The licence to practise Medicine Broomfield, Humphrey John. The licence to practise Midwifery Archer, Robert Samuels, Liverpool. Broomfield, Humphrey John, Rathdowney. The following Licentiates of the College having conformed to the by-laws relating to membership, have been duly admitted Members of the College Kenny, James Berry, 1868, Killeshandra. Warnock, Hugh, 1876, Clogher, Co. Tyrone. 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 18th inst., viz. :— Carter, D'Arcy B., Leeds. Clarke, Walter J., Birmingham. Evans, Thomas J., Llanybyther, Carmarthen. Hooley, Arthur, L.R.C.P. Edin., Cobham, Surrey. Houghton, Frank E. C., Dudley. Jones, Robert L., L.S.A. Ire., Bangor, North Wales. Loynd, William, Great Harwood, Lancashire. Matthews, Samuel, Llandinabo, Ross. Oates, John H., Dewsbury. Poett, Patrick M., LK.& Q.C.P. Ire., Trenure, co. Dublin. Prendergast, Joseph M., L.S.A., Melbourne. Sellers, William, M. B. Lond., Manchester. Sharples, William H., Preston, Lancashire. Eight candidates were rejected. The following gentlemen were admitted on the 19th inst., viz.: Bell, William T., Totteridge-park, Barnet. Chronnell, James, Manchester. Field, Charles A. E. A., Camden-road. Gardner, James C., Newcastle-upon-Tyne. Lidiard, Sydney R., Dulwich-road. Marshall, James, Plymouth. Puddicombe, Francis M., Dartmouth. Roberts, Frank E., Lower Norwood. Shepherd, Timothy A. J., L.S.A., Rotherhithe. 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, January 13: Conway, Thomas Henry, New Burwell, Newcastle-upon-Tyne. NAVAL, MILITARY, ETC., APPOINTMENTS. Surgeon William Sale Sandham has been placed on the Retired List from the 7th inst. BIRTHS. ELLISON.-On January 13, at Blythe House, Forest-hill, the wife of Fredk. MACSWINEY.-On January 15, at Woolwich, the wife of E. V. MacSwiney, TICEHURST.-On January 8, at Silchester House, St. Leonards-on-Sea, the wife of A. R. Ticehurst, M.R.C.S., of a son. MARRIAGES. HOBSON-WATTS.-On January 13, at Broughton, Manchester, John Morrison Hobson, M.D., of 3, Addiscombe-villas, Lower Addiscomberoad, Croydon, to Emily Ashton, eldest daughter of Joseph Watts, Esq., of Lower Broughton, Manchester. MANNING-COWEN.-On January 13, at St. Heliers, Jersey, William Edward Manning, Esq., Cape Colonial Service, and late British ViceConsul, Mozambique, to Constance Mary, daughter of Surgeon-General H. L. Cowen, A.M.D. (retired). PENFOLD-HUDSON.-On January 10, at Kingston, Jamaica, William George Edward Penfold, Esq., R.N., to Mary Lily, eldest daughter of Edmund L. Hudson, M.R.C.S., of Prince's-road, Liverpool. DEATHS. COOPER, HENRY, M.R.C.S., at 79, South Hill-park, Hampstead, on CRUCKNELL, B. H., M.D., at Epsom, on January 14, aged 50. IRONSIDE, WILLIAM, M.D., A.M.D., at Edinburgh, on January 16. TIMS, THOMAS LAMB, L.R.C.P., M.R.C.S., at North-street, Langport, on January 8. YOUL, ANNIE, wife of Richard Youl, M.D., at Melbourne, Australia, on January 8. 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. AYLESBURY UNION.-Medical Officer of Health. (For particulars see Advertisement.) Candi BRIGHTON AND HOVE DISPENSARY.-Resident House-Surgeon. dates must be members of one of the Royal Colleges of Surgeons of Great Britain or Ireland, and licentiates of the Royal College of Physicians of London, or licentiates of the Society of Apothecaries of London, and registered under the Medical Act. Diplomas and testimonials, with certificates of registration, to be addressed and sent to the Chairman of the Committee of Management, Brighton and Hove Dispensary, Queen's-road, Brighton, on or before January 81. CLAYTON HOSPITAL (WAKEFIELD) AND GENERAL DISPENSARY.-HouseSurgeon. Candidates must be registered in medicine and surgery under the Medical Act, and unmarried. Applications, with testimonials, to be sent to John Binks, Esq., Hon. Sec., on or before January 25. DEVON AND EXETER HOSPITAL.-House-Surgeon. (For particulars see Advertisement.) HOSPITAL FOR SICK CHILDREN, PENDLEBURY, MANCHESTER.-Junior Resident Medical Officer. (For particulars see Advertisement.) LIVERPOOL DISPENSARIES.-Assistant House-Surgeon. Candidates must be duly qualified and unmarried. Applications, stating age, with testimonials and registration certificate, to be sent to the Secretary, D. Leith, 84, Moorfields, Liverpool, not later than January 24. ROYSTON UNION.-Medical Officer of Health. (For particulars see Advertisement.) WOLVERHAMPTON FRIENDLY SOCIETIES' MEDICAL ASSOCIATION.-Resident Medical Officer. Candidates must be members of one of the Royal Colleges of Surgeons in the United Kingdom, and registered under the Medical Act. Applications (stating salary required), with diplomas and original testimonials of recent date, to be endorsed "Medical Officer," and forwarded to F. Blower, Esq., Chairman of Committee, Town Hall Hotel, North-street, Wolverhampton, not later than February 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. Cheadle Union.