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CHOLERA MALIGNA.
457 THE LANCET report, and justified the censure conveyed therein against the sanitary authority of Windsor for neglecting to provide a hospital for infectious cases. I am,
Sir,
yours
COLLINS, M.D.
Late Surgeon, 23rd, 1885.
To tlte Editor
and the to fight the battle all alone, but that many who think with him will give some expression to their thoughts. The remedies suggested by the Rev. Arthur Robins are for the good of the neighbourhood, and he deserves the thanks, not only of the Court and the town, but of the country. I am, Sir, yours faithfully, A RESIDENT OF WINDSOR. August 31st, 1885.
faithfully, W. M.
Cluny Castle, Aberdeen, Aug.
Windsor, and pronounced that Mr. Robins ia right, Corporation wrong, I hope that he will not be left
of THE
Royal Horse Guards.
LANCET.
Sin,-As you have permitted Mr. Robins and your special jeorrespondent to repeat with increased emphasis charges affecting my own reputation, I must ask you in courtesy to ’,
permit me briefly to
answer
them.
The accusation which is now most vehemently insisted upon is that I have refused to condemn certain houses in South-place as unfit for habitation; and, indeed, my gentle critic (who very properly protests against the use of strong language) finds in that refusal evidence of ’’appalling" immorality. But the question is a judicial one, and my opinion is that a court of justice would not order such houses to be demolished. These ten cottages are built against a dead wall (surrounding a garden); but they are only one room deep. They are in a tolerably good state of repair, and every room has a fireplace and a sash window. The closets, ashbins, and washhouse, of which they have the right of use, are situated in a yard at the opposite side of the court. Defective these houses certainly are, but I cannot pronounce them to be dangerous to health. Indeed, there is no evidence that the health of their inhabitants has, in fact, suffered. Another charge is that of neglect in not causing the water of all privte wells in the town to be periodically analysed at the public expense. It must be remembered that most of these wells belong, not to the cottages, but to the houses ef the well-to-do class; and also that it is not suspected that sickness has resulted from the use of impure water. Why should ratepayers, who are themselves content to buy pure water, be taxed for the benefit of their neighbours who choose to incur risk in avoiding that expense ? The sugges-
tion is
a
preposterous one.-I
am,
Sir,
Your obedient servant, EDS’_1RD CASEY. EDWARD Park-street, Windsor, August 31st, 1885.
To the Editor
of THE LANCET. SiR,-I am thoroughly acquainted with the town of Windsor, having lived in the neighbourhood all my life, and know every corner of its slums, and can testify to the truth and impartiality displayed by your Commissioner in the report of his investigations. The insanitary condition of the dwellings of most of the poor renders them always liable to epidemics of one kind or another. Were the cholera to visit us, it would in all probability settle, as it did before, in the Bier-lane district, the lower part of which is subject to floods, as well as other defects pointed out by your Commissioner, and this locality is not a hundred yards from that part of the Castle known as the Curfew Tower. What would our Corporation, now so dull to all remonstrances, say about their vanishing trade then, under the effects of a visitation of cholera ? The prevention so far as human agency is concerned is in their hands, and the time for action is the present. I remember some years ago that the Court was kept from Windsor by an epidemic of smallpox in Bier-lane, and that a regiment of household cavalry was ordered to remain in London, as Windsor was on that occasion considered an infected place. When the Blues were last quartered here there was a case of small-pox in the regiment, and for the want of a hospital for contagious diseases this case could not be "isolated," and so great was the deficiency considered, that the Foot Guards had to supersede the Blues, and take over their duties at the Castle lest the household there should suffer from contagion. But enough has been said and written to convince the public that the homes of the Windsor poor are for the most part, as you point out, a shame and a scandal. To get rid of this disgrace and danger one man, the Rev. Arthur Robins, has struggled for years with all his might, despite the obloquy and abuse thrown upon him. I always knew he would win, but now that THE LANCET’S Special Commissioner has visited
CHOLERA
MALIGNA.
