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mastoid, and the whole of the mylohyoid muscles wereexcised, together with the entire submaxillary gland andthe lower part of the parotid, also the bridge of salivarygland substance connecting the two glands. A large numberof arteries and veins had to be ligatured. At first the

patient experienced some difficulty in swallowing, and in ex-pectorating a quantity of tenacious and somewhat sanguino-lent mucus, for the existence of which no physical causecould be found by examination of the lungs. However,after a time all these difficulties passed off, and the wound,which was of course a large gaping cavity in consequenceof the quantity of tissue that had been extirpated, granu-lated lip and healed over. Two years and a half after-wards Dr. Matlakowski obtained information that the

patient continued in good health.

PUFFING QUACKS.WE notice in a recent impression of a highly respectable pro-

vincial daily paper a paragraph puffing the art of an "IndianEye doctor," at present residing in a fashionable sea coasttown. Of quacks and their ways it is bootless to complain.The indulgent provisions of our criminal law leave them aprovince which they are free to occupy with considerableprofit to themselves, and this being so, it is only naturalthat they should avail themselves of their opportunities.Nor is it surprising to find that what may be called quackjournals should be prepared to offer them facilities for theboldest and most effective forms of advertisement. But withself-respecting journalists the case ought to be different. Inthe paragraph to which we refer we read, " The plan ofpublishing both names and addresses of healed persons is aguarantee of good faith that should have influence amongafflicted persons whose objection to this popular form ofmedical treatment is a barrier to their recovery." It is not

easy to believe that the editor who admitted this passage tothe columns of his paper is really so unfamiliar with theways of unqualified " doctors as to believe that there is

any more difficulty in compiling lists of patients than in pro-curing names for a petition to Parliament. The criticisms ofa Parliamentary Committee do let in an occasional ray oflight upon the ways of the petition fabricator ; but, unfor-tunately, nobody-not even a committee-is charged withthe duty of exposing the artifices of the advertising quack.Still, this circumstance does not exonerate the journalist.Not only self-respect, but even the lowliest view of publicduty, should deter those who would scorn to practise fortheir own direct advantage on the ignorance and credulityof mankind from aiding and abetting their customers byrecommendations which must be either heedless or insincere.

REPORT ON THE CIVIL HOSPITALS OF THESTRAITS SETTLEMENTS.

THE annual medical report by Mr. M. F. Simon (actingprincipal civil medical officer) of this branch of the servicehas been published for the year 1889 It sets forth the condi-tion of the health of the Settlements of Singapore, Penang,Province Wellesley, and Malacca; and notes the arrange-ments for hospitals-general, pauper, military, and special-that obtain in these parts of Her Majesty’s dominions. The i

report shows that the authorities are evidently takingstringent measures, by instituting prosecutions &c., to

enforce the isolation of and to prevent the importation ofcases of infectious diseases. Notwithstanding this, how-ever, from the habits of the native population and othercauses, it appears that at some of the Settlements the mostvirulent and destructive of these affections have not been

wanting. Cholera, small.pox, and enteric fever have largelyincreased the death-roll, although the necessity of carefulstoring and using of water for drinking purposes has been

insisted upon by the responsible medical officers. A notablepoint in the report refers to the abolition of the Con.

tagious Diseases Ordinance in these districts, the effectof which has been manifested by the increase both innumber and severity of cases of venereal disease in hos-

pitals of all kinds in the Settlements. It seems that

very little has been done in the hospitals for women toavert the disastrous consequences arising from imperfectlegal examination of women, and the condition of thingsleaves much to be desired. Regarding vaccination, it is satis-factory to note the encouraging nature of the reports. Thelunatic asylums show an increased amount and variety ofwork. One of the difficulties in the Straits Settlementsarises from the lack of sufficient assistance in accomplishingthe work. It has been difficult to procure men either fromIndia or Ceylon. So much has this difficulty been felt thata scheme to open a medical school at Singapore with a viewof obviating it is now under consideration. The most

interesting feature of this year’s report of the PauperHospital at Singapore is the unusually large number ofadmissions into hospital, 90 per cent. of which were Chinese.The death-rate, however, remains very low, the most

frequent causes of death being old age, dysentery, andberi-beri. In the Leper Hospital of Yiiiau Jerejak, Mr.McClosky, colonial surgeon, reports the average daily num-ber of inmates as 174, and refers to the practice of selectingsuitable cases for special treatment with the Gurjon, Chaul-mogra, and Kachang oils. The results of his observationshave tended to the belief that in his opinion, though thesemedicines serve to prolong life, to alleviate suffering, andnot unfrequently to check exacerbations of the disease,especially in its incipient stage, strict segregation is the onlyway of dealing with the disease. Mr. Colston’s report says :" Beri-beri, I think, will always be in our midst. Thedeaths from it amounted to 225. The Chinese seem to bethe only nation attacked, and the majority of cases comefrom tapioca and gambier plantations and tin mines."

SUGAR IN THE BLOOD.

THE condition known as mellitæmia, or the presence ofsugar in the blood, has long been recognised. Pavy,Ewald, Seegen, and Otto have demonstrated beyond doubtthat sugar is a normal constituent of the blood, although itis present only in very small proportions; the quantity isnot altered when the blood is analysed after death. The

proportion of sugar in the blood is considerably raised incases of diabetes. In 1885 Freund examined the bloodof seventy patients suffering from carcinoma, and foundit to contain a large quantity of sugar, but he wasunable to detect it in cases of sarcoma. Freund’s experi-ments have not been fully verified by other observers.In the Centralblatt fiir die, Medicinischen Wissenschaften,1890, No. 25, Trinkler gives an interesting account ofa series of observations he has made as regards theamount of sugar contained in the blood in various diseases.He examined the blood of 109 patients, and the investiga-tion fell into two classes: 1. Quantitative estimation ofsugar and reducing substances in the blood during life, thequantity of blood required being obtained during the per-formance of operations. 2. In which the greater numberof analyses took place after death. The diseases fromwhich the patients were suffering were carcinoma, typhoidfever, pneumonia, morbus cordis, dysentery, peritonitis,nephritis, uræmia, &c. Sugar was found to be presentin all the cases. In carcinoma the amount was very large,next came typhoid fever and pneumonia, whilst nephritisand ursemia exhibited the least. In the case of carcinoma,the following conclusions could be drawn. 1. The bloodof patients suffering from carcinoma always contained aconsiderable percentage of reducing substances, of which