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: Notwithstanding the great mortality he thought that thecombined method had a certain field of its own, especiallywhen it could be foreseen that the removal by the sacralmethod would be too difficult or incomplete, or where suchproved to be the case after a beginning had been made withthe sacral operation.

Dr. JOHAN NICOLAYSEN (Christiania) reported two cases ofChronic Ileus, and Dr. P. BULL (Christiania) one of Volvulusof the whole of the Jejunum and Ileum.

Professor ALi KROGIUS (Helsingfors) illustrated and ex-plained an ingenious method of treating the duodenal stumpremaining after resection of the pylorus, so as to avoid thevarious unpleasant sequelse which often arise from its defec-tive treatment.

Professor BORELIUS read a paper on a series of 43 casesof Stone in the Ductus Choledochus. From July lst, 1898,to July 1st, 1907, he had operated on 180 cases of gall-stone and had performed choledochotomy in 30 cases withaix deaths. Of eight cases of stone in the ductus chole-doohus not operated on four died, while of six patients whowere only incompletely operated on all died.

Professor TH. RovsiNG (Copenhagen) said that in several- cases in which a choledochotomy proved too difficult he haddone a sort of choledocho-lithotripsy, gently crushing bymeans of two fingers the stones in the bile duct, so that thefragments might be pushed down into the intestine. Wherethis procedure did not prove efficient he had sometimessucceeded in forcing the stones from the bile duct back intothe gall-bladder by grasping the duct firmly below the stonebetween two fingers and exercising a pressure in the direc-tion upwards. In such cases it was, of course, necessaryto prevent the stone from impacting itself in the hepaticduct.

Professor ROVSING communicated a note on the AntisepticProperties of Nitrate of Silver. For many years he hadbeen constantly using it and now preferred it to all otherantiseptics in the overwhelming majority of circum-stances where antiseptics were needed. His reasons fordoing so were that, though not poisonous to the human

body, it was one of the strongest antiseptics known, andthat it retained its bactericidal power also when convertedinto albuminate or chloride of silver. He recommended it

particularly for the impregnation of gauze for dressings. It’had enabled him to do away entirely with iodoform gauzein his hospital-e.g., he always used "lapis-gauze" " for re -plenishing the Mikulicz bag in laparotomies. " Lapis- catgut,"the preparation of which was exceedingly simple, was abso-lutely safe and trustworthy as to sterility, agreeable to handle.and tie, and, as tests had proved, stronger than raw catgut,while all other methods of preparing catgut lessened its

strength. Moreover, "lapis-catgut" " kept its strength foryears, while iodine-catgut soon became brittle.

Professor TSCHERNING (Copenhagen) said that he also

thought nitrate of silver an excellent antiseptic. It hadbeen in use as such for many years at the Kommune Hospitalof Copenhagen. The preparation of nitrate of silver catguthad been published years ago by a Norwegian colleague.On August 9th an interesting discussion on the Treatment

o1)f Inflammatory Diseases of the Adnexa Uteri was openedby Professor OTTO ENGSTR&M (Helsingfors) and ProfessoxJoH. KAARSBERG (Copenhagen). While Professor ENGSTR6-Nlgave a lucid exposition of the different methods of treatment,operative and not operative, Professor KAARSBERG contributedto the Congress a conspectus of 289 cases on which he hadoperated. Perhaps the most important feature about hiscommunication was the information it contained about theafter-history of nearly all his operation cases. ProfessotKR. BRANDT (Christiania), Professor F. WESTERMARE(Stockholm), and Dr. H. FORSSNER (Stockholm) took parlin the discussion.

