THE LANCET,]

philosophical manner, and has shown that elevation seems not to be the only influence; the degree of motion of the atmosphere, the relation of sites to hills or valleys, the degree of exposure to the sun's rays, the aspect, the geological nature of the substratum, the degree of humidity, the frequency of rain, and other conditions on which the dryness or dampness of the soil depends, are to be largely taken into account. Dr. BUCHANAN, after noticing all these facts, and pointing out that allowance had to be made for many incidental influences before the conditions of scientific induction can be satisfied, and before we can say that a disease owns any given physical state as its cause; and that it was necessary to show that the condition adverse to the production of the disease is also favourable to recovery from it,—proceeded to speak of the influence of dampness of soil in the production of phthisis. In 1865 Dr. BUCHANAN noticed that certain towns experienced a reduction of their previous death-rates from phthisis, and on inquiry it was seen that this was in proportion to the diminution effected in their surface-water by engineering operations. This was the only constant relation. The case of Salisbury is a remarkable one; it was formerly one of the wettest cities; now it is improved in this respect, and its death-rate from phthisis has diminished 50 per cent., the amount of disease being found to vary with the degree of porosity of the soil

on which the inhabitants lived.

The gist of Dr. BUCHANAN'S communication on the present occasion was a therapeutical one-to emphasize the fact that those places which seem to generate little phthisis amongst their own population should be more distinctly regarded as advantageous residences for those of phthisical tendency. An authentic chart of the comparative salubrity of health-resorts for consumptives is unquestionably a desideratum. Hastings stands high on the list of good habitats, but it would be well if more evidence were forthcoming of the effect of quality of soil in restoring phthisical patients who seek residence in different districts. Another point of positive duty would seem to flow from Dr. BUCHANAN'S observations. It is this: that the practitioner should take care to urge upon families having strong phthisical tendencies, and living in low, flat, damp situations, the necessity of recognising the cause of phthisis here adverted to, and of paying less attention, in the choice of a residence, to convenience, and many considerations which now influence a decision in the matter.

WITH the new year, several new periodicals have sprung into existence, and from one of them, the Archiv für Dermatologie und Syphilis, the first number of which lies before us, we propose to make a few extracts for the benefit of our readers. The first communication is from the pen of Professor Von HEBRA, attesting the benefits of the adaptation of pads, gloves, socks, or even trousers, of vulcanised indiarubber linen (toile caoutchouquée), without any other application, in cases of eczema, as previously suggested by Professor HARDY, of Paris; and also in cases of psoriasis, ichthyosis, tylosis, and pityriasis, where it was requisite to remove dry epidermical masses. In all cases, the smooth side

[JAN. 2, 1869. 19

was placed next the part affected, and the linen was replaced once or twice a day with a fresh portion. This mode of treatment was also found to be extremely successful in several cases of that terrible affection, the prurigo senilis, abundant perspiration being induced, the itching ceasing, and sleep being obtained. The linen cloth used by Professor HEBRA was made by J. N. REITHOFFER (No. 2, Stadt Herrengasse), and seems to resemble our spongio-piline. We presume it could easily be produced by English fabricants of vulcanised india-rubber, and is certainly deserving of further trial. A second paper in the same journal is by Dr. H. KÖBNER and PAUL MICHELSON, on "Parasitic Sycosis." The former of these writers had already, in 1864, published observations showing that a parasitic form of sycosis existed, which was produced by the Trichophyton tonsurans, a fungus that is immediately associated with the Herpes tonsurans and circinatus. Whilst still maintaining this opinion, he does not deny that an idiopathic form of sycosis may also occur in which no fungus can be shown to be present. A case of the parasitic form is recorded by MICHELSON, caused by contact with diseased ox-flesh, in which KÖBNER's views were fully borne out.

