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That the Medical Practitioners, as a body, have notwithstanding no direct voice in the Medical Council which they thus support. That owing to the Medical Practitioners having no direct representatives in the Council, the Profession evinces but little interest in its proceedings, a disadvantage which has been admitted in the debates of the Council. That the Council, as at present constituted, has, amongst other matters, failed to deal satisfactorily with the question of Medical education, and that the public still suffers from the inadequate education of many of those to whom licences to practise are accorded, as proved by the not unfrequent rejection of licensed Practitioners by the examining boards for admission into the Medical service of the army and navy. That the introduction of representatives elected by the Profession would supply to the Council a knowledge of the needs of the public and of the Profession in respect to sanitary measures, Medical Jurisprudence, and Poor-law Medical relief, with regard to which there is at present a decided want. That the difficulty in the election of direct representatives by the Medical Profession which existed at the time of the passing of the Medical Act has been removed by the system of registration enforced by that Act. That the election of direct representatives by the registered members of the Profession can now be readily managed for each of the three divisions of the kingdom by means of voting papers. That your petitioners pray that in any Medical Acts Amendment Bill a provision may be introduced for the direct representation of the Profession in the General Medical Council, in the proportion of one-fourth of its members, four representatives being elected for England, two for Scotland, and two for Ireland. And your petitioners will ever pray, etc."

DIARRHOEA was unusually fatal; 4060 deaths in the summer, and 320 deaths by simple cholera were registered. The other fatal zymotic diseases were fever 2483 deaths, scarlatina 2921 deaths, hooping-cough 2369, measles 1989. The past year was distinguished by very heavy floods in the Thames basin in the winter, followed by excessive drought in summer. It was therefore to be expected that the quality of the waters of the Thames and the Lea would vary between limits unusually wide. Thus the total solid impurity in Thames water varied from 22.6 to 38.6 parts in 100,000, whilst that in the Lea water ranged from 21-2 to 36 parts in 100,000. In January, the Thames overflowed its banks above the point at which the metropolitan water supply is drawn, and, washing the surfaces of cultivated fields, mingling with the stagnant ditches and ponds, and receiving the contents of the suddenly flushed sewers of Oxford, Reading, and Windsor, became contaminated to an intolerable degree, as evidenced by the unusually large proportion of organic carbon, organic nitrogen, and previous sewage contamination in the waters of those companies which draw from that river. It is remarkable that the quality of the water supplied from the Lea by the New River and the East London Companies, was but slightly affected by this flood. On the other hand, in the summer months, the waters of both rivers attained a degree of purity which I have never before observed in them. The excessive drought prevented much animal matter, both solid and liquid, from reaching the streams. The refuse was absorbed into the thirsty soil, whence it was afterwards partially disloged by the heavy rains of October and December. It has been frequently asserted, but without proof, that the noxious organic matter of sewage, when discharged into a river of considerable magnitude, is entirely destroyed by oxidation after a flow of a few miles. This assertion is erroneous. The analyses of Thames water delivered in London during the past year, completely confirm Sir B. Brodie's opinion. They leave no doubt that, although oxidation does take place to some extent, a considerable proportion of the animal organic matter contained in the sewage of Oxford, Reading, Windsor, etc., reaches Teddington in an unoxidised condition.--RegistrarGeneral's Summary of Weekly Returns of Births, Deaths, etc., in London during 1868.

REMARKABLE MORTALITY FROM MEASLES.-In his annual report of the health of the Union Infirmaries at Leicester, Dr. J. St. Thos. Clark, Medical officer, says :-"In reference to the measles I may state that the first case appeared in the schools on February 12, in a little boy aged 5, admitted on January 29 from the town. As the time which elapses between the date of infection in this complaint and the appearance of the eruption varies from ten to fifteen days, it is highly probable that the lad had the germs of the disease in his blood when sent in, for he had been attending a large day school up to the date of his admission, and measles of a severe character were already rife in the town. The patient was immediately removed to the infectious ward of the workhouse, a considerable distance from