To the Editor of THE LANCET. SiB.—For safe criticism, accuracy and impartiality are ’ ’ indispensably necessary. It will not, I think, be difficult to show that Mr. Purvis fails in the former, andM.R.C.S.E., L.R.C.P. Ed.," in the latter qualification, in their communications of Aug. 22nd. In the first paragraph of his letter Mr. Purvis says that I have " brought forward several theoretical considerations to bear out what 1 consider to be the line of treatments in Asiatic cholera." Such a statement is, I consider, incomplete, and therefore inaccurate. My " theoretical considerations " are backed, first, by successful practice in one case out of many recorded; and, secondly, by a description of the acknowledged action of the drugs recommended as serviceable, in pathological conditions known to bear a similarity to those present in the disease. It needs no argument to that, if the two diseases referred to differ only in point of severity, remedies which are successful in the one must prove of use in the other. But Mr. Purvis should be aware that his simple assertion to the contrary is no proof. Again, it is difficult to see how they can be " quite distinct from each other " when they have " many clinical features in common." I again assert that they differ only in degree. What evidence is there to the contrary ? Passing to the second paragraph ot his letter, Mr. Purvis is inaccurate in stating that I consider opium harmful in the early stages of cholera. I have not said so. I have compared opium with chloral, and found the latter safer, because it causes less depression. A sedative is needed; morphia will answer; but to go beyond prescribing half a grain in twelve hours is to incur the risk of cardiac depression from the remedy, whilst chloral and belladonna can be given with safety. I reported a case of English cholera last year in THE LANCET in which a cure was rapidly effected with morphia, ammonia, and carbolic acid in an ordinary effervescing mixture. Mr. Purvis "knows of no remedy which can stay the progress of the disease when the stage of collapse has set in." I venture to hope that my formula may be of some service in that direction. But Mr. Purvis has not spoken, as I hoped someone would do, more particularly about opium. What proof have we that it is ever a cardiac stimulant ? If it should be positively demonstrated by experiment that it has only depressant properties - navy, if it should only be recognised as a doubtful stimulant of the heart,-its use would become contra-indicated in such diseases as pneumonia and cardiac debility, in which, I should as in many others, it is now regularly prescribed. like the matter tested by those engaged in experimental research, for it is, to my mind, one of immense importance. As for M.R.C.S.E., L.R.C.P. Ed.," the stamp of impartiality is so plainly absent from his communication that it needs no special comment for its indication. What evidence is there, though, that the painless looseness of the bowels, lasting from a few hours to several days, is not ordinary diarrhoea which predisposes to attacks of cholera proper? Such cases are, in my opinion, much more rapidly checked by ammonia and carbolic acid, with either morphia, opium, or chloral in small doses, than by acids and opium. There can be no true cholera, be it English or Asiatic, without
prove
vomiting.
paragraph of
his communication is simply cardiac depression in cholera," not even in the stage of collapse, " M.R.C.S.E., L.R.C.P. Ed. will, I think, find few to believe. The salts of ammonia have been tried by him, and found " next to useless." Carbolic acid has been found by him to haveno appreciable effect." After this ruthless dismemberment of my prescription, " M.R.C.S.E., L.R.C.P. Ed." feels justified in finding that "Asiatic cholera is a disease for which no specific has The second
astonishing.
