impervious gault, so that all the water which falls on this formation is held up by the clay beneath. This soil is in many places very damp, and the more so as from its position to the north of the Downs it receives less sunshine than other parts of the district. So few people dwell on the gault that these two formations may be taken together as wet soils for the purpose of comparison with drier districts. Taking the Weald clay as being the favourite seat of diphtheria it will be found that Horsham Union and the north sub-districts of Petworth and Midhurst Unions correspond in area pretty closely to this formation. And it is here that diphtheria is always more or less present. The rainfall here is very much greater than it is at Worthing, showing an average excess of more than eight inches per annum, and the surface is longer saturated with water than upon a porous formation. It is not difficult to show that there is a general relation between the amount of rainfall and the prevalence of diphtheria. The year 1879 was the wettest year known since 1860, and there was a marked increase in the number of cases. In 1878 and 1879, when diphtheria was most common in West Sussex, there was very little sunshine, while in 1880 there was a very great increase in the number of hours when the sun shone brightly. The surface of the Weald is thrown into gentle slopes and undulations, and many of the elevations are from 150 to 250 feet above the sea. This elevation of the Weald makes it open to cold winds from the north and north-east, and the situation is very bleak and cold in the winter. It is in the autumn, when fogs are very frequent and there are heavy dews at night, that diphtheria is most likely to spread. The average annual death-rate was 15.5 per 1000, and the average annual zymotic death-rate was 1.51 per 1000 persons living. The order of prevalence of zymotic disorders is quite different from that which obtains throughout England and Wales as far as regards scarlet fever and diphtheria; for whereas, in England generally, the deaths from scarlet fever are about six times as numerous as the deaths from diphtheria, yet in West Sussex the reverse is the case, and the deaths from diphtheria exceed those from scarlet fever. It must not be supposed that the Weald clay is more unhealthy to dwell upon than more pervious soils, for an examination of the general death-rate shows that there is no appreciable difference in the various districts if a series of years be taken, while the general zymotic rate is rather lower where diphtheria prevails than it is elsewhere. Scarlet fever and whoopingcough are less common in those parts where diphtheria prevails, and more common where it is habitually absent. An examination of the deaths at various ages shows that diphtheria is much more fatal in early life than in later years. Of 338 adults, 61 (or 18 per cent.) were attacked; of 676 children, 279 (or 41 per cent.) were attacked. At one time the deaths may represent the only cases of the disorder, while at another time they are the expression of a widespread epidemic. The most serious and extensive outbreaks of diphtheria have occurred in the autumnal months; those outbreaks commencing in the other months have generally been very limited in extent. In many old cottages, which are hardly fit to live in, the disease has attacked the inmates less severely than those who dwell in comfortable and substantial cottages. In the districts where diphtheria is mostly prevalent, intermarriage is very common, and an infusion of fresh blood is not often noticed. The children in these districts are fairly fed, but they do not seem able to resist any acute attacks of disease; they are not intelligent, and seldom make much progress with their education; they are mostly dull by nature and of a lymphatic temperament. Diphtheria is distinctly a disease of rural districts; it differs from other catching disorders in being most prevalent in those areas where the people are thinly spread and where isolation exists naturally. In rural districts the children have in many places to go a long way to school, and this is especially the case over the Weald. Often the children have to walk one or two miles to school along wet clay roads, they have to sit in school with wet feet, and then walk home again in the closing evenings of autumn along the wet and miry roads. There does not appear to have been any relation between epizootic disorders and the prevalence of diphtheria. The author had never been able to trace any connexion between the milk-supply and diphtheria; indeed, very few children in rural districts drink any milk at all. The one constant condition which alone seems to be marked is dampness of the soil or of the house. These conditions are chiefly to be found on the Weald clay and upper greensand, and more especially in the autumn and winter.

In the debate following the reading of the paper, Dr. BOND remarked that there was, strange to say, very little. diphtheria in his district of Gloucestershire-no real prevalence of the disease. He had only recorded twelve deaths in the past eight years. It was difficult to account for this, because all the conditions as regards variety of soil and elevation, such as Dr. Kelly had mentioned, were to be found in his district, and even a worse condition of the subsoil. Drs. Thursfield and Fosbrook, in their reports upon the prevalence of this disease, found that it occurred chiefly in the most elevated districts, and that one attack seemed to predispose the patient for second and third attacks.

The PRESIDENT remarked that, from his own observations, there seemed to be no relation between diphtheria and drainage. He believed diphtheria to be a commoner disease than it was generally considered by the profession. We often see a patch on a tonsil, which we hesitate to call diphtheria because it does not present the characteristics we are accustomed to associate with this disease. All infectious diseases are, he considers, communicable by fomites.

Mr. CORNER believed that the bad construction of our sewers, with unnecessarily large cubic space and small gradient, is the cause of diphtheria and other epidemic diseases prevailing in large towns.

MEDICAL NEWS.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.-The following gentlemen, having undergone the necessary examinations for the diploma, were admitted Members of the College at a meeting of the Court of Examiners on the 19th inst., viz. :

Anderton, James E., Blackheath.

