writing of an essay were not required, although those subjects were considered by the Council last year to be necessary.

Dr. STORRAR protested against the system which had crept into existence, of the Executive Committee receiving communications made to the General Medical Council by important bodies such as the Universities of Oxford and Cambridge, and dealing with them, handing over to the Council simply their recommendations upon the subject. He fully credited the members of the Executive Committee with a loyal desire to promote the interests of general education, but he objected to the adoption of the report of the Executive Committee, because they were never instructed to prepare a report. He would move as an amendment-"That the examination in general education conducted by the universities be accepted as heretofore."

Dr. FERGUS thought that, looking to the eighth Standing Order, the Executive Committee had not exceeded their powers. The Executive Committee were directed by that Standing Order to receive information and report on any subject which it thought desirable."

Dr. HUMPHRY said the question was, whether the Council thought it desirable that its business should be prepared by the Executive Committee taking up subjects which were brought before their notice in the intervals between the meetings of the Council, and whether it would not be expedient that the Executive Committee should put such subjects into such a form as would most expedite the business of the Council. The Executive Committee was appointed for the purpose of filtering and straining the subjects which it thought desirable to be presented to the Council. Every subject which was referred to the Committee was brought up with a definite report and recommendations, but it remained with the Council to accept or not the recommendations of the Executive Committee. Two or three years ago the Council increased the fees of the Executive Committee. Did they do that expecting that the Executive Committee would do more work, or less work? It was clearly intended that they should do more to facilitate the business of the Council than they had done before.

Dr. AQUILLA SMITH said that the reason for the increase of the fees of the Executive Committee arose from the fact that lately the Committee often sat for seven consecutive hours, instead of, as in former days, two or three. He thought that if Dr. Storrar's amendment were passed it would have the appearance of a censure on the Executive Committee.

Mr. SIMON thought that the Council would have some reason to be dissatisfied with the Executive Committee if it did not prepare business for the consideration of the Council. It would be convenient for the Executive Committee, however, to distinguish between the preparation of matter and the initiation of judgment. The more convenient plan would be not to adopt the report of the Committee, but to pass a resolution to the effect of the last words of the report, because reports were very often argumentative, and the members of the Council could not pledge themselves to the arguments or the particular phrases of the reports, as they would do if they adopted the reports. A simple resolution, moving the adoption of the recommendation, would have been a better course.

Professor HUMPHRY agreed.

The PRESIDENT thought the Council were in some danger of overlooking the extreme importance of the motion in discussing its particular form. The motion substantially was that certain recommendations made last year should, in the case of numerous and important bodies, not be considered as in force at the end of this year. As a member of the Executive Committee, he thought that they had no other course but to allow the examinations to be accepted as heretofore. He should be prepared to vote for Dr. Storrar's amendment, not looking upon it at all as a censure on the Executive Committee.

Dr. HALDANE said, as it appeared to be the wish of the Council that a separate resolution should be put, he should be quite prepared to accept Dr. Storrar's amendment, and, with his permission, would move his amendment in place of his (Dr. Haldane's) original motion.

Mr. TEALE Seconded the motion.

Mr. MACNAMARA said, as to the merits of the motion, that the Council spent a good deal of time last year in considering the subjects which it thought essential that medical students should be acquainted with to enable them with advantage to enter on the study of their profes

sion. The most important subject was that of elementary mechanics of solids and fluids, comprising the elements of statics, dynamics, and hydrostatics. It was a matter greatly to be deplored that there should be found in the ranks of the medical profession gentlemen who did not know the difference between a thermometer and a barometer. If the Council were going to accept, as heretofore, the examinations of the universities, they would be undoing that which they discussed so fully last session, and upon which they arrived at an almost unanimous vote. They came to the conclusion that the elements of dynamics were of some importance to students, and that no students' examination could be considered satisfactory which did not include the elements of that study. Several of the universities' examinations, however, did not include one word about dynamics.

