54

quickness of comprehension have both failed considerably hestill exbibits a fair amount of intelligence. Owing to acombination of circumstances he never acquired oral speech,but it is said that he was able to converse by means of themanual alphabet with exceptional volubility, using his righthand almost exclusively. He could also write very well inthe ordinary way, but at present he is incapable of shapingletters with his right hand either symbolically or on paper.When asked to go through the deaf-and-dumb alphabet hecan make an A after several attempts, and sometimes a B,but never has any further success; whereas with the lefthand he experiences no difficulty whatever. His right fore-arm is partially paralysed, but far from sufficiently so toaccount for the agraphia. He uses it when eating anddrinking, can grasp an object firmly, raise his handto the top of his head, &c. The movements of thelimb are cnly partially impeded, whereas the patient’spower of expressing himself therewith is totallydestroyed. He may consequently be said to furnish an

example of true aphasia of the right hand. Professor Grasset

finally comes to the conclusion that in a deaf mute a centrebecomes developed in the cerebral cortex which presides overmanual language, but is distinct from the centre whence theordinary movements of the upper extremity are controlled.The two centres must be separate from, and independent of,each other, inasmuch as they are susceptible of artificial

dissociation through disease. The manual language centre isphysiologically allied to that for writing : are they likewiseallied anatomically ? and ought they to be located in

the second frontal convolution rather than in the third ?Professor Grasset is of opinion that his case supports thesehypotheses, but does not establish them.

MEDICAL PRACTICE IN SOUTH AFRICA.

A CORRESPONDENT writes to us:-" The following factsmay prove useful to those who look on South Africa as a

good field for practice and who intend to emigrate there.The profession here, as at home, is vastly overcrowded, anda man coming out here must be prepared to bring enoughmoney to keep himself for a year or so until he eitherobtains some appointment or his practice becomeslucrative. I can confidently state that every small

village and town in Cape Colony and Natal is well sup-plied with medical men, and in the principal towns-such as Capetown, Johannesburg, and even in Buluwayo-the supply largely exceeds the demand. Everything here,as elsewhere, is obtained by local influence, and an out-

sider naturally has no chance against the colonial. Thisfact applies to every trade and profession out here. Locumtenencies and assistancies are extremely difficult to obtainas they are few and far between. Moreover, it is essentialto have a good knowledge of the Dutch language, andbesides there are always plenty of experienced men readyto take up these appointments, as I have found more thanonce to my cost. Fees certainly are higher, but then livingcosts at least double, even in Capetown, and in Johannes-burg about treble the amount of that in England. An

English practitioner can have no idea of the isolated roughlife which one is forced to lead in the up-country districts,the centre of which may be 100 miles from the nearest

railway station, and even there professional competitionis frequently quite as keen as at home. The majority ofmedical men here are either of Scotch or German nationality.In view of the following facts I must advise men in

quest of practice not to come here just now or theywill be doomed to disappointment :-(1) Rinderpest, whichby devastating the country must affect medical fees ; (2) theunsettled relations between the Dutch and the English allover the colony ; (3) the depression in the Transvaal; and (4)the uncertainty cf the future of Rhodesia, all Stock exchange

reports notwithstanding. I am writing this letter chiefly tocatch the eye of the junior members of our profession, andI shall feel sufficiently repaid if I am the means of prevent-ing disappointment in the minds of those who think thatSouth Africa is an El Dorado for the medical man as well asfor the artizan."

___

IS CYCLING HEALTHY ?

THE lengthy correspondence which has recently appearedin the columns of a contemporary has, as might have beenexpected, elicited a wonderful diversity of opinions. Somehave nothing but good to say of the cycle ; others record allsorts of aches, pains, and nervous affections coming onafter a ride. One rider attributes these entirely to theuse of the bicycle as apart from the tricycle owing tothe unconscious strain involved in keeping the former

upright. The plain truth seems to us to rest upon a verysimple basis. Cycling is not good for everybody, and ifabused is good for nobody. Within the last two years peopleof all ages have rushed into cycling in the most haphazardway. They have regarded neither age nor previous habitsnor their physical condition. Small wonder then that manyhave found evil rather than good come from an exercisewhich inevitably demands a heavy expenditure both ofnervous and muscular force. Probably just the same outcrywould have arisen if the same class had suddenly takento running or rowing or mountain climbing without

any previous preparation. It is easy to preach modera-

tion, but it must be remembered that moderation is a termvarying with the individual, and everyone finds for himselfhow much he can do. With regard to the strain involved inkeeping up a bicycle and keeping a look out it is probably nomore than that involved in walking down the Strand without" cannoning" against others, but many of us have done theone from childhood while the other is but a newly-acquiredaccomplishment. There is no need to make a bicycle a verywheel of Ixion, especially with a " safety," for it is easy to

get off and equally easy to remount; therefore the cry " Youmust go on or you will fall " seems to us to ignore the factthat we are reasoning animals.

THE RELATION OF SCARLET FEVER TOINSANITARY CONDITIONS.

THAT scarlet fever is infectious in a degree which probablyvaries in different years and outbreaks is a sufficiently obviousfact, but as to the exact channel by which infection is givenofE and conveyed there is not only considerable difference ofopinion but also a lack of reliable evidence. That thedisease is infectious during at least certain periods of thedesquamative process is clear, but it is not altogetherestablished whether infection is carried by the separatedparticles of cuticle or whether possibly desquamation is onlyassociated in point of time with infection. Similarly withregard to the acute stage of the disease there are many whoassert, upon what evidence it is not easy to ascertain, that thedisease during this stage is not infectious ; but, on the otherhand, cases have been recorded which tend to show that eventhe pre-eruptive stage is not free from infective power.In a word, the evidence upon which beliefs are foundedis somewhat scanty and unsatisfactory. Dr. Niven, themedical officer of health of Manchester, in his currentannual report, while accepting the usually accredited meansof spread, discusses as to how far scarlet fever may at timesbe disseminated by means of insanitary conditions, such,more especially, as defective privies and pails, which lead tosoil pollution. Dr. Niven has collected information from a

large number of houses which had been invaded by scarletfever, and he finds that conditions of filth such as thosereferred to are more intimately associated with scarlet feverthan they are, in Manchester at least, with diarrhoea and