We can only add a few remarks on an interesting paper by MORIZ KOHN, on the "Nature and Treatment of Lupus erythematosus." This affection, which occurs in the healthy and strong, as well as in the strumous, of both sexes, consists of nearly circular spots, of variable size, the centre of which is covered by a thin, dark, yellowish-brown crust, or by cicatricial-like skin, whilst the margin presents a narrow, slightly elevated, bright-red line, beset with yellowish or smutty-brown scales and crusts, or is punctated, and sharply differentiated from the adjoining healthy skin. This form of lupus is undoubtedly developed in the substance of the corium, and occurs upon the cheeks, or upon the bridge of the nose, and occasionally on other parts of the skin of the head, on the palms and palmar surface of the fingers, and It is sometimes accompanied by

on the trunk and arms.

We regret we have no space to give an abstract of a good paper by Dr. PICK on "Eczema Marginatum."

Medical Annotations.

"Ne quid nimis."

THE NOMENCLATURE OF DISEASE. THE last weekly return of the Registrar-General contains an announcement and an appeal to the medical profession, relative to the nomenclature of one class of diseases, to which we would direct particular attention. It has long been a matter of regret that in the valuable series of records of disease which the Registrar-General has been accumulating for thirty years past, the system of nomenclature adopted fails in some cases to preserve the distinction which exists between different types of disease, and that medical statists are obliged, in consequence, to undertake a special analysis of the death registers where they have need of the facts relative to diseases so undistinguished. We know, of course, that there is a wide distinction to be borne in mind as between a nomenclature and a classification of causes of death, and that for the purposes of publication it is absolutely necessary to limit the causes distinguished, to those possessing the most strongly marked and definable features, assimilating to a great extent therefore causes which in their main characteristics agree. The unsettled nomenclature resulting from imperfect diagnosis, which there is great reason to believe prevails (though, by the progress of medical science, we trust in a yearly decreasing ratio) more or less in town and country, renders the work of classification difficult, and really creates the obstacle to a complete system of disease statistics, of which medical men most frequently complain.

The Registrar-General, therefore, feeling that the settled nomenclature of the College of Physicians affords a basis for improvements in his records, has adopted a tentative measure of reform by asking the medical profession to enable him to distinguish the several forms of fever, which hitherto have been classed in his returns under the generic head "Typhus." The new nomenclature recognises the following forms of common fever: (1) typhus fever, (2) enteric fever, (3) relapsing fever, and (4) simple continued fever. The majority of the fatal fever cases in England, the Registrar-General says, may probably be designated as either typhus or enteric fever, the two forms being thus defined by the Committee:-Typhus fever: a continued fever, characterised by great prostration, and a general dusky mottled rash, without specific lesion of the bowels. Enteric fever (synonym-typhoid fever, or typhia): a continued fever, characterised by the presence of rose-coloured spots, chiefly on the abdomen, and a tendency to diarrhoea, with specific lesion of the bowels. Enteric fever occurring in the child is often named infantile remittent fever. Fevers symptomatic of worms, teething, or other sources of irritation, should not be included under this head.

Relapsing fever is defined in the nomenclature as a continued fever of short duration, characterised by absence of eruption, and an abrupt relapse occurring after an interval of about a week.

It is the wish of the Registrar-General to distinguish these forms of fever in his returns for the ensuing year, and to enable him to do so we would impress upon the profession the great desirability of their observing the required

SPECIAL HOSPITALS.

PUBLIC attention has been properly called by "A Physician and Governor of the Middlesex Hospital" to the way in which old-established institutions have suffered from the great and needless multiplication of the channels for relieving the sick and poor. We see no reason for modifying or altering what we have said on this subject: what is written is written, and the various communications we have received sufficiently attest the correctness of our verdict. The multiplication of special hospitals for every malady under the sun is opposed to the interests of a profession claiming to be composed of educated and scientific men. One would suppose that the human body was not made up of very interdependent parts, and subordinated to the controlling influence of a nervous system; but of various organs, discharging entirely separate and independent functions, and governed by special or even antagonistic forces. The prevailing fashion opens the door to grave abuses; and we shall not have to wait very long for these to become abundantly apparent. Carried to a logical conclusion, we ought to have as many specialists as there are parts of the frame to be treated; and the patients and medical students of a future generation may have to go to the West-end or Borough, east, north, and south of the metropolis, searching for the institution specially adapted to their requirements. When it has reached this pass, we suppose the eyes of the public will be opened with a vengeFar be it from us to stop the flow of charity, which was never more needed than at the present time. So long as funds are required, however, for the support of large and charitable institutions, the gifts of the benevolent are more likely to serve useful and beneficent ends by being given in that direction.

ance.

