.582 PROFESSIONAL SUBJECTS IN LAY PAPERS.

answer each point seriatim, but candidly acknowledge thatI am unable to cope with him in the matter of ethics.1. "Dr. Herbert Tilley names no names." In publishing,the cases referred to I had no wish to individualise anyinstitution or its officials. I wrote pro bono publico, feelingthat I was doing my duty to my profession and especially tothat branch of work to which I devote my time, and forwhose good reputation I am solicitous. If, however, Mr.Lennox Browne wishes for the names of the consultants’.referred to and the patients I shall be perfectly willing to’publish them (with their permission and that of the

editors) in a coming number of THE LANCET. 2. Iam acquainted with most of Mr. Browne’s treatises on.the subject and have carefully read the last-mentioned ofthem in the current number of the Liverpool Medico-Chirurgical Journal. I am amazed in reading there that hehas, amongst 1547 private patients seen within three years,no less than 438 cases (less than 1 in 4) of lingual varix. As.a result I am more than ever inclined to doubt the value ofhis observations. 3. Mr. Browne is apparently much per-turbed because I only write of three cases. These are onlysamples. If he prefers a much larger number I can supplythem and, if he so desires, the specialists consulted shallbe named, with the permissions previously alluded to.4. Finally, Mr. Browne is obviously incensed that one

younger than himself should challenge his observations.

May I be allowed to point out, although Mr. Browne mayhave been working at diseases of the throat longer than Ihave, that mere seniority is no proof of greater correctnessin observation and interpretation, and I am deeply sorrythat, with all his experience, he has not been able to find abetter explanation of the cases than he has done.

I am, Sirs, yours truly,HERBERT TILLEY, M.D. Lond.

Welbeck-street, W., Feb. 24th, 1896.

PROFESSIONAL SUBJECTS IN LAY PAPERS.To the Editors of THE LANCET.

SIRS,—With reference to an article which appeared in theGlobe of Feb. 18th I have received the enclosed letter fromthe honorary secretaries of the Medical Society of Londonwhich I have their permission to publish. I should feel.obliged by your kindly inserting the same in your next issue.

I am, Sirs, your obedient servant,HERBERT F. WATERHOUSE.

Wimpole-street, W., Feb. 25th, 1896.[COPY.]

The Medical Society of London, 11, Chandos-street,Cavendish-square, W., Feb, 24th, 1896.

DEAR MR. WATERHOUSE,—Your note of the 20th inst. was consideredby the Council this evening. They regret that your case of bone.grafting, shown to the Society on Feb. 10th, should have been com-mented upon in a non-professional paper, which unfortunately men-tioned you also by name. The Council have ascertained that theparagraph appeared entirely without your knowledge and sympathisewith you in your annoyance at the occurrence.

Yours trulv.AMAND ROUTH,G. R. TURNER,

Hon. Sees. toMedical Society.

SUBJECTIVE VISUAL SENSATIONS.To the Editors of THE LANCET.

SIRS,-In accordance with a suggestion of Dr. Gowers,who delivered the Bowman Lecture of the OphthalmologicalSociety last year upon the Visual Phenomena connected withEpilepsy and Migraine, we are desired by the council of theabove society to invite from members of the medical profes-sion any observations they may be willing to record. Itwould seldom be possible to obtain accurate descriptions ordrawings of such sensations from laymen, but it is felt thatvaluable information might be obtained if members of theprofession who are themselves the subjects of migraine wouldput into writing detailed accounts of the visual symptomsfrom which they suffer in connexion with an attack. Thevalue of these descriptions would be enhanced if they wereaccompanied (where possible) by drawings or diagrams ofthe appearances. It seems likely that the knowledge of thenatural history of migraine and allied cerebral conditionsmight be greatly increased if a large number of such well-recorded experiences could be gathered together and classified.The nucleus of such a collection has been formed and pre-sented to the society by Dr. Gowers, and the council will bevery glad if any of your readers who can do so will help to

I enlarge it. We shall be glad to receive any communicationsthat may be sent to us.

We are, Sirs, yours faithfully,S. H. HABERSHON, 70, Brook-street, W.,J. B. LAWFORD, 99, Harley-street, W.,

Honorary Secretaries of the OphthalmologicalSociety of the United Kingdom.Feb. 24th, 1896.

WITH DR. JAMESON’S MEN ON BOARDTHE "HARLECH CASTLE."

To the Editors of THE LANCET.

