must be supported, and nutritious broths, jellies, milk, and farinaceous food should be administered as freely as the stomach will bear. Stimulants, too, must be judiciously employed, and, while their effects should be carefully watched, their administration should be neither too sparing nor too long delayed. In a form of the disease described many years ago by Dr. Kennedy, in which the symptoms of marked collapse and exhaustion set in early, accompanied with tympanitis, showing, from the very commencement, an exaggerated train of symptoms, sunken countenance, small, rapid, and compressible pulse, but sometimes without a corresponding amount of abdominal pain, stimulants cannot be commenced too early, and can scarcely be administered too freely. It is in this form that the turpentine treatment best agrees. This variety seems to be one in which the intensity of the poisoning and the extent of the inflammatory lesions bear no relative proportion, or rather are found in an inverse ratio to one another.

Dr. Evory Kennedy concluded his highly philosophical and valuably practical communication with some observations upon the variety of the disease denominated as traumatic metria, and also upon that which appeared in an endemic form in the Dublin Lying-in Hospital in December, 1837, during his Mastership, and carried off, between that and the month of April, 1838, no fewer than thirty-five patients. This is the form described by him at the Dublin meeting of the British Medical Association under the designation of puerperal purpuric fever."

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REPORTS OF SOCIETIES.

METROPOLITAN ASSOCIATION

OF MEDICAL OFFICERS OF HEALTH. SATURDAY, MARCH 20, 1869.

Mr. LIDDLE in the Chair.

DR. VINEN read the following report :

"In pursuance of a resolution of the Association at the meeting held on January 16, a letter was addressed to each Metropolitan Officer of Health asking him to furnish certain particulars in reference to the epidemic of scarlatina during the year 1868. A request, in the name of the Association, was also made to the Medical officers of public institutions and to those engaged in Poor law Medical practice for their cooperation by contributing similar information, to facilitate which printed forms were prepared and forwarded.

"Answers have been received from fourteen districts only, comprising the returns of twenty-seven public institutions and parochial districts. From these limited returns comparatively little information of the causation, progress, or localisation of scarlatina can be gained. The chief facts elicited are the following:-Returns were received from eight out of ten of the parochial districts of the City of London. In three of these no cases occurred; in the other five there occurred 67 cases and 12 deaths; in the Bishopsgate district there were 18 cases and 5 deaths; in two districts of the West London Union, 36 cases and 7 deaths, leaving but 13 cases, none of which were fatal, in the other districts. In one of the districts of the West London Union nearly all the cases are reported as having been followed by albuminuria. Heart disease, dropsy, and pneumonia were also frequent sequelae.

"Returns were received from the Regent's-park, Camdentown, and Gray's Inn-road, forming three out of the six Poor-law districts of St. Pancras. (From the three other districts no returns were sent.) In these three 184 cases occurred; 14 of these only are reported as having been fatal, but 236 deaths actually took place in this parish from scarlatina.

"In the Poor-law practice of Chelsea 197 cases were reported, but there were no means of estimating the number of deaths amongst them. Between 139 and 200 cases were treated at the Chelsea, Brompton, and Belgrave Dispensary, amongst which were 12 deaths. The total number of deaths from scarlet fever in the parish was 162. The disease did not affect any particular locality, but was spread generally over the district.

"From the parish of St. George, Hanover-square, a return was made of 230 cases treated at St. George's Hospital and three Dispensaries; no return was made of those treated by the Poor-law Medical officers. The total number of deaths

was 77, but the proportion which occurred amongst the above 230 cases was not stated.

