THE MERCANTILE NAVY.

98 cal facts of the disease at Guy’s Hospital should differ so much that in some cases morbid irritation returns to the parts after from those which have been observed elsewhere." the healing process has been completed ; and if such is the What is here meant by "elsewhere"it is difficult to deter- case-and of which there can be no doubt-it is a proof that mine, but the intention of the writer is evidently to lead the the operation does not necessarily deprive the woman of reader to conclude that we are peculiar in having observed proper sexual feeling for more than a time. facts opposing the theory. The accusation is made with great That under menstruation, &c., there is general excitement intrepidity ; but how stands the factf At St. Bartholomew’s of all the organs of generation and of the peripheral branches I am informed by Dr. Andrew, who presides over the autopsies, of the pudic nerve, there can be no question, and is only that in cases dying collapsed in cholera not only were the lungs natural ; but such may continue to an inordinate degree after found well supplied with blood, but the left cavities of the menstruation has ceased, and it then becomes a disease which heart also ; showing a perfectly free circulation through the ought to be remedied if possible. pulmonary vessels. Dr. Andrew adds, "Dr. Johnson’s theory Upon the moral bearing of the question I have, however, was most unmistakably contradicted by all the cases which Sir, with your permission, a word to say ; for I should regret fell under my own observation." And Dr. Wilson Fox, the pa- it exceedingly if my opinions on this point were misunderstood. thological professor at University College, has shown me by It is no doubt a fact, that were it not for moral delinhis reports that in cases of collapse examined at the hospital quency of some kind on the part of a sufferer from disease the lungs were nearly always in a state of congestion, and or his forefathers, disease would not exist ; but it does exist, when the quantity of blood found could scarcely be considered and we, as medical practitioners, are called upon to make ourto authorise the use of that term they always contained a full , selves intimately acquainted with the moral as well as physical quantity of blood, and blood was always found on the left side infirmities of our fellow-creatures, and to treat them in such of the heart. One case only is reported in which, for some manner as is best calculated to give tone to both. I take it as an unquestionable fact, that an absence of a proper unexplained reason, a portion of one of the lungs did not contain blood, but the other lung was well supplied, and blood moral tone in an individual is an indication of the absence of was found in the left cavities of the heart. that principle of life which gives health and tone to the system, I have returns from St. Mary’s Hospital, and from the morally as well as physically, and, as such, is an excellent proof Middlesex, and the experience of those institutions is in ac- either of hereditary taint and predisposition to moral disease, cordance with that of Guy’s: the lungs always containing or of inattention to those observances which keep the body in blood. Atthe Middlesex, the anterior portion of the lungs good health, under which head we must include all those often contained less blood than the posterior, so that the an- habits or practices which enervate body or mind. Now, as terior portion might be called anaemic. It is possible that we have scarcely any power, I venture to affirm, of judging some such state as this may have led careless observers into how far moral delinquency is the result of transmitted disease, error. it behoves medical men, in the absence of any glaring fact, I have as yet no returns from St. George’s and the London to regard disease as the result of physical infirmity, and Hospitals, but I know from conversations with gentlemen con- rather to commiserate with his patient, than to tax with nected with those establishments that Dr. Johnson’s theory moral delinquency, which, in this case, would be of the No cases gravest character. has not been verified by post-mortem examination. ,occurred in the Charing Cross Hospital during the last epidemic, It appears to me that this operation is one the utility of and only one of collapse at the Westminster, and in that no which ought to be practically tested by