; Dr. Jacob, Leeds ; Mr. Carpenter, London; Mr. S. C. Hall,London ; Lieut.-Col. Forester, London ; Dr. Sheen, Cardiff ; Dr. Ulccia,Madrid ; Dr. J. Cumming, Edinburgh ; Mr. Brandreth, Helsby ;Mr. George, Dorchester ; Mr. Borchert, Netley; Dr. Boileau, South-hampton ; Dr. Engee, Berlin; Dr. Rumbold, St. Louis ; Dr. Spanton,Hanley ; Dr. Duckworth; Dr. Jagoe, Waterford; Dr. Scott, Glasgow ;Mr. Millar, New Wandsworth ; Mr. Brierley ; Dr. Fox, Chelmsford ;Mr. Barron ; Dr. Tatham ; Dr. Maule, Auchterarder ; Dr. Duncanson,Edinburgh ; Dr. Wahltuch, Manchester ; Mr. Crocker, Gunnislake ;Dr. Austin, Tongue; Mr. Noble ; Mr. Coleman; Mr. Stephens, West-bourne ; Mr. Baker, Birkenhead; Dr. Hardwicke, Sheffield ; Mr. Green :Dr. Walker ; Mr. Roads, Batley; Mr. Sergeant; Mr. Elliott ; Dr. Smith,Kilburn ; Mr. Bennett; Dr. Theebe, Carlisle : Mr. Phillips ; Mr. Haigh,Golcar ; Mr. Chapman ; Dr. Illingworth, Peterborough ; Dr. WoakesMr. Roocraft, Wigan ; Mr. Campbell ; Mr. Morgan, Morriston; LexMedicus, R.N. ; A Dispenser ; Justitia ; Cantab. ; M.D.; Aleclicii,;,Edinburgh; H. E. D. ; L. A. C. ; Amicus Curiæ; L.F.P.S.G. ; E. M. S.The Registrar-General of Births &c. ; Cagliostro ; Constant ReaderInquirens ; Reginald; A. Z., Folkestone ; The Registrar-General 01

Edinburgh; M.R.C.S.; P. T. E., Liverpool; L. D. S. ; &c. &c.

LETTERS, each with enclosure, are also acknowledged from—Mr. PodmoreOxford ; Mr. Eliot, Limpsfield; Mr. Skrimshire, Holt ; Mr. DunnMaryborough, Australia, ; Miss Henderson, Portobello ; Messrs. Smithand Son, Dublin; Mr. Horsfall, Wakefield; Messrs. Grace, BristolMr. Fuge, Taunton; Mr. Duncan, Perth ; Mr. Dowker ; Mr. HaleChew Magna; Dr. Gootlyii,,tii; Mr. Ewart ; A. F. Z. ; Orcadean; S. H.Medicus, Attleborough; C. P. M., Boxford; A. B. C., EasthonrneY. N. A. ; Medicus; M. D. A., Liverpool; W. H. ; Mcdicns, Manchester; Alpha; Rus; L.R.C.P.; Honse-Surgeou; Medicus, BristolH. W. H. ; M.D., West Bromwich ; Medicus, Pwllheli; 0. P. ; MedicusBishop-Auckland; Medicus, Weymouth.

’St. Pancras Gazette, lYi,gan Observer, Weston-super-Mare Gazette, HorrxetPudsey and Stanningley News, British Architect, Home ChroniclerEnglish Churclarrtan, Night and Day, European Mail, Dudley lleoaldNorth British Daily Mail, Daily Beho, &c., have heen received.

Medical Diary for the ensuing Week.Monday, Feb. 25.

ROYAL LONDON OPHTHALMIC HOSPITAL, MOORFIELDS.—Operations,10 A.M. each day, and at the same hour.

ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.—Operations, 11/2 P.M. eachday, and at the same hour.

