- Email: [email protected]
ON THE NATURE OF PHTHISIS.
that the import of some of these " communications" was far from friendly or generous on Mr. Syme’s part towards myself. I shall, for the present, pass over various irrelevant allusions in Mr. Syme’s letter, and contentedly let them remain for their exact value. If that is to be estimated by the same standard as his observations on the subject to which my paper is devoted, it must indeed be small. He evidently does not understand the subject in discussion between my three friends and myself, and interposes a gratuitous description of the method in which Mr. Liston held his knife, for which there is no authority, either from these gentlemen or from Mr. Liston himself, who nowhere states that he held the point of his right finger against the cutting margin of the knife, even at the part where it was blunted; nor do the various illustrations to which I have objected show such an attitude. No one can overlook or mistake the spirit which pervades Mr. Syme’s letter. I have now, Sir, for seven years submitted in silence to a long list of professional calnmnies from Mr. Syme’s mouth and pen. I have been unwilling to associate my humble name with squabbles and personalities, which are discreditable alike to individuals and to the profession. I have looked with contempt upon the many opprobrious epithets which have been applied to my public professional character, from a consciousness that they were beneath my notice, and that they came from one who had quarrelled with almost every friend he ever had, and who by law, and by a jury of his fellow citizens, has been proclaimed a libeller.** In the army, when language is used "unbecoming an officer and a gentleman," short work is made with the delinquent. Why should not a similar rule apply to the medical I might call on you, Sir, to interpose your high ethical authority, when a professor talks-in language which one would had come from Kansas instead of modern Athens-of suppose " running a knife into the bowels of a living man ;" but, whatever further provocation Mr. Syme may throw in my way, I sincerely trust that no consideration will induce me to alter the course which I have hitherto followed. I have the honour to be, Sir, yours, &c., WM. FERGUSSON. George-street, Hanover-square, Nov. 1856.
profession ?
To the Editor of THE LANCET. SIR,-Mr. Fergusson, in pointing out the error in the illustration in Liston’s " Surgery," as to the mode of holding the knife in lithotomy, has performed a graceful act of gratitude and justice towards the late Mr. Liston. He has spared posterity misconception and confusion on this point, and it will now be known that the illustration exhibits the knife in a position in which Mr. Liston never held it. I cannot, however, help observing, that Mr. Fergusson, in discharging this duty, has been far more elaborate than the occasion required. I also think, Sir, it will be perceived that he has claimed for Mr. Liston a priority or originality to which he was not entitled. Mr. Fergusson says, ’’ the operation of lithotomy, as at present performed in Great Britain and the colonies, is in a great measure founded on the example and doctrines of this distinguished surgeon." Hence we might infer, that in lithotomy there was something essentially differing from common in the " examples and doctrines" of Mr. Liston ; whereas he really held the knife only as all other surgeons did, and made his incisions in the same manner. Whoever has seen the late Messrs. Key, Morgan, and B. Cooper lithotomize, must have observed that, as regards holding the knife and making the incisions, Mr. Liston’s operation did not differ from theirs. I should be sorry to be understood as wishing to detract from the fame of a surgeon so justly great as the late Mr. Liston. I am only desirous that a special merit should not be claimed exclusively for Mr. Liston, which equally belongs to all surgeons who were his contemporaries, and even to many of preceding generation. I am, Sir, your obedient servant, AN- OLD GUY’S DRESSER. London, Oct. 1856.
BLACK URINE FROM THE ADMINISTRATION OF CREOSOTE. [LETTER FROM DR. HUGHES.] To the Editor of THE LANCET. a SIR,-In postscript to my " Select Cases," including "Cases of Black Urine from the Administration of Creosote," in the last volume of the " Guy’s Hospital Reports," the following sentences occur:-" While these pages are at press, I have a *
See case, Glover
v.
