167THE AFTER-CARE ASSOCIATION.

but no other signs of."a morbid condition were discovered. Dr.W. C. Weber evidently has some doubt as to whether this casecan be correctly described as astasia-abasia. If regard is paidto the meaning of the term only, it is apparently descriptive ofthe condition as regards the inability to stand or walk. The

case, however, differs from all others described under thesame title, so.far as we are aware, in the fact that the knee-jerkwas lost. Considering the habits of the patient, the possi-bility of the condition being one of alcoholic neuritis, withsome functional element superadded, must be borne in mind ;but this does not throw much light on the case, which must beregarded as an interesting and obscure one.

AWARD OF THE RIBERI PRIZE.

DNE of the " blue ribbons " of medical distinction in Italyis the Riberi Prize, so called from the late Professor AlessandroRiberi, the celebrated Piedmontese surgeon who founded it.It is open to competition every five years, and its value isP0, 000 fr. (.&bgr;800). The competitors are of all nationalities,the subject must be one of purely medical interest, and"original research " is a conditio sine q I[â norc of the com-petition. Of the works sent in, three were declared by theadjudicators to be worthy of the prize-one by a Frenchman,another by an Italian, and the third by a German. Amongthese the prize has just been awarded "per prevalenza diEnerito (for preponderance of merit) to a physician of thesecond-named nationality, who turns out to be Dr. CamilloGolgi, Rector of the University of Pavia and Professor ofGeneral Pathology in that school. His subject was "SulleFebbri di Malaria" (On Malarial Fevers), and his essay,soon to be made pzcbliei jU1’is, will, it is stated, be found toenhance the honourable reputation he has already won inthat field.

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THE AFTER-CARE ASSOCIATION.

THE After-Care Association, whose purpose is the succourof poor female convalescents on their discharge from lunatic-asylums, held a meeting last Monday, at 83, Lancaster-gate,the residence of the Earl of Meath, their president. SirB. W. Richardson pointed out to the meeting the im-mense good that the Association had been able to do, evenwith so limited a yearly income as 400, and appealed to allsuperintendents of asylums to endorse the value of such work,and so help by their powerful recommendations to secure fo theAssociation wider public support and facilities for extendingtheir useful labours. This is, we believe, the only charity ofthe kind in the United Kingdom, and its practical utility inconfirming in their convalescence the subjects of treatment inasylums is undeniable. The secretary, Mr. Thornhill Roxby,will give all information in answer to inquiries addressed to’him at the offices of the Association, in the Church-house,’Westminster.

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DEATHS FROM STARVATION.

IT is no merely scientific interest which attaches to the!:eport which has just been issued by the Home Office on thenumber of deaths from starvation occurring in London duringr-he period of a year. We may recognise in it the :.1rst stepin the practical treatment of a social evil as long-standing asit is from its very nature obscure and evasive. The report in’question deals with thirty-one recorded cases in which thecause of death was ascertained by investigation in a coroner’scourt. On perusing it one fact is at once evident-namely,that starvation pure and simple plays but a subordinate partamocg the conditions preceding death. It far more com-

monly appears as an aggravation of pre-existing disease.and is thus only secondarily accountable for the fatal issue.A certain proportion indeed of the cases in which the onlyrecorded illness was hunger might with equal truth be

classified among disorders of nutrition. Such are six deaths

in infancy from insufficient or improper feeding. Pareand simple starvation is the verdict in only four cases, twobeing those of aged people, one of a man aged fifty to fifty-six, and one of an infant of twelve months. It is further

noteworthy that in almost no instance had parish relief beensought either by or for the sufferer. In one case, that of aman aged ninety, it was obstinately objected to. This is onefeature in the official return from which it is possible toderive some encouragement. A not unnatural desire to

retain the privacy of home, however humble, and the mastery,sometimes unwise, of one’s own actions renders many of thepoor very unwilling to relinquish the bare disorder of theirsolitary lives for the comparative comfort of the workhouse,with its needfal and inseparable restraints. Such prejudices,however unjust, do not soon die, and it is therefore all themore necessary that their fallacious character should be

proved. The influence of neighbours and parish officials alikemay be profitably exerted in this direction. In very manyinstances, moreover, out-door relief is practicable, so that

such a term as absolute starvation becomes under the circum-stances hardly distinguishable from voluntary neglect.Another ground of hope is to be found in the fact alreadystated, that disease in most of the cases quoted cooperatedwith want in the work of dissolution. The effect, therefore,though a lesson in precaution, was not starvation.

TOUTING TELEGRAMS.

