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ani Citrate. Cstah. i888. 


Setog tijc incorporation of tf)c journals ^ttfjerto fcnoton a» "Cfjc press’’ 

anO “Cije ffceBtcal Circular,” 

% IKtcklg |o«rnd 

OF 

MEDICINE AND MEDICAL AFFAIRS. 

FROM JANUARY TO JUNE, 

1899 . 


LONDON: 20 & 21 KING WILLIAM STREET, STRAND. DUBLIN : 19 LINCOLN PLACE. 


Digitized by v^j ooQle 




Digitized by v^ooQle 


Bapolamcnt to 

The Mejjffl nm and Cirtmlar. 


INDEX. 


June 28th. 1888. 


INDEX. 


VOL. LXVII. NEW SERIES. (VOL. CXVIII. OLD SERIES.) 
JANUARY TO JUNE, 1899. 


Abortion advertisements, pay¬ 
ment for, S61 

Abortioneee, the punishment of, 
96 

Abrahams, Dr., rheumatic tonsil¬ 
litis, 113 

Abscess, renal, 619 
Abscess, trephining for cerebral, 
Mr. Croly, 161 
AbscfBB, metastatic, 393 
Abscess, or aneurysm, 683 
Abscesses, chronic tonsillar, 10 
Abscesses, tuberculous, 140 
Absorption, bacterial, 487 
Acrid*-nt society, 79,163, 259, 626, 
633 

Acolne, 221 

Act, the inebriate. 572 
Act. the lord Chancellor’s new. 
378 

Act, non-complianre with the 
notification, 20 
Act, the new inebriates’. 416 
Addison’s disease, Dr, Chauffard, 
582 

Address, Mr. McArdle'a, 285 
Adulteration, 90 
Adulteration bill, 280 
Adulteration, food and drug, 521 
Adulteration, a new form of 
milk, 677 

Advertisements, street, 147 
Affair, a disgraceful, 98 
Air, artificial, 115, 229 
Aid association, medical, 179 
Aibnraoeorla, the clinicAl value 
of, 331 

Alcohol, a victim of, 205 
Alcohol in the profesaion, 197 
A lcohol, phthisis and, 649 
Alcohol, scientific value of, 205 
Alkaptonuria, 648 
Amenities, professional, 659 
America, food adulteration in, 
200 

Analyst, the union drug. 680 
Analysts, public, 174. 464 
Anatomy, rch'ol of. 363 
Ansnryem, early diagnosis and 
treatment of, 642 
Antmaiia, lyssa. 639 
Anti-vivls'ction gala, an, 462 
Antlvivisertionists, Mr. L. Tait, 
and the, 680 
Anus, artificial. 9 
Apartments, disinfection of 
empty, 522 

Aphonia, a simple method of 
curing. 171 

Apothecaries' Hall, Ireland, the 
council of, 625, 627 
Apothecary, an unqualified, 205 
Appeal, Mr. Hunter’s 120 
Appeal, the assessment. 416 
Appeal, unsuccessful, 259 
Appendicitis, 115, M4, 271, 875, 
486 

Appendix, foreign bodies in the 
vermiform, 466 


Appointments, Dublin, 442 
Appointments, hospital, Man¬ 
chester, 653 

Appo:ntments—end of each No. 
Army medical corps, royal, 41 
Army medical service, the, 200 
Army, syphilis in the, 96 
Army, syphilis in the. Dr .1. A 
ohaw-Mackenzie 181. 211 
Arrangements, lecture, 129 
Anthrax, death front, 551 
Aithur, mortality of Russian 
troops at Port, 126 
Arthritis, relation of gout to rheu¬ 
matoid, Dr. Bwart, 207. 237 
Arthrotomy, a series of cases, of, 
Mr. Lockwood, 505 
Asepsy, 352 

Assistant’s libel action, an un¬ 
qualified, 680 

Association, Indian medical, 124, 
602 

Association, annual meeting t f 
Irith medical. 682 
Attragalectomy, 280 
Asylum discipline, lunatic, 468 
Asylum management, 676 
Asymmetry, pulmonary, 45 
Atropine, poisoning by, 2<e 
Atropine poisoning case, 276 
Australia, abortion tragedy in, 
151 

Australasia, abuse of friendly 
societies in, 42 


B 


Babies, the co'our of negro, 174 
Baby incubator again, the, 662 
Bacillus, pathological status of 
the, 302 

Bacillus, the death point of the 
tnbercle, 228 

Bacteriology, popular, 69 
Bacteriology, the modern doc¬ 
trine of Dr. B&ntock, 290 
Balneology, a post - graduate 
cause of, 657 

Bantock, Dr., the modern doc 
t> ine of bacteriology, 290 
Bath fever hospital, 122,149 
Barbarity, poor-law, 43 
Baths, public, 674 
“Barker” anatomic* 1 prize, 105 
Razaar, 6t. Mary s hospital, 630 
Bed, reading in. 441 
Belfast, the sanitation of, 71 
Belladonna plasters, 446, 627 
Benevolent fund, British medical, 

105 

Beware, foreign and colonial 
graduates, 306 

Berger. Prof., acute intestinal 
obstruction. 111, 131 
Bicycle, hernia and the, 140 
Bill, midwives, «83 
Biographies, medical. 464 
Birth-.—end of each No. 
Birthday hoaours, the, 602 
Birth-rate, a declining, 307 
Bishops, clearing a crypt of its. 


Rismuth, salicylate of, 99 
Blackleg, a medical, 415 
Bladder, rupture of gall-, 564 
Bladder, total extirpation of the, 
619 

“Bland, Dr.,’’ 468 
Blenorrbagia. 271 
Blood, the action of hydro¬ 
therapy on, 407 

Board, the local government, 67 
Bogey, the chloroform burglar, 
197,808, 336 

Bones in Southwark, more, W0 
Bordighem, 66 

Bottle, Stephenson’s new poison. 
632 

Box, the doctor in tho witness, 

439 

Boyd, Dr., death of, 966 
Bradford, hospital abuse in, 16 
Kradford, medico-ethical, 105 
Brain, gunshot wound of the, 460 
Brsin, revolver Injury of, 36 
Brain, the size of the, 546 
Bread, white r. brown, 18 
Breast-feeding, contra - indica¬ 
tions to, 17 

Broadbent, Sir Wm.. conduct of 
the heart in the face of diffi¬ 
culties, 53 

Bruce, Dr., the upper termina¬ 
tions of the aotero-lateral 
and direct cerebellar tracts, 

85 

Bubonic plague, the, 645 
Burroughs, Welcome and Oo., 682 
Burial, premature. 261 
Buttons. Morphy’s, *90 


Cadocylic acid, 670 
Crcsarean section, vaginal, Prof. 

Duhrssen, 187 
Crrsarean section, 826 
Caffetn,dangers of, 467 
Caley, Dr., dilated heart, 556 
Cambridge, tbe professorship of 
pathology at, 174 
Campbell, Dr., doable pyo-sal¬ 
pinx, 582 

Cambridge university, 669 
Cameron. Sir 0., new method of 
ventilating sewers. 662 
Canadian medical association,561 
Canard, a stupid, 440 
Cancer, biological aspect of, 417 
Cancer hospital, 985 
Cancer, lay views on, 696 
Cancer organism, 414 
Cancer society, 633, 648 
i bucer, the extension of, 668 
Cancer, thyroid treatment In, 409 
Cancer, uterine. Dr. M. Madden, 
556 

Candidates, hints to nervous, 880 
Cape, illegal practice at the, 566 
Capsules, vaginal, 650 
Cardiac muscle, neurotic tosvffl* 
clency of the, 870 


Cardiff, proposed .eamen’s hoe 
pltalat.686 

Carriages, dirty railway, 882 
Care books for sale, 359 
Castration in the male and 
female, Ml 

Catbcart, Mr., peritonitis, 293 
Cattle, tuberculosis among, 489 
Cavendish lecture, the, Df. Oeler. 
635 

Cavernitis, chronic, 564 
Centenary, a vaccination, 620 
Centenary, celebration of the 
royal collage of surgeons of 
Bngtand, 384.442 
Centenary, a Volta, 859 
Central authority, the Bngiiah 
local government board as a, 
646 

Cerebellum, tnmonr of the, 874 
Cerebro-rpinal fever, Dr. Oiler, 
635 

Chancre, a digital, 827 
Changes, editorial. 166 
Charities, munificent bequests to 

Charity, physicians and,883 
Charity, unchristian, 89 
Chauffard, Dr., the intoxication 
of Addison’s disease, 882 
Cheloid, 190 

Chelsea, physic garden. 889 
Chemists, boycotting the, 142 
Chemists, prescriptions and, 860 
Chest, gunshot wound in the, 588 
Chest, penetrating wounds of tbe. 
642 

Childhood, pericarditis in, 90 
Children, c*re of schools, 97 
" Children, the cry of the/* 964 
Children, diabetes in, 570 
Children, stillborn, 260 
Children, unvaccina tod, 178 
Chill, bacteria and, 247 
Chloroform is to be preferred , 
when, 44 

Chloroform, death from. 561,6BS 
Cigarettes banned in Arkansas, 

382 

Cigarettes, tea, 74 
Claes, mortality of foreign, 28. 
51, 129, 806, 285, 908, 285, 818, 
363, 390, 478, 527 

Clarke, Mr. J., two cases of meta- 
tarsalgia, 607 
ClsartflcsMon. pauper. 627 
Clavicles, fracture of both. 642 
Climates, diseases of tropical. 
313 

Climatology, 407 
Clothing, tuberculous infection 
and second-hand. 196 
Cndiotomy. deaths alter abdomi¬ 
nal, Dr. Smyly, 421 
Cold, catching, 94 
Colic, renal, ST 

Colleges, "grammar school ” 
science of the London, ill 
Colon, resection of the descend¬ 
ing, 539 

€0n m&iaTlM’ 1 * f * aUJe poen * 
Commission, M. BaffWne andtbe 

_ plague,H78 


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Bonplament to 
Pr.~ .nH r 


INDEX. 


Jane 88th, 1886. 


Commissions, secret medical. 308, 
310. 367, 413, 546 

Commlsslonorship in Scotland, 
the lunacy. 95 

Committees, medical men on hos¬ 
pital. 024 

Congress, balneological. 407 
Congress, the thirteenth Interna¬ 
tional 079 

Congresses, coming, 652 
Contest, prize fight v. boxing, 
255 

“ Conservative surgery,” Mr. 
Tait, 341 

“Consclentionsobjector,” the. 229 
Consultants, joint-stock. 599 
Consumption cure, the new 172 
Consumption, early diagnosis of, 
374 

Consumption hospital in Ireland. 
415 

Consumption, the hectic fever of. 
352 

Consumption, the prevention of, 
494 

Controversy, the” appendicitis,’ 
73 

Cooper, Mr. A., presentation to, 
124 

Cord, cocainisation of the spinal, 
491 

Coroners and post-mortem exami¬ 
nation, 678 

Coroner's court, new, 79* 

Corpses, the transport ation of, 125 
Oeosote and phthisis, 67* 


CORRESPONDENCE. 


Adenoids, chloroform and, 48 
Aid associations, medical, 152, 
362, 418, 445, 471, 498 
Anesthetics, mortality under. 471 
Army, syphilis in the, 309 
Bacteriology, popular, 100 
Birmingham, consultative insti¬ 
tution. 550 



ment of medical officers to 


the, 676, 604,631 
Censurable, 76 

China, administration of chloro¬ 
form in, 234 

“Cider and microbes,” 48 
Colonial degrees, registration of, 
446 

Diet, history based upon. 234 
Diplomas, bogus medical, 22 
“ Dossier secret," the, 650 
Ectopic gestation, determination 
of sex in, 152 

Education, examining boards and 
prellmiuary, 21 
Enuresis, 631 

Experts in criminal cates, medi¬ 
cal, 417 

Explanation, an, 178 
Palkenstein, Nordrach, and, 682 
Gala, the anti-vivisection, 498, 
524 

“ Hat" again, the hospital, 284 
Hernia of the vermiform appen¬ 
dix, 48 

Hospitals abuse act, 575 
reland, the vice-presidency of 
the royal college of surgeons 
of, 631 

"League of mercy,” proposed, 258 
Life, expectancy of, 178 
Listerian ritual, the 388, 417 
Medical register, inaccuracies of 
the, 190; personation and 
erasures from, 101 
Men, medical fees fer medical, 

Millinery, medical ritualistic, 
233 

Ophthalmic surgery, English v. 
foreign, 603 

Ovartotomised patients, the 
marriage of, 47 

Oxide, centenary of nitrons, 76 
Pelyclinic, 338, 657 
Poor-law districts, remodelling 
of, 445 

Salop hen, the treatment of in¬ 
fluenza by, 233, 258 
gernm inoculation, 575, 657 
South Africa, consumptive 
patients in. 445 

Spectacle-maker’s diploma, 604 
Syphilis, the attenuation of, 41*7 
Tetraaitiate, the dangers of 
prythrol, 338 


Tnbercnlons patients, state sana 
toria for, 388 

Tubing, new self-drainage. 178 
“ Unchristian charity,” 101 
Urethrotomy, hicmorrhage in 
nternal, 47 

Uvula-, primary epithelioma of 

the, 100 

Vestrymen, bacterioloy for, 658 
Wales’s. Prince of, hospital fund, 
22. 49, 127 

wark, Lient., the case of. 76 
Correspondents, notices to end of 
each No. 