That there is
no
458
yet been discovered, hence the thousand and one drugs advertised for its cure." But where is the chloral? where the mixture of ammonia, belladonna, chloral, and carbolic acid ? and where the evidence that, when a thousand and one remedies have been tried and found wanting, the thousand and second shall not prove equal to the occasion ? Neither Mr. Purvis nor " M.B.C.S.E., L.R.C.P.Ed." has said anything about my argument that, as acids have a direct astringent action upon the blood, which in cholera is already so viscid as to be almost devoid of flowing power, they should be avoided in all stages of the disease. I use ammonia with small doses of opium or morphia and carbolic acid (in twograin doses) in all ordinary cases of acute diarrhoea, and with better results than with sulphuric acid. I am inclined to think, therefore, that the good done is not so much due to the acid as to the opium in the mixture referred to. Trusting that the opium and morphia question may be more fully taken up by the champions for what they in all terrible earnestness believe to be their stimulant properties, I am, Sir, yours faithfully, C. R. ILLINGWORTH, M.D.Ed. August, 1885. as
difference. Under the former rule a Surgeon-Major, LM.S.m drew the rates of pay drawn by a Surgeon-Major, A.M.D., but under the "correction" rule, even when holding a permanent charge, he draws less pay than a Surgeon-Major, A.M.D., if they are both above fifteen years’ service. The subjoined table of rates of pay of the two services shows that the grievance increases by length of service, instead of diminishing. Why such an invidious distinction should be made I do not know; but I trust, Sir, you will bring to notice this grievance of Surgeon-Majors, I.M.S., and advocate its removal as successfully as you did that of the surgeons.
INCISION FOR THE RADICAL CURE OF HYDROCELE. To the Editor of THE LANCET.
SiR,--T see in THE LANCET for July 4th, 1885, that 12r. Bellamy advises the method of incision, in place of
NORTHERN
Edward
and injection, for the radical cure of hydrocele. I to see that British as well as American surgeons are at last beginning to realise that this plan is both less painful and more certain in results than the iodine or any other injection. I desire in this communication, should you think it worthy of publication, to once more solicit the attention of my confreres to this fact, by fully endorsing Mr. Bellamy’s remarks, and offering the following statement of my own extended experience in confirmation thereof. Since 1867 I have been teaching clinical surgery in the wards of the Charity Hospital of this city. I have treated every case of hydrocele coming to my wards during that period by incision, and I cannot recall a failure to effect a radical cure. My technique is almost the same as that
(From
tapping am
COUNTIES
our own
NOTES.
Correspondent.)
glad
advised by Mr. Bellamy-namely, a simple incision through the whole front wall of the sac, washing with carbolic acid, placing in a drainage-tube, and stuffing with lint saturated with carbolised oil, (1 part to 12). We differ only in my using the drainage-tube to secure prompt escape of the serous weeping, which is certain to occur early after operations involving serous surfaces. I am, Sir, yours faithfully,
SAMUEL LOGAN, M.D.,
New Orleans,
Emeritus Prof. Anat. and Clin. Surg. Med. Aug. 13th, 1885. Tulane Univ., New Orleans.
"UNEMPLOYED
Depart.,
PAY."
To the Editor of THE LANCET. SiB,—Last year the grievance of "unemployed pay" drawn by officers of the I.M.S. being less than the rates drawn by officers of the A.M.D. was brought to the notice of Parliament, and redress was promised. Accordingly, on Feb. 6th last a Special India Army Circular, as follows, was issued:-"Under instructions from Her Majesty’s Government, the Governor-General in Council is pleased to notify that in future an officer of the Indian Medical Service, when holding no specific appointment, will be allowed the rates of pay drawn by officers of the Army Medical Department. When holding an appointment, permanent or acting, he will draw either the consolidated pay fixed for that appointment, or unemployed pay (to be designated in future ’grade pay’) with full or half staff salary or charge allowance, under existing rules, provided the total be not less than the grade pay laid down in Article 301, Army Regulations, India, vol. i., part 1." The grade pay in Article 301 is the "unemployed pay" which constituted the grievance brought to the notice of Parliament last year. This order remained in force until the 20th May last, when another Special India Army Circular, as follows, -was issued :-" The following correction is made in Clause 16, India Army Circulars, 1885: For the wordsan "officer,’ in lines 2 and 3, substitute the words ’a surgeon."’ This makes a great
WASHINGTON HALL AS A CONVALESCENT HOME.
