838

THE King and Queen’s College of Physicians of Ireland, on the lst inst., in accordance with their resolution a month ago in favour of Miss Peachey, decided to admit Miss (orMrs.) Dunbar, M.D. of Zurich, to the examination for thelicences of the College. The step was resisted strongly andunanimously by the obstetrical members of the College, butwithout effect.

___

THE Health Committee of Birmingham have taken a stepin the right direction by providing mortuaries. This is

most gratifying. There is only one qualification to make.We hear nothing of a public provision for the con-

venience of the coroner’s court, orpost-mortem examinations.These indispensable additions should be conceded to com-plete the boon to public health and prudence.

IT should be generally known that at the HighgateSmall-pox Hospital, patients with the disease who are notpaupers are admitted at an inclusive fee of three guineas.Employers of young men and women should not hesitate toavail themselves of the accommodation offered.

THE sanitary authority of Westbury- on- Severn are of

opinion that the law for the prevention of infectious diseasesis wholly insufficient, and have forwarded a memorial to theLocal Government Board on the subject. The latter bodyis urged to take the matter up without delay, with a view toinvesting sanitary authorities with greater powers.

OWING to the proved inadequacy of the medical establish-ment at the Royal Arsenal, the infirmary will shortly be- enlarged by the addition of two adjoining buildings.

WE are glad to learn that Dr. Pirrie, Professor of Surgeryin the University of Aberdeen, has been appointed HonorarySurgeon to the Prince of Wales for Scotland.

ROYAL COLLEGE OF SURGEONS OF ENGLAND

A VERY important meeting of the Council of the RoyalCollege of Surgeons was held, on Friday, the 1st instant, toconsider the amendments proposed by the University ofLondon to alter the constitution of the Committee of Refer-ence in the Conjoint Scheme, whereby all the co-operatingbodies were to have an equal number of representatives onthe Committee of Reference, the corporations having anaggregate of six members against eight for the uni-versities. It may be remembered that at a meetingheld on October 26th, the Council decided by a small

majority to accept the amendment; and that at the

next meeting, held on November 9th, it was unanimouslyagreed not to confirm those parts of the minutes whichrelated to the alteration in the constitution of the Committeeof Reference. On the lst instant, however, after a verylong and warm discussion, it was resolved by a majority offifteen to eight to accept the amendments.

It is somewhat difficult to understand this vacillation onthe part of some members of the Council. It may be thatnot a few voted with the majority in order to have thescheme cleared away. Sir James Paget argued that if theamended scheme were not accepted there would be no Con-joint Scheme at all, and maintained that, as the College waspledged to accept some scheme, it should accept this one,which had been favourably received by the other co-operatingbodies.Mr. Marshall, who moved that the amendments pro.

posed by the Senate of the University of Londonshould not be accepted, objected to the inequality of re-

presentation on the Committee of Reference, and pro-tested against the interference of the universities in thescheme. The universities were, he alleged, not interestedas the corporations were in the creation of general medicalpractitioners, for whom the scheme was really intended. Forthis reason he claimed for the corporations a predominanceof representatives on the Committee of Reference, inasmuchas the powers of the committee would extend to every detailof examination. Others seemed to think that the chancesof the universities agreeing among themselves are so smallthat the excess in numerical representation will be morethan neutralised by the opposition of interests.

ARMY HOSPITAL CORPS.

ON Tuesday, the 28th ult., a "Sanitary Detachment,"under the command of Captain Osborne, consisting of 10

officers, and 100 non-commissioned officers and men of this

corps, under the direction of Surgeon Sandford Moore, M.B.,F S S., Instructor Army Hospital Corps, paraded on theGeneral Parade, Aldershot-the site of a supposed battle-with a number of ambulance waggons, store waggons, con-

taining medical, surgical, and other appliances, and mulescarrying cacolels and litters, for the purpose of being exer.cised in their duties in the field as " sick bearers," before

