RELIEF OF VAGRANTS.

A CIRCULAR letter has been issued by the Poor-law Board, drawing the attention of the guardians to the present system of relieving vagrants, and suggesting several reforms. The name and occupation of each appli cant, with the place whence he comes, and the place to which he is going, is to be recorded in a book of reference; but how this will enable the officers to distinguish between professional tramps and the genuine way. farer we do not know, unless a copy of the register is sent daily to the County Police Office. No man can determine by one examination whether a tramp is really able to work or to walk a given distance—that is, whether he be a genuine traveller or not, and the tramp, knowing this, is master of the situation. But he cannot deny his habits if they are recorded and sent to a central office. With such information the police would be able to prove a violation of the vagrant laws, and detain the professional tramp, which is the only punishment he really cares for. Without this central registration, we fear that the excellent regulations [ for uniform treatment now issued will lead rather to the more equable distribution of tramps than to their repression.

Dr. Sisson.-We should like to hear Mr. Jay's account of the case. As the facts are represented by our correspondent, Mr. Jay is decidedly in the wrong in two respects: first, in interfering with a patient under the care of another medical man; and secondly, in not answering a letter of complaint.

THE new Civil Service magazine, Under the Crown, has some good points— notably the papers by Tom Taylor, W. R. Greg, and Dr. Phipson. But why bring it out under so obvious a disadvantage as is implied by its cover, the design whereof may be briefly described as "two upright posts with a cross-beam and a dependent spirit-label"?

A Constant Reader.-1. Consult a registered medical practitioner.-2. The amount varies.-3. Certainly not.

W.A. K.-The works named are well suited for the purposes required.

THE RELATION OF WET SUBSOIL TO PHTHISIS.

To the Editor of THE LANCET.

SIR, IN THE LANCET upon several occasions the discovery of the relation between wet subsoil and phthisis in England has been attributed to Dr. Buchanan, and most markedly has this been done in your last number. Such, however, is not the fact, as will be seen from a perusal of the enclosed pamphlet, p. 17. In 1865, when Dr. Buchanan, as Inspector from the Privy Council, called upon me for information as to the results of sanitary works at Salisbury, I specially called his attention to the great reduction of phthisis here, and explained to him my theory, that the cause of such reduction was the drying of a very wet subsoil by drainage. At that time Dr. Buchanan had no knowledge upon the subject. I asked him to investigate it, and I have now before me a letter received from him some months afterwards, in which he writes: "As in several other towns where good sanitary work has been done I do not find any such great reduction, perhaps it would not be safe to insist on the effect of your sanitary operations in reducing the phthisis mortality." By subsequent inquiries Dr. Buchanan found the fullest corroboration of my theory of wet subsoil causing phthisis. Clearly, then, the accounts hitherto published of this discovery having been made by Dr. Buchanan are quite erroneous; for so far from it having emanated from him, the letter quoted is a distinct proof that he, at first, doubted the fact.

Having originated the Salisbury drainage works, and thus, by experience, founded as well as noted this very important discovery in England, are facts which I think fairly entitle me to ask you to set this matter prominently and permanently before the public.

I am, Sir, your obedient servant,

A. B. MIDDLETON, M.R.C.S. Eng.

The Close, Salisbury, January 4th, 1869. ** We give Mr. Middleton the opportunity of asserting a claim to priority, but really do not quite comprehend its nature. He has sent us a pamphlet, dated 1868, in which are reproduced the accounts he gave in certain communications formerly made by him to the local press, of sanitary improvements in Salisbury, including the diminution in the fatality of phthisis. Mr. Middleton will forgive us for saying that no evidence is forthcoming to show that he traced or stated the existence of any such connexion between consumption and wet soil as he now declares he told Dr. Buchanan But in a postscript to the pamphlet, the date of which must be subsequent at any rate to the publication of Dr. Buchanan's Report to the Privy Council, Mr. Middleton quotes Dr. Buchanan's results, and the opinion is strongly stated that the Salisbury phthisis rate has diminished because of the drainage of the town. We gather from the pamphlet itself that Mr. Middleton rather attributed it before to general improvement in sanitation; for he gives as the cause of consumption "mainly humidity and nastiness of atmosphere caused by canals and cesspools." To invent a theory is one thing; to prove its truth is another. We fail to find that Mr. Middleton has adduced evidence to show that the reduction of phthisis in Salisbury or anywhere else was due to the removal of soil water specially. It is, moreover, evident that Dr. Buchanan at the outset did not rest satisfied with the apparent proof of his position furnished by a solitary town, and withheld his judgment until he had obtained experience in those places in which the connexion between subsoil and phthisis could be traced.

