mitted by the boards of trustees. They speak from tients, which is double the number receivable in the an abundant observation and experience.

LUNATIC HOSPITALS.

There is an imperative demand for increased accommodations for the insane. The hospitals are crowded, and hundreds of inmates are compelled to occupy temporary cots, or beds in the corridors and upon the floors. I believe great economy of room is possible under a wise system of classification, separating the harmless, the criminal, and the dangerous, and other improved arrangements which professional knowledge and practical experience will advise. Let us adopt any and every reasonable expedient before we enter upon the construction of another hospital, or incur large expense in experiments in one field or another to test a theory. The financial affairs of the hospitals are reported in excellent condition. The surplus accumulated at Taunton, Worcester, and Northampton has been increased; while at Danvers the treasurer's report shows a balance of $1172.14, so that the $10,000 appropriated for an anticipated deficiency has been added to the surplus.

MEETING OF BOARD OF HEALTH, LUNACY,
AND CHARITY. RESIGNATION OF SUPERIN-
TENDENT OF OUT-DOOR POOR.

1st.

DR. H. B. WHEELWRIGHT's resignation as Superintendent of Out-door Poor was accepted, to take effect February 1st. Messrs. Fallon, Noble, Dean, Haggett, and Walcott voted to accept the resignation, although Dr. Wheelwright wished the term extended to April Meanwhile his department will be put in charge of the charity committee of the board. There was some animated discussion on this subject, but the result showed a large majority against the doctor. Ex-Governor Talbot intimated that those who wished to press this matter were active from personal spite. Colonel Haggett said he should throw the remark back in his face, and that he was not actuated by personal spite. Tewksbury has 1170 inmates, and will take no more at present. Miss E. C. Putnam was formally thanked for her efforts to reclaim wayward children by her plan of auxiliary visitors. Messrs. Talbot and Walcott were instructed to take advice of counsel as to having the State pay the Boston City Hospital for patients

sent there.

THE CHILDREN'S HOSPITAL.

house formerly occupied on Washington Street. Each of the two wards has twenty beds; there are five rooms for private patients, and three rooms designed for special cases, for those which need the quiet of a separate apartment. This year the aggregate of the house bills (as also the total cost of the maintenance of the hospital) has been double that of the previous year. This is due to the increase in the number of employees, and to the cost of their wards. The average daily number of children approximately in the former building was eighteen, and the annual expenses were, exclusive of rent, about $7500, making the daily cost for each patient about $1.14. In the present building the average has been thirty-seven patients per day, and the year's expenses have been $16,501.28, making the daily cost for each patient about $1.22. This record has been compared with those of similar institutions in Massachusetts, and the comparison is very favorable and satisfactory. The number of children received and treated in the wards during the year is 279, and the total number since the establishment of the hospital is 2033; in the out-patient department about 1000 in the last year. The report acknowledges aid received from the Ladies' Aid Association, the Sisters of St. Margaret, and others, and speaks appropriately of the deaths of Nathaniel Thayer, formerly president, and of Isaac

Thatcher.

SURGEON-GENERAL HOLT.

DR. A. F. HOLT, of Cambridge, has been appointed Surgeon-general on the staff of Governor Robinson, and has accepted the position. Dr. Holt was graduated in medicine at the University of Vermont in 1860, and enlisted in April, 1861, as a private in a Cambridge company, for which the claim is made that it was the first raised, and which became Company C of the Third Volunteer Regiment. Returning home at the end of his three months' service he was made assistant surgeon of the Thirtieth Massachusetts Regiment. A year later he was surgeon of the First Texas Cavalry, then major and lieutenant-colonel of that organization, of which he was in actual command at the close of the war. His military career was distinguished for bravery and he was made the subject of a complimentary general order from the Department of the Gulf for his courage in bearing away the wounded from under fire. the war Dr. Holt has been engaged in general medical practice in Cambridge, where he has filled the office of City Physician. He has been medical examiner since 1879, receiving his commission from Governor Talbot. We understand that his excellency has chosen to make appointments to his personal staff from those who saw actual service during the war, and in his selection of Dr. Holt he has a surgeon-general who by personal. and professional qualities will ably fill and adorn the honorable position.