Coegrave. Dr., treatment of tuber¬ 
culosis at Falkenstein, 241 
Cough, whooping. 115 
Conscil, general medical, 12,274 
573,623 

Council, General Medical - 
Presidential address, 588; 
hononr to whom honour is 
due—the F.R.B.G.—inspec¬ 
tion of documents, 589; reap¬ 
pointment of registrar—pre¬ 
vention of personation—mid- 
wives’ and opticians’ certifi¬ 
cate®-reciprocity with foi- 
eign countries—Mr. Samuel 
Bingham Shekelton — Mr. 
McKay, 690; Dr. W. 8teward, 
591 ; Mr. N. Holland—W. H. 
Cossens, 592: propoeed disci¬ 
plinary powers — Apothe¬ 
caries hall, Dublin, 614; 
standard of preliminary 
examinations—report of mia- 
wivee' bill commtttee - medi¬ 
cal aid association, 615; allo¬ 
cation of fines—colonial list— 
the Hunter case—inspection 
of higher examinations—ap¬ 
pointment of the legal ad¬ 
viser—the first year’s coune, 
618; report of the Dharmaco- 
pceia committee—the British 
pharmacopeia account — 
finances or the Irish branch 
council-Mr. H. K. Hunter, 
617; reciprocity of medical 
practice—appointment of ex¬ 
aminers—issue of unautho¬ 
rised diplomas—midwives’ 
committee—dental report, 818 
Counter-prescribing, 415 
Court appointments, 46 
Pramp, writer’s, 226 
Criminal cases, medical experts 
in, 377 

Croly, Mr., trephining for cere¬ 
bral abscess, 161 

Crusade, the antituberculous, 223 
Crusade, the consumption, 14 
Crusade, the flash point, 253 
Curettage, two cases of perfora 
tion of the uterns during, Dr. 
Elder. 3 

Cutler, Dr., two cases of eclamp¬ 
sia. 481 

“Cutters,” consultants as, 545 
Cycling incidents,228 
Cycling, mouth-breathing and 
649 


D 


" Day mare," Dr. Tom Robinson, 
480 

Dead, the disposal of the, 468 
Dens, Dr., erjthema uodosnm, 
242 

Death certificate, an irregular, 
150 

Deaths—end of each No. 

Defence onion, medical, 499 
Deformities, rachitic. Dr. Wil¬ 
liams, 399 

Degrees bill, the universities, 885 
Dental hospital. London, 313 
Dermatology, Ive’s colour po o 

graphy in, 116 
Diabetes, bicycling in, 680 
Wathesis, the stromous, 547 
Diet, history based upon, 146,168 
194 

Diet, prison, 196 
Dietetic treatment, 165 
Dilatation, dyspepsia or gastric. 
Dr. Murrell. 81 
Diph therla at Aldershot, 205 
Diploma the latest shaui, 19 
Di j loma, Nugent’s borrowed, 74 
Diplomas, deprivationlof medical 
for criminal conduct,'179 _ 


Diploma, the latest sham, 226 
Dipsomaniacs, women, 170 
Disease, the Liverpool school of 
tropical, 277 

Diseases, headache and nasal, 327 
Dispensaries, the general medical 
council and, 588 
Dispenser, a mechanical, 494 
Dispenser, the unqualified, 45, 94. 
520 

Dispenters doctors, unqualified, 
151 

Dispensers, salary of Irish poor- 
law 179 

Dissecting, Sonthwark gna dlans 
on, 388 

Districts, definition of dispensary, 

Dockrell, Dr., general health as a 
factor in skin diseases, 506 
Dockrell testimonial fund, 660 
Doctoring, company, 368, 621 
Doctor, coroner t\, 20, 679 
Doctors, dispensing by, 596 
Dogs and hospitals, 568 
Doran, Mr. A., gynecology in 
relation to surgery, 240 
Dorsalis, tabes, 142 
Douche, vaginal heat, 376 
Don gal), Dockrell v., 464 
Drugs, purity of. 572 
Druggist, a Lord Chancellor, 412 
Drunkards, lunatics and, 90 
Dublin, a municipal docto' for, 
468 

Dublin hospital 8unday, 179, 205 
Dublin orthopedic hospital, 19 
Dublin, public health salaries in, 
Dublin, university of, 659 
574 

Dum-dum bullet, the, 627 
Dundrum elect-on, the disputed, 
416, 495. 573 

Duhrssen, Prof., vaginal cesarean 
section, 187 

Duodenale. anchyloetoma, 539 
Dura mater, ossiflcatlng role of 
the 405 
Dystrophy, 135 
Diseases, tropical, 653,659 


E 


Earth-eating. 199 
Eclampsia, 272 

Eclampsia, two cases of, Dr. 
Cutler. 481 

Editor, the new American medi¬ 
cal, 278 

Editor, tribute to a medical, 129 
Education, anomalies of English 
medical, 382 

Education, insanity and, Dr. 

Macdermott, 532 
Egypt, the plague in, 568 
Elder, Dr., two cases of perfora¬ 
tion of the uterus daring 
curettage, 3 

Election, interesting Dublin dis¬ 
pensary, 832 

Elections, Irish council, 385 
Electrotherapy, 334 
Endometrium, adenoma univer¬ 
sale of the, Dr, Oliver, 344 
Endocarditis, ulcerative, 65 
Enfield, medical organisation at, 
680 

England, the council of the royal 
college of, 548 

Enlistment scheme, the special, 
332 

Enteric fever without symptoms, 
Dr. Murrell, 31 

Enterprise, medical and clerical, 

629 

Epilepsy colony, 577 
Epilepsy, Jacksonian, 376 
Epilepsy, successful operation in, 
432 

Epileptics, the care of, 490 
Epileptic*, proposed Manchester 
asylum for, 447 

Epiphyses, thejsurgery of the, 276 
Epithelioma, 325 
Erysipelas, 273 
Erysipelas, recurring, 190 
Escherich, Prof., peendo-tetanns 
(illustrated), 28 
Esvach water, 551 
Ether, death under, 73 
Ether explosion, a ratal, 359 
Ethics, medico-dental, 630 
Eucalyptus globulin oil,.446 


Evans, Major, death of, 308 
Evasions, margarine. 368 
Eve, Mr., resection of the large 
intestine, 507 
Ever, beautiful for, 173 
Ewart, Dr. W„ calcification of an 
adherent pericardium 400 
Ewart, Dr., the Harveian lectures, 
429; relation of gout to rheu¬ 
matoid arthritis, 207.287 
Examiners, congress of medical 
life, 206 

Examiners, election of, 416 
Examination, the Irish collegiate 
preliminary, 198 
Examinations, post-mortem. 18 
Examinations, the inspection of 
“ higher,” 697 
Excelsis l specialism in, 600 
“ Exercise, the question of, 397 
Exhibition, hygienic, 677 
Expectoration, pulmonary con¬ 
gestion without, 618 
Expedition, a malarial investiga¬ 
tion. 678 

Expurgation obstructed, profes¬ 
sional. 203 

Extraction, tooth, 228 
Extravagance, municipal, 410 


F 


Face, diffuse, hypertrophy erf 
the. 431 

Faces, fashion In, 636 
Falkenstein, treatment of tuber¬ 
culous at. Dr. Coegrave, 214 
Failure, cardiac, 414 
Farce, another death sentence, 
172 

Farce, a judicial. 416 
Faure, the death of President, 
203 

Fees in law courts, medical, 339 
Fees, no, 440 

Female Inspectors, more, 383 
Ferrometer, 672 
Fever, ce'ebro-spinal. 676 
Fever, change or ganglionic cells 
in, 9 

Fever, childbed, 142 
Fever, the palmar sign of 
typhoid, 280 
Fever, puerperal, 363 
Fever, recurrent, 273 
Fever, typhoid, 35,247,513 
Finny, Dr. sarcoma of the supra- 
renals, 401; three cases of 
tachycardia, 640 
Fistula 1 , immediate suture of 
vesical, 300 

Fleas as plague carriers, 46 
Fleming, Dr.. C.B., the eradica¬ 
tion of tuberculosis, 638, 661 
Flexures, volvulus of the sigmoid, 
325 

Food, colouring agents nsed in, 
277 

Forceps, axis traction (Illus¬ 
trated), 472 
Fra in Madame, 867 
France, academical protec¬ 
tionism In. 492 

France, law as to quack concoc¬ 
tion in, 226 

Fi ancis, Surg.-gen., the practical 
aspect or influenza, 187 
Fraud, a wicked, 70 
Fraud, patent medicine, 496 
French hospital, 447, 499 
Freyer, Dr., two cases of success¬ 
ful operation for Impacted 
6 tone in the are ter, 107 
Fund, awards of the Prince of 
Wales’s, 126, 227 

Fund, the Saturday hospital, 487 
Fund, windfall for the hospital 
Sunday, 98 


o 


Gall-bladder, the surgery of tbe, 
Mr. McArdle (Illustrated), 26 
Gall-bladder, rupture of, 59* 
Gall-stones, 117, 247 
Galliards. Prof., byo-pneumo- 
thorax, 367 

Galway, presidency of Queen’s 
College, 338 


Digitized 


Google 


INDEX. 


Jane 28 th, 1899. 




tod Obcaka 


Gaol, a worm-infected, 44 
Garrulity, the perils of judicial, 
385 

Gastrotomy, 65 

Gateshead medleal association, 
830 

Gazette, new hospital, 179 
Germany, the medical profession 
in, 227 

Gestation, ectopic. Dr. Laurie, 
188 

Gloucester vaccination and, 98 
Glycerophosphates, lymph of 
the, 659 
Glycosuria, 248 

Gonorrhoea, disease of the ovary 
„ with. Dr. J. Oliver, 320 
Gonorrhoea In the male, Dr. 
Thomas, 481 

Gordon, Sir C., C.B , notes on the 
„ plague. 315, 396,426. 463 
Gossip, literary notes and, 101, 
209, 812, 446, 656 

Goolstonian lectures, 347, 868, 383 
Gout, modern views of. Dr. Moull 
lot,'321 

Gown, royal college of surgeons 
and members’, 99 
Graduates’ association, Irish, 236 
" Gra mmar school’’ tcience 
years, 624 

Gratitude, a modern Greek’s ver¬ 
sion of, 147 
Graves’ disease, 264 
Gravidas, uterus myomatosas. 

460 

Gresham lectures, the, 51 
Gnmshaw, Dr., prevalence of 
tuberculosis in Ireland, 346 
Guardians, an enlightened board 
of, 140 

Guardians, anti - vaccinationist, 
22 » 

Guardians, niggardly board of 
197 

Gynaecological congress, the, 199 
Gynaecological society, British, 
78 

Gynaecology, lessons of, Dr. Mac- 
naughtoo-Jones, 58, 85 


Hsemagloblnuria, 875 
Htematogen, 812 
Hwmorrhage, post-partum, 141 
Haemato-myelfa, 672 
Hemorrhoids, 670 
Haemoptysis, 86 
Haemoptysis, heat in, 308 
Hair, curly, 401 
Harben lectures, the, 181,287 
Harrogate, the progress of, 124 
Harveian lectures, Dr.: Ewart, 4, 
28 

Health resorts, healthy, 415 
Health, salaries of medical 
offl ere of, 280 

Heait, dilated. Dr. Caley, 555 
Heart disease, mechanical treat¬ 
ment of. 648 

Heart, revolver-shot lesion In the 
region of, 11 

Health, salaries of Dublin officers 
Of, 522 

Heart, the conduct of the, 8ir 
W. Broadbeut, 58 
Heart, the rheumatic, 570 
Heart, stabbing wound of the, 117 
Hemiplegia ? hysteria or. Dr. 
Murrell, 466 

Heroalist, the educated, 20 
Hernia, the radical cure of, 485 
Heroin, the new drug, 142, 247 
“ Hipr’ mutton essence, 204 
Hogg, Mr. J., women quacka la 
the seventeenth century, 136 
Honours. New Tear, 19 
Hospital, a mismanaged, 20 
Hospital iund, the awards of the 
Prince of Wales’s, 15 
Hospitals, government and the 
colraial, 644 

Hospitals great and hospitals 
little, 97 

Hospitals r Infirmaries or. 668 
Hospitals, the Prince of Wales’s 
fund and the small, 488 
Han, am all-pox epidemic at, 680 
Hall, small-pox patients in, 478 
Hnnterlan oration, the, 193 
Hunter, Mr., the case of the late. 