-Dr. James Weaver has resigned the Caverswall District: area 5136; population 4052; salary £15 per annum. St. George-in-the-East Parish.-Mr. J. S. Belcher has resigned the office of Medical Officer of the Workhouse and Infirmary. Mr. A. D. O'C. Finegan has resigned the office of Assistant Medical Officer. APPOINTMENTS. Louth Union.-W. E. Ditchett, M.R.C.S. Eng., L.S.A., to the Louth District and the Workhouse. Pontypridd Union.-Edward P. Evans, L.R.C.P. Edin., M.R.C.S. Eng., L.S.A., to the Mountain Ash District. St. Asaph Union.-Robert Roberts, L.R.C.P. Edin., L.F.P.& S. Glasg., to the Llanfairtalhaiarn District. St. Matthew, Bethnal-green. --Alfred W. Stokes, F.C.S., as Analyst for the Parish, vice Dr. Tidy, resigned. St. Saviour's Union.-Warwick C. Steele, M.R.C.S. Eng., L.R.C.P. Edin., L.S.A. Lond., as Assistant Medical Officer and Dispenser of Medicines at the Infirmary. Sudbury.-James Napier, F.C.S., as Analyst for the Borough. On the recommendation of the Metropolitan Asylums Board, the visiting of relatives and friends to the inmates of the Metropolitan Workhouse District Schools and Orphanages in connexion with the Poor-law Administration has been prohibited in consequence of the prevalence of smallpox. THE PARKES MUSEUM OF HYGIENE.-The following subscriptions have been received or promised towards forming a guarantee fund for the International Medical and Sanitary Exhibition to be held at South Kensington in July and August this year. The sums in brackets show parts of amounts guaranteed which have been advanced for preliminary expenses :-John Noble, Esq., Henley-onThames, £50; Thomas Twining, Esq., Twickenham, £50 (£50); Messrs. Doulton and Co., £35 (£10); Professor W. H. Corfield, £25 (£10); Dr. G. V. Poore, £25 (£10); Messrs. Beard, Dent, and Hellyer, £20; Messrs. John Bolding and Sons, £20 (£10); Rogers Field, Esq., M.Inst.C.E., £20 (£10); George Godwin, Esq., F.R.S., £20; Professor T. Hayter Lewis, F.S.A., £20; Ed. C. Robins, Esq., F.S.A., £20 (£10); Mark H. Judge, Esq., £5 (£1); Benjamin Verity, Esq., £5 (£1); Messrs. Barron, Squire, and Co., £50; Messrs. Maw, Son, and Thompson, £50; William Eassie, Esq., C.E., £25 (£10); Sanitary Assurance Association, £25; Messrs. William Tonks and Sons, Birmingham, £25; the Silicated Carbon Filter Company, £21; Messrs. Benham and Sons, £20 (£10); Captain Douglas Galton, C.B., £20; Dr. J. C. Steele, £20 (£10); Messrs. J. Tylor and Sons, £20; John Eric Erichsen, Esq., F.R.S., £10 10s.; Edmund Johnson, Esq., £10 10s. (£5 58.); T. Roger Smith, Esq., F.R.I.B.A., £10 10s.; Messrs. James Stiff and Sons, £10 (£2); Marcus Beck, Esq., F.R.C.S., £5; Editor of the Plumber and Decorator, £5; John Glendenning, Esq., £5; P. A. Maignen, Esq., £5; Walter H. Coffin, Esq., £2; William Paton Buchan, Esq., Glasgow, £1 1s. THE MEDICAL SCHOOL OF THE UNIVERSITY OF MELBOURNE.-In an article in the Australian Medical Journal for November it is stated that the curriculum of this school was settled in 1862, and has remained substantially unaltered; and in the same year Dr. Halford, on the recommendation of Profs. Owen and Paget, was appointed to the chair of anatomy, physiology, and pathology. Land was furnished by the Government for a medical school, and in 1863 Prof. Halford delivered the first introductory lecture. The commencement was a small one, students at first only slowly increasing, and in 1867 only two Victorian graduates had received their degrees. Since then, however, the number has rapidly increased, and now there are above 130 students attending lectures, the dissecting-class alone numbering sixty-four. While the University requires every student to fulfil three distinct years of practical anatomy, it is felt that the teaching of practical and experimental physiology is not up to the level of its present position in Europe. The stock of instruments requires to be increased, and a new laboratory will have to be built. In furtherance of this end, Prof. Halford, after eighteen years of uninterrupted service, is on the eve of leaving for Europe, his main object being to acquaint himself with the most recent methods pursued in modern laboratories, and to select the additional instruments required. His endeavours will also be directed towards securing the admission of Melbourne graduates to the British Medical Register. THE SMOKE NUISANCE.-The Hampstead Vestry has resolved to inform the Smoke Prevention Committee of the National Health and Kyrle Societies-"That, whilst the Vestry and its sanitary department are fully alive to the importance of the subject, the evil produced by the comparatively few factories, bakehouses, etc., in this parish would hardly make any active interference with them advisable; that Hampstead suffered from London fogs and smoke when the wind was in certain quarters, and that the evil was undoubtedly on the increase; that little would be gained, therefore, by interfering with bakehouses while the half-million chimneys of private houses remained in their present condition; but that the Vestry will be happy to support any application to the Home Secretary for such reasonable amendment of the law as shall enlarge the existing Smoke Prevention Acts and render them thoroughly effective." foot A CHIROPODIST'S BEQUEST.