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Millerchip, and expressive of the regret of the Council a

the course taken by Mr. Cross, the Home Secretary.

SMALL-POX is reported to have broken out, and to bactively spreading, in Canning Town, West Ham. At;recent meeting of the local board the medical officer o

health, it is stated, recommended that revaccination shouldbe universally adopted, but information is not given of thmeans he suggested by which this excellent practice is tbe carried out. West Ham, we believe, has two infectiousdisease hospitals within its boundaries ; one belonging to thlocal authority, which rendered good service during a previous prevalence of small-pox in the district, and one belonging to the Poplar Board of Works. This latter hospital, understand, is capable of accommodating seventy patients.

A PAINFUL case is reported from Sheffield of a paupersuffering from advanced heart disease, being removed to thlworkhouse, and, while in the act of walking to a wardfalling down in fatal syncope. The question arose as t<

. whether there had not been carelessness on the part of th<workhouse officials in not having the patient carried to th(ward, but at an inquest upon the body the jury did not fee:justified in adding more to their verdict stating the cause o:

death than that the treatment the man had received at th(workhouse had not been satisfactorily explained, and ad.vising that the attention of the guardians should be callecto the question. -

THE Shipping Gazette reports that the first prosecutiorunder the Canal Boats Act occurred at Doncaster some few

days ago, when the owner, who lived and slept in his ownvessel, was fined 5s. and costs for not having had the boa1registered. As we predicted many mdnths since, the opera.tion of the Act is very partial and unsatisfactory, and theprovisions are so fragmentary that the measure will dolittle else than allay philanthropic clamours for so-calledpaternal

" legislation on the subject.

THE latest news from the hospitals of the Russian armyof the South-that is to say, the army on the Danube andin Bulgaria-now about three weeks old, states that thenumber of the sick had been reduced to 3600. Of the sickat Rustchuk 700 were then about to be removed to Russia;of the sick at Bourgas 1500, it was reported, would be in astate for removal in a fortnight, or thereabouts.

THE Council of the Royal College of Surgeons in Irelandhave arranged that from the 1st of next August every can-didate for the diploma in surgery of the College shall beobliged to obtain a certificate of proficiency in vaccination,and shall also be liable to be examined upon the subject athis final examination.

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DR. BRIDGES, one of the general inspectors to the LocalGovernment Board, has much " exercised" the ShoreditchBoard of Guardians by continuing to press upon them thegreat necessity of appointing an assistant resident medicalofficer for their union infirmary.

MR. SPENCER WELLS has been elected an honorarymember of the Royal Academy of Medicine of Belgium, inconsideration of the "great part he has taken in scientificprogress." It is always pleasant to record Continental re-cognitions of the merits of British surgery.

THE Council of the Royal College of Physicians re-commend Charles Darwin, Esq. F.R.S., as Baly Me-dalist for 1879.

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DR. IsAAC BALFOUR, of Edinburgh, has been appointedto the chair of Botany in Glasgow University,

DR. CHEADLE and Mr. MALCOLM MORRIS have been

appointed joint-lecturers on skin diseases at St. Mary’sHospital Medical School. Such appointments in generalhospitals are the true antidote to the evil of specialhospitals. ___

’ SURGEON-MAJOR FRANK POUT, Surgeons J. Andersonand A. R. Lundy, have been detailed for duty in Burmahwith the 43rd Regiment, in view of active operations beingnecessary on the Burmese frontier.

SURGEON-MAJOR WILLIAM CREAGH has been appointedto the medical charge of the Convalescent Dep6t at Dar-jeeling, vice Surgeon-Major Sam Black Roe, M.B.

THE ROYAL COLLEGE OF SURGEONS.

