soul, and spirit-man. And though in human conduct the end does not always justify the means, it would be surely worse than presumption in the creature to say that the end was less perfect, because he traced, or thought he could trace, the means by which the end was achieved in the Creator's type of workmanship. But, apart from theoretical discussion, it is something to be able to give practical consolation to distressed parents, in cases of malformed children, in pointing out that there are scientific modes of accounting for such malformations, little and inadequate as such consolation may be.

NOTE ON INCREASED RESISTANCE ON PERCUSSION AS AN AID TO DIAGNOSIS.

BY JOHN S. MAIN, M.D.

I HAVE been much struck and pleased for some time back by the valuable aid we derive from increased resistance, as felt by the sense of touch through the pleximeter finger, in the diagnosis of disease, and the "mapping out" of organs. On referring to several text-books, I hardly think due justice is given to this physical sign, and so I trust the following remarks may not be amiss.

In phthisis pulmonalis I take this symptom next to some alteration in the respiratory murmur (especially abnormally prolonged expiration), to be the most valuable physical aid we possess for its early detection: much more valuable in the majority of cases than any alteration in the quality of the percussion note.

To derive full benefit from it, however, it is well to bear in mind, that according as the deposition of tubercle is superficial or deep, so will the stroke given to the finger require to be the slightest touch, or a more definite tap: just as the same rule holds true for properly bringing out the percussion note.

In all cases, therefore, it is well to begin with a feeble stroke, gradually increasing in strength till we have gained

satisfaction.

With the aid of this sign alone, it is often possible to form a pretty accurate idea as to the presence of tubercle; but taken in conjunction with the stethoscopic signs, and those

derived from the sense of hearing as obtained through the pleximeter, it is simply invaluable. In advanced phthisis, I need hardly add, that it is a symptom never absent.

Again, in the "mapping out" of the outlines of the solid organs on the chest or abdominal wall, also as a means of detecting the limit of dulness in pneumonia and pleuritic effusion, I have found this aid very valuable. Indeed, taken with the quality of the percussion note, the cardiac, hepatic, and splenic areas, can be marked off with the greatest precision.

May I not add, that the double aid to diagnosis we thus derive through the pleximeter finger, points strongly to the superiority of those pleximeters with which nature has provided us, to those sold at the instrument makers.

VOLUNTARY LOCK HOSPITALS AND THE CONTAGIOUS DISEASES ACTS. REPLY TO DR. ALEXANDER PATTERSON.

BY FREDERICK W. LOWNDES, M.R.C.S. ENG.,
Surgeon to the Liverpool Lock Hospital.

IN the Glasgow Medical Journal for December, 1882, is a paper by Dr. Alexander Patterson, in which he endeavours to show the advantages of voluntary Lock hospitals, and of the Glasgow Police Act, over the compulsory provisions of the Contagious Diseases Acts. I also was summoned to appear before the Select Committee of the House of Commons, the object of my evidence being to show the deficiencies of the voluntary Lock hospital system, and the advantages which might be expected to accrue from compulsory powers. I also wished to bear testimony to the excellent working of the Contagious Diseases Acts, as observed by me on visiting Aldershot, Chatham, Devonport, and other districts in which those Acts are in force. Believing that my views express those of many readers of the Glasgow Medical Journal, and bearing in mind the excellent precept, audi alteram partem, I have ventured to reply to the various remarks contained in Dr. Patterson's paper. While willingly accepting many of his. facts, I cannot agree with the inferences he deduces from them.

No. 1.

D

Vol. XIX.

For instance, he assumes that, because the number of patients in the Glasgow Lock Hospital has been decreasing, while the population has been increasing, that therefore there has been a decrease of prostitution and disease. This is post hoc ergo propter hoc with a vengeance. In other words, we are asked to believe that, in the whole city of Glasgow and its suburbs, there are not to be found sixty females suffering from venereal disease who might be induced to enter the hospital! With every respect to Dr. Patterson, such an assumption is, to my thinking, utterly contrary to all reason and common sense. Mr. M'Call was most careful to admit in his evidence before the Select Committee that the Police Acts only applied to the City of Glasgow and not to the suburbs beyond; hence, there is no evidence that the number of prostitutes, admitted or clandestine, outside the city boundary has been reduced. To ask why they do not come, as Dr. Patterson does, is simply begging the question. In Portsmouth and Plymouth voluntary Lock hospitals, each containing about thirty beds, were tried by the Government some years before the Act of 1864 was passed. But even this small number of beds was more than enough, and they were rarely filled. That this was no proof of any decrease of disease was manifest after the Act of 1866 was passed, when 162 beds in the Royal Albert Hospital at Devonport, and 120 beds in the Royal Portsmouth, Portsea, and Gosport Hospital were all filled with females suffering from venereal diseases. Again, in the Winchester Infirmary, six beds were formerly set apart for females with venereal diseases, and because they were generally empty, it was rashly concluded that they were not required. But when, in 1870, Winchester was placed under the Acts, out of a total of one hundred and fifty-six women no fewer than sixty-two were found to be diseased, or enough to have filled up the six beds just ten times

over.