GRESHAM LECTURES.

THESE lectures will be continued on the 13th, 14th, and 15th of the present month at the Gresham College by Dr. E. Symes Thompson, who selects as his topic the "Influence of Occupation on the Health and the Eye." G. F. K.-As far as we know, the institution is a bond-f de one.

DR. GULLY, OF MALVERN, ON ANIMAL MAGNETISM. We owe an apology to Dr. Gully for not sooner than this noticing a rem able lecture for the entertainment and instruction of the working n Malvern, and to our readers for not sooner placing before them the and statements of Dr. Gully. These cases and statements are remar not only in themselves, but for their conspicuous absence in all scie works. It is painful to think that while Dr. Gully related the case audience seemed more moved to merriment and laughter than to reflection. We should be disposed to censure the audience for this corum were it not that Dr. Gully's own narrative shows that he is with such peculiar powers over other people as to make them but responsible either for their manners or their movements. It will b what power Dr. Gully can exercise over ladies at a distance throug medium of amber beads. It is true that working men are not so sei to beads and amber as are ladies; but we should gather that they we the whole audience of the doctor on the occasion of his lecture; and if they were, we think it scarcely fair to judge them harshly for beb somewhat strangely in the presence of such a magnetic influence i Gully evidently is. As we wish to give our readers the benefit of Dr. experience rather than our own comments, we say no more. We o mark that the doctor shows that peculiar preference for Mesmer to W and Faraday, and Matteucci, and Pacini, which generally is associate hydropathy and other peculiar forms of practice. He says:

"As the magnet might lose its peculiar power, so might the body; and when a man had lost his magnetic power, another restore it to him. Those were the results of the experiments during the last sixty years. The phenomena could not be ascr imagination. He could quote many instances in which it was imp to suppose that imagination had anything to do with it. He bered the case of a distinguished man who came under his care teen years ago. The man, who was an oddity, was dying when to him. He (the dying oddity) had a devoted wife, but he wo allow her to attend to him, and he said he would rather have di deaths than be mesmerised. (Laughter.) His wife mesmerised day, when he was asleep, and all his love returned (laughter), lived only three weeks afterwards. (Loud laughter.) That fact that the results were not to be ascribed to imagination; for the sleeping man whose affections had ceased towards his wife, and love returned by the effects of mesmerism. (Laughter.) There w at one time under his care, who was suffering from paralysis loins. He (Dr. Gully) magnetised her, and under its influence s walk when he held her hand; but if anybody else touched her, her into violent convulsions. (Laughter.) He magnetised her months, and she went home; but she could not sleep without} netism. (Renewed laughter.) He got some amber beads, an conveyer of electricity, and sent them to her by post. She ha put them into her hand, and she would go off to sleep. (Gener ment.) One day he was in a hurry to go away somewhere, and pened not to post them himself. He told an amanuensis, whor at that time, to put them in an envelope and post them-t having been previously placed in a silk bag, and enclosed in a return of post he (Dr. Gully) received a letter from the lady, sta she knew that some hand besides his had touched the beds; for ment she put them into her hand she went into convulsions. (L He spoke to his amanuensis on the subject, and the employé sa quite right; he had had the indiscretion to open the box. Sh knowledge of that. Thus it was proved that the result thr medium of the beads was just the same as when he himself was (Laughter.) They might laugh at these facts; but the mo agencies in the animal world were the most subtle. All the g nomena in the animal world went on by means of molecules agency which kept those molecules going must be of the mo character. It was absurd to laugh at the results of a myster subtle agency. Laughter proved nothing, and it was generally ignorant who indulged in it. People should not laugh until the quired. When they laughed at animal magnetism, they shoul ber that it was something far more subtle than magnetism w the world in its orbit. He advised them not to laugh at ani netism, but to direct their attention and those of their friends remedial agent. (Applause.)"

In the first case the mesmerism seems to have been killingly s Not only was the fine passion of love restored, but restored in suc as apparently to kill the unfortunate patient in three weeks. Wordsworth puts it truly, "that some have died for love." Bu of the beads puts the case of the "dying oddity" into the shad one with indignation at that meddling amanuensis who opene box, and threw the unfortunate lady into fits. Gloriana.--We advise our correspondent to consult his medical at the points mentioned.

