On the Mediterranean station, cholera appeared in a ship stationed in the River Danube, where it prevailed epidemically in some of the towns situated on its banks. Of eight cases, three only presented the characteristic features of the malignant form of disease, and of these only two proved fatal. An epidemic of yellow fever, limited in extent but very fatal in its results, occurred on the North America and West Indies station, chiefly at Port Royal, Jamaica. Of fortythree cases returned as specific yellow fever, twenty-seven proved fatal. The same disease also prevailed on the southeast coast of the American station at Rio de Janeiro, and attacked the crew of the receiving-ship permanently stationed in that harbour; in this case it was not very virulent, only two cases proving fatal.

In November, 1870, the epidemic of small-pox became so fatal and alarming that the Hampstead Hospital was opened for the reception of small-pox cases, and during the time it was open for this purpose (till July, 1872) 7352 patients were treated there. Eight fresh pavilions and four wooden huts were erected and furnished during the epidemic. In the summer of 1872 small-pox had so diminished in London that the managers were enabled to dispense with the Hampstead Hospital for the treatment of this disease, and after its complete disinfec tion they applied to the Local Government Board to allow of its being temporarily used for the care of imbeciles, chiefly the infirm and bed-ridden cases. This was eventually acceded to, with a clear understanding that the hospital was not to be diverted from the purpose for which it was origin.

On the West Coast of Africa and Cape of Good Hope stations, the operations on the Gold Coast in connexion with the Ashantee War were productive of a large amount of febrile disease and dysentery, and, as a consequence, with a great increase in the invaliding and death rates on these stations. Compared with the preceding twelve months, the increase in the ratio of invaliding was to the extent of 764 per 1000, and in the death-rate of 12.5 per 1000 of the force engaged.

The Appendix to the Report contains the usual medical and surgical reports on the different divisions of Royal Marines, the dockyards, naval hospitals, etc., and some papers by Staff Surgeons W. Ross, M.D., J. Mulvany, and P. W. Rolston, which we may take the opportunity of noticing upon a subsequent occasion.

THE PROPOSED HOSPITAL AT HAMPSTEAD. MR. SCLATER-BOOTH, President of the Local Government Board, has declined to interfere in the question now pending between the inhabitants of Hampstead and the managers of the Metropolitan Asylums District Board with respect to the proposed Hospital for Infectious Diseases. In reply to a deputation last week, Mr. Booth stated his reasons for declining to interfere. These reasons were founded upon a statement made to him by the managers of the Asylums District. That statement has since been circulated; and states that soon after the establishment of the Board in 1867 the managers appointed a committee to consider and report on the number of hospitals which it was necessary to erect to enable them to treat the normal number of fever and small-pox patients which they might be annually called upon to provide, and also to report on the best localities for such hospitals. It was eventually determined to provide three permanent hospitals for fever and two for small-pox: one should be situated in the north-west, one in the east, and one in the southern districts of the metropolis. After considerable difficulty they succeeded in purchasing sites in Hampstead, Homerton, and Stockwell which were approved by the Poor-law Board, and which were all fairly close to the positions originally marked out in the several districts. Great opposition was made by the inhabitants of these neighbourhoods, but the Board felt it their duty to carry out the plan, as similar opposition would occur wherever the site might be. The hospitals at Homerton and Stockwell were erected without delay, and plans were proposed for the hospital at Hampstead. The erection of this was deferred for a limited time at the request of the Poorlaw Board; and the site remained vacant till December, 1869, when relapsing fever became a serious epidemic in the metropolis, and three pavilions were erected on the ground, to which persons suffering from relapsing fever were admitted.

of an efficient hospital for any epidemic disease which the managers in the discharge of their duty might be called upon to provide. The statement of the District Asylums Board contains reports from Dr. Lord, the Medical Officer of Health for Hampstead, and Dr. Stevenson, Medical Officer of Health for St. Pancras, which prove that the inhabitants of Hampstead had suffered no injury from the presence of the Small-pox Hospital in that neighbourhood. Dr. C. T. Aveling, also, the medical officer of the City Union at Homerton, states—“I can, however, say most positively that the immediate neighbourhood of these hospitals has not been more obnoxious to contagious disease than any other part of this locality, and I believe that the good folks of Hampstead need not dread the hospital on that score." The subject is of so important a character, and is attracting so much public attention, that we quote the following from the statement of the District Asylums Board in full:

