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conditions-viz., Midhurst and Thakeham, lying also in thesame valley,--we find such an extraordinary difference as thefollowing :-Cancer mortality of Midhurst, I’ 757 per 1000; dittoof Thakeham, 4’799 per 1000-in ten years. It is clear thatsome purely accidental circumstance, such as the introductionof one or two cancerous families into Thakeham district, orthe presence of a single hospital, may have singly sufficed to Icreate all the apparent difference ; considering, as we said be- ,fore, the extremely low figures which we are dealing with. (b)The uncertainty introduced by the varying excellence of

medical diagnosis is, in the case of cancer, of most formidableimportance, both on account of the special difficulty of definingthe disease, and because of the immense variations whichmay be caused by a very slight difference thus introducedinto the calculation of mortality from such a rare complaint.

2. We must object altogether to the way in which Mr.Haviland tests the nature of the "geology " of districts whichhe examines with regard to the prevalence or otherwise ofcancer, &c. He appears to take merely the large geologicalfeatures of a district, and entirely to neglect the question ofdrift, gravel, &c. But the existence and nature of these over-

lying formations constitute the one geological question which,above all others, is important in reference to the spread of dis-ease. It is upon them that the dwellings of the poor actuallyrest; and we have already, in the instance of cholera as inves-tigated by Pettenkofer, and of phthisis as examined by Dr.Buchanan, the strongest reason for thinking that the influ-ence of the superficial layer is capable of effecting greatthings; and even more strikingly in the instance afforded bythe immunity of Limehouse schools-which stood on a littleisland of brick-earth in the midst of gravel--from the cholerain 1866, as mentioned in Mr. J. N. Radcliffe’s report to themedical officer of the Privy Council.And, finally, we have a general protest to make against Mr.

Haviland’s way of putting his case, in that he has not statedwith anything like care enough the apparent exceptions to therules which he endeavours to lay down ; nor can he be said tohave fairly stated the whole case in black and white. Wemust request the public not to assume the truth of his veryingenious views, and still more, not to put them into practice,until the subject has been much more thoroughly ventilated.

THE TRIAL OF JOHNSTONE VERSUS COTHAM.

THIS trial, which occupied the attention of the Chief Justiceof the Queen’s Bench and a special jury for four days, illus-trates in a forcible way the danger of doing good to a personin spite of himself. The defendant was the incumbent ofSt. John’s, Walworth, and the plaintiff, who had just beenappointed chaplain of St. Mary’s Hospital, had previously beenhis curate. The allegation of the plaintiff was that the de-fendant had caused him falsely to be imprisoned as a lunatic,and he claimed heavy damages for the injury he had sustainedthereby. The defendant justified what he had done on theground of the actual lunacy of the plaintiff at the time. Theevidence adduced in support of this justification certainlyproved conduct of so extraordinary a character on the part ofMr. Johnstone as to be capable of no reasonable excuse butthe sad excuse of a disordered mind. It was clear that he hadbeen for some days in a state of great excitement ; that he be-lieved there was a conspiracy against him, and that he waspersecuted and pursued by Fenians ; and that under these im-pressions he had threatened to commit, and had actually hadon some occasions committed, acts of violence. His sister,who was his only known relation, was written to, but she didnot come. Accordingly Mr. Cotham, actuated by good feeling,and doing with perfect honesty of intention what he thoughtbest for the plaintiff, indeed necessary for his safety and that

of others, signed the order for his removal, and had him re-moved at 2 o’clock in the morning to the Peckham LunaticAsylum. There he was seen by Dr. Sibson, and by two of theLunacy Commissioners, Dr. Nairne and Mr. Lutwidge, all ofwhom were convinced of his insanity, and their evidence wascorroborated in the strongest manner by Dr. Armstrong andhis medical assistant.The prompt steps taken for the plaintiff’s care and treat-

ment were happily successful, and at the end of about amonth he was allowed to leave the asylum under the care ofhis sister. Far, however, from being grateful for what hadbeen done for him, and what in all probability had saved hisreason, Mr. Johnstone immediately took steps for bringing anaction for damages against Mr. Cotham; and had it not beenfor the careful, lucid, and most able charge of the Lord ChiefJustice, it is more than probable, from the conduct of some ofthe jurymen during the trial, that he would not have broughthis action in vain. However, the clear reasoning of the LordChief Justice had its weight, and the jury returned a verdictfor the defendant, strongly disapproving at the same time themode in which the removal to the asylum had been effected.

Mr. Cotham may felicitate himself on having escaped asevere penalty, in addition to the anxiety and expense whichhe has had, for having done a prompt act of benevolence; andmay perhaps reflect how much more prudent it might havebeen, as the Chief Justice put it, ’’ to have left this gentlemanalone, and let him go on taking his morphine and his stimu-lants until he had got himself into a state of furious insanity,and then, in consequence of it, had lost his office, and had tobe sent to a pauper lunatic asylum."Had the verdict of the jury gone otherwise, the conse-

quences would have been lamentable, for few persons wouldthen have been found willing to undertake the responsibilityof putting under restraint those labouring under delusions,accompanied with excitement and disposition to violence, untilsome fatal catastrophe has occurred. A person having de-lusions that he is pursued and persecuted is always more orless dangerous to others, for at any moment he may act as ifhis delusion was the truth, and do injury to his fanciedenemies.

