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think, be found most useful in sick chambers, small rooms,and offices, and, if sufficiently large, at the stations of theUnderground Railway, should it be necessary to purify thelarge volume of air that will not enter the chamber after itemerges from the tunnels. An eminent firm in London isconstructing these punkabs, and hope soon to have them onpublic view. In theatres and other large buildings it is pro.posed to have one or more intakes in the roof, or elsewhere,connected by hose or tubes, with a sufficiently powerful ex-hausting fan in the basement of the building ; the foul airfrom above is then driven through a tank, or other form ofchemical lung, and allowed to escape and find its way backagain to the upper part of the building, being cooled, if need be,or oxygen added if desirable. The application of this prin-ciple to the purification of the air in Turkish baths, and alsoto destroy any noxious gases emanating from cremationfurnaces, is self-evident. Many have been the views takenof each individual portion of the scheme ; experience alonecan test its strong and weak points. As regards the Under-ground Railway, a few hours would be sufficient to form adecided opinion; with a single lung, the air, on entrance andexit, being analysed, would at once show the amount of foulgases passing through and destroyed in a given time andspace. The necessary amount of alkali per train could thenbe easily calculated.

I am, Sir. vours. &c..

Boundary-road, S. Hampstead, Aug. 21st, 1880.RICHARD NEALE, M.D. Lond.

"INFLAMMATORY AFFECTIONS OF THEJOINTS IN CHILDHOOD."

HENRY F. BAKER,

To the Editor of THE LANCET.SIR,—In a clinical lecture by Mr. Howard Marsh, on

" The Treatment of Chronic Inflammatory Affections of theJoints in Childhood, with especial reference to Excision,"which appeared in THE LANCET of July 31st, he points outin a very able manner the advantages of the treatment byrest and the use of leather splints, in which I entirely agreewith him. He says, however, that many cases come underhis notice of deformity as the result of other forms of treat-ment, and he asks the question : "Is surgery unequal to thetreatment of these distorted joints-are not these just thecases for excision ?" and in answering this question he says:" I grant these, if any, are the cases for which excision isappropriate ; cases, that is, in which there is little or nodisease, but much distortion. But the point is that youexcise a joint not because it is the seat of incurable disease,but because it has been allowed to get out of shape. Pre-vent the deformity and the necessity for excision vanishes."Now, in this I venture to think Mr. Marsh is in error, and

the question should rather be answered thus :-Very manyof these cases of deformity for which, in Mr. Marsh’sopinion, excision is appropriate, and especially those affect-ing the knee and ankle, can be rectified by gradual extensionafter tenotomy, sometimes with a stiff joint, and in othercases with more or less motion, according to the extent ofthe original disease. From the number of contracted jointsthat have come under my notice, and which have been suc-cessfully treated by this method, I infer that the value ofthis mode of treatment is not sufficiently recognised.

I am, Sir, yours faithfully,

Hanover-square, August 3rd, 1880.

LEATHER STRAPS v. BANDAGES.

GEO. E. JEAFFRESON,

To the Editor of THE LANCET.SIR,—The liability of bandages and slings, when required

to bear any strain to stretch and ruck, must be generallyrecognised. This disadvantage is particularly noticeablewhen treating a fracture of the clavicle or acromion process.Mr. G. Cardy Edwards of Ipswich, fifty years ago, met thisdisadvantage in fracture of the clavicle by the use of acouple of round leather straps, with an oval pad with abuckle on it at one end, and holes at the other. Thesestraps he applied as an ordinary figure-of-eight bandage,either pad being in front of either shoulder. The coolness,comfort, and firmness of these clavicle straps have inducedme to keep and use them for the past twenty years.

Last winter the horse of the whip to the Duke of

Hamilton’s harriers, while galloping across a ploughed field,placed its feet into a water furrow, threw the whip, and,in rolling over, struck his acromion with the edge of theback of the saddle and fractured it. I put it up in the or-dinary way, with sling, pad, and bandage. At the end offorty-eight hours I was dissatisfied with its firmness, andthought possibly the frequency of fibrous union in thesefractures might be due to the difficulty of keeping the ends inperfect apposition. I discarded the sling and bandage, andused the clavicle straps. One pad I placed under theelbow, and the other on the proximal side of the fracturedacromion, and tightened the straps till the ends of the frac-ture were in perfect position. I had put a second buckle onthe acromion pad, to which I fastened one end of a roundleather strap, and carried it across the back, under the arm,and up in front of the chest, and fixed the end in the samebuckle. The ordinary pad and the arm were kept to theside by another strap round the chest. Everything kept inperfect position. The clavicle straps brought the ends ofthe fracture quite close, and the second strap from theacromial pad made him, as he expressed it, "feel quitewhole."The coolness, firmness, and sense of security given by the

leather straps, I think, ought to lead to the sling andbandage being discarded in their favour.

I am. Sir. vour obedient servant.Framlingham, Aug., 1880.

CASE OF COIN-SWALLOWING.

JAMES WORTHINGTON,Surgeon to Lowestoft Hospital.

To the Editor of THE LANCET.SIR,—Perhaps you may think it worth while to publish

the following case as exemplifying the treatment alluded toin your number of July 31st, in a case of a child swallowingthe tongue of a bell :-A man, aged fifty-one, of rather irregular habits, swallowed

three sovereigns at a gulp for the wager of a pot of beer. Thenext morning, being in a more thoughtful frame of mind, heconsulted me as to what was best to be done, feeling appre-hensive as to the result of the previous evening’s folly.directed him to eat as much solid food as possible, avoidingsuperfluous fluids. The fear of impending mischief seemedto stimulate his appetite, for he carried out my advice in awonderful manner. In twenty-four hours he was rewardedby hearing the merry chink of his three sovereigns onceagain in his pocket. He had holes bored in his coins ; onehe wears appended to his watch-chain, perhaps to remindhim of his foolhardihood, another he presented to a friend,who wears it in the same way, and the other was, I believe,exchanged to the loser of the wager for one which had notpassed through the same unusual experiences.

I have frequently had occasion to advise eating, to thefull, solid food in cases where foreign substances have beenswallowed, and I cannot call to mind a single instance inwhich such treatment, when adopted immediately, failed tocarry off the offending body. Although I have never seen aninstance of fatal termination in any such cases where purga-tives have been at once administered, I do know of somewhere prolonged anxiety and pain have been occasioned bysuch treatment, notably in the case of a woman whoswallowed a date stone, and hoped to rid herself of it byimmediately taking a dose of castor oil. This patient suf-fered considerable pain about the neighbourhood of theduodenum, striking through to the back, increased aftereating, and sometimes accompanied with great anxiety andsome feverishness. This condition lasted for many weeks,and only subsided very gradually.

Faithfully yours,

I July 31st, 1880.

PARIS.(From our own Correspondent.)

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THE pestilential smells which have infested Paris forsome time are awakening a feeling of indignation against theresponsible authorities, which is expressed freely in the dailypapers, and that quite independent of party spirit. A fewdays since, the well known critic, Francisque Sarcey, devotedan article to this matter in the Dix-Neuvidme Siecle, and