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locomotion; but nothing occurred which could be called analarming symptom. As a rule, indeed, the mental condi-tion improved, the excitement, irritability, and motor

restlessness being diminished and the wretchedness dis-

pelled. It will thus be seen that the writer’s conclusionsare in accord with the majority of those already published,and that, while regarding sulphonal as by no means a perfecthypnotic, he is inclined to give it a very important place inthe treatment of sleeplessness and restlessness generally.The best doses he found to be between thirty and fortygrains, and it should be given just before the patient liesdown. The freedom of the drug from taste and smell, ashas been said, is one of its advantages, and renders itsadministration easy.

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THE PREVENTION OF RABIES.

WERE it not that experience has fully proved, both inEngland and on the Continent, the efficiency of the muzzleas a preventive of the spread of hydrophobia, we mightexcuse the delusion that the disease lately so prevalent in thiscountry has died anatural death. The facts mentioned in THELANCET of April 5th, 1890, however, show too close a con-nexion between the prophylactic method and its effect toadmit of any real doubt upon the subject. The past yearhas been a period of probation. The immunity conferredby the muzzling order has not, perhaps, unnaturally beentaken as justifying its discontinuance in favour of the lessirksome system of collar registration, and so far, there is

every reason to believe, with fairly satisfactory results.In this way such cases of rabies at least as arise amongstray dogs, and they comprise the greater number, should,if the regulations aie stringently enforced, be held in check.Of the efficiency of the muzzling system and the justice of

. its application two years ago we cannot entertain a doubt.In its absence registration is and must remain for sometime to come quite indispensable. It is difficult indeed tosee how, wibhout some such preventive arrangement,security against the disease can be relied upon. We trust,moreover, that, on the least sign of a recrudescence of thedisease, in the interest of our faithful friends the dogs aswell as of the human race, muzzling may again be strictlyenforced.

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DEATH FROM ATTENDING FUNERALS.

IT is one of the privileges of members of the medical pro-fession that they have the opportunities of seeing thevarious abuses incidental to our everyday life, and of sug-gesting the remedies, which, however, are not generallyheeded. By the death of the Duke of Clarence and Avon-dale the public mind has been thoroughly aroused to thedanger ’which has for years past been repeatedly pointedout in these pages. All the various suggestions now madeas to keeping the head covered and shortening the serviceat the graveside, so far from being original, as the variouscorrespondents would appear to imply, were suggested inTHE LANCET years ago. Our locl1.1 correspondent for-warded to us details of the deauh of a leading Liver-

pool citizen whose death was the direct result of a chillcaught while standing bareheaded at a funeral, and at

his own funeral, which followed but a fortnight after, theattendant relatives and friends were requested to remaincovered. Now that attention is strongly drawn to thispainfully important matter it may be profitable to supple-ment the preceding with some further remarks. Noneshould attend funerals in such weather as now prevailsexcept those who are in robust health; the aged and thosewhose health is in any degree delicate should be absolutelyforbidden to do so. It is not only at the graveside thatfatal chills are acquired. Cemetery chapels are proverbiallychilly places, and it is to be feared that care is not taken to

sufficiently warm them previously. This is all the more im.

perative, since in cold and inclement weather the whole ofthe service (excepb what must necessarily be said at thegrave), and particularly any address or panegyric on thedeceased, should be said in the chapel. Some clergymenwho wish strictly to obey the rubrics may objecb to sayingin the chapel what is ordered to be said at the graveside.We would point out, however, that there is one rubricwhich it is necessary to disregard-viz., the dipping ofan infant into the water at baptism. In spite of theplainest words which a rubric can have no child is dippedhowever "discreetly and warily," and the attendants arenot even asked whether the child "may well endure it."Whether the rubric was ever obeyed is a question which hasnever been satisfactorily answered ; it is enough that noinfant should be subjected to such a risk. By a parity ofreasoning it may be urged that the attendants at funeralsought not to be exposed to a similar danger.

CARDIFF AND IMPORTED INFECTION.

