1160 EPITHELIOMA OF BOTH EXTERNAL EARS.

EPITHELIOMA OF BOTH EXTERNAL EARS.To the ditor8 of THE LANCET.

SIRS,—In THE LANCET of April 15th, 1893, I recorded thecase of a man aged seventy-six years who was suffering froma persistent and increasing ulceration of both external ears,which I regarded as malignant. Dr. Snow wrote the

following week remarking on the rarity of the case, and atthe same time raising the question whether the disease wasreally epitheliomatous. I shall be obliged if you will nowpermit me to record a final brief note of the case. Thepatient firmly declined any operative interference, hisstrength gradually failed, and he died from exhaustion onJan. 13tb, 1894. During the last few months of his life thedestruction of the right ear steadily progressed, and its

malignant character became more and more pronounced,until, at the time of his decease, the ear-as such-wasscarcely recognisable, its place being taken by a large,fissured, fungating mass, attached by a broad base to thehead, the discharge from which was very profuse and fetid.The disease of the left ear also extended, but much moreslowly, and at the time of his death was scarcely so faradvanced as the right at the time my first note was written.It bled rather freely at times, but the discharge, althoughconstant, was never very troublesome, and there was scarcelyany pain. After death I removed a small portion of this leftear, cutting through the cartilage. This was examined micro-

scopically by Mr. W. A. Charlton of the Royal Infirmary,Newcastle-on-Tyne, and he kindiy reports to me as follows :"Bundles of fibrous tissue are seen running through thespecimen in various directions, easily recognised as longfibres which are stained red. Near the lower part is a well-defined band of cartilage enclosed by a layer of fibrous tissue.Just below this is a quantity of fibrous tissue infiltrated witha multitude of small round cells stained greenish, the resultof the irritation of several branching processes of epitheliumwhich are stained brown. Above the cartilage are severalprocesses of fibrous tissue with columns of invading epithe-lium stained light brown. The invading epithelial processes,cell nests, and exuded round cells attacking the deep structuresare characteristic of an epithelioma." The specimen, of"which the above is a description, was also sent to me, andlikewise a diagram showing the condition in an enlargedform. I am. Sirs. vnnrs trnlv.

W. J. ERNELY SUMPTER.Sherringham, Norfolk, April 16th, 1894.

RAW MEAT IN DIABETES.To the Editors of THE LANCET.

SlES,—I had used raw meat in the treatment of diabetesbefore the date (1873) to which Dr. Lauder Bruntonrefers in his letter in your last number. I had been led to- do so by a report brought me by some travellers returningfrom the East, who stated that at one of the Mediterraneanports-I think Constantinople-there was a medical man whohad obtained a great reputation for curing diabetes, and theypromised to obtain for me particulars as to his mode of treat-ment. I was informed by them shortly afterwards that hisremedy was the administration of raw meat. I tested thismethod on one or two patients in King’s College Hospital,but without any notable result. It may be that this methoddeserves further trial, and perhaps some additional care, inthe choice and mode of preparation of the meat. There israw meat and raw meat; the dry, blanched veal of thiscountry must be a very different thing from the dark juicyveal of the continent. This is a matter worthy of examina-tion. I may here mention that, in order to be able to procurea constant supply of pulped raw meat, I have induced Messrs.Van Abbott to prepare for me a pulp of raw meat in a specialmanner, by which its tendency to rapid decomposition isprevented. By mixing a small quantity of pepsalia andcloves with the pounded meat we have found it to keep goodfor several days, so that it may be sent some distance intothe country. I have used raw meat pulp thus prepared withadvantage in many cases-in typhoid fever, in influenza, infollicular tonsillitis when only fluids could be swallowed, andin other cases. This pulp mixes readily with light broth orclear soup, or claret and water, or weak brandy and water,or with thin chocolate, or indeed with almost any agreeableSuid. Messrs. Van Abbott are making further observationsfor me in the direction of finding means of conveniently pre- I

serving this raw meat pulp from decomposition withoutaltering its qualities.

I am. Sirs. vour obedient servant.I. BURNEY YEO, M.D.

Hertford-street, Mayfair, April 30th, 1894.

" THE ACTION OF ASPARAGUS ON THEKIDNEY."

To the Editors of THE LANCET.

