"CURIOSITIES OF A COUNTRY PRACTICE."

1109 soon amicably ended by the settlement of the account the disease by carelessness or imprudence ; and in how many by the guardians. At Liverpool the disease does not appear instances the fatal issue was precipitated by some contingency to make any great headway, as the fresh cases week by week which cannot be foreseen-e.g., haemorrhage. We are not7 But on one day last week inclined to admit that the medical profession in the United" never seem to rise to a dozen. there were as many as 6 attacks in the Toxteth-park Kingdom is so ignorant of the elements of climato-theralocality. House-to-house inspection in the affected neigh- peutics as our correspondent’s complaint would seem to bourhood is still maintained, and a large percentage of the imp1y; but we welcome any means that can be adopted for

non-vaccinated persons discovered

are found to be old "postThis shows one weakness of the present system under which vaccination officers are often put off with certificates of postponement, only to find that before the period certified has elapsed the children in question have been removed and their parents have "left no address." A case of small-pox was last week reported as sea-borne at Port Talbot, near Aberavon, as also a case at Dowlais, and In Dublin the disease one was heard of in Merthyr Tydfil. continues. In the third quarter of this year there were 170 cases admitted to the Dublin hospitals, and 17 deaths In the first week of October 8 cases were occurred. admitted, leaving 62 patients in the wards ; 28 admissions were recorded in the third week, 85 remaining ; the respective figures for the fourth week being 15 and 79, with 4 registered deaths. The disease has practically left the north side of the Liffey, but has manifested signs of increase south of the river.

ponement "

cases.

____

the profession a correct knowledge of’ the rules which must govern the recommendation of change of climate in this disease. Those rules have been often laid. down and will be found clearly stated in various textbooks. They may be briefly summarised as follows. The disease must be more or less quiescent; the destruction of lung tissue must be moderate and not rapidly progressive ; there must be no considerable continuous pyrexia, no rapid wasting, no profound debility ; there must be no extemion of the‘ tuberculous process to distant organs ; and there must be no serious complications. We do not say that the presence of any one of these symptoms is an absolute contra-indication to climatic change ; but we do say that it is only in such cases as we have sketched that it can be recommended with any real confidence. We may sometimes be compelled to allow a patient whose malady presents unfavourable features to try climatic change for the sake of palliation of symptoms and temporary relief, but we should be very frank in giving our opinion in such cases.

spreading throughout

-

THE HEALTH

OF SEAMEN.

WE have commented on the prevalence of phthisis among seamen of all nationalities, and in so doing we attributed this susceptibility to the very limited space allotted to the occupants of the forecastle. Dr. Collingridge, in his admirable lecture on the Hygiene of Ships, delivered before the Shipmasters’ Society, London, and printed in THE LANCET of May 5th, 1894, urged that the legal minimum of 72 cubic feet should be largely increased-say, to not less than 100 cubic feet. We observe with pleasure that the Fifth and Final Report of the Royal Commission on Labour endorses these views, and recommends that in new ships 120 cubic feet of forecastle space should be provided for each seaman. Every such concession implies sacrifice of cargo space or storage room of some kind, but shipowners will assuredly ultimately find their reward in the better service rendered by men whose health has benefited by the improvement in their quarters ; and not only their health but their general morale, for it is clear that every alleviation of the discomforts of seafaring life will tend to attract the services of a better class of lads who will eventually develop into useful sailors.

PHTHISICAL PATIENTS IN CAPE COLONY. A CORRESPONDENT writes to us from Herschel, Cape to protest against the practice of sending out advanced cases of phthisis to that region, and he encloses cuttings from the Qiie6nstorvn free Press giving instances of frequent deaths from the disease occurring among recent immigrants. We entirely sympathise with our correspondent in his strong condemnation of "the cruelty of sending out young persons-and elderly ones, too-in the last stages of consumption simply to die amorgst strangers." But the question is hardly so simple as our correspondent seems to suppose. Granting that climatic change is a valuable remedy in phthisis, and that South Africa is one of the best known health resorts in such casesand we do not understand our correspondent to dispute these views,-we must not sweepingly condemn a certain therapeutic resource because it sometimes leads to disappointment and hardship. We should like to know how many of these patients suffering from advanced phthisis went out to South Africa without competent medical advice or in opposition to it; how many accelerated the progress of

Colony,

THE SANITARY CONDITION SHIRE.