"Although the statements put forth by the Hampstead Committee of Residents apply rather against the erection of hospitals for infectious cases in general than against the erection of one at Hampstead in particular, the managers desire to make the following observations thereon:- By the passage of the sick through the streets to the hos pital. No better answer perhaps can be given to this than to quote the words upon this point of the President of the Local Government Board in 1871, when a similar agitation was being raised by the residents of Hampstead, viz., Mr. Göschen desires me to add that he has been advised, on medical authority, that there is not a particle of evidence to show that the conveyance of small-pox or fever patients in carriages is attended with the slightest danger to those persons who are living in, or passing along, the streets through which the patients are conveyed. Moreover, the removal of the hospitals to a greater distance from London would only add to the evil, if any, by increasing the number of streets through which the patients would have to be carried. And with the truth of these observations the managers entirely concur. There can also be little doubt that the prejudice against the removal of patients to hospitals at a long distance from home would materially check the removal of cases, and thus tend to increase the spread of an epidemic. The land at Hampstead, although in the parish of Hampstead, is on the confines of the parish of St. Pancras : it lies back at least 100 yards from the main thoroughfare, from which it is practically invisible, while a high wall separates it from the Fleet-road, which is only a thoroughfare for pedestrians. The situation is admirably adapted for the reception of sick persons from the parishes of St. Pancras, Holborn, Islington, Marylebone, and Paddington, as well as from Hampstead itself; and the managers, many of whom know the district well, do not hesitate to say that they believe it would be impossible to find another site equally eligible in the north or north-western district, and within the metropolitan area--it being absolutely necessary that an infectious hospital should be within the metropolitan drainage district and water-supply; certainly no site could be obtained which would not meet with the strongest opposition from the intended neighbourhood. If, however, the agitation now made by certain persons in Hampstead were successful, the managers would feel not only that it was hope less to look for any other site, but they would have no confidence that they should ever be able-should, unfortunately, the

necessities of the public health require it-to build on the two pieces of reserve ground held by the Board in the western and south-eastern districts of London; and in addition to this there would no doubt be strong pressure for the removal of the existing hospitals at Stockwell and Homerton."

All impartial persons must admit that there is much cogency and practical common sense in the statement of the managers of the District Asylums Board. While we sympathise with the inhabitants of Hampstead, we cannot regard their complaint as unanswerable after the statement which we have placed before our readers. That they have exaggerated the evils to which they think themselves exposed we think there can be no doubt.

THE WEEK.

TOPICS OF THE DAY.

A GOOD deal of excitement still appears to exists in the Woolwich garrison, caused by the epidemic of diphtheria now so seriously prevailing at the huts, or soldiers' cottages, on Woolwich Common. Several fresh cases were reported the latter end of last week. They were at once sent to the Herbert Hospital, Shooter's Hill, and placed in the special ward prepared for their reception. No cases whatever have occurred in Woolwich, where the largest number of married soldiers' quarters are situated. These quarters are of modern construction, having good ventilation and drainage.

The chief delinquents in the sale of articles of adulterated food in Portsmouth appear to be "the better class of shopkeepers." Mr. G. Turner, the Public Analyst for the town, in his last report to the Town Council, states that "the prosecutions have all been against the better class of shopkeepers. The magistrates have always been willing to give them a case; they have a union composed of grocers to support them; yet they have never hazarded an appeal."