Boswell, John J., Guilford-place, W.C.

Buxton, Dudley W., Harrington-street, N.W.

Cranstone, William L., L.S.A., Hemel Hempstead.
Evans, Thomas G. C., Seaton, South Devon.

Heyman, Frank G., L.R.C.P. Edin., Bristol.

Laurent, Oscar A. E., Mauritius.

Medley, Harold T. D., Kensington-gardens-square, W.
Mudge, Thomas, Hayle, Cornwall.

Slater, William, Taunton, Somerset.

Tew, James S., L.S.A., Stourbridge, Worcester.
Udale, Joseph J., Finsbury-park.

With this meeting the examinations for the Membership were brought to a close, with the following result, that out of the ninety-five candidates examined-fifteen were rejected the first day out of twenty-four, thirteen the following day, twelve on the succeeding day, and six out of twenty-one on the last day, making a total of forty-six, who, having failed to acquit themselves to the satisfaction of the Court of Examiners, were referred to their professional studies for six months. Seven were approved in Surgery, and when qualified in Medicine will be admitted Members of the College. The clinical cases on which they were examined were selected from St. Bartholomew's, St. George's, Guy's, King's College, and University College hospitals, and consisted of ununited fracture of the femur cyst; in the spermatic cord; strumous disease in the axilla, neck, etc.; varicose veins; a capital case of facial paralysis, which some found very difficult to diagnose; flat foot; bursa on head of the tibia; chronic arthritis; general struma; cyst of eyelid and ganglion on wrist in the same patient; encysted hydrocele; lupus; lymphadenoma; malignant disease of the eyeball; hydrocele of tunica vaginalis; excision of the os calcis; syphilis; strumous disease of the carpus and contraction of the tendo Achillis in the same patient; diseased spine and lumbar abscess; varicocele of the lip; enlarged testicle and hydrocele; gumma; general struma, etc.

The half-yearly Primary or Anatomical and Physiological examination for the Fellowship of the College was commenced on the 20th instant, when the following questions were submitted to the ninety-eight candidates, who were required to answer at least three out of the four questions in the time allowed, (from 11 a.m. to 2 p.m.), viz.:-Physiology: 1. Describe the minute structure of the two outer layers of the retina. What are their functions? Describe the effects of light upon them in the living eye. 2. Contrast the tension of the oxygen and carbon dioxide contained in venous and arterial blood respectively with the partial pressure of those gases in the pulmonary alveoli. Compare the gas interchange which takes place normally with that which occurs in suffocation. 3. Enumerate the different kinds of proteid

substances found in the human body. State where they are found, and give their distinctive characters. 4. Describe the formation of a blood-clot: Upon what does it depend? Mention the circumstances under which the blood may clot within the vessels, and describe the stages of the process. How may the coagulation of shed blood be prevented?-The following were the questions on Anatomy, three of which out of the four were required to be answered between 3 and 6 p.m.-1. Describe the arches of the foot, and the ligaments and muscles by which they are maintained. 2. Describe the dissection necessary to expose the left vertebral artery from its origin to its entrance into the skull. 3. Describe the spinal column as a whole-first, in reference to its curves, and the manner in which the several vertebræ are modified in shape in association with these curves; secondly, in reference to the movements which take place in its different parts, and the means by which these movements are effected and regulated. 4. The subject being in the supine position, describe the dissection by which you would expose the whole of the obturator externus muscle and its tendon.

The following gentlemen were reported to have acquitted themselves to the satisfaction of the Board of Examiners on the 21st and 23rd inst., and when eligible will be admitted to the pass examination for the Fellowship of the College, viz.:

Anderson, Alfred J., student of St. Bartholomew's Hospital.
Ashdown, Herbert H., of the Edinburgh School.

*Ballance, Charles A., of St. Thomas's Hospital.

Bulteel, Marcus H., of St. George's Hospital.

Collier, Joseph, of the Manchester School.

*Dingley, Allen, of St. Bartholomew's Hospital.

Dunn, Louis A., of Guy's Hospital.

Griffith, Walter S. A., of St. Bartholomew's Hospital.

Hind, Wheelton, of Guy's Hospital.

Horrocks, William H., of University College Hospital.

Maddox, Ernest E., of the Edinburgh School.

Power, D'Arcy, B.A. Oxon., of St. Bartholomew's Hospital. *Silcock, Arthur L., of University College Hospital. *Watson, George S., of St. George's Hospital. Williams, Edward R., of St. Bartholomew's Hospital. *Willis, William, M.D. Edin., of St. Thomas's Hospital. Twenty-one candidates were rejected. (Those gentlemen to whose names an asterisk [*] is prefixed are Members of the College.) The following gentlemen passed on the 24th inst., viz.:

Bostock, J. Y., B.A. Cantab., student of the Cambridge School.
Davies, John C., of the London Hospital.

Morris, Chas. A., B.A. Cantab., of St. Bartholomew's Hospital.
Paley, Frederick J., of St. Bartholomew's Hospital.

