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This form of peritonitis is not very rare ; a number of caseshave been published of which some were fatal. In a case

Described by Huber of New York appendicitis was diagnosedand the abdomen was opened. At the necropsy salpingitisand a healthy appendix were found. In a case under the

care of Baginsky there were salpingo-ovaritis and pus in thepelvis which contained gonococci. The peritonitis of vulvo-vaginitis, in spite of the acuteness and severity of the

symptoms, generally terminates quickly in recovery. Hence

intervention should not be precipitate. In this form of

.peritonitis vulvo-vaginitis is generally the last thing to be

thought of and the appendix is incriminated. When a little

girl suffers from peritonitis the external genitals should

always be examined. If vulvo-vaginitis is present the possi-bility of gonococcic peritonitis should be borne in mind.Its diagnosis indicates abstention from operation.

"THE NEW POOR-LAW INFIRMARY AT HALIFAX. "

..AT the fortnightly meeting of the Halifax Board of Guar-,;cians, held on August 21st, Father Russell, who had givennotice that he would move, That Dr. Dolan be appointednedical officer of the Halifax Union Poor-law Hospital,Salterhebble, at a salary of 100 guineas per annum, this sum--not to be included in the superannuation allowance,",-modified his notice of motion and simply proposed that Dr.T. M. Dolan should be appointed at a salary of 100 guineas pertannum. Mr. J. W. Tillotson, the chairman, said that Dr.,Dolan had written to the Local Government Board applyingto be superannuated then and there, but that the Board had,replied that such a course was impossible. Father Russell’s

motion was rejected by 20 votes to three. So there the

matter stands at present. Dr. Dolan keeps his post as

medical officer of the workhouse and the board of guardiansare trying to get three medical officers for the new infirmary.The senior medical officer is to be the responsible officer ofthe three and is to have a salary of <E105 per annum, while

he is to take the appointment subject to the duties beinghereafter defined. We await further developments withinterest.

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THE SYMPTOMS OF POISONING BY FUSEL OIL.

DR. THOMAS B. FuTCHER of Johns Hopkins Universityrecords in the New York 3ledioaZ Journal of August 3rdtwo cases from the clinic of Professor Osler of the somewhat

rare condition of poisoning by "fusel oil," an ingredient ofcrude spirits. The cases recorded in medical literature are

very few. Dr. W. M. Ord reported a case at St. Thomas’s

Hospital in 1889,2 and Dr. J. Swain 3 recorded a fatal case at theBristol Royal Infirmary in 1891. Fusel oil is the common name

for primary amyl alcohol (O&oacute;H110H) mixed with primary andsecondary, propyl-alcohols. In England it goes by the nameof :: fi!1ts," -and can be obtained gratis from some dis-

tilleries..Fusel oil is popularly used as an external applica-tion,for rheumatism. It is obtained from fermented grain orpotatoes by continuing the process of distillation after theordinary " spirit" has ceased to distil over, and forms an

oil liquid with a burning acrid taste and an odour said toresemble jargonelle pear. It has intoxicating and poisonousproperties superior to those of ordinary spirits, and is said tobe known in some of the northern counties of Europe to theconsumers of corn brandy who frequently ask to be servedwith a "glass of good fusel."

" The two cases recorded byDr. Futcher are as follows:-Case 1 was that of a woman,aged 28 years, who was admitted to the Johns Hopkins Hos-pital at about midnight, complaining of general weakness. It

was found that in company with a male (Case 2 infra)she : had been drinking out of a six-ounce bottle of fusel

1 See THE LANCET, August 17th (p. 482) and 24th (p. 540), 1901.2 THE LANCET, Dec. 14th, 1889, p. 1225.3 Brit. Med. Jour., 1891, vol. i., p. 903.

oil during a debauch and was lying unconscious on thefloor. At 9 A. M. next morning she had a headache, coated

tongue, and a bad taste in the mouth, and suffered fromgeneral weakness. Her forehead was red from rubbing it, asshe stated, with fusel oil a day earlier. There was a slightbronchitis. The pupils were normal in reaction and an

estimation of the blood showed 4,500,000 of red corpusclesand 7000 leucocytes per cubic centimetre. The urine was

of a pale yellow colour and slightly hazy, with a whiteprecipitate, and exhaled a peculiar odour resemblingviolets." " There was a faint trace of albumin, and on testingwith Fehling’s solution sugar was found to be present. Testswith phenylhydrazine and with yeast confirmed the presenceof sugar, but the polariscope showed that it was not glucose(dextrose) as the solution was loevo-rotatory. Next day theurine was free from sugar, but a trace of albumin persisted fora day or two longer. She was discharged as recovered afterfour days. Case 2 was that of a man, aged 28 years, who wasadmitted into the hospital at the same time and under thesame conditions as the above patient. His temperature was100&deg; F., the pulse was 120, and the respirations were 48 perminute. The right arm showed impairment of sensation andthe right leg showed loss of power and an excessive knee.