SiRS,-It may be interesting to your readers if I give a fewquotations on the action of asparagus, from an ancient work inmy possession, published in 1654 by Nich. Culpeper, entitledI I Pharmacopoeia Londinensis, or the London Dispensatory."The work is most interesting in many ways, and were spaceand time of no importance I could give extracts, if not in.structive at least amusing to the student of to-day. Indealing with " Roots, under which heading asparagus, or

rather "sparragus," appears, he classifies them-1st, accord-ing to their "temperature," and 2nd. "to their properties."Concerning the former, he deals with roots hot in the firstdegree," in the second degree, third degree, and fourthdegree; and then "roots temperate in respect of heat," ofwhich he gives "bears-breech, sparragus, thistles, mallows,garden parsnips, &c." Continuing under "Roots appro-priated to the several parts of the body, and so theyheat "-the liver-he gives asparagus with such roots as

fennel, cinkfoy, parsley, rhubarb, &c. He also givesasparagus as a root heating the spleen, and also thereins and bladder. In dealing with the "property ofroots," he classifies them as those that bind, cleanse,open, extenuate, burn, glutinate, &c., and he givesasparagus with those that cleanse. Lastly, in Chapter 14,"of medicines provoking urine," he writes as follows:"Urine is the thinnest part of blood separated from thethickest part in the reins. If, then, the blood be more thickand viscous than ordinary, it cannot easily be separatedwithout cutting and cZensing medicines ;" and, again, "thisis certain, that blood can neither be separated nor distributedwithout heat " ; but "cool diuretics, though they further notthe separation of the blood one jot, yet they elense andpurge the passages of the urine. Those cold things whichprovoke urine, though they bite not, yet have they a nitrousquality whereby they open and clense." I cffer no com-ment on the above ; but, in conclusion, express my experienceto be that the urine is decidedly more concentrated and lessin quantity after eating asparagus. The reverse may presentitself to many for this reason: asparagus appears on the tablemore often when extra wine is drunk than otherwise—viz.,at dinner parties ; but I think if anyone will in no case

increase their alcoholic drink in any shape and eat this verypleasant vegetable, they will find the urine to be as I state.

T am. Sirs. vours trnlv.

I Brigg, April 30th, 1894. ELLIOT DAUNT.

THE CHLOROFORM PROBLEM: ASUGGESTION.

To the Editors of THE LANCET.

SiRS,-I think the majority of your readers, whetherEnglish or Scotch, will agree in most points with "A LondonAnaesthetist" in the controversy which he has raised with theHyderabad Commission.1 As it is impossible to deal witheven a single aspect of this question satisfactorily in a briefletter, I would here make only one or two remarks and offer asuggestion. In referring to the particular failure of theheart described by the Glasgow Committee, I suppose yourIndian Correspondent means the fall of blood pressure tozero, which they observed to take place in a dog two minutesafter the chloroform had been left off and after the recoveryof the pressure. The Commission maintain that this couldonly have occurred as the result of accidental asphyxia.Now I have shown that in the cat, with moderate percentagesof vapour, the heart frequently stops and becomes irregularone or two minutes after the inhalation has ceased, and,further, that the pupil, widely dilated at first, contractsto a line in ten seconds and all at once dilates widelyafter another minute or so. There can hardly be a

doubt that, coincidently with this stoppage of the heart

1 THE LANCET, March 10th and April 28th, 1894.

1161"MEDICAL EDUCATION IN AMERICA."

and dilatation of the pupil there must also take placethat fall of pressure to zero observed by the GlasgowCommittee. My suggestion simply is, therefore, that the

experiment of the committee ought to be repeated, and

preferably by neutral parties, not biased by preconceivedopinions. Above all, I would suggest that it should be per-formed on cats, as they are not liable to the struggling stageas dogs are, and the question could be easily settled in them.For deeper anaesthesia, to show that this fall is then not soliable to occur, dogs would be preferable. Your Indian

correspondent ignores the fact that Sir James Simpson,whose teaching was the same as Syme’s, had a death fromchloroform, and he has yet to learn that the latest fatalityhappened only the other day in the hands of their pupil,Mr. Lawson Tait.2 One of the rules lately formulated by theHyderabad Commission re the respiration, and which theyregard as of "overwhelming importance," was not derivedfrom the Edinburgh School at all, but was taken from Dr.Snow, who, indeed, was taken to task in the JiJdinb1/’J’flhMedical Journal on the subject. I agree with your corre-

spondent in believing that chloroform will kill in India aswell as in England. A fatality lately occurred there in anadult, who got only one drachm of chloroform in fourminutes-a case deserving the attention of the Commission.

I am, Sirs, yours faithfully, ,

Glasgow, May 1st, 1891. ROBERT KIRK, M.D. j*** We are informed that the anaesthetic used by Mr.

Lawson Tait in the case alluded to above was not chloro-form, but a mixture of one part of chloroform and two ’,parts of ether.-ED. L.

"OPERATION FOR CURE OF CLEFT OFHARD AND SOFT PALATE."

To the Editors of THE LANCET.

SiBS,—! shall be glad if you will allow me to correct aninaccurate statement which I made at the last meeting of theRoyal Medical and Chirurgical Society. In speaking of myoperation for uniting cleft of the hard palate by carryingacross the gap a triangular flap with a free anterior extremityI said that I had operated in six cases between the ages ofone and two years, and in all with success. On referring tomy notes I find that I have operated by this method on onlythree patients between the ages of one and two. Of the restof my early cases, two were between the ages of two andthree, and a sixth was three years and a quarter old. In eachcase the flap united well. I am. Sirs. vours trulv.Harley-street, W., May 2nd, 1891. 1. N. DAVIES-COLLEY.