the schools, but the case, though only as yet in its state of development, had been sufficient to infect several others, for eleven more childeren showed the disease in from nine to twelve days, and others kept falling till twenty-one in all were affected. These were similarly removed as soon as discovered. The disease further spread, owing to too close proximity, from the infectious ward to the children's sick ward in the female Infirmary, and from the convalescent ward in the workhouse to the infant nurseries. Some of those in the children's ward were in feeble health, and the tender age of the infants exposed them all the more to danger from the complaint, which soon made sad work amongst them. Of seventeen infants under 2 years of age who were attacked, twelve died (about 70 per cent.), chiefly owing to the intensity of the chest complications, seven of these being carried off within five days; two children died two years old, and three aged three years; all above three years of age got well. The mortality of the complaint in the infants was materially checked by the infectious ward being at once thoroughly cleansed, white-washed, and provided with fresh bedding, etc., while the chance of fresh cases occurring in the schools was greatly lessened by your board sanctioning the application that no children should be allowed to go into the town, on any pretence whatever, so long as the measles remained prevalent. This regulation remained in force from February 14 to July 9, 1868. The mortality strikingly shows how greatly increased is the danger the younger the patient." SARAH ANDERSON, aged 102, born at Polsted, Suffolk, died at Lexden and Winstree Union-house on the 5th inst., after being an inmate about twenty-seven years. At the age of 97 she fell out of bed and broke her leg, but was able to walk in seven weeks afterwards. She enjoyed good health throughout life, and, with the exception of dimness of sight, was in possession of all her faculties. She leaves over 100 descendants.-Guardian.

THE DEPTHS OF THE OCEAN.-At a recent meeting of the Academy of Sciences, M. Henri Deville invited the members to visit his laboratory at the Ecole Normale, in order that they might inspect the apparatus erected by M. Cailletet, in which fishes are living under a pressure of 400 atmospheres, proving that the greatest depths of the ocean may be habitable.

NOTES, QUERIES, AND REPLIES.

He that questioneth much shall learn much.—Bacon.

The letter of a Brighton Practitiouer shall appear next week.
Medico-Ethical.-Dr. Barnes's forceps may be procured at Krohne and
Sesemann's, Whitechapel, or at Weiss's, Strand.

Dr. Barnes's concluding Lecture on Induction of Labour, which completes the subject of operative midwifery, will appear in our next number. We regret to say that the publication of Dr. Barnes's lectures must now be suspended till the close of the London season enables him to resume his pen.

Gymnast.-There is no doubt but that a very elaborate and complete system of gymnastic exercises was introduced by Dr. Roth. The worst of it is that these things tend to degenerate into specialties and panaceas; some Physicians advocate gymnastic exercises as a cure for all complaints; hence others neglect them altogether.

A Stranger will find that most of the places mentioned are sufficiently well known; any cabman will be able to take him to the places he may wish. Other information may be procured from the Medical Directory, Kelly's London Directory, and our Diary.

A Hospital Governor.-Dr. Heslop's pamphlet was published in 1864, and may be obtained of Hall, 71, High-street, Birmingham. It is entitled "System of Admissions at Hospitals: a Plea for Reform," etc. Just at this time, when the question of Medical charities is attracting so much attention, Dr. Heslop's pamphlet should be read by all who take an interest in the subject. He discusses with much ability the whole question under the following heads:-How and when Privileged Admissions arose? Evils of the System-Reply to Defenders of ditto. Continuation. Positive Advantages of the Free Method. Best Mode of working a Privileged System. Model of a Modified Free Method. Machinery for working Free Method.

Where shall a West-end Doctor fix his Tent?-A correspondent desires information on this head. He wishes to know the best site for a residence in the West-end of London, easily accessible, well known, and not extravagant in price. The house must be suitable for a married man. This is a question much easier asked than answered. Let us see how far we can be assisted by reference to this month's list of houses to be sold and let, of a fashionable firm of West-end house agents. We will give a specimen or two alphabetically:-Upper Brook-street-house, 16 rooms; ground rent £80; 7 years' lease; price £3000. Brook-street-house,

12 rooms; ground rent £20; 15 years' lease; price £3000. Charles-street, Berkeley-square-two houses, 13 rooms each; one, ground rent £46, the other £50; first lease 46 years, second lease 60 years; price of each £7000. Grosvenor-street-12-roomed house; ground rent £50; lease 20 years; 5000 guineas. Wimpole-street-ground rent £100; 27 years' lease; £4000. A house is to be let in Harley-street, containing 13 rooms, for £350. One in May Fair-15 rooms; £260 rent; 20 years' lease, £2000 premium. The agents mark this moderate. These are a few specimens, but they represent the rest. The above question is often put; who is to answer it?