When I was first appointed to the Liverpool Lock Hospital in 1875, the number of females admitted was in that year only 172, while in 1876 it fell to 150, and in 1877 to 141. It would have been highly gratifying to have referred this decrease to the decrease of prostitution and disease, especially as the local police had, in 1871, under the Vagrant Act, arrested large numbers of prostitutes for soliciting in the streets, and for being drunk and disorderly. But as I knew perfectly well that such an assumption would have been delusive, I set to work to find out the real cause of this decrease. Up to the close of 1876, students of the third and fourth years were

permitted to see the examinations of females, when this was abolished on the suggestion of my then colleague, Mr. M'Cheane (now consulting surgeon to the hospital), and myself. We also suggested that the patients should not be required to scrub the floors, as hitherto had been the case. Moreover, in company of one of our chief superintendents of police and other police officials, I visited a number of brothels, saw the inmates, and conversed with them. I found that the hospital was perfectly well known, and fully appreciated by such as had been inmates. They were very reluctant to admit that they themselves ever suffered from disease, though willing enough to volunteer information as to other women. result of all this will be seen in the following figures:

The

My present colleague, Dr. Bernard, and I, have every reason to expect a still larger number this year-not because disease has increased, but because the hospital is better appreciated. We have only 25 beds for females, and hope that in process of time the committee will be encouraged to increase the number. Admission is free, and we have no power to detain any who wish to leave. Dr. Patterson does not make any allusion as to the state of the women on their admission-whether they are severely diseased or not. Ours are in such a state, that I am constantly saying-" Why on earth did you not come here before?" and Dr. Rawdon Macnamara of Dublin, in his evidence, spoke even more strongly of the condition of many of the women admitted into the Westmoreland Lock Hospital. Similar testimony was given by Mr. James Lane as to the state of many of the females admitted into the voluntary wards of the London Lock Hospital. On the other hand, the patients admitted into the Government hospitals are almost invariably suffering from mild forms of the disease, the only exceptions being in the cases of women who have just come from unprotected districts, and who are most severely diseased. This is the reason why those who support these Acts urge the importance of periodical medical examination, and compulsory admission to hospital at once of all women found to be diseased-not to prevent men from the consequences of vicious indulgence, but to save these unfortunate women themselves from untold suffering.

While perfectly agreeing with Dr. Patterson that “females, however abandoned, rarely altogether lose the sense of shame," I fail to see how the Contagious Diseases Acts causes the "last remnant of modesty to be driven away." A woman enters the examining room in which are only the visiting surgeon and the female attendant, generally a nurse. From what I have seen of the visiting surgeons, Dr. Barr of Aldershot, Dr. Jardine of Chatham, Mr. Pearl of Windsor, Dr. Archer of Devonport, and Mr. Chaplin of Kildare, I am perfectly satisfied that the examinations are conducted by them with every kindness, delicacy, and care. No one except the nurse is ever present, and among the other "instructions for visiting surgeons" is this: "every examination is to take place in the presence of a female attendant or nurse, and is to be completed with as much regard to delicacy and the feelings of the woman examined, as in any case of private practice." Surely Dr. Patterson must see that, so far as the examination itself is concerned, the Acts do no more to drive away the last remnant of modesty than he and his colleague, or my colleague. and I, who conduct examinations precisely in the same manner. We never find it necessary to administer chloroform in order to pass the speculum, as we should, in "cases of young girls with acute inflammation of the parts," prefer to wait until the inflammation had subsided, when the speculum could be passed without pain. My experience, as I stated before the Select Committee, is that many a woman has learnt delicacy in our examining room for the first time for many years, and the sense of shame has been recalled to her by a few kind words from my colleague or me. Such is also the experience of all the visiting surgeons I have met and conversed with.

We cannot detain patients in our hospitals till cured, a circumstance which is much to be lamented. If any patient wishes to return home to her friends, or go to a "refuge," or enter a situation, it is obviously better that she should go there thoroughly cured. If, on the other hand, she will, in spite of "kindly advice," or "after being gently and kindly reasoned with," persist in returning to her former vicious life, surely the desirability of her being cured is still more obvious. For how vain have been all our efforts, and what are the results? She has been simply kept in hospital for a time to be sent out even more dangerous than when she came in. Then she was so diseased as to be unable any longer to ply her trade. Now she is sufficiently well to return to it without inconvenience to herself, and sufficiently diseased to