Hydrogen, liquefied. 629 
Hydronephrosis, intermittent, 9 
Hyeres, 56 
Hydrops, 191 
Hygiene, scholaf tic, 40 
Hypertrophy, cardiac, 73 
Hyperidrosis, 301 
Hysterectomy, abdominal, Mr. 
Byall, 370 

Hysterectomy, fibroid tnmoar 
removed by. Dr. L&wrle, 7 
Hysteria. 513 
Hyssop, poisoning by, 42 


Illegal ? is it, 279 
Impersonation case, 97 
Incarceration, intestinal, 300 
Inconsistency, glorious, 384 
iDcnbator ad hoc, 513 
Incubator, the baby, 520 
India, insanitary station* in, 360 
India, proposed university for, 19 
India, the plague in, 177 
India, vivisection in, 71 
India, venereal diseases in, 126 
Indian medical services, 633 
indulgence, charitable, 447 
Inebriates act, the. 144. 439 
Inebriates, D&lrymple home for, 
465 

Infants, feeding of, 375 
Infections disease, isolation of, 
633 

Influenza, 620 
Influenza again, 170 
Influenza, ear complications in 
Mr. Yearsley. 262 
Influenza, the epidemic of, 199 
Influenza, the practical aspect of, 
Surg.-gen. Francis 18“ 
Influenza, the tongue in, 619 
Inoculation, cerom, Dr. Wolfe, 
263 

Inoculation, tnberenlin, as a test, 
279 

Inquest, a curious, 97 
Insanity, early treatment. 330 
Insanity, facts and fallacies 
about, 224 

Insanity, medical jurisprudence 
of, 541 

Insipidus, three cases of diabetes. 
Dr. Lumsdeu, 640 
Insomnia, the physiology of, 571 
Instruction, inadequate. 545, 573 
Insurance, accident, 484 
Intellectuality, gout and, 281 
Intestine, resection of the large 
Mr. Bve, 507 

Intestinal obstruction, chronic, 
Mr. Lentaigne, 216 
Intussusception, four cases of. 
Dr. Morison, 424 
Invalids, church bells and, 414 
Iodine, tincture of, 90 
Iteland, election of examiners at 
the royal college of surgeons 
Of, 448, 498, 602 

Ireland, pharmaceutical penal¬ 
ties in, 386 

Ireland, royal college of surgeons 
in, prize list, 890 
Ireland, royal college of surgeons 
in 250, 683 

Ireland, the alleged sectarianism 
of the royal college of sur¬ 
geons, 336 

Ireland, university of, 526 
Italy, the ^practice of medicine 
Id, 680 


Janus substitution, hunyadl, 259 
Jenner, before the days of, 126 
Jenner society, Mr. Haggard and 
the, 51 

“Jiggers,” 522 

Johannis water, litbiated, 28) 
Joints, free bodies in, 432 
Joints, tuberculosis of the, 36 
Jubilee hospital again, 150 
Justice, a mere act of, 150 
Jute, tetanus in, 630 


Kalatonia, 407 

KanthAck, Dr„ influence of milk 
on the spread of tuberculosis, 
55 

Kashmir, medical practice in, 628 
Keratomalacia, 91 
Kerr, Dr., two cases of lateral 
sinus pytemia, 136 
Kidney, cystic, 593 
Kidney, granular, I)r. West, 157, 
213, 261 

Kidneys, malformations of the 
(illustrated). Dr. Newman, 
449, 475, 501 

Kidney, the surgery of the, 148 
Kidney test, methylene blue as a, 
124 

King’s college bacteriological 
department, 105 
Kipling’s health, Mr.. 640 
Kissing, the prohibition of indis¬ 
criminate, 601 

Knee-cap, habitual luxation of 
the. 487 

Knee-Joint, Hey’s internal de¬ 
rangement of the. Dr. Knott, 
579,607 

Knott, Dr„ Hey’s internal de¬ 
rangement of the knee-joint, 
579, 007 

Kolpocoeliotomy, 272 
Kruger, President, as a patient, 
196 


Labour, protection against infec¬ 
tion during, 300 

Lady resident medical superin¬ 
tendent of a lunatic asylum, 
651 

Larynx, transplantation of car¬ 
tilage into the, 563 
Law f what is the lunacy, 45 
Lawrie, Dr., etopic gestation, 188; 
fibroid tumour removed by 
hysterectomy, 7 
Lead poisoning, 221,356 
l-eave, holiday, 676 
Leavesden asylum, poisoning 
mystery at, 336 

Lee, Dr.. the smoke question, 3 
Leutalp ue, Mr., chronic intestinal 
obstruction, 216 

Leon, Dr„ general disorders 
originating in diseases of the 
female pelvic organs, 663 
Iietteomian lectures, 167) 213, 261 
Ijfuctemia, 141, 432 
I eucocy tesla, 671 
Lichty, Dr., dilatation of the ito- 
mach. 557 

Lindsay, Dr., ulcer of the (eso¬ 
phagus, 427 

Liquors, the abase of alcoholic, 
173 

Linen, new process of cleaning 
bed, 527 

Literature—see reviews 
Liver, syphilis of the, 220 
Liverpool, extension of hospital 
accommodation for infection* 
diseases at, 278 

Liverpool, hospital scandal at 
521 

Liverpool medical institution, 79 
Liverpool, new ward and labora 
tories for tropical diseases in, 
443 

Liviogstone college, the, 198 
London, dental hospital of, 577 
London, health of the city of, 442 
j ondon hospital medical college, 
659 

London lunatic asylums, 179 
London, medical society of, 526 
London, municipalisation of, 123 
London, presidency of the royal 
college of physicians, 336 
London, typhus fever in, 602 
Lock hospitals, the public and, 
441 

I ockwood, Mr., a series of cases 
of arthrotomy, 505 
Lozenges, chemical food, 669 
Lumsden, Dr., three cafes of 
diabetes insipidus, 640 
Lunacy in North Wales, 659 
Lunacy, the increase of, 72 


Lunatic patients, corporeal 
punishmeut of, 44 
Lunge, echinococcus of the. 853 
1 ung, gangrene of the, 406 
Lunn, Dr., results of operath ns 
for enlarged prostate, 188 
Lupus. 38, 376 

Luxe, eummer trains de, 633 
Lymph, scarcity of glycerlnated, 
197 

Lymph icmia, acute, 620 


M 


McArdle, Mr., the surgery of the 
gall-bladder (illustrated). 25 
MacMunn, Dr., protargol in ure¬ 
thritis, 404 

Macnaughton-Jones, Dr., lessens 
in gynaecology of a year, 
58, 85 

Macdeimott, Dr., insanity aDd 
education. 532 

Madagascar, the plague at, 43 
Madden, Dr. More, uterine 
cancers. 556 

M&hdi, myths about the, 255 
Malaria, 300 
Malaria commission. 577 
Malingereis, artificial tardiac 
disease for, 630 
Malpraxis, alleged, 281 
Malpraxis action, failure of a 
Manchester, 440 
Malpraxis, charges of, 70 
Malpraxis, curious charge of, 227 
Man. act. on of coloured light on, 
563 

Man, exteusion of the medical 
act- lo the Isle of, 281 
Man, libel against a medical, 147 
Man, medical practice in the Irie 
i f, 286 

Man, osteomalacia in, 325 
Manchester, notification of 
phthisis, 630 

Manchester royal Infirmary, 417, 
574 , 653 

Marriages—end of each No. 
Marriage, state regulation of, 38, 

68 

Martyrdom, anti-vaccinationist, 
557 

Maygrier, Prof,, treatmeTt of 
fissures of the nlnples by 
orthoform, 84 

Medulla, injections of coc&in into 
the, 486 

Meat infection, the bacterulogy 
of, 544 ; 

Mea', six months for selling bad, 
74 

Meath hospital, 478 
Medical society of I ondon, 
annual dinne*, 285 
Medicine, the academy of. 165 
Medicines, the action of, 165 
Medicine, French congress of, 593 
Medicine, the limits of experi¬ 
mental, 328 

Medico-ethical society, a new, 
173 

Medico psychological association, 
285 605 

Mi nelik’s diversion, 20 
Meningitis, epidemic of cerebro¬ 
spinal, 360 

v eningitis, pneumonia and cere- 
bro-spinal. 538 

Metatarsalgia, two cases of, Mr. 

J. Clarke, 607 
Microcephaly, rachitic, 220 
Middlesex hospital, 235,305 
Midwife censured, a, 199 
Mid wifely instruments (illus¬ 
trated*, 526 

Midwives' bill, a Dew, 42 
Midwives, the registration of, 418, 
548 

Migrans, erysipelas. Dr. Murrell, 
349 

Mill life, Lancashire, 574 
Milk, adulterated, 44 
Milk, condensed *' separated,” 
381 

Milk? is it desirable to boll, 225 
Milk, purity of, 179 
Milk, preservatives in, 329 
Milk, tuberculosis in, 106 
Milk, tuberculous, 385 
Miners, a new disease among, 566 
Mont-Dore, 191. 621 
Morality, a comparison in, 492 


Digitized by 


oogle 


MBptamant to 

9I.-0 P ww and l 


Pre«« »nd Clrml»r. 


INDEX 


June 86th, 1899. 


Mortem, Dr, four ewes of Intus¬ 
susception. 424 
Mortality, Influenza, 230 
Mooli lot, Dr., modern views of 
«mt.S21 

Munificence, royal, 173 
Mnrr&y, Dr., the Goolstonlan 
lectures, 347, 308, 393 
Murrell, Dr., dyspepsia or gastric 
dilatation, 81 ; enteric fever 
without symptoms, SI: ery- 
sipelas migrans, 349: enemata 
rashes, 580; hysteriaor hemi¬ 
plegia, 456 

My lee, I)r., perforating gastric 
ulcer. 395 

Myocarditis, lntestitial, 611 
Myoma, operations for, 565 
Myopia, operative. 487 
Myopia, the operative treatment 
of. 93 

Myxccdema. 65 


X 


Nantwich, infections disease dif¬ 
ficulties at, 628 
Navy, venereal in the, 518 
Netley, tropical diseases at, 72 
Neuralgia, operative treatment 
of, 593 

Neurasthenia. 414 
Neumann, Prof., syphilis ma¬ 
ligna, 1 

Newman, Dr-, malformations cf 
the kidneys, 419, 475, 501 
New York, Christian scientists in, 
519 

Nice, 118; fever scare at, 85, 48 
Nicholson’s rar drums. 126 
Noise*, prevention of on neces¬ 
sary. 122 

Nominations for the army medi¬ 
cal rervice, school. 333,411 
Non-nn onists, unionists and, 123 
Nodosum erythema, Dr. Deas, 
242 

Norfolk, increase of lonacyin, 437 
Nostrum denounced, a, 359 
Nostrums, nurses and, 489 
Notification, infections diseases, 
522 

Notification system, proposed ex¬ 
tension of the, 381 
Nuisances, women inspectors of, 
336 

Norse, abortion charge against a. 
72 

Nunes’ association, British, 605 
Nursing question, the. 644 


O 

Oath, a sanitary, 172 
Obesity, 327 

Obesity, treatment of, 65 

OBITUARY. 

Arkle, Dr. C. J., 283 

Arnold, Mr., 657 

»nice, Surgeon-General, 49 

Better, Mr., 284 

OshiU, Dr.. 681 

Oaite, Dr. W. A.. 445, 470 

Coats. Prof.. 128 

Cooke. Dr. Thomas, 177 

Cope, Mr. Joseph, 387 

Davy, Dr. Edmund. 49 

Eustace. Dr. -I..499 

Frazer, Dr. William, 418 

Hewetson, Mr., S50 

Hogg, Mr. Jabez, 444 

Kerr. Dr. Norman, 605 

McGill, Dr.. 682 

Macnamara, Dr., 984 

Molr, Dr. J. 549 

Mouat, Sir James, 48 

Nedley, Dr., 470 

Nngent, Bir John, 127 

Roberts, 8ir »m., 444 

Rutherford, Prof. William, 222 

Struthore. Sir John, 232 

Tait. Mr. Lawson (Illustrated), 966 

Wallicb, Dr., 3*7 

Wttsoo, Mr. A. H.. Wl 

Objector, the conscientious, 173 
Obstruction, acute intestinal, 
Prof. Berger, 111, 131 
Obstruction, Intestinal, 547 
(Esophagismus, 494 
(Esophagus, nicer of the, Dr. 
Lindsay, 4B7 

OMcere, medical feesamteg poor- 
law, m 


Officer, school medical, 37 
Ogilvie, Dr., the attenuation of 
syphilis, 456 

Oil. the deadly low fl*sh, 18 
Oliver. Dr., adenoma universale 
of the endometium, 3*4; 
disease of the ovary witn 
gonorrho-a, 320 

Ontario, malt husianlsm in, 412 


OPERATING THEATRES. 