-Dr. Romich, a doctor," who has just died, has left all his property, consisting of two houses and 150,000 florins (£15,000), for the purpose of founding a hospital for diseases of the feet in Vienna, and another at his native place in Upper Austria. He has made the Doctors' Collegium his executors and curators of the two hospitals. The will occupies fifty large folio sheets, containing many complicated clauses. College has appointed a committee to consider and report upon the will.-Wien. Med. Zeit., December 21. The CLOSING THE LEFT EYE.-The following authentic passage is extracted from a circular of the Swiss Federal Military Department:-"Infantry recruits who cannot close the left eye while keeping the right open should exercise themselves assiduously in order to obtain this result before the opening of their school. For this purpose they should place their left hand over the closed left eye, withdrawing it insensibly without closing the right eye. Recruits who on entering the schools are not able to come with the left eye closed must expect to be punished, unless it can be shown that this inconvenience is due to some organic defect." Cities and boroughs (Municipal boundaries except for London.) London 700 Temperature Temp. of Air (Fahr.) of Air (Cent.) Estimated Population to middle of the year 1881. Persons to an Acre. (1881.) Births Registered during Highest during Lowest during 1604 38-5 14 0 28 Rain Fall. Weekly Mean of Daily Mean Values. In Inches. In Centimetres, 0-2-22 0.13 0.33 28 37-4 155 219-5.62 0.02 0.05 43... 40 38.5 11.0 27-5 -2.50 0.00 0.00 34 87-9 19-081.1 -0.50 0.20 0.51 105 35 0 9.0 29-8-2-89 0:06 0.15 32 31-7 6-8 22-9-5'6 0'08 0.20 171 56 35-2 6-0 25 2-3.78 0.23 0.58 86 37 0 17 25-0-3-89 0.15 0.38 303 33-7 10'0 26-3-3-17 0.62 1.57 3707130 49-2 2486 61 109062 463 95 136671 30-5 86437 11-6 58 75700 54.8 48 217185 48-8 147 76850 22-6 59 400680 47 7 277 184350 42'0 75 177964 17.9 129 549834 105 5 373 864445 84-9 286 226 194077 37 5 123 118 119658 25'6 67 76 203544 28 2 182 81 35'6 16.0 27.5 -2.50 0.00 0.00 Leeds 826158 15 1 219 142 37 0 18 0 28-7 -1.84 0.06 0.15 Sheffield 312943 15'9 224 133 37 0 13 8 27-7-2.39 0.00 0.00 Hull 152980 42.1 99 58 Sunderland 118927 43.0 Newcastle-on-Tyne 151822 28-3 100 Total of 20 large English Towns... 7616417 38 1 5093 3444 38 5 1.7 26.8 2.89 0.17 0.43 www The figures for these towns (except for Nottingham, Salferd, 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 29.65 in. The highest reading was 30 29 in. at the beginning of the week, and the lowest 29.31 in. on Wednesday afternoon. BOOKS, ETC., RECEIVED NOTES, QUERIES, AND REPLIES. He that questioneth much shall learn much.-Bacon. John Forster, Esq., Adelaide, South Australia.-Letter and enclosure received. A Water-Rate Doubled.-It was reported by the Visiting Committee of the City-road Workhouse to the Guardians of the Holborn Union, at their last meeting, that the New River Company, which had heretofore charged them 6d. per 1000 gallons of water, had intimated their intention to charge 18. per 1000 gallons. This addition, it was stated, would increase the cost of supply by £150 per annum. A suggestion that an artesian well should be sunk was discussed, and ultimately it was decided to obtain the advice of an engineer on the subject. Z., Mile-end.-A house-to-house visitation is being made in Shoreditch, in reference to the prevalence of small-pox, and also as to vaccination. It is found that there is a very large number of children unvaccinated. Boarding-out Pauper Children.-A trial of the boarding-out system has been resolved upon by the Paddington Board of Guardians. They intend to send six children to various cottage homes. W. O. O'B.-The fee paid to superintendent registrars of births, deaths, and marriages in England is 7s. for each index to a register-book prepared by them. No similar fee is paid, we believe, to superintendent registrars in Ireland. Citizen.-The report of the Chief Surgeon for the year 1878 gives the daily average loss by sickness in the whole metropolitan police force a percentage of 3.14, which is as nearly as possible the same as in preceding years. The Metropolitan Police was established in 1829. M. C. C., New Cross.-In all the metropolitan sick asylums and separate infirmaries, the system of employing pauper inmates in the practical work of the sick wards, leaving to the paid nurses merely the work of general supervision, has been now entirely superseded by the employment of paid nurses. Poor-law Guardian.-1. The total number of paid medical officers sanctioned by the Local Government Board in the several unions or parishes England and Wales (metropolis included) in 1878 was 3937. 