794

London, 2 in Birmingham, and 1 in Sunderland. The; to "fever," which had been 1 and 3 in the two previous number of small-pox patients in the metropolitan asylumt weeks, further rose to 4 last week. The deaths both hospitals, which had been 51 on each of the two preceding of infants and of elderly persons showed an increase. Saturdays, denlinedto 47 at the end of last week; 8 newr The causes of 25, or nearly 15 per cent., of the deaths were not cases were admitted to these hospitals during the week,, registered during the week certified. against 5 and 7 in the two previous weeks. The Highgate Small-pox Hospital contained 10 patients on Saturday last, 2 new cases been admitted week. The deaths having during the THE SERVICES. ieferred to diseases of the respiratory organs in London, which bad increased from 163 to 252 in the four preceding weeks, further rose to 291 last week, but were 76 below the ARMY MEDICAL DEPARTMENT.—Brigade Surgeon Oliver corrected weekly average. The causes of 80, or 2 per Barnett, C. f.E , to be Deputy Surgeon-General, vice A. D. cent., of the deaths in the twenty-eight towns last week Gulland, M.D., granted retired pay ; Surgeon-Major Walter were not certified either by a registered medical practitioner Basnett Ramshotham, M.D., to be Brigade Surgeon. vice or bv a coroner. All the causes of death were duly certified 0. Barnett, C. 1. E. ; Surgeon Frederick George Leslie Eagar in Portsmouth, Nottingham, Oldham, and in four other has been placed on temporary half pay on account of ill smaller towns. The proportions of uncertified deaths were health. largest in Leicester, Cardiff, Sheffield, and Newcastle-upon- RIFLE VOLUNTEERS. - 1st Cheshire : Surgeon David Tyne. ’ Russell, M. D , is the rank of - granted honorary Surgeon- Major.-3rd Glamorgan : Surgeon James Griffith Hall is HEALTH OF SCOTCH TOWNS. granted the honorary rank of Surgeon.Major.—13th Middle- sex Pearse The annual rate of in the Scotch towns, (Queen’s. Westminster) : Surgeon George resigns mortality eight his commission ; also is permitted to retain his rank, and to which had been to 20 6 and 19’4 per 1000 in the two equal continue to wear the uniform of the corps on his retirement. preceding weeks, rose again to 22’4 in the week ending the ADMIRALTY. — The has been 27th ult. ; this rate exceeded by 2 2 the mean rate during following appointment made F. to the vice the same week in the twenty-eight English towns. The :-Surgeon Woore, Urgent, Acheson, rates in the Scotch towns ranged from 11 9 in Perth and 14 4 in Leith, to 23’6 in Dundee and in Paisley, and 26’0 in Glasgow. The deaths in the eight towns included 91 which were referred to the principal zymotic diseases, show- Correspondence. ing a further increase of 10 upon the numbers returned in recent weeks ; 23 resulted from diphtheria, 19 from scarlet " Audi alteram partem." fever, 18 from diarrhoea and dysentery, 13 from "fever," 11 from whooping-cough, 7 from measles, and not one from DIGITAL EXPLORATION OF THE BLADDER. small-pox. These 91 deaths were equal to an annual rate To the Editor of THE LANCET. of 3 8 per 1000, which exceeded by 1 ’0 the mean rate from the same diseases in the large English towns. The highest SIR,—I am much gratified to learn, through an interest- death-rates in the Scotch towns fiorn these diseases last ing communication to THE LANCET1 from Mr. Whitehead week occurred in Edinburgh and Glasgow. The 23 fatal of Manchester and Dr. Pollard, that the former has already cases of with the number in the diphtheria corresponded realised some valuable results from the of digital 9 were returned in 6 in practice preceding week; Glasgow, Edinburgh, the He to have 3 in Dundee, and 3 in Paisley. The deaths referred to scarlet exploration of bladder. appears operated fever, which had been 16 and 6 in the two previous weeks, on four males and on two females, in all six, who were the rose again to 19 last week, and included 13 in Glasgow and subject of vesical tumour, and on four others, males, suffer- 3 in Edinburgh. The IS fatal cases of diarrhoea showed a ing in various ways, with the effect of affording more or less from and were considerable decline recent weekly numbers, 8 relief. Such an would have been conceived less than those returned in the week of last experience corresponding almost to any of us a very few years To year. The deaths from "fever," which in the two pre- impossible ago. no one more than to has the been a com. ceding weeks had been 10 and 4. rose to 13. of which 6 myself knowledge occurred in Glasgow, 3 in Edinburgh, 2 in Dundee, and 2 in plete revelation, that a large group of cases exists affected Aberdeen. Of the 11 fatal cases of whooping-cougb, 9 were with disease, invariably fatal if left without surgical aid, returned in and of the deaths from 4 Glasgow ; 7 measles, but which are now mostly relievable, often curable, when occurred in Edinburgh and 3 in Glasgow. The 101 deaths this is afforded. referred to acute diseases of the respiratory organs in the But in a résumé intended to embrace all the cases eight towns showed an increase of 16 upon those returned offering on with a view to the in the but were 12 below the number in the operated by my method, appreciate previous week, the authors " and Whitehead" corresponding week of last year. The causes of 108, or result, report by Thompson a " total of fourteen with six recoveries and six 20 per cent., of the deaths in the eight towns last week were cases, not ceitified. deaths, whilst in one case very serious bsematnria, was