THE munificent gift of Sir Lowthian Bell of his late house and grounds at Washington, to be used as a convalescent home for our city, has come upon us as a great and agreeable surprise, and also, it must be admitted, at a time when it was much needed. I have, in previous letters mentioned the want for our city and district of an inland convalescent home, the magnificent institution at Whiteley being at some periods of the year not adapted for many classes of cases, while at others-the present time for instance-all its vast accommodation is called into requisition. Some doubts having been expressed as tm the salubrity of Washington, a large employer of labour writes to say, that among some hundreds of his workpeople, over whom he exercises the strictest personal supervision in sanitary matters, what are considered as epidemic diseases are almost invariably confined to single houses, where the original cases have been traced to the towns, and that there is an almost entire absence of chronic disease. In the district of Barmston, surrounding the Washington Chemical Works, the death-rate is 16 per 1000 ; and Washington is said to be the third driest place in England. In addition to this, the hall and grounds are so well sheltered that invalids and children might venture out in the severest weather. YORK EYE INSTITUTION.
At the annual meeting of the York Eye Institution, held on the 27th ult., it was stated that the number of new patients for the past year had been 774, being above the average of the last few years. The operations had been eighty-six. The financial state of the institution was also satisfactory. A vote of thanks was passed to Dr. Anderson for his valuable services, and also to the Nursing Institution for aid rendered by a supply of skilled nurses at a very reduced cost. CURIOUS CHOKING
CASE AT THE
NORTH
RIDING ASYLUM.
An inquest was held upon an inmate of the North Riding Lunatic Asylum, who died very suddenly from choking. The man was fifty years of age, and was insane and paralysed from intemperance. Although his food was minced, he had managed to seize and conceal some cut meat as he was passing to the dining-room. When he sat down to, dinner he was immediately seized with choking, and although the house-surgeon was soon on the spot, he found the At the post-mortem a piece of mutton weighing man dead. one ounce was found completely wedged in the glottis. A SAD CASE.
few weeks ago a little boy, aged nine years, by name Joe S-,was admitted into the Newcastle Infirmary A
Sir,
yours
COLLINS, M.D.
Late Surgeon, 23rd, 1885.
To tlte Editor
and the to fight the battle all alone, but that many who think with him will give some expression to their thoughts. The remedies suggested by the Rev. Arthur Robins are for the good of the neighbourhood, and he deserves the thanks, not only of the Court and the town, but of the country. I am, Sir, yours faithfully, A RESIDENT OF WINDSOR. August 31st, 1885.
faithfully, W. M.
Cluny Castle, Aberdeen, Aug.
Windsor, and pronounced that Mr. Robins ia right, Corporation wrong, I hope that he will not be left
of THE
Royal Horse Guards.
LANCET.
Sin,-As you have permitted Mr. Robins and your special jeorrespondent to repeat with increased emphasis charges affecting my own reputation, I must ask you in courtesy to ’,
permit me briefly to
answer
them.
The accusation which is now most vehemently insisted upon is that I have refused to condemn certain houses in South-place as unfit for habitation; and, indeed, my gentle critic (who very properly protests against the use of strong language) finds in that refusal evidence of ’’appalling" immorality. But the question is a judicial one, and my opinion is that a court of justice would not order such houses to be demolished. These ten cottages are built against a dead wall (surrounding a garden); but they are only one room deep. They are in a tolerably good state of repair, and every room has a fireplace and a sash window. The closets, ashbins, and washhouse, of which they have the right of use, are situated in a yard at the opposite side of the court. Defective these houses certainly are, but I cannot pronounce them to be dangerous to health. Indeed, there is no evidence that the health of their inhabitants has, in fact, suffered. Another charge is that of neglect in not causing the water of all privte wells in the town to be periodically analysed at the public expense. It must be remembered that most of these wells belong, not to the cottages, but to the houses ef the well-to-do class; and also that it is not suspected that sickness has resulted from the use of impure water. Why should ratepayers, who are themselves content to buy pure water, be taxed for the benefit of their neighbours who choose to incur risk in avoiding that expense ? The sugges-
tion is
a
preposterous one.-I
am,
Sir,
Your obedient servant, EDS’_1RD CASEY. EDWARD Park-street, Windsor, August 31st, 1885.
