Medical Returns, long in use in the Service, and under some of the heads of which medical officers are required to return their cases. This is a circumstance exceedingly to be regretted, as that very obsolete list of diseases is by no means in keeping with the requirements of clinical medicine or pathology in the present day. Many forms of disease which, in accordance with existing regulations, medical officers are hence to which they are not strictly obliged to return under a assignable, must be placed in a different and far stricter category by the pathological inquirer. Of such cases as those referred to by Drs. Chalmers and Marlow, I have no hesitation in saying, the greater part would be considered by me under groups very different from that in which diarrhoea takes a place. In strict pathological language, it must be admitted that the class of cases to which the term diarrhoea, considered as indicating a disease per se, is properly applicable, is exceedingly limited. If the phenomenon of looseness of the bowels be present in any particular case, in which there is any good ground for determining the lesion to which it is due, I believe most observers will agree with me in thinking that the heading " diarrhoea" would be regarded as a very unsatisfactory one whereby to designate the disease. From the want of a proper nomenclature, however, such a practice is, I regret to say, often necessarily adopted in the service. Undoubtedly cases exist with anatomical lesions so ill-defined, that "diarrhoea" is the only available denomination we can assign them, and it is then admissible possibly for no better reason than that we cannot very clearly determine the pathological condition to which this phenomenon owes its origin; for I maintain that, like emesis, hydrosis, diuresis, &c., diarrhoea is strictly not so much a disease itself as a symptom of, or phenomenon attendant on disease. Of the class of cases, in which the anatomico-pathological lesion hardly admits of very accurate definition, and which hence perhaps best admit of the use of the term diarrhoea to designate them, a very remarkable form was certainly that described by me under the head of " Atonic Diarrhoea," and presenting the symptoms detailed in the paragraph cited by the Director-General. Of its existence to a considerable extent during the months of June, July, and August, I can have no manner of doubt. I have experienced it myself, witnessed it in others, especially amongst new comers to the camp, and I have been repeatedly consulted about it. It is not improbable that it has often escaped notice, and that few, if any, records of it will be found in hospital returns, as, though it often produced, especially when continued for some weeks, very great general debility and depression of strength, there was usually no symptom which seemed to call for active treatment or confinement in hospital. I have known it, however, to be the insidious prelude to attacks of disease of a much graver and sometimes of a fatal character, and in such cases, of course, the milder symptoms of the earlier disease remained unnoticed, or were forgotten in the more urgent ones of the moment. With regard to the kopro-logical evidences adduced, if one may coin a word for things not suited to ears polite, opportunities for observing them were not wanted, and I did not fail to avail myself of them. I haverepeatedly identified fragments of ration biscuit, potatoes, carrots, &c., from one-eighth to one-quarter inch, cube, in the egesta; some of the vegetable fragments retained their characteristic colour. Their non-assimilation I was at first induced to ascribe to some indigestible quality acquired in the process of desiccation necessary for the preservation of the vegetable. These appearances differed certainly in a marked degree from those noticed in Dr. Taylor’s returns; but it will ’I, be now quite evident that in the extract in question I spoke of an entirely different class of cases from those so well described by the surgeons of the Third Division, and in which class of cases, I may state, my observations mainly concur with theirs. Lastly, I may add, that while I have no experience of the efficacy of quinine in the treatment of " Atonic Diarrhoea,"" not having had occasion to employ it, though I think the sugJ. Hall worthy of the highest consideration, I gestion found great advantage from the exhibition of the muriated tincture of iron, and occasionally also of the bitter tonic infusions. Astringents (acetate of lead with opium, &c.) seemed not to produce much effect towards arresting the abnormal action. Apologizing for this long trespass on your columns, and with a sincere hope that all future differences (if any) with my esteemed friend, Dr. Taylor, will admit of as ready and facile one
heading
of Sir
a
solution, I have the honour to be, Sir,
verv
faithfully
yours,
ROBERT D. LYONS.