jerk. He gradually improved in hospital, though themuscular and sensory impairment persisted for four or five

days. He was discharged on the sixth day. His urine had adark brown smoky " appearance with a ’’ peculiar aromaticfruity odour." It gave the same chemical reaction for sugaras did the urine in the previous case, but was inactive to

polarised light. Methsemoglobin was also present in the urinewith a few broken-down red corpuscles. The sugar dis.

appeared from the urine during the second day. The

presence of sugar in both these cases was a peculiar andvery rare feature.

-

VERMINOUS HOLLOWAY GAOL.

COMPLAINTS have recently been heard from unfortunateprisoners of the filthily verminous condition of HollowayGaol, and the forcible remarks of Alderman Sir JosephRenals, sitting at the Mansion House Police-court, led

recently to an interview between his worship and the

chairman of the visiting justices of the prison. Cor-

respondence on the subject is also said to be proceedingbetween the visiting justices and the Prison Commissioners.The case which particularly called attention to what con.stitutes a serious scandal was that of a man remandedunder a charge of obtaining goods by false pretences-that is to say, of a man neither convicted of a

crime nor temporarily imprisoned in a cell constantlyused by many different occupants brought in at randomfrom the streets, as is the case with cells at London

police-stations. The condition of this prisoner’s facewas such that Sir Joseph Renals, on his atten’

tion being called to it, remarked that he had noticed it

and had thought that the prisoner must have had small-pox.Whatever remedies may be suggested and whatever meansof prevention may be adopted in future it will hardly, wehope, be suggested that the state of things apparentlyexisting in one of our principal metropolitan .prisons-anestablishment which ought to serve as a model for the

imitation of similar institutions in this country-is eitherinevitable or anything short of disgraceful. Many prisoner!no doubt come into Holloway Gaol with vermin upon them.We are not aware of the precise arrangements as to the

cleansing of the persons and clothing of the unconvicted,but it is, we believe, possible to deal to some extent withthose who are obviously in need of purification, while evenif we grant that insect life must often be found where dirtypeople have been, we are still a long way from admitting thatinsects need be left to breed and to multiply undisturbed in a

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place where there is almost unlimited labour at the disposal of Ithe gaol governor. Sir Joseph Renals spoke of the plank beds

’’

at Holloway as harbouring vermin. No doubt they do, butinsects of the kind referred to do not burrow into solid wood

or stone ; they take shelter in chinks and crevices, whichneed not be there for their benefit, and multiply their speciesif left to do so undisturbed by soap-and-water and otheragents obnoxious to insect life-a second condition which,like the chinks and crevices, may exist at Holloway Gaol, butone which is hardly necessary or unavoidable. In the local

prisons on the continent, particularly in some countries, wemight expect to hear of prisoners suffering as they do inHolloway, while a prisoner in a Boer camp may have muchto endure inseparable from his circumstances ; when, however,we meet with such a state of affairs in London we wonderwhether the institution in question may not in other respectsalso be behind the sanitary standards of the age; while weare inclined to inquire the name of the person who is to beheld responsible. Visiting justices and prison commissionersmay deal where necessary with questions of construction ofbuildings and apparatus, but matters of administration arebest presided over by an official endowed with f ull powersand the knowledge that his continuance in office depends onthe proper performance of his duties.

DEATH UNDER AN AN&AElig;STHETIC.

IT is a great error to imagine that all cases in which deathoccurs while a patient is under the influence of an anaestheticare of the same nature. In some cases the an2estheticis at fault, in some the method of administration ; but thereare also cases, and they are by no means few in number, inwhich the condition of the patient is such as to make theadministration of, an - anaesthetic an exceedingly dangerousproceeding. Of course, when possible, the use of a generalanesthetic is avoided. Of all conditions which render difficultthe administration of an anaesthetic there are probably fewmore serious than an empyema. We have been favoured

by Dr. W. H. Cooke with notes of a death under an

anesthetic which occurred in the Royal United Hospital,Bath. A man, aged 39 years, but looking at least 55

