DEATH UNDER CHLOROFORM.

1158 crest between the real times. An impartial résumé of the many theories of dreams is given by Dr Sully in the article - on " Dreams " in the Encyclopœdia Britannica, and also in

the work on "Illusions"(International Science Series) by the same author. I may here say that the physiological theory there given completely accounts for all the phenomena -of dreams except their visual aspect, or what Wundcalls " the light chaos." In your second volume for 1889 I suggested that the visual aspect was due to actual light being more or less perceived by the intellect during the - sleeping state. That there is actual light developsd in the - body at all times is certain from the physical transformations of energy taking place, and from the presence of phosphorised fats, whether in the blood-corpuscles, nerve tissue, or brain substance. The chemistry of thee phosphorised fats, which is very complex, can be studied in Dr. Thudichum’s "Physiological Chemistry of the Brain," and also in a most interesting address on the cerebro spinal ’system in the last number of the Asclepiad. Dr. Sully ,describes a dream he once experienced after trying to fall - asleep by counting. The numbers took on visual form, and he saw them coming in endless procession, knocking and jostling against each other in moso grotesque and comical fashion. Were these blood-corpnscles actually seen and mistaken for the numbers with which the mind had been

,engaged a

moment

previously ?

I am, Sirs, yours faithfully,

)elumsteaci, May 11th,

1892.

FRANCIS EDWARD CANE.

THE ASSOCIATION OF MEMBERS OF THE ROYAL COLLEGE OF SURGEONS. To the Editors

of THE LANCET. SIRS,-Mr. W. G. Dickinson, in his letter publiehed in your issue of the 14th inst., employs an expression "took offence " which, as applied to myself, scarcely meets the case. Will you tberetore permit me to say that in my letter of resignation, dated April 15th, I stated that "II declined to forward to any professional man so insulting a .communication"" as that passed, in the unavoidable absence of both Dr. Steele and myself, on April 12th, and received by me for transmission to the solicitor on April 14th ? This

was one of my two immediate reasons, and I should again decline to forward, for any body of men, to any professional man a resolution that he be ’’forth with informed that his services are no longer required." How would Mr. Dickinson regard such a proposal if the gentleman whose "services were no longer required " were himself and the dismisser a .patient? Moreover, as to the plea of the committee’s " desiring to ascertain the extent of their liability as soon as possible," they had already, at a meeting at which the solicitor was present, on April 6oh-i.e., only six days previously-requested him to forward his bill of costs to one of themselves as soon as feasible, and did not then breathe

to this prospective curb dismissal. Declining, to forward the resolution of April 12th, my resignation followed as a matter of course; fjrlI did not wish the committee to be placed in the painful position of having to deal with a rebellious secretary. My other decisive reason, which I also stated in my letter of resignation, was that I strongly objected to the manner in which the Assoa

word

as

therefore,

Mr. Dickinson now having publicly occupied himself with the question of the recent changes in the officering of the Association, perhaps he will go a little fnrbher and induce the Central Committee to assemble and officially ieceive the month-old resignation of two honorary SEcretaries who have served that body for over seven years. I am, Sirs, your obedient servant, W. A. ELLIS. Late Honorary Secretary of the Association of Members of the Royal College of Surgeons of England. May 18th, 1892.

THE NEW CURRICULUM AND THE SCALE OF FEES. To the Editors

of THE LANCET. SIRS,-Rumour has many tongues, and not all of are truthful. It would be interesting to know what

them truth there is in the rumour that when the new prospectuses of the eleven London schools for the coming session are issued it will be found that there is the same wretched underbidding of each other in the matter of fees for medical education as in the years gone by. We all know that in view of the five years’ curriculum there have been meetings of the deans to consider the question of fees, and that there has been a widespread feeling that the opportunity should not be lost of raising the London fees to something like an adequate sum, and at the same time also of putting the fees of all the schools on an equal footing. Is it true, how. ever-is it possible-that this excellent scheme has been frustrated by the action of one of the smaller schools, by one which surely ought to have known better, by independently and, it is said, irrevocably fixing its new scale of fees at a contemptibly small increase upon that of last year ; that others of the smaller schools feel it in the circumstances impossible to raise their fees to the sum which they had wished, and which had been advocated and will be adopted by the large schools ; and that yet ethers of the schools are even descending still lower, and are proposing an addition to their fees, already too low, which is simply ridiculous? I name no names and no amounts, but if rumour be true we shall have three various and unmeaning scales of fees in force at our eleven London sshools, instead of one and the same at all of them, for which many had wished, and for the consummation of which a unique opportunity had at length arisen. Is it too late even now for the deans to arrange and finally settle that we, the constituents of the one great school of medicine in London, shall act together and in unison, that we shall raise the fees for medical education to a scale somewhat commen. surate with those of other professions, and that an era shall be begun when the various schools will show that they individually seek to attract students by the quality of their teaching, rather than by the deplorable system of under. bidding which to many of us is disgusting in the last degree ? I am, Sirs, yours faithfully, ULIM DECANUS. May llth, 1892.