"The returns from St. Marylebone include the out-patient paupers of the Rectory district and eight Dispensaries. A total of 588 cases were treated. Dr. Whitmore reports it to be impossible to ascertain the number of deaths amongst these, but 109 deaths from scarlet fever took place in the entire parish. In the in- and out-door practice of the Hampstead Dispensary and Poor-law practice there were 33 cases and a total of 7 deaths. In the parochial practice of St. Giles and Bloomsbury 19 cases and 3 deaths occurred; in the Bloomsbury Dispensary 46 cases were treated, 8 of which were fatal. The whole number of deaths from scarlet fever in the district was 71. In the parochial practice of the Whitechapel district 54 cases occurred, and in the Eastern Dispensary 20 cases and 3 deaths. In the entire district 40 deaths took place. In the district of Bow and Bromley 44 deaths were returned, number of cases not stated.. In the western district of Mile-end Old Town 48 cases occurred, among which were 3 deaths. The first case appeared in April. There were no deaths until the last quarter of the year. No particular locality was affected. In the outdoor Medical practice of the Hackney district 37 cases were treated. The whole number of deaths in the district from scarlet fever was 52. The Poor-law Medical officers of Lambeth, in a population of 180,000, treated 205 cases; amongst these 20 deaths took place. In the entire parish scarlatina caused 192 deaths. The disease in most cases was traceable to infection, and affected the wellto-do classes more than the poor. In St. Mary, Newington, 56 cases were treated by the parochial Medical officers. The number of deaths among these was not ascertained. In the whole parish scarlatina caused 76 deaths. No grave sanitary defect was discovered in any house in which the disease occurred. In the district of Eltham 5 cases appeared, none of which proved fatal. 53 cases of scarlatina are reported to have taken place in the Greenwich district, but in what Medical practice is not stated, nor the number of deaths. The cases occurred pretty equally among rich and poor. The greatest mortality took place in the low-lying districts and amongst the poorer classes. 9 deaths were caused by scarlatina in Rotherhithe; the number of cases was not stated. St. Olave's 7 deaths, cases not known. It will be readily seen how difficult it is to glean any satisfactory information from these returns. In some districts the deaths only are returned, in others the deaths exceed the number of cases, as the entire mortality from scarlatina is stated, while the number of cases refer in a few instances to the whole, and in others to a part only, of the parochial practice, with or without some of the dispensary patients. The total number of cases returned is 1788, of deaths 1088. In four instances only the deaths occurring amongst a given number of cases were stated-these were 476 cases and 46 deaths, being 9.7 per cent. It appears, also, that in many public Medical institutions no record of the cases treated is kept. Dr. Letheby states that in the City there are several Dispensaries, but they have either not had any cases of scarlet fever, or that no record is kept of them. Mr. Liddle states that there are two Dispensaries in his district, in one of which no records are kept. Mr. Pink, of Greenwich, says that the records kept by the six Poor-law Medical officers of his district will not bear investigation. Dr. Barclay draws attention to the extreme inefficiency of the parochial returns as indicating the course of the disease, and in my own district of St. Olave no information can be gained from the books of the Medical officer to the Union, the cases not being entered. This fact, therefore, is apparent, that in many public institutions no accurate record of disease is kept. With regard to the period at which the epidemic commenced, the returns seem to indicate the beginning of the third quarter of the year, and shortly afterwards the mortality began to show an increase, the maximum being reached towards the close of the year. This statement accords with the return of the Registrar-General for 1868, the deaths in London from scarlet fever being in each quarter respectively 368, 352, 738, and 1463-2921. And here the question may arise as to whether this high mortality might not have been prevented had there been any recognised and reliable return of sickness periodically published. The first intimation we now have of the prevalence of any disease is through the mortality tables of the Registrar-General, when death is already committing its ravages. As to the class of persons affected by the disease, it may be inferred from the number of deaths other than those which occurred in parochial or dispensary practice, that the better class suffered as well as the poorer. Dr. Puckle observes that in Lambeth the well-to-do-classes have been more affected than the poor. Mr. Pink says that in the Greenwich district. the discase has appeared equally amongst the rich and the poor.

Dr.

Dr. Woodforde says that the disease has fallen chiefly on a newly built district close to Victoria-park, inhabited principally by artisans and persons in comparatively easy circumstances, the houses being in a fair sanitary condition. He suggests as a cause some pieces of waste ground in a damp neglected state, which might be centres of malaria. Woodforde also states that in Bromley the disease has been much less prevalent, with only three deaths, although the condition of the houses is much less satisfactory, and the poverty of the people extreme. Dr. Whitmore says that in Marylebone the worst cases were often in the best houses; in the poorest and worst localities, and amongst the most wretched children, cases have been seen of a mild type. From remarks made as to the localities in which the disease occurred, it would appear to be spread pretty generally over the district in which it prevailed. With regard to the sequelæ, they were the diseases most usually seen after scarlatina, as dropsy, albuminuria, heart disease, pneumonia, and bronchitis, the first two being the most prevalent. In addition to the point already mentioned-viz., the desirableness of a periodical return of sickness -other points for investigation will readily suggest themselves, such as the influence of temperature on the rise and fall of scarlatina, as stated by Dr. Ballard. The reason this disease should prevail amongst persons living in the better class of houses, in more healthy and less crowded localities, and the comparative immunity of those living in low-lying districts, amid overcrowding, bad air, bad nursing, and all the concomitants of poverty, and the influence of disinfectants in controlling the spread of the disease, etc.-these are some of the points which require further investigation, in the hope of abating the mortality which from this disease alone destroyed nearly 3000 lives last year in the metropolis. Before concluding this summary of the scarlatina returns, mention should be made of the names of those gentlemen who have kindly lent their co-operation. In the City, Dr. Fowler, Mr. Elliott, Mr. Champneys, Mr. Mason, Mr. C. Hogg, Dr. Thyne, Mr. A. B. Thompson, and Mr. G. Brown; in St. Pancras, Dr. Claremont, Mr. T. Harley, and Mr. T. M. Harding; in Chelsea, Mr. A. C. Maybury; Eastern Dispensary, Whitechapel, Mr. J. J. Scott; Western District, Mile-end Old Town, Mr. H. C. Robinson; and to these gentlemen the acknowledgments of the Association are due for the assistance they have afforded."