Guy’s Hospital— 

Cartilage, dislocated semi¬ 
lunar, 6 12 

Neck, sarcoma of the, 11 
Obstruction, intnettnal, 461 
Pott’s fracture, 143,301 
Sigmoid, large volvulus of, 461 
Tibia, comminuted fracture 
of the, 143 

Tongue, hypertrophy of the, 

sol 

King’s College Hospital— 
Abscess, snbphrenlc, 354 
Cholecystotomy, 118 
Biemorrhage, supposed pon¬ 
tine, 827 

(Esophagus, gastrostomy for 
malignant disease of tbr, 622 
Middlesex Hospital- 
Appendectomy, 540 
Tongue for epithelioma, exci¬ 
sion of the, 376 

Tnmonr, flbro-cyst of uterus 
with an ovarian, 515 
Roval Free Hospital— 
Nephro-litbotomy, 666 
Radical care, operation for the, 
38 

St. Mary’s Hospital- 
Thigh, amputation of the, 488 
Bt. Peter’s Hospital— 

Lithotomy, snpra-pnbic, 540 
Prostatectomy, urethral, 645 
Urethrotomy, internal, 67 
St. Thomas's Hospital- 
Appendix, unusual case of her¬ 
nia of the, 11 

Axilla, removal of carcinoma¬ 
tous glmd from the, 166 
Choledochotomy. 37 
Gastrostomy, 249 
Myeloid of upper and lower 
jaws treated by enodeariou, 
695 

Penis, elephantiasis of icrotom 
and. 192 
l’ymmia, 408 

Ramus, tumour of the ascend¬ 
ing, 167 

Seamen's Branch Hospital- 
Patella, fractured, 92 
Vrethra, ruptured, 364 
Sick Children, Hospital for— 
Empyema, old-standing, 596 
Intussusception, 11 
West-LoDdon Hofpttal— 
Appendicitis, 222 
Stomach, ruptured, 672 
Tetanus, intra cerebral tojec- 
Jection for, 484 
Westminster Hospital— 

1 ithotomy. sopra-puMe, 434 
Testicles, tuberculous disc ise 
of the. M5, c. i 

Thyroid for <’ vspneca, exp loca¬ 
tion of tb" 248 
Tomen, Hosp.tal for— 

Ovaries, dermoid cysts of the, 
278 

Ophthalmic hospital, royal Lon¬ 
don, 23 

Ophthalmia, object-less ns in, 
413 

Ophthalmia, purulent, 171 
Ophthalmology, international 
congress of, 46 
Opticians, certificated, 571 
Organs, disease of the female 
pelvic, 539 

O ganisms, latent, 487 
Orthoform injection of, 90 
Ortboform, treatment of fissures 
of the nipples by, Frof. 
Maygrier. 84 

Orthopaedic hospital,ithe royal, 
602, 638 

Osier, Prof., 628 

Osl*r, Dr., pathology and diagno¬ 
sis or cerebrospinal Lver, 
635 

Oeteo-arthropathy in a child. Dr. 
Whitman, 294 


Ostitis, flbro-plastlc, 539 
Otological congress, 284 
Outlook, the parliamentary. 175 
Ovariotomised patients, the mar¬ 
riage of, 17 

Ovary, transplantation of the 
human, 650 

Owen, Mr., removal of kidney 
from front of sacrum, 475 
Owens college, 574 
Oxide, nitrous, 252 
Oxydol, 153 
Oxygen home, the, 527 
Oxygen, the supply of, 547 
Oyen! oyez! oyei! 494 
Oyster-typhoid, 679 


Pachymeningitis, 190 
Padded room, suicide in a hospi¬ 
tal, 256 

Paris, medical club In. 380 
Parliamentary news, 311,418,444, 
499.624, 550 

Park os’ memorial prize, 308 
Parturition, asphyxia as the de¬ 
termining cause of, 229 


PAST LISTS. 

Aberdeen university, 419 
Apothecaries' ball, Ireland, 235 
Apothecaries, society of Lon¬ 
don. 605, 683 

Army medical service, 205 
Conjoint board, England. 391 
Durham university, 447, 499, 
527 

Edinburgh, royal college of 
surgeons 577 

Edinburgh, royal college cf 
physicians, roval college of 
surgeons and faculty of phy¬ 
sicians and surgeons, Glas¬ 
gow. 153, 419, 473 
Glasgow university, 390,683 
Indian medical service. 206 
Ireland, university of. 473.527 
London, university of, 23, 51 
Naval medical service. 661 
Physicians England, royal 
college of 473 

8nrgeon«, Ireland, royal college 
ef. 259,577.683 
Victoria university, 363, 391 

Paralysis, peripheral, 141 
Patient*, lnnatios as private, 119 
Penal administration, 304 
Penis, cancer of the, 663 
Pen's, tuberculosis of the. 460 
People, the peculiar, 280 
Peptonate, ferro manganese, 659 
Pericardium, ra'cifioation of an 
adherent. Dr. Ewart. 400 
Paricardinm, the role of the. 383 
Peritoneum, syphilis of the. 65 
Peritonitis, Mr. Cathcart, 293 
Perityphlitis. 564 
Pessary holder, a new (illus¬ 
trated), 626 

Pest, laboratory and, 10 
Petroleum bill, the. 306 
Pharma y, the doctorate in, 361 
Pharmacies, a plea for all-night, 
121 

Pharmacopoeia, the Indian and 
colonial, 16 

Pharmaceutic judges, 60S 
Phenalgin, 204 

Philadelphia, typhoid In, 281, 
601 

Phosphorus report, the, 306 
Phthisis, alcoholism and. 467 
Phthisis, curative institution for, 
141 

Phthisis, the sanatorial cure of, 
567, 572 

Physicians of London, royal 
college of, 153 

Physicians of London, the presi¬ 
dency of the royal collegecf, 
359 

Physicat’s examinations, 434 
Picric tcid, 299 

PHkingtoo, Sir George, M.P., 600 
Pinchbeck, titles, 650 
Plague, the, 277.126, 453 
Plague, Dr. Lawrie on the, 70 
Plague in India, 21 


Plague, notes on the. Sir C. Gor 
don. K.C.B.. 815, 396, 426, 453 
Plague, prophylactic measures 
for the, «9 
Pl6sriKy ( 1A4 

Plymouth guardians, the 25* 
Pneumonia, a reported antitoxin 
of, 855 

Pneumonia, double. 230 
Pneumonia, infantile, Professor 
Comby, 155 

Pneamooocct, immunity against, 
221 

Pneumothorax, 11 
Poison romance, another, 860 
Poisoning, carbolic acid, 683 
Poisoner, a scientific literary, 334 
Poisoning, notification of mercu¬ 
rial, 415 

Polyclinic, the new Londcm, 140, 
308,468 

Poor, the sged, 673 
Poor-law medical officers, the 
selection, 542 
Pope, health of the, 255 
Porencephaly, 459 
Post, from pillar to, 230 
Postal medical officers, 683 
Post-mortem case, the bogus, S99 
Power, Mr. D’A., vanishing 
tumour, 263 

Precedent, registration an essen¬ 
tial. 383 

Pregnancy, extra-uterine. 117,300 
Pregnancy, removal of fcotus and 
sac in a case of advanced 
extra-uterine, Mr. M. Robson, 
909 

Predilection, disposition of the. 
37 

Preventive med'eine, the institute 
of, 673 

Primrose league a chari*y, 251 
*’ Private ana confidential,” 18 
Privilege, no medical. 494 
Profession in Ireland, the future 
masters of the, 13 
Progress, the provinces and 
medical, 169 

Prosecution, the right of, 253 
Prostate, enlarged, 253 
Prostate, hypertrophy of the, 352 
Proetate, the results of operations 
for en'arged, Dr. Luuii, 166 
Protargol in urethritis. Dr. Re 
Munn, 45-4 

Protection society, London and 
counties medical, 390 
Pruritus, senile, 66 
Pseudo tetanus. Prof. Escherich, 
28 

Puerperal fever, anti-strepto¬ 
coccic serum in the treatment 
of. 647 

Pue-peralls, neuritis. 626 
Punishment, lunatic attendants 
and corporal, 125 
Pupil phenomenon, undescribed, 

221 

Pyrrmia, artificial abscess in, 356 
Pytrmia, two cases of lateral 
sinus. Dr. Kerr, 136 
Pyelitis, 539 

Pylorus, hypertrophy of the, 363 
Pylori, stenosis, 594 
P^o-pneuraothorax, Prof. Gaj- 

Pyo-ealpinx, doable. Dr. Camp¬ 
bell 532 


g kery, rampant. 15 
k medicines, 677 
ks. a new opening for, 72 
ks, county councils and, 544 
ks. the Guernsey way of 
dealing with, 91 

Quacks in the seventeenth cen¬ 
tury, women, Mr. J.Hogg, 136 

a nolle, the Kaiser Frederick, 539 
ueetions, examination. 310 


Radiography, 620 
Hashes, enemata. Dr. Morrell, 586 
Rates, hospitals and, 96 
Rays, change In the akin pro¬ 
duced by, 190 
Bays, the rontgen, 89 
Reform association, medical, 473 
Reform, hospital. 544 
Reform, medical, 23 
Reform meeting, the Irish medi¬ 
cal association, 254 


Die 


JlIIZGCl DV 


.oogle 



The 


Supplement to 
Medical Preai 


*ud Circular, 


INDEX. 


June 38 th, 1899 


Reform, need of hospital, 519 
Regit ters. the new, 517 
Registration, midwives', 415 
Regulation", new poison, 173 
Registration, the romance of 
medical, 648 
Rejuvenescences, 225 
Representation, direct, 168 
Requirements, army medical, 20 
Research, medical, 551 
Retribution. 441 


REVIEWS. 

African climate, South, Dr. 
Schultz, 128 

Anatomy, pathological, 576 
Bladder, inflammation of the, 
Dr. Moullin. 104 

Children, diseases of. Dr. D. WiL 
liams, 664 

Conjoint-board, guide to the i ex¬ 
aminations by the, Mr. Gant, 
128 

Disinfectants, disinfection and. 
Dr. Rideal. 128 

Dissections, Profe. Cleland and 
Mackay, 654 

Epiphyses, traumatic separation 
of the, Mr. Poland, 472 
Bye diseases of the, Mr. Jessop, 
654 

Eye, examination of the, Mr. 

Snell, 359 
flout. Dr. Luff, 654 
Hygiene, natural, Dr. Lahman, 

380 

Hygiene, packet dictionary of, 
Mr. Kingzett and Dr. Hom- 
fray, 77 

Index-catalogue, 388 
Labour, the anatomy of, Dr. 
Barbour, 653 

Lexicon, Sydenham siciety's, 178 
Lumleian lectures, 576 
Medicine, practice of, Dr.Taylor, 
24 

Medicine, principles and practice 
of. Dr. Osier, 103 
Midwifery, Dr. Playfair, 77 
Myelitis, syphilitic. Dr. Tonr- 
ettes, 104 

Nurses, midwifery for midwives 
and monthly, 78 
Organism, living, Mr. Earl, 78 
Pharmacopoeia, pocket, Mr. 
HudBcn-Cox and Dr. Stokee, 
888 

Pharmacy, year book, 388 
Physiology, manual of. Dr. 
Stewart, 258 

Ringworm, Mr. M. Morris, 104 
Romances, poison, 624 
Sonthwood-Hmith, Dr.,524 
Sorcery, operative, Mr. Waring, 

Surgery, synopsis of, Mr. Tobin, 
128 

Therapeutics Profs. Brouardel 
and Gilbert. 389 

Transactions, clinical society's, 

104 

Tuberculosis, cattle, Dr. Legge 
and Mr. Sessions, 22 
Twentieth century practices, 624 
Varicocele, Mr. Lockwood, 103 
Water, purification of sewage, 
and, Mr. Dibdin, 128 
Windyhaugh, Graham Travers, 
362 

Women, diseases of, Mr. Webster, 
77 ' 

X-rays, M. Bottone, 78 
Tellow fever, Dr. Anderson, 103 

Rheumatism, tonsillitis and, 171 
Rickets, gastric origin of, 174 
R p van Winkle, 230 
Riso flour," 313 

Robinson, Dr., “ daymare," 480 
Robson, Mr. M„ removal of fcctos 
and sac in a case of advanced 
extra-uterine pregnancy, 209 
Rome, British hospital for, 99 
Rontgen photography, the pro¬ 
gress of. 461 

Room, death in a padded, 196 
Royal f ee hospital, 236 
Rubbieh heap, life on a, 307 
Ryall, Mr., abdominal hysterec¬ 
tomy, 870 


Sacrum, removal of kidney from 
front of, Mr. Owen, 476 


Salophen in influenza. 353 
Salpingitis, gonorrheeal, Mr. 

Taylor, 529, 563 
Salpingitis, gonorrheeal, M3 
Sanata, epi-dennitis perforam, 
166 

“ Sanction,” essentiality of, 438 
Sanitation, ideal, 208 
Sanitary science, the perfection 
of, 228 

Sarooma, Coley’s fluid lu, 619 
Sargesnt, Mr., death of, 259 
Saturday fund, hospital, 98 
Sausages, cat’s meat, 521 
Scabies,.Peruvian balsam and, 431 
Scandal, a hospital, 490 
Sclerosis, treatment of arterio, 9 35 
Schools and chiirches, disinfec¬ 
tion of, 572 

Schools, the sanitary inspection 
of, 121 

SCOTLAND. 