SIRS,-I have just returned from Natal to Plymouth asmedical officer to the Harlech Castle and as medical officerto Dr. Jameson’s men and officers on board the HarlechCastle. I thought it might interest you to have a shortaccount of the sickness amongst them. I enclose a photo-graph of a few of the wounded. Dr. Jameson’s column cameon board at Natal on Jan. 24th-viz., Dr. Jameson, 294 men,23 officers, and 10 women and children ; Imperial escort, 18men, and 2 officers. The men were naturally a very robustbody, in age averaging from twenty-three to thirty-five years;but as I am told by the officers and men that after theircelebrated march they were confined in Volksruit and Pre-toria gaols, where the sanitary arrangements were veryprimitive and the stench horrible, Surgeon-Captain C. H.Hale brought on board with him 18 men-11 gunshot wounds,5 cases of dysentery, and 2 cases of malarial fever-whom heplaced under my charge. Three of the wounded were trans-ferred three days later and sent to their homes at the Cape.

Illustration reproduced from a. Photograph of Wounded takenon board the " Harlech Castle."

The numbers read from left to right in the illustration.1. Bullet wound and compound 4. Bullet wound of side; paresis.

fracture of the forearm. 5. Bullet wound in the band.2. Compound comminuted frac- 6. Bullet wound of arm and side.

ture of the forearm. 7. Surgeon in charge.3. Bullet wound of side.

The wounds all progressed very favourably, being dressedwith antiseptic precautions ; the cases of dysentery pro-gressed favourably, a.s did also the malaria, but typhoid fecerbroke out on Jan 30th.A trooper came to see me at about the end of the second

week of the disease. I understand from his comrades that forsome three months he had been in a weak state of health.but did not care to ask for medical attention. When he

applied to me I immediately isolated him, disinfected hiscabin, and took the usual precautions. I then asked Mr. E. C.F. Garraway, Mr. W. H. F. Farmer, and Surgeon-CaptainSeton Hamilton, who had been with them in the field, ir theywould kindly meet me to see if anything further could be

done, but in spite of all our efforts he sank and died at aboutsthe end of the third week. His case was complicated Bviih

583"THE PROPER TEMPERATURE FOR VAGINAL INJECTIONS."

meningitis, and from the first he had very active, longdelirium. This case was followed by 6 other cases of typhoidfever, 25 mild cases of dysentery, and 28 cases of malarialfever. There was also an average of from twenty-five to thirtygeneral minor ailments per diem, and, with the exceptionof six cases of typhoid fever, which were through their thirdweek, one case of malaria, and one convalescent from typhoidfever, all were well when we arrived at Plymouth. These

eight cases were transferred to the hospital ship at Plymouth.My general opinion of the men was that they were fine

specimens of the nationality to which they belong and thatthe officers were a real good set of fellows.

I remain, Sirs, yours very truly,FRED. G. LLOYD,

Surgeon to the Harlech Castle : Surgeon in Charge ofDr. Jameson’s men from Natal to Plymouth.

Feb. 25th, 1896.

" THE PROPER TEMPERATURE FORVAGINAL INJECTIONS."

To the .Editors of THE LANCET.

SIRS,-With reference to the case reported in the LeedsEzening Express, upon which you commented in THE LANCETof Feb. 15th under the above heading, I anticipate thnt youwill be willing to permit me, through your journal, to thankthose members of my profession-nearly fifty in number-whohave kindly defrayed my entire expenses in the matter.It would give me much pleasure were I at liberty to

publish the names of those who have thus helped me,but you will see that the list which I now forward foryour perusal includes most of the best known prac-titioners both in the centre and outlying districts ofLeeds, and as to most of them I myself am entirelyunknown I am led to regard their action as due to a feelingthat I have been mulcted in damages contrary to the weightof evidence for the results of an accident (which none regretmore than myself) which occurred in consequence of a.

correct line of treatment necessarily under the circum-stances carried out hurriedly in a moment of supremedanger. I trust my unfortunate experience may be ofservice to others, but would regret were it to have the effectof deterring any medical man from doing his utmost tosave a life in imminent danger for fear of consequences,however unpleasant to himself.

I am. Sirs. vours faithfully.JAMES LAMONT.Armley, Feb. 19th, 1896.

"POINTS UNDER THE INFECTIOUSDISEASES (NOTIFICATION) ACT."

’

To the Editors of THE LANCET.

