the same subjects. He particularly noted the case of Dr. the angle formed between the thumb and index finger, HARVEIAN SOCIETY OF LONDON. President-Dr. THOMAS BALLARD. CASE OF EMBOLON OF LARGE VESSELS. DESCRIPTION OF A CASE OF CONGENITAL DISLOCATION OF Upon two former occasions he had had the honour to read BOTH WRIST-JOINTS AND RIGHT KNEE-JOINT. By Dr. CROLY. James Collier, aged 78 years; about five feet six inches in height; a weaver by trade; is married and has children; does not know of any congenital malformation having existed in any member of his family. Right Elbow-joint.-Flexion and extension perfect; supination cannot be carried beyond the mid-point between the prone and supine position; pronation nearly perfect; radius and ulna slightly curved, the latter forming the arc of a larger circle than the former; the carpus with the hand is displaced backwards, and the hand can be carried backwards to a right angle with the forearm; the lower extremity of the ulna projects forwards and inwards, and apparently unites by its outer and posterior aspect in articulation with the bones of the carpus; the lower end of the radius projects slightly forwards and the hand is thrown outwards; considerable effusion into the carpal bursa, forming a mid-prominence in front of the wrist. The measurements of the right arm:-From acromion process to olecranon, the forearm-the lower extremity of fourteen inches; radius, five and a quarter inches; ulna, seven and a quarter inches; hand, six and three-quarter inches. Left Elbow-joint.-Flexion and extension perfect; no pronation or supination allowed; the ulna projects backwards at its carpal end, its articular facette apparently on its anterior surface; the radius projects slightly backwards, and the hand is inclined outwards; much less lateral motion in the wrist-joint of the left than at the right side. The Right Knee joint displays a congenital luxation of the head of the fibula, which projects backwards and outwards; the tendon of the biceps projects prominently beneath the skin at the outer side of the popliteal space; the right fibula measured thirteen inches, while the left one was only eleven inches and a quarter. Left arm measured fourteen inches from acromion to olecranon; left radius six inches along the convexity of the arc; chord of arc, five inches; ulna measured eight inches; hand seven inches. DISLOCATION BACKWARDS OF THE SECOND PHALANX DR. STAPLETON wished to bring under the notice of the The patient, a woman about forty-five years of age, returning home about nine o'clock on Saturday night last, tripped and fell, the end of the thumb coming into contact with the ground. When she raised herself, she felt extremely faint from the pain, and believed she only sprained her thumb; the pain continuing severe, she sought relief at Jervis-street Hospital, and as he (Dr. Stapleton) happened to be at the time in the hospital, he at once recognised the nature of the accident, and explained it to the class. Having heard from Mr. Ledwich of his having successfully reduced a similar dislocation, the usual plans having failed, he (Mr. Stapleton), by placing the edge of a table in before this Society papers upon "Fibrinous Concretions, or Plugs formed in the Heart, and Great Vessels leading thereto and therefrom." He produced before the Society, this evening, a patient, who, on the 29th October last, came to him seeking relief from bronchitis, and who presented prominent symptoms of a fibrinous deposit slowly taking place in the vena cava superior, and probably extending into the right auricle. Robert L., æt. 59, married, a labourer in a timber yard, has lived freely in former years but not lately, and has never had rheumatism. He caught cold about three weeks before Dr. Stewart saw him, and took several home remedies, but had not applied for medical advice until now. Complains of chillness, difficulty of breathing, with cough and a copious expectoration; has thirst; tongue slightly furred; bowels constipated; urine scanty and dark-coloured; pulse 96, weak; his lips, nose, cheeks, and ears are of a deep purple colour, and slightly colder than the surrounding parts; general appearance of skin of face and neck deeper coloured than usual; veins of the neck, particularly the jugulars and superficial veins of the chest, enlarged, prominent, and varicose; chest abnormally flattened from before backwards; movements of the chest normal; percussion notes resonant; coarse crackling heard over the greater part of both lunge, particularly the right; slightly-increased impulse with the heart's beat; its rhythm irregular; there is a slight blowing sound or auricular-systolic murmur over the right auricle preceding apex beat. We cannot, said Dr. Stewart, have any great difficulty in reading this case, when we remember that the venous blood from the parieties of the