the Obstetrical Society, care being taken to divest the scientific question of all exautopsy was allowed. What arewe now to think of Dr. Johnson’s statement that traneous matter. It may then be found a valuable auxiliary the anatomical facts of the disease at Guy’s Hospital differ to other treatment, although unnecessary and unjustifiable from those which have been observed elsewhere ? when employed indiscriminately. I do not desire that Dr. Johnson should do penance with I am. Sir. vour obedient servant. R. C. SHETTLE, M.D. taper and white sheet,"but I really think he ought to apoloCann, Shaftesbury, Jan. lst, 1867. gise for the very unfair statement he has made in respect to Guy’s Hospital. We have no ill feeling against him, but believe him to be as honest as he is mistaken, and we can THE MERCANTILE NAVY. scarcely pay a higher compliment to his uprightness. To the Editor of THE LANCET. I am, Sir, your obedient servant, G. OWEN REES. SIR,-By way of addenda to my letter on the above subject, Albermarle-street, Jan. 14th, 1867. which appeared in The Times of Monday last, permit me to state a fact or two which I purposely abstained from mentionCLITORIDECTOMY. ing in that journal, for reasons which I need not name. To the Editor of THE LANCET. 1st. As a proof of the unhealthy state of the Limehouse I may affirm that’on the bankss of this basin can be seen one of those call Basin, as a SIR,-As you upon compurgatory witness to give evidence relative to Mr. Baker Brown’s opera- several large collections of fseea.1 matter, the accumulated mounds of years ! tion of clitoridectomy, I most gladly state the opinion I have 2nd. That besides the filth, potato-parings, &c., frequently arrived at, from the little experience I have obtained of the met with in the forecastles of most of our coasting vessels, it is results of the operation. It is to the effect that I agree with not uncommon to see a large tub filled with a mixture of dirty Mr. Harper in believing that benefit may be obtained from it water and very ammoniacal urine. 3rd. That barges laden with faecal matter, both human and in certain cases-i. e., cases where a morbidly sensitive organ, by its influence on the system generally, is preventing benefit animal, are constantly passing up and down the river ; these accruing from the adoption of treatment of a more general frequently anchor by the side of large ships, and wait there for At the same time I am bound to state that I a change of tide. This is evidently a cause of disease, and, character. can by no means endorse the views of Mr. Baker Brown as to during the time of cholera, places sailors in great danger. the nature of the cause for its necessity ; and, it appears to There is in the lower pool a small wharf, where there are me, that two of the cases, at least, quoted by Mr. Baker always some half-dozen barges taking in a stinking mass of Brown in his book can clearly be referred, the one to con- .this kind, mixed with decaying vegetable and other foul and cussion of the spine, from a fall, the other to debility, the abominable rubbish. This locality, I was informed, was visited result of nervous exhaustion from an attack of fever : both daily during the time of the late cholera epidemic by inthese cases would doubtless have yielded to other remedies. spectors from the Seamen’s Hospital Ship Dreadnought;and very little with regard to the physiology of the ques- more cases of diarrhcea were treated here than in any other I say tion, as I leave that to be discussed by those more able to do single part of the river. I am. Sir. vour obedient servant, so ; I must confess, however, it does not appear to me to be WM. DOMETT STONE, M.D., F.R.C.S. Exam. quite right to regard the clitoris simply as the homologue of Stanley-gardens, Jan. 15th, 1867. the penis. The vast difference in the construction of the organs of generation in the two sexes would cause amputation of the particular organ, in the one case, to be fatal to the propagation To the Editor of THE LANCET. of offspring, whilst it could scarcely be so in the other; and SIR,-Referring to your excellent report on the present Mr. Baker Brown quotes more than one case in which he states positively, that he has known pregnancy to occur after sanitary condition of the mercantile marine, allow me to state two of the suggestions just made by you were published clitorideetomy has been performed. Again, it is well known

