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were in round numbers 6000 in-patients and 161,000 out-

patients, and at this hospital, according to the 1894 editionof "Experiments on Hospital Patients," from which CanonWilberforce quotes, there are fifteen vivisectionists on

the staff or at work in its laboratories. This does not

look as if there were much uneasiness among the classfor whose benefit the hospital in question was founded.Canon Wilberforce means, we believe, to be sincere,though he is hopelessly wrong - headed. Let him sub-stantiate his innuendoes, not by references ten years old,but by some modern instances. The letter of "S. C. S.,"in the Times of Dec. 27th, 1895, though anonymous, wantsa better answer than Canon Wilberforce’s of the 29th.11 S. C. S." clearly shows that Canon Wilberforce’s decluc-tions are absolutely unfounded and puts him in the dilemmaof either not having verified his references or, if he did so,of wilful misrepresentation.

SOME CLINICAL ASPECTS OF THE COAGULA-BILITY OF THE BLOOD.

OUR attention has been called to an excellent and

suggestive paper by Surgeon-Lieutenant L. Rogers, M.B.,B.S., F.R.C.S., of the Indian Medical Service, which wasread before the late Indian Medical Congress and has beenreproduced in the pages of the Indian Lancet of the 16thult. The paper is on some clinical aspects of the coagula-bility of the blood. It appears that the writer had

an opportunity of studying, at Netley, Professor Wright’smethod of estimating the coagulability of the blood and ofclinically applying it. The method introduced by ProfessorWright is a very simple one. It consists in prickingthe finger-tip, as in the use of Gowers’ hsemocytometer. anddrawing up a small quantity of blood into a fine tube ofuniform calibre. From four to six tubes are filled at notedintervals. By blowing down these at given moments theshortest time in which the blood is found to be clotted, sothat it cannot be blown out of the tube, will be the coagula-tion time. With a little practice it can be determined towithin 15 sec. or even 5 sec. The normal time of a healthyperson is usually between 2 min. and 5 min., varyingslightly with the temperature and the time of day, especiallyin relation to meals, being shorter after a full meal and

longer after a fast. Surgeon-Lieutenant Rogers’s own timewas very constantly between 2 min. 15 sec. and 2 min. 20 sec.This officer then goes on to consider and describe the methodsof increasing and decreasing the coagulation of the intra-vascular blood as determined by numerous observations byhimself and others, and the results are both interesting andinstructive. He passes in review the influence of calciumchloride and the inhalation of carbonic acid gas dilutedwith atmospheric air by a Kipp’s apparatus, or an india-

rubber bag, in increasing the coagulability of the blood, andrecords some interesting experimental observations. Withcalcium chloride taken in fifteen-grain doses he found, ,,

for example, that his own coagulation time couldbe reduced from 5t min. to 1’4 min. As a result of his

experiments on coagulation with various drugs usually con-sidered to have hasmostatic properties he shows that severalof these, such as gallic acid, ergotine (except in the uterineform of hsemorrhage), and potassium iodide, have no effect.The substances which reduce or retard coagulability are nextconsidered, with the result that some interesting observationsare recorded in regard to numerous agents tested in this

respect, and a suggestive allusion is made to the probableexplanation of the benefit derived from the administration ofoxygen in some cases of pneumonia, and that of alcohol incausing a retardation of coagulation, a fact to be borne inmind in its administration during or after haemorrhage.As regards the practical clinical application of the results ofrecent researches in coagulation, the writer alludes to the

physiological styptic properties of calcium chloride appliedlocally, and to its use internally in hsemorrhagic conditions.such as severe haemoptysis, in some cases of which he-

successfully gave it in fifteen-grain doses, and he points.out that its use is indicated in hsematemesis and invesical haemorrhage. As regards haemophilia, it is re-

marked that the lack of calcium chloride in the blood’

is probably a very important pathological feature of the

disease, and reference is made to the use of this

agent and of carbonic acid gas in the treatment of thiscondition. His experiments with potassium iodide and lowdiet in their effect on coagulation do not tend to support thepresent treatment of certain forms of aneurysm except in so.far as these reduce the force of the circulation, whereas h&considers that an increased coagulability can be induced bythe methods described-viz., by the administration of car-bonic acid and the use of calcium chloride. The administra-tion of the latter agent by the mouth is also of service in

. safe-guarding the system against the risk of haemorrhage incertain operations. He suggests the use of vegetable acids-or oxygen in cases of threatened or actual thrombosis after

typhoid fever and in other morbid states attended withthromboses. We have said enough, however, we hope, to-induce our readers to peruse Surgeon-Lieutenant Rogers’ssuggestive paper for themselves.

