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THE MORTALITY OF CHILDBIRTH.

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what was tho habitual physiological temperature ; (2) what the actual post-mortem register at the time of observation-to iix this by tho apparent difference between the object and tho hand of the observer may suflice for ordinary purposes, but to elicit facts on which an indictment for murder is to be grounded or strengthened it is far too unreliable ; and (3) when the hands are exposed and especially where much blood has been lost the hands quickly become cold. When it was proposed by the defendant’s solicitor, Mr. Hills, to tender rebutting medical evidence by Mr. Thornton the magistrates objected unless Mr. Thornton posed as an "expert witness," and they refused to hear him even then except so far as his own personal practice and experience reached. Happily, we think, Mr. Thornton qualified as a witTHE MORTALITY OF CHILDBIRTH. ness by avowing himself as an expert "in a general way." THE important paper of Dr. Boxall on the Mortality of The expression "expert witness" is a technical one and Childbirth which appeared in THE LANCET of July lst is relates rather to the weight and value of evidence than to its worthy of the careful perusal of all practitioners in midwifery. medical man is an He concludes from a study of such data as are available in admissibility. Every legally qualified on medical matters. is more common in expert Nothing this matter that, whereas the puerperal mortality in hospitals, criminal and civil courts than for counsel to ask, "From especially that from all forms of puerperal fever, has greatly personal experience and from your reading can you your diminished, there is no corresponding decrease in the same and the question is allowed by the judge. It will &c.," kind of mortality in the country generally. An actual in- say be understood that the foregoing remarks apply to what has crease even has’ taken place from this cause in the proso far transpired ; they are not intended in any way to vinces. Dr. Boxall attributes the difference to the fact a case which, to a certain extent, is still sub judice. that in hospitals antiseptic and aseptic precautions have been prejudice taken more systematically than in private practice. This is PSYCHICAL CONTAGION IN SCHOOLS. doubtless the case. The hospitals were led to this care by the high mortality and frequent outbreaks of puerperal fever, Dr. REMBOLD of Stuttgart communicates to the Klinische and they have more facility for the application of antiseptic ll’ookenschrift of Berlin a remarkable outbreak of what he measures than is always practicable in the homes of the calls " Psychische Ansteckuna " in schools. He was quite Still the of will not practitioner poor. midwifery readily lately called to a school for girls in the Wurtemberg capital consent to be behind lying-in hospitals in their midwifery in consequence of one of the little pupils having fallen back, mortality, and Dr. Boxall’s paper will serve to stimulate in an unconscious state, on the form on which she was sitting them to the use of every precaution against septic influences -an incident which was followed in a few minutes by others of every kind. The diligent use of soap and water and nail- of the class fainting away, whilst others again broke out into brushes is generally practicable, and there is no excuse now crying and shivering fits, rhose who could articulate complainfor a practitioner failing to carry about with him either tabloids ing of feeling very ill. The alarm and confusion arising from of perchloride, liquor iodi or other materials for an easily this strange occurrence spread to the other classes, in one of extemporised solution for rendering the hands aseptic. It is which a girl thirteen years of age manifested the same no part of our present intention to discuss in detail the nervous symptoms which had been already witnessed in the can study first