2. Securities for loans to guardians and managers have, under the Act of Parliament, to be approved and registered by the Local Government Board. 3. The Board, under the Public Health Act, 1875, has power to alter the areas of sanitary districts. Teetotaler.-Yes; the Inland Revenue authorities have recently found that a considerable quantity of non-intoxicating drinks were just as strong as mild beer. The rule has been not to prosecute mannfacturers of socalled non-intoxicating beverages which contained less than 3 per cent. of alcohol. The Workhouse "Black Hole," Leicester.-No; it was only at their last meeting the Board of Guardians decided, by twenty-one to four votes, not to abolish the "black hole" as a place of punishment for refractory paupers. An Unhealthy Cow-shed.-A dairyman, of Zoar-street, Gravel-lane, Borough, has been fined £3 and costs at the Southwark Police-court for keeping in a dirty, unhealthy condition a cow-shed, .contrary to the Order of July, 1878. The Metropolitan Board of Works prosecuted. L. U., Albany-street.-The question as to providing a coroner's court and mortuary for the district has been referred by the Marylebone Vestry to a committee of inquiry. The complaint of the jury, "that publichouses are not proper places to hold coroners' inquiries," was forwarded officially to the Vestry, and we hope will have weight with the latter in their decision on the subject. Statistician. The returns of emigration from Liverpool during the past year show a large increase as compared with 1879. The number was 183,502, against 117,914 in 1879-an addition of 65,588. Of the total number of emigrants for the year 74,939 were English, 1811 Scotch, 27,986 Irish, and 74,015 foreigners. Toleration in Spain.-According to the Lerida journals, the curé of Scudoni has declared from the pulpit that any sick person belonging to his parish who has tried to cure himself by homœopathy will, in the event of death, be refused the rites of the Church! PERIODICALS AND NEWSPAPERS RECEIVEDLancet-British Medical Journal-Medical Press and Circular-Berliner Klinische Wochenscrhift-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 Medicinischen WissenschaftenRevue Médicale-Gazette Hebdomadaire-National Board of Health Bulletin, Washington-Nature-Occasional Notes-Deutsche MedicinalZeitung-El Siglo Medico-Leicester Daily Post, January 5, 13American-New York Medical Journal-Boston Journal of ChemistryBoston Medical and Surgical Journal-Anales del Circulo Medico Argentino-Westminster Review-Monthly Review of Dental Surgery-Le Concours Médical-Revue des Sciences Médicales-La Independencia Médica-Colonies and India-Illustrirte Vierteljahrsschrift der Erztlichen Polytechnik- Nordiskt Medicinskt Arkiv-Dublin Journal of Medical Sciences-Louisville Medical News-Hampshire Telegraph, etc., January 19. The Queen v. Thomas Titley-Annual Report of the Broadmoor Criminal Lunatic Asylum for the year 1879-Anatomy of, the Arteries of the Human Body, by John Hatch Power, F.R.C.S.-Diseases of Women, by Alfred Lewis Galabin, M. A., M.D., F.R.C.P.-Lectures on Syphilis, by James R. Lane, F.R.C.S.-Diseases of the Bladder and Prostate Gland, by Walter J. Coulson, F.R.C.S. COMMUNICATIONS have been received from THE SECRETARY OF THE "MONT DORE"; Mr. DE LA MOTTE, London; Dr. PETER BRAIDWOOD, Liverpool; Mr. RUSHTON PARKER, Liverpool; THE SECRETARY OF THE SANITARY INSTITUTE OF GREAT BRITAIN; THE SECRETARY OF THE WEST KENT MEDICO-CHIRURGICAL SOCIETY; THE HONORARY SECRETARY OF THE ASSOCIATION OF SURGEONS PRACTISING DENTAL SURGERY; THE SECRETARY OF THE STATISTICAL SOCIETY, London; Dr. JAMES ANDERSON, London; THE REGISTRAR OF THE APOTHECARIES' HALL, London; THE EDITOR OF "IRON"; Dr. F. T. ROBERTS, London; THE SANITARY COMMISSIONER, Punjab, India; Dr. DREWITT, London; DR. OCTAVIUS STURGES, London; THE SECRETARY OF TRINITY COLLEGE, London; Mr. R. CLEMENT LUCAS, London; Mr. J. E. INGPEN, London; THE SECRETARY OF THE SOCIETY FOR THE RELIEF OF WIDOWS AND ORPHANS OF MEDICAL MEN; THE SECRETARY-GENERAL OF THE INTERNATIONAL MEDICAL CONGRESS: Messrs. SAMPSON LOW AND CO., London; Mr. R. J. GODLEE, London: Messrs. MACLACHLAN AND STEWART, Edinburgh; Mr. EDGAR THURSTON, London; Mr. JOHN BELLAMY, Local Government Board); THE SECRETARY OF THE CLINICAL SOCIETY, London; Messrs. ALLEN AND HANBURYS, London; THE HONORARY SECRETARY OF THE BRITISH MEDICAL BENEVOLENT FUND; THE SECRETARY OF THE PARKES MUSEUM OF HYGIENE, London; THE SECRETARY OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND: THE SECRETARY OF THE ROYAL INSTITUTION, London; THE REGISTRAR-GENERAL FOR SCOTLAND, Edinburgh; Mr. W. B. THORNE, South Kensington; Mr. J. CHATTO, London; THE HONOBARY SECRETARY OF THE MEDICO-CHIRURGICAL SOCIETY. APPOINTMENTS FOR THE WEEK. January 22. Saturday (this day). Operations at St. Bartholomew's, 14 p.m.; King's College, 1 p.m.; Royal Free, 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 1 p.m.; St. Thomas's, 14 p.m.; London, 2 p.m. 24. Monday. Operations at the Metropolitan Free, 2 p.m.; St. Mark's Hospital for Diseases of the Rectum, 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m. MEDICAL SOCIETY OF LONDON, 8 p.m. Sir Joseph Fayrer, "On Tropical Dysentery and Diarrhoea." (Second Lettsomian Lecture.) 