A PRACTICE appears to have recently grown up which wewish to unequivocally condemn. It is that employed by theproprietors of certain preparations-doubtless often excellentthings in themselves-to bring their goods under the imme-diate notice of the profession by telegraphing to well-knownphysicians and surgeons a reference to the paper or journalwhere some favourable notice of the same has appeared.In these days we recognise that it would be ineffectiveto protest against many developments which a few

years back would have been held to be-to speak mildly-flagrant breaches of good taste ; but the annoyance whichthis particular form of touting may cause to many medicalmen is so acute that we consider it imperative upon us topoint out the fact; and that not only on behalf of the medicalman, but as a caution to the advertiser who may feel temptedtowards this method of casting his bread upon the waters.Many physicians and surgeons are compelled, at some j unctureor other, to treat their telegrams as private communications,and to arrange, during even a brief absence from home, tohave them forwarded at once to them, wherever they maybe, or even brought to them by hand at considerable incon-venience and expense. Let the enterprising advertiser con-sider whether a telegram transmitted to a medical man undersuch circumstances is likely to induce the recipient of thetelegram either to look up the reference or use the article.

ANTI-CHOLERAIC INOCULATION.

WE have received the following communication fromM. Haffkine:-"Anti-choleraic inoculations continue to

occupy all my time, and the process has now been applied toabout 16,000 persons. I try to work on as large a scale aspossible, because it is impossible to know beforehand in whatpart of the country cholera will make its next appearance. I

append the names of the places where inoculations have beenfreely made up till now : Agra, Alligarh, Lucknow, Delhi,Sanawar, Karsauli, Dagshai, Patiala, Rajpoorah, Chirat,Jhansi, Simla, Jatagh, Rawal-Pindi, Murree, Abbottabad,Peshawur, Sangrur, Nowshera, Naini-Tal, Almora, Ranikhet,Dworahat, Kainur, Pauri, Sakniana, Mussa Gali, Srinagar(Garhwal), Tehri, Mussoorie, Dehra Dun, Hardwar, Lahore, andMeean Meer. In all these localities it has been attempted tomake the inoculations upon persons who are living in preciselythe same environments as their uninocalated fellows ; that is

168 MIDWIVES’ REGISTRATION ASSOCIATION.

to say, I have selected half of a regiment, of a school, of aprison, or of a village for treatment. A record of the

names, social position and surroundings, symptoms whichappeared, &c., has been carefully kept of each case, with most minute details, and copies of these records havebeen given to the medical officers in these localities ;and it is from these gentlemen that I hope to receive clinicalobservations upon the subjects of operation when next anepidemic appears. The constitutional differences displayedby man with regard to cholera are so large that no experiencegathered from one, two, or ten individual cases would giveeven the most general result ; the probability being that allthe ten selected persons might be constitutionally incapableof being affected by the disease in the recognised manner.On the other hand, operations on animals on account of theparticularity of the symptoms which result, are always opento discussions. The results of experience now placed beforethe eyes of the medical service in India will bring about,I hope, in the near future a direct revolution in our ideasof the nature of cholera and the means of combating thedisease. "

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MIDWIVES’ REGISTRATION ASSOCIATION.

WE have received from the honorary secretaries, Dr. Boxalland Mr. Rowland Humphreys, a circular announcing to theprofession the formation of an association with the abovetitle, consisting only of registered practitioners, both in

general and obstetric practice. The object of the associationis to secure the cooperation of all such practitioners in anattempt to obtain legislation such as shall secure the propereducation, registration, and supervision of midwives. It is

feared that if such an association is not formed and sup-ported by the profession the education and control of mid-wives may fall into non-professional hands, with the effect ofperpetuating the present inefficiency of midwives and causingconstant collision with the interests of the general public andof the medical profession. The first list of members in-

cludes between fifty and sixty gentlemen. The following isthe list of those constituting the executive committee : Dr.F. H. Alderson, Dr. Watt Black, Dr. R. Boxail, Dr. Champ-neys, Mr. De’Ath (Buckingham), Mr. Freeborn (Oxford),Dr. W. S. A. Griffith, Mr. Edmund Hale (Chew-Magna,Bristol), Dr. Handfield-Jones, Dr. Herman, Mr. Rowland

Humphreys, Dr. A. D. Leith Napier, Dr. Schacht, and Dr. G.Danford Thomas. We trust that in any efforts to promote theobjects of the association care will be taken to make it clearthat the midwife is to act only in natural cases, and that inthe event of any departure from the normal, either as regardsmother or child, she is to call in the assistance of a dulyqualified medical practitioner.