DEATHS UNDER ANÆSTHETICS.

Two deaths have recently been reported from Guy’&Hospital as having occurred under an anaesthetic. Th&notes before us are unfortunately very scanty, althoughinformation was invited from the hospital authorities.A married woman aged twenty-six was admitted into’

Guy’s Hospital on Nov. 13th, 1895, suffering from

cystitis. On Dec. 2nd an operation was to be performedupon her for the relief of the condition which occasioned

the bladder trouble, and she was anaesthetised byone of the house surgeons, Mr. H. W. Beach. The-anaesthetic selected was ether, but nitrous oxide gaswas administered first, and just as this was being changed’for ether the heart’s action ceased. No explanation of the-death is suggested except that it was not due to respiratoryspasm but to failure of respiration and circulation. As

Mr. Beach remarked at the inquest, death at this stage ofthe administration of nitrous oxide gas and ether is extremelyrare. Without a fuller record of the sequence of events itis quite futile to attempt to explain so extraordinary anoccurrence. When so many persons pin their faith to

the almost absolute safety of this anaesthetic, andthis method of using it, it is startling to find an:

inexplicable death occurring in the hands of a careful andexperienced hospital officer in a large London hospital, andthis certainly emphasises what the events of the past few yearshave been impressing upon us-viz., that we know very little-about the causation of death by anaesthetics. We should’welcome a fuller and more detailed account of this

fatality. The second death was that of a domesticservant aged twenty. She was suffering from enlargedtonsils, and the glands in her neck were also affected. Onadmission into Guy’s Hospital her condition was consideredto be very unsatisfactory, but on Nov. 26th, 1895, after shehad been carefully prepared for the operation, Mr. C. H.Bryant, one of the house surgeons, administered chloroform.Two minutes after the commencement of the operationrespiration ceased. Artificial respiration was practised, andthe patient rallied. The operation was then resumed, butbreathing again ceased, and all restorative measures failedto restore life. Many surgeons object to the employment ofether for operations which involve removal of adenomatoustumours and tonsillotomy, but whether such objection shouldoutweigh the manifest advantage of ether for persons whose

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Titality is low can only be decided in each particular case.The sudden cessation of breathing, with its resumption afterartificial respiration, strongly suggests poisoning of the

respiratory centre, and whether it was wise to continuethe operation after so grave a symptom is at least open,to question. It would be instructive to learn whether any-further employment of chloroform was made, or whether thesecond failure of respiration was one of the " late effects "

which have attracted the attention of Chalot.

CONTAGION IN THE DAIRY.

IN order to ensure the local extinction of infectiousdisease it is not sufficient to apply any one routine formulaof treatment. Sanitary science is not, however, by anymeans a subject of purely technical character, but one whichis to a large extent comprehensible by the general intelli-

gence. For this reason the necessary safeguards, whichare its practical evidences, must also be numbered

among the duties of the private citizen. It follows

that a milk-dealer convicted a few days ago at

the Thames Police-court was liable for an offencein selling milk while his household premises, used also

for trading purposes, were contaminated by diphtheria.The defence in this case was that of ignorance, and as suchwas insufficient to justify acquittal. It is, however, sug-gestive as bearing on other and related considerations. The

disease was duly notified by a practitioner. It proved fatalin two days. Six days subsequently disinfection was carriedout. In the meantime the milk trade went on, the salesman

being, as alleged, ignorant as to what this implied to his- customers. There are instances, of course, and these not few,sn which the seclusion of the infected and the pursuit of acalling may be possible in the same establishment at thesame time. The present case was evidently not of such a’kind, yet the patient was not removed, and the dealer did nottknow that he should suspend his business. It is, to our

.mind, somewhat surprising that he should have been withoutinstruction in a matter so important after a visit from the-sanitary officer. Surely the work of inspection, though itcannot supersede the demand of the law, is understood tc

{provide for such instruction where occasion requires.

DIPHTHERIA MORTALITY AND ANTI-DIPHTHERIASERUM IN FRANCE.