ST. MARK’S HOSPITAL.—Operations, 9 A.M. and 2 P.M.METROPOLITAN FREE HOSPITAL.—Operations, 2 P.M.ROYAL ORTHOPÆDIC HOSPITAL.—Operations, 2 1’.11.LONDON HOSPITAL.—Operations, 11/2 P.M. ; on Wednesday, 2 P.M.; on

Thursday, 11/2 P.M.; and on Saturday, 2 P.M.ROYAL COLLEGE OF SURGEONS OF ENGLAND. - 4 P.M. Professor Parker,

" On the Morphology of the Batrachia."MEDICAL SOCIETY OF LONDON.—81/2 P.M. Dr. J. Milner Fothergill, "On a

Case of Opium-poisoning treated by the Hypodermic Injection ofSolution of Sulphate of Atropia." - Dr. Day (Stafford) : " Observations and Comments on certain Convulsive Disorders."

Tuesday, Feb. 26.GUY’S HOSPITAL. -Operations, 11/2 P.M., and on Friday at the same hour.WESTMINSTER HOSPITAL.-Operations, 2 P.M.NATIONAL ORTHOPÆDIC HOSPITAL.-Operations, 2 P.M.WEST LONDON HOSPITAL.—Operations, 3 P.M.ROYAL INSTITUTION. - 3 P.M. Professor Garrod, "On the Protoplasmic

Theory of Life, and its bearing on Physiology."ANTHROPOLOGICAL INSTITUTE OF GREAT BRITAIN AND IRELAND.—8 P.M.ROYAL MEDICAL AND CHIRURGICAL SOCIETY. - 8k 1’.01. Dr. Broadbent,

’’ On a Case of Amnesia."-Mr. Brodhurst, " On a Case of Anchylosisof both Knee-joints, with Shortening of the Femora."-Dr, Dickinson’s Microscopic Preparations, illustrating the Pathology of Dia.betes, will be arranged for inspection by 8 P.M.

Wednesday, Feb. 27.MIDDLESEX HOSPITAL.—Operations, 1 P.M.ST. MARY’S HOSPITAL.—Operations, 11/4 P.M.ST. BARTHOLOMEW’S HOSPITAL. - Operations, 11/2 P.M., and on Saturday

at the same hour.ST. THOMAS’S HOSPITAL. - Operations, 1;L P.M., and on Saturday at the

same hour.KING’S COLLEGE HOSPITAL. - Operations, 2 P.M., and on Saturday at

1 P.M.GREAT NORTHERN HOSPITAL.—Operations, 2 P.M.UNIVERSITY COLLEGE HOSPITAL. - Operations, 2 P.M., and on Saturday

at the same hour.SAMARITAN FREE HOSPITAL FOR WOMEN AND CHILDREN. - Operations,

21/2 P.M.ROYAL COLLEGE OF SURGEONS OF ENGLAND. - 4 P.M. Professor Parker,

" On the Morphology of the Batrachia."HUNTPRIAN SOCIETY.—71/2 P.M. Council.-8 P.M. Mr. R. Clement Lucas,

" On the Treatment of Lupus by Erosion."

; Thursday, Feb. 28.ST. GEORGE’S HOSPITAL.—Operations, 1 P.M.ST. THOMAS’S HOSPITAL.—Ophthalmic Operations, 4 P.M.CHARING-CROSS HOSPIT.L.-Operations, 2 P.M.

, CENTRAL LONDON OPHTHALMIC HOSPITAL. - Operations, 2 P.M., and on. Friday at the same hour.’ ROYAL INSTITUTION. - 3 P.M. Professor Dewar, "On the Chemistry of, the Organic World."

Friday, March 1.: ST. GEORGE’S HOSPITAL.-Ophthalmic Operations, 11/4 P.M.; ROYAL SOUTH LONDON OPHTHALMIC HOSPITAL.-Operations, 2 P.M.

ROYAL COLLEGE OF SURGEONS OF ENGLAND. - 4 P.M. Professor Parker," On the Morphology of the Batrachia."

ROYAL INSTITUTION.—8 P.M. Weekly Meeting.-9 P.M. Dr. R. Liebreich,,

On the Deterioration of Oil Paintings."’ Saturday, March 2.

ROYAL FREE HOSPITAL.—Operations, 2 P.M.; ROYAL INSTITUTION.—3 P.M. Mr. R. Bosworth Smith, "On Carthage,

and the Carthaginians."