THE COST OF MEDICAL TREATMENT.

300 the action of the law. In a padrone’s house of rnethod, he adds to professional skill and labour the generous this description our commissioners found in the rooms (charity of dispensing medicines to an opulent community. three and four beds; some were occupied by men lHe and others of the oppressed in pocket may, thereand women, others by single men or single women; all Jfore, learn with an interest born of new hope that it is conditions and sexes living promiscuously together. Some ofpossible, even easy, out of the smallest professional gains these Italians were piano-organ men, others traded in penny to make practice pay and more than pay. Such, at least, is ices ; and these ices were mixed or made on the premises, in one obvious moral to be derived from certain published statethe midst of indescribable filth and overcrowding. The ments relating to the Lincoln O.1dfellows’ Medical Institute. milk, the eggs, the cornflour mixture, &.3., as we reported The lodge, it is said, provides for 4889 members. Its receipts at the time, are left standing for hours in the foulest for last year amounted to .E1155 ls. 4d. Of this sum f.500 178. atmosphere, are manipulated by the dirtiest and most went in salaries to medical officers &c. 231 for rent and unwashed Calabrians, and are mixed-sometimes boiled-in general expenses, and £ 161 5s. lld. for drags, the credit the same saucepans and cauldrons employed to cleanse dirty balance being .E206 Os. 3d. Prescriptions numbered 31431, linen. Of conrse, in the case of such a population which and the drug bill distributed over these consists therefore of has no conception of the laws of sanitation, the liability components having each an average value of 1. This of the contamination of the stock of milk, eggs, and ice result is certainly very satisfactory in its purely financial creams is a factor by no means to be disregarded. Obviously aspect. As to whether it represents a relatively high average ices should be made with care and with all the pre- of medicinal or surgical efficiency we are not so certain If cautions necessary to prevent such contamination. But the panoply of the Oddfellows’ attack upon disease consists so long as no supervision is exercised by the authorities the merely of stock medicines of a simple character, we may well Italian padrone is not likely to indulge in so extravagant a agree that it does ; but it is clear that in such an armament luxury as cleanliness. Fortunately we are now informed that there exists no more than a nominal provision for many the Local Government Board has written to certain of the weapons of proved quality, to which our present modes of metropolitan vestries notifying that a Select Committee will treatment owe much of their mastery. We fully recognise be appointed to inquire into the advisability of instituting the value of economy, especially as applied in the medical legislative action so as to secure the registration of itinerant practice of charitable institutions. It is evident that the ice-cream vendors. Thus at last we may hope that some- Lincoln Oddfellows, and many other like associations, share thing may be done to improve the conditions under which our views on this matter. At the same time, we should like to be assured that they have not, with regard to it, bettered this popular delicacy," the penny ice, is made. the suggestions of business prudence after the manner familiar to some parochial authorities. An expenditure so MEDICAL MEN AND INSANITY IN RELATION trifling as 1. on each prescription seems hardly comTO LAW. with power and effect in dealing with the varied and THERE is, perhaps, no subject throughout the whole of often dangerous phases of disease. medicaljurisprudence which offers such difficulties to both1 medical men and lawyers as insanity. Numbers of both CLINICAL OBSERVATIONS ON WILD BEASTS. medical and legal text-books on the subject exist, all excellent in their way, but with the grave defect that the medical THE Bristol Medico-Chirurgical Journal for December Nor contains a remarkable paper by Dr. A. J. Harrison, in which ones are too technical for the lawyers, and vice t’e?’. is it only the members of these two faculties who are in need he embodies some of the more striking events in connexion of a clear and lucid exposition of the subject. Any educated with a branch of practice of which few have much expeman is liable to have to serve as a special juryman and to rience-that of physician to the inmates of a Zoological have to decide cases in which insanity may bear a large part. Gardens. The "tiger and ape " that lie dormant in every It is because we are sensible of this want in medico-legal man’s nature and occasionally get loose and secure for their literature that we welcome the announcement of a work late host the notice of a police magistrate are here found in entitled "The Insane and the Law," written by Percy Smith, plain, unvarnished form as one would expect, and Dr. M.D., F.R.C.P., Physician at Bethlem Royal Hospital, Harrison mentions several crimes of violence committed by F. Pitt Lewi, Q.C., and A. J. Hawke, barrister. From the animals under the influence of jealousy or sexual excitean advance sheet of the introductory chapter we learn ment. But what we should not expect to find is so much that the book will deal with the personccd position of the similarity among the cases related to the diseases and insane rather than with their property, as do the existing accidents most familiar in human experience. IntussB1scep. legal works on the subject, wbite existing medical books tion, pericarditis, empyema, phthisis, Pott’s paraplegia, treat of the disease as such only ; whereas the forthcoming cancer, ingrowing toe-nail, and ruptured uterus are examples work will try to set out in terms sufficiently plain for the non- of what we mean, and they serve to remind us that the medical mind, on the one hand, and the non-legal, on the gulf on the physical side between man and the brute is not other, the subjects of-(l) Detection and treatment; (2) main- so wide as might be imagined. Dr. Harrison’s most interesttenance ; (3) responsibility, both civil and criminal ; and ing patients were, fitly enough, the lions. The first monarch, (4) capacity to give evidence as a witness or to make a will. Hannibal by name, was found dead in his cage, the cause The authors’ names are a sufficient guarantee that the book of death being haemorrhage due to rupture of an enormously will be written by experts, and we await the appearance of enlarged spleen which weighed twenty-one pounds and a half, the work with the consciousness that it will supply a long- at least twenty times the normal weight. Just sixteen felt need. weeks later (the average period of gestation in the lioness) his widow was confined of twins, both of whom subTHE COST OF MEDICAL TREATMENT. had an interesting medical history. One, a lioness, THE managing committees of hospitals have reason to had a prolonged labour and died from a ruptured uterus, an think somewhat gravely of the cost of medical treatment. accident which Dr. Harrison has also known to occur in a The drug bill, the figured columns relating to surgical necesThe other twin-a lion-was for many years an saries, and the order lists of dietetic accessories are as leaden ornament to the Gardens, and died from "senile decay," but weights upon the heart of their endeavours to benefit man. in his youth he suffered from an ingrowing toe-nail, which kind. Nor is the general practitioner free from a like sourCE caused him so much suffering that its removal was necessiof anxiety, at all events if, guided by the metropolitan tated. Chloroform is badly taken by these larger camitom i

f patible

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sequently cheetah.