opinion the same decrease in the prevalence of that disease and other affections of the nervous system has not taken place, that recent improvements in the condition of the soldier have effected in some other maladies to which he is liable.

The CHAIRMAN then read some extracts from a report just received from Staff-Surgeon Roch, in which that medical officer gave an account of the voyage of the ship Golden Fleece from Annesley Bay to Portsmouth, via the Cape, with invalids from Abyssinia.

On the 5th of last June, 119 sick soldiers and fifteen sick officers embarked on board that vessel. Of the former, eight died during the voyage; and on the arrival of the ship at this port on the 1st of September, 111 were sent to Netley. Of the fifteen officers embarked, fourteen were under medical treatment during the voyage; one disembarked at Aden, and thirteen at Portsmouth for Netley. Among the troops, the prevailing diseases at the time of embarkation were dysentery, diarrhoea, and hepatitis. There were also two men who had suffered from insolatio, two from fracture, and five from gunshot wounds. The officers were, like the soldiers, chiefly affected with hepatic diseases, two laboured under the effects of insolatio, three from diarrhoea,

and two from rheumatism.

The heat in the Red Sea was intense and oppressive, and two soldiers died of heat apoplexy before the ship reached Aden, at which place it arrived on the seventh of the month. Three other deaths-namely, one by continued fever, one by hepatitis, and one by chronic dysentery, occurred between that date and the 14th of July, on which day the Golden Fleece made Simon's Bay. On the following day a soldier died from cancer in the stomach; on the 16th one from a relapse of dysentery, and on the 19th one from diarrhoea and general debility, after which no further death occurred during the

passage.

After leaving the Cape the more severely ill among the men were separated from the less severely affected, the latter being all accommodated on the lower deck. Parades took place three times a week for the examination by the medical officer of the men not actually confined to bed; and on the 16th of August, at one of the parades so held, a soldier was found affected with scurvy in a slight degree. A minute inspection of the invalids was held the following day, and a general tendency to the disease detected, although only apparent in the state of the gums, and most distinctly so among the convalescents on the lower deck. The numbers who had in the first instance been allotted to that part of the vessel were diminished; pickles, lime juice, and fresh meat were liberally given from the time that the scorbutic tendency was observed. On 23rd of August the ship touched at St. Mary's, one of the Western Isles, at which place a supply of fresh fruit was obtained. The scorbutic tendency had, however, already begun to give way, as the medical officer thinks, chiefly in consequence of additional space having been given to the men on the lower deck. He notices the fact that the scale of rations had been good, and sufficiently varied throughout the passage, and that therefore the cachectic condition alluded to could not be attributed to any defect connected with

food.

Medical News.

In consideration of the numerous victims of homeopathic treatment, a decree of the Emperor of Russia prohibits the practice of homoeopathy in the entire territories of Russian America.-L'Union Medicale. HYDROPHOBIA.—On Friday, a joiner, named Elkanah Turner, of Shay-lane, Ovenden, near Halifax, died in a fearful state from hydrophobia. It appears that about six weeks ago, a small terrier dog was given to deceased to destroy, it being a vicious animal. Instead of killing it, he sold it to a Mr. Smithson, and when on the way to deliver it, the dog bit him on the right hand. Next day the limb was inflamed, and gradually became worse, from which he shortly died in great agony.

The improvement in the Duke of Brabant's health continues, and every day adds to the hope of his recovery. He looks better, is more cheerful and animated, and his nights are less restless and more free from oppression and cough; so

much so that during the whole of last week the doctors (Wimmer and Henriette) do not find it necessary to hold any consultation with Dr. Spring, who hitherto during the Prince's illness has come once a week from Liège, where he resides, to give his opinion about the malady.-Court Circular. THE MILITARY SECRETARY, INDIA OFFICE, presents his compliments to the editor of The Medical Press and Circular, and begs to enclose a list of the candidates for Her Majesty's Indian Medical Service, who were successful at the last. India office, 2nd October, 1868. K. M. Downie, 2, 485; competitive examination at Chelsea, on the 10th of August F. M. Mackenzie, 2,240; C. R. Johnson, 2,130; W. E. Wrigt, 2.015; A. W. Supton, 2,005; W. C. Kiernander, 1,945; F. H. Blenkinsop, 1,910; G. Hutchson, 1,870; J. Macgregor, 1,850; J. Rabb, 1,775. (Maximum, 3,400 marks.)