chest and vertebral column is returned to the heart through the medium of the venæ azygos (major et minor), and the superior intercostal vein; the former opening into the vena cava superior immediately over the right bronchus; the latter into the left vena innominata. Any obstruction to the circulation in the vena cava superior would be evidenced by an enlargement of the superficial veins of the chest and neck, as in this case, and produce cyanosis of the lips, cheeks, nose, and ears. For the original cause we must look to his previous life, which was what is called "free," in other words "drunken." No doubt his abnormally-flattened chest may have contributed somewhat to produce disease, by diminishing the internal space required for the healthy performance of the functions of the chest; and lastly, his mode of gaining a livelihood, that of labourer in a timber yard, where he is frequently called upon to carry very heavy loads upon his shoulders. Since this examination was made he has been relieved of his bronchitis, and is altogether in better health. Dr. Cock said there was not time to go into the case; but he doubted the inference drawn by the author of the paper, from the symptoms. Mr. SEDGWICK was rather inclined to attribute the cyanosis, &c., to the consequences of some inflammatory condition of the lungs, than to take the view the author did of it. THE "Gazette de France" states that Madame Pillaud has just died at Bergerac (Dordogne) at the age of 105 years. Her son, a priest 80 years old, read the funeral service over her. called the right and which the left half of the auricle, as appears from the stated relations of the veins to the single cavity. Foreign Medical Literature. In the third chapter we find a description of the circu A CASE OF CONGENITAL MALFORMATION OF | lation and of the distribution of blood in the case related. THE HEART. By J. F. BAERKEN, Leyden, 1865. Selections from the Nederlandsch Archief voor Genees- en Natuurkunde, The absence of a partition between the right and left auricle caused a constant admixture of arterial and venous blood after birth. Moreover, the auriculo-ventricular orifice of the aortic (in this instance the right) ventricle was very narrow, so that much more blood was driven into the pulmonary artery, which then passed again, in part, through the ductus Botalli into the aorta. The absence of the auricular septum and the narrowness of the Translated by W. D. MOORE, M.D.Dub. et Cantab., M.R.I.A., ostium venosum of the aortic ventricle were the cause of HONORARY FELLOW OF THE SWEDISH SOCIETY OF PHYSICIANS; OF THE In the first chapter of his work, the author communicates this course of the blood, while the results (cyanosis, bronchial catarrh, cold extremities, defective nutrition) may be directly explained by the abnormal circulation. ACADEMIC THESIS. By B. J. WINKELMAN, Leyden, 1865. the history of the case, and the anatomical description of ON A CASE OF OSTEO-SARCOMA TELANGIECTODES; AN the heart. The child in whom the abnormal heart was found died five weeks after birth, with cyanotic symptoms, dyspnoea, diarrhoea, &c. The impulse of the heart was very strong. Ón opening the body the heart was found much enlarged; seen from before it had about the form of an equilateral triangle. The posterior surface was reniform. There was no auricular septum; only on the anterior wall did a large musculus pectinatus indicate a trace of partition. Close to a right, well-formed auricula a vena cava superior dextra opened, and immediately adjoining it two pulmonary veins entered from the right lung. In the left division of the auricle were the openings of a vena cava superior sinistra and two pulmonary veins. The left auricula was well formed. On the posterior wall of the auricle the two mouths of two venæ cave superiores were found. There were two ventricles separated by a perfect ventricular septum. The cavity of the ventricle lying to the right was small, and its walls were slight. The artery issuing from this ventricle curved backwards over the right bronchus; in its course and ramification it corresponded to the aorta. After being joined by the still completely open and wide ductus Botalli from the pulmonary artery, it became much thicker than it was at its origin. From the left ventricle proceeded an artery, completely corresponding to the pulmonary artery, dividing into a branch for each lung and the ductus Botalli. In a healthy workman a tumour had been developed after an injury on the inside of the humerus close to the elbowjoint. The tumour had increased in size for sixteen years after the injury, when, in consequence of a fall, fracture of the arm on a level with the tumour rendered amputation necessary. The tumour seems to proceed from the os humeri, and communicates with the medullary cavity, while on the inside the compact substance of