A discussion followed, in which Dr. Gibbon, Dr. Hardwicke, Dr. Ballard, Mr. Lord, and Dr. Vinen took part, on the unsatisfactory nature of these returns. In some cases the deaths only were returned; in some instances the number of deaths exceeded the number of cases returned; in some parishes the whole of the parish practice was given, and in others only a part. The Medical officers present inveighed against the fact that no records were kept in many Hospitals. They contended that it was a duty these institutions owed to their subscribers to keep and publish such statistics. It was ultimately decided that the return was too imperfect to warrant the Association going to the expense of printing it, and regret was expressed that Government had withdrawn the funds formerly allowed the Association for this purpose.

A discussion on "Outdoor Medical Relief" was opened by Dr. GIBBON, who at some length gave his experience of public Hospitals, tending to show that it was impossible, with 40,000 patients annually at one institution and 120,000 at another, that proper attention could be given. Dr. Gibbon contended that Hospitals both damaged private Practitioners and demoralised the poor.

The Rev. BROOKE LAMBERT Spoke at some length on the Hospital system. It was disgraceful, he said, to find well-todo people taking advantage of these charities, and he proposed a system by which the giver of a letter should state the circumstances of the patient, in order that some charge might be made.

Dr. HARDWICKE spoke of the success of the club system, more especially in the provinces, and thought that private Practitioners ought to be very indulgent in their charges to the poor.

Dr. TIDY defended the Hospitals, and maintained that they were necessary if only for educational purposes.

Dr. LORD censured the pseudo-charity which almost forces its gifts upon the people and tends to pauperise them.

Dr. WOODFORDE said that the outdoor system frequently propagated disease.

The CHAIRMAN adverted to the very large proportion of persons receiving Medical relief. He thought the same persons must go from Hospital to Hospital. Patients have been sometimes seen selling the medicine when saleable, or throwing it away. Indiscriminate Medical relief also led to other kinds of

relief and to an increase of rates. He also adverted to the anomaly that some of the smaller Hospitals issued larger returns than the greater Hospitals.

Dr. GIBBON made a short reply, in which he maintained that experience might be gained from indoor better than from outdoor patients, and from a smaller number better than from a larger number of cases.

After some other conversation, the meeting separated.

MEDICAL SOCIETY OF LONDON.
MONDAY, FEBRUARY 22, 1869.

Dr. B. W. RICHARDSON, F.R.S., President, in the Chair.

DR. DAY, of Stafford, read a paper on Cases of Injury to the Brain. The author announced his purpose to be chiefly a record of the clinical history of cases of injury to the brain which bore upon the question of aphasia and the localisation of the faculty of speech. He first showed, from a review of the older writers from Galen downwards, that the question which was now agitated was not a new one. Theophilus assigned memory, and with it memory of words and philosophy of speech, to the third or posterior portion of the cerebrum. It is strange that Dr. Wigan has used the same argument and almost the same words as Dr. Maudsley in the present day to illustrate the philosophy of speech by the philosophy of vision. 1. A man, aged 27, syphilitic, suffered sudden pain in right temple; progressive impairment of sight in right eye, with signs of intra-ocular anemia; after appearing to be benefited by treatment, he died suddenly eighteen months after commencement of symptoms. The post-mortem showed complete disorganisation of the left cerebral hemisphere, adherent and opaque membranes, and thickening of cranial bones; yet there had been no signs of cerebral implication during life except the symptoms referred to vision. 2. A man of 30, who had suffered from the bursting of a gun, shattering and driving in the forehead. He recovered primary effects, regained perfect intellect and consciousness, was committed to gaol for felony, and died there suddenly with symptoms of compression. At the postmortem the right hemisphere was completely disorganised, and a mass of iron gun-barrel, weighing two ounces, was found in this side of the brain; yet in this case there had been perfect performance of the cerebral functions. 3. A man of 53, who had enjoyed apparent good health, with ordinary discharge of intellectual functions till twenty-four hours before death. Post-mortem: Disintegration of left hemisphere; cancerous mass; right hemisphere also softened. 4. A boy; fracture of frontal bone; recovered all his powers; sudden death. Postmortem: Dura mater inflamed throughout; ulceration in three points, and both sides of the brain disorganised. 5. Severe blasting accident recorded in the Lancet. The Surgeon who reports the case passed a grooved director from frontal laceration to occipital bone, turning it round and round; he remarks, "both hemispheres must have been made a complete puddle of." Yet the patient recovered all health and function. These cases are completely subversive of the imagining of those who have given to the faculty of speech a habitation in a localised spot of brain matter. One case opposes the view of Majendie, for, though the hemispheres were disintegrated, vision was perfect; the same case seems also to contradict the opinion given by Sir C. Bell-viz., that disease of the general surface of the brain is always attended with derangement of the mind.

