index be set to the Bethnal Green population, as
enumerated in 1874 (120,104 persons), and the other
to the number of children under five years of age HOSPITAL
(18,142), and the cylinder be now moved round, so as
to bring the estimated population for each year to the
upper index, the proportionate number of children
may be read off at the fixed index year by year, until
we arrive at the 1881 population as enumerated
(126,961 persons), of whom 19,380 were children. Now
reading the rule we find it gives at the fixed index
19,180, two hundred short of the true number; this is
not the fault of the rule but of the method, the results
of which can only be an approximation, and when we
distribute the error over the ten years, it is very small,
only 20 per annum.

REPORTS OF

PRACTICE IN MEDICINE
AND SURGERY.

ST. BARTHOLOMEW'S HOSPITAL.

CASES OF ENTERIC FEVER.
(Reported by Dr. H. LEWIS JONES and
Mr. F. C. CRESSWELL.)

MENSURATION.—The cubic capacity of rooms having CASE I.-Enteric Fever-Parotid Bubo-Perforation of

a rectangular form is calculated by the multiplication of the height, length, and breadth, and for this purpose it is easier to take all measurements by the decimal measuring rod. I have had constructed and use measuring rods divided into feet and tenths of feet instead of inches; but this is not absolutely necessary, as the printed table on the body of the rule gives the decimal value of fractions of a foot.

CIRCULAR WARDS.-Several hospitals have been built lately with circular wards. The calculation of the cubic contents of such as these would be somewhat tedious, as the method given in books on mensuration is 34 times the square of the radius multiplied by the height. The decimal value of 3 is 31416, and a ward 52 feet in diameter by 16 feet in height would work out as follows:-26 x 26 x 31416 x 16 33979 cubic feet. Calculated out in the ordinary way, this gives a decimal fraction over; but unless the original measurements are taken with extreme accuracy it is a superfluous refinement to carry the result to a fraction, so that the figures as given by the rule are quite sufficient.

With a little practice one finds the rule capable of working out many problems, and I should not now like to be without mine. Indeed, I often wonder how I got on before I heard of it, as I am a bad

calculator.

It is almost needless to say that all problems must be correctly stated before they can be worked on the rule, for, though wonderfully accurate, it is only a machine, and of no more use to a person who cannot correctly state a rule-of-three sum than a pencil is to a child.

The manufacturer of the instrument is Mr. Stanley, of Great Turnstile, and his name is a sufficient guarantee for the accuracy with which it is made. To the kindness of Mr. Stanley I am indebted for the loan of the other slide rules I show upon the table.

PROHIBITION OF ADULTERATED BUTTER AND CHEESE IN NEW YORK.-The New York Legislature has just passed the Bill prohibiting the sale or manufacture of all adulterations of butter or cheese. The careful investigation carried on by the Committee brought out many curious and disagreeable facts. It was shown that the manufacture of oleo-margarine might be cleanly, and the articles used not unhealthy, but that in many cases this was not true. It also appeared that it was often difficult to detect the difference between butter and oleo-margarine, except by the use of chemicals, and that oleo-margarine was never sold under its name, but as real butter. It was, therefore, recommended that the manufacture and sale be absolutely prohibited, as all attempts to regulate the business have failed. The Bill embodying this recommendation has passed the Assembly and Senate, and is to take effect after July 1st.

Intestine-Death.

(Under the care of Dr. GEE.)

W. H., aged 32, a porter in Smithfield Market, was admitted Nov. 19th, 1883. He had been drinking heavily for six weeks, and for a fortnight had felt ill, with cough, headache, and diarrhoea.

His face was flushed, expression heavy and listless, tongue dry and brown, many rose spots on belly and chest. Next day he complained much of the state of his tongue, saying he felt choked by it. It was swollen, very dry and brown, his hands were tremulous, and at night he became delirious. This was the commencement of delirium tremens, which lasted for six days, November 20-26, although at night he slept fairly.

On Nov. 27th he was rational, recognised his friends and complained of pain at angles of jaw, where there was fulness and tenderness, especially on the right side. Nov. 28th.-Very great swelling and tenderness in both parotid regions, with much pain in swallowing. 29th.-Parotids as yesterday.

