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quite recently there were sold at Messrs. Puttick and

Simpson’s a lot of old books comprising inter alia 21 oldmanuscript volumes of cases treated at the Women’s

Hospital, Soho-square, by the late Dr. Alfred Meadows.

These books contained, as a matter of course, detailed

reports of all the ailments and troubles of the innumer-

able women treated by the doctor during a perioddating back to 1873." The whole lot only fetched 3s. 6d.,so that the hospital might easily have bought it, but thehospital authorities are stated to have ridiculed the ideathat there was anything improper in the sale of such worksby public auction. The Rev. A. W. Oxford informs us thatit is the custom of the hospital to present the physicianswith all their letters" bound up at the end of every

year. If the hospital really does this we consider it an

improper thing to do. Records of hospital cases are

not the property of the medical man in charge of suchoases but of the charity of which he is an officer. The z,authorities of the hospital may not have known that Dr. ’,Meadows’s case books were to be sold, but his executorsor whoever sold the books should never have had it intheir power to do so. Records of cases, unless pub-lished so as to be unidentifiable or published with theconsent of the patient,-should certainly be considered abso-lutely confidential. We hope that the authorities of the

hospital in question will see that .such a gross breach of thetrust committed to them does not occur again.

SANITARY STAGNATION IN RURAL DISTRICTS.

NOTWITHSTANDING Public Health Acts and Local Govern. I

ment Acts establishing county, district, and parish councilsthere has been up to the present no great awakening in thesense of sanitary reform in many of our rural districts.Conditions which obtained when the Public Health Act,1875, was passed persist at times even to-day, and therewould appear to be but little prospect, immediate or remote,of a better state of affairs. In a word, there are numerousinstances throughout the country where both central andlocal government have signally failed. As a case in pointwe may perhaps take the Easingwold Rural District, theannual report concerning which has recently reached us.

This district is situated in the North Riding of Yorkshireand has a population of some 10,500. In 1890 the lateDr. Barry of the Local Government Board inspected thedistrict and a printed report was subsequently issued bythe Board. At that time the sanitary condition of the

district was at a very low ebb indeed : houses unfit for

habitation, water from shallow wells liable to pollution,rubble drains of the rudest character, excrement disposal bymeans of defective privy-middens, no isolation hospital, and Ino disinfecting apparatus. Sanitary administration was i

practically at a standstill and such action as was taken was 1of a makeshift and apologetic nature. Year by year the ímedical officer of health, Mr. E. B. Hicks, who is still in (

office, has brought up the sanitary shortcomings of hisdistrict in his annual report and year by year his advice has ’-gone unheeded. It seems, indeed, that save for the water- fsupply and drainage of the most populous village-that of (

Easingwold itself-and two other villages, next to nothinghas been done, the state of the district being little different (

from that in which it was when Dr. Barry made his re- f

commendations with regard to it, and this in spite of sthe fact that in 1891 a committee of the sanitary Nauthority inspected certain places in the district and t

endorsed the recommendations of the medical officer of Ihealth. It is somewhat difficult to determine the share E

which the several bodies responsible may be held to have c

in this astounding apathy as regards sanitary reform which e

pervades so many rural district councils at the present day. ’NTae North Riding County Council does not appear in this i

instance at least to have brought an overwhelming amountof pressure to bear upon the Easingwold District Council, norhave the efforts of the Local Government Beard, whatever theymay have been, led to any very evident result. Obviouslynot too much is to be expected from the officers of localauthorities who receive a pay in no sense commensurate with

their services ; but the disease seems more deeply rooted thanthis, and it lies rather in the apathy of the members of

rural district councils and in their disinclination to

do anything which costs money. But this disinclinationto action is apparently common to county, district,and parish councils alike in cases where rural districts areconcerned, and furthermore it is obviously shared by theLocal Government Board itself. Clearly, in these days oflocal government, the central health authority might find itinconvenient to put too great a pressure upon rural district

councils, and indeed it would be difficult to find in either

political party a President of the Local Government Boardwho would be allowed by his colleagues in the Cabinet totake any very drastic measures with respect to rural dis-

tricts many of which are becoming rapidly reduced in

population. But we should withal be glad to see more

attention paid to rural districts than has been the case

hitherto and vigorous action taken in regard to certain ofthe more apathetic councils. The sanitation of rural