A vigorous discussion then ensued, in which Dr. Semple, Mr. Jabez Hogg, Dr. Thudichum, and others took part, the President also remarking that he laid it down as a dogma that definite lesions produce definite symptoms. Post-mortem appearances of the brain may lead to false inferences on account of the rapid decomposition of the brain, and this might occur even during the time occupied by the autopsy.

Dr. DAY, replying, said that, with one exception, the inspections were made within four hours after death, and in the cases attested by himself there was no symptom which could indicate, notwithstanding the undoubted physical disorganisation of brain, that the patients were intellectually wrong.

BRISTOL ROYAL INFIRMARY.-The Suple Medical and Surgical prizes have been awarded, the former to Mr. C. K. Rudge, the latter to Messrs. J. L. King and Henry M. Chute, who were equal, and the committee were, in consequence, obliged to award two prizes instead of one.

OBITUARY.

THE LATE SIR JOSEPH OLLIFFE. WE have received the following additional biographical memoranda from the pen of a well-known Physician :

Sir Joseph Olliffe was a native of Cork, and born in 1808. He came to Paris in 1828, and took his M.A. degree in the Paris University in 1829. For several years he was a tutor in the family of a French nobleman, the Comte de Cresnoi. In 1840 he graduated in Medicine in the above University, and soon after married the daughter of Mr. (subsequently Sir) William Cubitt. He rapidly got into practice. In 1846 he received the Cross of the Legion of Honour, and after the first French Exhibition was promoted to the rank of "Officier" in consequence of his services as one of the British commissioners. When Lord Cowley became Ambassador for France, he was appointed Physician to the British Embassy, which office he held until his death. He was admitted a Member of the Royal College of Physicians of London, without examination, and in the same year elected a Fellow. He was knighted in 1853.

In society Sir Joseph was very popular, and his amiable manners endeared him to his patients both rich and poor. His death will be an especial loss to the British Charitable Fund, for which he had acted as honorary treasurer and secretary nearly thirty years. It was mainly through his exertions that it has so long maintained its position as a most efficient charity, which affords relief in money, bread, coals, and medicine to the amount of nearly 28,000 fr. per annum.

Deauville, on the coast of Normandy, owes its existence as a watering-place to the combined enterprise of Sir Joseph and his friend the Duc de Morny. It is near Trouville, but separated from it by the river Toques. The unexpected death of the Duc seriously interfered with the success of their building speculations, and the consequent anxieties contributed much to shatter Sir Joseph's health.

JOHN HADDY JAMES.

to the

IN an obituary of the late Mr. Hodgson a few weeks back we mentioned that he was one of a race of Surgeons who, practising in the provinces, had identified their names with certain localities. Thus he was "Hodgson of Birmingham last. We have now to record the decease of, we believe, the last of his contemporaries, at the great age of 80-John Haddy James, of Exeter. He was born July 6, 1788, at Exeter, in which city he spent the greatest part of a long and eminently useful life. He received his early education at the Exeter Grammar School, and acquired there that love for the classics which has characterised so many distinguished members of our Profession. He was removed, however, from school at too early an age to become a finished scholar, for in 1805 he was apprenticed to Mr. Benj. Johnson, then in large practice in the city; but many an apt quotation from Horace or Virgil would attest in after times his fondness for and familiarity with the subjects of his early studies. From 1806 to 1808 he was a pupil of Mr. Patch, Surgeon to the Devon and Exeter Hospital. From 1808 to 1812 he was a student at St. Bartholomew's, and a pupil of Mr. Abernethy's, in whose house he resided for one year. He was also House-Surgeon at the Hospital.

In 1811 he became M.R.C.S. Mr. Abernethy took the warmest interest in his career, and wished him to settle in London, where he believed a high position would reward his industry and talent. But the appointments at St. Bartholomew's were not at that time open to men who had received a provincial education. Having, therefore, no hopes of becoming attached to the staff of a London Hospital, he accepted the post of Assistant-Surgeon to the 1st Life Guards, and in 1815 accompanied his regiment to Waterloo.

In 1816, being elected Surgeon to the Devon and Exeter Hospital, he commenced that long professional life from which severe illness compelled him reluctantly to retire, while still in the vigour of his powers, in the autumn of 1863. It was a life marked by singular success in the treatment of disease, by unwearied exercise of great powers, by much benevolence; and when his career was finished he said, and with reason, that he looked back upon it with almost unmingled satisfaction.