ST. ANDREWS MEDICAL GRADUATES’ASSOCIATION.

LAST week we were unable to report the proceedings of thisAssociation, on Thursday, the second day of session, furtherthan to give an abstract of the presidential address. We now

supply the omission. In the afternoon, at 2 P.M., Dr. Tukeopened a debate on the Criminal Responsibility of the Insane,and pointed out the insufficiency of the present legal test. Apaper by Dr. Crisp, "own the Inflnence of a Moist Atmosphereon the Production of Phthisis," followed.

Dr. Lloyd Roberts then read a paper "On ImperforateAnus." William Henry C-, a stout, healthy-looking child,was born on the 11th of June, 1868. When washing him, themidwife noticed that the anus was absent. On examination,eleven hours after its birth, Dr. Roberts did not find the ves-tige of an anal orifice. There was, moreover, no discolorationnor elevation of the skin; the raphéof the perineum, however,was more prominent than normal. On separating the buttocks,there was not even a pucker in the situation where the rectumwould naturally have existed. The abdomen was tense andflatulent, and the child cried and appeared in pain. In thepresence of Messrs. Runcorn, Kershaw, and Barnisb, Dr.Roberts made an incision with a scalpel in the mesian line ofthe perineum, in the position where he thought the rectumwould be situated. Dividing the skin and the subcutaneousareolar tissue in the direction of the coccyx, he continued theincision for about an inch and a half upwards, into the pelvis.Guided by a sense of fluctuation, a large curved trocar andcanula was plunged into the fluctuating spot. On withdraw-ing the trocar, meconium, accompanied with a little blood,

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freely flowed through the canula. This was allowed to passuntil it ceased to flow, upon which the canula was withdrawn,and the opening into the gut enlarged. Dr. Roberts passed abistoury into the bowel through the previous incision, andcommenced to enlarge it, directing the blade towards thesacrum. When he had done this, more meconium passedthrough the wound. A No. 10 elastic catheter was passed,and subsequently a No. 12. Afterwards the parts were cleared,and the bougie withdrawn. In the morning, June 12tb, thechild had had a good night’s rest, meconium, with faxcalmatter, had passed through the artificial anus, and it hadmade water. A No. 12 bougie was introduced, and retainedfor several minutes in the wound ; and on its withdrawal acopious motion was voided. The child continued well in everyway until 9 A.M. on June 20th, when, although faseal matterfreely stained the bougie, no motion passed after its with-drawal. The same thing had occurred on the previous day.The abdomen was very much distended, and looked blue. Thechild appeared feverish, restless, and uneasy. The bougiewas again introduced, and retained a little longer. On its in-troduction it appeared to pass through hardened faeces ; andon. its withdrawal it was marked by fseca.1 matter. A freedose of castor-oil and a warm bath relieved the child. Fromthis day he had not had a bad symptom. Dr. Roberts continuedto pass the bougie from time to time. The mother statedsome time ago that she had perceived, on his straining very hardto have his bowels moved, that two or three drops at a time ofsomething like faecal matter passed through the urethra, andthat except under these circumstances his water was alwaysperfectly clar. She states to-day (November 30th) that shehas noticed this circumstance half a dozen times since he wasborn. He is now five months and a half old, is thriving, andgetting an unusually fat, big boy. Dr. Roberts had examinedthe parts st this time, and the artificial anus appeared to befirmly sound and healed. On separating the opening, whichwas then circular, it looked like a sulcus, with its edges con-tinuous with the external integument. The child seemed tohave control over his fasces ; and his bowels were moved some-times daily, and sometimes every other day. Dr. Roberts’believed the success of this case was largely due to the timelyoperation performed before the child had bégun to vomit, or, asis too commonly the case, had been worried by purgative Imedicines.

Dr. Maund read a paper " On Strychnia in DiphtheriticParalysis." The cases of secondary nerve affections followingdiphtheria were very frequent and peculiar. He believed the