A CAUTION.

To the Editor of THE LANCET.

SIR, I think by giving the description of a thief, who is r rounds, it will act as a timely warning to medical men. He obtai sion to my consulting room during my absence, and the short ti there managed to pocket a midwifery case and several other sm He is a tall man, reddish whiskers and moustache, blue eyes, and complexion. He wore a thick double-breasted frock coat, buttone light trousers. I am, Sir, yours truly, Inverness-road, Bayswater, Jan., 1869. WM. WIGMORE, M

A Young Surgeon and Physician wishes to be informed whether 1 probability of the second volume of Cooper's Surgical Dictio published. Also when the new edition of Watson's Practic and of Pirrie's Surgery will be out.

Iatros.-There is no medicament for actually preventing the c cated.

A Physician.-Thomson's Domestic Management of the Sick Ro

THE LANCET,]

THE AUSTRALIAN MEAT QUESTION.

In consideration of the great distress which prevails in this country at the present time, and the probability of its increase, the supply of meat from our Australian colonies becomes a most important question. A meeting took place at Norton Folgate on the 29th ult., at which this subject was practically discussed by various gentlemen connected with the colonies and some of the metropolitan medical officers of health. There is no doubt as to the power of Australia to afford a plentiful supply if the difficulty attending its transport to this country can only be surmounted. The specimens of meat presented at the meeting were said to have been excellent. The meats are packed in large iron cases, holding about two tons and a half. Sheep are packed whole, without bone, and cured; and when the iron case is filled with the meat, boiling fat is run into the case, which is then hermetically "sealed" for exportation. The manner of exporting the beef is the same, and it comes to this country in good condition. Although the meat is without bone, it is sold at a less price than that in the London market when weighed with bone. It was stated that experiments were being made in order to bring frozen fresh meat from Australia to Europe. Mr. Tallerman, on behalf of the shippers of the ment, stated that stores had been opened for the retail sale of the meat in Norton Folgate; and, in order to clear away difficulties, receipts for preparing and cooking the food were given to the purchasers. We can, in common with everybody else, only hope that success may attend the undertaking. Cheap meat, of good quality, would be an immense boon to the poorer classes, many of whom must experience extreme difficulty in procuring animal food at all.

Sanitas.-The letter of "J. B." in Wednesday's Daily News discovers simply a mare's nest in regard to the assumed omission of the area of the City from the general plan of metropolitan drainage. The sewers to which he refers (Fleet, Dowgate, Walbrook, and London-bridge) still discharge into the Thames, for the simple reason that the intercepting low-level sewer is not yet completed so as to connect with the northern outfall system. "J. B.," therefore, fails to surprise us, if he succeeds in astonishing (as he assumes he will do) "all other editors whose head-quarters are contiguous to the Thames" by his discovery.

Dr. Thom Thomson.-In the Social Science Review, Sir James Simpson's paper was read at the meeting of the Social Science Association at Belfast in 1967.

Mr. M. Montefiore.-Thanks.

O. O.-If the imbecile is in charge of a person who keeps her for profit, a licence is necessary, and our correspondent should apply to the Lunacy Commissioners without delay.

Medicus (Brighton) will find a letter on the subject in another column.

LONGEVITY.

To the Editor of THE LANCET.

SIB, Dr. Allbutt, after considerations of philosophic profundity, has explained his views as being so much in accordance with my own that I should gladly have made use of his language were I gifted with the same poetic faculty. I remarked that most men do not die simply of age, but fall victims to adverse circumstances, to accident rather than to time. Dr. Allbutt, as the champion of time, makes full allowance for the action of circumstance. He admits that "perhaps none of us die of ourselves alone," and embodies this view in a parable, likening the span of human life to an innings at cricket, in which we have to stand up against such bowling that few of us carry our bats out. While Dr. Allbutt allows thus fully for assaults from without, I as freely admit that death may work from within; trace the footsteps of time in hereditary disease, and in the body of a syphilitic infant recognise a victim of age.

Before quitting the subject, I may allude to a letter from Mr. Dixon, in which he urged most truly and forcibly the fallacious nature of many of the stories of long life. I am fully aware of this, and nothing was further from my purpose than to constitute myself the defender of the unsupported statements which pass current upon the subject of longevity.