DEATH UNDER CHLOROFORM. To the Editors of THE LANCET. ciation’s Minute-book had been obtained and subsequently withheld from its lawful custodian, myself, the acting SIRS,-A case of death under the inflaence of chloroform secretary. having unfottunately occurred here, I think ib right to With regard to the resignation of my colleague, Dr. Steele, report it. A boy aged eleven years was recommended to I hear from him that the grounds stated by Mr. Dickinson have adenoid growths removed from his naso-pharynx. He formed buu a portion of the reasons which influenced Dr. was a pale, aneemic child, with no disease of lungs or heart. Steele in forming his decision, although anxious to assist He had been told to have nothing to eat after his breakfast the committee in any possible way, and that he likewise de- at 7.30 A.M. on the 14h ult. (being an out patient); and at clined to forward to the solicitor the resolution above referred 1.15 P.M. I was asked to give ch!oroform. H6 took it to. Mr. Taib was naturally informed by me of the above slowly, not breathing well, but with no difficulty or chapter of events, and this is probably one, but by no means struggling. His pupi!s being slightly contracted, and the - the " sum total," of the matters to which he alludes; though cornea insensitive, the operation ior removal of the neither the solicitor, nor my co-secretary, nor myself was growths, by Loëaberg’s forceps, was commenced. There aware of his intention to write you, until, in common with was not much haemorrhage or coughing, and the operaall your readers, we saw his letter in your columns of the tion was just finished. While spongirg out the pharynx, ’7th inst. Ib is no doubt a compliment to Mr. Lawson Tait however, the respiration was noticed to stop for a second, that his " advice" should be considered by Mr. Dickinson bat commenced again, there being slight cyanosis about the tro have outweighed the better judgment of the rest of the eyes, though the lips remained of good colour. The gag was Committee, but ib now appears to be met by them with a at once removed. The pulse was imperceptible. Onausculrecognition as marked as that shown to their other tating the chesb no heart sounds were audible, though the advisers.

