DIGITAL EXPLORATION OF THE BLADDER.

1009 in the two preceding weeks ; 16 resulted from scarlet fever, 16 from diphtheria, 13 from whooping-cough, 13 from diarrhoea, 12 from "fever" (principally enteric), 6 from "Audi alteram partem." measles, and 3 from small-pox. These 79 deaths were equal to an annual rate of 33 per 1000, which exceeded by 0’5 the mean rate from the same diseases in the large English towns. SPORADIC CRETINISM. The rates from these diseases in the Scotch towns ranged To the Editor of THE LANCET. last week from 0’8 and 1’4 in Leith and Aberdeen, to 4’6 shall be obliged if you will find room for the foland 5’1 in Edinburgh (the zymotic rate in Edinburgh is misSIR,—I otIicial and The 1’6 in the Greenock. fatal return) printed lowing quotations from my late friend Dr. Hilton Fagge’s cases of scarlet fever, which had been 15 and 30 in the two paper on "Sporadic Cretinism." You will see from it that previous weeks, declined again to 16 last week, of which 7 the sporadic cretinoid state has long been under consideraoccurred in Edinburgh and 7 in Glasgow. The 16 deaths referred to diphtheria also showed a marked decline, being tion-at Guy’s, at least,-and that such cases were brought 11 less than the number in the previous week ;4occurred in forward in the clinical teaching there. The very great Glasgow, 4 in Edinburgh, 4 in Dundee, and 2 in Aberdeen. pathological value of Dr. Hilton Fagge’s paper was his Eight of the 13 deaths both of whooping-cough and diarrhœa referring the state to atrophy of the thyroid, as will be seen in The deaths referred to "fever," the last were returned in Glasgow. paragraph. We must all deeply regret that his which had been 16 and 4 in the two previous weeks, rose and highly-informed mind should hwe been clear very again to 12 last week, and included 7 in Glasgow and 2 in to us in this interesting discussion. in wanting Four 6 deaths from occurred of the measles Edinburgh. Dr. Fagge writes as follows :-" The subject of sporadic Edinburgh. Two fatal cases of small-pox occurred in Glasgow, and one of chicken-pox in Edinburgh. The 129 cretinism appears hitherto to have attracted very little deaths referred to acute diseases of the respiratory organs attention. I am not aware that anything has been written in the eight towns showed a further decline of 11 from recent concerning it, with the exception of the papers which have weekly numbers, and were 10 below the number in the already been quoted. In Virchow’s great work on tumours corresponding week of last year. The causes of 86, or I have failed to find any reference to it, either in the 16 per cent., of the deaths in the eight towns were not chapter on goitre (in which endemic cretinism’ is discussed certified. at some length) or in that oa fatty tumours. It is, therefore, especially incumbent on me to state that in the course HEALTH OF DUBLIN. of his clinical teaching at Guy’s Hospital, Dr. Gals The rate of mortality in Dublin, which had been equal to 25 2 some years ago made me acquainted with many of the prinand 33’0 per 1000 in the two previous weeks, declined again cipal features exhibited by these cases. So far as I reto 25’7 in the week ending 1st inst. The mean death-rate member, the characters on which he laid most stress were in the city during the first nine weeks of the current quarter the broad face, the flat nose and thick lips, the broad hands and feet, and the mild, tranquil disposition, so different from was equal to 26’1, whereas it did not exceed 19’9 in London and 19’3 in Edmburgh. The 172 deaths in Dublin last week the mischievous tendencies of the idiots with whom these showed a decline of 49 from the high number in the previous children are so generally associated. I do not think that week ; they included 6 which were referred to scarlet fever, Dr. Gull’s attention had at that time been drawn to the 4 to diarrhoea,, 3 to "fever,2 to whooping-cough, and not presence of the peculiar tumours above the clavicles. He one either to small-pox, measles, or diphtheria. Thus 15 called the disease cretinism. ..... It is at this point, as I deaths resulted from these principal zymotic diseases, think, that the occurrence of sporadic cretinism, in associawith an absence of the thyroid body, may be brought against 17 and 27 in the two previous weeks; they were tion to bear to an of annual 2’2 while the rate upon the theory of the subject. We have but to rate 1000, per equal from the same diseases was 2’7 in London and 4’6 in suppose that the healthy thyroid body is capable of exerting influence, and that in most parts of Edinburgh. The fatal cases of scarlet fever in Dublin, such a counteracting which had been 6 and 16 in the two previous weeks, declined England the cause ot cretinism acts only with a low degree power, and we can then at once see why a form of again to 6 last week. The deaths from "fever" and from of should I"how itself when the thyroid body is cretinism were numerous those in less than returned whooping-cough the previous week; those attributed to diarrhoea, however, atrophied."-(Med. Chir. Soc. Trans., 1871, vol. liv., pp. Your obedient servant, showed an increase. The deaths of persons over sixty years 166, 169.) WILLIAM W. GULL. of age, which had been 44 and 60 in the two previous weeks, Brook-street, December, 1883. declined to 38 last week. The causes of 23, or more than 13 per cent., of the deaths registered during the week were DIGITAL EXPLORATION OF THE BLADDER. not certified. To the Editor of THE LANCET. THE LANCET of Oct. 6th, 13th, and 20th, Mr. SIR,—In THE SERVICES. Whitehead and Dr. Pollard treated at considerable length ARMY MEDICAL DEPARTMENT.—Surgeon-Major John the subject of my operation of "digital exploration of the Gordon Grant has been granted retired pay, with the bladder,and reported fourteen cases as the total experience honorary rank of Brigade Surgeon ; Surgeon-Major James of it by myself and by Mr. Whitehead. As I had already, Joseph McCarthy, M.D., is granted retired pay, with the in June, reported twenty-seven cases, including twelve cases honorary rank of Brigade Surgeon; Surgeon Charles de Mont- of tumour, I called the attention of the authors to this fact morency Palmer, M.B., resigns his commission. in THE LANCET of Nov. 3rd. As they have not taken any BREVET.-To be Brigade Surgeon : Surgeon-Major John notice of my letter, and as it has so important a bearing on James Durant, of the Bengal Army. the of their paper, I can only suppose that it, like ADMIRALTY.—Staff-Surgeon Robert Hay, M.D., has been the subject June referred to, has escaped their notice. report promoted to the rank of Fleet Surgeon in Her Majesty’s There is, however, a statement in their first paper of Oct. 6th, Fleet, with seniority of 12th November, 1883 ; Surgeon Malcolm Vincent Stace has been placed on the Retired List p. 630, to which I am compelled in the interest of historical accuof his rank from the 9th November, 1883. racy to call attention. They report, as an example of tumour The following appointments have been made: Surgeon removal by supra-pubic cystotomy, a case in the practice of Geo. W. Low. to the Repulse (complement incomplete) ; Sur- Mr. Liston. This is an error : the case, as they may see by the journal from which it was taken (Medical Times and geon Robert J. Lawson, to the Agincourt, vice G. W. Low. Gazette, August, 1862) is well known to me. The so-called " tumour was simply an exfoliation of the mucous memCLERICAL, MEDICAL, AND GENERAL LIFE As- brane, not then so well understood as at present, and was SURANCE SOCIETY.-The report presented at the nfty-ninth met with by him when tapping an old man for retention annual general meeting of this Society, held on the 30th ult., from prostatic disease. Mr. Liston preserved the membrane was of a highly satisfactory character. The aggregate new in his private collection, and it now forms preparation business of the past year was stated to be in excess of that No. 1993 in the Museum of the Royal College of Surgeons, of any corresponding year in the history of the Society. where it is described as " exactly resembling the mucous

