THE VOLUNTEER AMBULANCE SCHOOL OF INSTRUCTION.

1400 referred to the rapid increase of the population of London and sketched the changes which had taken place from the early conditions of the past to those which the County Council were endeavouring to bring into existence under the powers ’vaccinate and revaccinate. Although there is hardly a point conferred upon it by the Act of last year. He dwelt also on raised in this letter which is not perfectly familiar to the the saving of life which had been effected since medical medical profession, and although some of the statements-- officers of health were appointed after the passing of e.g., as to relative mortality of the two classes-may be the Metropolis Local Management Act of 1855, and considerably under the mark, yet it is well in these days of showed how the reduction in mortality had particularly " leagues ’’ and I I commissions " to bring into prominence the occurred in the cases of diseases which were influenced simple truth as it has appeared to the mind of an intelligent by sanitary measures. Passing then to the proposed observer whom the most pronounced anti-vaccinationist can by-laws, he pointed out that some of the subjects hardly dare to charge with those aspersions which are so thus dealt with were referred to in an Act of the time of George III., and these provisions had remained freely bestowed on the medical profession in this matter. in force until they were superseded by those of the Act The by-laws relating to house refuse are of last year. A LAUDABLE UNDERTAKING. particularly interesting because they are designed to bring A VERY considerable service is done by anyone who points 2about in the future a daily collection of refuse throughout out means by which the sources of everyday worries can be ]London, and they at once give to sanitary authorities facilities materially lessened. The other day we had an ;opportunityfor f organising this system in any parts of their districts in of inspecting an institution which, it seems to us, will‘which a daily collection is desirable. The old brick dustIt is housed in anbin well serve this very useful end. 1 will eventually be replaced by a movable metal reold-fashioned country house, near Caterham, in Surrey. ( ceptacle, all new houses are to be provided with an There are around the house, and at the disposal of "ash pit " in this form, and for existing houses every new this institution, twelve acres of land. Nine of these (dustbin is to be of this kind. Whenever the sanitary are meadow land, and the rest gardens, poultry yards is prepared to make a daily collection of dust it authority Close to the house stand its stable, dairy, cow- x &c. may require the householder, whatever kind of dustbin he house, and, in short, the ordinary surroundings of a farm- has, I to provide a movable receptacle, which is to be placed yard. Besides the usual offices, the house contains ten bed-in i front of the house at times of which the sanitary aurooms, and three or four sitting-rooms, all well furnished. t thority may give notice. Offensive refuse is to be removed at The purpose which this institution is intended to serve is onettimes and in a manner to prevent nuisance, and the collecwhich interests a very large number of people, for it aims atttion of manure in sunk manure pits is to be no longer the proper training of young women in the details of houseThe by-laws as to water-closets, earth-closets and 1 possible. hold management. A sensible woman, no matter what may privies are well designed, and will by degrees effect marked, be her station in life, will always greatly desire for herseff, improvement in the apparatus now existing in London. Theproand for other women, that intimate knowledge of household,visions which may perhaps excite some amount of opposition affairs which goes so far to make a happy home. Girls marry. are those which relate to the disposal of refuse; the Council and then too often find themselves obliged to try to managehas i evidently made up its mind to rid London of the dusta household without any clear ideas of how to do it. That yards where refuse is sorted and dealt with in proximity to much and great unhappiness results from this source inhabited houses, and it will probably be necessary for some is a matter of everyday experience. In this Surrey sanitary authorities to alter their arrangements to meet the farm-house at Caterham girls are taught, by actual practice,views of the Council. But these changes are distinct gains all the duties of the housekeeper. In turn the pupils to London and its inhabitants will be benefited,by the more do the marketing, attend to the sitting rooms and bedstringent conditions which the Council imposes. It is quite rooms, make the beds and do dairy work in all its branches. likely that some slight modifications will have to be made in They also do all cooking and kitchen and laundry work. the by-laws before they become law ; this is inevitable when The objects aimed at in this system of training are so any Bill is drafted, but they form a substantial code which important to the health and happiness of a home that we are3 will prove in every way serviceable to the metropolis. Mr. glad to direct attention to it. Those who are interested in theHutton’s explanations will go far to make the by-laws subject can obtain from the Principal, Fryerne, Caterham, anyr acceptable to the authorities who will have to administer information they desire. them, and we are convinced he has acted wisely in thus introducing them to the body of sanitary inspectors. The THE SANITARY INSPECTORS’ ASSOCIATION. interest which the chairman of the Council has manifested in THE address which Mr. John Hutton, chairman of the the welfare of the sanitary inspector and in his work will London County Council, has just given to the Association off constitute a useful tie between the Council and the large body Sanitary Inspectors contained a useful lesson to others as well1 of men upon whose efficiency the sanitary condition of Mr. HuttonLondon must as to those who were present on that occasion. largely depend. entitled his lecturesAn Attempt to improve the Sanitary Circumstances of London," and he took the opportunity of THE VOLUNTEER AMBULANCE SCHOOL OF explaining the intentions of the Council in the preparation of INSTRUCTION. the by-laws which that body proposes to make under the Public Health (London) Act, 1891. The subject was not THE staff. and members of this school dined together to only well chosen, but was in every sense timely, for the the number of over 200, at the Cannon-street Hotel, last draft by-laws have just been issued, and -Mr. Hutton’s Saturday evening. The president, Major Maclure, was in explanation will very considerably assist members of the chair, and was supported by Lord Sandhurst, Undersanitary authorities to appreciate their meaning. For Secretary of State for War. Major Maclure, in proour part we regard with much satisfaction this evidence posing the health of Her Majesty, was able from personal of the interest which the chairman of the great governing body knowledge to say that the Queen was well informed as to of London takes in the sanitary welfare of the vast popula- their work, and took much interest in it, as also did Miss tion of the metropolis-an interest which augurs well for the Nightingale. Lord Sandhurst displayed great interest in the development of an efficient administration. Mr. Hutton work done by the staff of the school, and in giving the prizes in powerful remedies." Father Patrick Mulcahywhich is the name of this discerning writer-concludes by saying that he himself has been vaccinated four times in forty-two years, and he advises and implores his friends to

