himself fully alive to the interests of the schools and the duties , sarily be the work of a longer period of time. The most readily’ of his office; at his hands we look for representations in official effective reform would be to raise the assistant-physicians and quarters which will greatly enlarge the circle from which he surgeons to active duties in the wards, and to abolish the in-and unmeaning title of " assistant." draws his supply, and diminish the cost at which it is procured.
At present the students cannot obtain the necessary number of subjects if they could afford to pay for them, and if they could afford to pay for them they cannot have them. GENUINE FOOD FOR THE POOR. For the same reason the study and practice of surgical operations upon the dead body are practically impossible. The cost THE Corporation of London have decided to introduce the of a subject ranges between four and five pounds sterling, and Adulteration of Food Act into the city of London. The Comthe fee for the professor amounts to about an equal sum. This mittee to whom this question was referred have reported that, is nearly prohibitive of the performance of one series of opera- on attentive consideration, they consider it advisable and extions on the dead body prior to practice on the living. The pedient that the Act should be introduced into the City, and shoemaker’s first shoe is not usually fitted for the foot of a that the Court should appoint an analyst of competent skill duchess, and the young surgeon’s first operations should rightly and experience to carry out the provisions of the Act; and be performed on flesh which cannot suffer, joints already for they recommended that Dr. Letheby, their present medical ever stiffened, muscles which he may mould and remould into officer, should be appointed to that office. Their report also fiaps, and bones which will never more give a troublesome stated that the Committee had been informed that the expense stump. The greatest and most laudable efforts are made in the of carrying out the proposed object would, in all probability, schools to teach operative surgery in the face of the great cost be considerably more than the sum that would be derived from to the student attending a full practical course, and the just the fees to which he would be entitled. It is, of course, imrequirements of some of the examining boards add a stimulus possible to ascertain at present what may be the amount of to their exertions in this direction ; but they are all very far labour, time, and expense attaching to the fulfilment of the short of what is needed, and they will never reach the necessary duties of this office. The report, therefore, recommended, in standard until anatomical subjects are as cheap and abundant accordance with an arrangement to which Dr. Letheby had in the schools of London as they already are in those of Paris. given his consent, that the public analyst should keep an This fact alone sufficiently indicates our present defect: there account of his expenses and disbursements during the first exist more than one large school in which practical operative year, and also of the labour done, and should render a return surgery is wholly neglected, and in none is it cultivated by to the Court at the expiration of that period. The Court would one-tenth of the students. thereupon decide what scale of remuneration should be afterFor clinical teaching the prospects are brighter ; but the wards adopted. The scale of fees ranges from 2s. 6d. to 10s. 6d. present state is lamentable. In many schools clinical study for each analysis that is required. It is obvious that these is difficult to the student, because he finds neither ex- payments will be insufficient to cover the actual expense that ample nor instruction from the medical officers of his hos- would necessarily be incurred by the analyst, and it is suffipital. Clinical teaching is a myth, and, on the part of the ciently clear that if this office is to be filled by a chemist student, clinical study purely an inspiration. For clinical whose time and opinions have any value, his services must be teaching, a physician needs a small number of good cases, remunerated. It was ingeniously suggested that the low rates and plenty of time to spend over them. Neither in the of payment fixed by the Act afford an inducement to tradesout- nor in-patient departments of our principal hospitals do men to employ the services of the analyst at this training fee, in these conditions exist. There are two ways of supplying this order to get their goods advertised as being pure ; and that want: by founding clinical wards, containing ten or more whereas a certificate of chemical purity and excellence has not cases, purposely selected for the typical illustration of disease ; hitherto been obtainable at a cost of less than from two to five and the increase of the personnel of the hospital staff at all our guineas, henceforth the market price will vary from half a great establishments. In