Since

THE fifteenth annual meeting of the managers of the Children's Hospital was held in this city, in December, and the following officers were chosen for the ensuing year: President, Robert C. Winthrop; Vice-President, John C. Phillips; Treasurer, John G. Wetherell; Secretary, Francis H. Brown; Managers, Charles Faulkner, William Ingalls, Charles H. Fiske, Jeremiah Abbott, Alanson Bigelow, J. P. Spaulding, H. G. Pickering, Roland C. Lincoln, J. Montgomery Sears, Oliver A correspondent of the New York Medical W. Peabody, Phillips Brooks, Charles L. Young. The Journal, December 29th, narrates the case of a young managers, in their annual report, say that the past man in whose rectum a hard, green pear, measuring year has been in many respects experimental in the management, care, and testing of the new building, and three and a half inches by two, had been placed by that they are well satisfied with the result. The entire companions while he was in a state of intoxication. cost of the building, including furniture and equipment, It was removed by lithotomy forceps (the patient behas been about $125,000. It is now wholly paid for. ing in Sims' position) with some hæmorrhage and temThe hospital has now accommodations for sixty pa-porary paralysis of the sphincter ani.

REPORTED MORTALITY FOR THE WEEK ENDING DECEMBER 29, 1883.

1,922,530), the total death-rate for the week was 21.05 against 18.60 and 21.60 for the previous two weeks.

In the 28 greater towns of England and Wales, with an estimated population of 8,620,975, for the week ending December 15th, the death-rate was 22.6. Deaths reported 3735: acute diseases of the respiratory organs (London) 471, measles 125, scarlet fever 105, whooping-cough 80, fever 59, diphtheria 40, diarrhoea 33, small-pox (London seven, Birmingham, Liverpool, and Sunderland two each) 13. The death-rates ranged from 13.9 in Portsmouth to 29.2 in Manchester; Bradford 16.1; Leicester 20.5; Sunderland 20.7; Sheffield 21; London 22.7; Nottingham 23.6; Birmingham 24.3; Leeds 25.1; Liverpool In Edinburgh 20.8; Glasgow 26.3; Dublin 32.1. For the week ending December 8th, in 170 German cities and towns, with an estimated population of 8,725,681, the death-rate was 23.4. Deaths reported 3922; under five years of age, 1711; consumption 563, lung diseases 465, diphtheria and croup 281,

25.3.

Deaths reported 2725 (no reports from District of Columbia and New Haven): under five years of age, 939: principal infectious diseases (small-pox, measles, diphtheria and croup, whooping-cough, erysipelas, fevers, and diarrhoeal diseases) 543, consumption 419, lung diseases 400, diphtheria and croup 226, typhoid fever 70, scarlet fever 67, diarrheal diseases 52, measles 35, malarial fever 35, cerebro-spinal meningitis 16, erysipelas 14, whooping-cough 12, puerperal fever 10, small-pox six. From diarrheal diseases, New York 18, New Orleans nine, Boston seven, St. Louis four, Baltimore, Cincinnati, Charleston, and Fall River two each, Philadelphia, Brooklyn, Chicago, Lowell, Cambridge, and Taunton one each. From measles, Baltimore 16, New York five, Philadelphia four, Brooklyn three, Buffalo two, Chicago, New Orleans, Pittsburg, Milwaukee, and Lowell one each. From malarial fevers, New Orleans 12, New York seven, Baltimore five, Brooklyn four, Chicago three, St. Louis two, Charleston and Nashville one each. From cerebro-spinal meningitis, Fall River three, New York, Cincinnati, and Spring-diarrhoeal diseases 124, scarlet fever 92, measles and rötheln 68, field two each, Philadelphia, Milwaukee, Charleston, Nashville, Lowell, Salem, and Taunton, one each. From erysipelas, New York eight, Philadelphia and Boston two each, Cincinnati and New Orleans one each. From whooping-cough, Boston three, New York, Philadelphia, and Baltimore two each, Brooklyn, Chicago, and New Orleans one each. From puerperal fever, Chicago three, Philadelphia, Boston, Buffalo, Milwaukee, Providence, Charleston, and Springfield one each. From small-pox, Philadelphia four, New Orleans two.