Syme, in the Edinburgh papers
524
of the
day.
under my care in the hospital, in whom the urine is rendered of a black colour when boiled with nitric acid. A further analysis shows this condition to be due to iodine, and it need scarcely be said that the patient is taking this remedy internally. To a similar cause, no doubt, must be referred the dark urine in the case of enema I mentioned at page 56, who was also under the same treatment." "Time dose not allow me to put this explanation to the proof by testing the urine in other cases of patients who are taking iodine; but I have little doubt that it is the correct one - that is, that this medicine probably produces this change under certain conditions of disease." Seeing that, in a brief notice of the " Guy’s Hospital Reports" in THE LANCET of October 25th, the former of these two sentences is quoted, I think it justice to you, Sir, and to the pro- ’ fession at large, that the opinion therein expressed-an opinion derived from pretty decisive statements of one of my colleagues, and apparently supported by the fact of both of the patients having been taking iodine at the time-is a mistaken one. It is true, indeed, that urine containing iodine, by boiling with nitric acid, becomes of a dark colour; but this is an entirely different thing from the black soot-like deposit which existed in the two cases referred to. In the latter instance it soon disappeared, and never appeared again, although he continued the same medicine. The urine of several patients who were taking iodine, submitted to the same tests, did not yield a similar deposit. Upon what it did depend, I am at present in entire ignorance-an ignorance which neither the chemists nor the microscopists to whom I have applied are able to man
dispel. St.
I have the honour to Thomas’s-street, Nov. 1856.
be, Sir,
yours
respectfully, H. M. HUGHES.
ON THE NATURE OF PHTHISIS.
[LETTER
FROM DR. EDWARD
SMITH.]
To the Editor of THE LANCET. SIR,-Considering the inconceivable importance to the community of any views of the nature of phthisis which give reasonable promise of diminishing the prevalence of that disease, I venture to ask your permission to correct a few statements of my views, contained in your report of the discussion on my paper on Saturday last. 1st.-Dr. Andrew Clarke considers that my theory would make phthisis a local disease. I believe it to be so far local, that its essential action on the lungs (that without which there could be no tubercular deposition) is a lessened inspiratory action of the air-cells. But this must be due to yet anterior conditions, and in chronic phthisis I believe them to be such as act through the general system-viz., whatever tends to exhaust the system, whether by exercise or defective action of any of the bodily or mental functions, the only peculiarity, so far, in my theory is, that I consider all these universally acting causes have one common mode of inducing the disease of the lung. But from a consideration of the structure of the air-cells, their supply of nervous power, and their importance in the economy, it is highly probable that they have their own disease induced locally; and in acute phthisis, as also sometimes in chronic phthisis, there is evidence to show the high probability of a local origin. I consider that far too little is at present known of the diseases to which the air-cells are liable. 2nd.-In reply to the statement that leucothysemia, as well as an alteration in the tone of some of the discs, and certain free molecules are found in phthisis, I would reply that the nature of the disease must not be determined by its co-ordinate circumstances, but by those which always attend its origin. The blood must become changed in the course of the disease, and may be changed before the origin of it, and yet not be causative of it. Moreover, leucothysemia, if it occur, (as I think it highly probable,) would not be peculiar to a distinction of phthisis, neither would a knowledge of that fact lead to any better views of the nature and treatment of that disease. 3rd.-The coincidence of scrofula and phthisis, and the alleged interchange of the two diseases in members of the same family, would not be evidence that they were essentially the same disease, much less that they would be necessarily causative of each other. It is easy to admit that the two diseases do occur together; but it is equally easy for me to provethat phthisis will occur without the scrofula, either in the patient himself or in his family, and that the contrary is found in only a very small proportion of the cases attending my practice at the Hospital for Consumption. I believe that the two diseases often result from similar causes-viz., a certain original pecu-