THE DIFFUSION OF SMALL-POX.

SMALL-POX continues to oscillate in the principal townsaffected, and the oscillations are mostly governed by theperiod of incubation of the disease; that is to say, the riseand fall in the number of fresh attacks are fortnightly. Last

week was one of rise as compared with the previous week. In

Birmingham the new attacks rose from 27 to 48, in Bristolfrom 6 to 36, in West Ham from 10 to 13, in Oldham from5 to 10, and in Bradford from 12 to 25. There were at the

same time some instances of fall ; thus, at Walsall 20fresh attacks were recorded, against 28 in the previousweek. Amongst other places infected fresh cases occurredlast week as follows : Handsworth, 4 ; Worcester, 2 ;Aston Manor, 8 ; Chadderton, 2 ; Wakefield, 7 ; Hull,4 ; Middlesbrough, 2 ; besides a number of isolated

attacks, as, for example, at Leicester, Willesden, Enfield,Nottingham, Manchester, Batley and York. News of small-

pox also reaches us from Aberavon, Caldicot near Chepstow,and a few other places. In Bristol the increase is largely

attributed by Dr. D. S. Davies, the medical officer of health,

to the fact that a number of cases are extremely mild. Thesecases are either not recognised at all, or they are so trivia)

that those affected move about amongst persons whilst

suffering from the disease. Most of these individuals have

been well vaccinated in infancy and are said to suffer no

inconvenience from their attacks, which go unnoticed bythe sanitary authority until their less protected fellows

have been infected. In five families attacked last week

the disease is said to have singled out, with characteristic

accuracy, the unvaccinated members of the families in

question, and the number of unvaccinated infants attackedhas been a noticeable feature. In reporting these matters,

Dr. Davies refers also to the growing practice of certain

practitioners who, by making one single small pnncture;fail to give adequate protection against the disease,The points adverted to by him, especially as to theinfluence of mild attacks going unrecognised, are of import-ance, especially as regards the view that isolation anddetention will, apart from vaccination, suffice to control

small-pox. The number of cases daily under isolation bythe Metropolitan Asylums Board has varied from 80 tc.

90, except on one day, when they fell just short of theformer number. At Halifax the epidemic, which may betermed that of 1892-93, has apparently come to an end; Mr.Ainley’s report upon it is dealt with in another column.

AN UNNECESSARY EXHUMATION.

SOME extraordinary proceedings in connexion with thedeath of an infant are recorded as having taken place duringthe last few days at Brentwood, Essex, reflecting upon thetreatment pursued by Mr. Cloete Smith, the medical at-

tendant. As Mr. Smith was not only exonerated from aR,blame, but commended for the splendid manner in which,under most adverse circumstances, he had performed ar,

admittedly difficult operation, it is difficult to conceive uponwhat grounds the Home Secretary gave the order for theexhumation of the child over whose body an inquest was held,on the 16th inst. The facts of the case, as far as they wereelicited at the inquiry, are simple. On Jan. 1st the child ofMr. Lawrence Petre had an attack of convulsions attributed tc’

teething and Mr. Smith was hurriedly sent for. Whenheaniveathe convulsions had ceased, but the child’s breathing was sc,bad that he at once administered hypodermically a dose of’

apomorphine to induce sickness. As this and subsequentinjections produced no beneficial effect Mr. Smith pro-nounced tracheotomy to be absolutely necessary, and withthe consent of the parents he performed the operation witba pair of dressing scissors, the instruments for which he bac."sent not being forthcoming. The wound was kept open bymeans of the scissors until a proper tube was available. Thechild died on the following morning and was interred in the’Roman Catholic Cemetery at Brentwood on the 5th. Deatbwas certified as deing due to "teething convulsions, sub-

sequent paralysis of the respiratory muscles, cedema of larynxand lungs.

" Mr. Petre not being satisfied with the cause ofdeath, communicated with the coroner, and the coronei

having communicated with the Home Secretary an orderfor exhumation of the body was obtained. Mr. Grogono andMr. Francis of Stratford were deputed to make a post-mortemexamination, and at the inquest stated that death was con-sistent with the certificate given, and that the operation oftracheotomy had been admirably performed. The jury ut

once returned a verdict in accordance with this testimonyand added a rider to the effect that, although the treatmentappeared to have been severe, yet that it was warrantedunder the circumstances. They emphatically declined to

add that the inquiry was justified, as was suggested biMr. Petre’s solicitor. Evidently, therefore, in the opinion

. of the jury the inquiry was totally unnecessary. That sceb