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are the drugs to be used; yet we know that these same stimulants are of great benefit in the more subacute forms. So with arsenic. Its use should be limited to diseases involving the epithelium, and in these after they have become distinctly chronic. I think good comes from the use of arsenic in these conditions by the improvement of the general health.

Dr. Hays: There can be no doubt that this remedy has fallen into disrepute largely because of its reckless or haphazard use. Many practitioners, though making a correct diagnosis, will resort to the use of arsenic, frequently to the detriment of the patient. As Dr. Bailey remarked, the drug seems to have its best effect in diseases of a chronic nature; hardly any acute disease would be benefited. In fact, the disease which is more likely to be benefited by arsenic is psoriasis. This is essentially a chronic disease, one that will persist for years. The two cases I referred to I would like to speak of again. One was a young man who had his first outbreak of psoriasis three or four years before coming under my care. He was treated by a prominent physician, who had made a special study of skin diseases, without receiving any benefit. The psoriasis had covered the trunk as well as the extremities. I do not know whether it was my treatment or not, but under arsenic and local use of an ointment of ammoniated mercury the patches quickly disappeared. I do not remember how long he was under treatment, but I imagine that the patches had entirely disappeared in three months. The patient left the city, and I had a letter from him two years afterward saying that the disease had returned. His physician was using internal medicine alone, and the disease was not improving. In this case while arsenic did some good it is impossible to say how much, as other remedies were used.

The other case had lasted fifteen years, and was confined to the arms. This case received arsenic and local treatment at the same time. The case seemed to be entirely cured, and remained so for several months, but the disease reappeared. Relapses are characteristic of psoriasis, and arsenic does not prevent them.

The only variety of eczema which seems to be benefited by arsenic is that exceedingly chronic form which is attended by considerable induration of the skin, but I have never seen any good whatever from the use of the drug. In fact, eczema in the great majority of cases does not require internal treatment; nothing we can give internally seems to have any effect upon this skin disease. Pemphigus is a disease that

I have never come across. It is claimed by Hutchinson that arsenic has almost a magical effect upon this disease; that no fresh bullæ appear after the drug is commenced.

I wish to say in conclusion that for many years the profession has been inclined to look upon arsenic too much as a specific for skin affections, as quinine is a specific in ague, and mercury in syphilis. JOHN L. HOWARD, M. D., Secretary..

Foreign Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

Spread of Diphtheria; Awards of the Hospital Fund; Ice-Cream and Typhoid; Alkaloid Treatment of Incontinence; Health of the Navy: London Sewage; A New Lunatic Asylum; Use of Antisudorifics; Watercress and Typhoid; Health of London, etc.

Comparisons of statistics of a few years ago with those issued for 1893 in relation to the spread of diphtheria in England and Wales indicate that the disease has made serious inroads. In the report of the Registrar General it is pointed out that in the years 1871 to 1878 the average death-rate was 137, whereas in the five years ending 1893 the death-rate had risen to 318 per million. The authorities believe that the large increase is due to the fact that children now have to attend school, and thus pick up the infection. With the view of obviating this difficulty the Local Government Board have issued circulars to all medical officers of health, offering to submit to bacteriological examination by experts material sent by any medical. officer for examination and diagnosis.

£17,303 have been awarded by the Hospital Saturday Fund for the year 1894 to sixty-one special hospitals, thirty-four dispensaries, twenty-nine general hospitals, seventeen convalescent homes, and nineteen miscellaneous institutions. The sum is slightly less than that distributed in 1893. In the first instance the delegates passed two special resolutions. The first was in connection with the Chelsea Hospital for Women, and was as follows: "The Distribution Committee, having carefully considered the official report of the Committee of Inquiry, are of opinion that a lamentable condition of affairs for the year 1893 has been disclosed. They hesitate to recommend the removal of this institution from the list, as they hope and believe great efforts are being and will be made to restore and justify public confidence. The committee recommend a grant being made in accordance with the plan

of award, but that the amount, £95, be not paid over until the authorities of the Hospital have fully satisfied your board that the requirements and reforms mentioned in the official report have been carried out. Furthermore your committee strongly approve the action of Dr. Louis Parkes, Medical Officer of Health, in calling public attention to the matter." The second case was the Queen's Jubilee Hospital, the grant to which was only to be paid when the serious charges made in the press have been met and publicly refuted. The grant to the Chelsea Hospital for Women has been given, as it is considered that the institution is now in a satisfactory state.

The medical officers associated with the vestries of Bermondsey and Islington have, after due investigation, agreed to ask the Local Government Board to institute legislation before the next warm season to enable the local authorities to compel the registration of vendors of ice-cream. Dr. Shaw says that not very long ago a serious epidemic of typhoid fever prevailed in Greenwich and Deptford, which, after exhaustive investigation, was attributed to the use of ice-creams.

Dr. McAlister speaks highly of the alkaloid treatment for nocturnal incontinence of urine, by means of atropine in minute doses increased till the desired effect is obtained, and intoxication being avoided by giving at the same time minute doses of morphine and strychnine. If visual trouble arises it is checked with eserine. The course of treatment generally lasts about six weeks, and he has noticed no cerebral or cardiac troubles.

The statistical report of the health of the Navy for the year 1893 has appeared as a Blue Book. The returns are generally of a satisfactory nature. The death-rate, however, was high, but this was due to the disaster to the Victoria. The total number of cases of disease and injury entered on the sick-list was 57.380. The lowest sick-rate was on the Southeast coast of the American Station, and the highest on the China Station. The number invalided during the year was 1,628. The number of deaths was 679. Compared with 1892 there was an increase in the death-rate on the Mediterranean, North American and West Indian, Southeast coast of America, Pacific, and Australian stations, but a diminution on the other stations.