Dr. HUMPHRY pointed out that the examination in elementary mechanics of solids and fluids was not required as a preliminary examination, because the note to the recommendation said that the subject might be passed either as preliminary, or before, or at the first professional examination.

Professor TURNER agreed that the subject was of great importance, but if the Council accepted examinations which did not include an examination in mechanics, provided that the candidate afterwards passed such an examination, he did not see so much difficulty in accepting the motion. In order to make the matter clear the motion should be somewhat enlarged in its terms, and should contain a distinct expression of the opinion of the Council to that effect; because he should be sorry if by reason of any motion of this kind the examination in the elementary mechanics of solids and fluids dropped out of the subjects which were thought essential for students.

Dr. STORRAR then added to his motion the following rider : "But that if in any of these examinations the subjects of elementary mechanics of solids and fluids are not included, a knowledge of those subjects should be required at a subsequent examination; and that a copy of this resolution be forwarded to the universities concerned.

The motion was put and carried unanimously.

Mr. SIMON then suggested that the Executive Committee should consider whether, subject to the condition that an examination in physics should be afterwards passed by the student, the second-class examination of the College of Preceptors should not be accepted in the same way as the universities' examinations had been. The Council recognised their first-class examination, and the second-class examination was very little indeed below the standard recommended by the Council, and the small diminution in quantity was made up by the better quality of the examination.

Dr. STORRAR thought that it would be better for a committee of the whole Council to consider this subject; and the discussion ended in

Mr. SIMON giving notice of motion for to morrow-" To bring under the consideration of the Council whether passing the second-class examination of the College of Preceptors, provided the candidate passes in the first division, may be taken to satisfy the requirements of the Council for preliminary general education."

The following report of the Executive Committee was then read:

The Executive Committee begs to call the attention of the General Council to cases of students coming from India who have passed the matriculation examination at the several Indian universities.

The examination at these universities includes Latin as an optional Fubject, but the students, as a rule, take up Sancrit or some other language in place of Latin. The regulations of the Council require that the certificate of examination from these universities should include Latin.

Certain students from Bombay who have passed the university examination there, not including Latin, have applied to be allowed to enter for examination, on condition that they shall now pass an examination in Latin; and this the Executive Committee has acceded to.

Certain other students in the same condition have applied to the Executive Committee to allow them to enter for examination without any examination in Latin.

The Committee, under the special circumstances of the case, has considered that the passing in Sanscrit may be accepted in place of Latin, and has granted their request.

As, however. this is not in accordance with the words of the recommendation of the General Council on Education and Examination, the Executive Committee thinks it right to submit the matter to the General Council, in order that the matter may be amended, and a rule laid down for the future guide of the Committee. The Committee suggests that the General Council delegate to the Executive Committee power to make exception to the recommendations on education and examination, in cases in which such exception shall seem to them to be reasonable.

Dr. STORRAR inquired how this question came before the Executive Committee.

ORIGINAL COMMUNICATIONS.

Dr. HUMPHRY stated that cases came before the Executive Committee of students who claimed exemption from the preliminary examination, which cases should rightly come before the English Branch Council, but the Executive Committee, when sitting at the time, thought that it would be better that they should take upon themselves the responsibility of making the exemptions rather than that the Branch Council should be called together for that express

purpose.

Professor TURNER said he did not intend to enter into the pretty quarrel which he could see was going to arise between the Branch Councils and the Executive Committee. The Scottish Branch Council had had from time to time precisely similar cases before it, in which young men had come from the various Indian universities without having passed an examination in Latin, and although they applied to be admitted to examination by some of the Scottish licensing bodies, the Scottish licensing bodies refused to register them because they had passed no examination in Latin, saying that they were complying with the recommendations issued by the Council in so doing. The Executive Committee was now overriding the recommendations, not of the English Branch Council, but overriding the resolutions of the General Medical Council itself. The Committee had taken a liberty with the recommendations of the Council which they had no right to take; but as it was near six o'clock he suggested that the further consideration of the report should be adjourned.