Pigeon, Henry W., B.A. Cantab., of Guy's Hospital.
Roughton, Edmund W., of St. Bartholomew's Hospital.

Wilson, Alexander, of the Manchester School.

Worthington, Sidney, of Guy's Hospital.
Wynter, Walter E., of the Middlesex Hospital.

Eleven candidates were rejected. The following gentlemen passed on the 25th inst., viz. :—

Brooks, Walter T., student of King's College Hospital.
Donald, James, of the Charing-cross Hospital.

Harrison, Edward, B.A. Cantab., of the Cambridge School.
Hewer, J. Langton, of St. Bartholomew's Hospital.

Hudson, Ernest, of University College Hospital.
Jones, David L., of the Charing-cross Hospital.

Wise, Charles H., of the Galway and Westminster Hospitals.

Thirteen candidates were rejected.

APOTHECARIES' HALL, LONDON.-The following gentlemen passed their examination in the Science and Practice of Medicine, and received certificates to practise, on Thursday, May 19:

Butler, Thomas Edward, Cape of Good Hope. Cockell, Edward Seaton, 144, Amhurst-road, Hackney. Craddock, Sidney Ernest, 16, Upper Woburn-place. The following gentleman also on the same day passed his Primary Professional Examination :

:

Brewster, William, St. Bartholomew's Hospital.

APPOINTMENTS.

The Editor will thank gentlemen to forward to the Publishing-office, as early as possible, information as to all new Appointments that take place.

BALLANCE, C. A., L.R.C.P., M.R.C.S., L.S.A.-Senior Assistant HousePhysician to St. Thomas's Hospital.

COLLIER, M. P. M., M R.C.S., L.S.A.-Junior Assistant House-Physician to St. Thomas's Hospital.

GUNN, ROBERT MARCUS, M.A., M.B., C.M., M.R.C.S.- - Ophthalmic Surgeon to the North-West London Free Dispensary for Children. HASLAM, W. F., M.R.C.S., L.S.A.-Resident Accoucheur at St. Thomas's Hospital.

SUTTON, S. W., L.R.C.P., M.R.C.S.-Assistant House-Surgeon to St. Thomas's Hospital.

NAVAL, MILITARY, ETC., APPOINTMENTS. ADMIRALTY.-Fleet Surgeon Arthur Borough Johnson has been placed on the Retired List of his rank from April 1, 1831.

BIRTHS.

CUNNINGHAM.-On May 17, at 50, Blacket-place, Newington, Edinburgh,
the wife of Deputy Surgeon-General Cunningham, of a son.
FENN.-On May 19, at Richmond, Surrey, the wife of Edward L. Fenn,
M.D., of a son.

GALLOWAY.-On May 10, at Epping, the wife of Arthur Wilton Galloway,
M.R.C.S., L.R.C.P., of a son.

HARDWICK.-On May 19, at Pillar House, Needham Market, Suffolk, the wife of Frederick S. Hardwick, M.D., of a son.

JENKINS.-On May 12, at Liskeard, the wife of J. H. Jenkins, M.R.C.S., L.R.C.P., of a son.

VIVIAN.-On May 22, at Chase Side, Southgate, N., the wife of R. T. Vivian, L.R.C.P., M.R.C.S., of a son.

WELLER.-On May 19, at Weston Zoyland, Somerset, the wife of John Weller, M.R.C.S., of a son.

MARRIAGES.

FARNELL-COLGATE.-On May 24, at Eastbourne, Henry Dawson Farnell,
M.R.C.S., of The Goffs, Eastbourne, to Mary, daughter of Robert
Colgate, F.R.C.S., of Hempstead House, Eastbourne.
FISHER-POLLARD.-On April 21, at Demerara, Frank Charles Fisher
L.K.Q.C.P., of the Government Medical Service, to Mary Eliza Rosalie
youngest daughter of the late W. B. Pollard, Esq., Auditor-General
British Guiana.

WYATT-SHEPHERD.-On May 18, at Highbury, William Thomas Wyatt, M.A., M.B., of Stamford-hill, to Edith Annie, fourth daughter of the late Edward Shepherd, Esq., of Aberdeen-park, Highbury, magistrate for the county of Middlesex.

DEATHS.

HILLIARD, GEORGE RICHARD, M.R.C.P., formerly of Rayleigh and Chelme ford, Essex, at the Vicarage, Tettenhall Wood, near Wolverhampton, on May 21, in his 81st year.

PEILE, BRANSBY COOPER, M.R.C.S., L.S.A., of Shepherd's Bush, on board the Agamemnon (ss.), in the Suez Canal, off Ismailia, on May 7, in his 55th year.

REID, HARRIET HARRISON, wife of James Reid, Surgeon-Major (Retired) of her Majesty's Indian Army, Madras, at Aslebury Dale, Torquay, on May 22, aged 78.

WHITAKER, JAMES SEALY, L.S.A., M.R.C.S., at North Walsham, on May 19, aged 29.