Rochdale. This town is just now in a state of considerable excitement. A resolution has been carried at a meeting of the Governors of the Infirmary that a ward should be devoted to the treatment of patients on "the homœopathic system." The Practitioners of legitimate Medicine have resolved in a body, if this resolution be carried out, not to enter the Infirmary again. Of course this resolution has called forth an abusive and angry series of letters in the local papers. The friends of homoeopathy have no words strong enough-though they use pretty strong ones-to denounce such an odious "trades union." These gentlemen seem to forget that there are two sides to a question. The "reciprocity," said Sheridan once in his humorous and pithy way, in a case in some respects similar, “is all on one side." If homoeopathy be true and worthy of general support, why not convert the entire Infirmary into a homoeopathic institution? If the governors are powerful enough to carry such a resolution as that mentioned above, they are surely powerful enough to carry one having a more extended influence. Let them, if they are in earnest, attempt to do so; if not, let them establish a Hospital for the practice of their favourite "system." It has been done in London-why not on a limited scale in Rochdale? "That is the question." Let them answer it without equivocation. The resolution, however, in favour of homoeopathy seems to have been carried at a meeting very thinly attended, and without notice that such a resolution would be proposed. A requisition has been forwarded to the proper quarter demanding that a special meeting of the governors shall be called to discuss the question. The requisitionists assert that the proposal of the resolution was, as the lawyers say, "a surprise." We shall be anxious to see the result of the discussion of so important a point by the collective wisdom of the Rochdale governors.

Venereal Diseases in the French Army.-We are indebted to Mr. Berkeley Hill for the correction of an error in the summary of the Medical statistics of the French army for 1866, published in our number of January 30, as to the prevalence of venereal diseases in that army as compared with the British. Mr. Berkeley Hill's correction appeared in our number of the 13th inst. We did not comment on it at the time, as the difference between our estimate on the subject and that formed by Mr. Berkeley Hill entirely depended upon the view taken on the question whether the French returns included under the heading "Malades Vénériens" patients suffering from all the diseases which we have until lately been in the habit of calling "enthetic," or merely those treated for syphilis. We had been informed, on authority which we had every reason to consider reliable, that the latter was the system of compilation of the French returns. On further inquiry, we have ascertained that we were mistaken, and have no hesitation in acknowledging the fact, and in expressing our obligations to Mr. Berkeley Hill for pointing out to us the much greater prevalence of venereal diseases in the British than in the French army. We need hardly say that, in giving expression to what we considered to be a fact as regards the prevalence of syphilis in the French army, we were not actuated by any desire to oppose the extension of the Contagious Diseases Act of 1866 to the civil population of this country, as advocated by the association of which Mr. Berkeley Hill is one of the honorary secretaries. On the contrary, we have steadily supported the views advanced by that association, and hope to see some effectual legislation on the subject during the present session. Mr. Berkeley Hill's letter in the Times of the 22nd inst. states the case so powerfully that it is a wonder to us that there should be any further hesitation about it. In his correction of one error, which we have admitted, Mr. Berkeley Hill has accused us of another, to which, however, we must plead "not guilty." The discrepancy between the strength of the British army at home as stated by us and by Mr. Berkeley Hill is more apparent than real. We took our numbers from the Appendix No. 1, which only refers to troops who have served throughout the year uninterruptedly in the United Kingdom. He took his from the table in page 2, compiled from the weekly returns, and including those who have served during broken periods, either on arrival from, or previous to embarkation for, foreign stations. It is evident that the numbers taken by us supply a more correct estimate of the strength of the army and of the prevalence of the various classes of disease. In the French returns, also, Mr. Berkeley Hill assumes as the basis of comparison the "effective" instead of the "mean strength present" of the French army. It is only the diseases of men actually present with their regiments which come under treatment by the French military Surgeons, and it is therefore upon their strength that the more accurate calculation can be made.

Dr. McM.-The value in English currency of the gold mohur of the East Indies ranges from £1 8s. to £1 9s. ; that of the Sicca rupee, from 1s. 10d. to 18. 11d. The salary attached to the office of Colonial Surgeon South Australia is £700 per annum, and is held by Mr. R. W. Moore. The

resident Medical officer of the Lunatic Asylum, Dr. A. S. Patterson, receives £500 per annum. The office of Immigration Agent is held by Dr. H. Duncan-salary £450 per annum.

CURE FOR SNAKEBITES.

Mr. Arthur Baillie, of Plymouth, recalls to our memory the fact that he paid attention to this subject as early as 1835. He entertained an idea that an emetic would be efficacious. Many years passed before he had an opportunity of trying the effect of such treatment. At length, in 1849, when he was staying at a cattle farm in Venezuelan Guiana, an Indian peon was brought to him who had been bitten by a rattlesnake. He treated him as he had previously determined, and had the satisfaction of seeing him recover. At the time he took notes of the case, and, a few weeks after, sent them to London for publication, and the fact was duly recorded in the Medical Times, September 1, 1819. He confidently recommends to the Profession the following treatment:-When a man is bitten by a venomous snake, the prompt exhibition of a full dose of ipecacuanha combined with a little extract of capsicum, which is a powerful diffusive stimulant. After waiting fifteen or twenty minutes, let him have warm water to promote its operation. After that ceases, give him some light or liquid food, with brandy or other alcoholic stimulant. Ligatures and all kinds of applications to the external wounds are useless; the punctures simply indicate the part where the reptile has injected two drops of venom into the capillaries. POOR-LAW MATTERS AT BIRMINGHAM.