CERTAIN facts and statistics which have been communi-cated to the Académie de Medecine in Paris by M. HenriMonod, the Director of the Public Health Department ofFrance, will have interest for all those who desire informa-tion as to the use of antitoxic serum as a means of stayingthe ravages of, and preventing death from, diphtheria. The

system for the registration of deaths is still very imperfectin France, and by reason of this M. Monod is restricted,as regards mortality returns, to 108 towns of 20,000 inhabi-tants and over ; but this gives him a population of 8,150,000,to deal with, although it is limited to that which is practicallyurban in character. As in England, so in France, diphtheriais a ru-ral as well as an urban disease. In the 108 townsof France which are in question the mean number of deathsfrom diphtheria in the first six months of the seven years1888-94 was 2627. In the three months November, 1894, toJanuary, 1895, the Institut Pasteur distributed over 50,000supplies of anti-diphtheria serum, and this supply, whichwas maintained, was made available not only for the well-,to-do but also for those who, by reason of poverty, werecompelled to receive it by means of gratuitous distribution.Now in the first six months of 1895 the number of deathsfrom diphtheria in the same 108 towns was only 904, or adiminution at the rate of 65’6 per cent. The rate of

,diminution month by month went on almost uniformlyfrom one of 56’2 per cent. for the month of January to

47’5 per cent. for the month of June. On these data alonea saving of 15,000 lives would have been effected

during the first half of 1895. M. Monod, however,deals with the matter as an affair of statistics, and he doesnot profess to enter into the question whether the climaticand other unknown causes which influence the power of

diphtheria for spread and for death were less operative inthe first six months of 1895 than in the corresponding monthsof the seven antecedent years. Such conditions may haveinfluenced the result to some extent; but it seems impossibleto attribute solely to an unknown cause such a diminution indeath as he shows in his paper to have gone on synchronouslywith the widespread use of the serum. The facts he quotesare well worthy of consideration by those who have to treatdiphtheria either in hospitals or in the homes of the peoplein this country.

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"SHOULD A MEDICAL MAN MARRY ?"

UNDER this heading La LOir6 Médicale has a rathercurious article in which this often discussed question istreated in a decidedly novel manner. There is no doubt

that in the Middle Ages medical practitioners were con-demned to celibacy, says the writer in our contemporary,but during the seventeenth century this monkish rule wasrelaxed, and they were permitted to marry. A disciple ofÆesculapius, desirous of domestic bliss, could then take untohimself a wife, it is true, but only think of the imprudenceof it ! Such, at least, was the view taken by a worthynamed John Jacob Treyling when inditing his thesis for theuniversity of Ingolstadt in answer to the foregoing query.The passage runs as follows : " Accidit ad hoc viro

præsertim medico, quod si juvenculam sibi junxerit, hancqueformosam, habeat quod metuat illud Epicteti dicentis: Quiformosam duxerit, habebit communem. Cum enim medicusdensa praxi obrutus, nee domus nee uxoris custos esse valeat,quid ? Si hæc interim hospitalis sit et Dianam æmulata cor-nificii metamorphosi maritum cervina superbum corona inActeonem transformat, heredesque ipse afferat, non nisiadamatico cum ipso sanguine conjunctos ? Ita ut non semel

saltem tacete secum murmurare querelus debeat: Haud egomihi uxorem duxi, tulit alter amorem : sic vos non vobis."We fear the worthy John Jacob’s Latin savours over-much ofthe canine variety, but nevertheless his meaning is intelli-gible. Whatever may be said of his argument as a whole,there is at all events little danger in these days of pro-fessional overcrowding that a medical man should become" obrutus densa praxi" !

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THE BACILLUS OF SYPHILIS.

THE whole etiological and pathological history of syphiliscompels the conclusion that its virus, like that of tubercle andleprosy, is an organised one, and that bacteriology will oneday reveal the microbe capable of such distinctive and

permanent effects upon the human body. Lustgarten’sdiscovery of a bacillus in the secretions of syphilitic ulcers,and even in tertiary lesions, has not been sufficiently widelyconfirmed to be regarded as solving the problem. It remainsto be seen whether a similar fate awaits the latest allegeddiscovery of the syphilitic bacillus, which is described atlength, with much additional speculation as to the bearingsof the discovery, in a monograph by Dr. van Niessen ofWiesbaden.1 The author is not a working bacteriologist, but,as he tells us, he is a neurologist, and it was the studyof the immense part played by syphilis in nervous

diseases which seems to have impelled him to makethe attempt to discover the contagium vivum. Whatever

may be thought of his work-and there is no doubt that it

1 Der Syphilis-Bacillus. With 4 plates; pp. 92. Wiesbaden: J. F.

Bergmann. 1896.