"BLOXHAM v. THE MEDICAL DEFENCEUNION."

To the Editors of THE LANCET.

SiRS,-Will you allow me to supplement your remarks onBloxham v. the Medical Defence Union by a statement ofthe points of law as held by the Lords Justices of Appeal ?The plaintiff’s counsel submitted three main points-that theaction of the council of the Union was ultra vires, that theiraction in supporting one of the parties rendered them liablefor "maintenance," and that there had not been "dueinvestigation" as required by the Articles of Association.The Lords Justices of Appeal, Lords Justices Lindley, Lopes,and Kay, held : (1) that the action of the Council wasiiltra vires, on the ground that, it being against naturaljustice to attack a man with his own money, the articles, asthey did not expressly provide for it, must be construed asforbidding it ; (2) that, as the Council disclosed no matter ofprofessional conduct which would give them an interest inthe case, they could not resist the imputation of maintenance;and (3) that as the Council had only heard the ex parte state-ments of Dr. Collie before deciding to support him there hadnot been due investigation as required by the Articles ofAssociation. Upon the last of these points the Council sub-mitted to judgment, in the form as stated in your remarks, ofa perpetual injunction restraining them from expending thefunds of the Union in the action of Bloxham tB Collie, withpayment of all costs. I am, Sirs, yours truly,Old Kent.road, S.E., April 30th, 1894. EDWD. C. BOUSFIELD. :

2 Birmingham Daily Post, April 27th, 1894.

"MEDICAL EDUCATION IN AMERICA."To the Editors of THE LANCET.

SiRS,-In THE LANCET of March 17th a correspondent,W. E. R , " writes that ’’ the University of Pennsylvania isthe only one making it compulsory for students to attendobstetrical cases before graduating." He cites ProfessorHirst as his authority. This is an erroneous statement, andone which must be due to a misunderstanding on the part ofyour correspondent, as Professor Hirst is too well informedto make such a misstatement. The Dean of the University ofPennsylvania writes me that the order requiring students totake obstetrical cases before graduation was passed Oct. 21st,1889, and the catalogue now announces that students arerequired to attend one case. The Harvard Medical Schoolhas required cases since the fall of 1882, at which time twocases were required. The number has been gradually increaseduntil June, 1890, when the number required was six, whichis now the requirement before graduation.

I am, Sirs, yours truly,WILLIAM L. RICHARDSON, Dean.

Harvard University Medical School, Boston, Mass.,April 21st, 1894.

" THE USE OF OPIUM IN INDIA."To the Editors of THE LANCET.

SiRs,-The result of the inquiry by the Opium Commissionhas gone a long way to demonstrate that the number of peoplewho consume opium in India compared with the total popula-tion is, after all, very small. All over the world peopleindulge in their customary stimulants, narcotics, or luxuriesof some sort or other. The use of tobacco is the most

generally diffused, and, on the whole, probably the leastharmful habit, although it is not by any means always harm-less, and the increased prevalence among small boys, oflate, of smoking cigarettes is especially detrimental andto be deprecated-to say nothing of its being often a nuisanceto other people. Alcohol reigns supreme in some countries,and the results of its abuse are too patent to need anyremark. Compared with the harm produced by alcoholicintemperance, the injury caused by the use of opium in Indiaseems to be insignificant. The opium eater is not, at any rate,a violent, excited, law-breaking member of society. The pro-hibition of its use, even were it practicable, would onlylead to an increased consumption of alcoholic spirits or

hemp drugs, and the effect of the cheap, vile country spirits onthe natives of a hot country like India would simply bemaddening. I do not think any competent and impartialobserver can have any doubt on this subject. It seems, too,that it is the exception for opium eaters in India to goon increasing the quantity they consume ; on the contrary,they get accustomed to a certain daily dose, and adhere to it.No one denies that cases of abuse occur, and it needed nocommission to establish the fact. No doubt people are betterwithout opium, as a rule ; but conditions and circumstancesalter cases, and there is, as Sam Slick observed, a great dealof human nature in man, who cannot be made good after apattern and content to relinquish his " pleasant little vices "by prohibitory laws. I suspect that the overwhelming amountof evidence-native and European-produced in India to showthat opium eating and smoking are not the parents of allthe horrors and evils ascribed to them was rather a surpriseto the Commission. As regards the political effect of suchCommissions on the native mind it is to be feared that their

tendency can only be to weaken the authority of the Govern-ment of the countrv. I am. Sirs. vours faithfullv,

AN ANTI-FADDIST.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

The Assizes.

LIVERPOOL, like Manchester and Leeds, enjoys the advan-tage of a fourth assize, which is generally held in May.Mr. Justice Day is presiding in the Crown Court, andalthough it is not six weeks since the last assize there aretwo prisoners charged with murder and about sixty for otheroffences. It is to be feared that crimes of brutal violence are