And now a word about a letter which lately appeared in a contemporary, pleading to the benevolently disposed on behalf of the Hospital for Diseases of the Throat. As the wards of this charity are never empty-so we are told, we wonder the other hospitals have any cases to treat at all; but "at this season of the year" these wards are said to be always full, and our waiting rooms, which never lack visitors, are now positively crammed." If so, we cannot but pity the visitors. They are in capital process of training for the wards; for the foul, heated air produced by the cramming of rooms, combined with the wet and cold of the streets, ought to prove a fruitful source of throat diseases. Then follows the little bit of gushing sentimentality about the time when festivity and enjoyments are rife, being that at which "the ailments this hospital was formed to relieve are most felt; and it is now; too, when pity melts the mind to love,' that we urgently appeal," &c.; neither the season nor the urgent appeal melts our minds to love this hospital. All we can say about its existence is-" Pity 'tis, 'tis true."

PROFESSOR CLAUDE BERNARD AND HIS
PHYSIOLOGICAL LABORATORY.

A CHANGE, which will doubtless be productive of the best consequences for the teaching and the progress of physiology in Paris, has just been made in connexion with the celebrated Professor Claude Bernard. The chair of General Physiology has been transferred from the Sorbonne to the Museum of Natural History, whilst the chair of Comparative Physiology of the Museum passes to the Faculty of Sciences under the mere title of chair of Physiology. At the same time M. Claude Bernard takes possession of the new chair

THE LANCET,]

at the Museum. The object of this change is to furnish the Professor with a large laboratory, wherein he may continue his investigations in the company of the numerous students who crowd around him. The small laboratory which he formerly commanded was unworthy of his great name and teaching, and of the country to which he belonged. When the new laboratory shall have received all the collections of instruments and apparatus, for the purchase or completion of which the Minister has demanded a sum of 100,000 francs, it is hoped that Paris will at length possess a laboratory which was much wanted, and which will stand on the same footing as the Physiological Institutes of Germany. It cannot be denied that the present rivalry between France and Germany has contributed greatly to the preparation of a new scientific era among the French. Until now, physiology, the great science of the age, has been much neglected by the French Government. Marey's private laboratory was the best, and indeed the only good laboratory to be found in the French metropolis; while the locale of M. Claude Bernard's physiological labours might have been compared to a bare chamber. Besides furnishing him with the means of pursuing conveniently his scientific investigations, the change we have mentioned can but conduce to the development of the Professor's best qualities. The teaching at the Sorbonne is a methodical, academical course of lectures; the teaching at the Museum is practical and experimental. M. Claude Bernard, who is above all a man of investigation, will therefore find himself in a favourable element, and it is to be hoped that his new location will be the scene of most interesting researches, and the source of many new and ingenious ideas and explanations.

SACRIFICES TO BACCHUS.

THANKS to the courtesy of the various house-surgeons, we are enabled to present our readers with a very interesting record the number and nature of the accidents due to drink which were treated in the metropolitan hospitals during Boxing-day and night. This includes some cases of injury inflicted under the influence of drink, the victim not being intoxicated. All the general hospitals of importance have furnished returns, and as accidents of any severity on such an occasion are with scarcely an exception taken to an hospital, it may be considered that the list fairly represents the amount of serious damage to limb which the festivities of Boxing-day inflicted upon the London population.

[JAN. 2, 1869. 21 weighing some hundredweights, and escaped with a slight abrasion. These two men "were too drunk to stand when brought to the hospital."

At University College Hospital Dr. Squarey, resident medical officer, tells us only 5 cases of the kind were treated.

At King's College, on the other hand, no less than 23 casualties are reported by Mr. A. Napper, house-surgeon, as 'due to drink."

From the Middlesex Mr. G. E. Norton sends us a list of 9 casualties.

Mr. J. K. Kidd tells us that at Charing-cross 5 such cases were treated.

At St. Mary's 9 casualties from drink were treated by Mr. J. R. Walker.