25. Tuesday. Operations at Guy's, 1 p.m.; Westminster, 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m.; West London, 8 p.m. ROYAL INSTITUTION, 8 p.m. Professor Schäfer, "On the Blood." ROYAL MEDICAL AND CHIRURGICAL SOCIETY, 8 p.m. Dr. Ransome, "Further Observations on the Value of Stethometry in the Prognosis of Chest Disease." 26. Wednesday. Operations at University College, 2 p.m.; St. Mary's, 1 p.m.; Middlesex, SOCIETY OF ARTS, 8p.m.-Ordinary Meeting. 27. Thursday. 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, 2 p.m. ROYAL INSTITUTION, 3 p.m. Mr. F. Hueffer," The Troubadours." SOCIETY OF ARTS, 8 p.m.-Chemical and Physical Meeting. 28. Friday. Operations at Central London Ophthalmic, 2 p.m.; Royal London Ophthal- QUEKETT MICROSCOPICAL CLUB (University College), 8 p.m. Mr. B. S. LETTSOMIAN LECTURES ON TROPICAL DYSENTERY AND DIARRHEA. By Surgeon-General SIR JOSEPH FAYRER, K.C.S.I., M.D., LL.D., F.R.S., Q.H.P. LECTURE II.-PART I. PATHOLOGY AND MORBID ANATOMY OF DYSENTERY. MR. PRESIDENT AND GENTLEMEN,-I purpose in this lecture to describe the pathology, morbid anatomy, and treatment of dysentery, and to illustrate them by recent cases and specimens, taken chiefly from the Calcutta hospitals and from Netley. I have already alluded to the general condition, and have anticipated in part what belongs to the pathology of a simple case of dysentery. There is nothing in the temperature that is typical, though in the acute attacks of vigorous persons, especially Europeans, there is a certain slight rise of temperature, as there would be in an acute congestive or inflammatory attack of another kind. But, as it frequently happens (in India at all events) that the disease is accompanied by malarious fever, we may expect the thermometric variations that characterise that fever, whatever form it may take-quotidian, tertian, remittent, or irregular. The temperature, therefore, is not symptomatic of the dysentery, but of the fever which results from the same general cause. In complications, where the liver, spleen, or other viscera are affected— and especially if suppuration is occurring there-the phenomena of that process will be manifested by high evening temperature, morning falls, and sweating after rigors or chills, such as occur in suppuration from other causes. I have already remarked that the true pathological explanation of multiple abscess in the liver (such as that I shall place before you) refers it to pyæmia, and that it differs from that of the insidiously forming liverabscess, when there is very little alteration in the temperature, which may be only a degree or two above normal. In cases of sloughing dysentery, especially when the sloughs are extensive, and in hæmorrhagic dysentery, when there has been much loss of blood, the temperature may fall below the normal standard. In perforation, the temperature, at first, during the shock is sub-normal, but as peritonitis sets in it again rises. This is quite apart from the dysenteric process, and the rise of temperature cannot be regarded as typical of that disease. The seat of localisation is chiefly in the large, but in scorbutic cases, and in others also, it may extend into the small intestine for several inches above the ileo-colic valve, and the whole intestine, including the jejunum, duodenum, and stomach, also may be involved in the catarrhal condition, whilst the viscera and serous membranes may suffer in the dysenteric process. The liver is especially disposed to suffer in tropical climates, and either ordinary or septicemic abscess may occur. The spleen and pancreas may be enlarged, indurated, or softened, and become the seat of abscess. When dysentery is associated with periodic fever, the spleen is frequently enlarged; and in such cases there is apt to be splenic cachexia, and the disease is of the asthenic type. The lungs are occasionally involved, and the remarks that I have made in regard to the nature of the se-called abscesses in the liver apply to them. The bronchial tubes may also share in the dysenteric inflammation, and their mucous membrane become the seat of puriform exudation in the finer tubes, with patches of lobular pneumonia dispersed here and there throughout the lung. There are other complications-the erysipelatous, scorbutic, and typhoid,-and one sees the close analogy of the disease with typhoid and diphtheria, and that, as the seat of the localisation in typhoid is the ileum, in dysentery it is in the large intestines. Does not the tendency of the disease to pass the ileo-colic valve, perhaps, throws some light on the pathology of the socalled