the bone has entirely disappeared. The central and most solid part of the tumour consists of closely accumulated cells, and exhibits great vascularity. The surrounding tissue is looser, consists of similar cells, and is furnished with many openings. The walls of these openings present the structure of those of the capillaries-namely, a structureless transparent membrane, provided at regular intervals with nuclei. As these openings at the same time everywhere contain blood, the author thinks that they have proceeded from vessels the walls of which have coalesced. Within the tumour bony tissue is in some places met with. The whole tumour is enveloped in a fibrous capsule. The author, on comparing this with two similar cases, one described by Lebert, the other by D. J. van Kaathoven, comes to the conclusion that this tumour has taken its origin from the spongy substance of the bone, and that its pressure has caused the compact substance to atrophy. From the extensive vascular development, which in this instance gives a peculiar character to the sarcoma, the author derives the name osteo-sarcoma telangiectodes. By S. DOEDES BREUNING. In the second chapter the author gives a short sketch of the normal development of the heart, and comes to the conclusion that our knowledge is not yet sufficiently advanced to explain deviations such as that now described. That at the time of the formation of the partition in normal cases, a torsion of the heart from left to right takes place, is very certain. The absence of this torsion may account for the position of the origin of the aorta and of ON THE TEMPERATURE IN INFLAMMATION OF THE LUNG the ventricle to the right, and of the pulmonary artery and its ventricle to the left, but a number of facts remain unexplained, the course of the aorta over the right bronchus, the opening of the pulmonary veins with the venæ cave into the same cavity, &c. The author then also endeavours, setting aside the causes of the abnormal development, especially to answer the question, whether, in a case like his, we may speak of transposition of the arteries proceeding from the heart. The unintelligible reasonings bearing upon this point, to be found at pages 16 and 17, lead to the conclusion that the better course is to speak of perversion of site. True transposition would, this appears at least to be the author's opinion, exist only if, in an otherwise normal heart, an artery should arise from the left ventricle, and ramify in the lungs, while the pulmonary artery (that is, the artery arising from the right ventricle, which would therefore receive the blood from the venæ cave) should divide as an aorta through the body (!) In his case the author cannot decide which is to be The academic thesis of Dr. B. comprises-1st, a short "Historical Review" of our knowledge of inflammation of the lung. In this the author refers especially to the importance of thermometrical observation in pneumonia for comprehending the morbid process in its integrity, and the state of reaction in the system, as thence the typical character of the disease is recognised. The thermometrical results obtained by Wunderlich in the three typical forms of pneumonia are briefly stated. In the Second Part, "General Considerations upon the Elevated Temperature in Inflammation of the Lung," the author endeavours to show that the increased production of heat in pneumonia must be considered as the result of continued oxidation in the blood, and not of increased consumption of oxygen in the tissues. In the third chapter six cases of pneumonia are communicated from the clinique of Prof. von Geuns. The results of the thermometrical observations, obtained in these cases, quite agree with what is taught by Wunderlich. At the end of the last chapter," Epicrisis," the author directs attention to the favourable influence which tartar-emetic seems to have exercised, in some of the cases described by him, on the diminution of the temperature. In this respect the remedy deserves a place not below but next to digitalis, which, on account of its disagreeable concomitant effects, is probably less to be recommended. ON BUTTERMILK AS FOOD FOR CHILDREN Under one year. By Dr. A. M. BALLOT. (Ned. tijdschr. voor Geneeskunde, 2 afd. 4 afl.). To find a good substitute for the mother's milk has been the object, and justly so, of many trials and investigations. Circumstances often occur, under which it is difficult or impossible to have children reared by the mother or a nurse. The most natural substitute, and that which is also most in use, is cow's milk. This is often prescribed diluted with water, the quantity of which is specified, and usually mine the quantity of water which is to be added, in the house where the child lives, to the milk, but we cannot then be absolutely sure of the composition which the milk the differences which may be in the milk as it comes from the cow (food, time of year, period after calving), we find a very great difference in the milk which we buy at different times from different dairymen. Analyses of different kinds of milk in Rotterdam gave the following extremes. In 1000 parts the contents amounted to with a little bicarbonate of soda. We can indeed deter so diluted will have. Even if we do not take into account lies in the lactic acid. By it the milk is already partly He commences If we now compare with the mother's milk the food which the child gets, under the ordinary prescription of one part of cow's milk to two of water, we obtain for Rotterdam the following table : : Sugar of Milk Ashes. 