Professor TSCHERNING demonstrated an original operatiorwhich he had devised for the removal of malignant nemgrowths in the lower part of the hypopharynx and thE

adjoining part of the gullet. In contra-distinction to aFother operations it spared all important nerves and vessel;and gave an excellent view of the diseased region, far betteithan a lateral or subhyoid pharyngotomy. An incision wafmade in the middle line of the anterior surface of the necka low tracheotomy performed, whereupon the anterior walof the larynx, with the hyoid bone and the uppermost ringfof the trachea, was divided in the middle line. After in

spection of the anterior of the larynx Professor Tschernindivided also the posterior wall of the larynx and thE

upper part of trachea in the middle line, and by insertin

retractors on the pharyngeal and cesopha.gea.1 surface of thesevered cartilages he could with the greatest ease inspect and,if needed, excise every wrinkle and fold of the mucousmembrane of the hypopharynx and uppermost part of thegullet. In the cases operated on the bleeding had beenpractically nil, this being one of the advantages of the

operation. Moreover, it spared the vocal apparatus, at thesame time giving just as good a view of the diseased regionas if a laryngectomy had been performed.The application of X Rays to the Service of Surgery formed

the theme of three communications. Professor JOHN BERG

(Stockholm) demonstrated a series of photographs of Stonesin the Urinary Bladder and related how in more than onecase the x rays had been of inestimable value to him. Hehad in one case emptied the bladder of stones and hadassured himself of the thoroughness of the operation bysearching it carefully with his finger. Nevertheless, thepatient’s symptoms continued and on the photograph thereappeared a shadow of a stone. A second operation at firstfailed to locate the stone, but after much searching he suc-ceeded in finding a diverticulum with so narrow an openingthat he could not get a finger-tip through it; the stone layin this diverticulum. In other cases the x rays had helpedhim to diagnose prostatic stones.

Dr. 0. BORCHGREVIKK (Christiania) illustrated by x taypictures the results of his ambulatory extension treatmentof fractures of the upper limb. His apparatus was verysimple, using only rubber tubing as extending force. Theresults, also in the difficult cases of supracondylar fractureof the humerus, were above all praise.

Dr. P. TETENS HALD (Copenhagen) showed a series ofRoentgen pictures demonstrating the great help that mightbe derived from them in the diagnosis of affections of theaccessory sinuses of the nose. While the healthy sinuseswere clear and had distinct outlines, the diseased onesappeared blurred or seemed to have entirely disappeared.That the sinuses were present even in the last-mentionedcases was proved by the photographs showing probes intro-duced into them. Photographs of affections of all theaccessory sinuses were shown and some interesting casesrelated illustrating the value of the method in diagnosticdifficulties.

(To be contimled.)

SECOND INTERNATIONAL CONGRESS ONSCHOOL HYGIENE.

THE EXHIBITION.IN connexion with the Second International Congress on

School Hygiene an exhibition of school buildings and

furnishing appliances was held in the central hall and

adjoining rooms of the University of London. The exhibitionwas wide in scope and members of the Congress and otherstook the keenest interest in the various exhibits whichillustrated recent progress in educational methods not onlyin this country but in Austria, Denmark, France, Germany,Holland, Italy, Spain, Sweden, and Switzerland.Many of the stalls necessarily embraced exhibits which

under a scientific classification would naturally fall underdifferent categories, but for the purposes of this notice theexhibits may be conveniently divided into two sections, thefirst dealing with buildings, and including materials of con-struction and sanitary arrangements, and the second dealingwith furnishing and equipment, including teaching andtechnical appliances.Under the heading of

School Buildingsmay be included the numerous and useful loan collections ofdrawings, plans, and designs. One of the chief attractionswas the collection of exhibits from schools under the controlof the London County Council. The details of medicalsupervision were admirably shown by’means of charts anddiagrams, while the plans and elevations of the differenttypes of schools under the control of the Council gave thevisitor to the exhibition an excellent idea of the work that isbeing done by this body. Several interesting exhibits wereshown by provincial schools and the Scottish section illus-trated the keen interest that is taken in education north ofthe Cheviots. One object in the English loan collectionwhich bore no label, but which was apparently intended toillustrate to children a lesson on the care of the baby, was acradle containing a large doll. Though roughly made the