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expressed his intention of being present at inspection on the and that it probably occurs here in pernicious anaemia and Monday following. Surgeon-Colonel Hamilton proposed the malignant jaundice. The resulting free blood pigment is toast of 11 success to the Volunteer Ambulance School of deposited to a large extent in the liver and to a lesser degree ’Instruction," and gave a. history of the evolution of the in the spleen, and even in the kidney-as evidenced by microThe toast was responded chemical examination. The subject embraces, however, whole Volunteer movement. to in an able speech by Surgeon-Captain H. F. Stokes. many other questions than these which we have indicated; He said that over a thousand members had received and we only regret that Dr. Hunter had no opportunity to instruction, a high percentage of whom had obtained gather up the fruits of his labours in a few general proproficiency certificates. Instructors had been sent on the positions. application of medical officers to distant camps of brigades EPSOM COLLEGE. and regiments, and such localities as Wye, Port Talbot, ONCE more we have to congratulate the College on receiving Bridgend, Minehead and Aldershot. The inspection took at London last the Scottish on a munificent headquarters, Monday place gift in aid of its funds. "J. S.," who recently when two strong companies paraded in drill order. The contributed E1000, has recently transferred to the College examining officers were Surgeon-Captains Yarr and Bostock. long mortgage securities to the extent of 2750. This Each company was put through a course of stretcher drill generous supporter of this most successful and deserving and lifting of wounded, after which each man underwent institution has now given between ;f6000 and :E7000 to help a viva-voce examination in first-aid, and at its conclusion on the good work. H. Mayo, a student, has gained an open Surgeon-Captain Yarr announced that he should have much scholarship of ;E50 a year at Caius College within the last few pleasure in recommending the whole of the class for certifi- days. The College is completely full, and the repute of the cates of proficiency. This is the fourth class in succession school has risen so rapidly that there are already four times where all the members have presented themselves for exami- as many candidates as there will be probable vacancies at nation and all have passed. The success is attributed to the Christmas. Such success and such pressure must compel the rule that any man absenting himself from drills or lectures council to lose no time in providing extended accommodation. -

three times is at once struck off the roll, and no man is allowed to present himself for examination unless he knows his work. Such discipline reflects high credit on the medical officer instructors. ___