the narrowness and exclusion which crown to half a sovereign. The remaining part of the fee nelimit the appointments to a very small number of individuals cessary to repay the labours of the analyst falls upon the parish, lies a source of weakness to these institutions, of inefficiency in which pays the analyst as a public officer. This is, however, a minor inconvenience, and one for which their administration, defect in their teaching power, and abuse in the ranks of the profession. Hence the host of spe- circumstances will afford a remedy growing out of the necessicialists ; hence the array of small charities, each with a staff ties of the case. The considerations which urge the application of often able men without pupils and without a public ; hence of this permissive Act to every community are of the most the hasty treatment of patients, the imperfect education of stringent character: they touch nearly the health, honour, and students, and the absence of necessary clinical teaching. morality of all its members. The City of London has done Clinical teaching is a shadow of a name in many of itself honour in taking the important initiative of adopting the our hospitals. Often this is less the fault of the teacher, Act. The Corporation have throughout shown an enlightened scientifically, than the necessity of his position. A surgeon or and honourable appreciation of the public advantages of the physician who is able to devote but an hour or two hours twice measure; for originally it was not intended to apply to the or thrice a week to the investigation of from thirty to a hundred City of London, but the Court of Sewers thought the subject --, cases distributed over the. wards of a large building, can do of so much importance that they instructed the Remembrancer little in personal clinical study of his cases-nothing whatever to apply that its provisions might be extended to the City. It in useful clinical teaching. To " walk the hospital" in the were greatly to be regretted that this excellent example should suite of the surgeon-or physician making his rounds is com- not be followed with unanimity throughout the kingdom; but monly to do no more than the phrase literally expresses. He already symptoms of the reaction induced by trade influence are is compelled necessarily to pass rapidly from bed to bed-here beginning to be felt. It is stated that the Vestry of St. Pancras a prescription-there a few words of clinical observation; and, have for the moment refused to adopt the Act. These gentleas he passes, some further words to those nearest to him. But men prefer that the poor should be denied genuine bread, milk, clinical teaching implies ten minutes-half an hour-it may be and beer. They reject the application of a scrutiny which more-spent at one bed. This a physician will often need to help health and morality alike demand. We refrain from inquiring him to determine the character or the progress of a disease for narrowly into the reasons which may induce them to shrink himself; but to teach a following of pupils, or even a few of from this seemingly obvious public duty, persuaded that the them, to trace the course of reasoning and observation which is voice of public opinion will so powerfully be heard as to sway mplied in the profitable clinical study of a case must neces’ their minds to another conclusion. The working of the Act in
the city of London will, no doubt, be watched with interest, and taken as a guide, by the local authorities of other parts of the metropolis.
THE WINSLOW CASE.
of this kind
having been reported to me by the inspectors
Hamilton-terrace, I found the slop used to consist of putrid organic matter, 8’77; water, 36’6; and of inorganic matter, at
54’18. Being of opinion that the use of such a mixture in plastering the interior of a house is not likely to be promotive of health, while it undoubtedly produces an inferior binding material, I requested the builder and the architect to discontinue
MR. JOSEPH J. PorE, the " medical assessor" at the late trial of Regina v. Winslow, has published a brochure, in which he nounces his "anxiety to express what appears to him the perfect justification of the acquittal of the prisoner," arising out of cir.cumstanceswhich "throw great doubt upon the medical evidence that the death of Ann James was accelerated by the action of antimony." He maintains that the symptoms during life and ,the appearances after death were compatible with existing natural disease, and concludes that the theory of "acceleration" of death was solely based upon the detected presence
its use, but not in time to prevent the fall of an arch, and the injury of three men engased in the construction of the build-
Correspondence. "Audi alteram
