fear from the most thorough instruction of the people upon those matters of every-day life which concern their health. The more complete the knowledge they may obtain on such points, the more fully will they appreciate the labors of those whose special duty it is to care for them when they are ill. As it is now, nearly the whole of the popular medical literature of the world has emanated from ignorant and heartless quacks, whose only objects are such as tend to their own aggrandisement. We hope the day is not far distant when all this will be change; and, regarding it as a step in the right direction, we extend a cordial welcome to Dr. Acton's treatise.

PROGRESS OF THE MEDICAL SCIENCE.

I.-HYGIENE.

1. From an interesting paper on the Medical History of England, by Dr. B. W. Richardson, we make the following extracts. The Medical History of Birmingham is under consideration. At present, when the sanitary condition of our own city is attracting much interest, the researches and experience of Dr. Richardson will doubtless be read with attention.

STREETS AND DWELLINGS OF THE POOR.

The streets of Birmingham are very irregular; but as a rule they are wide, well paved, and clean. The houses are dingy, I presume, from deposit of carbon, and the town consequently has a gloomy appearance when compared with towns free from the manufactory and workshop. In the dwellings of the poor overcrowding does not present itself in a marked degree; for of late years large numbers of small houses, giving a rental of from 3s. 6d to 5s. per week, have been erected, to the great advantage and comfort of the artisan classes.

From the results of the last census, it appears that in Birmingham every hundred persons possess 1.25 acres for space; and that the average number of persons to each house is 5.01.

DRAINAGE.

The drainage of Birmingham is as yet very defective. Prior to 1851 a system of sewers was carried out, and since then up to 1861 further advances have been made. I find by a map which the town surveyor has been so good as to lend me, and in which the system of sewerage, actual and projected, is very perfectly marked out, that the central part of the town is thoroughly intersected with sewers, and that, in fact, there is no district in which there are no sewers. But still, if the town is ultimately to be placed on a complete system, there remains a vast network of sewers to be constructed. At the close of the year 1863 the length of the sewers completed was 7415 miles, and the length remaining to be completed was 51% miles. In the absence of sewers, cesspools are made to suffice, and while the whole question of disposal and utilization of the debris of this immense population is under consideration, there are, I understand, many advocates for an improved method of cesspit convenience as against the extension of sewer. Amongst these Mr. Edwin Chesshire is foremost. He, as is well known, has devised an intercepting tank or catch-pit for the reception of the solid portions of sewers.

Mr. Chesshire's "catch-pit," or intercepting tank, is so constructed that it may be applied either to a common privy, in lieu of an ash pit, or to a water closet at some point intermediate between the seat and the sewer, catching the excreta of the household, and retaining the solid or valuable portion in a portable form, while the liquid passes away into the sewers.

The plan or form at present preferred is that of an iron box, large enough to hold the solid part of the excreta of an average household for from eight to twelve months, and yet, when full, within the power of two strong men to lift. The pipe from the privy, or closet, passes into the top of the box, by preference, at the opposite corner to the outlet or waste pipe, which, placed at the bottom of the box, is divided from the main part by a perforated grating extending across the corner, and the whole height of the box. Except as to the inlet and outlet pipes, the box is hermetically sealed, though the lid can be readily removed when it is desirable to empty it. The connection of the inlet and outlet pipes to the box can also readily be separated and remade. The boxes are all made to particular gauges. A full one can be removed and an empty one put in its place in five or ten minutes, and this, if necessary, may be done in the day-time, without any annoyance to the household, neighbors, or passers-by.

Mr. Chesshire has set up in his own house, or rather immediately outside of it, one of these intercepting tanks, and he was kind enough to explain to me its action. It unquestionably works well, and with infinitely less of trouble than would at first be assumed. If his system were generally adopted, it would follow that a system of sewers would still be required for the conveyance away of the liquid part of the sewage. But it is urged very forcibly that the construction of sewers for this intention would be comparatively simple and inexpensive; that as the quantity of water that passes out of a town, where there is no flooding from rivers or marshes, cannot be much greater than the supply of water into the town, a system of efferent pipes like to those that bring in water would suffice; and that fluid sewage thus carried away might easily be caught and afterwards utilized. But I must not trespass further on this ground; suffice, that if the "Chesshire" tank were adopted on a general scale, there seems to be no town in which it could be applied with better chance of success than Birmingham.

DIET OF THE PEOPLE. - DINING HALLS.