HÆMOLYSIS. IN the exhaustive and erudite study of the process of blood destruction or hmmolysis, which was chosen by Dr. Wm. Hunter for his recent lectures in conexion with the Grocers’ Company Research Scholarship, the proposition that the blood acts in its physiological and pathological relations similarly to other tissues is one which will at the present day be accepted without demur ; but, although there is no doubt of the waste and renewal of all tissues and cells, the blood is singularly adapted for observing the method of such changes owing to the special coloured element that it contains. It was then mainly of an exposition of the destiny of hemoglobin that the lecturer made, and the facts and arguments which he adduced from observation of normal changes on the one hand, and of abnormal-whether induced experimentally or as the result of morbid action-on the other, were both numerous and sufficient. :It would hardly be fair to Dr. Hunter to attempt a critical survey of the elaborate details of his work. He was dealing, as he said, with a comparatively novel subject, and no criticism could rightly be passed by anyone who had not traversed the same ground. It may, however, be permitted to indicate a few of the salient points which In the first place, are to be gathered from his exposition. the derivation of bile-pigment from haemoglobin is unquestioned, and it is to be noted that this conversion is not entirely limited to the liver cells, whither the products of effete red corpuscles are conveyed by leucocytes. For leucocytes and connective tissue cells can also produce pigments identical with bilirubin and biliverdin from hoemoglobin, although in the main the conversion is effected in the liver. The red corpuscles may, however, part with their hsemoglobin under the influence of changes created in the blood plasma, and the colouring matter thus set free may come to be deposited in the spleen, liver and bone marrow. That the portal area of the circulation is the region where this liberation of blood pigment (active haemolysis) mainly takes place is a view which was, we believe, originally propounded by Dr. Hunter, who has still further elaborated it. He shows that this haemolysis may occur in health, during digestion, in the spleen and gastro-intestinal capillaries ; that it may be effected, in the same area, by the action of toluylendiamine ;

LAPAROTOMY IN ITALY. PROFESSOR GIUSEPPE RuGGI, who holds the chair of Clinical Surgery in the University of Bologna, performed the other day his fiftieth successful laparotomy, and to celebrate the event, unique (it is said) in the surgical annals of Europe, 120 physicians and surgeons of the city and province A medal entertained him at a banquet in the Hotel Brun. in commemoration of the event was struck in Professor Ruggi’s honour and presented to him in a felicitously eulogistic speech. Professor Ruggi, in acknowledging the testimonial, referred to the high name achieved in abdo. minal surgery by Bologna, which records on a tablet in her surgical clinique the resection of the liver performed for the first time by Count Pietro Loreta, whose later and no less brilliantly successful feat of digital divulsion of the pyloric and cesophageal orifices affected with fibroid stenosis was described by THE LANCET in its obituary notice of that illstarred surgeon, whose death by suicide shortly after the operation in question is still mourned in Italy as a national loss.

THE HEALTH OF SCHOOL CHILDREN.

AMONG the

numerous associations which have recently for applied public assistance in carrying on the work entrusted to them is the committee appointed by the Congress of Hygiene (1891) to inquire into the physical and mental condition of children in relation to their education. The investigations instituted by the committee, as we learn from its latest circular, have not been fruitless. Altogether some 50,000 children attending 106 schools have been examined. These establishments included homes, orphanages, industrial and public elementary schools and those under the control of the Poor-law. The condition of the children as described by the committee is by no means encouraging, though we may gather some hope from the fact that the unhealthy state of many of them did not necessarily imply any marked reduction of the normal standard. Thus, while nearly 6000 presented " bodily defects, " 5000 showed deviations from the normal nerve state," 2000 were pale, thin &c., 3600 were reported as but 288 as "mentally dull, " only crippled, deformed or subject to fits. Without a more intimate knowledgeof the meaning of such general terms as the above, it is impossible to form a clear idea of the educational capacity of these children. It is sufficiently evident, however, that the physique of a large of them was perceptibly inferior. It is also a

proportion