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cradle admirably suited the purpose for which it was intendedand we should like to see such an article a prominent featureof every elementary school in the kingdom. The carpentryof such an article might well form part of the teaching forboys, and poor people through their children might thusbecome acquainted with a cheap and easily made cradlewhich if put into practical use might lessen the appallingnumber of cases of overlying.Among exhibits competing for medals was an excellent

type of portable school pavilion erected in the grounds byMessrs. Christoph and Unmack (a German firm withLondon representatives at 31, Ql1een-street, E.C.). This

pavilion, measuring 32 feet by 70 feet, contained twoclass-rooms, a physician’s room, and a corridor. This

type of pavilion, which has been registered under thename of the Doecker, is largely used in Germany. Theexhibit, which obtained a silver medal, was equipped withhygienic school furniture made by Mefsrs. Mueller of Berlin.Messrs. Humphrey of Knightsbridge, London, S.W., showedillustrations of various kinds of portable iron buildings,and the Ducker Company of Kingsway, London, W.C.,showed a school-house measuring 22 by 33 feet which was z,erected in eight days " without nail or screw." The BritishChallenge Glazing Company, Limited, Bank Chambers,London, W.C., showed samples of its patent flooring forhospital and general use for which it claims, amongother things, that it is uncrackable, fire-resisting, and dampproof. The same firm showed a patent glazing which seemsto possess genuine merits. The Plastom Asbestos FlooringCompany, Bunhill-row, London, E.C., also showed a fire-and vermin-proof flooring, while the British DolomentCompany, Caxton House, Westminster, exhibited samplesof its patent flooring which is said to be imperviousto acids and oils. The Limmer Asphalte Paving Com-pany, 2, Moorgate-street, London, E.C., showed specimensof paving blocks and other examples of the applicationof asphalt. The Chaddock Mechanical Window Company,22-25, Cornhill, Liverpool, certainly deserved the silvermedal which it obtained for its exhibit. Running throughthe centre of the window perpendicularly is a metalrod which fits into sockets at the top and bottom of thewindow frame. The window thus turns about a vertical axisand can be set at any angle according to the direction of thewind, while another advantage, and not a small one, is thatboth sides of the window can be cleaned from the inside. TheCombined Collapsible Ventilator Company, 85, Duke-street,Liverpool, also showed an improved window and a ventilatorwhich can be adapted to existing sashes with a view tosolving the problem of ventilation without draught.Ozonair, Limited, 27, Chancery-lane, London, showedthe different forms of their apparatus as applied toventilation and various manufacturing processes. Messrs.

Cassels, Park-place, Stirling, N.B., who have been awardeda silver medal, showed their Clarefont wash-basin withscrew-down taps, having an inner basin in whichwater is allowed to flow and overflow during the time ofablution in schools, a clean supply of water being thus main-tained for each pupil. Experience has shown that this

system is an economical one. The same firm also showed a" one each " towel distributor for providing a separate towel toeach scholar without danger of its being taken away or mis-laid. Messrs. Pryke and Palmer, 40, Upper Thames-street,London, E.C., exhibited alargeselection of school ironmongeryas supplied to the London County Council. Interestingfeatures of their exhibit were a portable hospital bath of steelcuvered with porcelain enamel and a patent window fasten-ing for asylums and other institutions whereby a window-sash can be prevented from being opened to a larger degreethan an attendant may desire. The Ajax Sanitary Company,22, Ely-place, London, W.C., exhibited their various basinsand sink fittings, which have recently been described inTHE LANCET, when they were shown at the annual exhibitionof the British Medical Association.1 The exhibit of theBritish Sanitary Company, 341, Bath-lane, Glasgow, forwhich they obtained a silver medal, consisted of self-acting earth closets suitable for country schools. Avery large collection of urinals, closets, and latrines,several of an excellent pattern, were shown by the LeedsFireclay Company, 2 and 3, Norfolk-street, London,W.C., and Messrs. J. Duckett and Sons, Limited, Burnley,Lancs, had a similar exhibit. For their overflow lavatoriesthey obtained a silver medal. Messrs. John Knight