This was agreed to, and

Dr. STORRAR then gave notice of motion that the Standing Orders with regard to the duties of the Executive Committee be reconsidered. He did not wish to reflect upon the members of the Committee individually. They had, no doubt, done what they considered to be their duty. At the same time, feeling himself placed somewhat in the position of Her Majesty's Opposition, he thought it would not be improper for him to express his views strongly.

Dr. PITMAN then moved, and Dr. AQUILLA SMITH seconded "That Sections 1 and 4 of the Standing Orders be referred to the Business Committee, to report whether anyand, if so, what-alterations were to be recommended in those sections of the Standing Orders."

This motion was agreed to, and the Council adjourned.

THE REPORT ON THE METROPOLITAN WATER-SUPPLY FOR MARCH, 1881.--The report of the examination made of the water supplied by the metropolitan water companies during the month of March last shows that, previous to filtration, the state of the water in the river Thames at Hampton, Molesey, and Sunbury, where several of the companies' intakes are situate, was good in quality from the 1st to the 4th of the month, when it became bad, and remained so for the rest of the period. On the other hand, the water in the river Lea, whence the New River Company and East London Company derive their supplies, was generally good throughout the whole month. Lieut.-Colonel Bolton once more calls attention to the fact that much of the water delivered in the metropolis for domestic purposes is constantly deteriorated after leaving the companies' mains by the dirty state of the cisterns on the premises of the consumers. Many of the cisterns, tanks, and butts for containing water, especially in small tenement-houses, are, he remarks, still in a disgusting and filthy state. The results of Dr. Frankland's chemical analyses of the waters supplied during the month of March are as follows:-The Thames water delivered by the Chelsea, Southwark, Grand Junction, and Lambeth companies was of considerably better quality than during the previous month; on the other hand, the West Middlesex Company's water, which in February was the best drawn from the Thames, exhibited in March a noticeable deterioration. The Chelsea and Grand Junction Companies alone delivered water that had not been efficiently filtered. Of the water derived from the river Lea, the New River Company's supply recovered its usual superiority over the metropolitan waters of river origin, whilst that of the East London Company was no better than average Thames water. The supplies of both these Companies were efficiently filtered before delivery.

EXAMINATION FOR TRICHINE AT HAMBURG.-In 78,597 parcels of American pork and bacon that were examined in 1880, trichinæ were found to exist in 1 per cent., while no trichina were found in 49,913 parcels of European origin.

CERTAIN MORBID PHENOMENA IN CONNEXION WITH THE HEART'S ACTION. By EDGAR THURSTON.

Assistant-Physician, Hospital for Epilepsy and Paralysis, Regent's-parki late House-Physician to King's College Hospital, etc. (a)

(Concluded from page 455.)

CARRYING out the same line of thought, I pass on to the consideration of another disease, in which the heart's action may be expected to be impaired-namely, pericarditis-and, as before, I cite a case, that of S. B., aged seventeen, female, who came into hospital with an attack of subacute rheumatism. Very little hyperpyrexia. After a few days, præcordial pain was complained of, and the physical signs of acute pericarditis, with well-marked triplicate friction sound, developed. As these passed off, an endocardial systolic aortic bruit became audible, persisting up to the time of her leaving hospital. Diagrams of her pulse-tracings are before you, and you see, by comparison of tracings in health of similar pulse-rates, that when she came into hospital her ventricle was contracting at the normal rate, but that, synchronously with the development of the pericardial symptoms, marked prolongation of the systole ensued, becoming, as the endocardial murmur developed, still more aggravated, and persisting up to the date of her discharge.