30th.-Better; can swallow with less pain; the swellings also decreasing, no fluctuation can be felt in them.

Dec. 1st.- Doing well.

2nd. Suddenly seized with pains in abdomen, and symptoms of perforation. He died early on the 3rd, the cause of death being perforation of the bowel, just above the ileocæcal valve.

The right parotid was examined, and pus was found in the interstices of the gland.

CASE II.-Enteric Fever-Suppuration around the
Parotid Glands-Recovery.

(Under the care of Dr. CHURCH.)

Florence T., aged 3, admitted in November, 1883, on the third day of her illness, with headache, vomiting, and abdominal pain. On the eighth day rose spots appeared, and her spleen was plainly palpable. Bowels loose. The temperature gradually fell from 104° on the eighth day to 100° on the thirteenth, but that evening it rose suddenly to 103°, and first the left, and afterwards the right parotid region rapidly swelled until she could swollen and red. Matter rapidly formed, and on the scarcely open her mouth; the whole face also became seventeenth day both abscesses burst into the external auditory meatus, the left again preceding its fellow by a few hours. A week later openings were made in front of the ears, and drainage tubes inserted. Convalescence proceeded favourably but slowly, and a small abscess formed on the scalp, fifty-five days after admission, which was opened and healed well.

mouth and tongue is noticeable, and it was Dr. Gee's Remarks. In the first case the great dryness of the opinion that the affection of the parotid glands might be directly connected with that state of the mouth, by extension of inflammation along Steno's duct.

Similar tender swellings of the parotid glands occurred in a severe non-fatal case of chorea in Dr. Gee's wards

in August, 1883, accompanied by a very dry state of mouth and tongue, but without formation of pus.

Dr. Angel Money, in Medical Times and Gazette, Vol. I, for 1883, p. 180, reported a case of parotid bubo in typhoid fever, where great dryness of the mouth co-existed.

CASE III-Enteric Fever-Purpuric Spots-
Intestinal Hemorrhage-Death.

(Under the care of Dr. CHURCH.)
John H., aged 10, admitted in December, 1883.
Had been ill eight days, with pains in the abdomen.
Bowels not moved for six days. Temperature 101 2°.
Four days after admission (twelfth day of illness)
several rose spots appeared, and on the following day
he passed two loose motions containing blood.

several others were scattered over the abdomen.

Two days later he died, the purpuric spots having slightly increased.

CASE IV.-Enteric Fever-Ecchymoses-Relapse

Recovery.

(Under the care of Dr. GEE.)

Medical Times and Gazette.

SATURDAY, JUNE 28, 1884.

THE Medical Bill came on for second reading in the House of Commons rather unexpectedly on Tuesday afternoon. Mr. Mundella, who has charge of it there, by virtue of his position as Vice-President of the Committee of Council on Education, did not speak at any length of its provisions. He felt both that they are pretty well known, and that they would have to be fully examined in Committee. He gave a slight sketch of On the seventeenth day of the attack he was much the history of the agitation, which has been carried on worse, his face pinched, mouth dry and full of foul more or less actively and persistently for very many stringy mucus. His evacuations were passed involun-years, for medical reform; of the grounds on which tarily. On the twenty-first day a large conglomeration of that agitation was justified; and of the reforms which purpuric spots was found near the umbilicus, and the present bill is intended to effect. Its main principles are, he stated, first, the reform of the Medical Council, by diminishing its numbers, strengthening its powers, Post-mortem.-The colon was found full of blood and giving direct representation upon it to the profession and fæcal matter. Death evidently resulted from at large; secondly, an approximation to uniformity of hæmorrhage, but its source could not be found. The examination, by means of the establishment of Medical ulceration of small intestine was moderate. Boards to regulate the examinations, under the control of the Medical Council; and thirdly, the provision that no one should in the future be admitted to the Medical Register, unless he or she had proved, at the final examination, his or her competency to practise medicine, surgery, and midwifery. The Government have no wish to imitate the State examinations of Germany and other countries, but they desire to make the profession in Great Britain rank as a body among the very first in Europe, and they believe the provisions of this Bill will place them in that rank. But they do not aim, happily, we may add, at any ideal uniformity, or unnecessarily high standard; and while adhering to the main principles of the measure, they are not pledged pedantically to all its details. Finally, Mr. Mundella asked for a full and fair discussion of the details of the measure in Committee; and, if we have understood him rightly, spoke of questions of colonial and foreign titles, of penalties for misuser of title, of medical education, and of some other matters, as questions which admit of amendment. He himself, he said, approached the whole matter with feelings of the deepest respect and gratitude to the profession, and hoped the bill would settle all the questions involved in a way that would add to the dignity and honour of such a noble calling. Altogether it will be admitted that Mr. Mundella showed a full comprehension of the importance of the measure, and a readiness to entertain any proposed amendments of it in a conciliatory spirit.