typhoid in India, which, by some, is referred to climatic causes rather than to a specific fæcal origin? If climatic conditions can cause disease in the gland-structures of the large VOL. I. 1881. No. 1596. intestine, it needs no effort of imagination to suppose a similar process may occur in those of the small intestine, or that the disease may pass the ileo-colic valve and appear in the ileum. It is not difficult, either, to imagine that the stress of the morbific agency may fall primarily on the glands of the ileum, and so give rise to the enteric lesions which so closely resemble those of the enteric fever of our own latitudes. I do not assert that it is so, but I would suggest that those who regard the disease (in India) as always of fæcal origin should give the subject reconsideration. The lesions in the large intestine are the result of inflammation and exudation affecting the mucous, sub-mucous tissue, and the glandular structures of the gut, and subjacent areolar tissue, which is infiltrated and swollen by effusion of serous, sero-purulent, or fibrinous matter, causing softening, ulceration, sloughing, or gangrene of the mucous membrane, which may extend to the whole substance of the gut. Bleker dwells on the pathological importance of the exudation, which he says takes place for the most part into the tissues beneath the mucous membrane, though occasionally on the surface in a diphtheritic form, or as in croup. But of him more presently! Virchow describes a catarrhal or sero-purulent and a fibrinous or diphtheritic form, at the same time admitting that in many cases they merge into each other, but says "that the lesions of dysentery can only be correctly understood when the two forms are studied independent of each other (Heubner). Sporadic dysentery, he says, is chiefly catarrhal, whilst true diphtheritic or fibrinous dysentery occurs in epidemics and in the worst form of malignant and gangrenous dysentery. In the catarrhal form, which corresponds to Rokitansky's follicular ulceration, at the outset there is hyperæmia of the mucous and sub-mucous tissues. The surface is covered by transparent mucus tinged with blood. The membrane itself is red, with dark points and patches corresponding to folds in the mucous membrane, and, when it occurs in the small intestine, to the valvulæ conniventes. The sub-mucous tissue is swollen by the distended blood vessels, but the rest of the intestinal coats are unaffected in the outset. The mucous membrane "is swollen and of a whitish-red colour, with red areola round the follicles, which appear like little white knots (Heubner). Where the swelling is considerable there are small apertures in the mucous membrane over the follicles. These correspond to depressions in the mucous membrane, and become filled with mucus when the membrane around swells.(Heubner.) The sub-mucous areolar tissue is swollen and infiltrated with serous or sero-purulent fluid. The whole intestinal wall may become thickened from the same cause. From this stage of acute hyperæmia rapid recovery under favourable circumstances may take place. In the next stage, purulent softening of the mucous membrane, which assumes an irregular roughened surface, occurs. The elevations are of various shades of colour-red, yellow, greenish, black, brown-covered with viscid mucus. This appearance is partly due to the disintegration of the softened and ulcerated mucous membrane. The sub-mucous and muscular layers are thickened and infiltrated. The follicles are destroyed, leaving depressions or apertures or elevations around the follicles that have not perished in the ulcerative process. They are not all so much destroyed as changed, and the apertures get filled with plugs of mucus and cell-growths, which appear in the dejecta. The ulceration may be very extensive and fatal, but, when not so, cicatrisation and repair follow. In Virchow's fibrinous or diphtheritic form, or in gangrenous dysentery, the changes are more serious. The intestine is intensely congested, the lumen diminished, and the whole tube thickened. The contents consist of a thin reddish fluid, with some fæcal matter. The mucous membrane is reddish or whitish, and is covered with discoloured patches, and the natural appearance of mucous membrane is lost. There is infiltration of fibrous exudation throughout the tissues, which may invade the whole gut, when gangrene and death result. Most cases, however, are probably combinations of the catarrhal and fibrinous, causing ulcer and thickening of the bowl. This causes the irregularly thickened state of the gut; and from such cases sloughs are thrown off and ulcers form. The site and extent of these ulcerations vary. The sigmoid flexure is a common site; the cæcum in certain cases, and the rectum in others, are the principal seats of it. In some severe instances the whole gut is involved; but it may occur at different periods in different parts of the bowel. The