1390 INTERFERENCE WITH A MEDICAL WITNESS.

from perfect although capable of amendment and improve-ment, but he expressed the belief that the changes broughtabout by it might in the future be found to exercise con-siderable influence upon the teaching of obstetrics in medicalschools. In considering the course of training generallyadopted in this country for this branch of medical studyhe drew unfavourable comparisons between English practicesand the superior efficiency which he claimed for Germanmethods. The Midwives Act is beyond question a measurewhich leaves to the board which it has brought into beinga very wide discretion in the framing of the regulations bywhich alone the Act will become effective and many will

study these with interest besides the class directly concernedin them. Although we have referred to the Act as havingcome into force on April lst our readers are aware that thatdate only marked the commencement of the powers of theboard the most immediate duty of which, as we have pointedout, consists in the framing of rules. It is not until

April lst, 1905, that a midwife not certified under the Actis precluded from taking or using the title of midwife or

any name implying that she is certified under the Actand consequently there is no immediate urgency for thecertification and registration of those who are permitted bythe Act to be certified without being examined under theregulations of the Central Midwives Board. They haveto comply with the necessary formalities in the course oftwo years from the date of the Act coming into operationbut are not obliged to do so before. It is not until April lst,1910, that every woman practising as a midwife will haveto be certified. As, however, the women who may desireadmission to the roll of midwives by means of the trainingand examinations to be imposed by the board will requiretime in which to prepare themselves that body is no doubtproceeding as rapidly as circumstances will permit with theframing of the necessary regulations.

INTERFERENCE WITH A MEDICAL WITNESS.

AT an inquest held at Acton on May 5th upon the bodyof a clergyman who had been found in his bedroom shot

dead with a revolver lying near him a medical witness madea complaint to the coroner of a nature which is happily un-usual. Mr. D. M. L. Campbell, after giving his evidence,asked the coroner whether it was right that a medical mansummoned to give evidence at an inquest should be visitedtwo or three times with reference to what he might be aboutto say and should receive a letter or letters suggesting thathis examination of the body had not been careful and thathe should make another. It was further suggested to himthat a clergyman would not commit suicide. The coroner

very properly and very naturally expressed his strong dis-approval of what had been done and refused to listen to anexplanation which was tendered, no denial of the accuracy ofMr. Campbell’s statement being made. The coroner’s ob-servations can hardly have been too severe for the occasion.Mr. Campbell pointed out that to him, as he had been

personally acquainted with the deceased, the task of makingthe examination and giving evidence had been exceptionallysad. In any case, a medical practitioner in such circum-stances has thrust upon him a painful duty incidental to thepractice of his profession and he is entitled to the protectionof the court before which he appears. Mr. Campbell,according to the report of the inquest in the Acton Gazette,said : ’’ When I was called I went into the room and the

body was lying supine. He was lying on his back with hishead inclined a little to the right side. The legs werestraight out and the little and index fingers of the righthand were resting on the floor, whilst the revolver was inthe position in which it had been grasped, althoughit appeared to have slipped from the grasp. Therewas a wound behind the right ear. The direction

of the wound was forward and onward. " In answer

to direct questions from the coroner he gave the opinionthat the wound was self-inflicted and that it could

not have been accidental. He also added that the hair

was singed. There may be a slight error in the reportquoted as to the course taken by the bullet, but this does notaffect our view of Mr. Campbell’s position. It will be per-

fectly clear that the medical witness who observes facts suchas these is obliged to include them in his evidence and isentitled to draw the deductions recorded. It was open to

the relatives and friends of the deceased through their legalrepresentative to cross-examine Mr. Campbell and this theydid propounding a theory of an unintentional dischargewhile the deceased was cleaning the revolver and supportingtheir theory with evidence, apparently to the satisfaction ofthe jury who found a verdict of "Accidental death." That

they should have taken the other course of seeking to

influence Mr. Campbell in his evidence is a matter which

they should now regret. A medical witness called at an

inquest is a member of an honourable profession, occupyinga position which renders him independent of all pre-judice. He is summoned to give evidence as to factsobserved by him and to express opinions which his trainingand experience enable him to form. The jury is not boundto adopt his view in their verdict, but he is not to be inter-fered with in expressing it without fear or favour.