A PROPOSAL is before the Cardiff corporation, in theircapacity as port sanitary authority, to place on a morepermanent and efficient footing the sanitary inspection ofvessels entering the port, the more especially with a viewto prevent the importation of infection. To fulfil thevarious requirements which are held to be necessary byDr. Walford, the port medical officer of health, it would berequisite to employ a steamer, which should be constantlyat the disposal of the port sanitary staff, and to add one ormore inspectors to the staff. Cardiff has more than oncebeen thus compelled temporarily to widen the scope of

port inspection, and has doubtless found the hire of asteamer costly; but, if such an arrangement as is now

proposed were adopted as a permanent measure, the portwould be much more secure as regards imported infection,always a source of expense and of possible panic, andhindrances to commerce would, to the utmost, be prevented.Other ports, such as the Tyne port, have long since adopteda similar system, and it can hardly be otherwise than anadvantage at Cardiff, where the circumstances of the port inrelation to the Bristol Channel tend to present somewhatexceptional difficulties under the system now in operation.

PROFESSOR GAIRDNER ON CLINICALINSTRUCTION.

PROFESSOR GAIBDNER, whose interest in clinical medicine,and especially in clinical teaching, is unsleeping, has beenreading Sir Andrew Clark’s lecture and our leading articleon the subject, and kindly forwards us a lecture, intro.

ductory to a course of clinical medicine, which has neverbeen published, but which is a type of one he is in thehabit of giving to his students in printed form. Ittreats of the real import and method of clinical instruc-tion, and, we need not say, goes thoroughly to the rootof the matter, insisting that both instructor and instructedare to be in the presence of the patient, and learningthe lessons of disease together from the absolute sourceof all real and final knowledge in respect to disease-thesick man. The lessons of a practitioner to his apprenticesin the days when apprenticeship still existed were trueclinical instruction ; and with such a man as Abercrombie,who practised this method exclusively, they must haveafforded clinical instruction of the best and highest kind. Dr.Gairdner adds that a well-conducted dispensary, in whichthe physicians not only see the patients at the dispensary, butfollow them up at their own homes and along with theirpupils, is also a very fruitful and admirable field for trueclinical instruction, and one which only requires competentand devoted men to make it at least equal, if not superior,to any other. Strange to say, however, neither of these is

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counted as formal clinical instruction in the curriculum of

study. Dr. Gairdner affirms such kind of instruction to hedesirable, and regards it as a modification of the GermanPoliktinik, or clinique of the town. With his usual pre-cision, he indicates the only limitations to the usefulness ofthis mode of instruction. The one is the limited number ofmen fit for such work, and the other is the risk of " hurry-scurring" through thirty or forty cases in an hour, as

sometimes must occur in the out-practice of hospitals.It is one of the recommendations of more private lessons,.ag in dispensary or general practice, that, being given inthe very homes and houses of the patients, there is themore guarantee for that humane and considerate treat-ment of the patient and for a certain amount of

thoroughness on which both Sir Andrew Clark and IProfessor Gairdner so properly insist. There are surely I

among the many thousand practitioners of Great Britainnot a few who could give most valuable lessons in the artof detecting and treating disease. The remainder of Dr.- Gairdner’s lecture deals with the importance of rightmethods of clinical instruction, the place of clinical

lectures, the physician and the patient and the ethics ofa clinical course, the details of clinical work, the verifi-catiom of details, and the composition of clinical lecturesproper. He thinks that a hospital patient, as comparedwith a rich man, derives immense benefit from themethodical investigation of his case. He allows that

4’ lecturing" is often overdone in clinical teaching, and heinsists, as all good teachers do, on treating the student andeven his mistakes with respect. It is clear that themethods of clinical instruction are about to receive more.attention than ever, and they both deserve and need suchattention.

BURIAL REFORM AND THE CITY CHURCHES

AT a recent meeting of the Church of England BurialReform Association, held in the vestry of St. Edmund theKing, Lombard-street, under the presidency of ArchdeaconSinclair, allusion was naturally made to the recent dis-closures at the neighbouring church of Sb. Mary, Woolnoth.’The Rev. F. Lawrence, the indefatigable secretary of theAssociation, observed that all the officials of the last-namedehurch had suffered from sore-throats in consequence of theioul air in the church arising from the large number of dead Ibodies in the vaults beneath. He quoted the words of Sir John IfSimon, to the effect that the most successful hermetical !sealing of dead bodies might retard, but could not possibly ’’,prevent, the escape of poisonous gases which mingled withthe air in the church above, to the great detriment of those:assembled there. The experience at St. Mary’s only addedanother example to the several other City churches whichhad been rendered equally unwholesome. The bodies en-tombed beneath that church will have to be removed and’buried in some suburban cemetery, as is generally done now,and as should have been done always.