Aberdeen, chair of zoology, 257 
Act. the inebriates. 46 
Address, the Lord Rector’s, 309 
At it again, 361 

Charities, a windfall to Glasgow, 
309 

Claim, a strange, 549 
Coats, Prof., the late, 151; pro¬ 
posed memorial to, 175 
Commissions, secret, 469 
Consumpt-oa campaign, 75 
Degrees, honorary, 231 
Department, Glasgow health, 
386,603 

Dbpute. medical election, 523 
Done ? now Is it, 152 
Dundee medical school, 496 
Edinburgh, influenza in, 200 
Sdinbnrgh university, 496 
Epidemic, typhoid, 496 
Examination, the general medi¬ 
cal council and preliminary 
630 

Fees, medical, 257 
Fever hospital, Glasgow, 496 
Fog, Glasgow. 200 
Glagow, medico - chirurgical, 
society, 288 

Glasgow, opening of the summer 
seesion in, 4J0, 574 
Glasgow royal infirmary, 46. 152, 
176, 337 

Glasgow, tuberculous prevention 
movement in, 528 
Glasgow university, 681 
Glasgow university, the vacant 
asseeorship, 232, 361, 443 
Horseplay. 681 
Inebriates act, 416 
Infirmaries, our, 549 
Leith hospital, extension of, 176 
Leith, Mr., appointment of, 652 
Leith, typhus at, 309 
Lunacy board. 257 
Lunacy commissioners, the new, 
837 

Margaret College, Queen, 681 
Medlco-chirurgical society, uni¬ 
versity, 608 

Medical society's dinner. 282 
Midwifery, the study of, 23 
Moderator, a medical, M9 
Murray, Dr., the late, 75 
Notification, medical oppoeitiou 
to, 523 

Ophthalmic institution, 416 
Pathology, the vacant chair of, 
152, 309, 385 

Physiology, the vacint chair of, 
231, 282 

Professors, new, 385 
Refuse, town, 416 
Residency in the royal Edin¬ 
burgh infirmary, 237 
Rutherford, Prof., the late, 231 
St. Mungo's college, 237 
Schafer, Prof., 652 
Sibbold. Dr. John, 337 
Story, Prof,, 200 

Strothers, sir J., the will of the 
late, 470 

Students, discontent of, 231 
Tactics, election, 652 
Victoria infirmary, 361 
Women, new college for, 386 
Women on hospitals and local 
boards, 630 

Women, Queen Margaret’s col¬ 
lege for, 470 
Year, the past, 20 
Seanen’s hospital resignation of 
staff of, 305 

Seamen’s ^hospital society, the 
new medical staff of toe, 601 


Secret commission bill, 467 
Sensational performance again, 
the, 495 

Senn. Dr. Nicholas, 601 
Services, compulBory vaccination 
in the, 179 

8ewere, ventilating, Sir 0. 
Cameron, 062 

Shaw-Mackenzie, Dr., syphilis in 
the army, 1812-1896,184,211 
Shelters, sanitation and salva¬ 
tion. 140 

Shilling a week, for the, 080 
Ships, tuberculous persons on, 546 
Side wind at the royal college of 
physicians, London, 382 
Sinus, thrombus in trarsverse, 91 
Skin disease, general health as a 
factor in. Dr, Dockrell, 506 
Skin, erdema of the, 220 
*• Skirts, trailing,” 440 
Skull, fracture of the, 486 
Slmder, medical action for, 676 
Bladen, Dr., influence of milk on 
the spread i f tuberculosis, 55 
Slaughter-houses, private, 147 
“Sleepiog boys," death of the, 
■ 622 

Small-pox, an epidemic of, 466 
Small-pox, breach of promise 
and, 125 

Small-pox in London, 650 
Small-pox, relative .immunity 
against, 146 

Smoke question, the, Dr. R. Lee, 3 
Smyly, Sir P., reelection of, 151 
Smyly, Dr., deaths after abdo¬ 
minal cuJcitomy, 421 
Snippets, a literature of, 571 
“ S.N.” stout, 576 
Snuff, the taking of, 174 
Soap, swan white floating, 313 
8obrlety, a certificate of, 573 
Societies, friendly, 381 
Soda, antipyrin and salicylate 
of, 230 

Soda, cacodylato of, 618 
Soldiers, lire risks of, 41 
Soloids. carbolic add, 313 
8olullous, saline, 246 
Somatoee again. 10 
Soups, ready-made, 78 
South Africa, the meoical educa¬ 
tion question in, 569 
Southport, the sex problem at, 
361 

Spectacle sellers new diploma, 74 
Sponges, aseptic, 659 
Spleen, ablation of the, 9 
Bquabblo, a bacte.iological, 
174 

Stamp lickera’ tongue, 466, 493 
Stanley hospital, the, 629 
Statistics, vital, 23, 51, 129, 259, 
313, 363, 390, 622 
Steeven’s hospital, 360 
Sterile ? is breast milk, 384 
Stoker, Dr., the oxygen treat¬ 
ment of wounds (illustrated), 
132 

Stomach, dilatation of the. Dr. 
Lichty, 567 

Stomach, foreign bodies in the, 

195 

Stomach, hemorrhage from the, 
518 

Stomach pump, an improvised, 
495 

Stomach, surgery of the, 271, 
Stomach, tuberculous uloer of 
i he, 670 

Stomach, traumatic ulcers of the, 
487 

St. Petersburg, academy of medi¬ 
cine. 19 

Strawberry cure, the, 678 
Streets, watering the, 493 
St. Thomas's hospital, 285, 419 
Students, medical, 486 
Suicide, a would-be, 10 
8aicide, a classical, 198 
Summary, registrar - general’s 
annual, 356 

Sunday fund, hospital, 61 
Surgeons, royal college of, elec¬ 
tion at tne, 650 

Sjrgery, gynacology in relation 
to, Mr. A. Doran, 340 
Surgical instruments, antique, 
281 

Surgery in India, modern, 303 
Surgery, naval and military, 436 
Supnnenals. sarcoma of the, Dr. 
Finny, 401 

Sussex, the new asylum for East, 
95 

Sweating the medical profession, 
649 


Diai 


Sycosis. X-rays and, 564 
Symptom, complex, 354 
Symblepharon, 671 
Sympathetic, section of the, 502 
Syphilis, influence at climate 
and place upon, 646 
Syphilis, the attenuation of, D 
OgUvie, 455 

ByphUts maligna. Prof. Neu¬ 
mann, i 

Syphilis, the Ju>tus test for. 437 
System, Irish union drug con¬ 
tract. 179 


T 

Tachycardia, three cases of, Dr. 
Pinny, 640 

Talt^Mr., conservative surgery. 

Tangle, a sanitary, 465 
Tarda, hereditaria, 539 
Tattooing, 381 
Taxation, new fields for, 385 
Taylor. Mr., gonorrheeal e&lpin- 

S tia, 529, 553 

. swallowed a set of false, 
619 

Tender, doctors at the lowest, 573 
Testator, a wily, 172 
Testicle, tuberculosis of the, 36 
431, 618 

Tetanus, death from, 105, 683 
Tetanus, new method of treat¬ 
ment, 463 

Theatres, smoking In, 600 
Therapy, vibration, 91 
Thomas, Dr„ gonorrhica in the 
male, 481 

Thome, Sir R. Thorne, the ad¬ 
ministrative control of tuber¬ 
culosis. 181, 287,317 
Thyroid, changes in the blood 
after removal of the, 45 
Thyroid gland, pregnancy and 
the, 463 

Thyroid medication, the danger 
of, 64 

Thyroglandin, 283 
Tobacco, the consumption of, 412 
Tomato as a tonic, 572 
Tongue, stamp llckers’, 493, 466 
Tonsurans, trycopbyton, 432 
Tooth, the wrong, 99 
Tonsillitis, rheumatic. Dr. Abra¬ 
hams, 113 

Tourette, Dr., convulsive twitch¬ 
ing. 610 

Tracts, the upper terminations of 
the anterolateral and direct 
cerebellar, Dr. Bruce, 85 
Trading, the perils of patent 
medicine, 679 

TRANSACTIONS OF 
SOCCTIE8. 

Academy op Mbdicisb hi 
Ireland— 

Addison’s disease, 637 
Aniesthetics and urinary secre¬ 
tion, 298 

Aneurysm, innominate, 62 
Aorta, aneurysm of ascending 
arch of, 8 

Aorta, rupture'of the arcending, 7 
Astragalus, fractures of, 219 
Atropny, muscular, 243 
Bacillus, typhoid, 188 
Belfast Samaritan hospital, 560 
Bari beri, 244 

Bladder, carcinoma of the, 483 
Bone, central sarcoma of, 613 
Breast containing new growth, 
404 

Cancer In Ireland, 687 
Cancer, uterine, 661 
Chyluria. 62 

Endocarditis, infective, 613 
Eyeball, advancement of the 
recti muscles of the, 611 
Femora and tibia. 188 
Foot, diseases of tsc, 372 
Heart disease, mercury in, 62 
Hemiplegia, ratal embolic, 482 
Henna, operative treatment of. 
33 

Hodgkins' diseuse, 403 
Insipidus, diabetes, 641 
Ireland, distribution of tubercu¬ 
losis iu, 352 

Knee-joint, Hey’s internal de¬ 
rangement or the, 511 
Lip, epithelioma of, 404 
Man, the sensory dlstributiou of 
the seventh cranial nerve in. 
297 

Meningitis (?) tuberculous, 480 


.oogle 



Supplement to 

The Medical Frees and Circular 


INDEX. 


Anne 28th, 1888. 


Obstruction, intestinal, 220 
(Esophagus, aneurysm of 
descending arch of aorta per¬ 
forating, 8 

(Esophagus, nicer of the, 430 
Pharyngitis, chronic, 637 
Pneumonia, croupous, 403 
Pneumonia, non-febrile, 431 
Reaction, Widal’s, 64 
Room disinfection, 687 
Tachycardia, three fatal cases of, 
041 

Tarsus, dislocation of the meta¬ 
tarsus on the, 613 
Testis, pathological condition of 
the tunica vaginalis, 613 
Tibia, Brodie’s abscess in, 482 
Tuberculosis, bacteriological as- 
poct of, 861 

Tuberculosis, the death-rate 
from, 351 

Tumour, peritoneal, 188 
Ulcer, perforating gastric, 373 
Vrine, secretion or, 297 
Uteri, myoma, 468 
vara, coxa, 33 

Wall, vascular tumours of abdo¬ 
minal, 613 

Balneological andChmato- 
I0GICAL SOCIETY, BRITISH— 
Droitwich brine baths, treat¬ 
ment of neuralgia at the, 669 

Bradford Mbdico-Chirur- 
oical Society - 
dancer, breast, S3 
Cancer, uterus, 512 
Contagion, 512 
Lympno-aarcoma, 139 
Rectum, simple stricture of the, 
374 

Clinical Society of London 
Abscesses, metastatic, 161 
Achondroplasia, 457 
Aneurysm, abdominal, 321 
Ankle-joint, erasion of, 268 
Aortic disease, 458 
Artery, aneurysm of the subcla¬ 
vian, 560 

Artery, wound of a large inguinal, 
401 

Atrophy, muscular, 61 
Brain, revolver sho of the, 457 
Breast, carcinoma of the, 454 
Bright's disease, hxemorrhaglc 
Erythema with, 569 
Bronchi, syphilitic Btenosls of 
both, 401 

Carpus, displacement of tubercu¬ 
lous, 61 
Cases, 216 

Clavicle, fractured, 458 
Colitis, colotomy for chronic, 608 
Cyst, pancreatic, 267 
Cysts, hydatid. 266 
Elephantiasis, 62 
Epiglottis, excision of the pos¬ 
terior half of the, 468 
Femora, solution of continuity of 
botn, 457 

Plexus, injury to the roots of the 
brachial, 468 

Gland, scirrhus carcinoma of the 
parotid, 61 

Humerus, two cases of ununited 
fracture of, 402 
Hypospadias, 61 
Jaw, tumour of the upper, 457 
Kidney, granular, 402 
Measles, progressive atrophy 
after, 61 

Meningocele, excision of a, 468 
Multiplex, lymphangioma tuber¬ 
osum, 322 
Myopathy, 161 

Obstruction, acute intestinal, 559 
Obstruction, pyloric, 822 
Ossificans, myositis. 60 
Paradoxus, paisas, 458 
Paralysis, pseudo-hypertrophic, 
61 

Pemphigus, 61 

l’nyrewva, myositis ossificans, 
217 

Prostate, enlarged, 162 
Respiration, unilateral hyper¬ 
trophy of the accessory 
mnscles of, 458 
Section, abdominal. 113 
Sinus, empyema of the maxil¬ 
lary, 508, 509 
Spleen, enlarged, 61 
Tendo-Lchillis, ossification of 
the, 458 

Thigh, eversion of the, 61 
Tonsillitis, rheumatic, 114 
Tumour, successful removal of a 
largo malignant frontal, 268 


Edinburgh Medico-Chirdb- 
gical Society— 

Addison’s disease, 137 
Oases and specimens, 8 
Fever, typhus, 483 
Kidney, movable, 138 
U8iitis, congenital syphilitic, 
614 

Ozsena, 138 

Rectum, peritonitis as a cause of 
increased peritalsis in the, 
298 

Tracts, the ascending antero¬ 
lateral and direct cerebellar, 

88 

Gynecological Society, 
British— 

Bacteriology, modern doctrine of, 
2SI4 

Ca-liotomy, abdominal causes of 
death after, 428 

Endometrium, adenoma of the, 
351 

Malignnm, dedduoma, 667 
Pregnancy, extra-uterine, 218 
Sarcoma, large Intra-cystic 
mammary, 634 
8alpingitis, discussion on, 635 
Specimens, 217, 294,360 
HarveiAn Society of Lon¬ 
don— 

Accessory nerve, complete para¬ 
lysis of left, 404 
Aneurysm, 484 

Arthrotomy for the relief of pain, 
611 

Ataxy, locomotor, 486 
Eczema, varieties of, 245 
Erythematosus, lupus, 481 
Ether inhaler, 209 
Gout, modem views on, 323 
Hip, dislocation of the, 481 
Heart, dilated, 661 
Humerus, fracture of, 434 
Intestine, malignant growths of 
large, 404 
Mumps, 163 

“ Opinion, the salt of fact,” 115 
Palate, pareses of, 404 
Sclerosis, disseminated, 484 
Syringomyelia, 404 
Torticollis, spasmodic, 405 
Trapezius muscle, paralysis of, 
448 

Vara, coxa, 484 

Liverpool Medical Society 
Children, the paralyses of, 139 
Krox, pruriga, 459 
Kidney, rupture of, 537 
Pulsus paradoxus, 537 
Pyhroplsaly, 459 
Section, vaginal, 269 
Tonsil, removal of tumours be¬ 
hind the, 138 
Ulcer, gastric, 63 
Vacination act, 1898, 63,188 
North of England Obste¬ 
trical AND GYN*COLOGICAL 
Society— 

Amenorrhcra, cases of, 688 
Hfemorrhage, accidental, 246, 324 
Hemorrhage, umbilical, 688 
Hysterectomy, abdominal, 140 
Ovary, sarcoma of the, 246 
Pregnancy, the anto-intoiication 
of. 140 

Pregnancy, fibroids complicating, 
246 

Serum, puerperal septicemia 
treated by anti-streptococcic, 
64 

Specimens. 324, 485,587 
Uterus, chronic inversion of, 588 
Uterus, malignant adenoma of 
the body of the, 485 
Obstetrical Society of 
London— 

Address, annual, 137 
Children, valval dischargee in, 
32 

Eclampsia, puerperal, 372 
Fcetns removed by vaginal in¬ 
cision, 32 

Fibroid, retro-peritoneal, 510 
Hydramnia, 612 
Labour, causes of difficult, 371 
Ligament, fibroid of the broad, 
510 

Monkey, menstruation in a, 371 
Tubal gestation, fatal case of, 609 
Tube, carcinoma of the fallopian, 
243 

Uterus, sarcoma of, 611 
Orthopedic Society— 
Abscesses, tuberculosis, 668 
Oases, 668 


Tibia, intrauterine fracture of 
tbe, 668 
Vara, coxa, 669 
Sheffield Medico • Ohi- 
rcrgical Society - 
Atrophy, progressive muscuVir, 
81 

Casarian section. 431 
Oases, 405 

Diarrhoea, infant feeding and 
epidemic, 89 
Zoster, herpes, 89 
West London Mbdico-Ohi- 
buegical Society— 
Appendicitis, 163 
Oases, 270 

Neuritis, doable optic, 34 
Phthisis, laryngeil, 34 
Surgery, use of gas in general 
ana dental, 486 

Tuberculosis, treatment of, 373 
Ulcer, gastric, 587 

Tremens, delirium, 74. 