s of constitution and certain exhausting agencies, andsecretaries or treasurers of these charities will therefore confer also that the occurrence of one would add another to the causesa favour by sending me a list of the number of each class annuof the other; but still I submit that the very frequent occur-ally relieved, and the amount expended on their behalf. To rence of the one without the other is evidence that there is nothe Poor-law medical officers who have not already sent me neccessary relationship between them. The fallacy in deter-replies to the questions I forwarded on the llth of October, I mining the identity of the two diseases from similarity of must beg they will do so without further delay, as it is most morbid products is, that we are not agreed as to the characters to have numbers to be enabled to form a fair average. of tubercle in its earliest state, and that the resemblance exists Those already received I have arranged under forty-six heads ; in the degeneration of products which may not in themselves and when all are collated, a summary of most valuable informbe identical. ation willbe obtained, which, when laid before Parliament, 4th.-The existence of a lessened vital capacity of the lung must to convince its members that we are not pleading is not peculiar to phthisis, and is not absolute proof of the for reform without having great need for it. The accompanyexistence of tubercle, but it is a proof of a lessened action in ing letter from the Right Hon. Sir John Trollope, Bart., will the air-cells, and if the expiratory action be perfect, whilst the show that we have a friend in him ; and I have every reason inspiratory is lessened, I believe that in a chronic case that tobelieve, from the numerous letters I have received from surshows an incontrovertible tendency to the induction of phthisis geons who have bad conversations with their respective memwith its tubercular deposit. Of course, as there must be a bers, that the majority are in our favour, but require us toliability to fallacy in determining the vital capacity, whether prove that our claims for redress are just and reasonable before in health or disease, the demarcation must have reached a legislate for us. certain point, and be corroborated by stethoscopic signs, before I must request those gentlemen who have volunteered ta we could venture to use it as a means of diagnosis. act as local secretaries to collect the quarterly subscriptions; 5th.-Dr. Clarke considers that I regard the importance of I those union officers who have not already subscribed lessened vesicular action as consisting in its chemical relations. will no longer hesitate to do so, as a contest of this kind cannot It cannot be that the two shall not co-exist; but it is not inbe maintained with vigour without ample funds. I am, Sir, yours, &c., that direction that I look for an explanation of the deposit ofE RICHARD GRIFFIN. the tubercle, and therefore of the progress of the disease. It; 12, Royal-terrace, Weymouth, Nov. 1856. is in the fact that the air-cells thus lose their vital influences, and become fit to be the depositories of diseased material; and Casewick, near Stamford, Oct. 16th, 1856. hence, quite apart from any influence upon the blood, it is of SIR,-I have had the honour to receive your note and the the utmost moment to prevent their closure, and to induce a enclosed paper, which show that you are still organising your return to their healthv degree of action. resources for the ensuing parliamentary campaign; and I beg 6th.-Dr. Semple considered that dulness, with absence ofto i assure you and the profession that I shall be ready to assist respiratory murmur and the presence of bronchial sound, wouldin any reasonable and fair demands. indicate the tubercular, and not the pretubercular stage. Such I am, Sir, your very obedient servant, also is my opinion; but the pretubercular stage is nevertheless JOHN TROLLOPE. R. Griffin, Esq. capable of definition, and of distinction from thee tubercular stage. The essential character is the lessened inspiratory action, Officers from the following unions have joined the Associaand therefore at some period that may exist alone; but it will tion since the last report was published: Skipton, West-Firle, soon induce consequent changes, such as a lessened size of the Bishop-Stortford, Camelford, Petworth, Iregaron, Chelmsford, cell, and consequently of that part of the lung, known as Wrexham, Walsingham. atrophy, and indicated externally by flattening and lessened mobility of the chest. With this, the quantity of air contained YELLOW FEVER IN ENGLISH SHIPS. by the cell and the lung at that part will be lessened, and con’1’0 the Editor of THE LANCET. a diminished resonance on must occur. sequently percussion Now all these are questions of degree and of progress, but when SIR,-By the mail just arrived from the West Indies the they are all combined it might be that no tubercle had even account is brought of the crew of another ship of war, the then been deposited. A familiarity in the examination of the Amphion screw steam frigate, having been attacked by yellow chest at this period enables the inquirer to determine whether fever. It has already carried off the assistant-surgeon, (Mr. the stage is really pretubercular, or whether it has progressed Lightbody, whom I knew personally to be most talented and to the earliest point of deposit of tubercle. When, however, skilful in his profession, and whose loss will be much deplored as Dr. Semple affirms, there is no action of the air-cells, and by many friends,) one of the naval cadets, and a seaman. I there is decided dulness, no one would doubt as to the non- am informed that nearly all the officers and many of the men existence there of the pre-tubercular stage. been attacked, but as yet