WHITLEY, GEORGE, M.D., at Bedlington Vicarage, on May 20, aged 65. WRIGHT, ELIZABETH, wife of Strethill H. Wright, M.D., at 17, Alexandraroad, Southport, on May 20.

VACANCIES.

In the following list the nature of the office vacant, the qualifications required in the candidate, the person to whom application should be made and the day of election (as far as known) are stated in succession. BROOKWOOD ASYLUM, SURREY.-Assistant Medical Officer. (For particulars see Advertisement.)

CROYDON GENERAL HOSPITAL.-House-Surgeon. Candidates must hold a medical and surgical qualification, and be registered under the Medical Act. Applications and copies of testimonials must be sent to Alfred George Roper, Hon. Secretary, on or before June 1.

LAMBETH (PARISH OF).-Assistant Medical Officer and Dispenser. (For particulars see Advertisement.)

METROPOLITAN ASYLUM DISTRICT: LEAVESDEN ASYLUM FOR INDECTLES, NEAR WATFORD, HERTS.-Assistant Medical Officer. (For particulars see Advertisement.)

NETHERFIELD INSTITUTION FOR INFECTIOUS DISEASES, LIVERPOOLResident Medical Officer. Applications, with testimonials, to be sent to Robert Calder, Secretary, 4, Commercial-court, 17, Water-street, Liverpool, on or before June 1.

NORTH-EASTERN HOSPITAL FOR CHILDREN, HACKNEY-ROAD, E-HouseSurgeon. Candidates must be registered under the Medical Act. Ap plications, with copies of testimonials only, to be sent to the Secretary, Alfred Nixon, 27, Clement's-lane, E.C., on or before June 1. QUEEN'S HOSPITAL, BIRMINGHAM.-Honorary Surgeon. Candidates must be Fellows or Members of the Royal College of Surgeons of England, Edinburgh, or Dublin. Applications, with testimonials and certificates of registration (under cover), to be sent to the Secretary of the Hospital from whom all further information may be obtained, on or before May 30.

ROYAL FREE HOSPITAL, GRAY'S-INN-ROAD.-Ophthalmic Surgeon. (Fer particulars see Advertisement.)

ST. MARY'S HOSPITAL MEDICAL SCHOOL, PADDINGTON.-Curator ani
Pathologist. (For particulars see Advertisement.)

ST. THOMAS UNION, NEAR EXETER.-Medical Officer. (For particulars ma
Advertisement.)
SHEFFIELD UNION.-Resident Assistant Medical Officer. (For particles
see Advertisement.)

TEIGNMOUTH, DAWLISH, AND NEWTON INFIRMARY AND CONVALESCENT
HOME.-House-Surgeon. Candidates must possess registered qualifies
tions and be members of the Church of England. Testimonials to be
addressed to the Chairman of the Committee on or before June 1.
TORBAY HOSPITAL AND PROVIDENT DISPENSARY, TORQUAY.-Senior H
Surgeon and Provident Medical Officer. Candidates must be qualitat
to practise medicine and surgery, and be registered under the Medial
Act, and unmarried. Applications, with recent testimonials, to be scal
to the Hon. Sec., W. H. Kitson, Esq., Hemsworth, Torquay, not later
than May 30.
WESTON-SUPER-MARE HOSPITAL AND DISPENSARY.-House-Surgeon. Can
didates must possess a registered medical and surgical qualificati
Applications, with qualifications and testimonials, to be sent to the
Secretary, M. Norris, on or before June 1.

UNION AND PAROCHIAL MEDICAL SERVICE.

The area of each district is stated in acres. The population is computed according to the census of 1871.

RESIGNATIONS.

Kensington Parish.-The office of Medical Officer for the South District is vacant by the death of Mr. Francis Godrich.

Leeds Union.-The office of Assistant Medical Officer at the Workhouse is vacant by the resignation of Mr. William Callender Oakley: salary £100 per annum.

Luton Union. Mr. C. F. Buchan has resigned the Barton District: area 6717; population 1796; salary £75 per annum.

Manchester Township.-Dr. Mark H. Macdonell has resigned the First District: salary £170 per annum.

Wharfedale Union. Mr. William W. Allan has resigned the First District: area 9438; population 14,042; salary £25 per annum.

APPOINTMENTS.

Dudley Union.-Joseph Bellingham, M.R.C.S. Eng., to the North District.

Greenwich Union.-Charles H. Hartt, L.R.C.S. Ire., L.K.& Q.C.P. Ire., to the Central District.

Lancaster Union.-George R. Parker, M.R.C.S. Eng., L.R.C.P. Lond., to the Southern District.

Maidstone Union.-James Battersby Bailey, M.D. Queen's Univ. Ire. and M.R.C.S. Edin., to the Sixth District.

Peterborough Union.-Thomas E. Stafford, M.R.C.S. Eng., L.R.C.P. Edin., to the Maxey District.

West Ham Union.-Thomas J. Vallance, M.D., M.R.C.S., L.S.A., to the Schools.