To the Editor
of THE LANCET. SiR,-I am thoroughly acquainted with the town of Windsor, having lived in the neighbourhood all my life, and know every corner of its slums, and can testify to the truth and impartiality displayed by your Commissioner in the report of his investigations. The insanitary condition of the dwellings of most of the poor renders them always liable to epidemics of one kind or another. Were the cholera to visit us, it would in all probability settle, as it did before, in the Bier-lane district, the lower part of which is subject to floods, as well as other defects pointed out by your Commissioner, and this locality is not a hundred yards from that part of the Castle known as the Curfew Tower. What would our Corporation, now so dull to all remonstrances, say about their vanishing trade then, under the effects of a visitation of cholera ? The prevention so far as human agency is concerned is in their hands, and the time for action is the present. I remember some years ago that the Court was kept from Windsor by an epidemic of smallpox in Bier-lane, and that a regiment of household cavalry was ordered to remain in London, as Windsor was on that occasion considered an infected place. When the Blues were last quartered here there was a case of small-pox in the regiment, and for the want of a hospital for contagious diseases this case could not be "isolated," and so great was the deficiency considered, that the Foot Guards had to supersede the Blues, and take over their duties at the Castle lest the household there should suffer from contagion. But enough has been said and written to convince the public that the homes of the Windsor poor are for the most part, as you point out, a shame and a scandal. To get rid of this disgrace and danger one man, the Rev. Arthur Robins, has struggled for years with all his might, despite the obloquy and abuse thrown upon him. I always knew he would win, but now that THE LANCET’S Special Commissioner has visited
CHOLERA
MALIGNA.
To the Editor of THE LANCET. SiB.—For safe criticism, accuracy and impartiality are ’ ’ indispensably necessary. It will not, I think, be difficult to show that Mr. Purvis fails in the former, andM.R.C.S.E., L.R.C.P. Ed.," in the latter qualification, in their communications of Aug. 22nd. In the first paragraph of his letter Mr. Purvis says that I have " brought forward several theoretical considerations to bear out what 1 consider to be the line of treatments in Asiatic cholera." Such a statement is, I consider, incomplete, and therefore inaccurate. My " theoretical considerations " are backed, first, by successful practice in one case out of many recorded; and, secondly, by a description of the acknowledged action of the drugs recommended as serviceable, in pathological conditions known to bear a similarity to those present in the disease. It needs no argument to that, if the two diseases referred to differ only in point of severity, remedies which are successful in the one must prove of use in the other. But Mr. Purvis should be aware that his simple assertion to the contrary is no proof. Again, it is difficult to see how they can be " quite distinct from each other " when they have " many clinical features in common." I again assert that they differ only in degree. What evidence is there to the contrary ? Passing to the second paragraph ot his letter, Mr. Purvis is inaccurate in stating that I consider opium harmful in the early stages of cholera. I have not said so. I have compared opium with chloral, and found the latter safer, because it causes less depression. A sedative is needed; morphia will answer; but to go beyond prescribing half a grain in twelve hours is to incur the risk of cardiac depression from the remedy, whilst chloral and belladonna can be given with safety. I reported a case of English cholera last year in THE LANCET in which a cure was rapidly effected with morphia, ammonia, and carbolic acid in an ordinary effervescing mixture. Mr. Purvis "knows of no remedy which can stay the progress of the disease when the stage of collapse has set in." I venture to hope that my formula may be of some service in that direction. But Mr. Purvis has not spoken, as I hoped someone would do, more particularly about opium. What proof have we that it is ever a cardiac stimulant ? If it should be positively demonstrated by experiment that it has only depressant properties - navy, if it should only be recognised as a doubtful stimulant of the heart,-its use would become contra-indicated in such diseases as pneumonia and cardiac debility, in which, I should as in many others, it is now regularly prescribed. like the matter tested by those engaged in experimental research, for it is, to my mind, one of immense importance. As for M.R.C.S.E., L.R.C.P. Ed.," the stamp of impartiality is so plainly absent from his communication that it needs no special comment for its indication. What evidence is there, though, that the painless looseness of the bowels, lasting from a few hours to several days, is not ordinary diarrhoea which predisposes to attacks of cholera proper? Such cases are, in my opinion, much more rapidly checked by ammonia and carbolic acid, with either morphia, opium, or chloral in small doses, than by acids and opium. There can be no true cholera, be it English or Asiatic, without
prove
vomiting.