In 1818 he was awarded the Jacksonian prize for his essay on Inflammation. In 1843 he received the diploma of F.R.C.S., and in 1814 became President of the Provincial Medical Association. Gifted with a singularly vigorous intellect, which

enabled him to master any subject, a most tenacious memory, a manner which inspired confidence while it enforced attention, he could not but regret at times that he had been denied the opportunity of metropolitan distinction; being deprived of this, his aim was not merely to attain professional eminence himself, but also to increase the reputation of provincial Surgery. Hence the interest he took in the Provincial Medical Association; hence the efforts he made, by able courses of lectures, in conjunction first with Mr. Barnes, and then with Mr. Delagarde, and by the formation of an extensive museum, to maintain and instruct a good Medical school at the Exeter Hospital. To this museum he continued to devote much care, and the catalogue, with the description of its contents, is largely written by his hand.

His desire to make the experience of his wide practice serve to the advancement of Medical science may be seen in his habit of daily recording notes of all his cases. Every fact worth mentioning is diligently entered in his books, and thus he had a mine of information to which he could refer, and many of his recent hours of increasing blindness were employed in giving to the world from these sources interesting memoirs. Mr. James had not only a mind, but a body, which seemed incapable of fatigue, and his strong constitution withstood the attacks of more than one severe illness caught in the exercise of his profession; but age told upon the frame, while the mind remained clear and acute, and the brain active to the last, as in his happiest days, and a brief sickness carried him off, still busy with his work, peacefully to his rest. Through life he was an earnest and profound believer. (a)

We must now give a short account of Mr. James's literary works, and first amongst these of his treatises on inflammation, remarking that it is no slight distinction to a provincial Surgeon to have written a book-not a mere practical book, but one treating of the subject from a scientific point of view-which passed through two editions, and has become classical, and will always be appealed to as one of the landmarks of the progress of opinion in English Surgery. The first edition, published in 1821, bore the title "Observations on some of the General Principles, and on the particular Nature and Treatment of the different Species of Inflammation; being the substance of an Essay to which the Jacksonian Prize Essay for the year 1818 was adjudged by the Royal College of Surgeons." A second edition, much increased in size, and fuller of detail, was published in 1832; and thirty-five years later there appeared a "Treatise on the Distinctive Characters of External Inflammations, on Inflammatory or Sympathetic Fever, and the Results of Thirty-six Years' Experience of the Effects of Bleeding, ascertained from Private Practice only." The greater part of this last was originally published in the Medical Times and Gazette for 1866, vol. ii. From first to last the key-note of these treatises is the same. The classification of inflammation is founded on the following facts:"1. That the mode of repairing injury and of arresting the progress of inflammatory disease depends upon the power which the animal economy possesses of effusing organisable lymph. If this exists in any given case in a sufficient degree, the progress of the inflammation will be limited; if the contrary, it will spread.

"And the danger of the disease being in proportion to the disposition to spread, cæteris paribus, more constitutional sympathy, denominated sympathetic fever,' will be excited.

"And this sympathetic fever, however salutary in its nature, will, when it exceeds certain bounds, tend to augment, rather than lessen, the mischief. The disposition to spread may be owing either to the nature of the part as a surface, of the cause as a poison, or to the state of the constitution; but the former are circumstances more or less accidental, and, though very important, cannot afford a basis of distinction; but the latter as a permanent cause certainly will, and when it is similar in nature and degree, and accompanied with the same concomitants, it will be found to produce the same effects, and there is no inflammation in which the disposition of the constitution does not tend either to produce its limitation or the reverse." The orders were founded on the nature of the organ involved-whether (1) of primary or vital importance; (2) of organs essential to the well-being of the animal; or (3) inflammation of common parts. The fact that the degree of general sympathy and disturbance bears a relation to the importance of the organ justifies this arrangement. (1st ed. pp. 13, etc.) The second edition of this work, published in 1832, and very much enlarged, though

(a) "Quatuor robustos filios, quinque filias, tantam domum, tantas clientelas Appius regebat, et senex et cæcus. Intentum enim animum tanquam arcuin habebat, nec languescens succumbebat senectuti."-Cic. de Senect.