Operations at University College, 2 p.m.; St. Mary's, 14 p.m.; Middlesex, 1 p.m.; London, 2 p.m.; St. Bartholomew's, 1 p.m.; Great Northern, 2 p.m.; Samaritan, 2 p.m.; King's College (by Mr. Lister), 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 1 p.m.; St. Thomas's, 13 p.m.; St. Peter's Hospital for Stone, 2 p.m.; National Orthopedic, Great Portland-street, 10 a.m. EPIDEMIOLOGICAL SOCIETY, 8 p.m. Annual Meeting: Election of Officers; Annual Report of the Council. Mr. George Fleming, "On the Transmissibility of Diphtheria from Animals to Mankind." OBSTETRICAL SOCIETY, 8 p.m. Specimens will be shown by Drs. Wiltshire, Brunton, Godson, and others. Dr. J. Hickinbotham, "Notes on a Case of Placenta Prævia complicated by a Large Myoma." Dr. Mansell Moullin, "On a Case of General Edema without Anasarca." Barnes, "A Note on the so-called Lithopaedion." And other communications.

2. Thursday.

Dr.

Operations at St. George's, 1 p.m.; Central London Ophthalmic, 1 p.m.; Royal Orthopedic, 2 p.m.; University College, 2 p.m.; Royal London Ophthalmic,11a.m.; Royal Westminster Ophthalmic, 14 p.m.; Hospital for Diseases of the Throat, 2 p.m.; Hospital for Women, 2 p.m.; Charing-cross, 2 p.m.; London, 2 p.m.; North-West London, 24 p.m. ROYAL INSTITUTION, 3 p.m. Prof. Tyndall, "On Magnetism."

3. Friday.

Operations at Central London Ophthalmic, 2 p.m.; Royal London Ophthal-
mic, 11 a.m.; South London Ophthalmic, 2 p.m.; Royal Westminster
Ophthalmic, 14 p.m.; St. George's (ophthalmic operations), 1 p.m.;
Guy's, 1 p.m.; St. Thomas's (ophthalmic operations), 2 p.m.
ROYAL INSTITUTION (Council Meeting, 8 p.m.), 9 p.m. Prof. W. G.
Adams, "On Magnetic Disturbance, Aurore, and Earth Currents."

West North Central East South...

Total

...

Males. Females. Total.

749

739

1488

771-7

702.7 1474-4

41

DEATHS IN SUB-DISTRICTS FROM EPIDEMICS.

...

3254260 103

66 23 9

3

METEOROLOGY.

22122

6

2 14

3707130 49-2 2463 1488 70-1 36-853-1 11.73 109062 46'8 50 31 62-0 40-751-1 10-62 136671 30-5 82 45. 86437 11'6 67 35 68.5 43.0 58.0 51 75700 548 25 61-9 40 8 51-7 217185 48-8 126 76 63 0 39 2 50-1 49 76850 22-6 35 400680 47 7 285 157 68 0 39-251-2 10 67 184350 42'0 80 45 68 2 35-051-4 10-78 177964 17-9 129 75 68 0 32 250-7 10-39 549834 105 5 408 269 62-2 40-0 59-6 364445 84-9 206 174 194077 37 5 118 71 119658 25'6 203544 28-2 114 326158 15 1 228 812943 15-9 181 Hull 152980 42 1 106 Sunderland 118927 43.0 88 Newcastle-on-Tyne 151822 28.8 101 Total of 20 large English Towns... 7616417 38 1 4998 303674-0 32-2 52 cl 11-11 10:58 1:47

0-521-32

0.26 0.66

The figures for these towns (except for Nottingham, Salford, and Oldham) are the numbers enumerated in April, 1871, raised to the middle of 1881 by the addition of ten years and a quarter's increase, calculated at the rate that prevailed between 1861 and 1871. Revised estimates have been adopted for Nottingham, Salford, and Oldham, based upon special returns of inhabited houses existing within those boroughs.

At the Royal Observatory, Greenwich, the mean reading of the barometer last week was 29.67 in. The lowest reading was 29.32 in. on Monday morning and the highest 30.21 in. at the end of the week.

NOTES, QUERIES, AND REPLIES.

He that questioneth much shall learn much.-Bacon.

"GASTROSTOMY AMD DUODENOSTOMY."

TO THE EDITOR OF THE MEDICAL TIMES AND GAZETTE.

I am, &c.,

SIR,-I was "ignorant of the fact that the word 'gastrostomy' is applied to an operation which provides an artificial mouth to the stomach;" but, used in that sense, I think the word as ill-formed and barbarous as if it were intended to mean something else. May 21. J. D. Deleterious Toys, France. It is officially announced that the Secretary of State for Foreign Affairs has received a note from the French Ambassador in London stating that the French Government have prohibited the importation into France of all children's toys coloured with poisonous substances.