cured, ____ and in another the symptoms were relieved" (p. 630). The real number is so much than this that I can HEALTH OF DUBLIN. larger only suppose that they have overlooked a communication, much The rate of mortality in Dublin, which had been more important than any preceding one, which I made to 25’8 and 23’3 in the two preceding weeks, rose aga,in to the Medical and Chirurgical Society on June 12th, 1883. la 24-9 in the week ending the 27th ult. The mean that paper, an abstract of which was published in all the death-rate in the city during the past four weeks of the medical journals-for example, in THE LANCET of June current quarter has averaged 24’4 per 1000, against 18’3 in 16th-I reported twelve operations by myself for vesical London aud 17’0 in Edinburgh. The 167 deaths in Dublin tumour alone, ten male and two female, exhibiting the pre. showed an increase of 11 upon the number returned in the paration in each case, together with sections under the preceding week; they included 7 which were referred to microscope.2 I stated also that up to that, date I had per- scarlet fever, 5 to diarrhoea, 4 to "fever," 2 to whoop- formed digital exploration twenty.seven times (the number ing-cough, 1 to diphtheria, and not one either to small- is considerably larger now), but gave no particulars of the pox or measles. Thus 19 deaths resulted from these principal cases in which tumour was absent, the latter being the zymotic diseases, against 24 and 35 in the two previous sole subject of the paper. The deaths among the twelve weeks; they were equal to an annual rate of 2’8 per 1000, tumour cases were five ; the total deaths among the twentv- while the rate from the same diseases in London was seven cases of digital exploration, including the five fatal 2’5, and in Edinburgh 44. The fatal cases of scarlet fever, which iu the two preceding weeks had been 7 and 19, 1 The Surgical Treatment of Tllmours and other Obscure Conditionqof declined again last week to 7. During the firJt four the Bladder. By Walter Whitehead, F.R C S.E., F R S. Biin and B. weeks of this 40 deaths have resulted from this p,)lla.rd. M D., B S., F.R C.S. (THE LANCET, Oct. 6th, 13th, 20th, IS-H) quarter " THE LANCET, vol. i., 1883, p. 1045, Table of Twelvt, Cases of Tumour. disease in Dublin, whereas in the nr:-t three quarters of In the report of discuqsion, Sir H. Thompson said "he had exolored this year they did not exceed 3, 6, and 33 respectively the bladder on this plan twenty-seven times, and found tumours in The deaths from diarrhoea and showed a marked twelve cases, in other cases affording relief bv the operation," p. 1046. dysentery In the list edition of decline from recent numbers. The deaths referred my " Cdnical Lectures," p. l!t. fourteen cases of weekly the operation are reported, six of which were cases of tumour. 795 tnmr.nr cases just mentioned, were only seven. Of the tion considered advantageous to the financial administration twenty-seven cises, seventeen are known to me to be now of medical charities ? living, and for the most part doing well, two having died r stating the case of the Denbighshire and Flintshire subsequently, one at the Antipodes and one of the earlier Infirmary, I feel that there probably are many other county cases of tamour, both from malignant disease developed in infirmanes, cottage hospitals, or charities whose securities other regions of the body. may be unsatisfactorily placed, and that an analysis of their I am quite sure tint my esteemed fellow-workers, who positions may discover similar insufficiencies or difficulties to have shown so practical an appreciation of the new method the,e. Registration appears to cover these cliffieliltiei so of examining and operating in obscure vesical disease, will well that more knowledge of its advantages and workings welcome fiesh evidence in its favour. One word in reference may be of more than local interest, and may prove useful to to inability to explore the interior of a bladder, which they committees in reorgauising the constitution of charities. seem to fear may not infrequently be encountered. Of the I am, Sir, your obedient servant, twenty-s?ven cases named, in only one was I unable to make J. LLOYD ROBERTS, a thorough examination when ansesthesia was complete (also Hon Med. Officer to the Denbighshire from considerable enlargement of the prostate in afat subject), Denbigh, Oct. 22nd, 1883. and Flintshire General infirmary. and I have always had someone present to verify the con- dition with myself ; for in no case have I operated with- " DISLOCATION OF THE SEMILUNAR CARTI- out the presence of one or more hospital surgeons, often LAGE OF THE KNEE-JOINT." American or German, who have sought the opportunity to observe for themselves the practical results of the proceeding. To the Editor of THE LANCET. I may say that it is exciting interest abroad, and that SIR,—Your opinion that this injury is not unfrequently several cases have been recently done in Vienna and else- overlooked is by the histories of several cases that t where. This is doubtless due to the fact that I published my supported first account of the operation in Paris and again in Italy have met with, and by the experiences of other surgeons which before 1 even named it here, so that the first foreign reports have been published from time to time since Mr. Hey, of Leeds, of the proceeding and of its objects should be complete and nrst described the nature of the accident. In THE LANCET and not, a from our own. authentic, meagre quotation