At the Westminster 15 such cases were attended by Mr. J. R. Haynes.

From the Great Northern we learn that 4 cases were attended by Mr. P. D. Hopgood, including a serious one of concussion of the brain, produced by a fall from a horse, and a punctured wound from a fall upon a butcher's knife. The latter would probably have been fatal but that the blade, happily, struck against the first false rib..

At the Royal Free 13 casualties are ascribed to drink by Mr. T. C. Murphy, the resident medical officer, who tells us that 3 of these were serious enough to require admission.

The total 181 will probably appear small to those who remarked the number of passengers with unsteady gait who filled our pavements on Saturday. It includes, however, 38 fractures of various bones, fractures of both bones of the leg very largely preponderating, and broken ribs coming next. There were nine dislocations. In 7 instances application was made on account of "retention," and strangely enough 3 of these cases were relieved at one hospital. The radial artery in one case, and the brachial in another, were wounded by glass. Cuts, sprains, bruises, and lacerations complete the catalogue of ills resulting from the mirth of Boxing-day.

WHOLESALE POISONERS.

A PARAGRAPH, bearing the sensational title of "A Wholesale Poisoner," has been going the round of the papers lately, based upon the confession of a mild Hindoo named Ramadheen, not yet quite twenty-one years old, of his having followed the trade of a poisoner for more than a year and a half, during which time he had managed to poison twentyseven victims in the neighbourhood of the North-western provinces of India. No motive, beyond a love of the exercise of his power and skill, is assigned. We are told by those who have resided in India, that poisoning is a common crime in that country, although not after this wholesale and motiveless fashion. A native servant will inform his master of the death of a fellow servant who was yesterday in good health, with no more concern or explanation of its cause than may be implied by a shrug of the shoulders. Jealousy and envy are the more frequent

From St. Thomas's comes a list of 13 casualties, including "a severe bite of tongue." Mr. Albert Bell reports 2 cases illustrating the proverbial luck of drunken men. A man was brought in, and found to be uninjured, who had fallen from a hearse; another was struck on the leg by a machine

ing papers as a daily source of interest, were treated with the details of a wholesale poisoning of patients by the nurse of a public hospital in France; and the apparently motiveless nature of the crime excited much curiosity. The ways of some men and women are past finding out. The perusal of a criminal case, and the bare love of imitation, with some women of peculiar temperament and morbid states of nervous system, will be sufficient to lead to their attempting the committal of crimes. A suggestion, of insignificant power at first, recurs to the mind, and is dwelt

upon until it fairly dominates the will; and our police reports and cheap literature undoubtedly exercise an injurious influence in these respects. In the case of the nurse, we are inclined to agree with a writer in the Spectator that something like a morbid desire to exercise power might have influenced her. It certainly could not have been from any love of cruelty, or wish to see suffering, because the agents employed would effect their object with relatively little or no expression of suffering of any kind. Such cases are not to be counted among examples of insanity; the fear of detection, or of some sharp punishment, would, doubtless, have controlled the criminals, if such fear had really been present to them.

LAMBETH PIGSTIES."

THE vestry and guardians of St. Mary-the-Less, Lambeth, are at this moment tormented by a clever and pertinacious female, who, under the signature of "A District Visitor," is exposing, in the columns of the Daily News and South London Press, the state of small houses, some of them belonging to vestrymen and guardians, which she designates by the title of "Lambeth Pigsties." Many of her descriptions would be ludicrous, except for the impossibility of raising a smile when the sad condition of the wretched inhabitants comes vividly to view. A very feeble attempt has been made to discredit these statements, but as we have ourselves been witness of the dreadful state of whole streets of houses throughout the southern districts of the metropolis, we can well believe their truth. That such a state of things should be permitted to exist shows conclusively that vestries and their officers require "inspecting" by imperial officers just as urgently as boards of guardians. We trust this important question will form a subject of consideration by the new Sanitary Commission, and that one of their earliest acts will be to make inquiries by independent sub-commissions, as to the manner in which vestries and boards of works have performed their duty as the executive of the Sanitary Act.

THE DISPUTED CORONERSHIP OF WESTERN MIDDLESEX.