More Trouble for the Local Government Board. -At the last meeting of the Islington Board of Guardians, a petition praying the Local Government Board not to carry out their proposal of converting the West London House of the City of London Union, at Shadwell-road, Upper Holloway, into a small-pox hospital for the reception of convalescent patients was considered. In the course of the discussion which ensued, it was urged that a more dangerous spot, surrounded by a large population, could not be selected for "an epidemic hospital." A motion that a letter be addressed to the central authority, pointing out the danger of opening the said building for the purpose proposed, and expressing the hope that the Board would forego their intention, was unanimously carried. Infelix.-According to the annual report of the British Home for Incurables, the financial position of the institution was not satisfactory. The expenditure had exceeded the receipts, compelling the Board to draw upon the reserve fund by the sale of £3500 Three per Cent. Consols. Reckoning this sum the receipts amounted to £12,819 0s. 6d., and the expenditure to £12,131 is. Ed., leaving a balance in hand of £687 19s. 1d. F.R.C.S., Manchester.-There were ninety-eight candidates at the primary examination for the Fellowship of the College of Surgeons. Of this number, nineteen were members of the College, the dates of whose diplomas ranged from July, 1858, to November, 1880. Seventy-five had previously passed the primary Membership, and four had not passed any examination.

The Crèche.-The utility and advantages of these establishments is exemplified by the fact that the number of attendances of children at the East-end Crèche, founded nine years ago by Mrs. Hilton, have considerably exceeded thirty thousand. The number last year was 2048. Practical Sanitary Knowledge for Plumbers.-Sanitation has become to almost all classes of society a daily increasing subject of interest. Public lectures and sanitary associations have largely, undoubtedly, promoted this general desire for knowledge on the question. The series of lectures recently commenced, under the auspices of the National Health Society, to working plumbers, with the view, inter alia, of instructing them in the best mode of affecting sanitary improvements in houses, has aroused an eager interest, among plumbers and other artisans, as testified by their large attendance on these occasions at the Hall of the Society of Arts. To the intelligent workman they can hardly fail to be both instructive and of considerable advantage. The lecturer remarked that, as to the trade of plumbing, in nine-tenths of the workshops where young men are apprenticed, painting and glazing were the occupations that they were really engaged in, and "plumbing was only an accessory"; and that there was generally a deplorable want of knowledge of sanitary matters.

Hospital Saturday, Birmingham.-The collections of the Birmingham Hospital Saturday Fund for the following years were-1873 (first year), £4215; 1874, £3850; 1875, £3606; 1876, £3484; 1877, £3069; 1878, £2994; 1879, £3330; 1880, £3666. The ninth collection was made on the 14th inst. The sum received on that day was £2947 13s. 9d., but other amounts were coming in.

Population and Mortality in "London within the Walls."-In the beginning of the last century the population of London within the walls was not much less than 140,000, as proved by deduction from the parish registers, and the annual mortality was as one to twenty of that population. In the year 1750, the population had decreased to 87,000; and, fortunately for the health of the citizens, space continues to become more and more valuable for counting-houses and warehouses rather than for human habitations, so that the population of the City within the walls became 78,000 in the year 1801.

An Incredible Excess of Zeal.-At the last meeting of the Bridgwater Guardians a complaint was brought before the Board by the Chairman that a child had been vaccinated by one of the medical officers of the Union in no less than twenty-five places, and that its arm in consequence had become "a mass of sores." Two of the Guardians stated that they had seen the child, and each of them counted twenty-three marks, and the child had evidently suffered a good deal. It was unanimously resolved to request the attendance of the medical officer at their next meeting, and that Mr. Courtenay, of the Local Government Board, be invited to attend the inquiry.

Forewarned.-The Toxteth (Liverpool) Guardians, remembering that after the last two small-pox epidemics in the metropolis, the disease made its way to Liverpool, and noting that it has made its appearance at Warrington, have determined to take necessary precautions, and ordered a poster and handbills to be distributed, warning the inhabi tants of a possible outbreak of the disease, and strongly urging the importance of vaccination and revaccination.

Hospital Out-patients.-Dr. Andrew Clark, speaking at a meeting held at the Mansion-house last week, in aid of the funds of the East London Hospital for Children and Dispensary for Women, at Shadwell, referred to his experience of the practical importance of the outdoor department of hospitals, and said he knew that in many parts there was now a crusade going on against out-patients generally, but, in his opinion, that was one of the saddest crusades ever undertaken. Inferior Building Materials.—At the instance of the Finchley Local Board of Health, a builder of Hornsey has been charged at the Highgate Petty Sessions, upon seven summonses, with offending against the bylaws of that Board by using inferior mortar and bad timber in the construction of eighteen houses built by him at Finchley. Fines were inflicted, amounting altogether to £26 18., which, with the costs, made a total of £40 Os. 2d.

