THE TREATMENT OF VESICAL CATARRH. To the Editor of the "Midland Medical Miscellany." Sir, I wish to call the attention of your readers to the following case which recently occurred in my practice:-I had under treatment a case of vesical catarrh in a man forty-six years old, of intemperate habits. The condition had existed in a mild form for some years as the result of a stricture in the membranous portion of the urethra. The latter was thoroughly dilated, when a most acute cystitis immediately supervened. So intense was the incipient congestion of the walls of the bladder that an active hemorrhage ensued, which quite filled the organ with clotted blood, the presence of which gave rise to the most atrocious suffering in the way of tenesmus I have ever witnessed. Following the breaking up and expulsion of this bladder-clot, the inflammation of the mucous surface commenced. Large quantities of ropy muco-pus digested in foul-stinking ammoniacal urine were frequently voided. Soon there were observed portions of exfoliated mucous membrane also floating in the urine, indicating ulceration of the bladder. The constant suffering, despite the treatment employed, began early to tell upon the nervous system, previously rendered unstable by a life of intemperance and abuse. The patient was almost maniacal at times from the unrelenting tenesmus experienced while voiding the contents of the bladder. He ate and slept but little, rapidly lost flesh, and altogether became truly an object of commiseration and sympathy.

During the four weeks of my attendance, I had used every means of which I had any knowledge to relieve the case. The bladder was frequently washed out with warm water and warm water carbolized. Injections were made of borate of soda (Thompson's) nitrate of silver, two grains to the ounce of water; nitric acid in water, and finally of normal urine, recently passed, and this left in the bladder. Such measures gave only transient relief.

Internally were administered alkalies, acids, triticum repens, buchu, hyoscyamus, benzoate of ammonia, and large quantities of milk. Opium

and belladonna, in maximum doses, were exhibited per orem, per rectum, and hypodermically. Morphia hypodermically, at frequent intervals, often reinforced by the inhalation of chloroform, was required to keep the tenesmus in check, and secure sleep.

Finally, with much apprehension as to the result of what I then considered to be an heroic measure, I adopted an injection of four ounces of pure water, containing one hundred and sixty grains of nitrate of silver, into the bladder. Opium and alkalies were continued, with the addition of quinine and stimulants, and especial attention given to systematic feeding. From this moment, the case began to improve. All hemorrhage ceased; the tenesmus was almost entirely relieved; long intervals of rest from micturition were secured; mucus and pus disappeared from the urine; the patient slept well; his appetite returned; and he expressed himself as fully realising his changed condition. On two subsequent occasions, when small amounts of glutinous mucus showed in the urine, the latter was promptly cleared up by the use of a weaker injection of the nitrate, twenty grains to the ounce of water. In about three weeks from the time of the employment of the first injection, the patient resumed his business, and, so far as I know, has had no relapse. I am, Sir, yours obediently, London, May 22nd. J.W.

ERRATA. In the type of No. II. "Select Reports from General Practice" in our last issue, read "asphalt" for "asphalte." (2). At page 135, column 1, line 24, for "membrane tympani" read "membrana tympani." (3). At page 135, in lines 2, 27, and 37, for "Roberts" read "Robert."

INQUIRER. Your letter has been referred to the writer of the article in question.

THE USE OF THE MENTHOL SPRAY IN NEURALGIA. To the Editor of the "Midland Medical Miscellany."

SIR, Of late so much has been written concerning the external use of menthol, both in solution and as a pencil or cone, that it may seem superfluous to call attention to its efficacy when applied in the form of a spray.

Nevertheless, I venture to suggest that as a spray the drug will most thoroughly and rapidly relieve the pains of intercostal neuralgia, spinal irritation, etc.

It has been my habit to use a saturated alcoholic solution of menthol crystals, to which a little sulphuric ether had been added, in an ordinary hand-spray. As a rule, the affected parts need not be sprayed more than once a day. Of twenty cases treated in this way all but two were promptly relieved, and in several instances the beneficial effects were permanent. Your obedient servant,

W. T. P.

Communications received from:-Dr. Wallace, Parsonstown; W. T. P.; Mr. A. Jackson; Bibliophile; Mr. A. Fletcher; Dr. Cooper; Dr. Stephens; Dr. Williams; S. M. S.; Dr. Mackintosh; J. W.; Dr. Braidwood; W. N. D.; A. Smith; General Practitioner; M. D.; Inquirer.