paragraph of
his communication is simply cardiac depression in cholera," not even in the stage of collapse, " M.R.C.S.E., L.R.C.P. Ed. will, I think, find few to believe. The salts of ammonia have been tried by him, and found " next to useless." Carbolic acid has been found by him to haveno appreciable effect." After this ruthless dismemberment of my prescription, " M.R.C.S.E., L.R.C.P. Ed." feels justified in finding that "Asiatic cholera is a disease for which no specific has The second
astonishing.
That there is
no
458
yet been discovered, hence the thousand and one drugs advertised for its cure." But where is the chloral? where the mixture of ammonia, belladonna, chloral, and carbolic acid ? and where the evidence that, when a thousand and one remedies have been tried and found wanting, the thousand and second shall not prove equal to the occasion ? Neither Mr. Purvis nor " M.B.C.S.E., L.R.C.P.Ed." has said anything about my argument that, as acids have a direct astringent action upon the blood, which in cholera is already so viscid as to be almost devoid of flowing power, they should be avoided in all stages of the disease. I use ammonia with small doses of opium or morphia and carbolic acid (in twograin doses) in all ordinary cases of acute diarrhoea, and with better results than with sulphuric acid. I am inclined to think, therefore, that the good done is not so much due to the acid as to the opium in the mixture referred to. Trusting that the opium and morphia question may be more fully taken up by the champions for what they in all terrible earnestness believe to be their stimulant properties, I am, Sir, yours faithfully, C. R. ILLINGWORTH, M.D.Ed. August, 1885. as
difference. Under the former rule a Surgeon-Major, LM.S.m drew the rates of pay drawn by a Surgeon-Major, A.M.D., but under the "correction" rule, even when holding a permanent charge, he draws less pay than a Surgeon-Major, A.M.D., if they are both above fifteen years’ service. The subjoined table of rates of pay of the two services shows that the grievance increases by length of service, instead of diminishing. Why such an invidious distinction should be made I do not know; but I trust, Sir, you will bring to notice this grievance of Surgeon-Majors, I.M.S., and advocate its removal as successfully as you did that of the surgeons.
INCISION FOR THE RADICAL CURE OF HYDROCELE. To the Editor of THE LANCET.
SiR,--T see in THE LANCET for July 4th, 1885, that 12r. Bellamy advises the method of incision, in place of
NORTHERN
Edward
and injection, for the radical cure of hydrocele. I to see that British as well as American surgeons are at last beginning to realise that this plan is both less painful and more certain in results than the iodine or any other injection. I desire in this communication, should you think it worthy of publication, to once more solicit the attention of my confreres to this fact, by fully endorsing Mr. Bellamy’s remarks, and offering the following statement of my own extended experience in confirmation thereof. Since 1867 I have been teaching clinical surgery in the wards of the Charity Hospital of this city. I have treated every case of hydrocele coming to my wards during that period by incision, and I cannot recall a failure to effect a radical cure. My technique is almost the same as that
(From
tapping am
COUNTIES
our own
NOTES.