2.4. 0.7. Solid Constituents. 47.0. 953.0. 37.0. 963.0. Milk. Correspondence. REMARKS ON CHOLERA IN THE EAST-END OF LONDON. TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR. SIR, AS I have had opportunities of observing the progress of cholera in the East-end of London, more especially in Mother's the Parish of Bethnal Green, it may not be out of place or presumptuous in me to state my views regarding the present 34.3 epidemic, and the treatment adopted at the Winchester25.3 street Dispensary during the time it was open. I acted as 48.2 Medical Visitor, and with three assistants attended 7000 cases in six weeks, 130 being cholera, many choleraic diarrhoea, and the remainder diarrhoea; besides the above number I have seen 30 cases in private practice-making a total of 160 cases, most of which occurred in districts badly drained, and where there was a deficiency of water to meet the demands of common cleanliness; also in houses where the filth of years had been allowed to accumulate on the walls without being brushed off or whitewashed (in one or two cases the houses had not been thoroughly cleansed for walls were so polished that they might well have served as over twenty years), and in some parts from friction the a looking-glass. The district, I might more especially mention as having been the occasion for the above remarks, was Hare-street, in which street a greater number of cases occurred than in any one in my district, though some houses and streets, even worse than Hare-street, seemed for a time to escape cholera; but sooner or later they also were visited if not so severely as Hare-street. 2.3 116.4 883-6 It will be seen that this artificial food cannot be called excellent. On its use accordingly often follow vomiting of large masses of casein, diarrhoea, and atrophy. In general it is borne only by children with a strong constitution. Seeking after a more suitable substitute for mother's milk, the author found that Prof. Simon Thomas of Leyden, employed as such buttermilk with flour. Although somewhat surprised at this he determined also to make a trial of it, which gave a favourable result that was confirmed by subsequent experiments, so that this method of feeding has now, after two and a-half years, been generally adopted in Rotterdam. The analysis gave as :— Of lactic acid Sugar of Milk Casein Minimum. It is not my object in mentioning the above state of the houses to try and form a theory as to the cause of cholera, and to mention the filthy habits of the people, and the want of sanitary reform in the East-end of London as being the 4:40 cause of the epidemic, for were I to do so I should go nearer 0.21 the west, having acted as Assistant in the West London 906.67 Union for some time. I am well acquainted with both dis66.66 tricts, so it is my intention simply to state that whether 2.06 cholera depends on, or is caused by dirty houses, the measures ought to be taken by Government to remedy the filthy habits of the people, or impure water, that active evil, by appointing visitors to see that the houses in districts known to have been the dens of fever are regularly cleansed at stated periods; for, sir, thoroughly as I believe Lactic acid after 24 hours filth to be the hand-maid of cholera, so do I believe it necessary that an official inspection of houses be made, and in saying so I do not ignore the valuable services of the Medical Officers of Health, who have done so much to stay the ravages of the disease, and I believe Dr. Sarvis, the indefatigable Officer of Health for Bethnal Green, to be worthy of all praise, for the promptitude with which he has acted during the epidemic; and not one of the least of the services rendered by him was the establishing of three dispensaries, in which over twenty-two thousand patients have been relieved, still I say there ought to be a system of inspection carried on more efficiently than at present by the Inspectors of Nuisance. The system of house-to-house visitation has doubtless done much good-in fact an incalculable amount of good-as houses which were buried in filth are now something like habitable; however, much remains to be