Trichinosis 570 

Troops, mortality among Ameri¬ 
can. 179. 280 
Tropic >1 diseases, 520 
Tro^ioa! diseases, new school for, 

Tropical diseases schools, Liver¬ 
pool, 98 

Tropical medicine. 419 
Tropical medicine, London 
school of, 494 

Treatment, £ s. d. of medical. 229 
Tube, a missing drainage, 278 
Tabercniia treatment, 248 
Tuberoukieis, 375, 653 
Tuberculosis and climate, 677 
Tuber, ulosis, auto-auscultation 
in incipient, 680 

Tuberculosis, camphor and pul¬ 
monary, 273 

Tuberculosis crusade, the, 194 
Tuberculosis, high altitudes in, 
412 

Tuberculosis, influence of milk in 
the spread of. Dr. Kanthack 
and Dr. Bladen, 55 
Tuberculosis, international con¬ 
gress on, 150, 594 
Tuberculosis in Ireland, Dr. 
Grimshaw, 346 

Tuberculosis, legislation against, 
879 

Taberculosis, medical officers of 
health and, 307 

Tuberculosis, milk in relation to, 
204 

Tuberculosis, miliary, 538 
Tuberculosis, new treatment for, 
628 

Tuberculosis, open-air treatment 
OT, 360 

Tuberculosis, teucrln and. 117 
Tuberculosis, the administrative 
control of, Sir R. Thorne 
Thorne, 181,287,317 
Taberculosis, the eradication of. 
Dr. Fleming, C.B., 638, 661 
Tuition, po«t-graduate, 566 
rumours, abdominal. 326 
Tumours, ovarian, 620 
Tumours, vanishing, Mr. D’A. 
Power, 263 

Twitching, convulsive, Dr. Tou- 
rette, 610 

Typhus in South London, 368 
Tuberculosis, eradication of, 661 

II 

Ulcer, perforating gastric. Dr. 
Myles, 366 

Ulcer, tuberculous, 327 ’ 

Ulcers, cassaripe in corneal, 334 
Undertakers, charges of, 492 
Undertakers, medical men and, 
466 

Unfit, the elimination of the, 675 
Union, medical, 126, 410 
United Kingdom, a royal aca¬ 
demy of medicine for the, 333 
University college hospital, 205 
University question, the Irish, 275 
University, the London, 203 
Uvula, epithelioma of the, 73 
Unemta, treatment of, 189, 563 
Ureter, two cases of successful 
operation for impacted stone 
in the. Dr. Freyer, 107 
Ureters, catheterisation of the, 91 
Urethral mucous membrane, the 
action of silver nitrate on the, 
116 

Urinary affections, surgical anes¬ 
thesia in, 271 


Urine, bile-cok>arlng matter In, 
487 

Urine, incontinence of, 612 
Urine, the aaepticity of, 268 
U ter as, cancer of the, 406 
Uterus, malignant dlseas) of the. 
Dr. Wlggin, 684 


Vacancies—end of each No. 
Vaccination amendment bill, 230 
Vaccination, tbe agitation 
against. 384 

Vaccination act, tbe new, 601 
Vaccination, certificates of ex¬ 
emption, 178 

Vaccination certificates, 304 
Vaccination officers, boards of 
guardians and the appoint¬ 
ment of, 150, 390 

Vaccination officers, payment or, 
71,390 

Vaccination, prison, 699 
Vaccination, the Insurance offices 
and, 17 

Vaginalis, hydrocele and ever¬ 
sion of the tunica, 191 
Varicose ulcers, 619 
Vascular deficiency, death from, 
433 

Vaults, ancient burial, 198 
Vehicles, infection in public, 368 
Vein, accidental wounds of the 
Internal Jugular. 116 „ 

Venereal diseases, the spread of, 
199 

Venereal, the prevalence of, 438 
Veslcte, ectopia, 91 
Vestry, 8t. ulave’s, 677 
Vibrona, 153 
Vibrona sherry, 561 
Victoria, medical aodety of, 256 
Victoria university, 668 
Vision, physiology of, 148 
Visitors, consumptives as hotel, 
43 

Vivisection, the Yorkshire col- 
lege and, 278 
Vivisection, sport 516 
Vivisectlonists, birthday honours 
and the anti-, 696 
Vomiting, persistent, 513 
Vulvitis in children, 70 

W 

War, X-rays in, 73,148 
Wardrobe, a surgeon's. 644 
Wales, H.R.H. the Prince of, 106 
Wark oase, the, 71 
Waters, rnrated table, 48 
Weber-Parkee prizes, 179 
West Africa, medical officers for, 
174 

Weet, Dr. granular kidney, 167, 
213.261 

West Keut medical society, 627 
West London medico-chirurgical 
society, 79,129 

Widows and orphans of medical 
men, society for the relief, 
of, 79, 419, 606 

Wiggm, Dr., malignant disease 
or the uterus, 684 
Williams, Mr., rachitic deformi¬ 
ties, 399 

Wolfe, Dr., serum inoculation, 

263 

Woman, an ointment, 677 
Women appointments, the.Chel- 
sea hospital for, 279 
Women, Chelsea hospital for, 79 
Women, International congress 
of, 414 

Women, London school of medi¬ 
cine for, 527 

Women, the Reid trust for the 
education of, 206 
Wooden water-pipes, 644 
Work, an old English, 468 
Workhouse nurese, 574 
Workhouses, nurse training for 
Irish, 468 

Worms, intestinal, 646 
Wounds, the oxygen treatment 
of (illustrated^, Dr. Stoker, 
132 

X 

X-rays, injuries from, 661 


I ears ley, Mr., ear complications 
in Influenza, 262 

Z 

Zoster, herpes, 692 


“ 8ALUS POPULI SUPREMA LEX. 


Vol. CXV1IL WEDNESDAY, JANUARY 4, 1899. No. 1. 


'Bkmut (Eiimral lectures. 

THE ETIOLOGY OF SYPHILIS 
MALIGNA. 

By Prof. NEUMANN, MJ). Univ. Vienna. 

At tbe Third International Congress of Dermato¬ 
logy, held in London, Tarnowsky read a paper on tbe 
“ Etiology of Syphilis Maligna,” which was at that 
time, and still is, one of the most obscure sections of 
syphilography. His remarks may be summed up in 
six paragraphs:— 

1. The course of syphilis is unfavourably modified 
and the disease manifests itself in a severe form 
when the organism is infected simultaneously with 
the syphilitic virus and with pyogenic cocci. This 
mixed contagion may have two pathogenic results 
which manifest themselves in the primary, secondary, 
or tertiary stage of syphilis. 

2 When this mixed infection can be clearly dia¬ 
gnosed at an early period of the disease, the charac¬ 
teristic manifestations can be isolated and recorded 
separately. The primary sclerosis presents a peculiar 
course from the very beginning, commencing with 
an acute form of ulceration with a tendency to become 
phagedsenic in character, the latter phase being 
ushered in by a short period of incubation not exceed¬ 
ing three or four weeks, with a well-marked febrile 
eruption of polymorphic pustular syphilides re¬ 
sembling ecthyma superficiale, rupia, or impetigo and 
rupia, with diy papules and macules. The special 
feature of these polymorphic syphilides is to be found 
in the pea-like tubercles forming the inflammatory 
centres which tend to soften, and three or four days 
later break down with the formation of pus and 
debris, leaving a sore that marks the secondary phase 
in syphilitic skin affections. 

3. These purulent syphilitic tubercles contain 
staphylococci aurei or aim, which can be detected 
throughout the whole course of syphilitic condylomata. 

4. A simple primary sore, or erosion, with an in¬ 
durated base and large indolent inguinal glands, 
having all the appearance of ordinary syphilis at the 
beginning, may, by exposing the organism to severe 
infection, so alter the ordinary character of the 
disease as to give rise to those purulent syphilitic 
tubercles on the skin which usher in the malignant 
eruptive disease. 

5. As a general rule the so-called deep ecthyma, 
rupia, and impetigo that occur during the secondary 
stage of the disease, usually precede the development 
of the purulent syphilitic tubercles. In addition to 
these the impetiginous syphilides, such as pustulosa 
orustosa, or the confluent pustular ulcer of the 
secondaries, assume a rapidlv destructive tendency. 

6. These tubercles are not identical with gummatous 
nodes, which develop early, running a rapid and acute 
course, but are easily differentiated by their active 
infectivity. Some doubt exists as to the connection 
they bear to the first *• proruption,” or so-called false 
gummata, which are also infective. 

To this resume of his paper may be added our 
actual knowledge on the subject, in that these puru¬ 
lent syphilitic nodules are to be found in the 


secondary period as well as in the primary, which^is 
now admitted by Tarnowsky himself, who assures us 
that the microscope has convinced him of this fact, 
which, moreover, has been confirmed more recently 
by Wlajew, Tschistjakow, and others. 

A case of this kind, admirably recorded by Tarnow¬ 
sky, has recently come under my own personal notice. 
It is, happily, a comparatively rare disease in Vienna, 
and this leads one to reflect on the difficulties that 
such a morbid process involve in the elucidation of 
controversial points. The most salient point in this 
argument carries us back to the belligerent scenes of 
the past, and raises the oft-disputed and still unde¬ 
cided question, whether this morbid condition 
(syphilis maligna) depends on the quality of the 
virus, or on other factors, such as constitution, idio¬ 
syncrasy or greater susceptibility to the syphilitic 
virus P—all of which are favoured by Tarnowsky’s 
conclusive results. But there is another question 
equally entitled to a reply when considering this 
matter, viz., how far do external circumstances influ¬ 
ence the course of the disease and transform its 
character from one of simple syphilis to the 
malignant forms P Is the virus the same, or is it 
different ab initio 1 or have we yet to discover some 
unknown concurrent factor that differentiates the 
one from the other ? 

On studying the course of the disease from the 
primary invasion to the gummatous stage, plainly 
demonstrated on the skin, mucous membrane and 
tissues, none will dispute that the morbid products 
are due to some syphilitic excitant or toxin. We 
must, therefore, conclude according to the foregoing 
logic that purulent or ulcerative sclerosis is a special 
or exclusive product of the pure syphilitic virus, as 
the pus is produced bv a pyogenic bacterium. At 
the present time we will not pause to consider this 
pyogenic microbe as it matters little for our purpose 
whether the bacterium was in tbe original infection 
in combination with tbe syphilitic virus, or is a later 
importation, 

It is not inadmissible, neither do I deny, that 
purulent accumulations can be produced by certain 
chemical irritants independently of pyogenic bacteria, 
and possi -ly this may be the case with the organic 
virus of syphiliB. The latter assumption muse be 
accepted as purely speculative, and i r , would be 
hazardous to place it on the same footing as the de¬ 
monstrated fact of a pyogenic microbe being present 
which must have been introduced ab initio, or during 
the progress of the disease. 

We must, therefore, conclude that this product is 
the result of a mixed infection of syphilitic virus 
and pyogenic virus, and that every purulent sclerosis 
is a mixed centre of this infection. 

Now daily experience, teaches us that the greater 
number of these purulent sclerotic cases run the 
usual course of tbe disease, and are seldom followed 
by the malignant form referred to. It must also be 
patent to every observer that the pathogenic element 
of syphilis, and the pyogenic cocci, or mixed infec¬ 
tion of Tarnowsky, per se, do not alter the usual 
course of the syphilitic virus, or by their com¬ 
bined presence invariably produce the dreaded form 
of syphilis maligna, otherwise the disease would be 


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more prevalent than we usually observe it to be. We 
consequently must conclude that some other factor, 
or factor, must be sought for to explain these rare 
individual cases of such interest and importance. 

