720

junction of the sixth costal cartilage and rib, makinga communication between the superficial abscess and

another beneath the thoracic wall. The rib was

denuded. There were evidently costal periostitis and"shirt-stud" abscess. The posterior pocket must have beenin contact with the pericardium. Sinuses persisted for

about three months, but finally cicatrisation took place. In

pulsating empyema if the pleural cavity be emptied byaspiration pneumothorax usually results, for the atelectasisof the lung is such that it cannot dilate to fill the vacuum.The heart is deviated to the right and fixed there byadhesions. Pulsating empyema is essentially chronic and ifleft to itself is usually fatal. Dr. Archambault relates the

following case. A boy, aged six years, had scarlet fever inApril, 1893. During the last stage of the fever cough ap-peared ; after recovery it persisted and grew worse, and painin the side and dyspnoea occurred at times. Advice wastherefore sought in August. The skin was almost livid andthe dyspnoea was intense. A pulsating, soft, and fluctuatingtumour of the size of the palm was situated over the left

seventh, eighth, and ninth ribs, about midway between theaxillary and scapular lines. There were signs of a large leftpleural effusion. Dulness extended anteriorly nearly to theclavicle, below which there was Skodaic resonance. The

apex beat was to the right of the sternum. Aspiration atthe angle of the scapula showed the presence of pus. An

operation differing from that for ordinary empyema only inthat the incision was made in the oentre of the fluctuatingarea, penetrating the pleura between the eighth and ninthribs, was performed. Progress was satisfactory and a month ’,after operation the pleural cavity had contracted so that itadmitted only one-fourth of the quantity of liquid which hadbeen used for irrigation. The heart had moved half waytowards its normal position, the side was slightly depressedand flattened, and some respiration was present. In 1899,when the child was 12 years old, the chest was symmetricaland expanded well; no abnormal signs were present. The

heart was hypertrophied from valvular disease and the apexbeat was outside the nipple line. This case is importantbecause it is opposed to the teaching of Comby that inpulsating empyema the lung is permanently contracted.

MEMORIAL :TO THE LATE MISS MABELELIZABETH WEBB, M.B.LOND.

AFTER the annual meeting of the Governors of the RoyalFree Hospital on Feb. 28th, the new museum and labora-tories recently added for the benefit of the Medical Schoolattached to the hospital were formally opened by LadyReay, C.I. This addition has been made as a memorial of thelate Miss Mabel Webb, who was curator of the museum andassistant pathologist to the hospital until her sudden deathon Oct. 28th, 1898. She had been curator of the museumfor two years and realising how much pathological work washindered at the hospital from want of space she had origi-nated and designed the extension of building which has nowbeen completed to perpetuate her memory. The influence ofMiss Webb’s fine character and personal charm upon all withwhom she came in contact was such that before definite

arrangements for a memorial had been made the studentswho worked under her had spontaneously raised a fund ofmoney for such a purpose. The medical staff of the RoyalFree Hospital and its lay governors were no less

impressed by their late curator’s service to the hospitaland good influence generally, and thus from the willingsubscriptions, of colleagues, students, and friends, bounti-fully supplemented by the generosity of Miss Webb’s

mother, a memorial of the most appropriate kind has

been raised to her memory. The new floor containsa museum with shelves for 6000 specimens, a laboratory forthe use of the curator and medical staff, and an assistant’s

room. The room below, which in Miss Webb’s day had toanswer all these purposes and also accommodated thecurator’s classes, is now devoted entirely to the last

purpose. A bronze memorial tablet which is to be placedin the museum bears the following inscription: ’’ This

building was enlarged by the family and friends of MabelWebb, M.B. Lond., Curatorto the Museum of this Hospitalfrom 1896 to 1898, to honour her memory and to carry out ascheme originated by her for the improvement of the Patho-logical Department. Through devotion to duty and pursuitof high ideals of work and conduct her term of service herewas in an unusual degree fruitful of good. Beati mundicorde : quoniam ipsi Deum videbunt.

"

METROPOLITAN BRANCH OF THE BRITISHDENTAL ASSOCIATION.

THE annual dinner of this association was held at theHotel Cecil on March, 3rd, the President, Mr. Ashley W.Barrett, M.B. Lond., M.R.C.S., L.D.S. Eng., being in thechair. The attendance was large and included many guests.The loyalty of the audience found felicitous expression inthe President’s speech and in the National Anthem, whichwas twice sung. The President also proposed " The Associa-tion and the Metropolitan Branch." The branch is in a

prosperous state and seems to be very efficient for the pro.motion of harmony and cooperation. A very pleasing partof the entertainment was furnished by the songs by Mr. J.Clulow and Mr. R. H. Manning, and the recitations byMr. Percival Reed, which were nearly all encored. Dr.

Glover, in responding for the guests, touched on thewonderful development of dentistry as a profession sincethe Act of 1878 ; and by way of illustration alluded to thefact that the Government had sent out Mr. Newland Pedleyand a staff of dentists to help to complete the arrangementsfor the medical comfort of our brave soldiers-a refinementof care which distinguished the present from all previouswars.

__

BERI-BERI IN THE STRAITS SETTLEMENTS.

IN his annual report on the Straits Settlements civil

hospitals for the year 1898 Dr. Max. F. Simon, the principalcivil medical officer, says that the estimated population ofthe whole of the Straits Settlements for that year was

592,587, as compared with an estimated population of 580,563for 1897. The number of births that were registered in 1898was 12,781 and the number of deaths registered was 18,032,giving birth- and death-rates per 1000 of population of 21’57and 30’43 respectively. The colony was very free from

epidemic disease during the year. Only nine deaths fromcholera were registered in Singapore and 39 in Penang;no cases occurred in Province Wellesley or Malacca.The deaths from small-pox were 46 in Singapore, twoin Penang, one in Province Wellesley, and 23 in

Malacca. There were considerably fewer cases of beri-beriadmitted into all the hospitals of the colony during1898 than during 1897, the. admissions numbering 1329 as

against 2095. The disease also appears to have been slightlyless fatal, 420 deaths having occurred (a percentage onadmissions of 31’6) in 1898, as against 692 (a percentage onadmissions of 33 28) in 1897. The death-rate from this:diseasewas, as usual, higher in Singapore than in any of the othersettlements. There appear to be upwards of 16 hospitals inthe colony, and the whole number of admissions to them for1898 was 23,662 with 3296 deaths. The diseases whichcaused the greatest number of admissions to hospital were asfollows : dysentery, 875 admissions, 369 deaths ; malarialfever and cachexia, 2174 admissions, 158 deaths; beri-beri,1329 admissions, 420 deaths; venereal diseases, 2594admissions, 121 deaths ; rheumatism (acute and chronic)1438 admissions, three deaths ; diseases cf the digestive