164

the same arrangement secures the diffusion of noxiousinfluences which are less easily traced than the contagionof small-pox. Surely some directions might be given toseparate the wards more perfectly, and to secure for themindependent ventilation. In many respects the arrange-ments of St. George’s Hospital do not compare advan-tageously with a modern workhouse hospital, and we wouldrecommend that the whole subject be remitted to competentadvisers for report. ____

RARITY OF THE HEALING OF CUNSHOTWOUNDS.

AN interesting paper, with this title, appears in a latenumber of the Wiener Itleciizin2schsr Wochenschrift, from thepen of Professor Billroth. He refers to various cases inpen of Professor Billroth. He refers to various cases incivil practice in which fragments of iron, chipped off byhammers or chisels, penetrated the skin, and caused littleirritation of the parts, healing rapidly occurring when theywere removed; but his experience of the present war hasproved to him that modern bullets, &c., are by no meanssuch unexciting guests. " Sooner or later in almost everyinstance," he says, "they excite suppuration, and it is rareto meet with a case which hea’s without pain and the dis-charge of pus." And he proceeds to explain the reason ofthis. Most of the projectiles he has extracted have theirform changed, so that they appear as amorphous and oftensharp-angled masses, and these sharp angles undoubtedlycause great irritation. When such a body is present, andyet cannot be found, repeated incisions with the object ofletting out pus are insufncient to arrest the progress of theinflammation, though this is immediately produced by theremoval of the foreign body. Fragments of granite actexactly in a similar manner to these irregular pieces ofmetal. Elongated bullets in particular become mult-angular when they strike against a bone, either simplybreaking or comminuting it. The coincident injury of theperiosteum with that of the bone is of the greatest im-portance in the production of the inflammatory process.Acute osteo-myelitis and periostitis have cell-proliferation soconstantly as their result that to these, as much as to theangular missile, the suppuration must be attributed. Evenquite unaltered projectiles have usually a pyogenic action,pus appearing two, four, or even six weeks after the receiptof the injury, especially when they lodge in the head of thehumerus, tibia, or femur; healing is here very rare, thebony tissue being more or less broken down, and suppura-tion, osteitis, periostitis, and inflammation of the jointoccurring sometimes at a very late period, and quite unex-pectedly. If, however, the ball can be extracted withoutdamaging or opening the joint, the result is often veryspeedy and successful. He records two cases in which per-fectly smooth and unaltered projectiles occasioned violentsuppuration. In all cases, then, he recommends that bul-lets and other projectiles should be removed as soon aspracticable with loug clawed forceps. In the several cavi-

ties, however, and in the region of the neck, groping aftera ball should be carefully avoided. Nelaton’s sound

appears to be useful, but the bulb should not be largerthan a good-sized pea.

____

A CASE OF OPIUM-POISONING.

OUR attention has been called to a melancholy instanceof death from opium-poisoning under very peculiar circuin-stances. The unfortunate sufferer was the wife of Dr.

Masson, who appears to have lately settled at lklitcholdeln,since his name does not appear in the "Medical Directory"for this year. The lady in question, who was twenty-fiveyears of a,ge, seems to have been in the habit of takinglaudanum for neuralgia, under which she suffered, and on

Friday, January 13th, she appears to have taken fromone to two drachms at least out of a bottle in her husband’s

surgery. Dr. Masson seems to have been aware that hiswife had taken an over-dose, and told her so; but she de-clared she had not done so. However, he prepared an emeticwhich she refused to take, and she showed no symptoms ofpoisoning for at least three-quarters of an hour. At theend of that time Dr. Masson fetched a Mr. Coleman, whoseadvice was that the patient should take some hot brandy-and-water. Within five minutes of taking this,:Mrs. Massonfell back in a comatose state, and in this condition she wasallowed to remain from four o’clock on Friday night tillnine o’clock on Sunday morning, when she died, withoutany treatment beyond the application of sinapisms to theneck and calves.

Dr. Masson having done what anyone else under thecircumstances would have done-viz., called in the nearestmedical practitioner, we do not propose to regard himin any other light than as a much-to-be-pitied privateindividual. But the case of Mr. Coleman is widelydifferent. Mr. Henry Edward Coleman, when sworn, said :-" I am not a registered medical practitioner, but a

general practitioner"; and as his name does not appear inthe Medical Directory, we have no means of knowing hisqualifications. Mr. Coleman said that he found the patientperfectly sensible, but looking sleepy, that she refused theemetic, and that he then suggested brandy-and-water to"rouse up the nervous system." He was also of opinion"that the emetic or stomach-pump was useless when hearrived at the house, and that the patient’s life could nothave been saved." He also 11 thought the emetic would beof no use if taken at the end of an hour." It is consolatoryto find that Mr. Coleman allows that he " has had no ex-

perience in cases of poison," and this may account for hisnot being " aware whether, if once in a comatose state, apatient may be recovered."Such a grossly mismanaged case is hardly conceivable in

the present day. To give a patient known to have taken apoisonous dose of laudanum hot brandy-and-water, so as tohasten the absorption of the poison, is bad enough; but toleave a patient in a comatose state, without employing thestomach-pump to evacuate the stomach, and without anyof the recognised modes of treatment being employed, shows.an incompetency little short of culpable.

THE PUBLIC HEALTH IN 1870.

THE Registrar-General’s Quarterly Return just issuedcontains a brief review of the registration returns for 1870,from which we gather that both birth and death rates wereabove the average, the deaths being relatively more

numerous than in seven of the previous ten years, the ex- #ceptions being 1864, 1865, and 1866. It is now possible toget approximatively at the number of deaths in the yearfrom the principal zymotic diseases without waiting untilsufficient time has elapsed for the publication of theRegistrar-General’s annual report, usually from a year to a

year and a half after date. With the beginning of 1870the local registrars were required to return every quarterthe number of deaths registered by them from seven of themost fatal zymotics, and hence it is that, while we can learnquite near enough for practical use how many deathsoccurred in 1870 from scarlet fever-the epidemic of theyear-we must wait some months yet before the number offatal cases in 1869 can be ascertained. Altogether therewere nearly 32,000 deaths by scarlet fever last year in

England, and the magnitude of the epidemic is apparentfrom the fact that the total mortality of the great epidemicyear, 1863, was 30,475 ; taking increase of population into