COMMUNICATIONS have been received from

Mr. JAMES DIXON, Dorking; Mr. SAXON SNELL, London; Mr. A. B. Joy, London; Mr. E. W. WALLIS, London; THE SECRETARY OF THE OBSTETRICAL SOCIETY, London; THE SECRETARY OF ST. MART'S HOSPITAL SCHOOL, London; THE REGISTRAR OF APOTHECARIES' HALL, London; Dr. F. R. HOGG, Netley; Lieut.-Col. BOLTON, London: Messrs. WILLIAMS, London; Miss DE LISLE ALLEN, London; THE SECRETARY OF THE LONDON FEVER HOSPITAL; Mr. HENRY MORRIS, London; Mr. J. CHATTO, London; Mr. GEORGE BROWN, London; Dr. SEATON, Nottingham; Mr. CHARLES MERCIER, London; Dr. HERMAN, London; Dr. J. W. MOORE, Dublin; THE HONORARY SECRETARY OF THE BRITISH MEDICAL TEMPERANCE ASSOCIATION, Enfield; THE HONORARY SECRE TARIES OF THE EPIDEMIOLOGICAL SOCIETY OF LONDON; Mr. THOMAS GRANT, Maidstone; THE SECRETARY OF THE ROYAL INSTITUTION; Tes REGISTRAR GENERAL. Edinburgh; Mr. N. I. KABATH, London: THE SECRETARY OF THE SOCIETY FOR RELIEF OF WIDOWS AND ORPHANA London; THE HONORARY SECRETARY OF THE SUNDAY SOCIETY, London; THE SECRETARY OF THE INTERNATIONAL MEDICAL AND SANITARY EXHIBITION, London; THE SECRETARY OF THE NATIONAL PROVIDENT INSTTUTION, London; Dr. BARNES, London.

BOOKS, ETC., RECEIVED

Supplement to Ziemssen's Cyclopædia of the Practice of Medicine-Wood's Household Practice of Medicine, Hygiene, and Surgery, vols. i. and .The Sanitary Chronicles of the Parish of St. Marylebone, during April, 1881-China Imperial Maritime Customs Medical Reports for the Halfyear ended September 30, 1830-Autobiography of Dr. Gheist-The Induction Current in Parturient Uterine Atony, by William R. D. Blackwood, M.D.-Die Wirkungen der Quebrachodroguen, von Dr. Franz Penzoldt-On the Localisation of Diseases in the Spinal Cord, by Edward C. Seguin, M.D.-The Cultivation of Specialties in Medicine, by E. C. Seguin, M. D.-Lehrbuch der Physikalischen Heilmethoden, von Dr. M. J. Rossbach-Rational Sunday Observance, by Rev. James Freeman Clarke, D.D.-Report on the Health of Bradford for the Year 1880.

PERIODICALS AND NEWSPAPERS RECEIVEDLancet-British Medical Journal-Medical Press and Circular-Ber liner Klinische Wochenschrift-Centralblatt für Chirurgie-Gazette des Hopitaux-Gazette Médicale-Le Progrès Médical-Bulletin de l'Académie de Médecine-Pharmaceutical Journal-Wiener Medizinische Wochenschrift-Centralblatt für die Medizinischen WissenschaftenRevue Médicale-Gazette Hebdomadaire-National Board of Health Bulletin, Washington -Nature-Occasional Notes-Deutsche MedicinalZeitung-Louisville Medical News-The American-Revista de Medicina -Revue d'Hygiène-The Scientific Roll-Students' Journal and Hospital Gazette-Philadelphia Medical Times-Detroit Lancet-Monthly Index.

THE INTERNATIONAL MEDICAL AND SANITARY EXHIBITION. The efforts of the Executive Committee of the Parkes Museum to obtain additional space for this Exhibition have been successful, and now, in addition to the galleries granted by the Commissioners of 1851, the Western Picture Gallery has been placed at the disposal of the Committee by the Council on Education, and the Royal Horticulturs. Society have given up the whole of their arcades for the parposes of the Exhibition. These extra facilities will insure to all exhibitors good positions, and the Committee will als be able to receive further applications for space up to the end of the first week in June. The list of exhibitors whe have already paid for space far exceeds in importance that of any previous exhibition of a similar kind. The exhibits T only include the leading industries connected with medicine and architecture in this country, but they include important contributions from France, Germany, Austria, Italy, Switzerland, Russia, Belgium, Holland, Norway, India, and the United States. The number of exhibitors has been so great that the final allotment of space has been delayed in conse quence. The plan of the Exhibition buildings has now been completed, and the exhibitors will know the positions they are to occupy by June 1. The Exhibition opens on July 16. Mr. Mark Judge, the Secretary, will supply al information at the Parkes Museum, University College.

Medical Times and Gazette.

ORIGINAL

LECTURES.

LECTURES ON OPHTHALMOLOGY.

By J. R. WOLFE, M.D., F.R.C.S.E., Lecturer on Ophthalmic Medicine and Surgery in Anderson's College; Surgeon to the Glasgow Ophthalmic Institution.

LECTURE VI.

FORMATION OF ARTIFICIAL PUPIL. THIS operation has for its object the opening of a passage through the iris for the rays of light, when the natural passage is closed or occluded by some pathological condition. It was first performed by Cheselden in 1728, and for a long period was considered a dangerous operation, which ought to be resorted to only in desperate emergencies. Thanks, however, to improved methods, it is now frequently performed without risk or danger; and, indeed, it is one of the safest operations, and yields very satisfactory results.