The sequence of events causing the disturbed action of the ventricle is, I think, not difficult to follow. At first uncomplicated subacute rheumatism, followed by exudation of plastic lymph on the surfaces of the pericardium, of itself sufficient, no doubt, to react on the ventricle, which in turn was affected with a condition of myocarditis, its muscular structure becoming soft, flabby, and infiltrated, and unable to contract with the same force as in its healthy condition. Had the myocarditis, as ordinarily, become resolved, the ventricle would, without doubt, have recovered its old vigour, but the deposit of lymph on the aortic valves kept up the impaired action, which would probably have continued indefinitely unless, as the myocarditis subsided, compensatory hypertrophy of the ventricle took place.

This impaired action of the ventricle I have demonstrated time after time in cases of cardiac disease and pericarditis, and I have only cited typical examples. I have found it also in marked degree in cases of aneurysm of the arch of the aorta, in which it is produced in consequence of the resistance to be overcome by the blood-current in traversing the aneurysmal sac.

Thus far I have considered cases only in which the disease acts immediately on the heart and its investments. But I must now pass in review some cases in which the blood is acted on primarily, and the heart secondarily, taking as a type the disease known as chlorosis, in which, according to the researches of Drs. Baxter and Willcocks, (b) the normal ratio between the number of corpuscles and their functional value ceases to be maintained; and while hypo-cytosis and hypo-chrosis co-exist, the latter is always in excess of the former. In a disease such as this the nutrition of the cardiac muscular tissue must be seriously impaired, owing to the impoverished condition of the blood supplied to it through the medium of the coronary arteries.

The ventricular walls become flabby and pulpy, and the degree to which this change of structure exists may, I think, be ascertained by examination of pulse-tracings. These tracings show you the marked prolongation of the systole at the height of the disease, and further-a fact which I wish to lay special stress on-the return of the aortic wave to the normal standard, under the exhibition of preparations of iron, and coincidently with marked improvement in the condition of the patient, giving us a measure of the improved nutrition of the cardiac tissue as the blood recovers its lost properties. I throw out a suggestion which I have had no opportunity of carrying out, that combined sphygmographic and hæmometrical examinations will shed more light on the condition of the heart at various periods of the disease.

(a) Lecture delivered before the King's College Medical Society, October 28, 1880.

(b) "Contribution to Clinical Hæmometry," Lancet, March 23, 1860.

In cases of chronic renal disease-cases in which there is great diminution of the amount of hæmoglobin, and a profound degree of anæmia-I have found repeated evidence of prolongation of the systole, indicating that the balance between the hypertrophy of the ventricle and the thickened arterioles is no longer maintained, owing to the impaired quality of the blood supplied to the cardiac muscular tissue. I pass on to a consideration of the action of the ventricle in cases of primary or idiopathic fever. It is an established fact that one great danger to be feared in severe cases of fever-e.g., typhoid fever-is the onset of a condition of acute myocarditis, but it is to milder cases that I wish to direct your attention. In the words of the late Dr. Anstie, (c) "The persistence of the febrile state at a high standard for a certain number of days involves large tissue-destruction, and this destructive process almost invariably involves to a large extent the muscular and other nitrogenised tissues of the body." The amount of this destruction can be ascertained by determination of the excretion of urea, and that the muscular tissue of the heart is involved in the destructive process, there is very little doubt. Dr. Anstie expressed great hopes of the utility of the sphygmograph in the prognosis of fevers, (d) employing, as the element in establishing a prognosis, the form of the pulse-wave, whether of the full dicrotous, hyper-dicrotous, or monocrotous type. In a case of typhus fever, the tracings of which I have published, (e) I have seen the pulse-curve pass within seventy-two hours from the hyper-dicrotous form, through various phases, to regain its normal character.