class. On Dr. Rembold’s arrival he found amongst recessary antiseptic measures-every practitioner them for himself ; but such a study is one of his first duties the forty little girls affected that ten were quite unand it will in the end amply repay him who carries it out conscious, seemingly sunk in profound slumber, a condition from which they could not be aroused, even with conscientiously. violent shaking and when loudly called upon by their THE RAMSGATE MYSTERY. names. Of those who retained consciousness he describes A FITTING climax to the recent prosecution of Noel on the some as trembling all over, weeping and sobbing aloud, charge of having murdered his wife was the address of whilst others of them seemed to be dazed and terror-stricken Mr. Justice Grantham at the Kent Assizes and the inevitable at the sudden illness of their schoolfellows. These latter were throwing out of the bill by the grand jury. We need not immediately relegated to another room and the agitated ones discuss the general bearings of the case, but there are were brought to an open window, and with every encouraging and reassuring word and deed were made to draw deep cne or two points to which we desire to direct special attention in its medical aspect. In the first place we breaths of the fresh air. Those who were still in an unconmay state that the attempt to fix the time of death by the scious state were brought round by strong douches of cold advent and progress of rigor mortis and by the degree of water and energetic appeals to them by name, after which coldness of the hands was, to say the least, on lines far too they were sent home, whence, either later in the day or next exclusive. Although a general average can be struck from morning, they returned to school without apparently any cullective observations the variations are far too numerous to serious after-effects from their seizure. The interesting exclude "philosophic doubt."When we consider that, on the point in this noteworthy outbreak is the spread, as if by one hand, so-called cadaveric rigidity has shown itself prior contagion, of the nervous or convulsive symptoms from indito total somatic death, and, on the other, that it has been vidual to individual and from class to class-a phenomenon delayed for twenty-four hours, it is obvious that in a par- amply attested as having occurred in previous centuries ticularcase it is unwarrantable to apply general rules with and which has been variously classed as St. Vitus’s dance exactitude; nay, more, it is necessary to allow a somewhat in Germany and as "typhus cerebralis convulsivus"by vide margin-much wider, in fact, than the medical Italian physicians. In these days the name for it is "autowitnesses for the prosecution admitted, since their evidence suggestive seizure," the peculiarity in the cases reported fixed the reserve time at something like twenty minutes. from Stuttgart being, as Dr. Rembold points out, the Again, as regards the coldness of the hands as an index of extraordinarily short period within which the symptoms the time of death, it must be borne in mind that there are arose and disappeared. 11’e should have wished, however, Several factors to be allowed for : (1) It should be shown for something like a "previous history" of an adequate rence at this time of the year is one to be deplored on behalf of Worthing. That town is by no means a backward one in regard of measures such as should be applied to a public health-resort, and it has the services of one of the most distinguished of English health officers. But we cannot hesitate, under existing circumstances, to warn visitors of the danger they may incur by a residence in Worthing. It may be that the cause is an accidental pollution of water, and that the boiling of the water will prove to be a sufficient safeguard; but this recrudescence is as yet unexplained. In the meantime the Corporation and the .health officer are doing their utmost to deal with the emergency.