You must bear in mind that ophthalmic surgery means nicety and precision; and this operation, if properly performed, may even be practised on outdoor patients.

We form an artificial pupil in the following circumstances: 1. In central opacity of the cornea, when so extensive as to obstruct vision and annoy the patient when facing the light. In this case we make the pupil opposite the transparent portion of the cornea.

2. In zonular cataract-i.e., when there is a transparent zone at the margin of the lens; and hence we direct the pupil so as to face the transparent portion of the lens. (See Zonular Cataract.)

3. When the natural pupil has been closed by adhesion to the lens capsule (posterior synechia), either simply or when it has been occluded by a false membrane.

4. When the iris is adherent to Descemet's membrane (anterior synechia); but more particularly when there is a leucoma adherens. In these latter cases an artificial pupil may become necessary not only for optical effect for the restoration of sight,-but to prevent the injurious consequences resulting from dragging of the iris, which is involved in the cicatrix, as this might induce choroidal and other structural changes.

5. Although I stated that, in cases of iritis, the iris should not be touched until the inflammatory process has long passed away, it is necessary to bear in mind that the contrary ought to be the rule in cases of hernia iridis. WhenOver the cornea is perforated, and the iris protruding from pressure forwards by the aqueous humour, neither pricking nor cutting of the hernia will do any good, while the formation of an artificial pupil will act instantaneously, as it releases the constriction, and thus allows the hernia to recede, and the cornea to granulate over it gradually.

The operation being a safe one, we ought to practise it even when the other eye is quite healthy, for it is always a prudent thing to provide for emergencies, and two eyes are better than one, although the one may not be quite so perfect as that which is normal. On the other hand, when the patient has only one serviceable eye, in which the pupil is contracted, although vision be imperfect, it should by no means be touched, as interference in such a case might injure the little sight which the person has. I have met with some sad cases of blindness where a young practitioner had endeavoured to mend the sight of the only eye which the patient had to rely upon. It should not be performed in recent cases of occlusion caused by iritis. We must rather wait for some months, until every vestige of inflammation has passed off, for otherwise dormant mischief may be awakened, and destroy any subsequent chance of restoration of sight. In cases of occlusion from syphilitic iritis you should wait for more than a year, during which time mercury alternated with potassium iodide should be regularly administered, and you should make sure that no trace of the virus remains in the system. During all this time there must be no trace of eye inflammation-neither conjunctivitis nor hyperemia of the conjunctiva, -the condition being perfect health of all the ocular tissues.

VOL. I. 1881. No. 1614.

We operate for artificial pupil at all ages-either in cases of old people, or of children two years of age who have anterior adhesion resulting from infantile ophthalmia; and it is most interesting to notice the change of physiognomy of infants after sight has been restored. In these cases it is necessary not to wait long, because the children will contract the habit of rolling or oscillating the eyeball; and the deep structures will by-and-by become involved in the disease. This applies with particular emphasis to cases of anterior adhesion at all ages, because the dragging of the iris is apt to tell upon the choroid and the other deep tissues, and abolish vision.

We must ascertain beforehand whether tension be normal, for a soft eye implies choroiditis, and perhaps detachment of the retina; while the existence of retinal disease can be pretty nearly ascertained in adults, although not in infants. It is of importance also to know whether the lens be opaque, for, if that be the case, the pupil must be made in such a direction as to facilitate the extraction of the cataract.

Operation.-In cases of central opacity or zonular cataract, when the iris is free from adhesions, we operate in the following manner (Fig. 9):-The eyelids being kept open FIG. 9.

by a speculum, and the eyeball fixed with forceps, the narrow curved lance is passed into the anterior chamber through the conjunctiva, half or one line from the corneoscleral junction, at the inner and lower segment, and is slowly withdrawn, pressure being made at the same time at the scleral lip of the wound, in order to cause the iris to protrude. If the iris advance and follow the course of the withdrawn lance, it is seized with small iris-forceps (Fig. 10) at the pupillary border, and a vertical cut is FIG. 10.

made into it without touching the ciliary margin; then with two other cuts the iris is trimmed round, and the rest is returned to float in the aqueous humour. If, however, the iris do not follow the lance, Tyrrell's hook is introduced flatly into the anterior chamber until it reaches the pupillary border, which is caught and withdrawn, and then seized with the iris-forceps and cut round. Care must be taken in withdrawing the hook to turn the point in such a way as not to catch at the lip of the wound. It may even be necessary to enlarge the conjunctival wound with scissors in order to give free exit to the hook. In this manner we are able to imitate the appearance of the natural pupil; and it is important not to make the pupil too large, as in that case you may do positive harm, for the patient can see better through a leucoma, when the natural pupil is dilated, than with a large coloboma iridis cut at random.

Place of Selection.-The best place for the formation of artificial pupil is downwards and inwards, so that the rays of light may fall upon the macula; somewhat less advantageous is straight inwards; while the third in point of choice is straight downwards; and the next, upwards and inwards. Fig. 11 represents artificial pupil in the left eye in the