done, but although as many as thirteen hundred houses have been visited by three assistants and myself in a week, I am impressed with the idea that, strictly speaking, much of the visiting done by medical men during the epidemic ought to have been done by the Inspectors of Nuisance, and that at a time when not excited by the presence of cholera, so as to do some little towards diminishing it altogether: but, sir, that the visiting done has been the means of diminishing the epidemic will be admitted, and the very fact of twenty-two thousand baving been treated at three dispensaries in only a few weeks is sufficient proof that the vestry were right in carrying out the recommendations of their medical officer. It will also be admitted, though the Registrar-General seems to have overlooked the important fact when he attributes the sudden decline of cholera to the improvement in the water, which was found to be polluted, and, although I fully believe with him that polluted water had its share in the production of cholera, still I cannot close my eyes to the fact that the very week cholera reached its maximum, the three dispensaries were opened, at Nichol'srow, Winchester-street, and Grattan-terrace. At Winchester-street the number of applicants on the second day after it was opened numbered 587; the rush was equally great at the other dispensaries, and if it be taken into consideration that each place was regularly besieged day and night for the first fortnight after they were opened, I think it but right to conclude that the treatment of premonitory diarrhea was certainly an important element in diminishing cholera, a fact which ought to be kept prominently in view, so that in case of another outbreak, local authorities, especially vestries, may be alive to the necessity of providing for the poor on such occasions at the very commencement. Regarding the treatment adopted at the Winchester-street Dispensary (without condemning, as Dr. Kidd seems inclined to do, all who differ with him respecting the treatment of cholera cases, and that in a weekly paper, see Morning Advertiser, August 18, 1866), I have adopted all kinds of treatment-both the astringent and eliminative-and have found patients derive benefit from both modes, but am fully convinced that I have seen more benefit derived from the administration of chlorate of potash, in the form of powder, than from any single drug, and in some cases the effect has certainly been remarkable, oftentimes relieving sickness and bringing about reaction in extreme cases of collapse; still I would not have any one believe that chlorate of potash was infallible more than castor-oil, or any astringent, but what I say is (and there are other medical practitioners who can say the same) that chlorate of potash, combined with a judicious administration of astringents where the dejections are frequent has given better results, and a large per centage of recoveries (I am below the mark when I say seventyfive per cent.), than either plan of treatment alone. The modus operandi of the drug I don't pretend to explain, as there are conflicting views respecting its operation; but surely, sir, we are not to weed the Pharmacopoeia of drugs known to be of great benefit in cases of scarlatina, cancrum oris, &c., because its modus operandi can't be chemically explained, although from the sudden change of the countenance and fingers, from being blue or livid, to their natural colour, I am inclined to think that, chemically, it does act, as generally supposed, by oxidizing the blood; but if we ignore such a statement from the fact that it is not supposed to be absorbed, then I believe it probable (taking into account the large amount of chlorine introduced when given in the form of powder)-a form I always insist upon-that besides introducing into the system, and making up for what is known to be thrown off largely in the excretions of cholera patients (chlorides), that some chemical change takes place, or its action upon the periphery of the nerves of the stomach and intestines is such that by reflex action the beneficial effects described are brought about, and one which I ought to have mentioned is the large quantity of urine voided. I have been led to give the chlorate of potash in powder in cases of cholera from having observed its different effects, in the form of solution and powder, in cases of ulceration of the tongue. Some time since I had two or three very bad cases of ulceration of the tongue and pharynx under treatment, and had tried a solution of the chlorate of potash without the least improvement in the appearance of the ulcers, although containing the solution of chlorate of potash, for six weeks. At this time one of your correspondents mentioned the circumstance of his having had under treatment a similar case, which did not improve while using a solution