LIST OF ENTRIES IN THE REGister of the BRANCH MEDICAL COUNCIL, IRELAND, FOR SEPTEMBER, 1868.-1st, Henry George Hall, 12, Seville Place, Memb. R.C.S., England, 1867, Licentiate 1868, and Lic. Midwifery, 1862, K.Q.C. Phys., Ireland; 4th, Henry Frazer, Gilford, Co. Down, Lic. 1868, and Lic. Midwfery 1868, K.Q. Coll. Phys. Ireland, Lic. R. Coll. Surg. Ireland; 8th, Thomas Joseph Aloysins Ryan, Cork, Lic. Apoth. Hall, Dublin, 1865, Lic. R. Coll. Phys. Edin., 1660, Lic. R. Coll. Surg., Edin., 1680; 19th, John Laird, Drumshombo, Co. Leitrim, Lic. R. Coll. Surg., Ireland, 1865, Lic. 1860 and Lic. Mid., 1860, K.Q. Coll. Phys., Ireland; 12th, John Colvan Sugars, Portadown, Co. Armagh, M.D., 1868, and Mastr. Surg, 1868, Q. Un. Ireland; 15th, Edward Joseph Nugent, 129, Stamford Street, London, Lic. R. Coll. Surg., Ireland, 1866; 22nd, Albert Johnson Watson, Cooldrina, Leixlip, Co. Dublin, Lic. R. Coll. Surg., Ireland, 1868, Lic. Fac. Phys. and Surg., Glasgow, 1868; 25th, Robert Henry Stevenson, Tartaragham, Co. Armagh, M.D. Qu. Un., Ireland, 1868; 29th, Robert Gage Fleming, Newtownlimavady, Co. Derry, Lic. R. Coll. Surg., Edin., 1867, M.D. Qu. Un., Ireland, 1868.

THE PUBLIC HEALTH.-The Registrar-General, in his usual return, states: In the week that ended on Saturday, Sept. 6th, the annual rate of mortality was 25 per 1,000 persons living. The rate was 22 per 1,000 in London, and 28 in Edinburgh; 19 in Bristol, 20 in Birmingham, 31 in Liverpool, 35 in Manchester, 42 in Salford, 23 in Sheffield, 32 in Bradford, 34 in Leeds, 22 in Hull, 25 in Newcastle-upon-Tyne, and 28 in Glasgow. The excessive mortality from summer diarrhoea, principally infantile, which recently prevailed, has nearly disappeared. The deaths referred to this disease in the eleven large English towns, which exceeded 900 both in the last week of July and the first of August, had declined to 228 in the week. During the ten weeks the annual death-rate from diarrhoea in the several towns was 4 per 1,000 in London, Bristol, and Newcastle, 7 in Bradford, 8 in Liverpool, Shef field, and Hull, 10 in Manchester, Salford, and Leeds; and highest, 11 per 1,000 in Birmingham. More than 6,000 deaths were referred to this disease in these eleven towns during the ten weeks, thus raising the average annual death-rate by 6 per 1,000 persons living. The deaths registered in London during the week were 1,327. It was the thirty-ninth week of the year, and the average number of deaths for that week is, with a correction for increase of population, 1,285. The deaths in the present return exceed by 42!the estimated amount, and exceed by 507 the number recorded in the preceeding week. The deaths from zymotic diseases wers 371, the corrected average number being 387. Twenty-five deaths from measles, 101 from scarlatina, 7 from dyptheria, 20 from whoopingcough, 62 from fever, and 64 from diarrhoea were registered.

COLOUR-BLINDNESS.-In an interesting paper recently laid before the Society of Industrial Sciences at Lyons, Professor Fournet announced that he had himself a singular imperfection in the visual organs known under the name of Daltonism, and which is much more common than is generally supposed. The defect consists of an erroneous perception of colours, and is named after Dr. Dalton, a celebrated English physician, who first discovered the peculiarity in himself, and found that cherries and their leaves had for him the same tint. M. Fournet knew two students of the Ecole des Mines, who, having no clear idea of colours, were unable to distinguish the various minerals, and one of them having to use a carmine wash in some drawing, used Indian ink for the purpose. In a lengthy treatise, Dr. Potton, of Lyons, has ranged in the same category a large number of shopmen who were obliged to be dismissed for the simple reason that they could never distin

BURKITT.-On September 16th, on his way from the West Indies, John M. Burkittt, M.D., L. R.C.S.I., second son of Dr, Robert J. Burkitt, of Waterford (Ireland,) aged 24 years.