only the three cases mentioned This, Sir, is a matter of the utmost moment, and one which above have proved fatal. I may state that Mr. Buchanan, is as capable of truthful investigation as other vital changes in surgeon of the Amphion, was formerly surgeon of the ’1"weed, the system, and I should be gratified if the profession would when two-thirds of the crew of that ship were lost by yellow fairly undertake the inquiry. If there is a pretubercular stage fever; he must therefore have had much experience, and no which is capable of definition, then it is highly probable that, doubt took every precaution to prevent the visitation of this were proper treatment universally adopted at that period, the frightful scourge on board of the Amphion. influence of the greatest scourge of the human race would be This is now the fifth ship (all steamers) the crews of which have been attacked this year by yellow fever, and still there greatly lessened.-I am, Sir, your very obedient servant, Nov. 1856. _______________ EDWARD EDWARD SMITH. appears no intention on the part of the Admiralty to attempt any fresh precautions to prevent our ships being visited by POOR-LAW MEDICAL REFORM ASSOCIATION. this disease. It has also been stated that the inhabitants of the Island of Bermuda are suffering much from yellow fever, To the Editor of THE LANCET. brought to the island by the Malacca, when the men of that SIR,-In the intended application to Parliament by the ship attacked by this epidemic were taken to the Naval Poor-law medical officers next session, I believe their position Does not this fact show that if there had been a may be materially strengthened by comparing the payments floating naval hospital solely for yellow fever patients, as I now made in unions with the average cost of patients in dishavebefore suggested, and communication with the shorer pensaries ; I shall, therefore, feel obliged by professional men strictly interdicted while the disease was on board, the inhaconnected with these institutions sending me a copy of the bitants would not have had to upbraid the navy for introducing last printed reports, or an extract of the particulars of the the fever amongst them ? yellow and under treatment. I the number annually expenditure This is a subject that ought not to be allowed to drop, for it shall also be glad if surgeons connected with gaols throughout is not because the crews of our ships may at one period be the kingdom will send me an account of the amount of their that we should delay any preparations for a sickly healthy salaries and the number of cases of illness thev annually attend season. I have been told by many persons of experience that in these establishments, which will be a further means of my suggestions are good; and, if so, I feel sure the people of showing to members of Parliament the gross injustice the England would not grudge the expense of giving them a fair union medical officers labour under. The sympathy of some trial, if by doing so they could in any way save the lives, or M.P.smight perchance be erlisted by a faithful account being alleviate the sufferings, of our brave sailors. shown them of the number of medical men, their wives or I am Sir, your obedient servant, widows and orphans, who are annually compelled to seek relief GEORGE THOMAS KRELE, KEELE, of the various benevolent institutions of the country; the late Assistant-Surgeon, R.N. R.N, Highbury, Nov. 1856.
liarity
important
tend
they can
and trust
_____
____
have
Hospital.
late 525
profession ?
To the Editor of THE LANCET. SIR,-Mr. Fergusson, in pointing out the error in the illustration in Liston’s " Surgery," as to the mode of holding the knife in lithotomy, has performed a graceful act of gratitude and justice towards the late Mr. Liston. He has spared posterity misconception and confusion on this point, and it will now be known that the illustration exhibits the knife in a position in which Mr. Liston never held it. I cannot, however, help observing, that Mr. Fergusson, in discharging this duty, has been far more elaborate than the occasion required. I also think, Sir, it will be perceived that he has claimed for Mr. Liston a priority or originality to which he was not entitled. Mr. Fergusson says, ’’ the operation of lithotomy, as at present performed in Great Britain and the colonies, is in a great measure founded on the example and doctrines of this distinguished surgeon." Hence we might infer, that in lithotomy there was something essentially differing from common in the " examples and doctrines" of Mr. Liston ; whereas he really held the knife only as all other surgeons did, and made his incisions in the same manner. Whoever has seen the late Messrs. Key, Morgan, and B. Cooper lithotomize, must have observed that, as regards holding the knife and making the incisions, Mr. Liston’s operation did not differ from theirs. I should be sorry to be understood as wishing to detract from the fame of a surgeon so justly great as the late Mr. Liston. I am only desirous that a special merit should not be claimed exclusively for Mr. Liston, which equally belongs to all surgeons who were his contemporaries, and even to many of preceding generation. I am, Sir, your obedient servant, AN- OLD GUY’S DRESSER. London, Oct. 1856.