The arrangements for the disposal of the London sewage have now, according to all accounts, been brought to a much more efficient state than formerly. A few years ago it was estimated that when certain works were completed 20,000 tons of sludge would be obtained from the north side of the Thames, but in reality only 8,000 tons were obtained. After further modification of the works at the outfalls at Crossness and Barking an average of 40,000 tons of sludge are now obtained per week The total quantity sent out to sea last year in specially constructed boats was 2,200,ooo tons. This explains the great improvement in the condition of the river Thames.

A new lunatic asylum for the metropolitan district is about to be erected at Bexley to accommodate 2,000 patients; it has been settled by the Asylums

Committee that the cost shall not exceed £175 per bed. This will be from £60 to £80 per bed less than a recent asylum elected by the County Council. The Asylums Committee of the London County Council consists of fifty-five members, and it has control of all the asylums. The actual control and administration, however, of each asylum is delegated to a subcommittee of fifteen members. Each subcommittee visits its own asylum one day every fortnight, when all the new patients are seen. Patients are discharged as may be recommended by the medical staff. The average of insane and imbecile patients for the whole of London is 4.14, many districts in the east and south contributing a number below the average, while the Strand and Westminster have nearly double the average.

Mr. Richardson has recently drawn attention to the necessity, before administering an antisudorific, of thoroughly understanding the cause of the secretory disturbance. If this be due to irritation of the sudorific nerves, remedies such as atropine should be given; but if it is due to central vaso-motor paralysis, excitants such as picrotoxine should, he says, be administered. He mentioned a case of a woman, of forty-three, suffering from sweating after influenza, in which picrotoxine succeeded in effecting a cure after atropine, camphor, agaricine, and gallic acid had been tried. without success. The daily dose used was one sixty-fifth of a grain.

Some months ago attention was called to the apparent connection between the consumption of watercress and cases of typhoid fever. A wellknown medical man stating that from an inspection of several watercress farms he was inclined to the belief that the danger was a real one, and that many cases of typhoid fever, diphtheria, and other diseases derived their origin from the noxious elements of sewage, which he found in some cases polluted the water supply used. The growers of watercress have now taken the matter up, and have determined to support an application to the Local Government Board for an inquiry on the subject of cress cultivation with a view of suppressing the supply to the London market of produce from polluted waters.

A remarkable and gratifying fact was noticeable during the late cold snap, that the deaths from affections of the respiratory organs in London were fewer than is usual during the same time of year when the weather is milder, reaching only one half the usual total. During the same period fatal cases of diphtheria declined to the lowest weekly total for two or three years. Since the advent of the thaw, however, influenza has again appeared in an epidemic form, at least one theater having to close its doors on account of the number of its employes of all ranks who are hors de combat from this

cause.

The lecture by Prof. Clifford Allbutt on Senile Plethora and High Arterial Pulse in the Aged, which he will give before the Hunterian Society will attract a large attendance.

LONDON, February, 1895.

Abstracts and Selections.

THE PHYSICAL SIGNS OF VIRGINITY.-The doctrine has come down to us from venerable antiquity that the hymen is the sign of virginity; its laceration the proof of defloration; its presence or absence the test of the virtue of an unmarried woman. In the ancient words of the Hebrew Scriptures: "And the damsel's father shall say unto the elders, I gave my daughter unto this man to wife, and he hateth her; and, lo, he hath given occasions of speech against her, saying, I found not thy daughter a maid; and yet these are the tokens of my daughter's virginity; and they shall spread the cloth before the the elders of the city."

Now, it is undoubtedly true that in most women there is a hymen; that in the first complete intercourse the hymen is usually torn; that in most women accustomed to sexual intercourse it can easily be seen that the hymen has been torn. But do these statements apply to all women?

In the first place the toughness of the hymen and the size of its orifice vary very much in different women. In some the orifice is so large and the hymen so distensible that intercourse can be completed without laceration; in other women, partly because the hymen is tough, partly also from some defect on the opposite side, it happens that after months or years of married life the hymen is not torn, but simply pressed backward, so that it comes to be funnel-shaped, with its apex inward, and the fossa navicularis becomes lengthened; this may happen without suspicion on either side that intercourse has not been complete. On the other hand, the absence of the hymen or the large size of its orifice does not prove unchastity. Further, scarcely a volume of the yearly indices to medical literature which are published can be referred to without finding a case or cases in which delivery of a child was obstructed by what is often incorrectly described as "imperforate" hymen. The presence of a hymen showing no sign of laceration therefore neither proves chastity nor negatives the possibility of pregnancy.

When we are asked what are the evidences of virginity, the question arises, what is meant by a "virgin?" When a prisoner is accused of rape, which is defined as "the carnal knowledge of a woman against her will," it is necessary, in order that the prisoner may be convicted of this crime, that it should be proved that penetration was effected. But for this purpose mere vulvar penetration is sufficient, and the fact of a persisting hymen would not necessarily be accepted as an answer to the charge. Now if a virgin, in a legal sense, was one who had never had complete sexual intercourse, it would sometimes be possible, from physical examination, to assert virginity. If the hymen is in its natural position, not displaced backward, and its orifice is small, showing no trace of having been torn, it is possible

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