The following additional names have been appended to the memorial for the Medical Practitioners of Birmingham to the Poor-law Board against the proposed reduction of the Poor-law Medical staff in that town :

Oliver Pemberton, Honorary Surgeon, Birmingham General Hospital.
V. W. Blake, F.R.C.S., Honorary Surgeon, Lying-in Hospital.
John Joseph Hadley, M.R.C.S.E., L.A.C.

Langston Parker, F.R.C.S., Consulting Surgeon, Queen's Hospital.
David Johnston, M.R.C.S.

W. P. Goodall, Honorary Surgeon, Birmingham General Hospital.
John D. Melson, M.D. and J.P.

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A. Admission of in-patients to the general Hospitals.

1. Emergency wards should exist, not only for Surgical, but also for Medical cases, no governor's letter being required.

2. No patient should be admitted solely on a governor's letter, but a Medical certificate should be required in addition. This he should have to obtain either from a Medical Practitioner or the Medical officer du jour -i.e., the House-Surgeon at the Hospital, or whoever does duty for him, should recommend him for admission.

3. The establishment of special departments should be proceeded with. B. Admission to the out-patient department and to the free Dispensaries. 1. Patients should, except in cases of urgency, produce a certificate of poverty, to be given by the governor who recommends them, their employer, or another respectable man of their district.

2. These departments or charities-at least, the more central onesshould be raised in position by the admission of pupils, and become a means of Medical education. The consulting Medical officers or Hospital lecturers should be delegated to lecture on the out-patients, and receive payment for this.

3. The free Dispensaries should allow the pupils to visit the poor at their houses occasionally under the supervision and guidance of the HouseSurgeon.

C. Central office for inquiries.

It should be founded in order to afford information on Hospital matters, and possibly be connected by telegraph with the principal charities. AlÍ the reports should be found there.

D. Parish Dispensaries.

Their establishment, under the Act of 1867, should be proceeded with immediately.

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SPEAR v. DoIDGE.--DOIDGE DEFENCE FUND. Since the commencement of the appeal to the Medical Profession and others in October last in aid of the above, the Secretary has received numerous remittances, accompanied by deep sympathy for the defendant in this case, with many suggestions for increasing the fund. The following extracts from letters may be interesting to our readers :Broadelyst, Exeter, October 27, 1868. "Dear Sir,-I deeply sympathise with Mr. Doidge, and enclose a Postoffice order for £1 1s. towards the fund being raised to defray his expenses. "Yours truly, JAMES SOMER." Devonport, October 26, 1868. "My dear Sir,-I wish I could do more for your good cause. If I can get any one else here to subscribe, I will. "Yours very truly, W. P. SWAIN." "St. German's, Cornwall, October 28, 1868. "Dear Sir, I herewith enclose a Post-office order for Mr. Doidge. I have not the pleasure of his acquaintance, but shall be heartily glad to find that your efforts in his behalf are attended with the success they deserve. Yours faithfully, GEO. M. GIFFORD."

"

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A highly influential landowner and magistrate in the neighbourhood of Lifton, where Mr. Doidge resides-A. Kelly, Esq.-sends his cheque for £10, and encloses another for £2 23. from a friend at Bristol, both letters speaking in the highest terms of Mr. Doidge as a Medical man, and expressing deep sympathy for him.

"Plymouth, November 6, 1868.

"Sir,-I have much pleasure in forwarding the enclosed Post-office order for £1 1s. as a contribution to the fund towards meeting Mr. Doidge's expenses in the trial Spear v. Doidge. I am exceedingly sorry for him. C. R. PRANCE." Although I have not the pleasure of knowing him personally, his name is "Yours faithfully, well known to me. "Barnstaple, November 14, 1868. "Dear Sir,-Enclosed I send you a cheque for £1 1s., my small subscription towards defraying the heavy expenses incurred by Mr. Doidge, of Lifton. I hope the call has been liberally responded to, and that Mr. JOSEPH HARPER." Doidge, who must have suffered greatly in his mind, will not suffer much "Yours very truly, in pocket. "Port Isaac, Cornwall, February 4, 1869. "Sir, I herewith send you a cheque for £1 18., as my subscription towards defraying the law expenses incurred by Mr. Doidge in defending F. TREVAN." his case against a most wicked and unjust prosecution. I most sincerely "Yours very truly, sympathise with him.

