material aid in certain surgical cases, which is none the less true in medicine; for instance, in cases that are absolutely beyond relief and in the management of which we can only hope to keep the patients comfortable until the end comes.

The suggestion made by Dr. Cottell is an extremely good one, and it was my first intention to write a paper setting forth the uses and abuses, the indications and contra-indications if you please of the drug under consideration, but I found the subject entirely too large for the time allotted in this society.

Opium is one of the most useful remedies we have; its uses are manifold; it may be used in thousands of cases. It was only in particular cases that I advised against its employment in the paper; if you will recall my remarks you will see that I referred to the injudicious use of opium before a diagnosis had been made, and in many cases I may say it should never be used even after the diaguosis has been established, for the reasons stated in the paper; and then the use of opium in cases in which it can only add further to the restriction of elimination.

The administration of morphine in connection with anesthesia, while not particularly touched upon in the paper is a question of considerable importance. We already have the deleterious effect of the anesthetic upon the eliminative functions, and in addition to that, if we add the physiological effect of opium, the condition of our patient is rendered much more grave. Undoubtedly many deaths which were attributed to chloroform or ether anesthesia, shock or something else, upon critical analysis would be recognized as deaths due to the administration of morphine. There can be no doubt that morphine under such circumstances further restricts the action of the kidneys, increases the depression, nausea, vomiting, etc., and its use should be prohibited in the management of surgical cases in general, although there may be special instances in which its use is beneficial.

I am perfectly willing to concede every thing that has been said in regard to the use of opium, in catarrhal affections, intestinal disturbances, the neuralgias, and in many other conditions, but since my attention has been called to the subject, since I have looked into it more carefully, it may be that I have been heretofore practicing in a rather injudicious way in many cases. So far, however, I do not recall any "long sleeps" in my practice that could fairly be attributed to the use of opium.

JOHN MASON WILLIAMS, M. D., Secretary.

Foreign Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

Hospital Sunday; Death of Mr. Henry Lee; The Sale of Poisons; Hospital Administration and Medical Relief; New Government Laboratories; A Hospital Sermon; New University Hospital.

Previous to Hospital Sunday the Lord Mayor of London issued a philanthropic appeal to all metropolitan worshipers, pointing out that there were nearly two hundred hospitals, convalescent homes, and dispensaries seeking to participate in this year's collections, estimating that quite £100,000 was required to make up the differnnce between the receipts and expenditure of the the various establishments for the relief of human suffering in Greater London. All hospitals participate according to their needs and difficulties in the Hospital Sunday Fund. Many of the minor charities look to this annual help to compensate them for the reduction of income and legacies from which they suffer through the pressure of more urgent claims.

By the death of Mr. Henry Lee St. George's Hospital loses its Senior Consulting Surgeon. Mr. Lee's "Lectures on Practical Pathology" ran through three editions. He was known as a bold and successful operator in days before the advent of antisepticism, and his success was largely due to the observance of that minute care in the after-treatment of operations which has since become a characteristic of modern surgery. On the necessity of adequate ventilation of surgical wards Mr. Lee always strongly insisted, attributing the then prevalence of erysipelas in the spring not to the east wind, as was the fashionable view, but to the closed windows which fear of the east wind induced.

A new bill to regulate the sale of certain poisons has been brought forward; it particularly relates to the sale of carbolic acid, which accidentally or otherwise is responsible for the death of at least two hundred and fifty persons per annum in England and Wales. Its sale has hitherto been as if it called for no more care than so much vinegar, for various reasons the Privy Council having from time to time refused to add carbolic acid to the list of poisons included under the Pharmacy Act. The new bill allows any one to sell certain "poisonous substances," among which carbolic acid is enumerated, provided the bottle, box, vessel, or package in which the substance is contained is distinctly labeled with the name of the substance, coupled with the word "poison," and accompanied by the name and address of the seller. It is intended that the bill shall not be a dead letter, the

enforcement of the present law resting with the Pharmaceutical Society; in future the Privy Council will have the same power as the Society.

At a conference called by the Hospital Reform Association, held for the purpose of discussing the administration of medical relief in the out-patient. and casualty departments of hospitals and dispensaries, Sir H. Burdett did not think that a proposal to form another committee, which would go over the old grounds, dig up the old facts, and report on the same lines, would solve the matter. They would never get a more enlightening guide than the report, which had become a classic of Sir William Ferguson's committee forty years ago. He was opposed strongly on conviction as a practical man to get another investigation. If they had a committee at all, it should stand on the old undisputed facts and try to bring together those who had it in their power to devise a new system. Sir William Broadbent said the majority of the hospital staffs were just as much alive to the evil of the increasing number of out-patients as anybody else. At the present moment the staff were in a very helpless position; being servants of the hospital, they had to see the patients brought to them. The reduction in the number of patients could not be effected by the staffs of the hospitals, but by a general consensus on all sides. He looked forward to a realization of the responsibility which the power conferred on the Hospital Sunday Fund and the Prince of Wales' Fund necessarily involved. Those bodies had the power of the purse, and their approval, and more especially their condemnation, would carry enormous weight.

The new government laboratories in Clement's inn passage are found to be a great convenience. No fewer than thirty-eight rooms, specially constructed and fitted with perfect appliances, are at the disposal of the staff. It appears that in 1867 the number of samples examined and reported upon was 9,055; in 1877, 14,024; in 1887, 39,244; and in the twelve months ended March of the present year, 64,664: of these, 28,875 were samples of beer and brewing material, 11,403 spirits, 14,872 snuff and tobacco, 41 coffee, 6,423 miscellaneous articles, and the standardization of excise instruments and 3,050 specimens of the contract supplies of government departments. The principal laboratory is specially adapted for the examination of beer and spirits. A set of rooms are used for the analysis of crown contract samples and of food and drugs as well as tobacco. The new building was constructed by the Board of Works at a cost of between £25,000 and £30,000.

