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THE MEDICAL INDEX FOR SCOTLAND.

To the Editor of THE LANCET.SIR,—For the satisfaction of all those interested in the

:success of the " Medical Index for Scotland," allow me again’to request a place in your pages.

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’Since my former communication to you on the above sub-ject, I have much pleasure in being able to state that the workhas been welcomed by every member of our body who hasbeen spoken to regarding it, and every day brings a freshaccession to the number of its supporters. For the informa-tion of the proprietors of the London Medical Directory, letme state that the "Medical Index" is to be a work the firstof its kind, unlike any other both in its compilation and theresults it will produce, and likewise for which no Directory,as at present published, can be a substitute. It will be astrue a record of our civil medical staff as the registrationbooks of our several colleges, and will not only give the nameand address of every medical man, but will also state thecollege to which he belongs. Pages might be written showinghow long we have suffered both in reputation and purse from- quackery, and just’because we have never determinedly,opposed the evil. Let us now, then, change our tactics; let usoppose truth to falsehood; let us put the public in a positionto be our judge; and, facts being stubborn things, let the pro-cess of quack extermination be resolutely carried out, andsoon may we expect to see the last of the race.As to the plan of the " Medical Index," I beg to refer your

readers to my paper in your journal of the 6th of Octoberlast, and would now further state, that as the work is to be gotXtp without any regard to profit in a pecuniary sense, the price’Will be made as low as possible, so as to bring it within reachof all classes of the community. The compiler of the worktaking no portion of the receipts derived from the sale of thework, the expense of publishing alone has to be met, and to Ipreserve the price as wished, and likewise to defray the ex-pense of correspondence regarding the eligibility of namesfor insertion, it will be necessary that each individual, in send-ing his name, should enclose either one or two postage stamps,-accordi7ag to the qualification he holds. The surplus stampsare to be expended in advertising the "Index" in the provin-cial papers of Scotland.-I have the honour to be, Mr. Editor,

Your much obliged and obedient servant.JUSTITIA.

PUERPERAL MANIA AND THE EMPLOYMENT OFCHLOROFORM IN OBSTETRIC PRACTICE.

To the Editor of THE LANCET.

SIR,—In a report of an adjourned discussion on chloroformat the Westminster Medical Society, contained in THE LANCET.of Saturday last, Dr. Webster, who, by his own statement,does not practice midwifery, alludes to "three cases whichhad come within his cognizance," in which symptoms ofmania had taken place subsequent to parturition, duringwhich chloroform had been exhibited; and these he hastilybrings forward as so many instances of " the serious conse-quences sometimes following the inhalation of chloroformduring child-birth."

Could it be clearly established that the obstetric use of thisvaluable anmsthetic agent acts, either immediately or re-

motely, as an exciting cause of puerperal mania, it would at’least furnish a strong objection to its employment, in caseswhere a predisposition to this mental affection might be sus.pected to exist; but as Dr. Murphy justly observes, in his

reply, Dr. Webster’s cases would be more valuable as "evi-dence of the asserted dangers of chloroform, if puerperalmania did not occur sometimes without the use of that agent."If Dr. Webster’s knowledge of the three cases in question--could have supplied information on several important points,as, for example, whether any or all of them were first labours,or, if not, whether they had, after former confinements, been Iaffected with mental derangement; and if he could have tes-tified as to the purity of the chloroform employed, and themanner in which it was exhibited, a more accurate estimatemight then have been formed of the value which ought to beattached to the cases which he has brought forward as in-stances of the bad effects of chloroform.

In confirmation of the doubtful character of the evidencefurnished by these cases, and still further, of the direct benefitof the employment of chloroform in labour, as a means ofwarding off the danger of an attack of puerperal mania, wherea predisposition to such a seizure was known to exist, I begto adduce as an example a case which occurred in my practiceupwards of eight months ago. Early in February last, I was

engaged to attend Mrs. W in her second accouchement,which she expected about the beginning of March. I wastold, that after her first confinement, fourteen months pre-viously, her recovery had not been favourable, and that twoor three weeks after her delivery, an attack of mental de-rangement rendered it necessary to seclude her in Morning-side Asylum for a period of three months. Her approachingaccouchement was expected by the patient and her friends withno small degree of solicitude. Before resolving on the em-ployment of chloroform when labour should take place, Iconsulted Dr. Simpson, our distinguished professor of mid-wifery, who unhesitatingly advised its use. On the 9th ofMarch, labour came on, and under the influence of chloroformit terminated most favourably about three hours after myarrival. Previous to its administration, the patient was in astate of considerable nervous excitement, which speedily sub-sided. Her convalescence was uninterrupted by a single un-favourable symptom, and up to the present date, after a lapseof more than eight months, she has continued entirely freefrom any indications of mental derangement.Allow me to remark, that the very general and successful

employment of chloroform in surgical and obstetric practice,both here and elsewhere north of the Tweed, excites a strongimpression that our professional brethren in the south musteither employ a very impure preparation of the medicine, orbe very much at fault in their mode of exhibiting it.

I am, Sir, your obedient servant,

THE ROYAL COLLEGE OF SURGEONS, UNIVER-SITY OF LONDON, AND THE APOTHECARIES’SOCIETY.

To the Editor of THE LANCET.

SIR,—The Council of the College of Surgeons having deter-mined to move in the matter of medical reform, it becomes theduty of the profession, and especially of the members of thatCollege, to see that the step be taken in the right direction.To secure this, two courses are open-lst. To call upon the Council to lay their plans before the

members for their approval; or,2nd. That the members should at once meet in their various

localities, and draw up memorials to the Council, expressingwhat their wants and wishes are.The memorial to the Council should request-1st. Remedy of the injustice done to the members by the

creation of fellows without examination.This, as it seems to me, cannot be done by creating more

fellows, but by making those already created pass a proformaexamination, or throw up their diplomas.

2nd. To make application for powers to institute medical aswell as surgical examination, making the College the greathead of the professional body, abolishing the Apothecaries’Company as a licensing body, and assimilating the professionin the three kingdoms.

If the Council refuse to accede to either of these plans, itwill then be open to the profession to memorialize Sir GeorgeGrey, praying him-

1st. To abolish the Apothecaries’ Company as a governingand licensing body, on account of dereliction of duty in refusingor neglecting to protect the interests of those who have ob-tained their licence.

2nd. To transfer the powers from the Apothecaries’ Com-pany to the University of London, giving the University alsothe power of examination and granting diplomas in surgery,independently of the College of Surgeons, thereby making itthe alma mater of the general practitioners.

3rd. In any and every case to refuse to incorporate a newcollege of general practitioners.

I am, Sir, your obedient servant,A MEDICAL REFORMER, M.R.C.S.L. & L.A.C.

THE ROYAL COLLEGE OF SURGEONS—THE CON-FERENCE AND MEDICAL REFORM.

To the Editor of THE LANCET.SIR,—The College of Surgeons is at present in especial

favour with you; and if it realizes your expectations, it willwell deserve all you have said of it. For my part, the expe-rience of past years leads me to put but little faith in theacts of corporate bodies; and even now, whether I look to thecouncil of the College of Surgeons presenting the fellowshipto its older members, or the National Institute inviting dele-gates from all the medico-political associations to combine