ON Saturday afternoon last a deputation of teachers fromthe metropolitan schools waited on the Committee on Ex-aminations of the College in support of the memorial whichhad been presented to the Council urging some modificationsin the present system of conducting the Primary Examina.tions. Mr. Thomas Smith and Professor Burdon Sandersonwere the chief speakers. They pointed out that at presentthe results of the examination were not as certain as couldbe wished, and that occasionally the best students from theschools were referred, whilst inferior candidates succeededin passing. They hoped that whatever changes might beadopted would not increase the severity of the examination,but diminish its uncertainty. To attain this end, they sug-gested an increase in the number of written questions, espe-cially in physiology, and the separation of the two subjectsof anatomy and physiology by setting a paper in each sub-ject and marking them separately, instead of including themin one paper, as at present. It was also thought that greatbenefit would result if the examinations in anatomy andphysiology were conducted by different examiners, accordingto the subjects to which they had paid most attention. Thedeputation was also anxious that the amount of comparativeanatomy required for the primary fellowship should be definedand scheduled, and that a separate examiner should beappointed in this subject. Some conversation between thecommittee and the deputation as to preparing a schedule inphysiology also led to the suggestion that Prof. Sandersonshould draw one up embodying his views, and lay it beforethe committee, and he promised to do so. The greatestdifficulty seemed to be in the question of the limitation oftime at the vivd voce. The teachers thought that this occa-sionally determined the rejection of a candidate who wouldhave passed if a longer time were given to him, but to carryout such an alteration the present system would have to becompletely changed. Now a candidate comes under thenotice of the examiners at every one of the four tables,either in the written or the viv&acirc; voce, the arrangement beingthat the examiners who read his paper have no share in hisviv&acirc; voce, which devolves on all the others. At every other

examining board the same examiners read the written papersand conduct the vivd voce ; they are consequently enabledto lengthen or shorten the oral examination as the quality ofthe written answers may determine. The president of thecommittee, Prof. Humphry, promised that the suggestionsshould have every consideration, as the authorities of theCollege were most anxious to make the examinations asperfect as possible. The deputation retired, after havingthanked the members of the committee for their courtesy andattention.At an ordinary meeting of the Council of the Royal

College of Surgeons, held on Thursday evening, the Pre-sident, the two Vice-Presidents, Sir James Paget, Messrs.Humphry, Marshall, Savory, Holmes, and Erasmus Wilson

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(ex officio), were appointed the Erasmus Wilson Fund Com-mittee. Mr. Hancock’s motion to throw open the examina-tions for the licence of dental surgery to all registered.dentists sine curriculo, was seconded by Mr. Humphry, but(lid not receive any further support, and was rejected by afull majority. The request of the ophthalmic surgeonsfor compulsory instruction and examination in ophthal-mology was refused; as likewise was that of the obste-

tricians, for an extension of the instruction and examina-tion in midwifery. The Jacksonian prize was presented toMr. Priestley Smith for his essay. Permission was givento Mr. Smith to publish his essay, and he was allowed

temporarily to remove the preparations and drawings illus-trating it.

THE AFGHAN WAR.

THE Brindisi mail of Monday last brings us letters fromthe forces operating in and beyond the Khyber Pass and inthe Kurrum Valley. During the last few weeks not manychanges had occurred in the distribution of the troops andthe medical arrangements connected with them. An ad-vance on Cabul was expected to take place as soon as thesnow on the passes had cleared off sufficiently to allow

passage for artillery, baggage, camels, and sick transport.In view of this Sir S. Browne’s division had concentratedon the Jellalabad plain, the 2nd division, under Major-General Maude, V.C., taking charge of the entire line ofcommunication from Peshawur to Jellalabad, a distance ofnearly ninety miles. The move to the Gundamak heightsof the greater part of the European troops of the 1st Divisionwas to commence in a few days ; for the present the fieldhospital will be encamped on an elevated plateau, waterbeing good and abundant there. The health of the troopswas fairly good, but the weather was sensibly hotter, thesun in the middle of the day being felt excessively throughthe thin covering of a tent. Gundamak, the elevation ofwhich is 4000 feet, will, it is believed, be a cool andhealthy encampment for the summer months. Comingto the 2nd Division, it is intended, we learn, to cantonthe majority of the European troops at Landi Kotal;this plateau is situated at an elevation of 3700 feetabove the sea, and is two miles and a half long byone and a half wide. It will probably become a permanentmilitary garrison-the advanced post of our new " scientificfrontier." Held, however, as at present, tentatively, theerection of barracks would be premature, and for this seasonthe men will be located in double tents covered with a"chopper" roof, while, as quickly as they can be obtainedand set up, huts consisting of an iron frame and roof, coveredwith mud, will be made use of. Numerous borings havebeen made by the Royal Engineer department, and excellentwater found at depths varying from 60 to 70 ft. Sites on theadjacent hills have been inspected and selected for sani-taria. Some of them are as high as 4900 ft. above sea level,and should be proportionately cooler. On these sick andweakly men will be quartered. During the very hot months,or between May and October, sending back sick to the basehospitals at Peshawur, or to the convalescent dep6t atMurru, is out of the question. The main section of thefield hospital has been already established at Lundi Kotalunder Surgeon-Major J. H. Wright; the second half atBusowal, twenty-six miles further on the Jellalabad road,under Surgeon-Major Shaw. Each of these is fairly wellequipped, and so arranged as to be split up into two, thusforming four separate and complete units, any one of whichcan be moved off at a few hours’ notice should any militaryexigency require a sudden advance of troops. Thus, lookingat the chronic turbulency of the tribes in the vicinity, is atany moment to be anticipated.The increased number of native troops at Ali Musjid and