OF GLOUCESTER-

GLOUCESTERSHIRE is one of the counties which has not yet; deemed it necessary to appoint a county medical officer, but. which has felt the desirability of making some use of the, district officers’ annual reports. Unfoitunately, the Council has not entrusted the duty of tabulating and summarising these reports to an experienced officer of health, but has appointed a special committee for the purpose. This comemittee has just issued its report for 1893, and it extends, to only six and a half pages octavo with well-spaced type. Its character may be gathered from the fact that the account of the "water-supply" of the various districts in the county takes five lines and the "drainage" eight, and that many most important subjects, such as the "housing of the working classes," are not referred to at, all. Such a report, concluding with the statement that the committee can confidently assert that generally throughout the county the duties of the sanitary authorities appear to be carefully and efficiently discharged," is scarcely likely to carry conviction to a sceptical mind, and it is possible that it may do positive harm by engendering a feeling of satisfaction and security not at all justified by the actual.’ conditions. ____

"CURIOSITIES OF

A COUNTRY

PRACTICE."

THE writer of an article under this title, which appears inthe November number of the Cornhill Maga;:;ine, is a medical practitioner in Cornwall, and gives some curious’ and most interesting examples of the survival in his district of strange superstitions. A few years ago a white witch-"a the repository dirty old woman living in a back street of innumerable absurdities handed down from countless generations of traffic in the black art "-shared with the: orthodox practitioner the confidence of the country folk. The wise woman under her different names may, we know, be. found in many parts of England yet, though her functions are generally more those of the soothsayer, of the astrologer, or of the detective than of the physician, but it is hard to’. believe that such a remedy as the one that follows-a remedy redolent of Alexander of Tralles-could really have been proposed in England in the year of the Jubilee. Yet as. late as 1887 the finger of a man who had committed suicide ......

1110 used to charm away epileptic fits ! A story is also told of how and why a woman preserved in spirit a toe which had been amputated, and the view taken by the patient shows in a wonderfully vivid manner how inextricably the materialistic and the transcendental are mixed in all vulgar superstitions. She had lived a bad life, she said, and she did not know where the toe might go if she allowed it to be buried at once; but as she had resolved to lead a more creditable career in the future she kept the lost member by her, "that she might get her toe again some day and not go limping in the next world." The article is, in fact, an amusing collection of suggestive stories. The dates are not given, and this deficiency makes it impossible for us to see whether the fairy story confirms or refutes Mr. Andrew Lang’s theory on the extinction of fairies as given in his new Yellow Fairy Book ; but, with sufficient proof appended to render them trustworthy contributions to a science, many of the episodes described in I I Curiosities of a Country Practice"would be welcome additions to the archives of folk-lore.

’by hanging was

ENTERIC FEVER AT BUDOCK. THE Falmouth rural sanitary authority have had before them a report by their medical officer of health upon an outbreak of enteric fever at Budock. The place seems to be a iikely breeding ground for fever, being riddled with offensive privy pits, defective drains, and such like abominations, whilst the river Budock has up to the present received ’the sewage of the village and a great deal of that from Penrhyn ; but, despite all this, the pump is looked Tipon as the main cause of the prevailing fever, which has attacked about twenty persons. This pump has, it would appear, been already ordered to be closed, but has been continued in use. As far back as August the medical officer advised its closure ; but lack of this precaution had now ’been followed by the inevitable consequence of delay in matters of sanitary importance. A scheme for the innocuous disposal of the sewage seems now, however, to be in pro.gress, and the authority appear to be desirous of at last dosing the pump, though the order is apparently for six months only. It is to be hoped that there will be no disposition to reopen it until there is no longer any possible doubt - of the wholesomeness of its contents as a permanent supply.