frequency of them to be in inverse ratio to the severity of theprimary attack. He had never met with more than one casefollowing a severe primary attack, but he had had many casesof secondary paralytic affection where the attack of diphtheriawas so slight as to have escaped notice. The case described indetail exemplified this. Strychnia has usually been found mostbeneficial, but he confined his remarks chiefly to the one casewhere the effect of this drug was most remarkable. A lady,aged thirty-three, was seized suddenly with most intensefrontal headache, and febrile symptoms, which were arreatlyaggravated every afternoon. After a fortnight her sight be-came dim, and her taste was lost, except for sweet things.She stated that she was in her usual health till the day beforehe saw her, when the frontal pain came on. Very close in-quiry elicited that she had a "sore-throat" three weeks beforethe,attack. Her husband likened the appearance of the ton-sils to the "whitish mould which comes on the top of soupwhich had been kept too long." This cleared up the case. Inthe course of the next four weeks she nearly lost her sight andtaste ; deglutition was most difficult, fluids returning throughher: nose ; sensation and motion were almost annihilated in thelower half of the body, and to a less degree in the hands andarms. In the dark she was powerless to move her hands ; ifshe clasped them in th<* dark she could not separate them tilla light was brought. Strychnia was given in increasing doses,but without very marked effect till the dose reached one-tenthof a grain four times daily. The effect was then remarkable.Before taking her dose of strychnia one leg was quite help-less ; a depressed and anxious countenance; the sight so dimthat she-could not discern the largest print on a posting-bill;her voice highly nasal, and she was almost unable to swallow.Twenty minutes after her dose her countenance began tobrighten, the paper on the wall (which previously appeared ofa drab colour) began to show its pattern, which rapidly becameclearer, till in half an hour she could perfectly discern both itsform and colour ; the voice lost its nasal twang, and deglutitionbecame easy ; the taate was restored, though much less per-fectly, and the different functions were performed. In an

hour the sight began to become dim, and she returned to herprevious condition, and waited with longing for the next doseof strychnia. At the end of three months she had regainedall her faculties, with the exception of the use of the legs.She could walk from room to room when it was light, but wasstill powerless in the dark. It was ten months before she wasrestored to health.A paper was then read by Walter Whitehead, F.R.C.S.,

Surgeon to St. Mary’s Hospital, Manchester, "On the Physio-logical Effects of Chloroform." The theory that all anaestheticsowe their value to the property of preventing oxygen unitingwith the blood is not beyond question. The effects of chloro-form and ether would be ill described by the symptoms ofasphyxia. Those agents which have asphxiating propertiesexcite and convulse muscular structures, causing contraction.Chloroform and ether paralyse muscle, and give rise to relaxa-tion ; the one producing contraction, the other dilatation ofthe vessels. Chloroform and ether are capable of interruptingthe communication of sensibility from the periphery to thenervous centres without compromising the general sensibilityof the brain. Whether the nervous agent be electricity ornot, there was one property common to them both which boreparticularly upon his subject, and that was, the necessity toboth of a continuous, insulated conductor. The beautiful ideaof Du Bois-Reymond, "that the electro-motive molecules ofnerves are minute centres of chemical action, all arrangedregularly so as to turn homologous sides the same way, mutu-ally determining their position of equilibrium, and controllingtheir deviation from it ; that in such a system, though elec-tricity were the connecting link of the whole, and the meansof transmitting power through it, the rate of transmissionwould be independent of that of electricity, and might indeedbe what the rate of transmission of the nervous agent reallyis,"-this view has at least the recommendation of being inharmony with all the known laws of nature. Whatever viewis taken with respect to the nervous agent, the contiguousmolecules composing the axis-cylinder of the nerve must alwayshave a certain relation to one another ; remove a single one,and an entire chain of communication is destroyed. Chloroformwhen inhaled permeates every structure of the body, and con-sequently must insinuate itself between the constituent mole-cules of the nervous substance, and thus interfere with theirmutual relation, and upon which the fulfilment of their func-tion certainly depends. Chloroform is proved to be a badconductor of electricity, therefore it is to a certain extent aninsulator, and if each molecule be a minute centre of chemicalaction, insulation would have the effect of exhausting the in-trinsic value of each electricity-producing point, and collec-tively of destroying the utility of the entire nerve as a meansof communicating motion or sensation.

Dr. Bogg’s paper " On Fracture of the Sternum " was basedon a case in which that injury was due to violent muscularcontraction. The patient was engaged at the time in lifting aheavy cask. A case is mentioned by Chaussier where fractureof the sternum was caused by violent muscular contractionduring labour. Dr. Bogg’s argument was, that if, as SirAstley Cooper relates, cases have occurred where the humerusand tibia had been fractured by violent muscular contraction,there was no reason why other bones should be exempt fromall liability to similar injury. It is a pity that injuries of thesternum are so briefly handled in the works of English surgi-cal authors, the chief information on the subject being con-tained in the Jacksonian Prize Essays for 1809, 1831, and1841.

Correspondence .

LONGEVITY.

"Audi alteram partem."

To the Editor of THE LANCET.’

SiR,-Dr. Allbutt’s communication has added fresh interestto the question of Longevity, and I am glad to have an oppor-tunity of discussing the subject with so old a friend and sopolite an antagonist.

Dr. Allbutt first questions the accuracy of the ages whichare assigned to the standard examples, and considers that"there is as much evidence for the reputed ages of Jacob andMethuselah, as for those of Jenkins, Parr, Agnes Skynner,