Dakka has necessitated the establishment of field hospitalsfor natives at these stations.In the Kurrum Valley several medical changes have

taken place, consequent on the visit of Sir Frederick Haines,the Commander-in-Chief, and Surgeon-General Kerr Innes.Kohat, which at this season is not only very hot, but ex-

cessively malarious, will be garrisoned entirely by nativetroops. The field hospital there has accordingly beenadvanced to the Peiwar heights, which range from 6000 ft. to9000 ft. high, and a plateau on one of these will be themedical base for the summer months ; water and fuel areabundant. General Roberts’ force here has been increasedby the addition of the 67th Regiment and the 92nd High-landers. The entire length of the Kurrum Valley, cal-culated roughly at seventy miles, is one gradual rise afterleaving Thull to the village of Peiwar, at the top of thecrest. Water is everywhere plentiful, rice cultivation isuniversal, and fevers of the malarial type are, in the hotmonths, exceedingly prevalent. To avoid exposing our

soldiers to their deleterious influence, as far as is compatiblewith military necessities, the four posts held for strategicreasons between Thull and the Pass itself will be garrisonedby troops of the Native Contingent, one company ofEuropeans occupying a village 1500 ft. above the valley.The men of the Royal Artillery and 8th King’s, who havespent the whole of the winter months in the Peiwar, andhave often been snow-bound for weeks, are looking healthyand robust, contrasting with the pallid, weakly countenancesof their comrades, who have not had the bracing advantagesof campaigning high up in the mountains.

I

Correspondence.

CARBOLIC ACID AND DEATH AFTER AMPU-TATION AT THE HIP-JOINT.

"Audi alteram partem."

To the Editor of THE LANCET.

SIR,-You report the discussion at the Clinical Society onthe 18th April of Mr. Gould’s case of amputation at the hip-joint ending fatally in sixty-eight hours, after progressingfavourably for forty hours. The reporter, whose generalaccuracy will be admitted by all, describes the post-mortemappearances as consisting of black coagulum occupying theveins of the left foot, leg, and thigh, reaching just into thecommon iliac vein. The report closes with this sentence."He (Mr. Gould) attributed the thrombosis to carbolic-acidpoisoning." Mr. Gould certainly suggested that the co-

agulated state of the blood was the cause of death, andwas itself possibly caused by the carbolic acid. But hedid not put it so decidedly as your reporter would imply.The time was up or I would at the meeting have venturedto express my regret that a surgeon, so sound in antisepticfaith and practice as Mr. Gould, on the strength of anisolated case, should have broached so doubtful a theory.Amputation at the hip-joint is a grave operation. It willbe often followed by death under every variety of practice,and for an event so common before the use of carbolic acidwe need not seek an explanation in its action. But, as faras I know, the records of cases of death by actual carbolic-acid poisoning refute Mr. Gould’s theory. In his case theman did well for forty hours, and up to this time exhibitedno signs of carbolic-acid poisoning, intestinal, cerebral, orurinary. The only constitutional indication of the presenceof some carbolic acid in the system at the later stage of thecase was the not uncommon one of a dark appearance of theurine. Even if thrombosis in the veins of the left leg werea sufficient explanation of death, this cannot be considered anote of carbolic-acid poisoning. So far from thrombosis

being such a sign, the reverse would seem to be the case.In THE LANCET of March 1st, 1873, a case of poisoning bycarbolic acid in St. George’s Hospital is recorded by Mr.T. H. Brabant. It is distinctly said that " the blood wasuniformly flitid, and on exposure became of a bright-redcolour." In THE LANCET of June 21st of the same yearanother fatal case is reported, under the care of Dr. Russell,of the General Hospital, Birmingham. The following areshort extracts from the account of the autopsy, twenty-fourhours after death : " Rigor mortis was persistent. Afterligaturing the venae eavee close to the heart, the right sidewas found to contain three ounces of blood, which was of adark colour, and quite fluid. This was the case also in thelarge vessels....... The brain contained much venous blood,