Correspondence.

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half-pay,

1010 m’’mhrane of the bladder deposited as a slough in one piece." The history, also given by the catalogue, shows that the bladder was opened above the pubes by a trocar ;that the urine not flowing freely, the opening was subsequently enlarged, when the membrane escaped with much mncopurulrnt urine. Close to this preparation are four others, similar;two from malei and two from females, the latter presented by Sir T. S. Wells. It is necessary thus to explain the particulars of this case, otherwise some future diligent, cotlnctor of examples will repeat the statement that Mr. Liston operated by cyatotomy for the removal of a tumour from the b’a’ider. T

OITYB

Wimpole-street, Dec. 1st,

Sir

vnnra

1883.

nhar1i"ntlu

HENRY THOMPSON.

THE WEST LONDON HOSPITAL PREPARATORY SCHOOL OF MEDICINE AND SCIENCE. To the Editor

0/’THE LANCET. forthe liberal toneof your critical Sn:)—While thankingyou notice of the prospectus of the West London Hospital Pieparatory School of Medicine and Science, my I ask for a little space in your journal in which to allay a few apprehend ma which may be troubling others besides yourself. First,withregard to the science teaching not being entirely in the hands of specialists. What are the facts ? Why, that the lecturers on zoology and botany, and -the demonstrator of chemistry are specialists pure and simple. If, also, we have a lecturer on chemistry who is a practical physician, he is also a practical chemist who highly distinguished himself in chemistry in the science schools at Oxford. I am sure there are many people who will acknowledge a certain advantage in the fact of such a person taking a share in teaching chemistry There to students intended for the medical profe-siun. remaios only the lecturer on mechanical and natural phIlosophy. Though a surgeon, he is also a university graduate, and he is prepared to resign the office of teacher of the above-named subjects as soon as the managing committee of the school have had time to find out a first-class successor, more of a specialist in natural philosophy, &c. Secondly, with regard to the science teachings not being likely to be thoroughly practical. This impressIOn must be due to the fact that no mention is made of laboratory work. In truth, we have to build laboratories ; but the nece-sary steps preliminary to such an undertaking are being, and have been for some time, very actively taken, and before the time arrives when they will be needed they will he ready. It must be well known that it is not the custom for medical students to commence with labotatory work. With regard to zoology and botany, the names of Dr. Garson and Mr. Boulger will be sufficient to assurd all who know them that their pupili will receive no mere theoretical instruction. In order to allay any fear that may be felt of the students being too much occupied with such subjects as medicine, surgery, and the like, I beg to particularly point out that the classes on all such subjects will take place only once a day-namely, each afternoou at 4 r.M., exclusive of Satarday. Please "note that it is expressly stated in the prospectus will be purely elementary, being, in fact, that these adapted to excite an intelligent interest in, and to give a general idea of, hospital practice." Though elementary, they will not be shams. It will amount to this, that a number of experienced teachers will devote themselves to the task of doing systematically what, in the case of the provincial iniirmaries to which you refer, is done more or less irregularly and imperfectly by overworked bouse-surgeons. Personally I have had as large and varied an experience of provincial hospitals as, I believe, anyone in the profession, and I hope I shall be excused for speaking plainly on this point. I quite agree with you that pupilage at a provincial infirmary is probably the best mode of initiation into medical studentship at present. But I hope a careful consideration of the virtues and defects of this plan has lead the staff of the West London Hospital to device a still better for use in the future.-I am, Sir, yours obediently, C. B. KEETLEY, Secretary to the School. Dec. 1883. _