G. P., aged 23, admitted Nov. 29th, 1883. He had been ill since Nov. 23rd with headache, vomiting, cough and diarrhoea. The temperature on admission was 104° F. On the 1st of December rose spots appeared on abdomen; he became delirious, and the delirium, which was violent at first, but afterwards became moderate, continued until the 14th of December. On December 6th (fourteenth day of disease), ecchymoses appeared on both hips. These increased rapidly in size, and on the 7th were each the size of the palm of the hand, and there were two small fresh ecchymoses on the front of the abdomen, the size of a shilling. His condition on this day and the next was very grave, with low delirium, and plucking at the bed-clothes; but after that he gradually improved. No fresh ecchymoses made their appearance, and by Dec. 19th the large patches over the hips had almost

gone.

There was a relapse from Dec. 23rd to Dec. 31st, with slight hæmorrhage from bowel on Dec. 31st and Jan. 1st, and on Feb. 1st he left the hospital quite well. Remarks.-The four cases do not give much help to prognosis beyond this-that neither of the complications foretells a necessarily fatal result.

Dr. Murchison, in his "Treatise on Continued Fevers," 2nd Ed. p. 582, says that he has six times seen parotid bubo complicating enteric fever, and of these six cases tive died.

Trousseau too regarded the appearance of parotid bubo as a most unfavourable symptom.

Dr. Murchison also says (Op. Cit. p. 515) that purpura-spots and vibices are met with in rare cases, several of which have recovered, and he also gives a reference to Trousseau which we have been unable to find, as it does not occur in the earlier edition from which the English version is translated.

ST. THOMAS'S HOSPITAL.-The Archbishop of Canter bury will distribute the prizes to the students, in the Governor's Hall, on Wednesday, July 19th, at 3 p.m.

SIR LYON PLAYFAIR, who said that he had not expected the bill would be reached so soon, and that he would so soon be called upon to speak on it, enlarged on the points referred to by Mr. Mundella; but he spoke also, at some length, of the importance of making the profession more attractive to eligible candidates, and of taking care to secure, if possible, that the universities of the United Kingdom shall take a larger part in the education of medical men. He gave statistics to prove that, from one cause or another, the number

fore he would not at present venture to express any opinion upon the medical statement referred to. Mr. Mundella was further asked whether, in consideration of the grave fact that the Queen's Bench Division of the High Court of Justice had decided that the master of a public elementary school has no authority to impose upon the children the duty of studying at home, he would not any longer instruct the inspectors of those schools that a school marked "excellent" ought to provide "a regular system of home exercises?" The answer given to this question by the Vice-President of the Committee of Council on Education was hardly worthy of his position as a Government official. He could not see any reason, he said, to modify the instructions to the

of medical practitioners has not, since 1861, increased in proportion to the increase of the population of the United Kingdom, and the profession had not attracted a sufficient number of men; and he thinks, if wisely framed and wisely administered, the bill may increase the numbers of the profession; while, if unwisely framed and administered, it may have the contrary effect. He dwelt on the great value of a university education in turning out medical men of general culture as well as of professional knowledge; and pointed out that in the constitution of the new Medical Boards care is taken that this training, which exists largely in Scotland and Ireland, and is becoming more common in England, shall still be given to a large proportion of the profession. Whether or no the proposed proportions of the repre-inspectors of the schools. All that had been decided sentatives of corporations on those boards is right, will be, he said, a fit subject of discussion when the bill is in Committee; but the essential principle is this, that a university preponderance on the boards will be fair as giving a definite bias to a liberal professional training as against cram by mere examination and examining bodies.