condition of chronic dysentery into which these cases often pass is due to these structural changes in the bowel-i.e., to thickening and imperfect cicatrisation of the ulcers, and to the permanently injured state of the glandular structures. In referring to the condition of the abdominal and mesenteric glands, I alluded to the fact that they are sometimes found to be enlarged. In cases of tubercular diathesis-a condition in which dysentery (it is said, I believe) is prone to occur-the glands, and indeed the sub-mucous coat of the bowel, may be the seat of such a deposit. The late Dr. Chuckerbutty, who divided dysentery into a great many forms, gives cases in his paper in the Indian Annals of Medical Science (vol. x., pages 115, 116) in which there was such tubercular deposit in the membrane and mesenteric glands and in the lungs in one case; in another he relates how the tubercular deposit was found after death in the large intestine itself, in the vicinity of the ulcers, under the mucous membrane, infiltrating the areolar tissue between it and the muscular coat. Dysentery is always a subject of anxiety when it occurs during pregnancy. It is very prone to cause miscarriage or abortion, and the progress towards recovery is generally more rapid after the ovum is extruded. It is less amenable to treatment in the early stages in this state, and in either chronic dysentery or ordinary dysentery serious symptoms are more likely to supervene in the pregnant woman than in others. It also frequently complicates the recovery after delivery, and assumes a very dangerous condition, though happily, even in this form, it is under the control of appropriate treatment. Intestinal worms-lumbrici, e.g.-are a frequent accompaniment of dysentery in Bengal, and their presence must tend to intensify the local irritation and to aggravate the disease. Bleker's description, where it differs from others, does so more in appearance than in reality; but the various accounts of the morbid anatomy by authors are rather conflicting. Dr. Aitken sums up well when he remarks--"When one says that it is a process of inflammation, exudation, softening, and ulceration of the mucous membrane, in which the solitary and tubular glands of the bowel are much, and probably primarily, involved, and in which other tissues and organs of the body and the viscera may take part, the most important conditions have been stated. The various kinds of mucus, blood, serum, pus; the extent and site of infiltration or exudation and thickening; the colour, form, and extent of the ulceration, and the magnitude of the sloughs,all express differences of degree or progress in the disease."" For my own part, I think its separation into catarrhal and diphtheritic is rather artificial than real; the one passes into the other, or the two forms are so inseparably combined that, except in typical cases of the ordinary catarrhal or the severely gangrenous, most cases of dysentery present a combination of both forms. We are indebted to the late Dr. Parkes for a description of the morbid anatomy and nature of the changes that take place in the intestinal glands and coats of the intestine. He showed that these structures are very early implicated, and that true dysentery never occurs without ulceration being present. From investigations made in Moulmein (Burmah), he concluded that, first, certain alterations in the glands of the mucous membrane of the large intestine, and sometimes of the ileum, constitute the earliest symptoms of dysentery. Secondly, that in all cases not too far advanced the mucous membrane presented the appearance of numerous whitish round elevations of a size varying from a millet-seed to a size so minute that only a lens can show the lesion. These elevations were hard, and, being pierced, gave forth a white excretion. Many of these had a hard black speck in the centre and were surrounded by a vascular circle. Thirdly, that exudation sometimes occurred in points beneath the mucous surface; that such points of exudation had a white appearance, with contents similar to those of the solitary glands. The mucous surface over these points could be easily rubbed off, leaving an ulcer (Aitken). Baly, Cheyne, Abercrombie, and others, have observed similar changes in the dysentery of Europe, showing that the tropical so far resembles the European form of the disease. The tubercles, pustules, ulcers, described by Pringle, Broussais, Hewson, Davies, and others, as occurring in the camp epidemics of the Continent, have their origin in the solitary glands. Dr. McConnell, of the Medical College Hospital, says :"The disease commences essentially and primarily in the glandstructures. I have had opportunities of seeing several cases-i.e., post-mortems at a very early period; and then the only visible alteration is in the solitary glands and follicles of Lieberkühn: the former especially, which I have found enlarged to the size of