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-’-Mr. Keetley evidently agrees with us that practical scientific teaching must be more fully developed in a " preparatory medical school " than was in evidence in the West London Hospital prospectus. "-ED. L

DEATHS FROM ERYSIPELAS AFTER VACCINATION. To the Editor of THE LANCET. weeks past the medical papers have reSu:,—For of erysipelas following vaccination, in c 18e3 several ported A short account some instances the children having died. of the following cases, which came under my observation in the month of October last, and which all occurred at the same time, may probably be of some interest to those engaged as public vaccinators :On Uct, 2nd I vaccinated seven children, whose agea varifd from three to eight months. All the children were vaccinated from the same lymph out of the same tube, and from the same child I had previously vacciuated between seventy and eighty children without any unpltasmt results. The chitdren of A, B, and C, of the seven vaccinated on Oct. 2nd, presented symptoms of eryaipelitous inflammation about the vaccine mal ks on the twelfth, thirteenth, and fourteenth days afterwards. A, whose first symptoms appeared on the fourteenth day, apeedily recovrre i, B, whoo symptoms appeared on the thitteenth day, is now recovering and able to go out of doors; aud C, whose symptoms were set up on the twelfth day, had a very violent attack, the hjmmmation spreading to the cheat, abdomen, left let, and leftside of head and face, thecae terminating fatally on Oct. 23rd. The remaining four children never had the least unplea. sant symptom, there being very little irritation about the marks. The sanitary surroundings in the cse of two of the children, A and C, and who were next-door neighbours, were far from being satisfactory, and there were cases of erysipelas and diphtheria in the town at the time. Upon inquiry I found that the clothes worn by the three children had been washed with a certain kind of soap, and the clothes of the remaining four children had been washed with the regular washing soap, and the irritation iu all the cases began as an eczematous rash in the vaccinated arm. I was led to the inquiry as to the kind of soap used from the fact that on the 14th of October a washerwoman presented her. self at my surgery with both her arms up to the shoulders one mass of ioflammation, having the same peculiar appearance, and upon inquiry I found she had for the first time in her life washed a whole day with the same kind of suap. I have on previous occasions had trouble after vaccination, and I have been able to trace it, in my opinion, to the clothes having been washed with the same kind of soap, and I have been in the habit of cautioning parents not to use that soap to children’s clothes. It is possible others may have had similar cases, and it would be interesting to know their experience. I remain, Sir, yours truly, PHILIP S. FENTEM, M.D. Bakewell, Nov. 23tb, 1883. some

PHILIP S.

HOSPITAL SATURDAY FUND. To the Editor of THE LANCET.

SiR,—Justice me

to this movement will, I am sure, secura for space in your columns to reply briefly to one or two

serious, although doubtless u.ninttniona.1, misstate ment3 made in your last issue. You state : ’’We hive taken little trouble to inquire iatt the facts." Since we have every ds’ to submit the 1’caZ facts of the movement, as shown by the rdcord, in thi-< «m;e, wa are the more surprised to find that in almost every particular the writer of the article should be so wide of the mark, Inquiry has certaiuly not been made at the proper source. In impugning the figures of Mr. Hamilton Hoare, the writer has thought proper ’o ignore entirely the work of the last twelve months, during which time the amount collected has been considerably larger, and the expenses less than in any former year. Every trienof the movement regrets that in former years the expenses were so heavy, but we claim that at the present time our percentage of expenditure will compare favourably with nnny of the best managed of the London charities. In criticising our work it must not be forgotten that during each year many thousands of letters of recommendation are distributed through our collectors in the various workshops to those needy and deserving cases with which as working men they are brought face to face, the Fund being able to