The Committee would venture to remind the Medical Profession that the total damages and costs in this action exceeded £583. The subscriptions to the present date are short of £120.

COMMUNICATIONS have been received from

Mr. G. F. WHITE; Dr. C. B. TAYLOR; Dr. MACCORMAC; Dr. CHARON; Mr. ARTHUR BAILLIE; Mr. PEAL; Dr. HESLOP; MEDICO-ETHICAL; Dr. BATEMAN; Mr. J. SCALES; Mr. H. SERJEANT; Mr. C. J. Fox; Dr. W. ARDING; A STRANGER; Mr. LE NEVE FOSTER; A SURGEON; Dr. JOHN HARLEY; Mr. J. B. CURGENVEN; Mr. CHARLES BRADLEY; Mr. JOHNSON; Mr. A. BRUCE; Dr. GERVIS; Mr. ROBERT SOUTHEE; Mr. JOHN CLAY; Dr. WHITEHEAD; Dr. J. B. SANDERSON; Dr. JAYAKAR; Dr. LIONEL S. BEALE; Dr. B. W. RICHARDSON; Dr. DAY; Mr. JABEZ HOGG; Dr. GRAY; Mr. J. CHATTO; Mr. J. D. HILL.

BOOKS RECEIVED

Dunn on Loss of Speech-Annual Report of the Shedfield Cottage Hospital
-Wirksworth Cottage Hospital Report-Modern Instances of "Healing
by the Laying on of Hands," by Rev. F. R. Young-Report on the
Royal Infirmary and Dispensary of Montrose-Report on the Royal
Lunatic Asylum of Montrose-Soelberg Wells on Impaired Vision-
Medicine in Modern Times-Debrett's Peerage, 1869-Debrett's Baronet-
age, 1869-Dublin Quarterly Journal of Medical Science, February 1869
-Brown's Conduct of the Admiralty-New York Medical Journal,
No. 47-Pacific Medical and Surgical Journal, No. 20.
NEWSPAPERS RECEIVED-

Leicester Journal-Oldham Standard-Oldham Chronicle-Carlisle Patriot
-Rochdale Observer.

BIRTHS and DEATHS Registered and METEOROLOGY during the Week ending Saturday, February 20, 1869, in the following large Towns:

Boroughs, etc.

Deaths.

Rain

Temperature of Air (Fahr.) Fall.

53.9 33 2 45.5 0.17

Estimated Population in

middle of the year 1869.

Persons to an Acre. (1869.)

Births Registered during the week ending Feb. 20. Corrected Average Weekly Number. Registered during the week ending

Feb. 20.

Highest during the Week. Lowest during the Week. 11176 MeanDailyValues.

In Inches.

254 2: In Tons per Acre.

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Week
ending Week ending Feb. 13.
Feb. 13.

53 0 34 0 43'6 0'00
51.7 33 0 42.7 0.80, 81

...

At the Royal Observatory, Greenwich, the mean height of the barometer in the week was 29 856 in. The barometrical reading decreased from 30-24 in. on Monday, February 15, to 29 52 in. on Thursday, February 18. The general direction of the wind was W.S.W. and S.W.

Note. The population of Cities and Boroughs in 1869 is estimated on the assumption that the increase since 1861 has been at the same annual rate as between the censuses 1851 and 1861; at this distant period, how ever, since the last census it is probable that the estimate may in some instances be erroneous.

The deaths in Manchester and Bristol include those of paupers belonging to these cities who died in Workhouses situated outside the municipal boundaries.

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February 27. Saturday (this day).

Operations at St. Bartholomew's, 14 p.m.; St. Thomas's, 9 a.m.; King's,
2 p.m.; Charing-cross, 1 p.m.; Royal Free, 1 p.m.
ROYAL INSTITUTION, 3 p.m. Prof. Odling, "Hydrogen and its Analogues."
March 1. Monday.

Operations at the Metropolitan Free Hospital, 2 p.m.; St. Mark's Hospital for Diseases of the Rectum, 1 p.m.; St. Peter's Hospital for Stone, 2 p.m.

MEDICAL SOCIETY OF LONDON. 7 p.m. General Meeting for Election of Officers and Council. 8 p.m.: Casual Communications. 8 p.m.: Dr. John Cockle, "Further Contributions to the Pathology and Diagnosis of Pulsating Tumours of the Neck."