for September 20ch, 1851, a lecture delivered by Mr. Samuel I am, Sir, obediently, yours Smith, senior surgeon to the Leeds Infirmary, upon the sub- lvimpole-street, Oct. 28th, 1883. HENRY THOMPSON. ject was published, and he stated that during the thirty-two years which he had passed as surgeon to the infirmary he had REGISTRATION OF MEDICAL CHARITIES rarely had a year without seeing a case, and he had seen as UNDER THE COMPANIES ACT, 1867. many as three to five cases in a year. To the Editor of THE LANCET. In Apr.l, 1882, I published the histories of four cases which I had treated with success. In one the lame- SIR,—By the evolutions of time it has become necessary patient ness had existed for three years, with occasional temporary that the freehold properties and the funded securities of the increase from slight accidents. I lately heard from this Denbighshire and Flintshire General Infirmary shall be patient (from America), and she states that the leg has reinvested. In the case of the freehold of the building remained quite sound since I reduced the dis1ocation two and of the most of the securities the original trustees are years ago. In another case the had existed for five dead, so that these respectively are vested in the last sur- displacement yeara. This was also cured, and has remained well. Since writing viving trustee’s representatives. Although these are legal the paper I have had other cases, one being that of a. are to com- trusteeships, they manifestly open many lady who had suffered almost constantly for more than ten plications, and it is highly desirable that they should be years. The leg has remained perfectly sound since treat- secured by new appointments. Before proceeding to the ment was discontinued (ten months ago), and the patient has been on the Continent with comfort:. selection of new trustees, it was pointed out to the com- travelling perfect With to I would that mittee of that the of the regard treatment, strongly urge management they (or governors after reduction of the move- could the as a limited liabilities thorough displacement, passive charitj) register charity ments be made the for a few under the 23rd section of the by surgeon frequently weeks, company Companies Act, 1867; the knee must not be fixed in an that such the and the re- ordinary knee-cap ; by registration appointment, for free flexion and extension should be and an from time to of new trustees would be allowed, appointment timp, should be worn which all other move- and that the freehold and other of apoaratus prevents unnecessary ; properties ments of the and in some cases it is of to the would be vested in the joint, advantage charity permanently existing body a pad to the where the has of or their on the committee of adapt press upon place cartilage governors representatives been felt to If all were to Before to a further protrude. surgeons recognise management. proceeding decision, these facts, and act we should hsar less of the information as to was with the upon them, registration sought, together succcesses of the bone-setter. experiences of charities, and such-like bodies not trading for I under am, Sir. -yours faithfully, profit, registration. NOBLE F.R.C.S.Ed. The nearest such as is SMITH, parallel instance of registration, Queen Anne-street, W., Oct. 1883. under consideration for the Denbighshire and Flintshire Infirmary, is that which was recently effected for University college Hospital, before the opening of the new building, by a private Act of Parliament. Other instances cited bythe Board SCOTTISH NOTES. of Trade are those of the School Liverpool Royal Infirmary (From our own Correspondent.)) of Medicine, the Hampstead Home, and another similar In THE LANCET’S articles hospital. special upon Ho.pital DR. LITTLEJOHN AND THE HEALTH OF WIGTON. Administration I do not find any mention of registration; I nor is it alluded to in the proceedings of the July Conference SOME suspicion having recently fallen, and apparently of Hospital Administrators, nor in Mr. Burdett’s book upon with some justice, upon the water-supply of Wigton, an Cuttage Hospitals. Thus, with such meagre available intor- investigation into the death-rate, among other matters, was mation I ask and upon registration, may you, Sir, your instituted by Dr. Littlejohn. Putting aside some slight readers for opinions upon for under registration ; experiences errors into which the returns led the it registration ; and for the modes of procedure to obtain, and registrar’s doctor, the government under, registration ? appears that daring the past two and a half years there have In particular, how are securities dealt with under re- been 101 deaths in the burgh. Of these 19 occurred in gistration ? What is the cost of registration, including the children under five years of age, and no fewer than 54 in memorandum and articles of association, and what form do persons over sixty. Among the 54 who outlived their three- these latter take ? Do committees of management find them- score years, the average age at death was seventy-five years. i-dves in any way hampered by registration in their pre- With regard to the general conditions found by Dr. Little- vious discretionary powers ? What formalities have to be john, they seem to have been favourable, but it is unusual observed in framing and instituting new rules other than for a man in his position, whatever the well-known views of these embodied in the articles of association? Is registra- the majority of the Town Council may be, to discourage au