PERITONITIS FROM PERFORATION OF THEINTESTINE IN UTERO.

DR. ANTON GENERSICH of Clausenburg recently ex-

hibited at a meeting of a Hungarian Pathological Society.a case of peritonitis occurring in an infant which haddoubtless originated from perforation of the small intestinebefore birth. He referred to Dr. Zillner’s report of severalsomewhat similar cases where the sigmoid flexure had beenruptured, the explanation proposed by Dr. Zillner being thatthe rupture was due to distension by meconium of a coil ofintestine fixed between the vertebral column and the abdo-minal walls. He considered that pressure and distensionf this kind must occur even in normal parturition ; butthis view is combated by Dr. Platauf, who insists that the

rupture is due to fsecal accumulation without any externalmechanical cause, such as the pressure exerted in labour.In Dr. Genersich’s case an abscess containing meconium hadformed under the umbilicus, this abscess communicatingwith the ileum by means of an infundibuliform passage.The extent and character of the granulations, which hadbecome calcareous in some places, and the firm adhe-sions in the neighbourhood of the lesion, showed thatthe perforation must have taken place some timebefore birth, as the child only lived forty-five hours.It is probable that the pressure during birth and theentrance subsequently of pathogenic bacilli through thealimentary canal caused a sudden increase of the peri-tonitis as well as the phlegmonous inflammation of theabdominal walls. The spontaneous perforation of the ileumis, as has been well pointed out in this country in somewhatsimilar cases by Mr. Bland Sutton, intelligible only byreferring to the embryology of the intestines. A smallMeekel’s diverticulum may have been split on the spon-taneous reduction of the normal umbilical hernia, or theobliteration of the physiological umbilicus may have re-mained incomplete, so that on the retrogression of theumbilical coil of intestine a small aperture was left, fromwhich the meconium percolated into the peritoneal cavity,subsequently becoming encapsulated by adhesions betweenthe intestines, the omentum, and the abdominal walls. Thelatter view is the one which Dr. Genersich considers themost applicable in the present case, as a most minuteexamination resulted in finding no vestige of a diverticulum,while the large intestines were found to be rather thin.

IS CHELMSFORD WATER-LOGGED ?

AN increase of diphtheria in the town of Chelmsford,taken together with the now admitted circumstance thatthe diffusion and maintenance of that disease are in some

way related to damp and cold soils, has raised the questionas to whether this Essex town is water-logged or not. Thisis a matter which ought long ago to have been set at rest,for it is no less than twenty-six years since Dr. Buchananpresented to the Privy Coumil Office his classical report onthe relation of phthisis to subsoil wetness, and in this hequoted the case of Chelmsford as one of the crucial proofsof his contention. He then showed that in a number oftowns where deep sewerage had lowered the subsoil waterthere had been a remarkable diminution in the rate of

phthisis mortality; but when he came to Chelmsford, whereworks of equal importance had been carried out, no vestigeof any corresponding diminution of the phthisis death-ratecould be discovered. The explanation, he maintained, layin the fact that mill-rights, with their corresponding flood-gates below the town, held up the river water, and so

prevented any reduction of subsoil wetness beneath thetown. If ever there was a case for immediatelysecuring the benefits elsewhere obtained by the result ofdeep drainage it was at Chelmsford, and many have doubt-less come to the conclusion that the story of 1866 is amatter of curious past sanitary history. Such observerswill be astonished to find that a discussion has recentlytaken place in the Town Council on the subject, 11 its thetown water-logged ? " and that the question still arises in1892 whether the heading-back of the river water at suchplaces as Moulsham Mill shall be prevented by purchasingthe mill rights. The most that could be said at the meetingwas that the whole of the soil beneath the town was not

water.logged, the South Ward standing upon a compara-tively dry surface. But, as regards the remainder of thetown, it would seem that matters stand just where theyhave done all these twenty.six years in which Chelmsfordhas served as witness to the injurious effects of a maintainedhigh level of subsoil water. Now that the matter is again