COLONEL KING-HARMAN thought there was too much of the principle of centralisation in the bill, and said that the corporations in Ireland complained that it aims to a very great extent at minimising the powers they had worthily exercised, and at confiscating their funds. He announced his intention of proposing some amendments with regard to this question, and hoped they would be carefully considered by the Vice-President of the Council. Two or three other members of the House spoke briefly on the bill, giving it a general approval; but seemed to think that the final examination provided by it for the minimum qualification to practise is to be in addition to the final examinations of the corporations, and this they of course objected to. Mr. Gray distrusts the centralising tendency the bill will have in Ireland, and holds that it will probably end in the destruction of the independence of the local corporations; and he maintains they do not deserve such a fate. He thinks also that the influence of the universities on the boards will be greater than it should be; and he regrets the probable extinction of the Apothecaries' Hall. Whether he intends proposing any amendments did not appear, for while he was speaking the hour arrived for closing the afternoon sitting, and the debate stood adjourned. The bill again came on for consideration yesterday (Thursday) afternoon, but too late for us to be able to record the result here.

MR. S. LEIGHTON, who is indefatigable in his efforts to protect the children in our elementary schools from over educational pressure, drew the attention of Mr. Mundella on Thursday se'nnight to the fact that a recent weekly return by the Registrar-General contains the following statement, appended by a medical man to his certificate of the cause of death of a young girl: "This the second death in my practice within a week, the cause of which was produced from pressure at a Board School." Mr. Mundella replied that the case was under investigation, and that there

by the judgment referred to was that it would be illegal to detain a child in school after hours, against the will of the parent, because the home lessons had not been prepared. But that need not prevent managers and teachers from providing a regular course of home lessons for the children in the higher standards. He admitted that, according to this legal decision, home lessons are not obligatory, and that consequently a child ought not to be punished for not learning them; but, said Mr. Mundella, if we are to believe the newspaper reports of his observations, "I do not think this will make of this declaration will surely be that the Committee any practical difference." The popular interpretation of Council on Education consider that the preparation of home lessons is necessary, and that a regular course of them will be provided for; care being only taken that children who do not learn them shall not be punished in a way already judged to be illegal. Mr. Mundella feels sure, no doubt, that school managers and teachers will invent various not illegal modes of making scholars and parents feel that such lessons had better be prepared; but is it judicious or expedient to provide so possibly fruitful a source of discord between the managers of schools and the parents of the children forced to attend them? We trow not. The evidence of the existence of over-pressure in elementary schools is increasing in bulk and force; and it is rapidly becoming more and more important that great and wise care be exercised in enforcing the code of inKnowledge grows, but wisdom lingers ;" and the tone adopted by Mr. Mundella is likely to excite a formidable amount of popular irritation against the management of the system of instruction over which he presides.

struction for such schools.

66

LORD ROSEBERY has shown in many ways before now that he has an exceptionally open mind for one of his order, but he never showed it more strikingly than in his suggestion in the House of Lords the other day that artists, doctors and other workmen, should be admitted to seats in that gilded chamber. For our own part we have for years been in favour of the creation of medical life-peers, believing that it would be a boon both to the State and to the profession; to the former by bringing to its counsels the scientific knowledge and judgment which are nowadays so frequently called for; to the latter by opening to its picked members a new and higher sphere of usefulness,

without exposing them to the ordeal of an electioneering contest, and by rewarding them at the same time with a less common and less burdensome honour than a baronetcy. A successful doctor now, feeling an hereditary title in store for him, is driven in his own despite to amass money in support of the future dignity; while if he saw before him the alternative of a life peerage, he could follow his own inclinations and leave even his eldest son to take care of himself. Science ought not to be driven to buttress up the privileges of primogeniture.

THE Standard, in its comments on LORD ROSEBERY's proposal, says that there can be " no doubt whatever that Parliament, as a whole, might be very considerably improved by the admission of men to the House of Lords who will not, and cannot be persuaded to, undergo the toil and trouble necessary to secure and to retain a seat in the House of Commons. If the men of culture and refinement who seem likely to be driven every day further and further from the House of Commons could find a place in the House of Lords, it would unquestionably be a great gain to the country. The presence of such men as Mr. Herbert Spencer, Professor Huxley, Sir William Gull, or Sir Frederick Leighton in any Assembly could not fail to strengthen its charactèr, and give it a greater hold on the confidence of the nation." That is a surprising and pleasing admission on the part of the leading organ of the Conservative party.