244
ON THE INJECTION OF SOLUTIONS INTO THE NARES IN SCARLATINA. To tlte Editor of THE LANCET. SIR,-The discovery of a remedial procedure, and its subsequent disclosure for the universal distribution of its benefits, is one of the most remarkable events that can distinguish the life of man, and he who would wrongly deprive the originator of the merit of his laudable design is guilty of behaviour reprehensible in the extreme; but we should, ere we give credence to it, pause and inquire whether his innovation is simply apparent from an ignorance of the current literature of the science to which his pseudo-nov elty appertains, or adorned with a semblance of reality, when (like Dr. Cory, in THE LANCET of the 9th ult.) he declares that he is " not aware of any author having mentioned the use of the syringe in this disease." His not being aware of its being mentioned I will not dispute, but that it has been mentioned, recommended, and practised, is undeniable. Mason Good speaks of the utility of injecting liquids with a syringe in scarlatina; and in the more popular and instructive volumes of Drs. Watson and West it is referred to as having been accompanied with success. Other solutions, more powerful than warm water, (that suggested by Dr. F. C. Cory,) have been injected into the nostrils in this disease, viz.:-1. Of nitrate of silver. 2. Of chloride of soda. Of the efficacy of the former I can testify from experience. Before throwing up the medicinal fluid, I inject warm water, which, by cleansing the passages, enables the solution of nitrate of silver to operate more effectually. I usually commence with four grains to an ounce of water, and gradually diminish the strength of the application as the severity of the local distress is overcome. It is in children who are unable to gargle, or adults who, in consequence of their enfeebled condition, cannot employ gargles, that the syringe may be substituted to deterge the fauces and nasal passages. The beneficial effects derived from this topical treatment have been exemplified by separation of the gangrenous sloughs, and acrid, ichorous discharge which, with the swelling, nearly occlude the nares; decrease in their formation, succeeded by greater facility in the respiration, by the removal of the obstacle which contributed to occasion the difficulty; more complete arterialization of the blood, and increased corporeal vigour and comfort. The solution of chloride of soda, thrown in by the same contrivance, is serviceable in correcting the foetor. Without digressing to descant upon the numerous curative measures pursued in this rebellious disease, I may add, that when I cannot detach the deposits on the fauces with a syringe, I have applied, with a curved probang, a solution of lunar caustic, in the proportion of eight grains to an ounce of water, and have been gratified with the results produced by it. The mode advised by Drs. Maunsell and Evanson (that of applying it with lint placed upon the forefinger) is more objectionable, because it conceals the parts from view. I am, Sir, your obedient servant, HENRY HANKS, M.R.C.S.E.
THE MEDICAL PROFESSION BILL. To the Editor of THE LANCET. Medical Profession Bill is now fairly before If it become the law of the land, we shall get the old us. Registration Bill and something more. There is to be a Medical Council of twenty-one (so it appears to read) for the United Kingdom, and a new officer, called a Medical Registrar. Respecting the duties of this latter gentleman I beg leave to offer a few remarks. If the Legislature choose to delegate him sufficient authority, he might do us good service. In England and Wales the Registration Act is now in full, working order. At the present time every registrar is from. time to time required to transmit to the Registrar-General the name, address, and medical titles of every person who. takes up his residence and commences practice in his particular district. I would suggest that each registrar or suh,.registrar be also empowered under this new Act, to call upon each fresh practitioner who may come into his district, and demand possession of any diploma, or other qualification to practise that he may possess; that the same may be open for inspection at his residence during a certain time; and, that he shall be required to transmit a notification of it-or,where there is no qualification to practise, to transmit the name and address---the MedicalRegistrar, who should- have power to punish the
SIR,-The
new
offender, if his name be not on the register. By this means illegalpractice would in each instance, where the Registration Act is in force, be promptly met at the very commencement.
Medical Profession Bill also proposes that each person already in practice should pay twenty shillings for registration. So far back as July 24th, 1845, there were upwards of 11,000 qualified medical men practising in England and Wales alone; so that, if this fee be made imthe throughout the United Kingdom will for registration, which will make it rather pay about .615,000 " a "heavy bill., I am. Sir. vour obedient servant. W. N. SPONG.
This
I
[FROM
SCOTLAND. OUR CORRESPONDENT.]
new
duly-qualified
perative,
profession
THE INFLUENCE OF WEATHER ON THE HEALTH.-Dr. Stark,. a recent communication to Sir J. S. Forbes, secretary to the Meteorological Association, remarks upon the pernicious effects of the dense, damp fogs of Scotland to men, cattle, and crops; when preceded by a few days’ warm and sultry weather. A singular instance occurred in Edinburgh, November, 1847, when, after close, damp weather, at a mean temperature of’ 51°, an intense frost, with a mean temperature of 25°, set in, attended with dense fogs. Influenza then became so remarkably prevalent as to render a connexion between the two strikingly apparent. When the cholera visited Scotland in 1848, the phenomena had been remarkable previously, and during the past year of 1855 the occurrence has been manifest, in the midland counties. During the month of January, the mean temperature was 36°, when 5977 deaths occurred ; in February the temperaturefell to 27°, and some nights The deaths upon this increased to 7227; but in as low as 4°. April, when the temperature again rose to 44° *4, the deaths fell to 5323. This is the more striking, as in Scotland January is proverbially a fatal month, whilst February and March are usually most healthy. From these facts of Dr. Stark, it is evident how important it is that the meteorological phenomena of this country should be observed and registered, making them available for comparison with the monthly return of mortality.