Books, Pamphlets, etc., received :-Practitioner, Health, Schmidt's Jarbücher der in-und Auslandischen, Gesammten Medicin, Birmingham Medical Review, Philanthropist, New England Medical Monthly, Centralblatt für die Medicinischen Wissenschaften, Philadelphia Medical and Surgical Reporter, Birkenhead News, Bulletin Général de Thérapeutique, Medical News, Medical Record, New York Medical Journal, Students' Journal. On Insanity and Nervous Disorders Peculiar to Women, in some of their medical and medicolegal aspects. Specificily and Evolution in Disease. The Gheel Lunatic Colony. Herschell's Urethral Charts. Invalid's Recipe

Book, etc., etc.

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VOL. III.

Ellustration.

THOMAS PRIDGIN TEALE, F.R.C.S.

In the town of Leeds and for many miles around this important northern borough, the name of Teale is held in high esteem. Diverge in whatever direction one will, and enter any of the numerous populous straggling villages that surround the great emporium of woollen manufactures, where almost every cottage is a manufactory, and where scarcely one exists in which "from early morn till dewy eve" the rattle of the industriously-plied shuttle may not be heard, or wander away from the prose of these grim and gloomy dwellings of the northern Titans—of which it may be almost said every one is a castle, certainly a veritable fortress in comparison with the flimsy erections of the unsanitary jerry builder of modern suburban London-and stray into the poetry of their surroundings, where nature displays some, and art also some, by no means despicable productions; where studded here and there may be noticed the homes of the manufacturer and the merchant-enter any of the habitations mentioned and you will find the name of Teale is known and honoured, known to, and honoured by, each and all of the toiling thousands poured forth each evening from the mills, the foundries, and the quarries. Such was the condition of things before the subject of our present sketch had yet arrived at man's estate, and it is no detraction from his individual worth to mention the fact. Thomas Teale, our subject's grandfather, was in extensive practice as a surgeon in Leeds in the last - century, and his son (the father of our present subject) succeeded him he was born on the first day of the present century, and when but twenty-two years of age came into prominent notice as a provincial operator. He was actively associated with the foundation and after success of the Leeds School of Medicine; chief contributor to the more

No. 31.

than ordinary success of the "Leeds Philosophical and Literary Society," and was honorary curator of the zoological department. He was appointed by the Queen a member of the General Medical Council at its institution in 1858, and became Member of the Royal Society in 1862. He held important offices in connection with the Leeds General Infirmary for many years; he contributed copiously to medical literature, and he achieved for himself a high reputation among his professional brethren. The portrait and brief memoir which in this issue we present to our readers, relating as they do to a name so long and honourably associated with the profession, will we feel assured give no little pleasure and satisfaction and secure for us that appreciation of our efforts which we study to obtain.

Thomas Pridgin Teale, M.B., M.A., F.R.C.S., son of the eminent man to whom the foregoing observations refer, was born in the year 1831. He was educated first at Leeds Grammar School, and afterwards for five years at school at Winchester, under Dr. Moberly, now Bishop of Salisbury. After spending three years at Oxford, he graduated B.A. from Brasenose College; and subsequently he went to study at King's College, London. This was in the day of Fergusson, Partridge, Todd, and Bowman, of whose teachings our subject had the advantage. He was clinical clerk to Dr. Todd and dresser to Mr. Partridge, and later he was clinical assistant to Sir Wm. Bowman at the Moorfields Ophthalmic Hospital, filling the place of Mr. Hulke during his absence in the Crimea. He then sought fresh fields of instruction on the Continent, and after spending a period of six months in visiting Paris and other places, he settled in his native town, Leeds. In 1856, he was elected to the office of Demonstrator of Anatomy and Lecturer at the Leeds School of Medicine. After about ten years spent in the anatomy course he became Lecturer on Surgery, a post from which he retired after a period of twenty years' service at the Leeds School of Medicine. In 1864, Teale, on the retire

ment of his father and of the late Mr. S. Smith, was elected Surgeon to the Leeds Infirmary, along with the late Mr. Nunnely and Mr. Wheelhouse, and this present year he (as well as Mr. Wheelhouse) retires from the surgeoncy after having filled that position for twenty years, to become Consulting Surgeon, in which capacity he acquires the right to the use of six beds in the hospital. Our subject was for about nine years one of the examiners for the degree of M.B. in the University of Oxford.