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(vol. i. page 632) as far back as 1862. I then strongly recommended the issue of preserved potatoes to ship’s companies in all vessels proceeding to China, and on other long voyages. I also recommended the use of condensed water in all cases where good and pure water could not be in THE LANCET

NEWCASTLE-ON-TYNE. (FROM OUR OWN CORRESPONDENT.) I

IT appears that the number of deaths registered within the district of All Saints (comprising a large portion of the East end and older parts of Newcastle) during the quarter ending well-water by hltration, boiling, and the use of permanganate Dec. be a in all 31st, 1866, was 322, being the largest number of deaths there should of which of potash, supply ships." Were these and other simple suggestions attended to, and registered in the parish during a similar period since 1858 ;9 good lime-juice regularly issued, we should henceforth hear the excess having been caused by typhus and scarlatina. I less of the appalling sickness and mortality of our seamen am glad to say that this last has considerably abated during from cholera, diarrhœa, dysentery, and scurvy, which last has the last few days in the old town. been long unknown in the Royal Navy. The This question has recently been most ably discussed, and past year has been one of great fatality for our profesI trust that the present Government may show itself con- sion in this district, and we have seen the old, the young, and servative in the best sense, and pass such stringent legislative the middle-aged stricken down in its course before it was very old. I am sorry to have to mention in this, the first week of measures as the great importance of the subject demands. the new year, the death of Mr. J. L. Gilcbrist, surgeon for the I am, Sir, your most obedient servant, No. 3 district of the union, a most energetic and highly reJOHN ROSE, M.D. Kidderminster, 15th Jan., 1857. spectable practitioner. His district included Sandgate and. Pandou, the most unhealthy in the town, and which is hardly It was while proever free from typhus and other epidemics. LITHOTOMY AND LITHOTRITY. his important, arduous, and dangerous duties in this. secuting To the Editor of THE LANCET. part of Newcastle that Mr. Gilchrist was, a little over a week, seized with the illness which has terminated his useful SIR,-As I see the Registrar of Guy’s Hospital has taken ago, career. the initiative in replying to the statements of the supporters At Sunderland Mr. G. V. Morgan is about to make a comof St. Peter’s Hospital, you may, perhaps, think the following mendable effort to remove the harass and expense, to say facts worthy of insertion :nothing of the ill feelings so often stirred up by a canvass for an hospital appointment by the present system, by moving the the eleven cases of of which six past year stone, During underwent lithotrity, were admitted at University College following resolution at the next meeting of the governors of Hospital. During last week two additional cases were ad- the Sunderland Infirmary : -" That, inasmuch as the efficiency mitted, one of which (a child) will be cut, and the other of this institution depends so much upon the fitness of the crushed. Tam. Sir. yours &c.. house-surgeon for his office, and since the members of the committee-from their frequent attendance at the house-have the J. W. LANGMORE, M.R.C.S., best opportunities of becoming competent judges of candidates, University College Hospital, Jan. 14th, 1867. House-Surgeon. it be resolved that the election of house-surgeon shall rest with the committee of the infirmary, in whose hands all other house appointments are already placed, and that all canvassing. To the Editor of THE LANCET. on the part of candidates be prohibited." SIR,-An error was inadvertently committed in my note Jan. 7th, 1867. addressed to you last week, and published in the current number, which doubtless you will do me the favour to rectify. GLASGOW. The concluding paragraph should have beenOUR OWN CORRESPONDENT.) (FROM During the thirteen years, 1854 to 1866 inclusive, 211 patients one the above underwent or other of mentioned. operations THE directors of our principal medical charities have, in acThis gives about an annual average of sixteen cases. I am, Slr. vour obedient servant, cordance with their laws, been submitting to the public reports JOHN BIRKETT. Green-street, Grosvenor-sqnare, Jan. 15th, 1867. their transactions during 1866. Of these institutions the Royal Infirmary is the most important; a noble charity with 600,

obtained. As you remark, " when distillation cannot be resorted to, every means should be taken to purify river or

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of

POOR-LAW MEDICAL " EXTRAS." To the Editor

of THE LANCET.

since I was called by my deputy to the lying-in ward of the Strand Union. On my arrival I found, on examination, that it was a case of extremely contracted brim, and of very grave character. I decided at once on a consultation, and therefore sent for Dr. Hall Davis. I will not now enter into the details of the case save to state that it taxed all our energies for some two hours and a half. Yesterday I wrote to the Board of Guardians and described what I felt it my duty to do, and also asked for additional pecuniary consideration for myself. I enclose you their resolution :"That a fee of 91Is., in addition to the usual fee, be allowed to Mr. Rogers for his attendance upon Frances Ann W-, a difficult case of midwifery ; and that he be allowed the sum of £313s. 6d. to enable him to pay the fee of £3s. 3s. to Dr. Hall Davis, and 10s. 6d. to Dr. Watson, for professional services relating to the same case, subject to the approval of the Poor-law Board." I feel that the Strand Union Board, in acceding to my request for consideration in this case of difficult labour, have established a very important precedent ; and, if given publicity to by you, may induce some of my Poor-law medical brethren to make similar applications should they be so unfortunate as to meet with so grave a complication in practice. I am, Sir, your obedient servant, Jos. ROGERS, M.D. Dean-street, Soho, Jan. 9th, 1867.

SIR,-Two nights

beds, supported entirely by voluntary contributions. The number of patients treated last year was 5619, being a decrease of 1232 on the previous year: this decrease is entirely on fever cases, which speaks well for the sanitary condition of the city. The income amounted to £ 19,366, the expenditure to £ 17,445The students’ fees were £1178, one-half a gra,tifving result. £ of which goes to the clinical lecturers. For several years a jarring and want of accord had existed between the medical and non-medical directors, but I am happy to learn that since a recent change among the non-medicals this has disappeared, and that great harmony now exists, which must tend very much to the good of the hospital. The Pathological Museum Hall has recently been much improved, and an elegant gallery erected, so that the fine collection which it contains can now be made more available for clinical instruction. About a month ago Dr. G. Buchanan tied. the external iliac in a case of elephantiasis with the happiest results. The report of the Royal Asylum for Lunatics, also a very large institution, and open to medical students, is satisfactory, but is defective on points that would interest the profession, and might with advantage be pruned of some trivial matter. The narrow end of the wedge seems at last to have been inserted into the "hole and corner system"which has long existed at the Lying-in Hospital. The directors have just appointed a very efficient medical staff, and we shall now watch with interest how this important department of our medical school is cond icted. Three years ago an Hospital for Convalescents was opened at Bothwell, a salubrious district about eight miles fiom town, a large proportion of the funds for which were raised by a bazaar of fancy work. Encouraged by the success which at-