breath sounds could be well heard and air

was

entering

1159 on his behalf the threatened process and entering appearance, and preliminarily investigating the matter the doctor concerned is saved great expense and anxiety. head. Partial inversion of the child was tried, and arti- Thirdly, the mere receipt of an offiei%l letter in reply to the ficial respiration was continued for three quarters of as threat of proceedings in blackmailing cases (which are more hour. The breathing having ceased some minutes after frequently of occurrence than would be imagined) generally stoppage of the pulse, the child gave only one or two short prevents further action being taken. The blackmailer seeks gasps and showed no more signs of life. The chloroform 00 isolate and terrify his intended victim; and the facts. used was that manufactured by Macfarlan and Co., and the that he has taken counsel with others, and that the would-be quantity given was only two drachms, the administra- blackmailer finds that he has to deal, not with one person, The but with a powerful association, like the Medical Protec. tion having lasted but from five to ten minutes. portion remaining in the bottle has been sent to Professor tion Society, having its head-quarters in London, and assoRamsay, of University College, for analysis. My colleague, ciated with some of the most eminent London and provincial Mr. H. G. G. Cook, the house surgeon, performed the opera. practitioners, are almost certain to make the attacker stop tion. An inquest was held, and the jury returned a verdict proceedings. I have seen great evils arise from cases being tried in, of "Accidenual death from syncope during the administration of chloroform." Unfortunately a post mortem country towns. I hope our council will decide, whenever it examination was not obtained, the coroner not having is possible, to have country cases in which our society is interestEd dealt with in the London Courts, where the attendordered it to be performed. I am, Sirs, yours truly, ance of experts would be easy to obtain, and, what is most R. C. M. COLVIN SMITH, M.B., B.C. Cantab. important, all local influence and feeling would be excluded. Victoria Hospital, Uhelsea, Mlay 18th, 1892. Starving the defence is a very bad policy; that error, I am sure, our council will not fall into. In one case within my cognisance a respected practitioner, owing to these two’ causes--local prejudice and the absence of experts,-was THE INTERIM REPORT OF THE VACCINATION mulcted in costs &n. amounting to nearly 2600. I am sure that had the case been tried in London the action would COMMISSION. either have been abandoned or decided very differently. To the Editors of THE LANCET. I I am. Sirs. vours verv faithfully. GEO. B. MEAD, Hon. Sec. SIRS,-The fifth report of the Vaccination Commission May 16th, 1892. must have come as a thunderclap to those public vaccinators who have not been watching the course of events. One of your daily contemporaries to-day in a short leader says :-" The THE TREATMENT OF THE NASO-PHAEYNX. conduct of the Local Government Board in reference to this M.6 tra2tors oj THE LANCET. matter has not been wise, in advising boards of guardians after a fashion very similar to the recommendation now made the SIRS,-In very kind notice of my recently published by the Royal Commission." In regard to vaccination, the work which appeared in your columns reference is made to. Local Government Board and the public represent the devil two of considerable practical importance. Asthoseand the deep sea. I have been a public vaccinator for a who points read the review without perusal of the book may number of years, and formerly earned a respectable sum in arrive at an erroneous idea concerning my views, you will, fees and grants. I was then vaccinating by three insertions, perhaps, kindly allow me to make an explanation. Your and in every way satisfied the requirements as to the area reviewer is perfectly accurate when he writes : "...... while of foveation. A few years ago I was directed to make four he the reader the theory that affections of the impresses insertions. Afcer representing the inevitable result, I com- anterior naresupon and pharynx, when coexisting with middle plied. The attendance at most of the stations has fallen ear disease, need only be treated in so far as they are prooff, and my principal one is nearly deserted for the surgery I ducing direct symptoms." Ib has, however, appeared to, of the private practitioner who will vaccinate in two me desirable to explain that the naso-pharynx is very or even in one. If the object of the Local Government excepted from this statement (p. 567). With Board was to obtain more efficient vaccination, it has specially to the connexion between atrophic nasal catarrh and regard utterly defeated itself, as many parents, in addition to those sicca, my own experience points to the existence who paid for scanty insertions, decided against the opera- laryngitis of two varieties of the latter. One of them, the more comtion altogether, and no prosecutions followed. mon, occurs, so far as I have seen, independently of any The Local Government Board ought to have obtained an nasal affection ; while the other, less frequently met with, Act of Parliament requiring every cerbificate to state that is identical with Baginsky’s 11 ozoena laryngis,’ practically four insertions of lymph had been made, and then they described on p. 119.-I am, Sirs, yours faithfully, might have begun with the public vaccinators. In the preP. MCBRIDE. Edinburgh, May 14th, 1892. sent political situation they were too wise, no doubt, to attempb such a task. I am. Sirs. vours faithfully. PUBLIC VACCINATOR. May 12th, IF92. LIVERPOOL.

freely. Steps were at once taken to stimulate the heartamyl nitrite inhalation, injection of ether hypodermically-and hot towels were applied to epigastrium and

to receive an

..

j

places,

(FROM THE LONDON AND COUNTIES MEDICAL PROTECTION SOCIETY, LIMITED.

OUR

OWN

CORRESPONDENT.)

Hospital Saturday in Liverpool.

was observed this year as Ho&. of THE LANCET. pital Saturday. As might have been expected in so busi. SIRS,-One of the greatest legal hardships affecting ness-like a community as this] is, the committee have medical men is, that any pauper can issue a writ on the profited by past experience, and have resolved to rely more

To the Editors

triflirg of pretexts, and so put not only one of us, but any one, to great expense. Even a man with some means can harass a medical man with proceedings, bringing a case to the verge of trial, and then, by paying some £30 or £40, witbdrawirg it, probably costing the unfortunate doctor oae to two hundred pounds for unrecoverable costs. Combination has several advantages: Fitst, a protection society places, through its organisation, at the command of any medical man, for a payment of 10s. a year, a staff of skilled experts, used to dealing with all kinds of cases of difficulty, whether legal, surgical, or medical, likely to arise in the practice of his profession. Such a society reduces to a minimum the enormous expense and inconvenience caused to a man who has to leave his business and work up his defence properly. Secondly, by the society at once offering most

SATURDAY, the 14bh inst,,

upon the amounts raised by weekly or monthly contributions all the year round, in workshops and other large centres of working men, than in that raised by boxes deposited on a certain day, to be called for a few days later. The results of this latter mode of collection have been found insufficient to justify the expenditure. A concert is also to be given in St. George’s Hall on the 23rd inst., under distinguished patronage, for the benefib of the medical charities, and there is every reason to expect a " bumping house " and a substantial addition to the Hospital Sunday Fund.

Crimes of Violence. Lancashire has for years past had an unenviable reputation for crimes of violence. Some years ago it took the form of what was locally termed " purring "-i.e., kicking