BLACK URINE FROM THE ADMINISTRATION OF CREOSOTE. [LETTER FROM DR. HUGHES.] To the Editor of THE LANCET. a SIR,-In postscript to my " Select Cases," including "Cases of Black Urine from the Administration of Creosote," in the last volume of the " Guy’s Hospital Reports," the following sentences occur:-" While these pages are at press, I have a *
See case, Glover
v.
Syme, in the Edinburgh papers
524
of the
day.
under my care in the hospital, in whom the urine is rendered of a black colour when boiled with nitric acid. A further analysis shows this condition to be due to iodine, and it need scarcely be said that the patient is taking this remedy internally. To a similar cause, no doubt, must be referred the dark urine in the case of enema I mentioned at page 56, who was also under the same treatment." "Time dose not allow me to put this explanation to the proof by testing the urine in other cases of patients who are taking iodine; but I have little doubt that it is the correct one - that is, that this medicine probably produces this change under certain conditions of disease." Seeing that, in a brief notice of the " Guy’s Hospital Reports" in THE LANCET of October 25th, the former of these two sentences is quoted, I think it justice to you, Sir, and to the pro- ’ fession at large, that the opinion therein expressed-an opinion derived from pretty decisive statements of one of my colleagues, and apparently supported by the fact of both of the patients having been taking iodine at the time-is a mistaken one. It is true, indeed, that urine containing iodine, by boiling with nitric acid, becomes of a dark colour; but this is an entirely different thing from the black soot-like deposit which existed in the two cases referred to. In the latter instance it soon disappeared, and never appeared again, although he continued the same medicine. The urine of several patients who were taking iodine, submitted to the same tests, did not yield a similar deposit. Upon what it did depend, I am at present in entire ignorance-an ignorance which neither the chemists nor the microscopists to whom I have applied are able to man
dispel. St.
I have the honour to Thomas’s-street, Nov. 1856.
be, Sir,
yours
respectfully, H. M. HUGHES.
ON THE NATURE OF PHTHISIS.
[LETTER
FROM DR. EDWARD
SMITH.]
To the Editor of THE LANCET. SIR,-Considering the inconceivable importance to the community of any views of the nature of phthisis which give reasonable promise of diminishing the prevalence of that disease, I venture to ask your permission to correct a few statements of my views, contained in your report of the discussion on my paper on Saturday last. 1st.-Dr. Andrew Clarke considers that my theory would make phthisis a local disease. I believe it to be so far local, that its essential action on the lungs (that without which there could be no tubercular deposition) is a lessened inspiratory action of the air-cells. But this must be due to yet anterior conditions, and in chronic phthisis I believe them to be such as act through the general system-viz., whatever tends to exhaust the system, whether by exercise or defective action of any of the bodily or mental functions, the only peculiarity, so far, in my theory is, that I consider all these universally acting causes have one common mode of inducing the disease of the lung. But from a consideration of the structure of the air-cells, their supply of nervous power, and their importance in the economy, it is highly probable that they have their own disease induced locally; and in acute phthisis, as also sometimes in chronic phthisis, there is evidence to show the high probability of a local origin. I consider that far too little is at present known of the diseases to which the air-cells are liable. 2nd.-In reply to the statement that leucothysemia, as well as an alteration in the tone of some of the discs, and certain free molecules are found in phthisis, I would reply that the nature of the disease must not be determined by its co-ordinate circumstances, but by those which always attend its origin. The blood must become changed in the course of the disease, and may be changed before the origin of it, and yet not be causative of it. Moreover, leucothysemia, if it occur, (as I think it highly probable,) would not be peculiar to a distinction of phthisis, neither would a knowledge of that fact lead to any better views of the nature and treatment of that disease. 3rd.-The coincidence of scrofula and phthisis, and the alleged interchange of the two diseases in members of the same family, would not be evidence that they were essentially the same disease, much less that they would be necessarily causative of each other. It is easy to admit that the two diseases do occur together; but it is equally easy for me to provethat phthisis will occur without the scrofula, either in the patient himself or in his family, and that the contrary is found in only a very small proportion of the cases attending my practice at the Hospital for Consumption. I believe that the two diseases often result from similar causes-viz., a certain original pecu-