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AMDULANCE ARRANGEMENTS ON THE ROYAL WEDDING DAY.

number of the little patients. We know from contemin Germany, France of similar outbreaks accounts porary and Italy that they have occurred as the sequelas of widespread epidemics ; indeed, the classic description of the choreal distemper so diffused in the fourteenth century distinctly tells us that it followed the prevalence of the "peste noire." Now, in Stuttgart influenza was, on its first appearance some two and a half or three years ago, especially severe, and left behind it traces of a very pronounced neurotic character. Dr. Rembold might, we think, follow up his investigation of the interesting phenomena he has described and ascertain how far the patients whose remarkable seizure he witnessed had been predisposed to it by the influenza epidemic, or how far their susceptibility to contract it by contagion had been determined by that cause.

repair, that during the process of reparation it became apparent that there were a large number of bodies buried under the church, and Dr. Sedgwick Saunders, the medico officer of health for the City of London, reported that it was necessary on sanitary grounds that the bodies should be removed. Dr. Tristram, the Chancellor, has granted a faculty

for the removal of the remains under the church and for their reinterment in consecrated ground. The Stationers’ Company, whose garden adjoins the church, applied that the remains of 350 to 400 bodies buried in two vaults beneath this garden should be removed at the same time, but as the ground had not been consecrated the Chancellor could not grant a faculty. He suggested, however, that they could be removed by licence from the Home Secretary, and he would authorise their reinterment in consecrated ground within the diocese of London. This is very satisfactory and, indeed, it is the only proper course ; but the costs will have to be paid A "FOYER" OF CHOLERA. out of the rates, which neither the churchwardens nor the IN view of the spread of cholera the meaning of the word will relish, whilst the question arises, which will foyer requires to be defined. The French Government, it is parishioners be the next City church whose vaults must be emptied? For stated, proposes to notify other countries of the existence of is too much to expect that the proceedings at St. Martin’s, cholera only when a foyer has been created. Everythingit will be the last of the kind. depends, therefore, on the meaning of the word foyer. Un- Ludgate-hill, doubtedly it means head-quarters or a radiating centre. The i "SANITARY INSPECTION WITH REFERENCE TO I foyer in the house is the fireplace, where the heat is INFECTIOUS DISEASES." and radiated. In the theatre it was formerly a room used by A LECTURE on this subject was delivered by Dr. Theodore the actors, though now the term designates the crush-room Thomson on April 22nd, at the Town Hall, Huddersfield, which is frequented by the public. In politics the French under the Government has just closed the Labour Exchange because it auspices of the West Riding County Council, the of the City of Sheffield, the County Boroughs of Council In optics the foyer is was a foyer of revolutionary agitation. Halifax and Huddersfield, the Yorkshire College and the Sanithe point in the glass where the rays of light unite. In and was repeated on April 29th at Keighley. Institute, of tary Spain, during the great cholera epidemic, we always heard the " focus " of the disease. Practically the use of the term The lecture was chiefly intended for the guidance of sanitary foyer means that if there are isolated cases of cholera in a inspectors, and in opening his subject, Dr. Thomson at once town the French Government will not notify; but if cases stated that he did not mean to take the term "sanitary are grouped together and form a sort of kernel-a centre, inspection" in "any limited sense," but rather to cona focus, radiating, scattering around the germs of sider all the duties of a sanitary inspector when he visits disease,-then the French Government will notify. Of a house in which there may be infectious disease. During the course of his remarks Dr. Thomson dealt with most course one single case of cholera may be considered as a centre or a foyer. This is how the term should be accepted of the acute specific diseases, indicating the periods of if notification is to be of service; but this is not the way incubation and quarantine and the means to be adopted the word is generally employed. A foyer of epidemic for the prevention of their spread in each case. To the a centre of disease. One case sanitary inspector, however, Dr. Thomson commits the imdisease means practically of cholera is no more a centre than a sentinel is an portant duty of investigating the cause, progress of an and the means to be adopted for limiting its spread. army. But the army may come where the sentinel stood, and epidemic the one case of cholera may ultimately become the centre or Nay, this important official may not only be a teacher, but foyer of an epidemic. Instead of notifying when this one he may also be a "leader of public opinion." Practically isolated case has occurred, the French propose to wait till a the lecturer handed over to the sanitary inspector not only foyer has grown up around it. In that case, as already the mere routine work of inspection of infected houses, but observed, the notification would come too late to be of any also the elucidation of important and difficult etiological problems which have taxed the ingenuity of the best disuse and the sanitary authorities of various countries will have to rely, as in the past, on newspaper reports or on the watch- ciplined minds in the medical profession. Etiology is a field? fulness of the consuls. If, in this respect, the Dresden con- which preeminently a:Eords scope for the energy and abilities ference is to be of any service the word foyer must certainly of the medical officer of health ; and we feel sure, did he enter it, that he would do far greater justice to the weighty be withdrawn. questions which demand solution. THE REMOVAL OF HUMAN REMAINS FROM CITY CHURCHES. AMBULANCE ARRANGEMENTS ON THE ROYAL WEDDING DAY. THERE is one class of persons who are at the present time OCCASIONS upon which great crowds of people are drawn deserving of the most hearty sympathy. We refer to the clergy, churchwardens and all connected with those City together naturally cause a certain amount of anxiety in the churches underneath which are vaults containing human minds of those responsible for their safety and well-being. In remains. During the last few years it has been found neces- this country, at least, the arrangements are generally so good sary to remove the dead from the vaults beneath several City and the people themselves are so orderly and law-abiding that churches, and only very recently allusion was made in THE little concern arises in the case of sightseers. The ambulance LANCET to the fact that this had become necessary in arrangements for the civilian population who took part in the St. Michael’s, Bassishaw. We learn with regret that the festivities were left, as usual, to the St. John Ambulance rector, the Rev. J. Stephen Barrass, is ill, and that his Society, the members of which performed their allotted tasb friends ascribe his disorder to a too careful scrutiny of with their accustomed energy. Many circumstances combined the remains beneath his church. Now it appears that St. to render the number of cases of illness and accident someMartin’s Church, Ludgate-hill, is being put into substantial what large, and the value of the assistance rendered by the

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