It is not, however, to the character of the pulse-tracing that I wish to call your attention, but to the position which the aortic notch holds relatively to the whole beat in comparison with its normal position; and I take, as my example, the case of C. C., aged twenty, male; first seen on the eleventh day of the disease (typhoid fever). Temperature 104-6°. Sixteen motions, and a trace of blood in the stools. Slightly delirious. The delirium persisted until the fifteenth day, by which date the temperature had fallen to 103°, and he was sweating profusely. Eight motions daily, with no further passage of blood. By the eighteenth day the tongue was, instead of being black, covered with a thin white fur, and the temperature had fallen to 99.6°; seven motions daily. On the nineteenth day he suffered a relapse, having been allowed to talk to his friends for a long time. By evening his temperature had risen to 102.4°, and he was once more delirious, the tongue covered with a black fur. The delirium persisted for forty-eight hours, after which the temperature fell to 99.8° by the twenty-third day. He was then perfectly conscious, and passing a few slight motions daily. There was a trace of albumen in the urine. From that time his symptoms gradually subsided, and on the forty-ninth day he left the hospital, quite convalescent.

I have here (Fig. 3) a chart indicating the day of the disease and the state of the bowels, the horizontal line representing the normal temperature and normal length of systole. The temperature record is indicated by the continuous black lines, and the prolongation of the systole in twentieths of a beat by the dotted lines. Following the chart (which is to be read from right to left), you notice that the greatest degree of prolongation of the systole coincides with the highest degrees of temperature on the eleventh and twelfth days, and gradually approaches the normal length, with a slight remission on the fifteenth day up to the nineteenth day, when, coincidently with the relapse, an extreme degree of prolongation ensued, the systolic portion continuing, however, from the following day to return progressively and uninterruptedly to its normal length, which was regained about the thirty-fifth day, keeping pace with the decline of temperature and improved condition of the patient. The coincidence of the greatest prolongation of the systole with the acme of hyperpyrexia, the simultaneous return of temperature and the aortic notch towards the normal standard, the aggravation of the prolongation coincidently with the relapse,-these facts, I think, all point to an intimate relation between the heart's action and the body-temperature; a relation which would serve as an argument in favour of those who support the antipyretic treatment of fevers by hydrotherapy or other methods. Let me add, in conclusion, that the most severe degree of

(c) Anstie, Practitioner, vol. xii., page 192.

(d) Vide Lancet, vol. ii. 1867, pages 35, 63, 123, 169, 385.
(e) Medical Examiner, June 14, 1877.

systolic prolongation which I have encountered was in the case of a girl suffering from a severe attack of typhoid fever, in addition to old-standing disease of the aortic valve, the ventricular action being already chronically impaired by the aortic disease, and to a still further degree acutely impaired by the excessive hyper-pyrexia. In other words, in a complicated case, the prolongation of the systole is equal to the sum of the prolongations of the constituent disorders. I have to-night studiously avoided all details of figures and mathematical calculations, putting the question in its most simple aspect, by comparing together actual tracings of health with those of disease with similar pulse-rate, and drawing therefrom certain conclusions. If the aortic notch does not represent the termination of the systole, these conclusions are absolutely worthless; but, believing, as I do, strongly, that the termination of the systole is represented by the aortic notch, I have brought the facts, which I have collected, before your notice, in the hope that I may enlist the services of some worker in the same field of research.

TORBAY HOSPITAL.-On Tuesday last a testimonial was presented to the Senior House-Surgeon of this Hospital, Mr. G. W. Hamilton Cumming, on the occasion of his leaving Torbay to practise near Bath. The inscription on the testimonial runs thus:-" Presented to Mr. G. W. Hamilton Cumming, on his resignation of the office of House-Surgeon, by the Weekly Board, medical staff, nurses, and friends connected with the Torbay Hospital, as a mark of their high appreciation of service rendered at a critical period." In making the presentation, the Vice-Chairman of the Weekly Board (Col. Bainbridge) said Mr. Cumming had come among them at a time of great difficulty, when the credit of the Hospital was at its lowest, and by his tact and judgment, and his courtesy and attention to his duties, he had helped them and the other officials to raise the institution to its present efficient state, and to dispel the unfortunate feeling which had existed out-of-doors.