Major-General Lysons, C.B., Quartermaster.General of theHorse Gnards, Sir William Muir, K.C.B., M.D., DirectorGeneral Army Medica1 Department, and Surgeon-GeneralMunro, M.D., C.B., Head of Medical Branch. On thearrival of the staff, the " Advance" was sounded. A fewmen were left to pitch a tent, and to get ready everythingthat would be required upon the arrival of the wounded,thus establishing what is technically termed the "fieldhospital," or " second line of surgical assistance," while theremainder of the column with its transport proceeded tothe front, to within about 600 yards of the supposeddivision.* Here the line of waggons was formed, and bandag-ing places appointed.The division, which was represented by a number of

men of a local infantry corps, was now supposed to havecome into contact with the enemy. The action having com-menced, the division still advancing, the men began to liedown as though wounded, and were found scattered aboutin every direction.A company of men were advanced to the "first line of

surgical assistance" in files consisting of four men each,equipped with a stretcher and a haversack containingbandages, lint, tourniquets, and splints, &c. Each filemarched to the most seriously wounded, and proceededto render the first assistance"; this done, they retired tothe line of ambulance waggons and other conveyances,and here the supposed wounded were further examined,and then put into the vehicles according to the nature ofthe wound they were supposed to have received, this being

’ indicated by an "identification label" found attached to abutton of his tunic.†

In the meantime another company was sent out, in partiesof two men each, with the necessary dressings, who pro-

, ceeded to dress the less injured patients, and then carried

. them by improvised methods of transport as two-, three-, or

.

four-handed seats, and stretchers formed of two rifles anda blanket.

l Those men who were not actually engaged in carryingD the wounded were utilised in bringing in the arms and,

accoutrements of the supposed deceased or injured, so,

that they might not get into the hands of the enemy.Aq soon as the waggons and other transport were loaded

- they were directed to retire to the field hospital, second line3 of surgical assistance, which was indicated by a large white

flag bearing the red cross of the Geneva Convention. Then

* On active service, the distance from the front to the field hospital, orsecond line of surgical assistance, is such as to be out of range of artilleryfire. The bandaging place, or line of transport, is just out of range of rifle

’

fire ; while the first line of surgical assistance is formed under fire.1 t On active service this label would bear in addition the man’s name

and regiment, the label being preserved in case of death, so as to afford’ the necessary information to the authorities and his relatives.

839

the conveyances were unloaded, the least injured wereassisted to the hospital.tpnt, while the more dangerouslywounded were carried. The whole were again examined,and such as were supposed to require it were got ready tohave their limbs amputated : for instance, a case of gunshotwound with fracture of the tibia was treated with a plaster-of-Paris splint (Bavarian method), and which a man ofthe Army Hospital Corps applied in an incredibly shortspace of time. After this, Major-General Lysons inspectedthe men, and expressed himself much pleased with what hehad witnessed, and stated his intention of making a veryfavourable report to his Royal Highness the Field-MarshalCommanding-in-Chief. To give an idea of the scope of

training these men receive, the following list of subjectstaught (at the Army Hospital Corps Training School atAldershot) is appended :-Outline of the general anatomyof the human body; bandaging; treatment of fracturedbones; the dressing of sores, gunshot and other wounds andinjuries; the administration of medicines and the applica-tion of external remedies; the management of hospitalwards, and nursing patients generally; the immediatetreatment of the apparently drowned, and cases of fits,burns, scalds, frosthites, poisoning, and other emergencies;the names and uses of medical, surgical, and other appliances,and the instruments required for operations; the first assist-ance to be rendered to wounded on the field of battle ; themode of transporting wounded by stretchers, mule cacoletsor chairs, mule litters, ambulance waggons, railway, and im-provised methods when no stretchers are available.

HEALTH OF THE NAVY.

THE statistical report of the health of the navy for th,

year 1875, is issued as we go to press. With regard to th,state of the Home station during that period, it woul<

appear that there was little recorded worthy of note. Therewas a trifling increase in its sick rate and in its ratio 0

invaliding compared with the preceding year, but its deathrate was lower. The Contagious Diseases Acts are workinfmuch good and the advantages of their operation are fullyrecognised. On the Mediterranean station the continued

prevalence of enteric fever, especially in Malta harbour;was the cause of a commission being appointed to inquireinto its origin and condition, the results of which are

stated. On the North American and West Indian stations,owing to immunity from yellow fever, the total death-ratewas only 8 5 per thousand. On the South-east coast of theAmerican station the men were equally healthy. In oneof the ships on the East Indies station cholera appeared andcaused some mortality. Histories of the measles epidemicin Fiji, of an outbreak of enteric fever on the Australianstation, and the results of inquiries made into the reputedpoisonous nature of the arrows of the South Sea Islandersare recorded. Altogether the sanitary condition of theservice afloat in 1875 was satisfactory. Compared with thepreceding year there was a reduction in the ratio of casesof disease and injury to the extent of 375 per thousand; ofinvaliding 4’7 per thousand, and of mortality of ’6 perthousand. We shall take an early opportunity of dealingwith the various interesting features of the report.