Seven cases of small-pox were reported in St. Louis; diphtheria 26, scarlet fever 25, and typhoid fever 10 in Boston; scarlet fever 17, and diphtheria six in Milwaukee.

In the 79 cities and towns of Massachusetts, with an estimated population of 1,170,947 (estimated population of the State

whooping-cough 52, typhoid fever 48, puerperal fever 19. The death-rates ranged from 30.5 in Dortmund to 14.1 in Kassel; Königsberg 29.1; Breslau 26.9; Munich 27.3; Dresden 26.5; Berlin 25.2; Leipzig 24; Hamburg 23.5; Cologne 22; Frankfort a. M. 16.0; Strasburg 25.4.

For the week ending December 8th, in the Swiss towns, there were 27 deaths from lung diseases, consumption 22, diarrhoeal diseases 17, whooping cough four, diphtheria and croup two, typhoid fever two, puerperal fever one. The death-rates were, | Geneva 13.3; Zurich 12; Basle 17.5; Berne 27.1.

The meteorological record for the week ending December 29th, in Boston, was as follows, according to observations furnished by Sergeant O. B. Cole, of the U. S. Signal Corps:

·

1 O., cloudy; C., clear; F., fair; G., fog; H., hazy; S., snow; R., rain; T., threatening; Sl., sleet.

THE WORSHIPFUL COMPANY OF GROCERS, LON-
DON. ORIGINAL RESEARCH IN SANITARY SCI-
ENCE.

FIRST QUADRENNIAL DISCOVERY-PRIZE OF £1000.

1883-1886.

SUBJECT to the conditions of the Company's scheme, the Court now announces, as the matter of competition for this Prize, the following Problem:

"To discover a method by which the Vaccine Contagium may be cultivated apart from the animal body, in some medium or media not otherwise zymotic, -the method to be such that the Contagium may by means of it be multiplied to an indefinite extent in successive generations, and that the product after any number of such generations shall (so far as can within the time be tested) prove itself of identical potency with standard Vaccine Lymph."

The Prize is open to universal competition, British and Foreign. Competitors for the Prize must submit their respective Treatises on or before the 31st of December, 1886; and the award will be made as soon afterwards as the circumstances of the competition shall permit, not later than the month of May, 1887. In relation to the Discovery-Prize, as in relation to other parts of the Company's Scheme in aid of Sanitary Science, the Court acts with the advice of a scientific Committee, which at present consists of the following members: John Simon, C. B., F. R. S; John Tyndall, F. R. S.; John Burdon Sanderson, M. D., F. R. S.; and George Buchanan, M. D., F. R. S. All communications on the subject are to be addressed to the Clerk of the Grocer's Company, Grocers' Hall, London, E. C. GROCER'S HALL, May 30, 1883.

declares himself to be a candidate for the Prize, and the treatise on which he bases his candidature; such letter, and such treatise, to be addressed to the Clerk of the Company, who will give a dated receipt for the same. The competition-treatise of a candidate may, if the candidate so prefer, be delivered in successive parts, each bearing its proper date.

(7.) Each treatise in competition for the Discovery-Prize must be an original work by the candidate who sends it in. It may be a treatise which he has published at any time within the allowed period, or may be a treatise which he has not previously published.

(8.) Although candidature is not restricted to any one nationality, all treatises, and all communications with the Company in relation to them, must be in the English language. Translations into English of competition treatises published (within the allowed period) in a foreign language will be received on a like footing with treatises originally in English. (9.) All treatises must be in print.

(10.) Each treatise must bear the name of its author. (11.) Any particular candidate may be required to demonstrate practically to the Court, or to persons acting on their behalf, any fact or result which he claims to have discovered.