I find amongst my medical brethren an unanimous expression of opinion that the whole population of Birmingham is well fed. The lowest classes obtain animal food at least once a day. Pork is the staple article of animal food amongst the lower classes. Drunkenness is not so marked a vice as in many other towns. There is no comparison between Birmingham and London in this respect. I made a night survey twice in Birmingham to see the worst of it, and was most agreeably surprised at the quiet and sobriety that prevailed. Of course, drunken men and drunken women, too, were met with, but I could go into one particular street in London, I think, at any hour between sunset and midnight, and could find more helplessly drunken wretches there than I saw in many hours of night peregrination in all Birmingham.

The dining-hall movement, commenced so happily and continued so successfully in Glasgow, has been followed up in Birmingham with equal satisfaction. The halls are fitted up with great taste and comfort, the waiting is excellent, and the provisions all that could be desired. You enter the hall and find a ticket keeper at hand, who tells you the bill of fare. Soup, 1d. a dish; haricot mutton, or roast beef, or boiled mutton, or other similar dish, 1d.; vegetables, 1d.; bread and cheese, 1d. Fourpence for a good dinner. Daniel Lambert himself could hardly spend a shilling over one meal. I paid a visit to one of the halls for luncheon, and had soup for a penny that was perfect of its kind, and saw a hundred people dining as neatly as at a London club, and more comfortably than in the majority of eatinghouses. The capital of the company that has started the dining-halls is £5,000, in 250 shares of £20 each. The calls are £1 a share, and never exceed £2, an interval of three months occurring between each call.

Small as these sums appear, and small as the profits would appear, the experiment in Birmingham succeeds. The business done is enormous. School boys dine in the halls, artisans dine there, workwomen dine there, clerks and others lunch or dine there, and many send at luncheon hours for a fourpenny meal, which answers for a dinner. And the best of all is, that the people are well fed. If in London a number of companies were formed, and the movement were more actively carried out than it has been so far, establishments as useful as profitable would soon rise in every thickly-peopled locality, where good food, ready cooked, is asked for at the cheapest possible rate.Medical Times and Gazette.

SURGERY.

2. Abstract of a Paper on the Difference of the Sensibility of Joints. By JAMES W. BELL, M. D. Rochester.

The author pointed out the difficulty of foreseeing the amount of mischief that may ensue upon any injury of joint, in consequence of difference in the susceptibility of joints. This difference is due to the following causes: a, anatomical and physiological; b, diathetic; c, morbid state of system present at the period of injury; d, accidental. The author recommended the removal of dead portions of bone from the cavity of joints, in the place of excision, in selected cases, and at a medium period, viz., neither too hastily nor too tardily.

Dr. Bell narrated the heads of several cases.

CASE I. A publican sustained a compound comminuted fracture of the patella by a fall from a cart. The recovery was perfect. The treatment consisted in the application of twelve leeches within the first twenty-four hours; and in the use of tartarated antimony, digitalis and opium, for a fortnight, and of iodide of potassium subsequently.

CASE II. A man met with compound comminuted fracture of the olecranon. Unhealthy inflammation of the soft parts supervened on the fourth day; the joint became disorganized; pyæmia occurred; and death was the result.

CASE III. A man received a lacerated wound of the knee-joint without injury of the bones. Traumatic delirium set in on the fifth day; and death occurred about the tenth day.

CASE IV. was that of a youth whose knee-joint was twice injected with iodine without the supervention of much local inflammation or general disturbance. - British Medical Journal.

3. Case of Excision of Portion of the Lower Jaw. By GLASCOTT R. SYMES, one of the Surgeons of Steevens' Hospital.

E. McG., aged 45, was admitted into hospital May 13, 1864, under my care. For some four months previous to admission he had observed a swelling on the right side of the lower jaw, from the outer incisor to the first molar tooth. This gradually increased, until eventually he was obliged to apply for relief. He experienced very little pain, except when it was subjected to rough treatment by those examining it.

On admission, the tumor was about one inch and a half in its horizontal diameter, and three-quarters of an inch in its vertical. The appearance presented externally was not likely to attract much attention, as the skin was not discolored nor engaged in any way; altogether he seemed to be suffering from an ordinary gum-boil. The bicuspid and all the molar teeth were decayed. The mucous membrane covering the tumor was not attached to it so closely but that it might be moved over it, nor was it discolored. The sense of touch revealed that the growth was not osseous, though of a resisting nature, still a certain amount of elasticity could be discerned. I inserted a grooved needle into the mass, and in the direction of the centre of the bone. It passed in for a considerable depth, so far, that I was expecting to see the point appearing beneath the tongue. Nothing followed the introduction of the needle but a few drops of blood. The mass was not movable on the bone, nor was it pedunculated.