small hazel-nuts, and filled with that glazy, semi-transparent, glue-like mucus which we almost always find voided with the earliest evacuations during life in this disease." The more severe forms, in which the mischief extends into the small intestine, are most generally seen in tropical countries, so are the inflammation, pulpy softening, changes in the mucous membrane, ulceration, sloughing, and exudation of tubular casts of a diphtheritic character. It is in such cases, too, that fibrinous exudations are apt to result in thickening chronic ulceration, and in the train of wretched symptoms that result from the contracted, strictured, and indurated gut found in some of the worst cases of chronic dysentery. The distinguished Professor of Pathology at Netley says— "There can be no doubt that the anatomical signs of true dysentery are inflammation of the solitary lenticular follicles of the large intestine, tending, in the first instance, to infarction (i.e., the intumescence and congestion), and subsequently to ulceration and destruction of the gland-tissue. The disease, extending by a similar process, ultimately involves the tubular glands of the general mucous membrane, which tend to soften and to be cast off as a slough, exposing the sub-mucous connective tissue, or even the muscular coat of the gut. It is the mucous membrane of the great intestine, and especially that of the rectum and lower portion of the colon, which is the seat of these characteristic lesions. The exudative process is generally diffuse, involving the whole of the tissues of the mucous membrane in a diphtheritic process of infiltration. The diseased part looks as if it were covered with a bran-like coating, especially over the summits of the folds of the mucous membrane, which are deeply reddened by ecchymosis. and injection, and infiltrated by the exudation. This branlike coating cannot be scraped off without loss of substance, and the sub-mucous connective tissue below is oedematous and swollen." In scorbutic or other low forms of dysentery, "a diphtheritic exudation covers not only the mucous surface of the colon, but the surface of the ileum above the ileo-colic valve. This. exudation corresponds with the course of the blood vessels ramifying from the mesenteric attachment transversely across the surface of the gut, and especially over the prominences of transverse ruga" (Aitken). As regards the ulcers and exudations of the bowel: the former are various in form and extent, from small circular patches to extensive ragged surfaces corresponding to the amount of mucous membrane and sub-mucous tissue destroyed. They present different appearances and combinations according to the extent of tissue disintegrated. The contractions of the gut that follow, where life has been saved, are sometimes exceedingly distressing, and it is to these chronic ulcerations and thickening from infiltration of the tissues of the gut that the distressing conditions of chronic dysentery are mainly due. With these changes the abdominal and mesenteric glands are often enlarged. The ulcers are described by Dr. Aitken as follows: "The summary of the processes from which ulceration may proceed is as follows: "1. After intumescence, softening, and simple ulceration of one or several lenticular solitary glands. "2. After intumescence, softening, and sphacelus of many solitary lenticular glands and the intervening tissue in one mass. "3. After softening of the tubular structure and the detachment of sloughs, ulceration follows the intumescence and germination of growths from the tubes which cover the surface, as croupous, catarrhal, or diphtheritic exudation, to which the name of aphthous erosion has been applied. "4. After sub-mucous inflammation and new growth, with fibrinous and mucinous effusion. "5. After intertubular inflammation and inflammation surrounding the base of inflamed glands. "6. After the formation of sub-mucous abscess. "7. By changes of an ulcerative nature commencing in the vascular exudation itself, as in scorbutic cases.' The rectum is the part most affected, next the sigmoid flexure, then the cæcum; but in bad cases the whole gut is involved, and the appearance, when examined after death, is that of irregular ulceration, blackened or otherwise thickened. Sometimes the ulceration seems to surround the gut in rings, as it were. There are excavated ulcers-ragged cut-outlooking patches-or small circular ulcers, taking their origin in diseased solitary glands. The melanic deposit is very common and characteristic. Bleker, who wrote an interesting paper on Dysentery in Batavia in 1849, describes it as an exudation process, and gives most detailed descriptions. "The deposit takes place beneath and in the mucous membrane of the colon, particularly beneath the mucous membrane, between it and the muscular coat, in the shape of solid yellowish-white fibrinous masses.' This follows the hyperaemia. Next there |