THE PATHOLOGY OF GASTRIC ULCER.MANY theories have been proposed to explain the origin of

true gastric ulcer which was first distinguished as an affec-tion sui generis by Cruveilhier. Some have attributed it to

the action of the gastric juice, some to disturbances of thecirculation such as are seen in thrombosis and in septic andaseptic embolia, and others again to the attacks of micro-

, organisms ; but in 1874 Dr. Durante, recognising its affinitywith the I mal verforant " of the foot, pointed out that inboth instances the tissues affected were predisposed to

disease in consequence of deep-seated disturbance of the

nerves distributed to them. The subject has again been

taken up by Dr. R. Dalla Vedova of Rome who has

endeavoured to determine, by means of resection of the vagiand of the solar plexus (from which sources the stomachreceives its nervous supply) or by the injection into

these structures of an aseptic fluid such as concentrated

alcohol, the effects of the suppression of nervous influ-ence upon the nutrition of the stomach. He foundthat about half of all the animals operated on ex-

hibited distinct changes in the gastric mucous membrane.This effect was not due to the toxic action of the alcohol

causing acute septic peritonitis without any characteristicmicroscopic inflammatory changes, for no less than two-thirdsof the animals survived for ten days ; nor was it due to

exposure of the intestines to cold or to any mechanical

injury to the parts, since these were not, and need not be,touched in extirpation of the cceliac plexus. Dr. Dalla

Vedova considers himself to be justified, from a careful con-sideration of all the circumstances, in drawing the conclusionthat the necrotic ulcers of the gastric walls observed in hisexperiments were directly due to the lesions inflicted on theabdominal sympathetic. The ulc8rative processes were

noticed to affect chiefly the antrum pylori, and many

drawings accompany Dr. Dalla Vedova’s article showingthe position of the ulcers, haemorrhages, spots of necrosis,and cicatrices of ulcers that were seen after the death

of the animals. This position of the ulcers he attributesin part to the more highly acid reaction of this segment3f the stomach and in part to the constant irritation ofthe several tunics debilitated by the loss of their nervous

supply owing to the passage over them of the more solid

aarts of the chyme in the later stages of digestion.

1391THE KING’S SANATORIUM.-PUBLIC HEALTH LITERATURE.

The size of the necrotic spots varied from that of a Ipin’s head to that of a lentil ; they were more or less

circular and they were elevated on an cedematous and

hyperaemic area. The haemorrhages were small and variedin colour from yellow to blackish-brown and the ulcers werefunnel-shaped, extending through the whole thickness of themucous membrane, the base being formed by the muscularcoat. Their borders were fairly well defined and on the

depressed surface was some necrotic detritus. A Germantranslation of Dr. Dalla Vedova’s original article, which wascontained in the report of the sixteenth annual meeting ofthe Societa Italiana di Chirurgia which was held at Rome in1900, has recently appeared in the Archiv für VerdauungsKrankheiten, Band viii., Hefte 3, 4, and 5.

THE KING’S SANATORIUM.

A SITE for " King’s Edward VII.’s Sanatorium " has beenacquired from Lord Egmont at Lord’s Common, Easebourne,six miles south of Haslemere and about three from Mid-

hurst. The site is 150 acres in extent and contains in its

northern and eastern portions a magnificent fir wood.

Towards the south and sheltered by the wood is a naturalopen plateau over 450 feet above sea level and commandingin the distance a beautiful view of the South Downs. Uponthis the sanatorium will be erected. Behind the groundgradually rises until at the northern extremity of the

property a height of 620 feet is attained. Completeshelter from north and east winds is thus secured. To

the west and immediately adjoining the site is an opencommon of considerable extent, which will add materiallyto the usefulness of the institution. The lower greensandis the geological formation. A delay in acquiring the sitewas occasioned by the difficulty experienced in obtaining adue supply of water, but by impounding springs about amile away to the north of the site this difficulty has beenovercome and an abundant supply of water of great organicpurity, as tested both bacteriologically and chemically, hasnow been obtained. Mr. H. Percy Adams, F.R.I.B.A., thearchitect appointed by the advisory committee, who hasrecently by its direction made a very careful study of

sanatoriums both in Germany and Switzerland, is now

preparing his plans. -

PUBLIC HEALTH LITERATURE.