(12.) Candidature will be held to imply that the candidate undertakes to accept as regards himself the award which the Court

shall make.

Award of the Prize. -(13.) The Discovery-Prize being intended to promote the fullest possible elucidation of the given subject, the respective merits of candidates will be rated by that standard; and, if the Court be advised that the most meritorious candidate has produced an original solution of the main scientific problem or problems involved in the matter of the competi

For the Conditions of Candidature and Award, see under- tion, the Court will award to him the entire Prize. neath.

QUADRENNIAL DISCOVERY PRIZES IN SANITARY SCIENCE. Purpose of the Foundation. - (1.) The Quadrennial DiscoveryPrize of £1000 is intended to reward original investigations which shall have resulted in important additions to exact knowledge in particular, previously defined, sections of sanitary subject-matter.

(2.) During the pleasure of the Court, the Court will, once in four years, propose some subject for investigation; and a period of at least three and a half years will on each occasion be allowed for the investigation of the subject that has been proposed.

(3.) In determining, on each occasion, what particular subject shall be proposed for the Prize, careful regard will be had to all the scientific circumstances of the time; both as the urgency of existing needs for particular kinds of knowledge, and as to the expectations which may reasonably be held that discovery in the needed kinds of knowledge can be made within the allowed period.

Candidature for the Prize. (4.) The Discovery-Prize will be open to universal competition, British and Foreign.

(5.) The period allowed for the competition will begin with the day of announcement of the subject for investigation, and will end with the last day of the fourth following December.

(6.) Any person who desires to be regarded as a candidate for the Prize must deliver, or cause to be delivered, at the Hall of the Company, within the allowed period, a letter in which he

(14.) Should the Court be advised that no candidate has solved the main scientific problem or problems, but that valuable progress towards the object has been made by one or more of the candidates, or that collateral discovery valuable to sanitary science has been incidentally made by some candidate in his prosecution of the main research, the Court will apply such portion of the Prize as they may see fit in recognition of merits thus brought to their notice.

(15.) In estimating the originality of treatises, the Court will have regard not only to the state of knowledge which existed at the time when the subject for investigation was announced, but also to such later advances of knowledge as may have been made up to the time when the treatises were sent in.

(16.) Where two or more candidates equally claim to have made discovery in the subject-matter of the Prize, further information may be required of them in support of their respective claims, and the Court will judge between the claims as they shall think right. Each candidate will have been at liberty to notify to the Court at his own time any discovery which he believes himself to have made. See above, § 6.

(17.) Neither the Prize, nor any portion of it, will be awardable to any person who has not formally declared himself a candidate for the Prize. See above, § 6.

(18.) The awarding or withholding of the Discovery-Prize is to be entirely in the discretion of the Court, and the Company is not to be under any legal responsibility with regard to the

same.

66

IN February I was asked to see Mrs. W., a friend of one of my patients. She seemed to be suffering from a slight cold," and was soon better, but remained rather weak. March 9th I saw her again. She was then suffering from an eruption which resembled in some respects urticaria, a local swelling of the skin, slightly red, which itched and smarted. There had been disturbance of the stomach for a few days previous, but not sufficient to attract much notice, simply a sense of distention and flatulence. The eruption soon disappeared, and later reappeared; the gastric distress was temporarily relieved, but two days later she had much trouble with wind in the stomach; the temperature was 100.4° F., the pulse 102; there was also nausea and an aversion to food. The distress from flatulence was not constant, but recurred at intervals, and continued several hours; sometimes the ingestion of food seemed to give rise to an attack. These were relieved by spirits of chloroform, and by careful feeding with milk, lime-water, and a very small amount of brandy, she gained steadily, and by the 17th was receiving about two quarts of milk in twenty-four hours. On the 17th there was an attack of flatulence, during which she strained hard to raise the gas, and had a pain on the right, just below the breast.