SIRS,-Dr. Leonard Cane’s letter to, and his answer from,the Local Government Board opens up a very interestingquestion. Here (in Leicester) we are expected to notify eachand every case of infectious disease which occurs in a house,but are only paid for the first one notified. The assistant

secretary to the Local Government Board distinctly says that"the town council must pay the prescribed fee for eachcertificate, whether or not it relates to a person belonging toa family in which the presence of infectious disease has

already been notified." It would be interesting to know whywe Leicester practitioners-are not thus paid. An elucidationof this question would be welcomed by all of us, including,

Yours faithfully,W. L’HEUREUX BLENKARNE.Leicester, Feb. 22nd, 1896.

*** The Leicester system of compulsory notification iscarried out, not under the general Act, but under the

Leicester Corporation Act, 1879. That Act contains the

following provision, Section 8 (5): "The corporation shallpay to every medical practitioner who shall, in pursuance ofthis section, duly make and give any such certificate or

declaration a fee of 2s. 6d. for each such certificate or

declaration, but only one such certificate need be given andonly one such fee shall be payable within an interval ofthirty days to the same medical practitioner for certificatesgiven by him in respect of the same disease occurring in thesame building." This system was studiously avoided in thegeneral Act of 1889, and it has many obvious disadvantages.Thus, no trustworthy statistics of infectious sickness can be

obtained and no rate of fatality to attacks can be ascer-tained.-ED. L.

To the Editors of THE LANCET.

SiRS,-Would you kindly inform me through the columns.of THE LANCET if the urban district council are justifiedin the following actions ? I notified fifty-five cases at the endof last year charging half a crown as usual, and which,previously has always been paid ; without any notice I amsent a cheque for £3 Us. 6d., with the information that infuture the council will only pay a shilling for cases otherthan private. I am medical officer to a society for theminers employed by a company here, and which is only for-their working men. Would you kindly inform me if this isa legal act and is what is meant by the Notification Act of1889, which speaks of public bodies and institutions ?

I am, Sirs, yours truly, ,

J. W. HUDSON, L.R.C.S., L.R.C.P. Edin., L.S.A.Millom, Carnforth, Feb. 18th, 1896.

*** We are of opinion that the urban district council are-altogether in error. The question has been discussed before-and it has been decided that whilst " public body or institu-tion" includes a public hospital or infirmary, that expression)does not include private hospitals to which patients are-

admitted for payment, or a medical club, or a dispensary.In the case submitted the medical attendance on a miners’

society is carried out by a private medical practitioner. Weshould advise, in the first instance, that a detailed statementof the circumstances be submitted to the Local GovernmentBoard and that their opinion be asked.-ED. L.

NUTROA FOOD.To the Editors of THE LANCET.

SIRS,-My attention has been called to an advertise--ment in pamphlet form of a food called " Nutroa " whichis stated to have the same composition as my " ideal diet.for children." I wish to state (1) That the use of my namein these advertisements is without my sanction ; (2) that the-expression " ideal diet for children " has never been used by-me in any of my writings ; and (3) that the figures quoted are-taken from my work on Chemical Physiology, which gives.the average minimum diet (a very different thing from idealdiet) for persons of different ages. The figures selected bythe advertisers are those for children between the ages of six:and fifteen’; the entirely different figures given on the samepage for infants under the age of one year and a half areignored. Nutroa food is advertised as a substitute forhuman milk, and therefore presumably intended for thoseunder eighteen months of age. I may state in conclusionthat since seeing the advertisement I have examined a sampleof this food, and that I do not consider it in any sense asubstitute for human milk.

I am, Sirs, yours faithfully,W. D. HALLIBURTON.King’s College, Feb. Glst, 1896.

"THE EAST LONDON WATER INQUIRY."To the -Editors of THE LANCET.

SIRS,-With reference to your annotation upon the sub-ject of the report of the inspectors of the Local Govern-ment Board as to the service of the East London Water-works Company, may I be allowed to point out thedrawbacks of a branch service pipe as recommended

by you? ? The inspectors very properly advocate the pro-vision of properly designed domestic storage cisterns,and you maintain "that for the exclusive purpose ofa drinking supply water direct from the main should,when possible, be drawn. This does not mean the abolitionof cisterns, or of some means of domestic storage, for theservice-pipe may be made to branch into two, the one to feedthe cistern and the other to supply directly to the tap."If this arrangement be adopted the consumer would natu-rally utilise the direct tap with the result that the waterin the cistern might be undisturbed for months. Shoulda breakdown of the constant service impel a resort to thewater in the cistern the consumer would have at his disposalwater dangerously stale and stagnant. If a cistern is pro-perly designed, and in principle is but an enlargement of the