ODONTOLOGICAL SOCIETY, 8 p.m. Mr. J. Turner, M.R.C.S., L.D.S., "On Chlorætherine."

ROYAL COLLEGE OF SURGEONS OF ENGLAND, 4 p.m. Prof. Huxley, “On the Construction of Vertebrated Animals."

ROYAL INSTITUTION, 2 p.m. General Monthly Meeting. ROYAL MEDICAL AND CHIRURGICAL SOCIETY, 8 p.m. Anniversary Meeting. 2. Tuesday.

Operations at Guy's, 14 p.m.; Westminster, 2 p.m.; National Orthopedic, Great Portland-street, 2 p.m.

ANTHROPOLOGICAL SOCIETY, 8 p.m. F. Hovenden, F.A.S.L., "Man an Indestructible Atom."

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Operations at University College Hospital, 2 p.m.; St. Mary's, 1 p.m.;
Middlesex, 1 p.m.; London, 2 p.m.; St. Bartholomew's, 14 p.m.; Great
Northern, 2 p.m.; St. Thomas's 1 p.m.; Ophthalmic Hospital, South-
wark, 2 p.m.; Samaritan Hospital, 2.30 p.m.
OBSTETRICAL SOCIETY, 8 p.m. Dr. Madge, "Case of Hydronephrosis of
the Foetal Kidneys." Dr. Brunton, "Observations and Remarks on
Cases of Twins." And other Papers by Dr. Cory, Dr. Wynne, and Mr.
Houghton.

ROYAL COLLEGE OF PHYSICIANS, 5 p.m. Croonian Lectures-"Regarding certain Effects of Modifications of Nerve-Influence in Disease," by Dr. John W. Ogle.

ROYAL COLLEGE OF SURGEONS OF ENGLAND, 4 p.m. Prof. Huxley, "On the Construction of Vertebrated Animals.'

4. Thursday.

Operations at St. George's, 1 p.m.; Central London Ophthalmic, 1 p.m.; Royal Orthopedic Hospital, 2 p.m.; West London Hospital, 2 p.m. University College Hospital, 2 p.m.

HARVEIAN SOCIETY, 8 p.m. Dr. Sanderson, "On Pneumonic Phthisis." ROYAL INSTITUTION, 3 p.m. Dr. John Harley, "On Respiration." 5. Friday.

Operations at Westminster Ophthalmic, 14 p.m.; Central London Ophthalmic Hospital, 2 p.m.

ROYAL COLLEGE OF PHYSICIANS, 5 p.m. Croonian Lectures-"Regarding certain Effects of Modifications of Nerve-Influence in Disease," by Dr. John W. Ogle.

ROYAL COLLEGE OF SURGEONS OF ENGLAND, 4 p.m. Prof. Huxley, "On the Construction of Vertebrated Animals."

ROYAL INSTITUTION, 8 p.m. Mr. W. Huggins, "On some further Results of Spectrum Analysis applied to the Heavenly Bodies." WESTERN MEDICAL AND SURGICAL SOCIETY, 8 p.m. Mr. T. Holmes, "Some Remarks upon Lister's Method of Treating Abscesses by Means of Carbolic Acid. Dr. Martyn, "A Case of Extra-Uterine Pregnancy."

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CHOCOLAT-MENIER.

(Manufactured only in France.)

ANNUAL CONSUMPTION EXCEEDS 5,000,000 lb.

The healthiest, best, and most delicious Aliment for Breakfast known since 1825; defies all honest competition, unadulterated, highly nutritious, and pure.

Sold in Half-pound Packets.

Wholesale, MENIER, 23, Henrietta-street, Strand,
London.

Retail by all respectable Houses.

BOUDAULT'S PEPSINE.

In 1854, after many experiments, PEPSINE was obtained in a pure state by M. BOUDAULT, Chemist, and Dr. L. Corvisart, Physician to the Emperor Napoleon III.

Boudault's PEPSINE was honoured with two Reports at the Academy of Medicine, Paris, and with having its formula inserted in the New French Pharmacopoeia.

The International Jury of the Universal Exposition, Paris, 1867, awarded to Boudault's PEPSINE the ONLY MEDAL given for PEPSINE and its preparations.

Boudault's PEPSINE is the only one that has been furnished to the Hospitals in Paris since 1854.
PEPSINE Wine, in bottles, 4/. Dose-a tablespoonful before each meal.

PEPSINE Pills, in bottles, 3/. Dose-3 before each meal.
Dose-15 grains, sold in 1 oz. and oz. bottles.