CEREBRAL LESIONS AND GONORRHŒA. IN a recent number of the Revue .J.révrologique Professor Pitres has a short paper on this subject. He has been led, 3ie says, to publish the two cases presently to be referred to because of a recent communication given to the Society of Neurology and Psychiatry at Moscow by Professor Tambourer own affections of the nervous system resulting from or associated with gonorrhoea. In this communication M. Tambourer mentioned the case of a young man aged twenty-five years who in the course of a chronic gleet lasting three years was suddenly struck down with apoplexy and died on the third day. Unfortunately no necropsy was permitted, but M. Tambourer attributed the attack to septic embolism. Professor Pitres’ The first was that of a man aged fifty- cases are as folloffs. nine years who, in the course of an acute attack of gonorrhoea, had painful swelling of some joints the day after admission to hospital, and later in the same day was suddenly attacked with right hemiplegia accompanied with coma. Six weeks later he was seized with Jacksonian convulsions, in which he died. At the necropsy a very extensive softening was found in the region of - the Sylvian artery. The parts were diffluent, and no atheroma of the vessels could be discovered. No bacteriological examination was made. The second case was that of .3, young man aged twenty-three years. He had an attack of

from which he made a good recovery. A second two years later had lasted for five months and was not quite cured when one morning he suddenly had an attack of left hemiplegia, which rapidly cleared up, so that in a few weeks he was able to use his hand and walk without difficulty ; but there still remained facial asymmetry and a certain amount of awkwardness in carrying out voluntary movements with his left hand. There was no evidence of cardiac lesion The coincidence of those or of atheromatous arteries. attacks with the presence of gonorrhoea is certainly striking, and the well-known fact that myelitis occurs apparently as a result of gonorrhoea suggests that these cerebral lesions may have a close causal connexion with that disease and are not merely coincidences.

gonorrhoea., one

DIPHTHERIA IN

LONDON.

THE records as to diphtheria in London last week were in all respects save one less favourable than those of the week preceding. The admissions to the hospitals of the Metropolitan Asylums Board, which had been 102 in the preceding week, fell to 99 ; but the cases remaining under treatment at the close of the week were 537, against 521, 521, and 531 respectively on the three preceding Saturdays. The deaths, which had been 54, 61, and 49, were last week 54 again, 4 each being credited to Paddington, Kensington, and Camberwell, and 3 each to Hackney, Poplar, St. George Southwark, Lambeth, and Greenwich sanitary areas. In the outer ring there were 20 deaths, of which 12 belonged to the borough of West Ham. ____

MEDICAL

AND

DENTAL PRACTICE TRANSVAAL.

IN THE

ACCORDING to information supplied by Mr. Quin, L.D.S., Johannesburg, the Volksraad has recently ratified a new arrangement in regard to medical and dental practice in the Transvaal. No person in the Republic is allowed to be advertised as medical practitioner, surgeon, dentist, apothecary, chemist, or druggist unless his name appears in the Register of the Medical Board and his admission fee has been paid. The British Journal of IJental Science presumes that the same rule applies to any person who may wish to use such title without advertising it in the usual acceptation of the word. Contravention of this regulation will bs punished by a fine of from f:1O to £ 100, and in case of non-payment of the fine by imprisonment with or without hard labour for a period of from one to six months. Other financial arrangements oblige medical men and dentists to take out a licence during the time they carry on their profession within the Republic, the cost of which is as follows : for one year, a25 ; for nine months, a20 ; for six months, z15 ; and for three months, :&10. of

-

PAYMENT FOR THE ADMINISTRATION OF ANÆSTHETICS.

following letter, dated Nov. lst, and signed by Sir Hugh Owen, Secretary of the Local Government Board, has been sent to the various boards of guardians :—"I am directed by the Local Government Board to state that it would appear from representations which have been made to them that some misapprehension exists as to the power of boards of guardians to pay for the professional assistance required by their medical officers in connexion with the administration of anaesthetics in cases of operations. As the guardians are aware, the Board recommend that, under ordinary circumstances, a case in which a serious operation is required should not be treated in a workhouse or at the patient’s home, but should be sent to a public hospital. When, however, the latter course is not practicable, or when the operation is not of a serious character, the Board are prepared, in any case where an anesthetic has been required, to THE