It appears from the report for the past quarter of Dr. Taaffe, Medical Officer of Health for Brighton, that diarrhoea was the zymotic disease which was most fatally prevalent in the borough, and caused sixty-three deaths. Of these, fortyseven occurred in children under one year, and ten in children aged one and under five, while only six were of persons over five. Notwithstanding this increased mortality among children from this disease, the health of the town was in a very satisfactory state. Dr. Taaffe remarks that his "own experience as physician to the Children's Hospital bears out that of others, that numbers of infants are literally killed by improper feeding. This evil exists in every grade of society, but principally among the poor. The great majority of the deaths from infantile diarrhoea took place in the poor neighbourhoods. The prevention of infant mortality is a very difficult subject to deal with. The establishment of crèches or day nurseries would doubtless do good in this direction; as also the frequent distribution among the poor of printed directions as to the proper mode of feeding infants. Deducting the deaths from diarrhoea, we had a very small degree of zymotic mortality during the last quarter, only amounting to an annual rate of 1.7."

Last week about 120 gentlemen met at dinner at Willis's Rooms to commemorate the election of Dr. Hardwicke to the Coronership for Central Middlesex. The proceedings passed off satisfactorily; and, with Dr. Richardson in the chair, it may be supposed that the evening could not fail to be a most interesting and, we may say, a most instructive one.

VIVISECTION AT NORWICH.

THE action brought at Norwich, by the Society for the Prevention of Cruelty to Animals, against four medical men of that city, who had apparently assisted Dr. Magnan, of Paris, in making some experiments on living dogs, and of which

action we gave a short notice last week, has ended in the dismissal of the case as against the four Norwich defendants. M. Magnan did not appear; and the magistrates, after a long inquiry, came to the conclusion that the complicity of the four defendants present in the proceedings of M. Magnan was not proved; but they held, by a majority, that the Society had been justified in instituting the proceedings, and they therefore refused the defendants their costs. It will be remembered that the experiments were made in order to show the difference between the effects produced by alcohol and by absinthe on the living organism, and to demonstrate that absinthe may excite epilepsy; and the real point in question was whether or not the experiments were unnecessary and cruel. Very contradictory, and some decidedly sensational, evidence was produced, and we cannot say that we are inclined to quarrel with the decision of the magistrates. We think that the manner, time, and place of performing the experiments were ill-chosen and injudicious; and, further, we are not at all satisfied that such a demonstration of the poisonous effects of absinthe was either necessary or useful. We most entirely acquit the actors of every idea of cruelty, and credit them fully with the belief that they were engaged in demonstrating in a scientific manner an important and useful fact-the special poisonous qualities of absinthe; but we think the whole proceeding was an unhappy mistake.

DEATH OF THE PRINCIPAL MEDICAL OFFICER OF THE
BOMBAY PRESIDENCY.

DEATH has been very busy lately amongst the senior ranks of the Medical Department of the Army. But a short time has elapsed since we had to record the demise of Surgeon-General Beatson, the Principal Medical Officer of her Majesty's British Troops in India; only the other day we had to chronicle the loss of Deputy Surgeon-General Barclay, the Head of the Statistical Branch in London, and of Surgeon-General John Bent, the Principal Medical Officer at Aldershot; and it is now our melancholy duty to announce the death of Surgeon-General R. J. O'Flaherty, C.B., the Principal Medical Officer of the British Troops in the Bombay Presidency, which is reported to have taken place at Bombay on the 8th inst. Mr. O'Flaherty entered the service as Assistant-Surgeon on January 9, 1835; was promoted to the rank of Surgeon in May, 1845; Surgeon-Major, 1854; Deputy Inspector-General, July, 1859; and Inspector-General, 1872. Surgeon-General O'Flaherty served in the Crimea from September 17, 1854, for which he held the medal and clasp, fifth class, of the Medjidie, and the Turkish medal.

MEDICAL STUDENTS IN FRANCE.

REFERRING to the Medical Faculty of Paris, the Liberté states there are 5000 students. The curriculum is generally six years, four years of which are devoted to obtaining the usual promotions (inscriptions réglementaires). During the two last years the student undergoes his examination for the doctorate. Those who succeed in obtaining a supernumerary berth at the hospital sometimes have to work nine years before gaining that degree. The Medical Faculty this year granted about 500 diplomas. In the Pharmaceutical Faculty the curriculum is generally three years. The last return showed 700 students. The nine other Medical Faculties in France scarcely reach the figure of 3000 students-Bordeaux and Toulouse 500 to 600 each, Montpellier 200, Nancy 300, etc. Amongst the 8000 of the étudiants matriculated at the Paris University, about 600 are foreigners, mostly Spaniards, especially in the Medical Faculty.