years of age, was admitted to hospital on April 24thsuffering from an empyema of the right side. He had

had double pleurisy for a month, and when admitted tothe hospital he looked seriously ill. It was decided to

operate and the anaesthetic was given four hours after

admission. A.C.E. mixture was administered on a Schimmel-

busch’s mask, the man being on his back. At first he took

the anesthetic well, but after seven or eight minutes hecommenced to struggle, and Dr. Cooke remarked that he

hoped the operation would not be long as the man was veryill. As the struggling became more violent the anaestheticwas stopped. At this time the heart was beating, the respira-tions had not ceased, and there was no marked cyanosis ; thepupils were not widely dilated, the conjunctival reflexes

were present, and he had only had four and a half drachmsof A.C.E. Then, quite suddenly, whilst struggling, hefell back dead, both the heart and respiration at once

ceasing. Artificial respiration, strychnine, and ether

were tried but in vain. At the post-mortem examinationit was discovered that the right pleural cavity containedat least two pints of curdy, non-smelling pus, andthere were many pleuritic adhesions and the right lungwas much collapsed. The left lung was adherent allover and contained much bronchial secretion. There wasa little turbid fluid at the left base, but no pneumonicconsolidation in either lung. The heart, which was slightlydisplaced to the left, was large, flabby, and in a state offatty degeneration ; there was no valvular disease. Thethorax only was examined. This case is of interest from the

fact that the man died whilst taking an ansesthetic, though

the death was not due to an over-dose of the anesthetic.Four and a half drachms of A.C.E. (containing one and a halfdrachms of chloroform) were administered for about 10minutes by the open method and the reflexes were neverlost. The sudden death was probably due to syncope causedby the struggling in a patient with an empyema and a heartwith fatty degeneration. In cases of empyema patientsoccasionally die suddenly on change of position, especiallywhen under the influence of an ansesthetic, and irrigationof the pleural cavity in empyema is sometimes followed bysudden death. In some of these cases it would be safer to

aspirate as a preliminary to a further operation a day or solater, when the patient might be the better able to take ananesthetic, the heart and lung having to some extent regainedtheir normal positions.

--

"MEDICALLY UNFIT."

To say that Lord Kitchener must find the variety andamount of work and responsibility inseparable from hisposition in South Africa as the directing head of an enor-mous army sufficiently onerous and overwhelming is to statean obvious platitude. But we find that Lord Kitchener has

felt himself called upon amid the distractions of warfare to

forward a despatch to this country protesting against the

great and needless trouble that has arisen from two

causes-first, that large numbers of men of the new

Imperial Yeomanry have been sent for service in the

field who were practically untrained and therefore unfit forit, and secondly that hundreds of these recruits have been

sent out suffering from complaints and physical disabilitiesthat the most cursory medical examination would have

detected, who are filling the hospitals and are afflicted withsuch diseases as varicocele, affections of the heart, deafness,lameness, and defective vision, there being even one case ofpartial paralysis-all diseases totally unfitting the sufferers forservice in the field, and in every case of such long standingthat the men must have been so afflicted before passing themedical examination. There was only one thing to be donewith them-namely, to discharge them as " medically unfit

"

and promptly to send them home again as invalids. To someextent the same neglect seems also to have characterisedthe raising of the first drafts of the South African

Constabulary. Lord Kitchener is quite right in sayingthat such occurrences could not have happened if a

methodical medical examination such as is laid downin the regulations had been carried out. We understandthat an official inquiry into the matter will be instituted bythe Commander-in-Chief and that as regards the SouthAfrican Constabulary the Colonial Office will deal with it ; 3and we are very glad to hear it. With regard to the com.plaint about men having been sent out who were untrainedand unprepared for field service we have nothing to do ; it

concerns the military authorities and the purely militarybranch of the service. But with those found medically unfiton their arrival in South Africa the case is different. While

making every allowance for occasional mistakes and over-sights where reinforcements are urgently needed and men arehurriedly enlisted and the medical examinations have to bequickly, and consequently in some’cases perfunctorily, per-formed, we cannot admit that there was any excuse for menbeing passed in a medical inspection as fit where such physicaldisabilities and complaints existed as are in the presentinstance alleged to have been present. Assuming the

correctness of these allegations-and provided that sub.

stitutes were not used to personate recruits-there must,we think, have been manifest blundering or gross care-

lessness somewhere-indeed, as we cannot understand

how such physical defects and disabilities could have

escaped notice we are inclined to think that there must

be some explanation forthcoming, because we hesitate to