From these conflicting deductions on the origin of 
malignant syphilis, we are forced to exclaim in the 
words of Jullien, “ II est peu nrobable qu’il faille 
accuser en pared cas la nocuite particuliere de la 
grains virulente," a general expression used long ago 
and just as applicable to-day, with regard to the 
nature of the virus as it was in his time. We are 
thus compelled to admit that a purulent sclerosis 
exists in both malignant and simple syphilis, that on 
the inception of the former the virus implanted is 
more individually severe on the organism, and 
when favoured by external influences the malignant 
condition is induced terminating fatally. Tarnowsky 
acknowledges this in his arguments, although he 
attempts to prove that the association of the pyogenic 
cocci must be present, and adds that alcoholism, 
duberculosis, scrofula, scurvy, diabetes, or other 
tebilitating conditions of the system tend to affect 
the virulence of sypoilis, and increase its intensity. 
Daily experience also proves the converse, viz., that 
many very severe cases of syphilis by careful treat¬ 
ment, and hygienic attention are converted into a 
simple and benign character, which otherwise would, 
in all probability, have proved malignant. There is 
another point in Tarnowsky’s arguments that is in 
conflict with experience. His teaching is that if one 
be infected with a benign virus of syphilis the course 
of the disease must necessarily be simple. Now the 
obverse of this is the daily experience of every 
syphiloligist, viz., that infection form a simple c«se 
may assume a very virulent type, and even terminate 
in the malignant form. 

Tarnowsky records another peculiar condition very i 
oommonly observed that, although the dry sclerotic 
or papular form, has no pyogenic bacteria in the early 
stage, yet a pustular eruption follows. Now, if the 
primary quality of the syphilitic virus indicated its 
virulence, the manifestations of the future reaction 
on the organism should appear in some definite 
form, thus indicating the potency of the toxin and its 
attributes on the organism in preeenti et pro futuro. 
If, for example, a patient be infected with benign 
syphilis, and pass on to ulcerative sclerosis, while a ! 
second patient, infected from the same source runs 
rapidly into a phagedtenic sore with lymphangitis and 
euormous swelling of glands nothing can be dis¬ 
covered in the source to differentiate these two cases; 
the bacteriology is the same, pyogenic oocci being 
found in both, and both may have a favourable 
termination. 

This plural connection of virus and cocci in the 
primary stage of syphilis is admitted by every care¬ 
ful observer, yet Tarnowsky’s results are invariably 
absent. All are cognisant of the dangers that may 
possibly arise when the products of mixed forms are 
thrown into the system, as “ papules in the mouth 
are prone to produce pyogenic bacteria ” “ the fissures 
on the tongue are often covered with a grey purulent 
coating from pyogenic cocci ’ which are acknow¬ 
ledged to be severe complications. Many other 
authors, such as Hallopeau, Jaenseiine, <fcc., have 
demonstrated this pyogenic combination in the nose 
and pharynx, as well as the purulent dermatose con¬ 
dition which they have ingeniously designated 
“ Biopsia,” bnt none of them have been able to come 
to conclusions in favour of the view that these mul¬ 
tiple oentres are all malignant, nor do they believe in 
two pathogenic causes, the one benign, the other 
malignant, because very few of the cases assume the 
latter unpropitious properties. 

Before this question can be settled several answers 
are neoessary. We are foroed to admit that the pro¬ 
duct of this mixed infection is largely affected by 


external circumstances. If no pyogenic bacteria are 
found in the organisms from the centres of invasion 
by which syphilis, is known to enter; can we confi¬ 
dently say that the organism is perfectly free from 
malignant syphilis? No affirmative reply can be 
-vouchsafed, because no positive proof is forthcoming 
to establish the presence or non-presence of the 
yogenic cocci in the original virus. There are, 
owever, individual cases which become malignant, 
while the greater number do not though inoculated 
with the same virus. Why should the former become 
pysemic while the latter are exempt? I think we may 
safely conclude that there are external conditions 
which modify, and so alter the course of the disease 
as to transform a simple into a malignant case; and 
the most powerful of these external agents are 
alcohol, tuterculosis, diabetes, malaria, &c. These 
again can be so modified and altered by therapeutical 
and hygienic measures and by condition of environ¬ 
ment, and mode of life, as to obviate the malignity of 
very ominous and threatening cases. 

Tarnowsky, though strongly advocating his pysemic 
theory, makes a few assertions in his concluding 
remarks, which would lead us to believe he has 
very little faith in his own hypotheses. He 
tells us: “ the problem of mixed infection is not yet 
conclusively solved.” “ All the elements of purulent 
syphilis with their conditions are not yet sufficiently 
known,” while he admits that chronic alcoholism 
acting in the blood-vessels of liver, kidneys, &c., may 
pervert very innocent cases by checking elimination, 
and thus lead to imprisonment of the pysemic 
infection, and its products, thus intensifying the 
syphilitic virus. 

We have yet to prove that the pyogenic bacteria of 
syphilis maligna constitute the principal factor in 
the production of this intractable disease. They are 
admittedly associated with the malignant state; but 
how far the pyogenic bacteria are entitled to be re¬ 
garded as an setiological cause, it is at present diffi¬ 
cult co determine. Pending the discovery of the 
potent factors that govern the disease, Tarnowsky 
merits our best thanks for the suggestion of an early 
introduction of the pyogenic germ before pustular 
eruption or efflorescence. Though largely hypo¬ 
thetical. his view is rational enough, but it proves 
fallacious in practice. The susceptibility of this 
mixed infection must also be influenced by the dis¬ 
position of the individual; in one it may be intense, 
while another may experience little of its action, and 
this, moreover, may even be only temporary in its 
duration. The precocious cases, i.e., where later 
forms appear among the early symptoms, running a 
fulminating course with a destructive tendency, and 
having the pyogenic bacteria, have no pathogno¬ 
monic indication to prove the malignancy; out other 
hypothetical factors added on to these conditions 
foretell grave results. The syphilitic virus,combined 
with pyeemic infection, is undeniably a severe form of 
common syphilis, but it carries no assurance that it 
will in future become malignant. 

In the tertiary stage of syphilis the purulent dis¬ 
charge is profuse, from sores on the rectum, genitals, 
gumma, &c., with frequent toxic erythema multiforma, 
yet the formation of pus usually ceases, and the 
discharge ultimately resumes its normal character. 
Fournier affirms that sores in the pharynx with 
pyogenic oocci, and great disturbances of tissue pass 
off as simple sores without any apparent invasion of 
pysemic symptoms, and all this tends to prove that 
certain unknown factors must be associated with 
these specific conditions to produce the malignant 
result. Experiment on dogs with thermic, mechanical 
and chemical irritants in combination with different 
bacteria have failed to produoe the malignant result. 

I Wurtz and Hudel’B experiments, especially with 
alcohol, equally failed to produce the desired 


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The Medical Pbess. 3 


result. It follows that the individual specific reaction 
of the tissues is influenced by the pathogenic opera¬ 
tion of the several factors, and that the pathogenic 
bacteria and purulent processes are mere incidentals 
occurring in the progress of the disease. We may, 
therefore, conclude that early severe symptoms of 
syphilis do not form essentially characteristic 
phenomena of syphilis maligna; neither can we 
prove that rapidity of course or phagedaenic tendencies 
will always lead to pysemic infection. 


TWO CASES OF 

PERFORATION OF THE UTERUS 

DURING CURETTAGE. 

By GEORGE ELDER, M.D., 

Vice-President, British Gynecological Society, late Senior Surgeon 
to the Samaritan Hospital for Women, Nottingham. 

In the November number of the Medical and Sur¬ 
gical Review of Reviews reference is made to several 
cases recently reported of uterine perforation by 
sound and curette, and also of a case where apparently 
an unduly patulous Fallopian tube caused a simulation 
of the accident. In addition, two cases of apparent 
perforation are quoted from Bentauer (Centralblatt 
fur Oynecologie No. 42, 1897), which he endeavours 
to explain on the assumption that occasionally during 
manipulation the uterine muscle becomes so relaxed 
or so elastic that it readily yields to the pressure of 
an instrument. These and many other cases related 
in various journals and recent books on gynaecology 
(notably in Kelly’s “ Operative Gynsecology,” Vol.Y., 
p. 479), which proved that the danger of perforation 
of the uterus is not so rare as generally is imagined, 
and that occasionally it is followed by fatal results, 
prompts me to give my own personal experience 
of the accident, more especially as I have heard a very 
eminent gynaecologist scoff at the possibility of a 
sound perforating the uterus, a state of scepticism 
which, when it finds expression in speech or writing, 
is apt to give an impetus to the already too frequent 
and incautious use of instruments. 

My experience is limited to two cases which, curi¬ 
ously enough, happened within a few weeks of each 
other. 

The first occurred in the person of the wife of a 
medical man in the country, who was suffering from 
persistent metrorrhagia after a premature birth, 
which rest and the usual medicinal remedies had 
failed to check. The patient was a young, healthy 
woman—the mother of two children—and with no 
record of previous uterine mischief. Ether was given 
by my late colleague, Dr. Truman, and as is my 
custom I examined the uterus bi-manually to ascer¬ 
tain its size, direction, and freedom from tubal or 
ovarian inflammatory mischief likely to contra¬ 
indicate instrumental interference, and then dilated 
with Hegar’s dilators. This was quickly and easily 
done and a blunt curette introduced when, to my 
astonishment, it passed in without any sensible 
obstruction until ail but the handle had disappeared. 
A sound penetrated in the same manner, and the point 
of it could distinctly be felt under the abdominal 
parieties. Beyond packing tbe uterine cavity and 
vagina with iodoform gauze nothing further was done, 
and to my relief convalescence was smooth and 
uneventful 

The value of dilatation alone in such cases was 
shown by the patient having no return of the uterine 
hamorrhage. A few weeks afterwards Dr. Huth- 
waite, lately of Sandiacre, near Nottingham, and now 
of Skipton, asked me to curette a young woman for 
post-puerperal endometritis. Coming so soon after 
the other, even more than the usual care was taken.in 
dilatation, and, just as in the previous case, the curette 


had hardly been used befora the same accident 
occurred. To prove the matter beyond a doubt, a 
piece of Dowel presented in the cervical canal. This I 
replaced and packed the u'erine cavity and vagina, as 
before, with gauze This patient also seemed none 
the worse for the perforation and recovered well. 

In both of my cases I am disposed to believe that 
the damage was done by the dilator and not by the 
curette, inasmuch as curettage had barely commenced 
before the perforation declared itself. 

Curettage has now become so well established in 
the treatment and diagnosis of intra-uterine troubles 
that one is apt to lose sight of its dangers and adopt 
it, when other and safer procedures might be substi¬ 
tuted. It is well known that the uterine walls are 
softened and thinned by recent abortions or labours 
at term, by sepsis, and by cancerous, sarcomatous, 
and tuberculous degeneration—conditions most ex¬ 
posed to injunr from instruments—and it is just in 
these cases, whether for the removal of decidual re¬ 
mains or the clearing up of diagnostic doubts, that 
digital exploration is of service. 

Adopting this method would greatly limit the need 
for curettage, and in the latter event the risk of 
accident is much diminished by a preliminary bi¬ 
manual examination of the parts to ascertain the 
< ondition of the appendages and the direction of the 
uterine body. The selection of a means of dilatation, 
is of great moment. Tents for this purpose on 
account of the danger of sepsis are, I take it, now 
almost obsolete. 

On account of their tendency to tear the tissues 
by reason of their shape, I have recently discarded 
Hegar's dilator for a modification—conical shaped— 
instead of cylindrical; and more finely graduated. 
Unless for scraping away malignant tissue, I always 
use a blunt curette. 

Now, with regard to the treatment of perforation, 
assuming that all needful antiseptic precautions have 
been taken before and during the operation; the 
packing with iodoform gauze is, it seems to me, the 
best, leaving graver operations, such as opening the 
abdominal cavity, and suturing the rent or removing 
the septic uterus, for future consideration should the 
symptoms poino towards them 

It is only in a very small minority that such 
occasions will arise. 


THE SMOKE QUESTION 

By ROBERT LEE, M.D.Cantab., F.R.C.P.Lond. 

Late Chemical Scholar of Caiiu College Cambridge; and Lecturer 
on Forensic Medicine and Pathology at the Westminster 
Hospital, 4c., 4c. 

There is no doubt as to the smoke question being 
one of great interest to all metobers of the medical 
profession, and one that can be better discussed by 
them than by any other class of educated men. It is 
a question which requires some knowledge of 
chemistry, of physics, and of physiology to enable 
us to deal with it properly. To understand how 
smoke is produced, in fact to answer the simple 
question, What is smoke ? is not as easy as may be 
thought; and it must be answered before we can 
hope to prevent smoke. We have also to understand 
the physics of ventilation, a subject by no means 
simple, but on the knowledge of which the construc¬ 
tion of our chimneys and firepla es depends. The 
architect cannot be expected to know very much of 
either the chemistry or physics of the smoke ques¬ 
tion ; and as regards its physiology, the public must 
come to Officers of Health, those who have made 
sanitary science a matter of study, ana to the medical 
rofession generally for an opinion on the injury 
one by smoke. 