of the drug, but rapidly got well by sprinkling the ulcers over with the powder two or three times in a day, so I at once tried the powder, as mentioned in the cases under treatment, and was pleased to find the ulcers get rapidly well. I am aware that chlorate of potash has been given in cholera cases, in solution, but am not aware that the powder has been given, and that given in solution it is but little thought of; but, setting aside the fact that the powder mixed up in a little jelly is much more readily retained on an irritable stomach than the same quantity in solution, I imagine it quite possible, and even probable, that the powder, being the most concentrated form, may act by chemically decomposing the intestinal secretions, or, as I said before, by acting on the sympathetic system of nerves, and so altering the character of the secretions; and if so, the different effects of the drug may be as great in cases of cholera as in cases of ulceration of the tongue; so I can readily understand the fact of its failure as hitherto used in the form of solution, and think it deserves further trial before being condemned. The mixture generally used at the dispensary was tr. opii minims v-10; T. capsici gtt. i; T. catechu 3ss; æther chloric minims x to xv; with mist. creta to an ounce; and that seemed to check the diarrhoea in the majority of cases; but if the disease ran on to the second stage, I generally used to alternate the mixture with powders of chlorate of potash, or gave the potash alone without the mixture if the diarrhoea had ceased or was abating. In cases where the patient complained of pain in the bowels, a feeling of constriction as if tied around the waist with a cord, sickness, and cramps, but no diarrhoea, then tr. of opium and castor-oil acted well; but as I have not used castor-oil sufficiently extensive to justify my expressing a decided opinion as to its effects, all I can say is that as opium was only given in sufficient quantity to relieve pain, I attribute the beneficial effects, and especially the relief afforded when the bowels were relieved, to the eliminative effects of the oil. But, sir, strongly as I have spoken of chlorate of potash, and convinced as I am that much good has been done by its administration, I believe the time has not yet arrived to place reliance upon any one drug, but feel confident that we may at no distant period find cholera to be as amenable to treatment as pneumonia, or fever-to which it is more nearly allied-is in the present day. C. C. RICHARDS, M.D. Brick-lane,Bethnal-green, December, 1866. MEDICAL INSPECTORS. TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR. SIR,-The question I took the liberty of asking a year ago still presses itself on the notice of an observer-What has become of the Medical Inspectors? We hear a good deal about their appointment, &c., through your columns, and from other sources, but so far as seeing them, or any service to some parts of the country from their existence, is concerned, they might be as well among the myths of bygone ages. I am not inclined to place a very high value on the services of those gentlemen. Nevertheless, they did constitute a kind of arbitership, to which an honourable-minded medical officer might have recourse from time to time in the discharge of his duty to the poor, and in the assertion of his own just rights and privileges, without the somewhat obnoxious course of writing to the Commissioners, which is the only one now left to him. It is true that to those medical officers who fall in with the views of the ratepayers in keeping down the rates to the lowest possible figure, things go on very smoothly-albeit the poor are neglected and stinted in the necessaries of both food and medicine which the law contemplates supplying them with, and are sometimes left to the care of (it may be incompetent or careless) subordinates; while the man who draws the salary which the law appropriates for their attendance, is engaged among the rich, or with his farm, or merchandize. But, sir, there are some medical officers, I take pride in believing there are many, who having engaged for a certain salary to give medical attendance to the poor of a district, and as far as in him lies, to avert therefrom pestilential diseases, applies himself in earnest to that as his chief duty, in the discharge of which he sometimes incurs both opposition and odium, because haply he considers the lives and health of the poor and labouring class of more importance than a few shillings more or less on the rates. | LEGAL INTELLIGENCE. CHARGE OF ILLEGALLY RECEIVING A LUNATIC PATIENT. AT Bow-street a summons was preferred at the instance of the Commissioners in Lunacy against Mr. George Naylor, Surgeon, of 8, George-street, Hanover-square, charging him with having taken the charge and care of a person of unsound