In 1876 Teale was nominated one of the Crown Members for England on the Medical Council, and this position he still holds. In 1881 he was appointed by the Medical Council as visitor, along with Professor Gairdner, of Glasgow, and Professor William Stokes, of Dublin, of the Medical Corporations of the three kingdoms, and in the following year the report of the visitors was presented to the Medical Council. Teale was President of the Public Health Section of the British Medical Association at the meeting held at Liverpool in August of last year, and in the following October he was President of the Health Section of the Social Science Association at Huddersfield. Following in the footsteps of his father, he has done good work as an author and contributor to various periodical publications. His "Dangers to Health" and "Economy of coal in House Fires," both of which took their origin in a lecture to the Leeds Philosophical and Literary Society, are probably too well known to need comment here even if the limits of our space permitted such. His "Hurry, Worry, and Money, the Bane of Modern Education," is a reprint, with Appendices, of his Address on Health at the Social Science Congress at Huddersfield. But the authorship of "Amputation by a Long and a Short Rectangular Flap," commonly called "Teale's Amputation," belongs not to our subject, as is sometimes erroneously supposed, but to his father. We feel assured that the profession will heartily join us in the hope that the present bearer of a name so long and so closely connected with surgery may long be spared to pursue the career of usefulness with which that name is intimately associated.

THE Executive Council of the International Health Exhibition have determined to hold an International Conference on Education, in connection with the Education Division of the exhibition. They have appointed a committee of management, who have drawn up a programme. For convenience of discussion, all papers to be read will be printed beforehand, and they will subsequently be published by the Executive Council,

THE POOR LAW MEDICAL SERVICE: ITS PAST, PResent, and FuTURE.

III.

The Present-The organization of Poor Law medical relief seemingly well devised: unfortunately this is not true-Conservative nature of English institutions-Reasons why reform is slow-Outside pressure -The Lancet-Bombs-The result-The Metropolitan Sick Asylums and Dispensaries: work to be done in such institutions-Some representative men-The Poor Law medical service and literaturePosition of asylum superintendents-Educating up-Part of the Poor Law machinery satisfactory-Blots on the system-Position of parochial medical officers-Superannuation, salaries, etc.-The law of supply and demand-The Lancet of May 10th, 1884: its advice Questions submitted to candidates for Parliament in 1868Political power of the Profession-A contrast between the Lancet and the British Medical Journal- Opinion of Dr. Godrich and Dr. Joseph Rogers on the British Medical Journal-Altered timesImportant principles-Sickness the great factor in the production of pauperism-The ringing of the chapel bell-An ultimatum.

AT first sight, and theoretically, the organization for the medical relief of the sick poor appears to be well devised to direct and supervise the system. We have, scattered and complete. We have a central bureau of chief officers over the country, a large number of hospitals, well built, well furnished, and in almost every way well adapted for officers-in some cases resident, and in other cases nonhospital work. Connected with these hospitals are medical resident-and there is a large staff of parochial medical officers to visit the sick poor at their homes.

The total staff of medical officers engaged in the Poor Law service reaches nearly to 4,000. With such a staff, and with such an organization, one would almost imagine that the provision for the sick poor of England left nothing to be desired. When we come to examine the actual working of the system in detail, we shall find that such is far from being the case, that there is much the Poor Law system is like many other English institutions room for improvement. We must always remember that as regards its origin and development; still more like many other English institutions, a conservative policy has always guided it, so that whether the Commissioners or Presidents were Tory or Liberal, they were alike influenced by the spirit of resistance to change.

The reason of this is very simple. Permanent officials do not like change: they have their formulæ, their creeds, and their crotchets, to which they faithfully adhere. The nominal chiefs follow the traditions of the office: they soon drop into the official groove, so that progress is impeded and the whole machine runs on on the old lines. Outside pressure alone can influence such departments; and outside influence, as we have shown, directed by the Lancet, compelled even the permanent officials of this very conservative English institution to make a new move, and to reform its workhouse infirmary system. Though some attempts were made to bolster up the old workhouse system, and to dispute some of the charges made by the Lancet Commission, as in the case of the Farnham inquiry, and though Dr. E. Smith threw in the weight of whatever little authority he had on the side of officialism, it was all As a result we have in vain. The system was doomed. the metropolitan sick asylums and the metropolitan dispensaries. These institutions are, we trust, the beginning of the end. They are an attempt to place the Poor Law infirmaries on a true hospital footing. They are the forerunners of our future State hospitals. By their establishment nearly all has been conceded that was claimed by the Lancet. The workhouse infirmaries at Liverpool, Man