COOKESLEY.-On the 23rd ult., at The Grove, Boltons, South Kensington, J. M. Cookesley, M. D., late of Boulogne-sur-Mer, aged 58. COST.-On the 12th of August, at Munmar, near Bombay, T. 8. Cost, Esq., of Egutpoora, Assistant-Surgeon G.I.P. Railway. FISHER. On the 29th ult., at Sittingbourne, Kent, James Howard, the youngest son of Charles Holdrich Fisher, M.D, aged 2 years. GREENBANK.-On the 24th of August, at Philadelphia, the Rev. Richard M. Greenbank, A. M., M.D., of Sedbergh, Yorkshire. MOORE. On the 19th ult., Y. J. Moore, M.R.C.S. E., of Torquay, aged 41.

ROOTES-On the 27th ult., of diphtheria, at Guy's Hospital. London, where he was one of the House-Surgeons, George Rootes, son of W. Symonds Rootes, M.D., of Ross, Herefordshire, aged 24.

NOTICES TO CORRESPONDENTS.

Mr. F. S. GARLICK, Halifax.-In our next.

Mr. W. E. C. NOURSE.-Owing to the length of the Introductory Addresses and pieces of other matter, we are again compelled to defer the insertion of your letter. We have given four pages extra this week to accommodate our friends. UNIVERSITY OF LONDON.-Pass List received with thanks. We regret that press of matter compels us to postpone the publication of this List.

The following communications are in type, and shall appear as soon as possible :-Dr. Phelan, on "Lying-in Hospitals." Dr. Morgan, on "Total Destruction of the Epiglottis," illustrated. "Notes on Carbolate of Quinia," by Dr. H. S. Purdon. "The Forms of Pneumonia," by Dr. Octavius Sturges. "A Lecture on Health and Disease," by Dr. Thos. C. Shiokwin, &c. Dr. McGRIGOR CROFT.-Perhaps next week; the subject has, however, been before discussed in our columns before the invention changed hands.

Mr. R. TEBBOTT.-The points in your argument were clothed somewhat ambiguously; your second letter is eminently satisfactory, for which please receive our thanks.

The following will please to receive our thanks for enclosures re

Advertisements.

ROYAL COLLEGES OF PHYSICIANS AND SURGEONS OF OF EDINBURGH.

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OTICE IS HEREBY GIVEN, that the PRELIMI NARY EXAMINATIONS in GENERAL EDUCATION by the Royal Colleges of Physicians and Surgeons of Edinburgh, during the Sessional Year 1868-69, will be held on the following days, viz.:Saturday, October 24th, 1868; Saturday, November 7th, 1868; Saturday, April 24th, 1869; and Saturday, July 24th, 1869. On each occasion the Examination will be continued on the succeeding Monday. Information as to the Subjects of Examination, &c., may be had on application to the Officers of either College.

Intending Students of Medicine are reminded that they must pass the above Examination, or one of those accepted by the General Medical Council as equivalent to it, before they can be registered as Medical Students.

D. R. HALDANE, Secy. to the Royal College of Physicians
JAMES SIMSON, Secy. to the Royal College of Surgeons.

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Clinical Lectures on Diseases of the Liver. M.D., F.R.S. London: Longmans, Green, & Co. The British Army in 1868 Third Edition.

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Original Communications.

SYPHILITIC AFFECTIONS OF THE LARYNX. By Mr. MORGAN, F. R.C.S.I., A. M., T.C.D.,

Surgeon to the Westmoreland Lock Hospital.

AFFECTIONS of the larynx occurring during the various stages of syphilitic infection have always been of interest to the practitioner, and of great anxiety to the patient, -to the one from the difficulty of thorough inspection and appreciation of the morbid condition, to the other, from the inconvenience of the diseased phenomena. Since the introduction of the laryngoscope, however, fresh and more definite information has been gained, and such facility attained, especially in the local application of remedies, that I have selected the following cases occurring in my wards of the Lock Hospital, in illustration of the increased facility of treatment, showing ulceration of the laryngeal membrane, whether as the sequel of a primary infection, of constitutional infection from childbearing, or combined with primary at the time of its existence. All the cases illustrated were treated without mercury, and the cure of the laryngeal ulceration chiefly accomplished by the application of tannin solution, which I have found particularly to agree with these ulcers, whether touched directly with the solution, or applied by the spray producer.

TOTAL DESTRUCTION OF THE EPIGLOTTIS BY SYPHILITIC

ULCERATION EIGHT YEARS AFTER INFECTION.

