881

the efficiency of the hospital staff. With the readingof this letter from Mr. Liddell the matter dropped. We

trust that this is not the usual way in which collieries

deal with the medical treatment of their workers. It

is perfectly monstrous to suppose that the medical officer

of a hospital will submit to have his diagnosis called in

question by any practitioner whom an outside authority maychoose to send. If Mr. Liddell wished to have a report uponthe condition of the pitman’s hand his proper course wouldhave been to write to the house surgeon of the hospitalasking for a report and inclosing the usual fee to be paideither to the house surgeon or the hospital according to

the rules of the institution. If he was not satisfied withthe report of the house surgeon he would have been quitewithin his rights in asking for another opinion from one

. of the visiting staff. However, he seems to have seen theerror of his ways, and we hope that such an incident willnot occur again.

-

THE EFFECTS OF DUM-DUM BULLETS.

A STRIKING instance of the very severe effects of Dum-dum bullets when fired at only a short distance was affordedby the suicide recently of a private in the Scots Guards.The newspaper reports are not very full, but sufficient can begathered to show the extraordinary results produced. Theman placed the muzzle of the rifle in his mouth and pressedthe trigger with his foot. Some of the effects must doubt-

lessly be attributed to the action of the gases liberated fromthe cordite, for they were set free in large volumes and hadto escape either by the mouth or through the channelformed by the projectile. The bullet was a soft-nosedor Dum-dum, and it passed through the hard palate,the base and vault of the skull, then through a clothcap, and struck the ceiling. It had spread out or

4’ mushroomed" and had lost its nickel sheath. The man’shead was enormously swollen, many of the bones beingbroken and nearly all of the sutures opened. This was due to

what has been called the" explosive" " action of these high-velocity bullets; the contents of the skull acting as a liquid,the effect of the increased pressure due to the entry of thebullet is transmitted equally in every direction. The onlywound in the skin was a vertical one at the back of the headmore than nine inches long with sharply-cut edges. Most ofthe brain substance and many pieces of the skull bones weredriven through this wound and scattered about the room.The injuries were remarkably severe, much more so thanthose resulting from the firing of a Martini-Henry rifle in asimilar position, for in the case of similar suicides with thatrifle the bones were merely perforated.

TYPHOID FEVER IN THE CITY OF YORK.

ON Nov. 17th the Local Government Board wrote to thetown clerk of York that they had observed that 10 deathsfrom fever were reported to the Registrar-General as

occurring during the quarter ending Sept. 30th in the

registration sub-district of Micklegate. The Board there-fore requested the town council to instruct their medicalofficer to prepare a report upon the prevalence of fever inthe borough. This report, drawn up by Dr. E. M. Smith,medical officer of health of York, now lies before us.

The report states that during the year 1900 244 cases of

typhoid fever were reported to Dr. Smith as occurring inthe sanitary district of the city of York. Of these 38

patients died-14 in hospital and 24 at their own

homes. The death-rate from typhoid fever for the yearwas therefore 15’5 per cent. of the cases notified. Duringthe first half of the year there were 23 cases with four

deaths ; during the second half of the year there were 221cases with 34 deaths. As regards age-distribution, in 19 caseswith two deaths the patients were under five years of age ; 89

cases occurred in persons between five and 15 years of age,of whom five died; 52 cases in persons between 15 and 25years of age, of whom 11 died ; and 82 in persons between25 and 65 years of age, of whom 19 died. Of the totalnumber of cases 17 of the patients apparently contractedthe disease outside the city. The unusual prevalenceof typhoid fever during the second half of the year is

attributed by Dr. Smith to the very dry spring and the veryhot periods of the summer, which fostered and developed theevils attaching to the increasing number of specificallyinfected midden privies. During the first half of the year23 cases occurred in 21 houses, and of these 21 houses 11were associated with the existence of foul privies, and 10with water-closets of which seven had defective drains.

During the second half of the year 221 cases occurred in 171houses, 97 of which had midden privies and 74 had water-closets. In the former there occurred 124 cases of typhoidfever, 27 of which were secondary and five of which hadcontracted the disease outside York. The large majority ofthe midden privies were more or less foul or leaking.In the 74 water-closet houses there were 97 cases,but deducting those houses where no sanitary defectwas observed, so that probably the patients contracted thedisease elsewhere, and those cases which were known tohave become infected elsewhere, there remain 57 water-closethouses to consider. Of these 27 had defects of drainage,16 were decidedly dirty, and 10, although not having defec-tive drainage, were associated with polluted soil. In 15water-closet houses only could no clue be found to the prob-able or possible origin of the disease. Dr. Smith statesthat taking the whole of the cases into consideration hefinds that the majority were associated with midden priviesmost of which were foul or leaking. The water-supply, themilk-supply, and the consumption of oysters and ice-creamare stated to have had no connexion with the outbreak. Dr.Smith’s chief recommendation is the abolition of all midden

privies and the substitution of water-closets or dry ashreceptacles. The report is very interesting from the largeproportion of cases occurring in persons under 15 years ofage, there being 108 such, with seven deaths, a case-mortalityof 6 4 per cent.

APHASIA WITH LETTER-BLINDNESS BUT WITH-OUT WORD-BLINDNESS.

DR. Guy HINSDALE of Philadelphia has published in theJournal of the Arnerican Medical Association of March 2ndan interesting case of aphasia with letter-blindness butnot word-blindness which possesses a somewhat exceptionalvalue in that the patient was a physician belonging to a well-known institution. The patient was a man, 35 years of age,the subject of pulmonary phthisis, probably of about fouryears’ duration. On Jan. 2nd, 1899, he had a sudden attackof paralysis involving the right face, arm, and leg, withalmost total loss of speech. During the first 24 hours hecould only speak the word " no." On the next day he couldutter four words, could move his right arm, and had good con-trol of the facial movements. He regained power steadilyafter this. On the ninth day he walked to the sitting-roomand insisted on helping himself to tobacco and a glass ofwine. On the eleventh day he was able to write his namefor the first time and his vocabulary was steadily increasing.When shown a silver pencil he could not name it ; whenasked if it was a knife he said " No." "A pencil ?

" "No."

"Something to write with?" " "Yes." On the nine-teenth day he was shown a silver dollar, but could notsay what it was. "Is it a watch 2 " "No." "Is it awheel 7 " "No." " Is it a piece of iron ?

" .. NO." It 4 & Isit a dollar?" " " Yes, it is a dollar." He was given a fewcoins ; he added them in a properly written column with thetotal value correct. He mispronounced some words and used