In accordance with a special request made to us we publish in another part of our number the list of present contributors to the fund which is being raised for testing the legality of the recent election of Dr. Diplock to the coronership of Western Middlesex. A fitting opportunity again presents itself to urge upon the authorities the pressing need of reforming a mode of election to an important and venerable office which is followed by results highly injurious to the public weal. The facts of the case of Hardwicke v. Diplock are now pretty well known. The bonâ fide freeholders supported Dr. Hardwicke in large numbers, but their influence was overridden by the voting in favour of Dr. Diplock of men who should have no claim to the exercise of votes, and who are not in reality freeholders. The sheriff had no power to question the votes tendered, and in consequence an action in the form of a quo warranto in the Court of Queen's Bench was commenced against Dr. Diplock, and the argument upon the rule absolute, contesting the validity of the votes for graves, and of men calling themselves watermen, is expected to come off at Westminster during next term. Meanwhile it has been thought that further action may be abandoned. However, owing to the generosity of the professional and other friends of Dr. Hardwicke, this has been defeated, and we are glad in one sense at this result. Anyone who attaches proper value to purity of election must devoutly wish that the points in dispute, involving the legal definition of a freeholder, or an

elector entitled to vote for coroners, may be authoritatively settled. Dr. Hardwicke, in defending his own interests, is indeed fighting the battle of a great public principle, and he is deserving of every consideration at the hands of the community.

"HONORIS CAUSA."

THE Queen was pleased quite recently to distinguish Dr. Joseph Fayrer, Professor of Surgery in the Calcutta Medical College, and one of the most eminent of Indian surgeons, by making him a Companion of the Most Exalted Order of the Star of India. Dr. Fayrer is a Member of the Royal College of Surgeons of England of 1847, but has had neither the opportunity, nor possibly the inclination, to present himself for the Fellowship examination. It has been repeatedly represented to us, and we believe also to some members of the Council of the College of Surgeons, that Dr. Fayrer's was one of those exceptional cases contemplated by section 5 of the Charter of 1852, which runs as follows:- It shall be lawful for the Council of the said College by diploma, &c., to admit to the Fellowship of the said College in each and every year from the date of these our letters patent without examination......any two persons, being at the time of such admittance Members of the said College of not less than twenty years' standing." This clause is further elucidated by section xxii., 7, 8, 9, of the College bye-laws, which provide that the proposition for the election of such a Fellow shall be made at the quarterly meeting in January, and must be signed by six members of Council; and that the Council shall ballot for the admission of any person so proposed at the quarterly meeting in April.

We are aware that this clause of the Charter has never been put in force-in fact, it is only of late years that it could have been utilised, but we think that the opportunity which now offers of enrolling an honoured name among the Fellows of the College should not be lost. The only difficulty we anticipate is that the six members of Council signing the recommendation are to declare that "from their personal knowledge of the party proposed he is in their opinion a fit and proper person to be admitted into the Fellowship." But as the word "personal" is defined by the dictionaries to mean "belonging to men or women," we presume that the knowledge which the members of the Council of the College cannot fail to have of the eminent Calcutta professor may be considered personal-i.e., belonging to them as men (or women); and thus the Gordian knot may be divided.

THE SICK IN ST. PANCRAS WORKHOUSE.

OUR prognostication as to the necessity of holding frequent inquests upon the sick who die in workhouses has been speedily realised at the St. Pancras Workhouse, of which, if we are to believe the guardians, the management is unusually good. Mary Ann Collins having died suddenly from accidental causes, it transpired before the jury that the night nurse is a pauper, that she had 346 cases under her charge, and that she did not even hear of the illness of the deceased for three hours after her attack. We should like to know what the guardians have to say to this extraordinary arrangement. How could it be reasonably expected that this pauper nurse, without the slightest incentive to the performance of her duty beyond an extra pint of beer, should be held responsible for ferreting out a dying woman from the mass of age and infirmity committed to her care; and the wonder is, not that the unhappy patient was found after three hours' suffering, but that she was found at all. Can it be supposed that other serious cases do not suffer from equal neglect-nay, is it not certain that