mind, without the proper order or medical certificate. The prosecution was conducted by Mr. Metcalfe, instructed by Messrs. Vandercombe, Law, and Co., solicitors to the Board of Commissioners in Lunacy; and Mr. Harrison, instructed by Messrs. Lewin and Co., defended. Mr. Metcalfe, in opening the case, said the proceedings were taken under the sections 90 and 91 of the Act 8th and 9th of Victoria, cap. 100. It appeared that in October last a young man, whose name he did not mention, being unwilling to make a family affliction unnecessarily public, was sent as a lunatic patient This, you will agree, is rather a lamentable state of things. to Southall-park Asylum, with a certificate signed by the The Registration Law, however perfect in the lapse of defendant. It appeared from it that the defendant had years it may become, as yet forms a very inadequate test of examined him at Deane's cottage, Hanwell, and had come to the sanitary condition of the country, and its returns seem the conclusion that he was of unsound mind. It was not, calculated to mislead the public, and perhaps to lull the however, stated that the defendant, who described himself as Commissioners into too great a security as to the working of a Surgeon practising at 8, George-street, Hanover-square, the poor-law machinery. The administration of the re- was also residing at Deane's cottage, Hanwell, and was the lief to the sick poor is left much as it was in former times-person in whose care and charge the patient had been for i. e., between the local governing bodies (boards and com- the preceding seven and a half months. The evidence would mittees) on the one side, and the medical officers on the show that this was so, Mr. Naylor having signed an agreeother; but with this difference and disadvantage, that ment by which he undertook the charge, board, and lodging whereas under the old system the contributions were of the patient, providing him with wine, &c., in fact everyvoluntary, and there was consequently no antagonism thing but clothing, for £2 10s. per week. At that time the between the contributors and the doctors, who were patient had been for twelve years in a state of imbecility, thus placed in a position more favourable for the good brought on by over-study. In the opinion of Dr. Allen, of the country. Under the present system the contri- who had examined him prior to his removal from his butors-i. e., the ratepayers-are under compulsion to father's house to Deane's-cottage, he was incurable. During support the doctor, who is therefore liable to be regarded as the early part of his stay at Deane's-cottage he appeared to a Government officer forced on and supported by the people, improve, but in October, as he seemed to be getting worse and therefore to be made the most of at the least possible again, he was removed by his father's suggestion to the expense either of money or courtesy. As might be expected, asylum. Mr. Harrison cross-examined the witnesses, enthe Doctor is too often fain to purchase favour and a quiet deavouring to show that defendant was not aware that the life by falling in with the views of cheeseparing guardians- patient's mind was affected until lately, and also that the a line of conduct more politic than humane and just to the prisoner was not under his charge (notwithstanding the agreement), but, under that of a widow lady residing at Deane's-cottage. Counsel also suggested that he had witnesses to call, but, on Mr. Vaughan's intimation that unless their evidence was most stringent the case must go for trial, Mr. Harrison reserved the defence, observing, however, that if Mr. Naylor had committed any infringement of the Act it was rather an error of judgment than a wilful offence. The defendant was committed for trial, bail being taken in two sureties of £100 and himself in £200. poor. The Medical Inspectors might constitute a barrier against this degenerating tendency in the working of the poor-law. But they are nearly unknown, not having been seen or heard of, in some districts for more than five years.—I remain, sir, your obedient servant, DISPENSARIUS. "TELEGRAPHING FOR THE DOCTOR." TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR. SIR,-No doubt every physician in the habit of receiving DISEASES OF THE EAR. TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR. SIR, I would suggest to your correspondent "Miser" the advisability of submitting, together with his question of December 19th, a statement of the physical examination of his ear. The symptoms he alludes to may be due to very serious causes-mechanical or vital-and therefore no one line of treatment can be recommended with confidence as long as the condition of the external auditory passage, the membrana tympani, the cavitas tympani, ossicula, Eustachian tube, &c., is unknown.-I am, sir, yours obediently, SPECULUM. |