In conclusion, let me revert again to the pathological aspect of the question, and ask any of your readers who are able to grant me such a favour, to give me the means of examining the tissues of any person who has survived ninety years. Your obedient servant, Chesterfield-street, May-fair, Jan., 1869.

W. H. DICKINSON.

Expectans. So far as our information goes, it appears that the Royal Sanitary Commission has not yet recovered from the state of disorganisation into which it has been thrown by the appointment of some of its original members to posts in the Ministry. A new Chairman has to be selected, and we understand that the Marquis of Salisbury and Mr. Gathorne Hardy are the favourites by choice for that post. We want to see the Commission get to work without more ado.

Dr. Bryan.-The pressure on our space has unfortunately delayed the publication of the case.

CHRISTMAS TREES IN HOSPITALS.

FOLLOWING a now very general custom, several of the hospitals have given the patients the treat of a Christmas tree or féte. This was the case at Charing-cross Hospital on Wednesday last, and at the Children's Hospital a few days since.

Beta.-A L.S.A. London can practise as an apothecary, and keep open shop, anywhere in Great Britain.

Dr. Russell, (Neath.)-Please send us the account to be given by Dr. Ryding to the next meeting of the Board.

Dr. Greenhalgh (Stockport.)—The subject shall be inquired into.

METROPOLITAN ASYLUMS.

[JAN. 9, 1869. 71

THE Builder states that plans are now before the Poor-law Board for their approval for Fever and Small-pox Hospitals, to be erected for the accommodation of about 150 and 90 patients respectively at Stockwell. Designs are being prepared for a Sick Asylum, to accommodate 600 patients, for the Newington district, to be erected at Peckham Rye. The Lambeth authorities have also invited designs for a similar building, For the Fever and Small-pox Hospitals at Homerton, premiums have been awarded for designs, the best having "some excellent points," the Builder says. Thus the staircases leading to the upper wards are entirely separated from them by a gallery open on both sides; the "administration," which forms the centre of each hospital, is well away from the wards, and is divided into four distinct blocks of building-the medical and official, the attendants, the store and kitchen, and the laundry departments,-all unconnected except by the ground floor corridor, opening on both sides if required. The plan of the Small-pox Hospital provides for two pavilions for each sex, radiating from the two ends of a short corridor, the adminis trative blocks (divided into four) being in the centre. The instructions for these designs prescribe pavilions not more than two stories in height; 2000 cubical feet space per occupant; impervious cement for the walls; open windows reaching to the ceiling; ventilating stove-grates to bring in fresh warmed air; outlet shafts; iron staircases; and that no expense is to be incurred for ornamental work.

Mr. J. Brown. The penalty on persons selling articles of food and drink, knowing the same to be injurious to health, is not to exceed £5, together with costs attending the conviction; and if any person convicted shall afterwards commit the like offence, the offender's name, place of abode, and offence may be published, at his expense, in such a manner as may seem desirable.

Inquirer.-We think not.

ONE of the reporters of the Glasgow Herald, in a visit to Malin Head, the northernmost point of Ireland, has fallen in with a medical man whose practice embraces an area of fifty-seven square miles, having a population of 10,000: "Every family in that vast tract," says the writer, "having a claim upon his services, one was quite prepared to hear that often for forty-eight hours together he could not find time either to eat or sleep." Mr. R. W. Goldie.-1. Jeaffreson's Book about Doctors.-2. Grossmith's, Fleet-street, E.C.

Nunquam.-All registered pharmaceutical chemists are exempted from serving upon juries or inquests.

SUTURES IN SCALP WOUNDS.

To the Editor of THE LANCET.

SIR, I have much pleasure in endorsing the experience of Dr. L. Porteous in the treatment of scalp wounds. While assistant-surgeon at the Portland Convict Prison, I had a large number of wounds of the scalp under my care, and in the majority of cases adopted the wire suture with good results.

At the Silvertown Iron-works I had still greater opportunities of treating such injuries, and employed sutures in nearly every case, chiefly from the success obtained on former occasions, but partly owing to the insuperable objection entertained by the men to having their hair sufficiently removed for the purpose of obtaining a firm purchase with strapping. Adhesive plaster was of little use amongst the boys, who frequently removed the dressing immediately on leaving the surgery, to satisfy their companions as to the nature of the injuries received.

Through the courtesy of Messrs. O. Vincent and Case (late house-surgeons to the Middlesex Hospital), I was enabled to watch several very severe cases of scalp wounds treated by sutures with the best results.