s of constitution and certain exhausting agencies, andsecretaries or treasurers of these charities will therefore confer also that the occurrence of one would add another to the causesa favour by sending me a list of the number of each class annuof the other; but still I submit that the very frequent occur-ally relieved, and the amount expended on their behalf. To rence of the one without the other is evidence that there is nothe Poor-law medical officers who have not already sent me neccessary relationship between them. The fallacy in deter-replies to the questions I forwarded on the llth of October, I mining the identity of the two diseases from similarity of must beg they will do so without further delay, as it is most morbid products is, that we are not agreed as to the characters to have numbers to be enabled to form a fair average. of tubercle in its earliest state, and that the resemblance exists Those already received I have arranged under forty-six heads ; in the degeneration of products which may not in themselves and when all are collated, a summary of most valuable informbe identical. ation willbe obtained, which, when laid before Parliament, 4th.-The existence of a lessened vital capacity of the lung must to convince its members that we are not pleading is not peculiar to phthisis, and is not absolute proof of the for reform without having great need for it. The accompanyexistence of tubercle, but it is a proof of a lessened action in ing letter from the Right Hon. Sir John Trollope, Bart., will the air-cells, and if the expiratory action be perfect, whilst the show that we have a friend in him ; and I have every reason inspiratory is lessened, I believe that in a chronic case that tobelieve, from the numerous letters I have received from surshows an incontrovertible tendency to the induction of phthisis geons who have bad conversations with their respective memwith its tubercular deposit. Of course, as there must be a bers, that the majority are in our favour, but require us toliability to fallacy in determining the vital capacity, whether prove that our claims for redress are just and reasonable before in health or disease, the demarcation must have reached a legislate for us. certain point, and be corroborated by stethoscopic signs, before I must request those gentlemen who have volunteered ta we could venture to use it as a means of diagnosis. act as local secretaries to collect the quarterly subscriptions; 5th.-Dr. Clarke considers that I regard the importance of I those union officers who have not already subscribed lessened vesicular action as consisting in its chemical relations. will no longer hesitate to do so, as a contest of this kind cannot It cannot be that the two shall not co-exist; but it is not inbe maintained with vigour without ample funds. I am, Sir, yours, &c., that direction that I look for an explanation of the deposit ofE RICHARD GRIFFIN. the tubercle, and therefore of the progress of the disease. It; 12, Royal-terrace, Weymouth, Nov. 1856. is in the fact that the air-cells thus lose their vital influences, and become fit to be the depositories of diseased material; and Casewick, near Stamford, Oct. 16th, 1856. hence, quite apart from any influence upon the blood, it is of SIR,-I have had the honour to receive your note and the the utmost moment to prevent their closure, and to induce a enclosed paper, which show that you are still organising your return to their healthv degree of action. resources for the ensuing parliamentary campaign; and I beg 6th.-Dr. Semple considered that dulness, with absence ofto i assure you and the profession that I shall be ready to assist respiratory murmur and the presence of bronchial sound, wouldin any reasonable and fair demands. indicate the tubercular, and not the pretubercular stage. Such I am, Sir, your very obedient servant, also is my opinion; but the pretubercular stage is nevertheless JOHN TROLLOPE. R. Griffin, Esq. capable of definition, and of distinction from thee tubercular stage. The essential character is the lessened inspiratory action, Officers from the following unions have joined the Associaand therefore at some period that may exist alone; but it will tion since the last report was published: Skipton, West-Firle, soon induce consequent changes, such as a lessened size of the Bishop-Stortford, Camelford, Petworth, Iregaron, Chelmsford, cell, and consequently of that part of the lung, known as Wrexham, Walsingham. atrophy, and indicated externally by flattening