PEPSINE Lozenges, in bottles, 3/. Dose-3 before each meal.
Boudault's PEPSINE or Poudre Nutrimentive.
All the above Preparations are guaranteed to be genuine which bear the label and seal of the

Sole Agent for GREAT BRITAIN, PETER SQUIRE, 277, OXFORD-STREET, LONDON.

LIEBIG'S FOOD FOR

Prepared strictly from the Formula of

Baron Liebig, by

HOOPER,

OPERATIVE CHEMIST,

TRADE MARK

INFANTS & INVALIDS.

Sold in Tins, 1 lb., 18.; 3 lb., 2s. 6d. ; 6 lb., 58., by all Chemists and Druggists,

and direct from Mr. HOOPER'S Establishments,

7, PALL MALL EAST, And 55, GROSVENOR STREET.

Wholesale of Barclay, Edwards, Newbery, all Patent Medicine Warehouses, and Wholesale Druggists.

LIEBE-LIEBIC'S NOURISHMENT IN SOLUBLE FORM,

For INFANTS, WEAK CHILDREN, and CONVALESCENTS.

Prepared by J. PAUL LIEBE, Apothecary, Dresden.

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Medical Times and Gazette

ORIGINAL

BARNES ON OBSTETRIC OPERATIONS.

LECTURES.

A COURSE OF LECTURES ON OBSTETRIC
OPERATIONS.

By ROBERT BARNES, M.D. Lond.,

Fellow and late Examiner in Midwifery at the Royal College of Physicians;
Obstetric Physician and Lecturer on Midwifery and the Diseases of
Women and Children at St. Thomas's Hospital; Physician to the Royal
Maternity Charity; Consulting-Physician to the East London Children's
Hospital; Examiner in Midwifery at the Royal College of Surgeons.

LECTURE XX.-PART III.

THE INDUCTION OF PREMATURE LABOUR CON-
AND
TINUED. THE MODE OF PROCEEDING-PROVO-
ACCELERATION
CATION OVERNIGHT
CONCLUSION OF LABOUR NEXT DAY-DESCRIP-
TION OF CASES DEMANDING INDUCTION OF
LABOUR-MODE OF DETERMINING EPOCH OF
CONTRACTED
GESTATION -- PROCEEDING IN
PELVIS OR OTHER MECHANICAL OBSTRUCTIONS
-IN CASES OF URGENT DISTRESS OF MOTHER.
HAVING discussed the various methods of provoking labour
which have been practised, we are now in a position to select
the most safe, convenient, and efficient. It has been already
said that no method is so much in harmony with the principle
of acting cito, tuto, et jucunde, as the introduction of the
elastic bougie into the uterus. The plan I have successfully
practised for some years is the following:-First, overnight
pass an elastic bougie six or seven inches into the uterus, coil
up the remainder of the instrument in the vagina; this will
keep it in situ. Next morning some uterine action will have
set in. In the afternoon, at an appointed time, proceed to
accelerative measures.

Before rupturing the membranes, adapt a binder to the abdomen, and let this be tightened, so as to keep the head in close apposition to the cervix. This will often prevent the cord from being washed down by the rush of liquor amnii. Dilate the cervix by the medium or large bag, until the cervix will admit three or four fingers. Then rupture the membranes, and, before all the liquor amnii has escaped, introduce the dilator again, and expand until the uterus is open for the passage of the child. If the presentation is natural, if there is room, and if there are pains, leave the rest to nature, watching the progress of the labour. If these conditions are not present, and one or other is very likely to be wanting, proceed with accelerative methods -that is, to the forceps or turning, or, in cases where the passage of a live child is hopeless, to craniotomy. By pursuing this method we may predicate with great accuracy the term of the labour. Twenty-four hours in all-counting from the insertion of the bougie-should see the completion of the labour. The personal attendance of the Physician during two hours is generally enough. The mode of proceeding must vary according to the conditions of the case. (a)

What are the conditions that call for the induction of labour? Gestation may be divided arbitrarily into two parts. During the first part, terminating at 6 or 7 months, or at the end of 180 or 200 days, it is scarcely probable that a viable foetus will be expelled. To induce labour within this period is really to bring about abortion. It is therefore only done under the pressure of conditions that preclude waiting till the child is viable, and out of regard solely to the safety of the mother. Between 200 and 230 days is a stage of very doubtful viability, and the Physician will still endeavour to postpone interference until after the latter date, or the second part of gestation, when, the child being viable, the operation may be undertaken in the interest of both mother and offspring.