1 THE LANCET, August 17th, 1907, p. 458.

and Co., 24, Gertrude-street, Chelsea, who obtaineda silver medal, displayed a large selection of drainagefittings in stoneware, and the Berkefeld Filter Company,121, Oxford-street, London, W., showed a wide range oftheir well-known filters. Messrs. Candy and Co., Limited,87, Newman-street, Oxford-street, London, W., showedtheir excellent stoves, "The Devon Fire," which were

commended in the report of the experiments carriedout under the joint control of the Commissioner of Worksand the Coal Smoke Abatement Society (ride THE LANCET,May 19.b, 1906, p. 1414). The Gas Light and CokeCompany, Horstferry-road, Westminster, had an interestingexhibit, as did also Messrs. Colbran and Co., 10, Mortimer-street, London, W., the "Heaped" Fire Patent, and Messrs.A. E. Podmore and Co., 32, Charles-street, Hatton-garden,London, E.C., who showed their dust-proof Bunsen burner.The Wenham Light Company, 90, Great Russell-street,London, W.C., also exhibited their new pattern invertedmantle lamps.

Furnishing and Equipment.The two important exhibits of the Tintometer, Limited

Colour Laboratories, Salisbury, and of Messrs. E. J. Arnoldand Sons, Limited, Leeds and Glasgow, may be convenientlyreferred to under this heading. The first-mentioned firmshowed apparatus and diagrams for class demonstration,together with a colour nomenclature for the precise definitionof any colour. The tintometer has been applied to manypurposes, industrial and scientific, and in particular hasbeen used by Dr. George Oliver in blood examination. (Dr.Oliver’s apparatus, the hasmoglobinometer and the basmocyto-meter, were referred to by him in the Croonian lectures of1896, and described in THE LANCET of Jan. 23rd, 1897, p. 251,and March 9th, 1901, p. 711.) The particular form of tintometershown at the exhibition is adapted for educational purposesand consists of three glass standard scales in the colours red,yellow, and blue. These scales are graded into equal units,which are in colour equivalent with each other, and areused in connexion with a set of revolving colour discs,transparency frames, and diagrams. The apparatus is usednot only for teaching children colours but also for testingtheir vision for colour blindness. Messrs. Arnold andSons are educational publishers and also exhibited a largecollection of their books and educational appliances for usein physiological and hygienic teaching, including anatomicaldiagrams, charts, and their well-known "Food ValuesDiagrams." The chief feature of their stall was, however,"The Spectrum Colour Scheme," which has been workedout by Mrs. Florence Kirk, M.R.San.I., the head-mistress ,

of the Belle Vue Council School, Bradford. This schemeembraces a system of teaching in which improved kinder-garten methods are used in conjunction with systematicinstruction in the recognition of the prismatic colours.In connexion with this scheme the firm supplies an excel-lent prism at a low price, and paper, wool, paints,crayons, and chalks of a practically uniform standard ofcolour. It is worthy of note that the instruction hasbeen so graded that no undue strain is put upon the eyesof young children. The Educational Supply Association,42, Holborn Viaduct, London, E.C., among other educationalappliances, showed some excellent adjustable desks, notablythe "Farringdon," which is so designed that both desk andseat can be adjusted to suit pupils of any height. This is an

important consideration when the ages of pupils vary to anygreat extent. The adjustable desks and laboratory fittings ofthe Bennett Furnishing Company, 47, Glengall-road, Peckham,London, S.E., also deserve notice. Messrs. Thomas J. Syerand Co., of 45, Wilson-street, Finsbury, London, E.C.,had a very interesting collection of fittings and toolsfor technical schools and laboratories. Particularly note-worthy was their exhibit of metal - working tools andbench in connexion with hand and eye training."Messrs. Harbutt, Bathampton, Bath, makers of the well-known plastic paste, "Plasticine," had an interesting exhibitof this substance, which has many uses beside modelling,such as the making of temporary cells for microscopic pur-poses, and so forth. Messrs. Merritt and Co., 8, White-street, Moorfields, London, E C., exhibited their steellockers for use in schools, and the "England Works," ofLeeds, their excellent cloak-room fittings. Messrs. Newtonand Co., 3, Fleet-street, London, E C., showed their opticallanterns, and Messrs. Fletcher, Russell, and Co. a selectionof their well-known furnaces, blow-pipes, and various labora-tory appliances. Messrs. Spencer, Heath, and George,Limited, Goswell-road, London, E.C., showed a completely

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equipped educational gymnasium as applied to Ling’sSwedish system and a collection of anthropometric appa-ratus.