On the 21st of May I proceeded to remove the portion of the jaw which was engaged in the disease. My friend, Dr. Grimshaw, Jr., assisted me materially by first extracting the incisor on the left side, and the stump of the second molar on the right side. The patient was placed in the sitting posture, and as he did not wish for chloroform it was not administered. With a sharp-pointed scalpel I transfixed the lower lip below the red border, and carried the incision down about half an inch below the prominent edge of the lower jaw; the saw was now applied, when the symphysis was rapidly divided. The knife was now carried along the horizontal ramus of the jaw to a point opposite the second molar tooth. A vertical incision was made perpendicular to the extremity of the horizontal one; it extended below the border of the bone. The three incisions were in the form of the letter H. The saw was again applied, and the bone quickly sawn through, an assistant having held it steady by grasping it firmly with a strong crow-billed forceps. The intervening piece of bone, including the disease, was removed by a few touches of the knife. The facial was the principal artery requiring ligature. The inferior dental was considerably enlarged, and spouted freely. The hemorrhage from it was restrained by inserting a small wooden plug into the dental canal. The wound was drawn together by points of hare-lip suture. The greater portion of the wound healed by the first intention; but at the posterior inferior angle, where the sub-maxillary gland was implicated in the necessary incisions, a considerable time elapsed before union took place; the saliva and thick mucus, along with much of the fluid which he attempted to drink, passed through the opening. However, in the course of time this also healed up, and he left the hospital in about four weeks after the operation. I have seen him within the last three weeks. There is no return of the disease. He is very slightly marked, so little that none but an experienced eye could detect the line of the incision. He has allowed his whisker to grow down, so as to cover the spot, which took some time in healing, where the skin is slightly puckered. The substance by which the gap between the ends of the bone have been filled up is of cartilaginous consistence, and, except in the matter of articulation, he is as well as before the appearance of the disease.

A great number of cases of excision of various portions of the lower jaw have from time to time occurred in Steevens' Hospital, especially in the time of the late Mr. Cusack. Many happy suggestions were made from them by that experienced surgeon in reference to important points in the operation. It was his habit, if possible, not to cut through the red border of the lips; thus there was very little deformity afterwards, and not only that, but the undivided lip served far better than any sutures in keeping the edges of the wound in apposition. I have heard that this was proposed to him by the late Mr. Maclean, the celebrated dentist; and, indeed, many important improvements, especially in the matter of instruments and surgical appliances, have emanated from the gentlemen of this profession. It is always well to have an assistant at hand to draw any teeth that may be in the way. Although a simple operation, yet nothing is so likely to discompose an operator as when he is baffled by a tight tooth and generally, especially if the disease has lasted for a long time, the teeth are much longer and more tightly set in the alveolar process than what is usual. I find the best saw to use is Weiss' small straight tennon saw; it cuts through very rapidly, it can be used in any situation, and is much more manageable than the chain saw. One of the most important points of the operation consists in the situation of the horizontal incision; it should be made high up on the lower jaw, on a level with the teeth. In this way the facial artery does not retract much; but if the incision be made too low down the artery retracts into the substance of the sub-maxillary gland, and the surgeon will experience the greatest difficulty in securing the vessel. I know of a case where this mistake was made, and the patient had lost an alarming quantity of blood, when the greater portion of the gland had to be included in a ligature before the hemorrhage ceased. As to the occurrence of salivary fistula, we have found that it is only likely to occur where the parotid gland or its duct have been divided. Such an unfortunate contre temps does not usually take place when the sub-maxillary and its duct have been crossed by the line of incision.

On examining the tumor, I found it to be one of the myloid variety which has been so ably described by Mr. Paget. The outer table of the bone had been completely absorbed, the mass was lying immediately beneath the periosteum. This could readily be dissected off, at once showing that the tumor was not malignant. When a section was made, the disease was found to have commenced in the interior of the bone, probably at the dental canal, which could still be traced. The whole thickness of the bone had been absorbed, with the exceрtion of a thin layer at the inner side. The cut surface presented a homogeneous appearance of the consistence of an apple. It had a