THE MODEL HOUSES ASSOCIATION.

THE improvement of the dwellings of the industrial poor, and the diffusion of sanitary knowledge amongst that class on a scale which the subject demands, are, no doubt, two most important questions. These questions were ably discussed

SOME INQUIRIES INTO

at a meeting of the Model House Association held last week in Lower Seymour-street, Portman-square; the Earl of Aberdeen presided. A resolution proposed by Sir Thomas Chambers, seconded by Dr. Douglas Hale, and carried unanimously, embodied the urgent necessity of rigidly enforcing such statutes bearing upon the sanitary condition of both the urban and rural population as are now or may hereafter be enacted; that adequate remedies should be demanded for the reduction of the frightful mortality arising from preventable diseases which not only sweep away multitudes of constitutionally healthy men and women, but leave still vaster numbers to linger on with health shattered and insufficient for either the duties or enjoyments of life. Resolutions were also adopted urging that ladies should be encouraged to join the Association.

APHASIA PRODUCED BY PRESSURE ON THE BRAIN IN THE
COURSE OF MENINGITIS.

IN the Centralblatt für Chirurgie, No. 36, is the report of a
case of so-called acute pachymeningitis, in which Stassin
observed on the third day of the disease the disturbance of
speech characteristic of aphasia, accompanied by no impair-
ment of the intellect. The patient could answer all questions
which required a simple "Yes" or "No "correctly, but if an
answer of several words were required, he could only bring
out, with evident distress, the following words, "reçu, verse-
ment, merci." A remarkable point in the case was the almost
complete return of the power of finding words, accompanied
by a slight amelioration of the symptoms lasting for three
days.
After an abundant hæmorrhage from the nose, aphasia
became complete again, and the patient died delirious after the
occurrence of spasm on the right side of the body, and later
general convulsions. The cause of the aphasia was supposed
to be the pressure exerted on the brain by the meningeal
exudation which was found at the autopsy.

WATER SUPPLY TO THE METROPOLIS.

A REPORT has been laid before the St. George's, Hanoversquare, Committee of Works from Dr. Corfield on the water supplied by the Chelsea Waterworks Company. Dr. Corfield found on analysis that the water was flood-water imperfectly filtered. There was too much organic matter in it, which was too fine to settle. The Company have written a letter to the Committee to the effect that they were considering the acquisition of land for storage purposes, and were duplicating their filtering area. A copy of Dr. Corfield's report was ordered to be forwarded to the Government Water-Examiner, Major Bolton.

HEALTH OF THE METROPOLIS.

THE deaths registered last week in London were 2082, showing an excess of 356 on the average numbers, and an annual death-rate of 32 per 1000. This excess was chiefly due to the fatality of discases of the respiratory organs. The deaths from scarlet fever further declined last week to ninety-one. The Asylums District Hospitals contained 238 scarlet fever patients on the 12th inst., against 243 in the previous week.

THE DRAINAGE OF DUBLIN.

THE Lord Lieutenant of Ireland, in reply to a deputation which waited on him on Monday for the purpose of obtaining Government interference in reference to the drainage of Dublin and the purification of the Liffey, said he understood it was probable a private Bill would be introduced next session transferring from the Corporation their powers under the Main Drainage Act.

THERE has been another outbreak of the fever epidemic at Darwin. Several fresh cases were reported on Monday and Tuesday last.

THE CAUSES OF GOÎTRE

AND CIRCUMSTANCES UNDER WHICH CRETINISM IS DEVELOPED.

By J. B. WILSON, M.D.,

Surgeon to 11th (Prince Albert's Own) Hussars.

BHAGSOO, Dhurmsala, a hill station of the Punjaub for British troops, is situated upon a spur of one of the lower ranges of the Himalayan mountains at a height of about 6100 feet above the sea-level, in a position of about 76° longitude, and 32' north latitude.