districts is not a matter which can be consideredwithout regard to the relations which the defectivesanitation of such districts may bear to urban communities.This fact will probably become more apparent in the nearfuture now that the question of tuberculosis is attracting somuch attention. The dweller in towns will soon wish to

know more of the sanitary condition of the rural cowshedsfrom which much of his milk is derived, and of the methodsadopted for recognising and controlling infective disease inlocalities where annually he may seek with his family torecruit his health. But so long as the Local GovernmentBoard have practically no control over the salaries of officers

no part of whose remuneration is defrayed out of the countyfunds, so long will insufficient salaries be offered and, alas,accepted, and so long will the medical officer of health be atthe mercy of those who care but little for sanitary reform.When adequate salaries are paid and permanence of office isassured we may look for a better state of things, but a moreradical change than this is necessary if our rural district

councils are to awaken to a proper sense of their

responsibilities. -

SORE-THROATS AND ISOLATION.

THE position of diphtheria when recognised as such is nowclearly defined and allowed for in the general scheme ofmedical treatment. Something still remains to be done,however, in similarly defining the place of a multitude ofsore-throats uncertain in their source and developments butevidently infectious nevertheless. M. du Mesnil de Roche-

mont, whose paper is quoted in the Journal de Clinique et deThérapeutique Infantiles of March 16th, has usefully directedattention to the wisdom of isolating for a sufficient periodcases of this doubtful character. In support of his

argument he refers to the well-known fact that in

examples of throat disease clinically indistinguishablefrom true diphtheria careful examination has failedsometimes to detect the LofBer bacillus. Nevertheless,very grave consequences, local and general, have attendedtheir progress which has even attained an epidemicprevalence. The writer states that he has himself observed

such a generalisation of sore-throat in hospital practice, 18out of 67 children being attacked. He quotes the similar

experience of Cardeur, Basquet, and others. In his opinion,which is founded on an examination of 60 cases, this

infectiveness is more than apparent and is associated with

978

the presence of the staphylococcus or the streptococcus, oneor other of which is commonly found on the fauces. Theconclusion he arrives at is that isolation should form part ofthe routine treatment of inflamed sore-throat. These obser-

vations, it is true, are not entirely new, nor indeed is theconclusion which is founded upon them. It has longbeen one of the axioms of careful practice, at least as

regards tonsillitis, that this disease ought to be isolateduntil its true relation to diphtheria or scarlet fever is made

out. We are probably right in regarding the isolation of

cases of sore-throat not related to either of these diseases asa matter of somewhat less importance. At the same time it

cannot be denied that many such are attributable to the

activity of morbid germs and are therefore possessed of agreater or less infective power. There is much to be said

therefore for the view that cases of inflamed throat which

are not accounted for by mere atmospheric changesshould be treated in seclusion.

THE DIFFICULTY OF LOCALISING PULMONARYLESIONS.

AT the meeting of the Société Medicale des Hopitaux onJan. 27th M. Tuffier read a paper on this very importantsubject. At the Moscow meeting of the InternationalMedical Congress he analysed all the accessible cases (306)of pulmonary surgery. This prolonged study impressed onething on him: that difficulties lay much more in insufficiencyof diagnosis and in defective localisation than in operativetechnique. 17 cases of pneumotomy which he performedconfirmed this opinion. To attack a pulmonary disease effi-

caciously its position and extent as well as its unity or multi-plicity should be known. Of 221 cases diagnosis was in-complete in 45 ; in his own 17 cases an error was committedin seven although the patients had been examined by oneor several of his most distinguished colleagues. If an errorof diagnosis was of minor importance in abdominal it was ofcapital importance in pulmonary surgery. Hepatic abscesscould be distinguished from purulent pleurisy only withdifficulty. M. Tuffier had operated on a case of non-

suppurating hydatid cyst supposed by a great number ofhis colleagues to be situated in the liver but which he foundto be entirely in the lower lobe of the right lung. It was

necessary that the height and depth of a pulmonary lesionshould be defined. In a case of hydatids the stethoscopicsigns were supposed certainly to show the presence of a

lesion in the upper two-thirds of the lung, but the cyst,as large as the foetal head and packed with livingechinococci, filled the lower lobe alone. Radiographyrevealed no opacity in this position. In a case of

