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the lower jaw. The skin of the face was coarse, and the lips considerably thickened. There was no hermianopia, and no optic neuritis. Amenorrhea had lasted two years, but menstruation had re-appeared whilst the patient was under observation.
Dr. Thomas Wilson read a paper on Some Cases of Rupture of the Uterus."
THE NECESSITY FOR AN IMPROVED AMBU
LANCE SERVICE IN BIRMINGHAM. We understand that efforts are being made to improve the ambulance service in Birmingham, and we feel sure that all who have much experience of the accident and emergency work of a large hospital realise that the majority of English towns are backward as regards the proper provision of horse ambulances, which can be used for the purpose of rapidly taking injured persons to hospital. We believe that it is correct to say that in Birmingham proper there are two horse ambulances, one belonging to the General Hospital, and the other to the police, and that, of these, the latter only is used for the work above mentioned. One ambulance cannot possibly be quickly available for all parts of the town. As a rule, the police take a patient, who has sustained an accident in the street, to the hospital on a hand-litter. This is a slow mode of progress; it is uncomfortable, and adds to the discomfort of the patient by attracting a large crowd of loiterers. But the greater number of patients who have sustained accidents or are suffering from urgent, acute diseases are taken to hospital doubled up in cabs or four-wheeled cars, or laid on straw on the floor of a wagon or dray. To take some definite examples of the danger of this to the patient, one has only to imagine the case of a person who has sustained an oblique fracture of the tibia. The conveying of such a patient to hospital in any way other than on a properly-constructed ambulance will render it highly probable that the simple fracture will become a compound one, and that the wound will become infected. Or again, to take the case of a patient who has an abscess resulting from acute appendicitis. Such a patient is hardly ever brought to hospital on an ambulance or litter of any kind. On the contrary, he is doubled up in a cab or some such conveyance, and must inevitably run a great risk of rupture of his abscess into the general peritoneal cavity. Many more examples of this kind could be
given. There is no question but that much discomfort and danger would be prevented, were it possible for there to be stationed at several positions in the city horse ambulances, which could be hastily summoned to the scene of any accident. No part of the town should be more than a moderate distance from an ambulance station, and the ambulances should be available not only for cases of accident in the street, but also for accidents in manufactories or on other private premises. They should be available, too, in many cases of illness not resulting from accident. The establishment of such an elaborate system as that of the New York ambulance service is, perhaps, not to be hoped for at present, but a great improvement in the present ambulance service of Biriningham is urgently called for, and could without great difficulty be effected.