The whole district is hilly; we look below upon the Kangra valley, which stretches from east to west, and is in this neighbourhood about 3000 feet above the sea-level; we see above in a north-easterly direction successive ranges of the Himalayan mountains varying in height from 10,000 to 18,000 feet. The highest range visible, which bounds us on the north at a distance of about six miles, is of primary formation, and consists of granite and gneiss. Except when covered with snow, as it is during the greater part of the year, this range is quite bare, no soil resting upon its stony surfaces. The lower hills, immediately beneath and intervening between the main visible range and this station, are for the most part of sandstone of varying degrees of hardness, and are covered with soil and vegetation, chiefly Himalayan oaks, rhododendrons, and fir trees. The valleys between these hills are rich in deep alluvial soil, largely mixed with pulverised stone. Through the sandstone hills, which are chiefly formed of rich red clay, overlaid with a vegetable mould, are numerous extensive veins of marble-veined lime-stone, and valuable seams of fine slate, and these stretch to the Kangra valley, below which, at a radiating distance of about ten miles, is the local boundary point in that direction of the present investigation. (a)

The primary source of the water-supply is the main visible range; it finds its way to the valleys by streams, whose beds are cut out of, and seen in great numbers along, the slopes of the successive hills already referred to.

Amongst the native inhabitants of this district "goître' abounds. The remark of Dr. Parkes in his Manual, "that there is want of chemical analysis" in support of the hypothesis that there is no relation between the hardness of water and goître, prompted me, with such unusual opportunities at hand for making investigations in this important and interesting subject, to analyse specimens of the drinking-water obtained from this district within a radius of ten miles.

The preliminary examination of the first six specimens gave negative results, when testing for organic matter, lime, magnesia, iron, etc., and the colour, taste, and smell also indicated more than usual purity; with the object in view, I considered that these results dispensed with further examination except to determine the total hardness of each specimen. The preliminary examination of the last three specimens indicated a small amount of lime, confirmed afterwards by the soap-test. The colour, taste, and smell indicated purity of the specimens, and there was no reaction produced when testing for organic matter.

I have also to submit the analyses of 100 cases of goître, taken indiscriminately from among natives residing within a radius of ten miles from this place, with regard to the following points:

1st. Occupation.-Labourers, 52; shoemakers, 9; musicians, 9; cloth-printers, 6; beggars, 4; glass-blowers, 3; breadmakers, 3; silversmiths, 2; merchants, 2; no occupation, 2; policeman, 1; barber, 1; basket-maker, 1; carpenter, 1; overseer, 1; butcher, 1; housewives, (b) 2: total 100.

2nd. The average number of pulsations per minute of the 100 cases examined, arranged according to the following ages: -Between the ages of seven and ten there were 3 cases, and the average radial pulsation per minute was 101}. Between the ages of eleven and twenty there were 26 cases, and the average radial pulsation per minute was 93. Between the ages of twenty-one and thirty there were 47 cases, and the average radial pulsation per minute was 86. Between the ages of thirty-one and forty there were 14 cases, and the average radial pulsation per minute was 84. Between the ages of forty-one and fifty there were 4 cases, and the average radial pulsation per minute was 84. Between the ages of fifty-one and sixty there were 4 cases, and the average radial pulsation per minute was 92. (c) Between the ages of sixtyone and eighty there were 2 cases, and the average radial pulsation per minute was 70.

3rd. The time of life that the disease made its appearance: in 30 cases it appeared during infancy and childhood; in 42 cases it appeared between the ages of ten and twenty years; in 17 cases it appeared between the ages of twenty-one and thirty years; in 6 cases it appeared between the ages of thirtyone and forty years; in 4 cases it appeared between the ages of forty-one and fifty years; in 1 case the time of appearance was not known.

cases

4th. Concerning the transmission of the disease from one parent, or both, to offspring: (a). In 16 cases the parents, one or both, had been the subjects of goître. (b). In 9 of these cases the subjects were of dull intellect; in some approaching cretinism. (c). In 4 of these the subjects were complete cretins. (In 2 of these cases it was stated that the mothers had very large goîtres.) (d). In 3 of these the subjects were not of dull intellect. (e). There were five cases of dull intellect in which neither parent had suffered from goître.

