SUGGESTIONS FOR THE SYSTEMATIC INSTRUCTION OF NAVAL MEDICAL OFFICERS AT HASLAR AND OTHER NAVAL HOSPITALS.

392 visit, the

Correspondence. "Andi alteram partem."

PRISON DISCIPLINE. To the Editor of THE LANCET. SiR,—In your report of the discussion on Dr. ForbesWinslow’s " Prison Discipline" (read before the Medical paper upon Society of London, on Saturday, March 22), I am represented to have stated that the proportion of Pentonville exiles to the rest of the population of the colony of Port Phillip* was as 37 to 50, (or 74 per cent.) This is a sad mistake. My statement was, that at one of the assizes at Melbourne there were fifty prisoners tried, and out of that number thirtyseven had been sent to the colony as exiles from the Pentonville Prison. If one of the members of the House of CommonsI were to move for and obtain a return of the annual number of prisoners transported to Van Diemen’s Land, together with the entailed on this country consequent thereon, commencing cost in 1835 and germinating in 1845-the five years preceding and subsequent to the introduction of the probation system-such returns would show the great additional expense incurred by that system. Abundant evidence might be adduced to prove that the present (probationary) scheme has totally failed as a reformative measure. I am, Sir, your obedient servant, ERASMUS WREN.

cervix admitting the finger is divided, within eleven hours the uterus is extensively and in about fourteen hours the woman is delivered by the forceps. The state of the vagina during parturition is almost as sure a guide to the progress of labour as the os uteri itself; if rigid, the os is scarcely open; if relaxed and soft, uterine dilatation is going on. The beautiful preparation of the parts by Nature to admit the passage of the child proceeds according to the necessity of the case, and this in all instances up to a certain point. And in this case we are told the vagina became slightly relaxed, the pains being regular and severe. Why were those pains not moderated ? Why was not a longer time given! Dr. Sheppard considers this case less as a guide for practice -and so do I-than for its value in showing how much the uterus may be injured without a fatal result; but the annals of obstetric surgery also tell how often a wounded uterus is synonymous with death. I am, Sir, your obedient servant, WILLIAM MUTRIE FAIRBROTHER, M.D. London-road, Southwark.

ON DR. SHEPPARD’S CASE OF AGGLUTINATED OS UTERI.

opened,

SUGGESTIONS FOR THE SYSTEMATIC INSTRUCTION OF NAVAL MEDICAL OFFICERS AT HASLAR AND OTHER NAVAL HOSPITALS. To the Editor of THE LANCET. SIR,—In your journal of March 16,1850,see you make

mention of the want of instruction for naval and military medical officers: concerningthe latter I know nothing, and cannot therefore speak; but with regard to the former I can

testify. A ship,

of all places in the world, is least adapted for study; well is this known, as affecting the junior medical officers, that the lords of the Admiralty have caused them to pass an examination at the end of three years, for which they are obliged to keep up their knowledge at any rate to that