After the consideration of several hundred cases I have arrived at the following conclusions:

1st. That the employment of metallic sutures in scalp wounds is less liable to induce erysipelas and sloughing than strapping with adhesive plaster. 2nd. That by their use we are enabled to bring and preserve the edges of the wound in most perfect apposition, dispensing with much of the heavy strapping and bandaging in common use.

Lastly. That should an inflammatory blush appear at the edges of the wound, or much tension on the sutures ensue from suppuration or otherwise, their removal may be had recourse to forthwith. I am, Sir, yours, &c., HORACE BASAN,

Resident Surgeon to St. Marylebone General Dispensary.

January 5th, 1869.

THE paper of Dr. Charteris is in the hands of the printer. The reference in regard to "authentication" in last week's issue did not apply to our correspondent, as imagined.

SCULTETUS AND HIS BANDage.

Dr. Bolton, of the Infirmary, Newcastle-on-Tyne, in kindly answering a correspondent, only does justice to Scultetus in the following notes:-"Scultet's (sic) Bandage' in Smith's Minor Surgery is orthographically incorrect. Cutler on Dressing and Bandaging illustrates the bandage of Scultetus for fractures of the femur. (Synonyms Many-tailed Bandage; Bandage à Bandalettes Séparées. Fr.) We are also indebted to Scultetus for the hoop cradle used in cases of fracture of the thigh and leg. I would refer your correspondent to Heister's Surgery (1743), or to the Armamentarium Chirurgicum of Scultetus, 4to (1666), for a fuller description of bandage and cradle. Both are in constant use in hospital practice, and poor Scultetus is never associated with either."

P. C. S. should give notice of his loss to the licensing body from which he obtained his diploma. The fact of the name of our correspondent appear. ing in the Medical Register would, no doubt, suffice as regards the obtaining of a public appointment.

SANITARY STATE OF STAMFORD.

THE MARQUIS OF EXETER presided at a meeting held in this town last week for the purpose of considering what should be done to improve its sanitary condition. The system of cesspools in the porous limestone formation was admitted on all hands to be a source of constant danger as affecting the water-supply. Lord Exeter stated that round his house at Burghley there were eight cosspools, and when they were opened nothing was found in them, the contents having disappeared through the rock; and he had no doubt that to this cause was attributable much of the sickness from which the servants and children had suffered, because since he had substituted drains for cesspools the servants had become much more healthy, "and an oppressive feeling which seemed to hang about the house had been removed." Although a good deal was said during the discussion of the subject to create a feeling adverse to the adoption of sanitary works, on the ground of their expense, the meeting adopted resolutions affirming the necessity of such works, and calling on the Town Council to carry out the Sanitary Act.

Omega. The son of a deceased medical man, if not provided for, is eligible for admission to the Medical Benevolent School, the election to which is by votes of subscribers, and involves unfortunately considerable expense in printing, postage, &c. Write to the Secretary, 37, Soho-square. If the widow is in immediate and urgent want, apply to the Secretary of the Medical Benevolent Fund, Dr. Broadbent, 44, Seymour-street, Portmansquare.

THE NEW PHARMACY ACT.

To the Editor of THE LANCET.

SIR, The Pharmacy Act of last session will be the cause of great annoy. ance to medical men. As an illustration of this, I may name a circumstance which occurred to myself.

Having a tedious midwifery case in Leadenhall-street, I went to a druggist, Mr. Brown, of Aldgate, for a little ergot to give my patient. Not having any, he recommended me to apply to a Mr. Constance, of Leadenhall-street; and going to this shop, I was immediately told by the manager (as he styled himself) that he could not supply me, as it was contrary to the Pharmacy Act. I told him who I was, and that Mr. Brown (who had known me for twenty years) sent me. He replied he declined serving me. I stated to him I believed the Act did not come into force until January, 1869. Still he would not give me the ergot. At last he condescended to say if I would go to Mr. Brown, and bring a note from him, he would serve me. Urgently requiring the drug, I went to Mr. Brown again, and he kindly furnished me with a note, requesting I might be served, on presentation of which I was attended to.

Now I ask, Mr. Editor, if this is the way medical men are to be served when wanting some scheduled drug in the middle of the night, and to be met as I was? I leave your readers to imagine themselves in the hands of a person like the manager of Mr. Constance's business in the dead hour of the night, and urgently needing a drug scheduled by the Act, to either mitigate the sufferings of some fellow-creature, or perhaps save life, and this Act of Parliament steps in to prevent any such humane effort from being made. I think the Medical Council should at once see to this Act, and seek its amendment. Yours respectfully,

Hackney, December 30th, 1868.