The results of the chemical analysis seem to strengthen the theory that it is not absolutely necessary for people to drink hard water before they can become affected with ordinary goître; indeed, the extreme purity of some of the specimens examined, and which are and have been daily consumed by those goîtrous people for years, leads one to conclude that the disease is not connected with the composition of the water at all. The classification of the cases according to occupation shows an excess of the disease to occur amongst those whose daily duties are most laborious; for we see 52 per cent. of the subjects of it to be labourers.

It will be well to define the term "labourer" or "coolie" as it is applied in this classification. His duties are either to carry heavy loads strung upon his shoulders and back, or, in company with others, to carry for long distances in a dooly (an eastern conveyance borne by men) European passengers.

The labourer or coolie in this district is often employed in carrying and cutting stones, building walls, and cultivating land. I wish to mention the attitude that he assumes when engaged in any occupation of this kind. He is rarely seen in the erect posture unless conveying loads; all other duties he pursues in a position that is peculiar to eastern countries.

it

The soles of his feet rest upon the ground, and the nates are brought into close proximity to the heels, by the thighs being flexed on the body, and the calves of the legs being applied to the posterior surface of the thighs. In this position also the shoe-maker and other artisans pursue their work, for chairs and stools are never employed by them, even when at rest. With regard to the time of life that the disease usually appears, will be seen that in 42 per cent. of the cases it first made its appearance between the ages of ten and twenty-a period including the time of life when active labour is first pursued; also the era of life when the constitution receives the new impulse and modification of puberty. The time of life that I found next in order susceptible to the disease was the unresisting period of infancy and childhood.

(b) There were altogether 8 females; but when pursuing occupations, hey were returned accordingly in the list with the males.

(c) In one of these cases the pulse was 100, in another 92, per minute.

It will be seen, from the classification of the frequency of the arterial pulsation, that the average results of the cases, registered according to age, invariably showed a marked excess in frequency. There is great difficulty in obtaining precise information from a native, but when it could be obtained, I always found that the subjects of goître were liable to palpitation of the heart.

This associated condition I invariably found amongst Europeans here resident who were the subjects of ordinary goître. As far as it goes, the last classification shows a tendency for a degenerate form of intellect to be present in the offspring of goîtrous parents, and that cretinism does not exist except in the offspring of parents who are the subjects of this disease. Before I venture to submit some conclusions and facts in support of them, based upon these investigations, I must mention the very universal frequency of this disease in hilly and mountainous districts. The purity of the water consumed by the inhabitants of this district, amongst whom goître has existed so long, and is daily reappearing, naturally leads one to conclude that the disease is not connected with the composition of the water at all. There is strong evidence in favour of the theory that ordinary goître, like the exophthalmic variety, is entirely a circulatory disease, and that its tendency to occur is encouraged, and in some cases induced, by the following conditions when the constitution is in a reduced state, and thus favourable to the invasion of this disease:

1st.-Active occupation, necessarily so much more severe in hilly districts, seems to influence the production of this disease to a great extent, as is shown by its so frequent occurrence in those who lead a laborious life, or pursue active duties in a constrained position, and by the comparative immunity there is in those oppositely circumstanced, except they are in a relaxed and depressed state of health. The effects of violent exercise upon the circulation and blood vessels generally are well known, and it is only necessary, on this point, to refer to the relation of the thyroid gland to the large vessels of the heart, its remarkably large supply from them, and its dense capillary structure and consequent ready liability to enlargement from the dilatation of its vessels, under the conditions produced by violent and prolonged exercise.