IN another place we publish under the heading of ’’ The

Aerial Convection of Small-pox" " a letter from Professor

Antony Roche, and certain points raised in that com-

munication have a general interest for the public healthservices. As regards the literature relating to the aerial

convection of small-pox, we venture to think that there

will be found in the numbers of THE LANCET, either ineditorial articles or in our abstracts of the annual re-

ports of medical officers of health, references to most of

the literature which is really of importance. Moreover,the reports of societies dealing with public health andepidemiology will also be found in our columns. But

the main point in the communication under considera-tion is the suggestion that the Local GovernmentBoard should publish annually a résumé of the reportsfurnished by the medical officers of health throughout thecountry. Apparently, a suggestion in this sense was madeto the late Sir Richard Thorne, whose only objection to thecourse was the expense which it would entail, more

particularly if a copy of such a publication were to be

sent to every medical officer of health in the country.Although it does not appear to us that a r6sut)ij

of all the reports is called for, seeing that but a

small proportion thereof contain matter of any interest

to those outside the district concerned, we quite agree I

that a useful purpose might be served if the LocalGovernment Board could be induced to publish annually avolume of the more interesting points contained in the

reports of medical officers of health. Possibly a deputationto Mr. Long might assist this matter. But what we think isof at least equal importance is that the annual reports of themedical officer of the Local Government Board, which con-tain not only selected reports by the medical inspectors butalso the records of valuable bacteriological and chemicalresearch, should be made more accessible to medical officersof health. Unfortunately, the price of these volumes issomewhat prohibitive but if they could be presented tomedical officers of health or supplied to them at a reducedprice a very material service would be rendered to the

public health service. It would be well in the event of Pro-fessor Roche’s suggestion being carried out that the annualvolume which it is proposed to establish should contain

selections not only from English public health literature butalso from the report srelating to the more important foreigncities. But public health literature, more especially if it be

held to embrace bacteriology, covers in these days a verywide field and the volume in question would be likely to runto very bulky proportions. As regards the reports of

the medical inspectors of the Local Government Board,Professor Roche will find notices thereof from time to

time in our columns and all these reports can be pur-chased for a few pence from the Government publishers,Messrs. Eyre and Spottiswoode. Unfortunately, the annual

reports of medical officers of health cannot, as a rule,be so purchased, but there would seem to be no suffi-cient reason why this should not be arranged for in the

future. ___

THE PUBLIC SALE OF INDELICATE PRINTSAND OFFENSIVE LITERATURE.

A PICTURE that looks well and can be properly appreciatedin the hallowed precincts of an academy may not look sowell or refined when reproduced in the form of a cheapengraving and sold openly in the public streets. We havenoticed for some time past that at regular periods in thestreets of the city there seem to be epidemics of the sale ofbad literature and suggestive prints, and only this week wesaw reproductions about two feet long of a well-known picturewhich is a study of the nude being openly offered for sale ata penny each not a mile from the Stock Exchange. We areafraid that in many cases the purchaser, who may be a smallboy with a penny to spare, is not likely to possess that subtlediscrimination, generally only the outcome of a mature mindand refined nature, which appreciates only the artisticbeauties of such a picture and rejects all grossness. Again,pamphlets are often sold in the city streets either reallyobscene or professing to be so and often possessing analluring cover as a bait to entice purchasers to taste of thecarrion within. The gutter merchants who sell such noxiouswares should receive attention from the police.

OPERATION FOR EXTRA-DURAL HÆMORRHAGEFROM WHOOPING-COUGH.

IN the Nerv York Medical Journal of A -)ril 25th Dr. G. S.Brown has published a case which is not only important asa contribution to the scanty literature of the cerebral com-

plications of whooping-cough but also appears to be uniquein the fact that an operation was performed for cerebral

haemorrhage from this disease. A healthy boy, aged sevenyears, had whooping-cough. The paroxysms were pro-nounced but not severe. After four weeks he complained ofpain in the head and became irritable. On the next day,when Dr. Brown first saw him, he was suffering intenselyfrom pain in the right temple. " The pain was so severe

a,-, to suggest rupture of a vessel, particularly as there