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upon the same basis, is one to which we look with the greatest respect, from the immense amount of practical information it contains, from the vigour and precision of the author's style, and from its presenting a vivid picture in small bulk of the state of Medical science and practice in the days immediately preceding the modern microscopical and chemical era. This work will never be obsolete, but must retain its place as a classic. In the third and smaller treatise ("On External Inflammations") published in 1867, the author criticises and reviews his own earlier opinions, comparing them with some of the results of later observation and research, claiming much that he had foreseen, and combating some things contrary to his own views. It is curious to observe how purely metaphysical was the conception of vital processes and forces at the time when Mr. James's treatise first appeared, and how difficult it seemed for him in his last work to take kindly to the more positive and analytical view which we now are able to get through the labours of modern microscopists, physiologists, and chemists. How distinctly in the quotation above is the idea of "inflammation" distinguished from that of the "animal economy" in which it occurs, and of the cause " which gives rise to it! Inflammation is represented as a something which is controlled by a "disposition of the constitution." The difference between the metaphysical and the positive conception and description of "inflammation" may be illustrated by a comparison with the kindred word "conflagration." Both signify "fire," an abnormal and mischievous process in which the chemical relations of an animal body, or (say) of a house or hayrick, are altered, so that the subject of the alteration is destroyed or damaged; much useful material is converted into carbonic acid and ashes, and much heat given out. In the case of the " 'conflagration' the "devouring element" may act in a variety of ways, depending on the arrangement of the burning edifice, on the cause, and on the nature of the construction. It may be a mere smouldering affair and strictly limited, if the forces of the building that is fired are such as to limit it. In a well-built warehouse, with iron fireproof doors, substantial party walls, and no timber partitions, the fire may burn itself out in loco, like a "phlegmon" on a healthy rustic's head after a blow. Let the "cause " be peculiar, such as the bursting of sundry casks of Laphtha, and the conflagration will spread like erysipelas of septic origin. And if the whole edifice be a rickety lath and plaster affair, there will be no "power of adhesion;' "the conflagration will go on and on till there is nothing more to burn. The change that is taking place in Medicine is parallel to that which enables us to analyse the phenomena of a house on fire. We do not look on the latter as a "process to be conceived metaphysically, but we can tell how wood heated to a certain degree gives off hydrocarbon gas; how this gas explodes in contact with air and forms flame; how the redhot carbon of the wood combines with the oxygen; how a stone partition may be calined and crumble; how fire may be fed by oxidisable substances, as jute and turpentine; how its conflagration is enhanced by actual oxygenophoric bodies, as saltpetre (as was the case at a fire in one of the great City wharves); and how water acts by cooling and by shutting off oxygen from the burning mass. Analogous to this is the knowledge we are slowly getting of the wonderfully rapid aberrant behaviour of the minute germinal constituents of the tissues in inflammation; of their tendency to produce pus and other abortive tissues; of their power to attract streams of blood; of the Lechanism whereby both blood-vessel and nerve are subservient to local inflammation; and of the nature of inflammatory fever. Whilst we thus thankfully acknowledge the increased depth and width and the positive character of modern research, it is impossible to refuse our tribute to the industry, accuracy, and sagacity of authors who, like Mr. James, got only glimpses and general conceptions of these processes which can now be analysed in detail. Nor must it be supposed that we yet nearly know all, or that there are not hiatus in our present line of argument which well-informed men of the olden school are not slow to detect. One of the still obscurest parts of pathology is the nature of that change in the blood which occurs in (or, as we believe, which constitutes) sympathetic inflammatory fever. Of the elders, some looked on its seat as being in the nerves; some in the blood; and the blood was looked upon by Mr. James as an "organ"-an instrument with powers, and purpose, and intelligence "living, feeling, and acting in every part," and "able to control" certain changes occurring in it when tainted. Beneficial changes in sympathetic fever often occur, says Mr. James-e.g., after the opening of abscesses-much more quickly than the composition of the blood can be conceived to be changed. A small ulcer in the cornea will cause as much fever as a sloughing ulcer of the leg; yet the amount of blood

contamination cannot be the same. Throughout his works, though Mr. James was from the first a humoralist to a certain degree, he adhered to doctrines implying a preponderance of the nervous element. The doctrine of sympathy, he says, is going out of fashion; but it must never be forgotten that there are palpable effects which may be produced by immaterial causes; and hence that it is not necessary in every case to appeal to reflex action or to contamination of the blood for a solution of the mode in which disturbance of one part of the animal economy may affect the whole.

That Mr. James was not the man to abandon old convictions, or suddenly-after the manner of some persons-to rub his eyes as if awaking from a dream, and to declare that the learning and practice of half his life had been a delusion, is evident by the remarks on bleeding appended to his work on External Inflammations" (1867). He insists, with the utmost justice, that in bleeding we imitate one of the natural and beneficial operations of Nature. He objects to the idea of making Hospital practice amongst town poor a test of what is applicable to healthy persons in the country attended as private patients. To obtain something like trustworthy data, he refers to his "own records, contained in eleven large folio volumes of cases of all kinds, taken indiscriminately between August, 1816, and August, 1863. I had tabulated every one where general bleeding had been practised, giving the volume, date, age, sex, disease, quantity, and result." Omitting the first four years, in which Hospital and private cases were intermixed, he went through the cases of thirty-six years, divided into "two periods -i.e., from 1827 to 1845, and from 1845 to 1863, the latter period being commensurate with my return to the RegistrarGeneral. The total number of the first period of eighteen years offers 157 cases of general bleeding for diseases of every kind. Of these, 129 are recorded in a way to leave no doubt as to the recovery of the persons." In reality only 16 of the 157 died. These persons were "bled for acute diseases of various kinds. But it will be understood that these form only a small proportion of the acute cases which presented themselves in the eighteen years, the remainder having been treated by other means than general bleeding, and have no place here. It will be seen that the proportion of persons bled was about nine per annum, no very large number when the amount of cases which came under my care during the eighteen years is considered. It will be further seen that the proportion of recoveries to deaths was very nearly nine to one, the deaths being 16 in 157. If we look at the sixteen cases of death (which it will be observed is less than one per annum), we shall probably find that the greater number would have been lost under any treatment whatever."