R. BENTHAM, M.D.

A Candidate writes to complain that though a month has elapsed since the last examination in Arts at the College of Surgeons, no list of successful candidates has yet appeared. The examination is, we believe, conducted by the College of Preceptors, and it certainly seems remarkable that a longer time should be occupied with a smaller number of candidates than at the matriculation examination of the University of London, where also the candidates have to be "classed."

A. B.-At University College.

Mr. Mortimer's statement is not correct. The gentleman's name is in the Medical Directory for 1868.

EXCESSIVE SNEEZING.

To the Editor of THE LANCET.

SIR,-In answer to the inquiry of "Beta" in your last impression, I beg to inform him that I have found immediate relief following the inhalation of spirits of camphor, applied by placing a drachm in the palms of the hands, and directing the patient to inhale the vapour thus arising. I may say that I have never found this remedy to fail. Yours obediently, Osnaburgh-street, Jan. 4th, 1869. İ. N. JAKINS.

To the Editor of THE LANCET.

SIR,-Has "Beta" tried the plan of pressing the tip of the forefinger firmly on the upper lip, immediately below the middle of the nose, and keeping it there while the inclination to sneeze continues ?-Yours truly, January 5th, 1869. ALPHA.

To the Editor of THE LANCET. SIR,-Your correspondent, "Beta," will, I think, find good results from the use of chloroform (inhaled) in his case of "excessive sneezing," especially where the "general health is so much improved."-Yours, &c., January 6th, 1869. DIOGENES.

SUBDUED LIGHT IN THEATRES.

A CORRESPONDENT writes:--" You would do a good service to the theatreand concert-going public if you would call attention at this season to the state of places of public entertainment, which are crowded, and every breath of air carefully excluded, rendering the atmosphere inhaled by so many persons packed closely together all the more vitiated. If people knew the comfort of 'subdued light' and moderately heated rooms, the pleasure held out to visitors would have less present annoyance and aftersuffering attached to it."

THAMES VALLEY DRAINAGE. WINDSOR and Eton are to be drained on the plan of the separate system, as recommended by Colonel Ewart, R.E. The cost is estimated at £16,000. Observer. The letter is, no doubt, objectionable; but at this season of the year must be excused.

Mr. Anthony C. Foster's case shall receive the earliest possible attention. SEVERAL of our correspondents have complained of the lateness of the publication of our last week's number. The delay, which was unavoidable, is explained by the fact that the type was entirely new, thus entailing great additional labour, and that at the same time the number itself contained a supplement of eight pages.

EVERY communication, whether intended for publication or otherwise, must be authenticated by the name and address of the writer. Papers not accepted cannot be returned. Articles in newspapers, to which attention is sought to be directed, should be marked. Communications not noticed in the current number of THE LANCET will receive attention the following week.