Misoellaneous.

Among the miscellaneous exhibits may be mentioned theoxygen bath of the Aeosan Company, 102, Charlotte-street,Birmingham, which is described on p. 517 of this issue. The"Sanitas" Company, Limited, Locksley-street, Limehouse,London, E., showed their various specialities, as did alsoJeyes’ Sanitary Compound Company, Limited, 64, Cannon-street, London, E.C.; and Messrs. Newton Chambers, Lime-house, E., exhibited their "Izal" " toilet and other prepara-tions. Messrs. N. and N. C. Bletchley, anatomical and ortho-paedic boot manufacturers, 89, Nortbgate-street, Gloucester,showed a wide selection of boots and shoes for both normaland abnormal conditions of the foot and a special bandagefor weak ankles. A boot made by them with a flexiblesole for ordinary use should be both useful and comfort-able in cases of tender feet-most difficult cases to remedy asmany surgeons know. Mr. D. H. S. Brown, 72, Hartfield-road, Wimbledon, among other things, exhibited pillow-slipsand sheets the chief feature of which is a tuck runningacross the fabric in order to distinguish the two sides, withthe object of insuring that one side only shall always be keptnext the body. He also exhibited an improved support forladies’ garments. Among the publishers who exhibited bookson physiology and hygiene were Messrs. Macmillan and Co.,St. Martin’s-street, London, W.C., and Messrs. Constableand Co., 10, Orange-street, Haymarket, London, S.W.

MEDICINE AND THE LAW.

The Verdict " Felo de se." "

THERE are numerous cases of persons slaying themselves asto whom there is no evidence adduced to the inquest jury ofunsoundness of mind, either recent or remote. Publicsentiment, however, has rendered a formal verdict "thatthe deceased killed himself during a state of temporaryinsanity " almost invariable. Following what appears tobe the present-day custom of coroners, Dr. W. WynnWestcott has usually been observed to conclude a short

summing up in these cases with the question: " Willyou say that this act was done during a state of

temporary insanity ?" During a recent week it appearsthat this coroner has varied his practice and hasconcluded by addressing the jury in these terms, "Asno evidence of insanity has been laid before you are

you of opinion that the deceased did wilfully kill himself andhence is felo de se?" " In five cases during one week inthree different parishes have inquest juries without the

slightest moral pressure beyond this simple suggestionbrought in verdicts of felo de se. The cases were all men.Three were at the Hackney court, all having been found inthe River Lea, one, aged 74 years, afflicted with a chronicillness and tadium vita; a second, aged 6Z years, sufferingfrom poverty and lack of work ; and a third, aged 53 years,a drunkard who had quarrelled with his family; one was

at the Shoreditch court, his age being 51 years, hewas a drunkard on the verge of delirium tremens whenhe took hydrochloric acid ; and the last case was at BethnalGreen, an ex-prisoner, aged 38 years, who could not findwork, and who took oxalic acid. The lay press, in com-menting on these facts, has referred in several placesto the incident as "a return to more blunt but moretruthful verdicts." Probably there is a better, becausetruer, explanation. The inquest juries concerned were com-posed wholly of men of a moderate standard of education.Among such the final suggestion in the summing-up of thefacts and probabilities of the case made by the president ofthe court would have a great influence in their minds whenimmediately afterwards they considered the terms of theverdict. Suggestion must have a great influence over

jurymen whose knowledge of pathological conditions andlegal technicalities is very small, if it exists at all ; hencemuch may depend upon the bias of an individual coroner asto how an inquest jury will frame its verdict.