in
To the Editor of THE LANCET. SIR,-Approving in the main of Mr. Headlam’s Bill, with some modifications, I hope it will be sanctioned by Parliament. One feature must, however, be altered-namely, the large number of councillors proposed for Scotland. According to the last census, there were 2244 medical practitioners living north of the Tweed, which makes one councillor to every 293; whereas in England, having then 20,289 physicians and surgeons, the proportion, according to the present proposition, would be only one councillor to every 2640 medical men in practice. Such an idea is preposterous; and John Bull never can or will consent to give this lion’s share to my countrymen; to say nothing of Ireland, which, with more than double the population of Scotland, it is intended shall have but two-thirds-that is, six Irish to nine Scotch members of council. The following MORNINGSIDE ASYLUM. - A singular case was brought a distribution would be much more equitable :-The University short time since before the Sheriff by the Procurator-Fiscal, of Glasgow and Faculty should elect one councillor; the Uni- who represented a pauper as being a dangerous lunatic. Theversity of Edinburgh and the resident fellows of the College of Sheriff, therefore, ordered the lunatic to the Morningside AsyPhysicians, who are only forty-nine in number, seven being lum ; but a man, representing the parish liable for the pauper, professors, should have one councillor; the College of Surgeons, interfered, and stated that Morningside was too good a place. one; and the Universities of St. Andrews with Aberdeen, one Upon this the Sheriff changed the destination for a licensed collectively or alternately. If representative members of coun- madhouse. Has ever such a singular objection been heard of cil are to be granted, then one for Scotland, one for Ireland, as that of the parish representative ? He must surely have and two for England would be sufficient. To these seventeen had some practical experience of the Morningside luxuries, I think Government should have the power of nominating otherwise would he have ventured the insane objection that a three persons, either laymen or medical, as they might deem lunatic asylum was" too good" for the reception of a patient ? most expedient. If high in the law, in science, or occupying THE THOMSONIAN OF THE COMMITTEE.-political and official position, so much the better, as that would On Tuesday, the 12thBEQUEST.-REPORT the Report of the College Cominst., of influence to this council members, twenty impart greater and connect them more with the non-professional world, whilst mittee regarding Dr. Thomson’s bequest was laid before the" Town Council. The contemplated by Dr. Thomson, if they would thus become excellent legislators for all classes of carried out, divided object itself into two branches: 1st, The society. Promotion of Mineralogy by lecturer; and, 2ndly, The I am, Sir, yours, &c., Preservation and Increase of the Collection. The right of SCOTUS IN ANGLIA. February, 1856. appointing a lecturer was declared to be in the Lord Provost and magistrates, the President of the Royal Society, the President of the College of Physicians, the Principal of the University, and the Professor of Chemistry. In 1808, Professor Jameson had been appointed Thomsonian Lecturer by this Commission. He was required to deliver an AnHOUSE OF COMMONS. nual Course of Lectures on Mineralogy; also to Preserve the Collection of Minerals; and to conform himself -in all reFEB. 26TH. TUESDAY, spects to the conditions of the will, during the life of Miss POOR-LAW MEDICAL OFFICERS. Thomson, the life-rentrix. No salary had been paid him, Mr. PIGOTT asked whether it was the intention of Her according to the conditions of the appointment; but during Majesty’s Government to carry into effect the recommendations the latter six years of his lectureship, the Thomsonian salary contained in the report of the select committee on Medical had been received by him. On the 6th of June, 1854, ProRelief of session 1854, or to make any change in the present fessor Forbes succeeded to the lectureship, but, owing to his early death, the arrangements had never been carried out. In system? Mr. BouvERlE observed that the recommendations of the October last, Professor Allman received the appointment, and committee were three in number; one was to the effect that the lectures were commenced in the present month. The next the attention of the Poor-law Commissioners should be directed point was the provision in Dr. Thomson’s will for preserving to the propriety of making a gradual diminution of the area of and increasing the collection. For this purpose, one-fifth part the districts of the medical officers; another was, that the of the annual proceeds, and any salary accruing during a salaries of the medical officers should be increased; and the vacancy, were appointed to be set apart. According to this, third, that after a certain date in last year the medical officers when the benefit of the fund accrued, in 1848, the Council should have permanent appointments, and should not be re- ought to have retained one-fifth part of the annuities of X44 15s. movable from office except upon dismissal by the Poor-law for the preservation and increase of the collection, or to have Board. The last recommendation has already been carried obtained from Professor Jameson a certificate that he had done into effect, an order of the Poor-law Board directing that after so. This was not done; and during a period of six years there the 25th of March last all appointments of medical officers is no evidence how Professor Jameson applied the annual oneshould be permanent. With regard to the medical districts fifth of the fund destined for the increase of the collection. The and the salaries of the medical officers, those were matters not Committee conclude their report by alluding to the zeal and immediately under the control of the Poor-law Board, they exertions of Professor Jameson in establishing an extensive being settled in the first instance by the guardians ; but the and valuable museum in every department of natural history. recommendations of the committee had been attended to by The Council expressed their satisfaction at the report; and the Poor-law Board, who had directed the guardians to take Mr. Brown Douglas stated that there had been strong charges into consideration the carrying out of those objects ; and con- made against the Committee, but these charges were groundsiderable increase was going on in the amount of the allowances less. It remains to be seen whether the public are of the same to medical officers. opinion.
especially
-
Parliamentary Intelligence.
245