COMMUNICATIONS, LETTERS, &c., have been received from-Dr. Greenhalgh;
Mr. Paget; Dr. Wilks; Mr. Brodhurst; Dr. Ramskill; Dr. Sydney Ringer;
Dr. Braxton Hicks; Dr. Anstie; Rev. W. Kirkus; Mr. Worth, Milbrook ;
Dr. Charteris; Mr. Barton; Mr. Owen; Dr. Oppert; Dr. Carruthers, Edin-
burgh; Dr. Phillips; Mr. Riggall; Mr. Jack; Mr. Hamlyn; Dr. L. O. Fox,
Broughton; Dr. Hartley, Halifax; Dr. Harrison, Walsall; Dr. Tylecote,
Sandon; Mr. Crick; Dr. Browne, Everton; Mr. Southam, Manchester;
Mr. Galton, Exeter; Dr. Bell, Cockermouth; Dr. Doyon, Lyons; Dr. Lowe,
Lynn; Mr. C. J. Fox; Mr. Taylor, Broadstairs; Mr. Bowkett; Mr. Curtis ;
Dr. Slyman, Newtown; Rev. J. Branch; Dr. Chalmers, Glasgow; Dr. Jones,
Rhyl; Dr. Thomas, Cyfartha; Mr. Horner, Sheerness; Dr. Gore, Limerick ;
Dr. Eastwood, Sheffield; Dr. J. Murray; Mr. Wigmore; Mr. Booth, Hud-
dersfield; Mr. Mackaye, Ardgay; Mr. Tomson, Luton; Rev. C. A. Moore,
Spalding; Dr. Harding, Whittlesea; Mr. H. Basan; Dr. C. S. Smith, Liver-
pool;
Mr. Pincott; Mr. Knott; Mr. Hendley; Mr. Little; Dr. R. King;
Mr. Everett, Oldham; Dr. Farrow, Ingham; Mr. Cooper; Dr. Newhouse,
Birmingham; Mr. Spencer; Dr. Willshire, Erfurt; Mr. Handcock, Leeds;
Mr. Poole; Dr. Warburton, Carlisle; Mr. Greame, Forfar; Mr. Bernard,
Bristol; Dr. Goldie, Withington; Dr. Knipe, Malvern; Mr. MacDonnell ;
Dr. Rhind, Trinidad; Dr. Coats; Dr. Murphy; Sir W. Croslin; Mr. Vacher,
Birkenhead; Dr. Tennant, Newbottle; Dr. Watson, Creetown; Mr. Tallan;
Mr. Mortimer; Dr. Soffe, Thetford; Dr. Brunton, Redditch; Mr. Grose,
Woolwich; Dr. Sexton, Kurrachee; Dr. Jennings, Coleford; Mr. Sewill;
Dr. Herbert, Ashton-under-Lyne; Mr. Byford, Chicago; Dr. Woodhouse,
Hertford; Dr. Miles, Gillingham; Mr. Pope, Stepney-green; Mr. Coleman ;
Messrs. Higgins and Earlam, Abbots Bromley; Mr. Hewitson, Allenheads;
Dr. Reynolds, Arlington; Mr. Hughes; Mr. Godson; Dr. Tuson, Glasgow ;
Mr. Greenway; Dr. Thomas, Bronphillip; Mr. Henderson; Dr. Morris,
Blackpool; Dr. Roberts, St. Asaph; Dr. Tizard, Weymouth; Dr. Moxon,
Carnarvon; Dr. Black, Glasgow; Mr. Neville, Southampton; Dr. Cobbold;
Mr. Wall; Mr. Middleton, Salisbury; Mr. Lane; Dr. Wilson, Lanchester;
Dr. Cullinan, Ennis; Dr. Jayallar, Ahmedabad; Dr. Jakins; Mr. Pratt,
Poole; Mr. Constable; Dr. Gill, Manchester; Dr. Johnston, Sheffield;
Dr. Hollingsworth; Dr. Meymott, Ludlow; Messrs. Fannin & Co., Dublin;
Mr. Steeds; Dr. Ritchie; Dr. Cooke; Mr. Griffith; Mr. Kingsdown, Iver;
Dr. Blaker, Portland; Mr. Colthurst, Keynsham; Mr. Davies ; Mr. Brook
Mr. Kerr; Dr. Broadbent; Mr. Coales; Mr. Hill, Newport; Dr. Robertson,
Doncaster; Dr. Davis; Mr. Moss; Dr. Sumpter, Cley-on-the-Sea ; Dr. Fryer,
Manchester; Mr. Warner; Mr. Shield; Dr. Sisson; Mr. Kelly; Mr. Neat;
Dr. Jones, Saxmundham; Mr. Dennant, Brighton; Dr. Bulmer, Hackney;
Mr. Yarrell, Skibbereen; Dr. Walker, Bordighera; Mr. Wright; Dr. Ryley,
Sandy; Mr. Black, Thurso; Mr. Somerville; Mr. Hughes, Parsonstown ;
Mr. Maclean, Caistor; Mr. Fenton; Mr. Hills, Totnes; Rev. Mr. Wilson;
Dr. Russell; Mr. Sutton; Mr. Anthony C. Foster; Ethnological Society;
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Clinical Lecture

ON THE

BY JAMES PAGET, D.C.L., F.R.S.,

SURGEON то ST. BARTHOLOMRW'S HOSPITAL. (Shorthand Report, revised by the Author.)