and

so

To the Editor of THE LANCET. is difficult, and sometimes even impossible, to Srn,—It criticize with perfect fairness the published practice of another time. medical man; but the case of " Agglutination of the Os Uteri," Now, suppose an assistant-surgeon appointed to a ship-a by Dr. Sheppard, reported in THE LANCET of March 22nd, small craft, for instance, on the Indian station. The messcalls, in my opinion, for some remarks-an operation having place will be about eight feet square, (more or less.) This is been then resorted to, terrible in its character, although suc- the place of nine commissioned and subordinate officers !Do cessful in its termination; and if even this should by any vou think it possible that a man could read in such a place? chance be prematurely or unnecessarily performed, it would Yet, Sir, I was obliged to pass three years in this state. The equal in barbarism the extirp-ition of the uterus, Caesarian dispensary was just large enough for me to stand in; I could not well read there. You know assistant-surgeons are not section, or division of the symphysis pubis. Briefly to recapitulate the facts of this case. The patient, allowed a cabin. In fact, Sir, reading in a small craft is out thin but healthy, thirty years old, pregnant for the first time, I of the question, and in a larger vessel it is much the same. In a frigate in which I served, the members of the mess taken in labour at three o’clock one morning, seen at The os uteri not to be felt, vaginal walls undilated, cervix varied from thirty to forty. The mess-place might have been uteri not perceptible to the touch. The presenting portion of twentv feet long, (but I do not think it was so much,) and six the child could not be detected. After this the neck was found feet wide. Every day we were obliged to have two dinners. developed, but unnatural. A friend in consultation introduced You could not expect much reading in such a place. By the the " very tip" of the finger into the uterus; subsequently the Navy List of January, there are twenty-two line-of-battle cervix admitted the finger with difficulty. The posterior and ships in commission; and allow two assistants to each, (which anterior walls of the unyielding neck were divided with a they have not all got,) forty-four might therefore have the penknife, considerable force being necessary. It was not benefit of reading in the sick-berth, providing the captain and thought advisable to attempt depletion or the warm bath, the surgeon did not object, and the number of sick was not too uterus being "very hard, very thick, and in the neighbour- great; the remaining 227 assistants, and twenty-six actinghood of the os, semi-cartilaginous." At half-past six the os assistants, might read where they could. It is thus nonsense e;y;ternum was still undilated, and the sides of the vagina only of the Admiralty to talk of the sick-berth as an accommodation slightly relaxed. It was determined in consultation to divide for assistants, or their reading-room, when it exists down in the lower segment of the uterus freely. The posterior wall the cockpit. was divided for about two inches; then the anterior wall, and But, Sir, if assistant-surgeons are so placed that they cannot subsequently another portion of the uterus, which then split possibly study at sea, why is there not some provision made up as high as the attachment of the vagina. Three hours for them on shore ? Allow me to suggest a plan. At present after, two doses of ergot were given. Turning was then un- Haslar Hospital contains a vast space unoccupied. Why do successfully attempted, the uterus being again torn. One not the Admiraltv enforce the delivery, in the theatre of that blade of the forceps was introduced to fix the head on the establishment, ofa course of lectures by each medical officer brim, and subsequently the forceps being applied, the child attached to it, as follows-viz., Inspector of Hospital, Mediwas born uninjured, and the mother did well. cine ; Deputy-Inspector, Anatomy; Surgeon and Medical StoreI am- not ignorant of the established rule for practice in keeper, Surgery; Assisting-surgeon, Operative Surgery; and cases of cancerous thickening of the os uteri, and know that at the same time oblige every assistant-surgeon in her an unyielding state of that part requires a remedy; but in all Majesty’s service, not on active employ abroad, to attend, cases of obstructed labour from this cause it seems desirable giving them at the same time full. pay and time as they do to wait as long as is consistent with the safety of the patient; mates in the Royal Naval College. There is plenty of room and I ask if the cervix uteri, at first undiscoverable, was in the hospital for their accommodation; one wing might be afterwards made out, resisting at one period and subsequently entirely given up to them; they might be under the same readmitting the finger; if at one time the sides of the vagina strictions as the assistants at present at the hospital; and if the superior medical officers are not fit to lecture, they are not were slightly relaxed, which were formerly firm and undilated, why were not the pains moderated, and continued sleep pro- fit to hold their situations. After an assistant-surgeon has been abroad three or four duced, perhaps by morphia, and that most efficient remedy for the production of relaxation in rigid tissues given a fair years, as the case might be, let him have three months’ leave, chance of success; but here, within eight hours of the first or more, and then oblige him to report himself to the superintendent of Haslar, and commence study, which shall con* 1’ort Phillip was never a penal settlement. tinue for one year. After that time, let him pass an exatni-

eight.

393 nation, if required, (and perhaps a reward tor proficiency might be given,) and I think the medical service would be very much improved by it. If the Admiralty think that Haslar Hospital will not contain all, let some go to Plymouth or Chatham, and the same thing be adopted there. But I do not know whether those hospitals afford so much spare room. The library and museum at Haslar, the asylum for lunatics, and the size of the building, are all in favour of that establishment ; and I think that very much good might be done to the junior medical officers in her Majesty’s naval service by theadoption of some such plan as the one proposed. I am, Sir, your obedient servant,