THE accompanying illustration shows the extensive destruction of the epiglottis that can take place with impunity. Considering the extreme sensibility of this region and the delicate anatomical arrangement concerned, it is extraordinary that so protective and mechanically important a structure can be dispensed with, or that its office can be supplemented or even entirely supplied by the accommodation of the parts around.

In Baron Larry's celebrated case of the soldier who had the epiglottis shot away, the accommodation is well shown, as the patient was in danger of dying from inanition, such was the difficulty of swallowing drink or food, till time effected a compromise, though at first being fed with a tube introduced into the pharynx, the man was after six weeks enabled to swallow soft food, and finally could accomplish deglutition without difficulty,

The subject of the illustration No. 3, A. W., was admitted to my wards in the Lock Hospital (ward 1, bed No. 3), June 24th, 1868, complaining of hoarseness and difficulty of breathing, but specially annoyed by threatened suffocation when drinking, and that at night the secretions trickled down and awoke her with fits of coughing. The voice was not that of the syphilitic aphonia of Diday, described by him as a failure of voice on attempting high notes, but was peculiar in that, no matter how she exerted herself, she could not increase the tone or intensity, nor could she speak in a whisper; on attempting it, the voice was at once lost. This condition had existed for nine months. The patient is otherwise in good condition and vigorous, affording no symptom of chest affection; there is no stridor on taking a deep breath, or any very great inconvenience but in eating and drinking. She gives the following history:- She is ten years unvirtuous. Eight years ago she got a primary sore, and in a few weeks after got an eruption generally over the skin; from her description it would appear to be squamous, since which date she has never had any sign whatever of the infection, till about nine months ago she became hoarse, and had some difficulty in breathing. There are no cicatrices, osseous enlargements, or other signs of any venereal taint. On laryngoscopic examination, the epiglottis is seen to be completely cut away by ulceration, the edge is irregular and jagged, and two small specks of ulceration still remain ; the edge is eaten down to the very frænum epiglottidis, and the rima is plainly discernible uncovered by the epiglottis, which is as effectually taken away as the knife could do it; the arytenoid movements are free, and the vocal cords are not swollen, but seem rigid and unpliant, and can only be protected by the accommodation of the muscles and parts immediately around.

She is compelled to drink in gulps only, but can swallow solids tolerably well.

The ulcers were treated by applying a jet from a sprayproducer of weak tannin solution, gr. xxx. ad. 3j., every second or third day, the irritability of the opening being thus considerably diminished. The patient was discharged

much relieved August 3, 1868.

(See illustration, No. 3.)

ULCERATIONS OF EPIGLOTTIS COMBINED WITH PRIMARY SORES ON GENITALS, AND BUBO. K. B., aged 24 (ward 1, bed No. 7), was admitted 18th August, 1868, suffering from patchy soft sores on genitals, followed by non-suppurating bubo on one side. She is of

the chest.

On laryngoscopic examination, the appearance of the epiglottis was remark ble, four little ulcers being visible on the free edge, three the size of a large pin's head each, and the fourth about the half of a No. 5 shot. The epiglottis was otherwise healthy looking and pliable; the aryteno-epiglottidean folds appeare I flabby and pale; the arytenoid movements were perfect and very distinct. Treatment. The ulcers were well brushed with nitrate of silver solution, gr. xxx. ad. 3., and taunin solution, gr. xxx. ad. 3j., applied to the folds, which constringed the membrane, and caused the healing of the epiglottidean ulcers. The general treatment consisted of large doses of iodide of potassium, iron, bitter infusion, and good diet, with local applications to the sores and bubo, which was resolved. She was discharged cured September 28, 1868. (See illustration, No. 2.)

She has never before had any venereal affection, and has been rather poorly circumstanced now, being eight months unvirtuous. There is no difficulty in swallowing; and on examination, the chest sounds are perfectly healthy; there is a slight anæmic bruit in the jugular veins; engorgement of the cervical glands, and of one under the jaw. On laryngoscopic examination, the right false chorda vocalis is distinctly swollen, and sufficiently tumid to encroach upon the opening of the glottis; at its arytenoid extremity an ulcer is seen of a greyish colour, about the size of a split pea, exhibiting not so much the appearance of a "mucas patch" as of a distinct ulcer, with well marked edges, as in torn.

Treatment.--The ulcer was touched on four occasions with nitrate of silver solution, gr. xxx. ad. Zj., and tannin solution, gr. xxx. ad. 3., ten-grain doses of citrate of iron and iodide of potassium in bitter infusion, good diet, and occasional warin baths dissipated all the symptoms, the patient being discharged with completely restored health, August 4, 1868. (See illustration, No. 4.)