Correspondence.BLOODLETTING IN THE DAYS OF CULLEN.

"Audi alterm partem."

To the Editor of THE LANCET.

SIR,&mdash;I suppose all of your readers are acquainted withthe following passage from Cullen’s " First Lines:"&mdash;" Thereare persons who by their constitution are ready to fainteven upon a small bleeding; and, in such persons, this mayprevent the drawing so much blood at first as a pneumonicinflammation may require; but as the same persons aresometimes found to bear after-bleedings better than thefirst, this allows the second and subsequent bleeding to be

larger, and to such a quantity as the symptoms of thedisease may seem to require." *Now, it has already been repeatedly shown by quotations

from Cullen’s own clinical lecturps, and from others of thesame period, that the ordinary run of pneumonic patientsseen by him was in every respect precisely similar to whotwe see now-a-days. It seemed, therefore, that if we couldascertain the precise amount of blood the withdrawal ofwhich induced faintness in the individuals referred to, andif we could further discover what was the average ratio of

prevalence of such peculiar constitution in Cullen’s days,we should have a very accurate measure of comparisonbetween the constitution of the average Briton in our owndays and that of his predecessor one hundred years ago,quoad bloodletting at all events. In all the publishededitions of Cullen’s work, there is, however, no hint of theinformation required ; the paragraph in each of them standsexactly as I have quoted it. In the Library f the RoyalCollege of Physicians here, we have, however, Cullen’s owncopy of the second edition of the 11 First Lines," interleaved,and with copious MS. notes in his own handwriting. Inthis copy, after the words " small bleeding," we have thesymbol " iv. " introduced in Cullen’s own handwriting.This, then, was the amount of btood the withdrawal ofwhich was sufficient to induce faintness in a certain numberof patients in Cullen’s days, and as I fancy there can be nogreat number even yet who could not bear at least thisamount of bloodletting without fainting, so there can beno great difference between our constitutions and theirs.At the conclusion of the paragraph quoted Cullen appendsanother MS. note: ,This fact and rule hold very univer-sally." Now, if the "fact" thus referred to signifies theprevalence of persons ready to faint upon so small a blood-letting as four ounces, it reveals a state of matters which,to say the least, is not better than what now exists; while,on the other hand, if it be held to refer to the statementthat the "same persons are sometimes found to bear after-bleedings better than the first," it at all events indicatesthat Cullen must have had some considerable experience inthis class of cases before he could make so strong a state-ment. These annotations of Cullen’s are extremely in-teresting, and indicate pretty clearly that our hospitalsmight still be streaming with blood if the acting physicianspossessed the same faith as Cullen, or one-tenth of thecredulous boldness of his followers, such as the celebratedDr. Butter, who in a case of phrenitis actually cut downupon the carotid artery, and was only with difficulty pre-vented from opening it.

I am. Sir. vours ebedientlv.GEORGE W. BALFOUR.Nov. 25th, 1876.

DUTIES AND POWERS OF A MEDICALOFFICER OF HEALTH.

To the Editor of THE LANCET.

SIR,&mdash;Amongst the Annotations in your issue of November25th, 1876, are some remarks with the above heading.apropos of the recent case before the Court of Queen’sBench of the Medical Officer of Health of Harrogate vei-sttsthe Local Board of Health, in which the Lord Chief Justiceexpressed the following opinions as to the relations whichare recognised by law as subsisting between medical officersof health and inspectors of nuisances :-

" The order of Dr. Deville, as officer of health, is in itselfsufficient to make it obligatory on the inspector to do hisduty, and though the Board tell him not to perform hisduty and obey the lawful orders of the officer of health, he isbound to obey..... They huve no right to give theinspector instructions as to his discharge of his duties. The’Act gives them no such authority, it is vested in the officersof health. Their order to the inspector not to obey him ismere brutum fulmen, and will not protect him from the con-sequences of his disobedience of the lawful orders of theofficer of health. Mr. Justice Mellor and Mr. Justice Lushconcurred."As a medical officer of health of great experience, who has

had and now has the supervision of large districts, each ofwhich is provided with its inspector, and as one who knows

* Second Edition, Edin. 1778: section cccxlviii., p. 279.