selves the’ greatest real difference is, that the one class pays rates and taxes fur shops, and that the other does not. There is, to our shame, no country in the world where this system of£ adulteration is carried on to the sime extent as in England ; and there is no place in England where the villainy is so widely-spread as in London...... Coffee is largely mixed with chicory-not at the low price of the inferior, but at the high price of the superior article-the vendors having the impudence to justify the fraud on the plea that chicory is wholesome, and that the public like it. Of fifty-six samples of coffee recently purchased at random in various shops in different parts of London, for the purposes of the exposure which is now goingon in the pages of THE LANCET, the microscope Jonrr. detected that only five were genuine.’The brown sugars of commerce,’ as we learn from the same publication,’are in ina state wholly unfit for human consumption,’ and THE PATHOLOGY OF SEA-SICKNESS. are largely adulterated with ’blood, albumen, fragments of To the Editor f THE LANCET. the sugar-cane, starch granules, lime, lead, iron, and grit or SIR,—In the Observer newspaper some time since, under sand,’ besides swarms of sng2r-acari, or mites, and the sugar the head " Cause and Cure of Sea-sickness," there is mention fungi. Out of thirty-six samples of brown sugar, the acari, or. of a paper lately read before the French Academy of Medicine, sugar-lice, were found in thirty-five." of Majendie and other distinguished phywith theinapproval which sea-sickness is said to " depend upon the sicians, movement of the intestinal canal, which floats as it were on (From the Lady’s Newspaper, March 22.) the abdomen. It descends with every movement of the "MORE COFFEE REVELATIONS.—We are likely at last to under’ vessel, and then ascending, pushes up the stomach and the diaphragm." Should you find time, Sir, to look over the few stand the full force of that expression which has been invented lines which are here transcribed from the work of an English to cover the brigaudism of civilized life with a flippant phrase physician, you will probably see reason to maintain, with me, ‘ the tricks of trade.’ Tiianks to THE LANCET, we know that in the Clinique of the Mctl du Mer, Britannia rules the something definite of these tricks with respect to one class of The passage is extracted from pages 122, 123, of a the trading community. It has revealed a system of dishonesty waves. small volume on " Spasm" and other disorders of the muscle, which goes far to show how slight a guarantee is civilization published by John W. Parker, West Strand, in April, 1843. of itself for good faith; and how weak is the bulwark of mere talkative morality against the temptations of avarice and opporI am, Sir, your obedient servant, ÆGRONAUT. London, 1851. tunity. And this revelation, let us add, has come at a time our reputation. It would not have done that our " As the principal stays and binders of the human frame, fortunate for the abdominal muscles, are employed unceasingly in support- newspapers should be teeming with proofs of a scandalous disinfecting a large body of our tradesmen while London ing weight, and resisting pressure from all that is lodged honestv within the chest and belly, by their thoracic attachment was filled with foreigners, as it bids fair to be ere long. We should be loth to redistribute our visitors over the world with they directly influence the business of the chest under all cir- such experience of the English shopkeeper vouched by the cumstances of disease. Beneath the diaphragm, should they THE fail in their supporting power, the functions of the several English journalists. the LANCET of last Saturday has fulfilled chicory question, by a detail of the viscera are no longer healthy or complete. Let any one sud- itstask by exposing this article of adulteration is itself adulterated. denly withdraw the support given by his hand to the lower it gentle readers, you who have been drinking part of the abdomen in his own person, and by the sense of chicory formocha, and, on being undeceived, have consoled what falls within, he exactly measures the degree and extent with the belief that chicory, after all, is no very yourselves of the internal pressure. Sea-sickness, there is reason to bebad sort of thing-bear it in mind, henceforth, that you have lieve, is in this way occasioned, by want of tonic resistance in not even had chicory for your money. Out of thirty-four the abdominal muscles to the passive weight of the collected tested by THE LANCET, and obtained from retail and samples in their disturbed and viscera, suddenly respective positions, wholesale dealers, nearly half were mixed with other materials gravitating with the motion of the vessel. By continual - with roasted beans, burnt corn, and acorns !-while others of to a in this centre. duty ready adjustment varying practice of earthy and mineral substances ; with the seaman at length learns to command his stomach while partook plentifully " carrot, parsnip, mangold-wurzel, dog-biscuits, a kind of burnt he‘finds his legs."’ sugar known asblack-jack,’ and a worthless, if not pernicious, article, from Egypt, supposed to be lupine-seed. Within the last few days, indeed, eighty tons of the latter article have been offered by a Scotch house, at less than three-halfpence THE ANALYTICAL SANITARY COMMISSION. per pound ; and it may be that some of this same seed may NOTICES OF THE PRESS.

IB

general

I

extent to which Bear in mind,

’

(From the Illustrated London News, March 29.) " THERE are subjects of national importance and concern which never come under the notice of the legislature,and which only at rare intervals excite from the press and the leaders of opinion the notice they deserve........ Upwards of a quarter of a century ago, the publication of a well-known chemist, entitled,’Death in the Pot,’ exposed many of the malpractices of the London shopkeepers in this respect, and created quite a sensation in the public mind. But the exposures then made by Mr. Accum are as nothing to those which have taken place within the last few months, and for which the public is indebted (if such miserable knowledge can be considered a benefit) to the industry and research of the editor of THE LANCET. It appears that there is scarcely an article that we eat or drink that is not mixed up in some way with inferior substances, to the injury of our pockets, or with positive poison, to the ruin of our health..........There is scarcely an article of food or drink, with the sole exception of fruits and vegetables, that retail traders do not adulterate, committing a double wrong and injury. Yet these very men who carry on these nefarious practices would prosecute a pickpocket or a burglar, if he stole their handkerchiefs or broke into their premises. These very men sit continually upon juries, to condemn to gaol or to the hulks their brothers in iniquity, between whom and them-

smoke upon many a breakfast-table where this week’sLady’s Newspaper shall lie, at a cost of two shillings and a profit of£ one and tenpence halfpenny per pound. Lupine-seed, however, is not likely to poison many of our readers, since acorns, it appears, are cheaper, and have also the prior claim of nationality, upon the British stomach. But it has been said that chicory is wholesome. The Materia Medica settles this point. In that invaluable record thispoor man’s blessing’-how poor men are blest by having to pay coffee price for chicory, which costs but a fourth of coffee, will do for a puzzle for the Exhibition-this poor man’s blessing figures as the cause, amongst other collateral blessings, of ’dyspepsia, flatulency, pain, and diarrhoea.’ So much for what it will do; and now for what it will not.’Wewill suppose,’ says THE LANCET,the following case of poison, not an improbable or infrequent one :-An infant has been given an overdose of Godfrey’s cordial. The proper remedy is a strong infusion of coffee. The coffee already in the house, inasmuch as it is the most readily obtained, is used, and consists principally of chicory. The child dies.’ Is it not time that Government should put a stop to the iniquitous extortion which is practised upon the public in the sale of this article, by -rescinding that Treasury order which first sanctioned the adulteration of coffee with chicory, and naturally led the dishonest, and those who would be virtuous were it the fashion, to complete the fraud by the inxportation with coffee of

every

species of rubbish and filth !"