The second period of eighteen years began with the returns to the Registrar-General, which came into play in August, 1845, and of course offered most conclusive evidence as to death. I find in these eighteen years my returns amounted to 185 deaths of diseases of every kind, chiefly, however, chronic or subacute. Then comes the question, How many of these 185 were bled? The answer is two. One was a case of much complicated pneumonia, attended by a very experienced Physician as well as myself, and bled to 15 oz., after anxious consultation. The other had the character of fever with pneumonia. In a little more than a fortnight after the bleeding an abscess burst into the stomach, and she died four days after. The next and all-important question is, whether in the course of my practice during the eighteen years any other persons were bled. The answer is 24, all of whom recovered. We may now sum up the two periods of persons bled during the thirty-six years, amounting to 157 +26=183, from which take 18 deaths. This would give a proportion of about ten recoveries to one death."

Mr. James then shows the number of persons bled annually, which fluctuated from 0 to 23, thus relieving him from the charge of indiscriminate phlebotomy. "In the second place, we perceive that the numbers remarkably diminished about the year 1837. It may be asked if this arose from any diminution in my practice. The answer is, certainly not! for it was more extensive from 1835 to 1855 than at any other period. Did it arise, then, from any opinions at that time promulgated in opposition to the practice heretofore in use? The answer is, No! for at that period no opinions that would have had any weight had been promulgated. It must, therefore, be referred to an alteration in my opinions, as resulting from my own observations of a change in the character of diseases, and not from any previous ill-success of the measure." Mr. James shows most truly that, in his earliest work, the practice of giving stimulants in appropriate cases and the antiphlogistic virtues of tonics are fully pointed out, and he intimates that

indiscriminate stimulation may have taken the place of indiscriminate depletion.

Mr. James's papers on the "Mortality after Amputations,” published in vols. xvii. and xviii. of the Transactions of the Provincial Medical Society for 1850, are valuable contributions to a subject still of daily increasing interest. Mr. James ascribes an almost complete immunity from pyæmia which has been the case in his practice to the excellence of his Hospital.

"The Devon and Exeter Hospital not only stands insulated in an open situation, but has had the great advantage of possessing for a very long period small wards of separation, lofty, and sufficiently spacious, receiving only one patient, with every advantage of ventilation, light, and air, as regulated by the occasion, free from noise and disturbance, and the moral and physical causes which must operate more or less in wards where a number of severe cases are accumulated; and more especially are exempted from the injurious effects of an atmosphere tainted, it may be presumed, by the effluvia of so many bad cases, whatever care may be taken to lessen their influence. I take it that such an atmosphere may be regarded much in the same light as that of a ward where erysipelas or hospital gangrene are prevalent; and that the pyæmic influence is rather induced through the atmosphere than caused by any mixture of pus with the blood, for this might just as well take place in our own small wards of separation as in the large ones alluded to, and such an admixture would equally apply where limbs are amputated for disease as for injury, which is by no means the case. The advantages of these small wards of separation I cannot urge too strongly."

He testifies to the much greater mortality after primary operations for injury than after operations for disease, and ascribes the difference to the depressing and poisoning nature of shock. Of his primary amputations of the thigh for injury, were fatal; of secondary amputations for injury, 1; and of amputation for disease, These differences cannot, he thinks, be due to other than the cause he assigns.

In 1849 Mr. James was selected to deliver the Retrospective Address in Surgery before the Provincial Medical Association at a meeting in Liverpool. This address contains such a summary as might be expected of recent improvements in Surgery, and includes much useful matter for reference. Its highest point of interest, however, lies in the glimpse which it gives of the profound dissatisfaction of the Profession in the provinces at the centralising influence and blighting monopolies perpetrated by the London teachers of Medicine and Surgery, who, as Examiners and Councillors of Royal Colleges, were enabled to provide for the interests of themselves and their pupils and friends as teachers in the metropolitan schools. Mr. James speaks bitterly of the eminence which has been enjoyed by small cities on the Continent as schools of Medicine, claims the same capacity and power for English cities, and complains that the legislature, by delegating the whole of its power to the members of the Profession who reside in the metropolis, have taken the most effectual mode of blighting, instead of encouraging, the means of improvement which exist elsewhere. Amongst this assemblage of provincial Practitioners," he continues, "must be many who feel that a great injustice has been done to many cities and towns of less size possessing excellent means of instruction, of which no account worthy of notice is made by our chartered bodies, who have determined, with little evidence or examination, that unless a school is complete it is not to be considered at all."