2nd. The effect of elevation from the sea-level upon the circulation of people residing in high mountainous districts, seems to be favourable to the production of goître, and in some cases the chief cause of the disease; hence the more frequent occurrence of the disease in such districts. The frequent complaints of people after arriving from the plains at a high elevation, of palpitation, sense of giddiness, the frequent bleeding at the nose, and the invariable increase of the frequency of the pulse, are all symptoms which point to a diminution of force upon the balance of the circulation as the cause of them. Nor is the loss of balance difficult to account for, when we remember that at the sea-level there is a pressure of 15 lbs. on the square inch, and, calculating that the atmosphere reaches forty-five miles around the earth, the loss of pressure resulting from this elevation would be equal to about 6:06 oz. avoirdupois on the square inch, or a little more than one ounce loss of pressure on each square inch of the body per every thousand feet ascended. The pressure would be a little less, though, for this calculation, contrary to accepted facts, supposes the forty-five miles of air to be of uniform density.

The increase of force the circulation would receive by the diminution of atmospheric pressure, resulting from ascent within the limits of a certain height, cannot then, I think, be denied. I will relate some cases in which the disease seems markedly to have been produced by residence in an elevated locality alone.

Mrs. S., in November, 1866, went to reside in Mussoorie, a hill station of Bengal, between 6000 and 7000 feet above the sea-level, and remained there until November, 1867. In the month of July, 1867, during some slight indisposition, a goître appeared; it was about the size of a large walnut. It did not increase in size at all, but continued that size until Mrs. S. went down to the plains again. She remained in the plains until August, 1873, and during the whole time no more enlargement of the gland was noticed by her. She visited this stat on in August, 1873, and before she had resided here a month found that the gland was rapidly getting bigger. It is now (September, 1873) the size of a small apple, and rather painful. She is subject to attacks of intermittent fever; she is now free from the fever, but the pulse is 108 per minute, and she often suffers from palpitation. There is no exophthalmic appearance. Mrs. B., a sergeant's wife, states that, in 1860, when she was

aged eight years, she went from the plains to Sanawur Lawrence Military Asylum, a sanitarium situated about 6000 feet above the level of the sea. Before she had resided there a year, a small goître appeared, and has remained the same size ever since. She herself says that she is quite well, the pulse is 100 per minute, and she often suffers from palpitation. There is no exophthalmic appearance. At this asylum every precaution was taken with the water, which was always boiled and filtered before use.

Juhar, a labourer, aged twenty-five years, came from Grow to Dhurmsala a year and a half ago: there is a difference in the height of about 3000 feet between these places, the latter being the higher. After arriving he took to new employment, much more laborious than that he had pursued below. After a residence of six months the goître first appeared.

Grousam, a beggar, aged fifty years, first came to this district from the plains eight years ago; shortly after his arrival the goître began to appear.

3rd. The increased frequency of the circulation invariably noticed in the subjects of this disease is further evidence of its resulting chiefly from a more active force conveyed to the circulation and so to the thyroid gland, when the resistance necessary to overcome that force does not exist in it; in a similar way as, in one subject, aneurism takes place as the result of violent exercise or from constrained positions, or as, in another, enlargement of the spleen, when subjected to a determination of blood, may take place.

4th.-The fact that the periods of life when this disease most frequently occurs are those when the circulatory powers are in their greatest activity is not, I think, of trivial import in support of the theory here submitted as the primary cause. There is the testimony too that, when the forces upon the circulation resulting from violent exercise in hilly districts and residence at a great elevation from the sea-level appear to be the chief causes necessary for the production of this disease, those engaged in the more active life are the more subject to it -viz., the male population; whilst in my experience concerning the occurrence of the disease in the plains, where it is of infinitely less frequent occurrence, the subjects more liable to it are females, whose constitutions are usually more relaxed and unresisting than those of males, and whose circulation, moreover, is subject to more variation of force, consequent upon the changing phenomena of menstruation and pregnancy.

5th.-If the conclusions arrived at from these inquiries into a limited number of cases hold good generally, the prevalence of this disease, once recorded to have taken place in a prison at home, may have arisen, not from the water that the prisoners drank, and which was blamed as the cause, but from the excessive exercise at the treadmill, or some other violent labour, and this, too, whilst the inmates were on prison rations.

In conclusion, and with regard to cretinism, the question naturally arises, whether it is found to be generated only in the offspring of goîtrous parents, under which circumstances it has been invariably found to occur amongst the subjects of it in the cases of goître forming the subject of the present paper?