An assemblage of managers and artists of the London and provincial music halls have met at Grosvenor House, the town house of the Duke of Westminster, for the purpose of putting on an organized basis the effort of the variety stage to assist the Queen Victoria Jubilee Nursing Institute. During the meeting the methods of nursing the sick poor in their own homes were explained, and it appeared that substantial help had been given to this movement last year, when the fund in all was benefited from various sources by about 156,000, as much as £250 had resulted from an entertainment specially given at the Tivoli Music Hall.

The Bishop of Stepney, preaching in St. Paul's Cathedral on Hospital Sunday, said that it had been said that the Christian Church was the oldest fighting regiment in Europe, but he thought it was something better than that. It was the oldest Red Cross Society in Europe for the relief of suffering and distress. In the name of the 1,755,000 patients who came to the hospitals last year, on behalf of the daily London sick list of 173,874greater than the population of Brighton, Cardiff, and Bolton-by the consideration of the 214,000 who lived in single-roomed tenements in London, by the generosity of those ancestors who paid to-day ten shillings out of every pound for the hospitals, and by the sacred name of their most Holy Redeemer he made his appeal.

The Prince of Wales has laid the foundation stone of the new buildings at University College Hospital. The hospital will eventually be entirely rebuilt, the cost being borne by one individual who is the proprietor of a furnishing business in the neighborhood of the hospital. The cost will be upward of £100,000.

LONDON, June, 1898.

Abstracts and Selections.

PICRIC ACID IN THE TREAtment of BURNS.-C. Willems, of Ghent (Ann. de la Soc. Belge de Chir., May 15th), points out that picric acid is really of use only in burns of the first and second degrees. The special action of the acid is to favor the growth of new epidermis. In such superficial burns the utility of the agent, he holds, is beyond question. By means of it he has seen extensive burns of the face and limbs heal with great rapidity. Epidermization takes place so quickly that no suppuration occurs. Another advantage of the picric acid is its marked analgesic property. In burns of the third degree Willems found the acid much less useful; it does indeed check suppuration, but it has no effect in quickening granulation. As in practice, however, these three degrees of burns are generally present at the same time, the acid may with advantage be used at first, as it soothes the pain and rapidly heals the superficial lesions; an antiseptic can then be substituted for the treatment of the granulating surface. The pain and the toxic accidents which have been placed to the discredit of picric acid are to be attributed to the use of too strong preparations. Willems points out that a saturated watery solution has generally been used, compresses soaked in this being applied to the wound and allowed to dry on it. He points out that picric acid is dissolved in water in the proportion of only about onehalf per cent. In cases reported to the Surgical Society of Paris not long ago, as proving the serious disadvantages of the treatment by this agent, solutions of five per cent and ten per cent appear to have been used. Wil

lems contends that it is unfair to condemn an agent for effects due to its misuse. Willems himself uses the acid in vaseline ointment of the strength of one, or at most two, per cent; 15 g. of this spread upon lint makes a dressing suitable for a vast burn. Although most of his patients have been children, he has seen no signs of toxic effect, and the pain, when there was any, was slight and transient. The sole drawback is the yellow dicoloration of the skin which the acid produces. This can be got rid of by repeated washing with alcohol, or with carbonate of lithine diluted with water.-British Medical Journal.

ENDARTERITIS OF RENAL Arteries and Cortical NECROSIS.-J. R. Bradford and T. W. P. Lawrence ( Journ. of Path. and Bact.) record the case of a woman, aged thirty-six, confined with a stillborn child some days before admission, suffering from anuria. History mainly negative. Anemia and weakness, but no dropsy, headache, sickness, or convulsions; intellect clear to the last. The cortex of each kidney was found bright buff-colored, and sharply defined from the pyramids; microscopically the convoluted tubules were seen to be necrotic. This necrosis was due to thrombosis of all those branches of the renal artery which had reached an approximate diameter of 100-evidently of the so-called "interlobular" arteries; all branches of the renal arteries were extensively diseased, the media and especially the intima being thickened and sclerosed. The interstitial tissue of the kidneys was not increased. The patient thus presented the typical clinical picture associated with "obstructive suppression," while the morbid appearances were such as should, according to theory, have given rise to uremia. The authors hold that this case throws grave doubts on the view held by many "that uremia is independent of the mere retention of normal but toxic products that ought to be excreted." The case also shows the independence of renal endarteritis and extensive renal cirrhosis.—Ibid.

TROPHIC LESIONS IN GENERAL PARALYSIS.-Cololian (Archives de Neurol., March, 1898,) records fifty-seven cases of general paralysis of the insane with reference particularly to the occurrence of trophic lesions in this disease. Of these cases thirty-three were men, twenty-four were women. The commonest lesion was found to be alopecia, which occurred in twenty-six cases. Changes in the teeth and nails occurred next in frequency, nineteen and seventeen cases respectively. Ichthyosis occurred in eleven cases, and other skin lesions (for example, bullæ, edema, and zona) with less frequency. General wasting occurred only in three cases, muscular wasting only in one case. Cutaneous pigmentation, hematuria, perforating ulcer, and erythema were only found in isolated cases. In most of the cases more than one trophic lesion occurred, and in only eight of the fiftyseven cases was there no evidence of trophic lesion.-Ibid.