In a large proportion of cases we are able to select our time
within certain limits. For example, where there is moderate
pelvic contraction, admitting of the safe passage of a child a
little below the full size, we may be justified in waiting until
say, 250 days. The difficulty
the end of eight months-
is to determine the starting-point of the pregnancy. There is
a very probable range of error of at least 15 days. If we
count 15 days too many, we reduce the duration of pregnancy
to 235 days-that is, we run the risk of falling within the first
part, when the child is of doubtful viability. If, on the other
hand, we count 15 days too few, we run the contrary risk of

(a) For a series of cases illustrative of this practice, see St. George's
Hospital Reports, 1839.

VOL. I. 1860. No. 975.

approaching too near the natural term of gestation, and of
having a child too large to pass the narrow pelvis alive.

The best way, perhaps, of avoiding these two rocks is to
reckon the pregnancy from the day after the cessation of the
last menstrual period, the most probable time of conception.
Count 230 days from that epoch, and add 20 days for a margin
of safety. This will leave a full month, or 30 days, to com-
plete the development of the child. The cases are few, if all
the resources in the acceleration of labour are turned to
account, in which a child of 250 days may not be delivered
alive. But if we fall upon a child of 215 days or less, the
chances of its surviving are very slight. I regard the error of
procrastination as being generally of less moment than the
error of anticipation. Of course, if the pelvic contraction is
great-say to 2.50"-it will be prudent not to calculate beyond
240 days, but rather to incur the risk of bringing a non-viable
child.

It will be convenient to enumerate first those conditions which, in the interest of the mother, and disregarding the child, demand the interruption of gestation during the first part. These are, A. Certain cases of extreme contraction in the bony or soft parts-e.g., distortion and narrowing of the pelvis below 2.00"; the encroachment of considerable tumours, especially if they are unyielding, upon the pelvic canal; some cases of advancing and extensive cystic disease of the ovary; great contraction from cicatrices of the os uteri and vagina, not admitting of free dilatation-retroversion or retroflexion of the uterus not admitting of reduction; some cases of carcinoma of the uterus or vagina; some of tumours of the uterus. B. Certain cases of urgent disease of the mother, depending upon and complicating pregnancy—e. g., obstinate vomiting with progressive emaciation, and a pulse persistent for some days above 120; some cases of advancing jaundice with diarrhoea; some cases of convulsions associated with albuminuria or chorea; hæmorrhages producing marked anæmia, especially if depending upon commencing abortion or placenta prævia; some cases of disease of the heart and lungs, attended with extreme dyspnoea; such are aneurism, great hypertrophy, valvular disease, oedema of the lungs, pleurisy.

If, in the presence of any of the foregoing complications, we have been fortunate enough to carry the patient over the first part of pregnancy, reaching the period when the child is viable, we may still be compelled to induce labour. The indications from disease beginning in the first part, as hæmorrhage, convulsions, cardiac distress, vomiting, jaundice, may grow more urgent, or they may arise during the second part.

soon.

My experience leads me to conclude that in cases of urgent disease there is more frequent occasion to regret having delayed the operation too long than having had recourse to it too When through obstinate vomiting, for example, nutrition has long been arrested, the starved tissues craving for supplies, and falling into disintegration, feed the blood with degraded and noxious materials; the system feeds upon itself and poisons itself; the poisoned blood irritates the nervous centres, and these centres, wrought to a state of extreme morbid irritability, respond to the slightest peripheral, uterine, or emotional excitation. All nervous energy is thus diverted from its natural destination and exhausted in destructive morbid action. Irritative fever ensues, the pulse rises to 140 or more, no organ in the body is capable of discharging its functions, At this for the pabulum of life is cut off at the very source. point labour, whether it occur spontaneously, as it often does, or be induced artificially, comes too late. The tissues are altered, the powers are impaired beyond recovery, and death soon follows delivery.

The most generally recognised indication is the presence of such a degree of pelvic contraction as to forbid the birth of a live child at term.

No one, I believe, disputes that, where we have the choice, induction of labour should be performed where the ultimate alternative is the Cæsarian section, and this rule should hold whether the proceeding hold out a hope of saving the child or It should also be resorted to for the sake of avoiding craniotomy.

not.

In the great majority of cases we are led to determine upon the expediency of inducing labour by the history of antecedent labours. Where craniotomy has been performed on account of contracted pelvis clearly recognised, there can be little ground for doubt. But why should one or more children be sacrificed in order to teach the Physician that the pelvis is too small? Is there no other gauge of the capacity of the pelvis than a child's head? Of course it will be admitted that a woman pregnant for the first time is equally entitled to the benefit of the premature induction of labour if it be known that her

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