and lessened mobility of the chest. With this, the quantity of air contained YELLOW FEVER IN ENGLISH SHIPS. by the cell and the lung at that part will be lessened, and con’1’0 the Editor of THE LANCET. a diminished resonance on must occur. sequently percussion Now all these are questions of degree and of progress, but when SIR,-By the mail just arrived from the West Indies the they are all combined it might be that no tubercle had even account is brought of the crew of another ship of war, the then been deposited. A familiarity in the examination of the Amphion screw steam frigate, having been attacked by yellow chest at this period enables the inquirer to determine whether fever. It has already carried off the assistant-surgeon, (Mr. the stage is really pretubercular, or whether it has progressed Lightbody, whom I knew personally to be most talented and to the earliest point of deposit of tubercle. When, however, skilful in his profession, and whose loss will be much deplored as Dr. Semple affirms, there is no action of the air-cells, and by many friends,) one of the naval cadets, and a seaman. I there is decided dulness, no one would doubt as to the non- am informed that nearly all the officers and many of the men existence there of the pre-tubercular stage. been attacked, but as yet only the three cases mentioned This, Sir, is a matter of the utmost moment, and one which above have proved fatal. I may state that Mr. Buchanan, is as capable of truthful investigation as other vital changes in surgeon of the Amphion, was formerly surgeon of the ’1"weed, the system, and I should be gratified if the profession would when two-thirds of the crew of that ship were lost by yellow fairly undertake the inquiry. If there is a pretubercular stage fever; he must therefore have had much experience, and no which is capable of definition, then it is highly probable that, doubt took every precaution to prevent the visitation of this were proper treatment universally adopted at that period, the frightful scourge on board of the Amphion. influence of the greatest scourge of the human race would be This is now the fifth ship (all steamers) the crews of which have been attacked this year by yellow fever, and still there greatly lessened.-I am, Sir, your very obedient servant, Nov. 1856. _______________ EDWARD EDWARD SMITH. appears no intention on the part of the Admiralty to attempt any fresh precautions to prevent our ships being visited by POOR-LAW MEDICAL REFORM ASSOCIATION. this disease. It has also been stated that the inhabitants of the Island of Bermuda are suffering much from yellow fever, To the Editor of THE LANCET. brought to the island by the Malacca, when the men of that SIR,-In the intended application to Parliament by the ship attacked by this epidemic were taken to the Naval Poor-law medical officers next session, I believe their position Does not this fact show that if there had been a may be materially strengthened by comparing the payments floating naval hospital solely for yellow fever patients, as I now made in unions with the average cost of patients in dishavebefore suggested, and communication with the shorer pensaries ; I shall, therefore, feel obliged by professional men strictly interdicted while the disease was on board, the inhaconnected with these institutions sending me a copy of the bitants would not have had to upbraid the navy for introducing last printed reports, or an extract of the particulars of the the fever amongst them ? yellow and under treatment. I the number annually expenditure This is a subject that ought not to be allowed to drop, for it shall also be glad if surgeons connected with gaols throughout is not because the crews of our ships may at one period be the kingdom will send me an account of the amount of their that we should delay any preparations for a sickly healthy salaries and the number of cases of illness thev annually attend season. I have been told by many persons of experience that in these establishments, which will be a further means of my suggestions are good; and, if so, I feel sure the people of showing to members of Parliament the gross injustice the England would not grudge the expense of giving them a fair union medical officers labour under. The sympathy of some trial, if by doing so they could in any way save the lives, or M.P.smight perchance be erlisted by a faithful account being alleviate the sufferings, of our brave sailors. shown them of the number of medical men, their wives or I am Sir, your obedient servant, widows and orphans, who are annually compelled to seek relief GEORGE THOMAS KRELE, KEELE, of the various benevolent institutions of the country; the late Assistant-Surgeon, R.N. R.N, Highbury, Nov. 1856.
liarity
important
tend
they can
and trust
_____
____
have
Hospital.
late 525