Correspondent.)
glad
advised by Mr. Bellamy-namely, a simple incision through the whole front wall of the sac, washing with carbolic acid, placing in a drainage-tube, and stuffing with lint saturated with carbolised oil, (1 part to 12). We differ only in my using the drainage-tube to secure prompt escape of the serous weeping, which is certain to occur early after operations involving serous surfaces. I am, Sir, yours faithfully,
SAMUEL LOGAN, M.D.,
New Orleans,
Emeritus Prof. Anat. and Clin. Surg. Med. Aug. 13th, 1885. Tulane Univ., New Orleans.
"UNEMPLOYED
Depart.,
PAY."
To the Editor of THE LANCET. SiB,—Last year the grievance of "unemployed pay" drawn by officers of the I.M.S. being less than the rates drawn by officers of the A.M.D. was brought to the notice of Parliament, and redress was promised. Accordingly, on Feb. 6th last a Special India Army Circular, as follows, was issued:-"Under instructions from Her Majesty’s Government, the Governor-General in Council is pleased to notify that in future an officer of the Indian Medical Service, when holding no specific appointment, will be allowed the rates of pay drawn by officers of the Army Medical Department. When holding an appointment, permanent or acting, he will draw either the consolidated pay fixed for that appointment, or unemployed pay (to be designated in future ’grade pay’) with full or half staff salary or charge allowance, under existing rules, provided the total be not less than the grade pay laid down in Article 301, Army Regulations, India, vol. i., part 1." The grade pay in Article 301 is the "unemployed pay" which constituted the grievance brought to the notice of Parliament last year. This order remained in force until the 20th May last, when another Special India Army Circular, as follows, -was issued :-" The following correction is made in Clause 16, India Army Circulars, 1885: For the wordsan "officer,’ in lines 2 and 3, substitute the words ’a surgeon."’ This makes a great
WASHINGTON HALL AS A CONVALESCENT HOME.
THE munificent gift of Sir Lowthian Bell of his late house and grounds at Washington, to be used as a convalescent home for our city, has come upon us as a great and agreeable surprise, and also, it must be admitted, at a time when it was much needed. I have, in previous letters mentioned the want for our city and district of an inland convalescent home, the magnificent institution at Whiteley being at some periods of the year not adapted for many classes of cases, while at others-the present time for instance-all its vast accommodation is called into requisition. Some doubts having been expressed as tm the salubrity of Washington, a large employer of labour writes to say, that among some hundreds of his workpeople, over whom he exercises the strictest personal supervision in sanitary matters, what are considered as epidemic diseases are almost invariably confined to single houses, where the original cases have been traced to the towns, and that there is an almost entire absence of chronic disease. In the district of Barmston, surrounding the Washington Chemical Works, the death-rate is 16 per 1000 ; and Washington is said to be the third driest place in England. In addition to this, the hall and grounds are so well sheltered that invalids and children might venture out in the severest weather. YORK EYE INSTITUTION.
At the annual meeting of the York Eye Institution, held on the 27th ult., it was stated that the number of new patients for the past year had been 774, being above the average of the last few years. The operations had been eighty-six. The financial state of the institution was also satisfactory. A vote of thanks was passed to Dr. Anderson for his valuable services, and also to the Nursing Institution for aid rendered by a supply of skilled nurses at a very reduced cost. CURIOUS CHOKING
CASE AT THE
NORTH
RIDING ASYLUM.
An inquest was held upon an inmate of the North Riding Lunatic Asylum, who died very suddenly from choking. The man was fifty years of age, and was insane and paralysed from intemperance. Although his food was minced, he had managed to seize and conceal some cut meat as he was passing to the dining-room. When he sat down to, dinner he was immediately seized with choking, and although the house-surgeon was soon on the spot, he found the At the post-mortem a piece of mutton weighing man dead. one ounce was found completely wedged in the glottis. A SAD CASE.
few weeks ago a little boy, aged nine years, by name Joe S-,was admitted into the Newcastle Infirmary A