.R’00 Nuts sold for Hmnan Food.A trader in the City, named Brinkley, who had dealt in nuts

for 16 years, recently made an experiment of a dangerouskind and may be congratulated that no worse result ensuedfor himself than a fine of e5 at the Tower Bridge police-court.According to his story, in telling which he appears to have

peen perreCtilY scraigmiorwara, ne was lDtirOaUCea Dy a man,whom he described as an old traveller, to a ship’s captainwho had some nuts to sell of a kind not usually seen inEngland and he bought some. He ate several himself withoutany untoward result, and without any further precaution putthem within reach of the public by disposing of some

to a costermonger at the price of 7s. 6d per hundredweight.The costermonger advertised them on his barrow as " theking of nuts, Kaloo, from South America," and foundsufficient customers to cause several children to be taken toGuy’s Hospital suffering from poisoning. One of these, whohad only eaten two nuts, nearly died, and two others gaveevidence at the police court to the effect that theyhad eaten six and seven respectively before being taken ill.

Investigation by the police followed, the costermonger wastraced, and the merchant who supplied him was summoned.Mr. Alfred Long, chief sanitary inspector to the boroughof Southwark, gave as the result of his inquiries at Kew andelsewhere that kaloo nuts come from Central China whereoils used for varnishing are extracted from them, which oilshave poisonous qualities. He could find no trace of anyimportation of them to England during the last 50 yearsamong firms engaged in the fruit trade in the City. Mr. G.Millson, medical officer of health of the borough of South-wark, had examined the nuts and gave evidence that apartfrom their inherent unwholesome qualities the nuts in ques-tion were rancid and in such a condition as in any case wouldrender them unfit for human food. In fining Mr. Brinkley,who had sold them to the costermonger, Mr. Chapmanmade the observation, from which none will dissent, that toput a novelty upon the market with the intention that itshould be eaten involved the responsibility of first ascertain-ing whether it was fit for human food or not. Mr. Brinkleyis reported to have said that he had been in the nut tradefor 16 years and that this was the first time that he hadheard that a nut was unfit for food.

Public Health and Poor Law.LOCAL GOVERNMENT BOARD.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

City of Lil’erpool.-The population of Liverpool in 1906was estimated at 739,180. The birth-rate was 32’ 6 and thedeath-rate 20 2 per 1000. The infantile mortality amountedto a high figure, 171 per 1000 births, but there was duringthe year considerable prevalence of measles. Amongst theagents upon which Liverpool relies for the reduction of thisinfantile mortality are hospital accommodation for infantssuffering from measles and whooping-cough, together withspecial arrangements for the earliest possible notification ofbirths, and a staff of female inspectors. For mothers whoare unable to suckle their young a suitable food is providedwhich is " within the reach of all." Typhus fever wasintroduced into Liverpool on three separate occasions during1906, the introducers being Russian emigrants. The totalnumber of cases occurring was 52 and the disease still claimssome 20 deaths annually. Dr. E. W. Hope speaks appre-ciatively of the system of the voluntary notiflcation ofpulmonary tuberculosis which has now been in vogue inLiverpool for several years. During 1906 there were 1842cases notified, a very considerable number when regard ishad to the fact that the notification is voluntary and thatnotifications are only asked for in cases where, in the opinionof the attending medical practitioner, a useful purpose is likelyto be served by visits from the sanitary staff of the munici-pality. As regards the control of milk-borne tuberculosis, towhich subject the recent report of the Royal Commission onTuberculosis has directed public attention in an accentuatedform, energetic steps are being taken in Liverpool under theLiverpool Corporation Act, 1900, which confers powers uponofficers of the corporation to visit farms and to examine cowsin districts outside Liverpool from which milk is introducedinto the city. The Act also enables the officers to takesamples of milk at the railway stations. During 1906 tuberclebacilli were apparently discovered in milk from Cheshire,Lancashire, Staffordshire, Shropshire, and North Wales.Dr. Hope reports that both the farms and the cows in thecountry districts are markedly inferior to those within thecity, and he furnishes photographs showing the deplorablecondition of some of the country cowsheds as regards light.ventilation, cleanliness, and cubic space. It will be a source