ULCER OF LARYNX NINE MONTHS AFTER PRIMARY

INFECTION.

WOMAN INFECTED BY CHILD BEARING, NEVER HAVING HAD PRIMARIES.

R. D., aged 26, a married woman (bed No. 11, married ward), admitted August 31, 1868, mother of two children, one two years old, another born one year since, but died, when eleven weeks old, of infantile syphilis. Two months after the birth of the first child she had sore throat and pains in the head, and in about four months she got a sore on the head over the frontal bone, which healed after treatment; she remained well till after the birth of the second child, when, in about three weeks, she got sore throat, and about nine months after got secondary sores on the arm, chin, eye, and head, over the parietal region; she never had joint pains or rash, primary sore or bubo; she is hoarse now for four months, is losing flesh, and has been under treatment for these affections for one year and nine months. The chest sounds are perfect.

On laryngoscopic examination, a well-marked deep ulcer like a chink is seen at the base of the right arytenoid, near the attachment of the false vocal chord; the mucous membrane generally in the neighbourhood is congested looking and tumid.

Treatment. The parts around and the ulcer were brushed with nitrate of silver solution, gr. xxx. ad. 3j., and every third day touched with tannin solution, gr. xxx. ad. 3. Iodide of potassium in large doses a iministered. The improvement after three applications to the larynx was remarkable, though the ulcer, from the mobility probably, was rather refractory.

This case is an interesting example of intermediate infection by child-bearing, and the more complete affection of the system after the birth of the second child. She is now again about four months pregnant. Discharged cured September 26.

(See illustration, No. 1.)

ULCER OF THE FALSE CHORDA VOCALIS, WITH FIRST SORES ON GENITALS, AND ERUPTION.

R. B., aged 23, a patient (bed No. 11, first admission ward), presented all the symptoms of syphilitic cachexia, being affected with several patchy soft sores of the labia, disseminated papular eruption, a murky hue of the skin, some osteoscopic pains, and suffered much from hoarseness with partial loss of voice. She dates the initial sore as occurring about six weeks ago, and that two weeks after its formation the papular eruption appeared, first in the ower limbs; and about two weeks after the eruption the

M. B., admitted July 31 (bed 6, ward No. 1), married, aged 31; was infected by her husband nine months previous to admission with soft sores, and a vaginal discharge; cations chiefly. She remained without any symptom whatever of the disease till three weeks previous to admission, when she became affected by the formation of mucous patches" about the anus, and slight vegetations in the vicinity of the urethral orifice; she also suffered a little from osteoscopic pains. On admission, there was no hoarseness or difficulty of respiration; but about three weeks after this date she got hoarse, and gradually the voice became nearly extinct.

66

On laryngoscopic examination, an elevation of the mucous membrane, with ulceration of the surface, could be distinctly seen in the space between the bases of the arytenoid cartilages, the appearance being that exactly of a mucous patch" of the membrane in this region.

66

Treatment. The "patch" was touched with nitrate of silver solution, gr. xxx. ad. 3j., and afterwards on four occasions with tannin solution, gr. lx. ad. 3j., gr. x. doses of iodide of potassium in bitter infusion, and local applications to the anal patches, effected a cure. Discharged September 28.

(See illustration, No. 5.)

of the voed chords.

The occurrence in this case of the "mucous patch," both far to explain the cause of the peculiar voice of syphilitic at the anus and in the larynx simultaneously, would go infants, as called by Colles, "the peculiar hoarse cry," so characteristic a token of infantile infection. The hoarseness gradually comes on, as Rosen remarks," without ay man fest cause," and remains till the taint is removed by treatment. A the formation of " mucous patches" on the cheek, tongue, and lips is of so frequent an occurrence in infants it is to be concluded, as in this case, in the adults (fig. 5), that “mucous patches" form in the vicinity I have had an opportunity of fully and carefully examining, after death, the fauces of a child that died in the Lock Hospital, after an existence of six weeks in a pining condition from birth. The mother was suffering from syphilis at the time. The infant had no rash on the body, but had "mucous patches" at the anus and the commisure of the lips: it was impossible to see the back of the throat during life. After death, however, at the base of the tongue a patch was to be seen and another far down on the back of the pharynx. A full post-mortem was not admissible, but it is not unreasonable to conclude that the "peculiar hoarse cry" was caused by the existence of a "patch" in the more immediate neighbourhood of the vocal chords, as one of the phenomena