Punjaub, India.

JOHN HUNTER, F.R.S.

WE now bring to a close the correspondence of the great physiologist, which has appeared from time to time in this journal, by the publication of the following letters from the collection of autographs in the possession of Mr. Charles Hawkins, a former member of the Council of the College of Surgeons, and of Mr. T. M. Stone, so long connected with the same institution. It is interesting to observe that of the letter No. 3 several copies appear to have been written-probably for circulation amongst the members of the House Committee of St. George's Hospital, as Messrs. Hawkins and Stone have each one in their several collections, only signed, however, by Hunter. That in possession of the latter gentleman is increased in value by the following testimony to its genuineness by one well able to judge: "The above signature is the veritable autograph of the great surgeon.-Richard Owen.-Coll. Chir., March 21, 1850."

[No. I.]

"To Messrs. Gunning, Walker, and Keate. "Gentlemen,-As the time approaches when you propose referring to the Governors of St. George's Hospital my determination respecting the money arising from the Surgeons' pupils, I beg leave to acquaint you that I intirely agree with you in the mode you have proposed-a mode I did not myself adopt, as it took from you the power of acceding to my proposal, and made me appear to the Governors as an accuser; but when you bring it before them I shall meet it fairly and very willingly.

"I am, Gentlemen, your most obedient Servant, "Leicester-square, Feb. 8, 1793. JOHN HUNTER.”

The following circular was sent to the Governors:

[No. II.]

"St. George's Hospital, February 13, 1793. "My Lord,-A Special General Board having been called, to meet upon the 1st of March next, to consider of and to determine on a letter addressed by Mr. Hunter to the other Surgeons of the Hospital, wherein he appears to reflect upon their conduct, and objects to account for the profits arising from the general attendance of the pupils at the Hospital; and endeavours to break through a custom which is common to other hospitals, and which has subsisted in this from its first establishment to the present time. The Surgeons request the favour of your attendance that day, and have the honour to be, with all possible respect,

'My Lord,

"Your Lordship's most obedient humble Servants, "J. GUNNING.

[No. III.]

WM. WALKER. T. KEATE."

"Sir,-My three colleagues having opposed a resolution of mine respecting the pupils who enter under me at the Hospital, and having stated that there is a custom against it, as an argument in their favour, I beg leave to submit to you the enclosed reasons for having deviated from that custom; and I take the liberty to observe that the custom which they say has subsisted so long makes no part of the established laws of the charity, and has been gone into without the consent of the Governors. I have transmitted to you these reasons for your deliberate perusal, that you may be enabled thoroughly to understand them when they are read before the General Court. "Your most obedient Servant, "Leicester-square, Feb. 27, 1793. JOHN HUNTER.”

[No. IV.]

"To the Chairman of the Special General Court,

St. George's Hospital.

"Mr. Chairman,-Having on most occasions been desirous of promoting the surgical education at the Hospital, my name not appearing to the present proposals may give an idea of my being less zealous than usual on that subject. I beg leave to say that this is not the case; but not having been consulted by my colleagues who drew them up, nor the Committee by which they were approved, my assistance has been supposed unnecessary.

"They certainly appear to me in many respects very incompleat, and in some altogether impracticable; but if they meet with the approbation of the Governors, it is my business, as a servant of the charity, to do the duty of my situation. "Your most obedient Servant, "Leicester-square, June 14, 1793.

JOHN HUNTER."

Hunter suddenly expired the following October. Our readers will no doubt feel obliged by the permission of Messrs. Hawkins and Stone to publish these interesting documents of the renowned founder of the Hunterian Museum in the pages of the Medical Times and Gazette.

We have lately had occasion more than once to notice with satisfaction the determination of the metropolitan magistrates to enforce compliance on the part of recalcitrant offenders with the requirements of the Sanitary Acts. Mr. Ingram last week fined Edward Fuelling, of 124, High-street, Notting-hill, £5, in addition to 40s. for one day's default, and costs, for refusing to comply with an order of the Vestry to construct a drain into the sewer in front of his premises.