PRESCRIBING IN ENGLISH.-A Bill is now before the State of Pennsylvania with the following preamble:"Whereas, grievous errors and mistakes have been made by druggists and others in the compounding of the prescriptions of physicians by reason of the same being heretofore written in the Latin language and in abbreviations thereof, as well as the quantities or proportions of the drugs or medicines being designated therein by figures or symbols in a mode not readily understood by the bulk of the people, whereby undue advantage and a mystification of the patients may be taken by unscrupulous doctors, druggists, and persons who prescribe or compound medicines for the sick and poor, and, it being desirable to simplify the practice of medicine and to enable the public generally to better comprehend the names and nature of such drugs." All physicians and others prescribing, therefore, are, under a penalty of $20, to be compelled to write the names and quantities in English, without abbreviations; and a copy of such prescription is to be affixed to the bottle or packet containing the medicine in question. All druggists, under a penalty of $10, are to be compelled to conspicuously label, in unabbreviated English, everything they sell.-Philadelphia Med. Times, February 26.

(Continued from page 457.)

(Under the care of Mr. R. CLEMENT LUCAS.)

[For the following reports we are indebted to Mr. W. B. ETCHES.] Case 2.-Linear Fracture of the Left Side of the Occipital Bone, extending to the Foramen Magnum-Extensive Bruising of the Opposite Side of the Brain-Trephining for Meningitis-Temporary Relief of Symptoms-Coma-Death. W. P., aged fifty-three, was kicked on the head by a horse, while in an intoxicated condition, and run over, after which he remained in a semi-conscious state for thirty hours, and was then brought to Guy's Hospital on October 12, 1880.

On admission the patient is still in a semi-comatose condition. There is a wound about one inch above the occipital protuberance in the median line. There is some facial paralysis; he does not close his right eye so tightly as the left; the right naso-labial fold is obliterated, and he moves his tongue slightly to the right. Sensation is unimpaired on the face. There has been no bleeding from the ears, but he cannot hear so well on the right side. There is loss of power in the right arm, and considerable bruising of the left thigh. He can raise both his knees equally. He was placed on low diet, and an ice-bag was applied to his head.

October 14.-The facial paralysis is less marked. The patient passes his motions and urine involuntarily. Temperature 98.4°.

15th.-At 5 a.m. the patient was clear and collected in mind. About a quarter of an hour after this he was attacked by a fit; his eyes were opened, and his head turned to the left side; his pupils became dilated and the eyeballs turned to the left. The face was congested, and his left arm tightly drawn up, his right only slightly so. After the fit the pulse was 125; respirations 13; temperature 98.6°. The patient experienced fourteen attacks of this kind between 5 a.m. and 11 a.m.; they followed each other at intervals of about fifteen minutes. In the afternoon the patient was put under chloroform, and Mr. Clement Lucas trephined over the seat of injury, a little to the left of the median line. A linear fracture was found. There was no blood under the bone; but the dura mater appeared to bulge a little into the hole. The wound was dressed antiseptically. In the evening, after recovering from chloroform, the patient appeared quite rational, and answered questions intelligently. Evening temperature 98.6°.

16th.-During the night the patient has been attacked with the same fits, though not so severely. The facial paralysis still continues. He is more conscious this morning. Temperature: Morning, 100°; evening, 102.8°.

17th. The patient is in a comatose state, and passes his evacuations under him. Temperature: Morning, 100 7°; evening, 101.2°.

18th. The conjunctiva of the right eye is congested, and some secretion has collected about the lid. The facial paralysis is more marked, especially at the lower part of the face. He has more power in the right arm to-day than yesterday. The patient swallows better and seems less comatose than yesterday. Morning temperature 991°. At 6 p.m. temperature rose to 103°, and at 8.30 p.m. to 105·4°. 19th. In the night the patient's breathing became stertorous. He could not swallow fluid, and perspired freely. He died early this morning.