From the 18th to 22d the right side and back, to right of the spine, were the seat of most distress; Occasionally the flatulence gave trouble. There was tenderness at first just below the right breast, then over the lower edge of the ribs, finally below the ribs, near the spine. All motions of the body were painful. Physical examination of the lungs showed nothing abnormal. The urine was normal. Once after taking tincture of aconite on account of dryness of skin and slight elevation of temperature the pulse became irregular. The amount of food taken at this time was very small. The pulse ranged from 96 to 120. The temperature was about 100° F., once ran up to 102° F. She was fed by enema, an egg beaten up with pepsin being given every four to six hours.

From the 20th till her death Dr. Mack, of Salem, her family physician, saw her nearly every day, and made valuable suggestions in regard to treatment.

The pain in the side was diminishing, and the amount of morphia was decreased. She seemed to be gaining. On March 22d, while straining in vomiting, she felt a sharp, severe pain in her neck and head. This was followed by very severe headache and an unwillingness to move the head, and later an attempt to move the head gave rise to expressions of pain, and every passive motion of the head was resisted.

From the 22d to 28th there was a gradual failure. Intelligence gradually diminished; she lay without speaking unless spoken to, and then answered very briefly; at length there was almost no response to 1 Read before the Boston Society for Medical Observation, No

vember 5, 1883.

questions, but she seemed to know her daughter; she moved her hands, drew up both legs or straightened them out at will, evidently suffered from distress in her head, slept only for a short time without waking, took a larger amount of food, had a temperature generally below 1000 F., but in the evening of the 27th it was 102° F.; pulse about 90 to 96; respiration 22 to 30.

On the 28th she showed almost no sign of consciousness, would swallow liquids which were placed in her mouth, but seemed unable to swallow solid food. It was necessary to catheterize her. During the morning visit the left pupil was larger than the right; both responded to light. Respiration was occasionally interfered with; in the afternoon it ceased for a few seconds, and she became cyanotic. At six P. M. pulse was 120; temperature 102° F.; respiration 40. At eight P. M. she had had three spasms, and had a fourth during the visit. Both eyes were open and in constant vibratory motion; the face, especially the left side, was contorted; both eyes turned towards the left in extreme conjugate deviation; she raised the right hand, trembling, towards the head. The left hand and leg did not move sufficiently to disturb the bedclothes if at all. The spasm continued less than a minute. After it was over the left hand and leg were found to be completely paralyzed. There was no reflex action on irritating the skin of hand or foot, though on the right reflex action was perfect. Pulse was 120; respiration 40; temperature was not taken.

From this time the spasms were more or less frequent until the twelve hours preceding death, when there were none. After many of the spasms respiration ceased for one minute or longer, and the skin became very cyanotic. There was no gesture showing any sensibility excepting once when the position of the head was changed, she groaned and put her right hand to her head, and once when a subcutaneous injection was administered in the right arm she made a motion showing that she felt the prick. The convulsions underwent a slight change, the left hand and arm were more agitated, the right less. I saw one which began with opening the eyes; rapid convulsive agitation of the lids, of the left side of face and left arm, and to a less degree of the left leg; the whole body was moved, both eyes turned to the left as far as was possible, the head was not turned, the right side was much less agitated than the left. When the spasm ceased both eyes returned to the right and respiration ceased for nearly a minute, the skin became deeply cyanotic, and after breathing was reestablished the dark color faded out very slowly. The pulse varied from 100 to 120; the respiration between the convulsions was about 36; the temperature when taken on several occasions varied little from 100° F.

Death occurred quietly on the morning of March 31st.

The autopsy was made two hours post mortem. There was a very abundant development of adipose. The heart was small; there were three or four small rough nodules on the mitral valve, not recent; the lungs were healthy, a few small ecchymoses under the pleura. Stomach, many small ecchymoses in the mucous membrane. Liver, spleen, intestines, normal; a medium-sized calculus in the pelvis of the right kidney.

The skull was of normal thickness, no undue adhesion of dura mater. Under the dura mater, between that and the pia mater on the right side over most of the posterior two thirds of the right hemisphere, was a