June 20th, 2 deaths from cholera; June 21st, 3 deaths from cholera; June 22nd, 13 deaths from cholera; June 23rd, 6 deaths from cholera. Captain Duroch, a retired naval officer, who lived in the country on his own estate, having been to the theatre at Toulon, died of cholera the next morning at his residence at Dardennes.

DRS. BROUARDEL and PROUST were immediately sent to Toulon, with a Ministerial Commission. Drs. Straus and Roux, formerly members of the French Scientific Mission to Egypt during the late epidemic in that country, have also started for Toulon, to resume their scientific investigations. Great alarm is felt at Marseilles, which however is protected from contagion at present by the prevalence of the mistral (north wind). Six thousand persons are said to have left Toulon. The troops have been disseminated in various stations outside the city, and all proper sanitary precautions have been adopted. On Tuesday, at the Academy of Medicine, Dr. Fauvel distinctly stated it as his opinion, that the epidemic at Toulon was not Asiatic cholera. He founded his opinion upon the fact, that, instead of growing and spreading, as cholera would be sure to do, if it had once broken out in a city so unfavourably situated, the epidemic was actually losing ground. Drs. Brouardel and Proust, in a telegraphic report sent to the Minister of the Interior, state it as their distinct opinion, that the disease is only cholera nostras. The local physicians, however, maintain the opposite view. Proper measures for establishing special hospital services in all large French towns, in case of need, have already been taken. The new establishment known under the name of Hôpital des Mariniers, on the outskirts of Paris, has been devoted here to that purpose. Whatever may be the result of the present alarm, it must be hoped that the opporA MOST unwelcome guest, writes our Paris correstunity will be seized to use compulsory measures pondent, has suddenly appeared at Toulon, under the to reform the sanitary state of Toulon, which makes form of cholera-whether Asiatic or sporadic is a ques- Asiatic cholera, or of cholera nostras. In the epidemic it a focus of infection, either in the case of true tion still at issue. Toulon, one of the most important naval stations of France, is also one of the filthiest of 1865, 6,000 persons died at Toulon, out of a popucities in Europe. In the old town the state of the lation of 70,000 souls, which, by adding the milistreets defies all description, and as there are no water-tary garrison and the naval service, might be esticlosets the refuse of private dwellings is simply poured into the streets, from which it is washed by the rain into the old port. A pretty similar state of things prevailed in Marseilles not very long ago, and the Phocean

MR. GIBSON, who has made himself the spokesman of the aggrieved officers of the Indian Medical Department, gave notice in the House of Commons on Friday last, that he would call attention to that Service, and move a resolution that day four weeks, i.e., on July 18th.

founders of the cities that stud the coast of Provence do not seem to have brought great notions of cleanliness from their home in Asia Minor. The port of Toulon constantly contains a powerful fleet, and the garrison of the place amounts to twenty-five thousand men. The seeds of disease when sown upon such a promising soil are apt to grow fertile. It has been supposed that a troopship, La Sarthe brought the infection from China. A death from cholera is said to have occurred on board, and the man's clothes were not burnt, according to sanitary prescriptions. Be this as it may, the first fatal case occurred on the 14th June (Saturday). A man died on board the Montebello. No further deaths occurred till the 19th, since when deaths have occurred daily, viz.: June 19th, 1 death;

mated at 110,000 in all. The Republican Government is bound in honour to suppress a standing nuisance, which is not only a permanent threat to the sanitary condition of France, but also to the health of other European nations.

THE number of deaths in London last week was as many as 80 below the average, and the death-rate accordingly fell to 17.8 per 1,000, the lowest rate recorded for months. In only twelve of the twenty large English towns, and in only two of the eight large Scottish ones, was there a lower mortality. In both the zymotic and the respiratory class of diseases, the number of deaths exceeded the average-in the one case by 28 and in the other by eight—a fact probably due in some measure to the comparatively low temperature of the week. Of the zymotic class, measles and whooping-cough-the two in which a low temperature most sensibly affects the result-killed respectively 81 and 68 persons, or in the