Post-mortem Examination.-A fracture was discovered starting from the left side of the occipital protuberance, and running down the vertical crest to the foramen magnum, where it ended. There was no fracture of the right temporal bone; the right frontal lobe was deeply bruised, and the temporo-sphenoidal lobe was lacerated, the laceration extending nearly to the lateral ventricle. Over the right hemisphere there was a good deal of blood both on the arachnoid and beneath it. On the left side there was some arachnitis, chiefly about the vertex, and the dura mater on this side was much thickened and rough on its inner surface. No communication was traced directly between this menin

gitis and the trephine opening, nor with the lacerated brain on the right side. There was distinctly no bruise on the left side. The skull was unusually thick, there being hardly any trace of the inter-parietal or parieto-frontal sutures. Some bronchial pneumonia was present.

Remarks (by Mr. Lucas).-This case was one which excited considerable interest at the time, owing to the nurse employed in the surgery having sent the man away when he was first brought to the hospital soon after the accident, without calling the dresser or house-surgeon. I have little doubt that had either of these gentlemen seen the patient he would have been admitted at once, because it is always the rule to take in every doubtful case of head-injury; but I am equally certain that it would have been impossible for them to have detected the linear fracture present through the wound, for at the time of the operation, with the bone fully exposed, I was in doubt as to the fracture, and asked a colleague to assist me with his opinion. The history of the manner in which the injury was received should have determined his admission, as a scalp-wound when a man has been knocked down and run over, and remains confused in intellect, is of very much more serious import than a more extensive wound inflicted by a light instrument. Further, a careful examination would have brought to light severe bruising of the right thigh and scrotum, a wheel having apparently passed over Scarpa's triangle. When I first saw him there was confusion of intellect and a drowsy state, such as is common after concussion, but at the same time it was noticed that there was incomplete paralysis of the right side of his face and some weakness in the right arm. On the fourth day after the accident he was seized with convul. sions, and these were found to affect the left side more than the right. They recurred at frequent intervals, and ap peared to call for some interference. He was accordingly taken into the operating theatre for the purpose of being trephined. I then explained to the students that, had the symptoms present come on within the first twenty-four hours after the accident, they would almost certainly have indicated blood-pressure, but that coming on after three or four days they probably indicated meningitis of the left hemisphere. Trephining might save the patient's life if there was blood extravasated between the dura mater and bone, and even with meningitis it might give relief. When the bone had been exposed by a crucial incision, a linear fracture was detected to the left of the occipital protuberance. I trephined to the extreme left of this so as to be near the posterior branch of the middle meningeal artery, and also because all the symptoms pointed to injury of the left side of the brain. No blood was found, but the dura mater was thought to bulge somewhat through the aperture in the bone. After the operation the patient appeared much benefited; the convulsions ceased for twelve hours, and he answered questions rationally. The temperature, however, gradually rose, the fits returned, and he died three days after the operation and seven days from the time of the accident. The post-mortem examination confirmed the diagnosis I had given before operating-viz., that there was meningitis over the left hemisphere. In addition to this, extensive bruising by contrecoup was found at the anterior part of the right hemisphere, with meningeal hæmorrhage, but no inflammation.

POISONING BY INADVERTENCE. - Dr. Jules Lefort brought a case of this before the Académie de Médecine (Bulletin, April 12), in order to see whether anything could be suggested to prevent accidents of this kind. A druggist, having to prepare five powders, each containing two centi grammes of calomel and two of santonine, substituted strychnine by accident, causing the deaths of two children. In this particular case the accident was the more distressing because it was only by excess of precaution that the santonine was placed in the poison cupboard at all, as it is not directed to be so by law. However, there it stood, next in alphabetical order to the strychnine which was mistaken for it. Dr. Lefort observes that if the compound labelled santonine was officinally designated by its proper chemical name, santonic acid, the accident would also probably have been prevented, as the names santonine and strychnine are too similar. Moreover, as the former is chemically incorrect, he suggests that it should be abolished from all prescriptions and materia medicas.