GENTLEMEN,-You have recently had the opportunity of seeing four cases of carbuncle treated in my wards after methods which you would probably describe, if asked to do so, by saying that "nothing was done for them." Here are the patients' papers; and there is, to be sure, no medicine set down for them to take, and you know that no surgery was inflicted on them, and yet a good deal was done for them, though the treatment was what does commonly pass by the name of doing nothing." They were carefully fed, washed, cleaned, and bedded; and their carbuncles were very skilfully dressed and washed with proper things, and every care was taken to shut out all untoward influences from them. And if any complication in their cases had arisen, these would have been immediately met. But no complications occurred; and, therefore, the cases passed through their course without treatment, as it is said—that is, without medicine, and with no surgery, no active surgery, no incisions or anything of that kind. And since all these cases passed through their course very favourably, and all the patients were, or will be, discharged at a comparatively early time after their admission into the hospital, I will take this occasion of giving you some observations on the manner of treating this disease.

Although you may not have seen much of it, you must all have heard of the ordinary manner in which carbuncles were treated formerly, and still are by some; a method which consists mainly in making large incisions through them, and giving very large quantities of food and stimulants, as well as considerable doses of quinine, bark, and other tonics. I do not at all mean to say that the things which in these cases I left undone would have done any harm; but what I hold of them is, that they would have been quite useless, and some would have been sources of great discomfort to the patients. And in the way in which I speak of these things you may notice that I exemplify that rule which I have always impressed upon you, of asking yourselves, when you seem to have been successful with some medicine, "What would have happened if I had not given it ?" The apparent consequence of giving a medicine may be plain enough; but you cannot too often repeat to yourselves the question-as a rule, I will not say of practice, but of the study of your own practice,-"What would have happened if this or that, which seems to have been successful, had not been done?"

or four days I have seen sufficient numbers of carbuncles thus divided, and have divided enough for myself, to say that it will not hinder the spreading. I have seen carbuncles spread in as large a proportion of cases after incisions as in cases that have never been incised at all. I have in my mind a striking case that occurred to me early in practice, when I followed the routine, and, in a friend of my own, divided a carbuncle most freely. I cut it after the most approved fashion in depth and length and width, and then it spread. After two or three days more all the newlyagain, and again it was cut as freely. Then it spread again, formed part was cut as freely as the first, and then it spread and was not cut. Then, in a natural time, it ceased to spread, and all went on well. These are only general impressions that I give you, because one cannot count the cases in which it has not; nor even then could it be said whether which cutting has been practised, and those similar cases in if left alone. On a very strong general impression, however, those in which the cutting was practised would have spread I say that carbuncles will spread after cutting in as large a proportion of cases as they will spread in without cutting. Then it is said that carbuncles are relieved of their pain if they are thus very freely cut. Here, again, however, is standing, which is hard, tense, and brawny, is very painful; only a partial truth. A carbuncle of two or three days' and cutting it will relieve, in many cases, a considerable portion of the pain. But after this, when the carbuncle begins to soften, and when pustules begin to form upon its surface, and pus in its interior, it ceases to be painful of its distinct stages of carbuncle in reference to the pain; the own accord, and without incisions. Thus there are two early stage, when it is hard and still spreading, and is generally intensely painful, and the later stage, in which that pain nearly ceases. A carbuncle divided in the first stage, in the first two or three days of its existence, may be relieved of some of its pain; if divided in the later stage, what little pain may exist is altogether unaffected by the cutting. And even cut as you may, you cannot always put aside the extreme pain that a carbuncle sometimes has, even to its later time. Some two or three years ago, I was called to a member of our profession with a large carbuncle in the middle of his back. His friends had been much alarmed about the state of his mind, for he had been suffering great mental anxiety for some time, and they were in fear lest the excessive pain of the carbuncle should, in its disturbed state, do his mind permanent damage. So they persuaded me to cut it, and I cut it after the old plan, very wide across, and far into the adjacent textures, as freely as could be. It did not in the least relieve him. I never saw a carbuncle through its whole course so painful as that was, and up to the last, till the healing was nearly completed, he suffered more or less pain in it. So that the conclusion in reference to pain must be this: if they can be divided in the first three or four days, while still hard and brawny, it may relieve some measure of the suffering; at a later period the incisions have no influence at all.

was evident that the cases uncut healed more readily than those cut. A man who is now in the hospital I have brought round here that I may illustrate this point to you. This is the man, Timothy C, aged fifty-five. When he came in, his carbuncle had a length of more than six inches, and a breadth of three and a half; and it formed the ordinary hard, compact, tense, and brawny mass that a carbuncle. usually does. It had at that time already taken to suppurate, and little pustules were pointing on the surface. If I had followed the practice of incisions, I should have had to make a cut in one direction of about seven inches, and in the other of about five, and after that I should have had not only the wounds wide, open, and gaping, and having

C