gangrene the centre of the lesion was localised in the eighthintercostal space ; the inferior extremity was found in theseventh. This error though small had entailed dangerousexplorations. The depth of the lesion was still more difficultto define. M. Tuffier had operated on two patients in whomauscultation revealed cavities so superficial that pyo-pneumothorax was diagnosed without reserve. He had to

penetrate more than a finger’s breadth of lung to reach apulmonary cavity. The mistake appeared to have beeninevitable ; the lung was indurated, lardaceous, and adherentto the chest wall. Such errors were not peculiar to his

countrymen. In foreign literature he had collected 10

examples in the case of pulmonary gangrene alone. InTHE LANCET of Jan. 13th, 1894 (p. 87), Priestley Leech hadrecorded a case where multiple punctures failed to discoverar. abscess complicated by gangrene. Quinckel openedone cavity but the necropsy showed several. The extentof the cavity was still more difficult to determine-a small cavity might simulate an enormous one. The

1 Mitteilungen aus den Grenzgebieten der Medicin und Chirurgie,1895, vol. i., p. 15, obs. vi.

diagnosis was especially difficult in bronchiectasis, where saseries of small suppurating excavations would cause thesame symptoms as would be caused by a large cavity. In-one case the diagnosis was septicaemia consecutive to S).

vast superficial pulmonary excavation at the anterior part.of the lower left lobe. The incision showed severalsmall cavities of the size of a walnut. If auscultation,was powerless, so equally was puncture. The form of-

expectoration might lose its significance, especially inchildren in whom the thorax was supple and all the bronchicould be emptied by a single effort thus simulating the:evacuation of a single cavity. The number of foci was of

capital importance but nothing was more difficuU to ascer-tain. A man had abundant foetid expectoration. A focus of

the size of the fist was opened by pneumotomy. The presence-of a second focus was diagnosed as blood did not escape bythe mouth whilst it escaped abundantly from the woundwProgress was made for a time but the septic symptoms re-appeared. Though assured of the existence of a second

focus search was in vain. The patient died and a second’

cavity was found a little over an inch above the first in the,midst of sclerosed tissue. Most errors had been made in<reference to lesions of the inferior pulmonary lobe ; they were-much rarer at the apex. M. Tuffier did not mean to attackmedical diagnosis ; on the contrary he found that it was’usually exact and that error was exceptional. Radiographywould no doubt prove of great value in the problem offlocalisation.

__

THE INTERNATIONAL CONFERENCE UPONSYPHILIS.

AN International Conference upon the subject of the’

Prophylaxis of Syphilis and Venereal Diseases will be’held in Brussels in September next. The secretary, Dr-Dubois-Havenith, has sent us a letter in which he expresses;the opinion that medical men practising in the British

Empire could render a great service to the conference-

by sending in a detailed report of the results of the-

absolutely free traffic in venereal disease which obtains

throughout the United Kingdom and most of the rest of the"empire. A very complete programme of subjects for dis-

cussion has been drawn up and a set of questions printedon a regular form which, if carefully filled up, should afford’good grounds for coming to a definite conclusion on the-

subject in hand. Dr. Dubois-Havenith’s address is 19, ?ue-de Gouvernement Provisoire, Brussels.

THE COUNTESS OF DUFFERIN’S FUND.

THE fourteenth annual report of the National Associationfor Supplying Female Medical Aid to the Women of India;shows that the year 1898 has been marked by good progress-in carrying out the objects of the association. During thepast five years the Countess of Elgin has presided over the’fund and an encouraging advance has been made in everydirection ; many new hospitals have been erected, the’number of patients treated, including purdaa nashirc

women, has steadily increased, and every possiblefacility has been offered to female students who"wish to adopt a medical career. The total numberof patients treated in zenana hospitals, wards, and’

dispensaries throughout the country was 1,484,967, of whom30,598 were in-patients, 1,419,145 were out-patients, and35,224 were visited at home. The staff employed in thevarious hospitals for women throughout India include 35lady medical practitioners of the first grade-i.e., personsqualified for registration in the United Kingdom-75 assistantsurgeons or practitioners of the second grade who have beentrained in India and who hold Indian appointments, and257 hospital assistants or practitioners of the third grade