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We must pass lightly over Mr. James's observations on Operations for Hernia, 1859; on Cicatrices after Burns, 1868 (a practical protest against an unwarrantably dogmatic assertion in Holmes's "System of Surgery "); Remarks on Fibrous Tumours, in the Lancet for 1867; Some Remarks on Bloodletting, in the British Medical Journal, February 24, 1866; on Diseases of the Heart, Med. Chir. Trans. vol. viii., 1817; on Bronchocele treated by Seton, ib. vol. xi. ; on the Removal of Cicatrices after Burns, ib. vol. xiii.; and a case in which the femoral artery and aorta were tied for aneurism of the external iliae, ib. vol. xvi.

We need add little to complete the picture of activity and vigour of mind and body of which Mr. James was an example. He was cautious in forming an opinion; but once formed, stuck to it with indomitable resolution. He liked to have his own way in everything, and usually had it. Like Cato Major, he delighted in agriculture, which formed the amusement of his earlier years and the solace of his age. Altogether he was a man whose name will remain amongst the choicest Surgical worthies of his century.

MAURICE HENRY COLLIS, M.D. DUB., F.R.C.S.I., Surgeon to the Meath Hospital and County Dublin Infirmary. NUMEROUS as have been the breaches caused by death within the last few years in the ranks of the Medical Profession in Dublin, in no instance perhaps was a feeling of more profound sorrow and sympathy excited than by the announcement, on Easter Sunday, that Maurice Henry Collis had that morning succumbed to an illness of little more than four days' duration, the result of a wound got in the exercise of his profession. Many circumstances combined to produce this deep regret. Apart from the recollection of those sterling qualities which had procured for Dr. Collis the respect and attachment of his colleagues, it was felt that a meritorious and industrious Surgeon, scarcely arrived at the prime of life and just attaining to well-deserved success, had been cut off, apparently by accident, at the very time that he was commencing to reap the fruits of years of well-directed labours, leaving a large and youthful family to deplore his loss.

On Monday morning, March 22, while engaged in the Meath Hospital in removing the upper jaw for a cancerous tumour in the antrum, Dr. Collis punctured his finger, but thought no more about the occurrence until, on Wednesday, at 3 o'clock a.m., he was seized with a severe rigor, speedily followed by other symptoms of blood-poisoning, and eventually by secondary pneumonia, under which he sank and died at 6 o'clock on Sunday morning.

Maurice Henry Collis, son of the Rev. Robert Collis, was born in the year 1824, and, after receiving a good preliminary education, entered Trinity College, Dublin. Having obtained honours during his undergraduate course, he took the degrees of B.A. in 1847, M.B. in 1848, and M.D. in 1867. In February, 1842, he was apprenticed to his uncle, Maurice Collis, Surgeon to the Meath Hospital; in 1847 he became a Licentiate, and in 1850 a Fellow by examination, of the Royal College of Surgeons in Ireland. On his uncle's resignation he was, on October 11, 1851, elected Surgeon to the Meath Hospital. He has since filled the office of Examiner in Surgery in the Queen's University, and at the time of his death he was Examiner in the same department in the Royal College of Surgeons in Ireland. He was also Member of Council of the Surgical Society, and President of Council of the Irish Medical Association. He was well known to the Profession as the author of a valuable work on the " Diagnosis and Treatment of Cancer and Tumours analogous thereto," of "Contributions to Operative Surgery,' and of papers on Cancer, Cleft Palate, the Treatment of Anthrax by Pressure, Vesico-vaginal Fistula, and the Esthetic Treatment of Harelip.

We cannot better close this brief tribute to the memory of Dr. Collis than by quoting the concluding paragraph of the opening lecture delivered by him in the Meath Hospital on November 4, 1867, of the truth of the warning conveyed in which his own career was, alas! so soon to prove a striking illustration :

"Whether, then, you seek to follow your profession at home or abroad, in the busy haunts of man, or in the comparative retirement of the country, remember that, to fill it as you ought, the same diligence, the same cultivation, and the same rectitude of purpose should be yours; and fret not yourselves if, in this world, an equal reward to others be not given to you. The time is short; work while it is day, for a night will come when work will give place to rest, and after that, the dawn of a perfect day."

We need in this country a naval Medical school, conducted upon the same general principles as those in such successful operation at Toulon, Rochefort, and Cherbourg in France, where Medical men may be prepared for the duties of naval Surgeons, by suitable lectures and other exercises given by an able corps of professors. Some of the most brilliant naval and millitary Surgeons of France, as Broussais and Larrey, not to mention others, received their education in these institutions. Such a seminary, surrounded with proper safeguards, could not, in the slightest degree, interfere with the interests of the regular Medical colleges of the country, while its beneficial effects in supplying the service with a more thoroughly trained corps of Surgeons would be incalculable. There is just as much need of such a school as there is of a school for the education of sailors and officers of the line.Address of Samuel D. Gross, M.D., LL.D., President of the American Medical Association.