To the Editor of THE LANCET. send SIR,-I you the following account of a case of poisoning aconite which has lately occurred in this neighbourhood. by It may prove interesting to many of your readers, as forming a fresh instance of an error which has been committed more than once : I mean that of mistaking aconite-root for horse-radish. In the present case, about a pound of the root of aconitum napellus was cut into slices and mixed with a gallon of pickles. A young married woman, who partook of them the next day, was seized, within ten hours of the meal at which they were eaten, with violent spasms and severe pains, with pricking sensation in the limbs, back, and chest, difficulty of breathing, and partial loss of sight; the pulse was considerably lowered, and the skin cold and clammy. Chloric ether and ammonia were given in full doses, and in an hour or two the patient rallied. The cause of these symptoms was unexplained until the following day, when three other members of the family, (namely, the mother, sister, and brother,) within an hour of having again eaten some of the pickles, were attacked in a similar manner. The mother was only slightly affected, but the brother and sister, especially the latter, who had taken a large quantity of the vinegar, suffered much more severely. These two patients were made to walk about; emetics were freely administered, and large quantities of brandy, ammonia, and chloric ether were given at frequent intervals; mustard HOUSES OF ILL-HEALTH. poultices were applied to the chest and back of the neck, and hot water bottles to the soles of the feet. Galvanism, by THERE is one way to make homes unhealthy which has often means of a Pulvermacher’s chain, was also employed over the been criticized by our Medical Officers of and which still region of the heart, in the case of the sister, whose pulse was at one time imperceptible. Fully twelve hours elapsed before demands all their vigilance to prevent. It forms a regular part this patient could be pronounced out of danger. The sympof building operations in many localities around London. You toms were much the same as in the first case, but in a more may ventilate a house and drain the street; supply plenty aggravated form, opisthotonos and trismus being very marked. of light, air, and fresh water; but there may still be a source They are now all gradually recovering their usual health, of disease in your house which may elude discovery, and if though for some days they complained of great pain and tenderness in the region of the spine, together with loss of sleep discovered defy remedy. It is literally bound up in the comand appetite. position of the road, and forms part of the fabric of the house Hoping that, from the rarity of similar cases, this rough wall. A Scottish registrar lately noticed that the increase of sketch may be worthy of a place in your valuable columns, I remain, Sir, yours obediently, fever and zymotic disease in his district was chiefly confined to JOHN BARR M.R.C.S. a street of newly-built and somewhat superior houses. Some surgeons have from time to time made the like observation in the suburbs of London. If the composition of the roadway be VERSION WITHOUT INSERTING THE HAND observed, and the air of the basement tested, the cause may IN THE UTERUS. be partly guessed. It is not unusual, in making these roadTo the Editor of THE LANCET. ways, to cast into the chasm to be filled every kind of refuse, SIR,-I think the following case so fully confirms the value including animal and vegetable d6b2,is of the most unsavoury of the method of turning described by Dr. B. Hicks, that I beg a on level the with character; and this being packed together its insertion in your journal. the mass steal all from the emanations basement, through Early on the morning of July 24th I was summoned by a lower part of the house and ascend to the upper rooms. A in this neighbourhood to go over to Woking to see a midwife surgeon in the southern suburb communicated to us a case in woman under her care, and who was in a dangerous young the members which of a numerous family were successively state from flooding. I found the patient, a delicate person, attacked by zymotic disease-in two instances fatal, and re- aged twenty-eight, in labour with her fourth child, in a most extremities cold; pulse peatedly renewed, until removal from a house so poisoned. critical condition; face and lips pallid; Dr. Dundas Thomson, in his weekly report, draws attention 140, small, and tremulous. She had had only three slight but had lost a large quantity of blood. I found the to a cognate defect in the hygienics of masonry which deserves pains, filled with coagula; the os uteri dilated to the size of a vagina to be duly noted :crown-piece, and entirely blocked up by the placenta. On " My attention has frequently been called to, I trust, an passing two fingers between the wall of the uterus and the almost obsolete practice indulged in by some builders, of mix- placenta, I felt a cephalic presentation, the membranes being ing up putrid slop from the streets with their mortar, insteadunruptured. Knowing that no time must be lost, I determined Af using sand which has chemical relation to the lime A trying the plan of version suggested by Dr. B. Hicks. With