If we wanted to explain this matter to anyone who 

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ORIGINAL COMMUNICATIONS. 


Jan. 4. 1899. 


knows nothing of chemistry, physics, or physiology; 
and many are in that happy state of. ignorance ; we 
could not do better than take a common paraffin lamp 
and light it, and ask our pupil to look at the smoky 
flame when there is no chimney on. And if we slowly 
put the chimney over the flame we show how the 
flame becomes brighter as' we lower the chimney, and 
at last when it is fixed the smoke has disappeared, 
and the flame burns bright and clear. 

That petroleum lamp, when it is lighted, is rather 
like a living animal. It must have air, pure and 
abundant, if it is to burn well. The chimney pro¬ 
vides this air, and the way in which it brings air right 
into the flame, and thus supplies it with the oxygen 
it requires to make it burn properly. 

We can go on and explain how it is that smoke is 
produced when anything is ignited and bums. If 
the combustion is perfect there will be no smoke; 
and perfect combustion is the result of proper 
combination of the carbon of which the substance is 
composed, with oxygen, so that these elements unite 
and form carbonic acid and carbonic oxide gases, 
and no smoke is occasioned. 

But if some of the carbon escapes, not united, be¬ 
cause it is not supplied with oxygen to form one of 
the gases, the result is smoke. The question then of 
how we are to get rid of smoke, reduces itself to the 
problem, how can we supply air or oxygen in such 
quantity that no carbon can escape free, ununited with 
oxygen. 

When we try and treat an open fire in an ordinary 
grate, much in the same way as we have treated a 
petroleum lamp when we put the chimney on, and 
get a bright flame, we may succeed in preventing the 
smoke whioh coal usually produces. 

But there is a great difference between different 
kinds of coal when being burnt. Some will produce 
smoke very easily, and some, such as anthracite, will 
not bum unless then have a good supply of air. 

The question we have to consider ib how our fire¬ 
places or grates can be constructed so that they may 
ensure the proper combustion of the fuel we are using, 
much on the same principle as the chimney of the 
paraffin lamp secures the proper combustion of the 
oil. If we take a glass chimney and cut away two 
or three inches of the lower part, so that the burning 
wick on one side is not covered in, we find that smoke 
is produced on account of air passing over the flame 
ana not through it. In our ordinary grates the space 
above the bars is so great that smoke is inevitable. 

Now, there is a. curious fact which is known to 
very few, and that is that a great deal more air 
passes through the top of the open part of the grate 
than over the top bar. This is best shown by holding 
an anemometer just above the top bar when a fire is 
burning, and then raising it slowly straight up 
towards the top. We often find that the anemometer 
does not register more than 10 or 15 feet per minute 
just above the top bar, but at the highest point it 
registers 250 or more. The reason of this we will not 
now discuss, but we can see that the chief point to 
attend to is the prevention of this passage of air above 
the fire instead of through it. 

If we wish to prevent smoke and obtain perfect 
combustion of fuel we must in some way lower the 
chimney and bring it down towards the top bar. Of 
course we can do this by putting on a blower. The 
effect of the blower iB to cause air to pass through the 
fuel. By this, the combustion of the fuel is greatly 
increased and the draught up the chimney is more 
active. We do not gain anything, however, by 4 he 
blower, as the increase of heat is only expended in 
making more draught, and not in making our room 
warmer. We must in seme way prevent the heat 
from escaping so rapidly, and this can only be done 
by a damper or something to arrest the passage of 
the heated air. If we calculate carefully the size of 


the blower and the damper and use these two properly, 
we can prevent smoke and save about half our coal. 

When we compare an open fire-place to a closed 
stove, we can appreciate the advantages and dis¬ 
advantages of each. The open fire-place is a good 
ventilator, the closed stove is a bad one. The open 
fire-place causes ^reat loss of heat, the closed stove is 
the great economiser of it. The one is healthy, the 
other is unhealthy, so far as ventilation is concerned. 
It is probable that if we can obtain a medium between 
these two we may safely go, in medio tutisgimus. It 
is probable that this medium will soon be found, if 
it is not already thought out; and if the science of 
our fire-place is understood, any method proposed to 
us may he fairly criticised by those who understand 
why smoke is caused and how it can be prevented. 


^he Hartman hectares, 1898. 

ON DISEASE AND ITS TREATMENT 


AND THX 

PROFESSION OF MEDICINE 

IN THX 

YEAR 1899. (a) 

By WM. EWART, M.D., F.R.C.P., 

Senior Physician to St. George’s Hospital, and Joint Lecturer on 
Medicine to the Medical School; Senior Physician to the 
Belgrade Hospital for Children. 

Lkcturk III.—EDUCATION AND MEDICAL 
PRACTICE. 


Our attention is claimed to-day by the Medical Pro¬ 
fession, its labours, its difficulties, its prospects, and its 
rewards; but the future of medical education and some 
questions of practice bearing upon our status will be 
dealt with more prominently. 

The lateral pressure from which we have suffered will 
probably be relieved for the growing generation. The 
world is expanding at a rate for which there is no 
parallel in history. An entire continent has not only 
been explored within a few years, but is being wired and 
railed, and the machinery of civilization called into 
existence simultaneously at many centres. China may 
soon offer a field where the English physician may come 
into fashion. The colonies, especially those where gold is 
the attraction, are only beginning their period of expan 
sion. But we must realize that Canada, Australia, and 
New Zealand are no longer dependant upon home supply. 
They are now medically self-supporting; the pupils of 
their universities come home for the study of special 
subjeote and to watch our clinical practice, but they are 
already fully qualified, and their numbers are sufficient 
for the local needs. 

Our worst pressure has been from below, and to this 
we sha'l presently revert. From above our limitations 
arise from too much or too little legislation. Of late 
instances have not been wanting in which the unreason¬ 
ing opposition of the uneducated vote, or that from noisy 
or hysterical sections has been brought to bear against 
us with the sanction of the law. Thus some of our 
professional events have been retrograde. I need not 
dwell upon achievements such as ihe ticket-of-leave 
given to small-pox and syphilis, and the setting back of 
the clock of experimental science. 

These evils were avoidable. Fortunately they may 
yet be remedied, but for the loss of irrevocable time. 
Compared with the dealings of those well-ru : ed nations, 
whose progress is not allowed to swerve from common 
Bense, and who follow a straight road to any social object, 
in this country we are, thanks to those manmuvres, left 
hopelessly behind, electing to follow where we might lead. 
These risks and delays are the sport which delights a free 
people,and in favour of which it can only be said that by 

(«) Lecture delivered before the Harveian Society of London, 
Dec. 15th, 1898. 


izea Dy 


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ORIGINAL COMMUNICATIONS. 


The Medical Press. 5 


■way of compensation it perhaps keeps us active and in 
fighting condition. 

Other reforms are of onr own making; they bear upon 
medical education and examinations, and upon the rules 
which govern our mutual relations and our relations to 
the public and to the State. Well considered and mea¬ 
sured to suit the times, they may not always be adapted 
to meet all future needs. But they cannot again be 
modified until after a period of friction which makes us 
long for the next change, and yet dread the unknown 
complications which it may cover. 

Professional Altruism and Self-Sacrifice. 

To practice medicine is to learn that our lives belong 
to others rather than to ourselves. There is an uncon¬ 
scious and passive altruism in the lives of most men; 
they are unaware that they are wearing themselves out 
for the sake of their fellow men. Our altruism is both 
conscious and intended; it is an active altruism. It 
would be difficult to find a more striking sight than that 
of a whole profession working strenuously for the sake 
of its fellow-creatures, at the systematic destruction of 
its own means of support. Is any disease voluntarily 
allowed to survive in the individual or in the community, 
any contagion given free scope, any sanitary defect left 
unobserved and uncorrected, any oppressive or dele¬ 
terious conditions of labour allowed to proceed un¬ 
checked P It is left for others outside the profession to 
marshal every resouroe of ignorance and prejudice for 
thepurpose of keeping alive fatal diseases. 

The same unreckoning policy has led us to instruct 
our patients in practical matters of health. Institutions 
have been started for teaching the principles of hygiene 
and of elementary treatment, and First-Aid Societies 
have been multiplied over the country, every opportunity 
being utilised to spread among the public an ample 
knowledge of the arcana of medicine; and with the same 
view medical writers are now lending their pen to the 
Press. 

But there are limits beyond which generosity itself 
ceases to be wise, and fails in its purpose. The quality 
of work deteriorates when, instead of strengthening, it 
wears the labourer; and to avoid this is of importance, 
not alone to the profession. 

While the earnings of other workers have been rising 
with the general increase in our national prosperity, the 
reverse has happened with us, and events have brought 
about difficulties for which none can be held respon¬ 
sible. All sections of the profession have felt them, each 
section imagining itself to be the only one to suffer. 

To put the matter briefly, there are, perhaps, not too 
many medical men, but whilst there might be work for 
all, this is neither properly apportioned nor paid for. 
Of the two chief contributory factors, the over-crowd¬ 
ing of the profession is, to my thinking, the least. But 
the opportunities for practice have been restricted by 
science and by charity. And it is now manifest that by 
seeking some relief from their difficulties in the provi¬ 
dent system, individual members have helped to restrict 
the supply of employment for the profession. 

The Provident System and its Problems. 

In its ideal form the provident system seeks to secure 
the greatest good to the greatest number, benefiting 
alike the deserving poor and the profession. Its prin¬ 
ciple is the insurance of the healthy against the expenses 
of future illness. That principle has been accepted by 
the profession as belonging to our scheme of usefulness, 
and as tending to professional advantage if only it were 
fairly worked. Our services are for many a necessity, 
and it is right that they should be within the reach of 
those for whom they are intended. 

The poorer patients have five courses open to them: 

(1) 8ome of them are sufficiently near the margin of 
pauperism to enable them to obtain Poor-law relief 

(2) Many of them apply to the chemist for advice and 
medicine, and this largely keeps up the practice of 
counter prescribing. (3) Others are anxious for treat¬ 
ment by hospital physicians and surgeons, and endeavour 
to obtain it at the hospital for which they have a pre¬ 
dilection, though this may not be the nearest one to their 
own home. (4) A large number enrol themselves in the 
lists of the provident dispensaries and of the dubs. (5) 


Others prefer to get their advioe independently, and at the 
time when they think they need it. If the medical man’s 
charges should be prohibitive he would drive this humble 
practice into the other channels which have been indi¬ 
cated. In order to meet the necessities of the case there 
must be for his advioe a sliding scale within the reach of 
the humblest means. This una\ oidable smallness of re¬ 
muneration is a reason for his preferring a system 
where it is to a certain extent disguised. Unfortunately 
the slender compensation so well deserved has been only 
partially reaped by the profession. Benevolent in its 
intent, oo-operation has opened the door to novel 
dangers and abuses of which the practitioner is ulti¬ 
mately the victim. 

The Provident Association .—The beneficent institutions 
known as dispensaries seek to be self-supporting; but a 
charitable interest is taken in their management by mem¬ 
bers of a richer class, and this is a saving clause, for much 
depends upon the spirit of those who administer as well 
as of those who receive the relief. The collateral 
advantages which are opened up to those who serve a 
well-conducted dispensary render it a matter for regret 
that it has not been found practicable to extend them to 
all the local practitioners, or at least to as many as may 
wish to participate The remuneration itself is small, 
but it is fairly divided according to the work done. 

The difference between these institutions and the 
friendly societies is fundamental; in the latter the 
softening element of charity iB less prominent, and that 
of sentiment is not included. In early days the medical 
man’s willingness to help them may have been con¬ 
sidered a favour. This is now changed, and they have 
not always refrained from turning his difficulties to 
account. Other associations, built purely upon the 
principle of commercial insurance, although business¬ 
like in some directions, are free from any scruples con¬ 
nected with medical etiquette, and in other directions 
there is less regard than in the friendly societies for the 
individual interests and for the professional dignity of 
the medical officer. 

The Prevalent Abuses. 

The defects which have arisen are clearly uninten¬ 
tional, and the outcome of ordinary economical prin¬ 
ciples. They include: (1) The obviously inadequate 
remuneration for excessive work and responsibility; and 
(2) the unjust appropriation of advantages intended for 
the poor by those able to pay. 

Were the charitable ministrations bestowed only on 
the deserving poor, their cost would be a lighter burden. 
But it is well known that, owing to imperfect checks, and 
to the failure to realise the fault of which they are 
guilty, many thoughtless individuals receive relief who 
are really able to pay a fair honorarium for private 
attendance, and this is contrary to the intentions of those 
who manage these institutions. 

This abuse is not sufficiently guarded against in the 
organisation of clubs. Some men of substance are ad¬ 
mitted as members, or retain a membership assumed in 
less prosperous days, and do not refrain from getting 
their medical advice at an almost gratuitous rate. The 
practice of others is made to suffer besides that of the 
medical officer, for should he fail to meet cheerfully the 
behests of his employers, or refuse to submit to a reduc¬ 
tion, the club may find a stranger to fill his place, and 
this will mean additional competition in an already 
restricted field of practioe. 

The worse troubles arise in connection with the 
medical aid societies. They actively canvass the public. 
Their medical officer is advertised—not always fairly, it 
is said—but he may have to suffer for the advertisement. 
And the climax is reached when he is victimised not only 
by the societies but by intermediate agents Instances 
have often occurred when agents have induced people 
to ensure, and to transfer themselves from the private 
list to the club list of the same nodical man. 

The Detriment to the Profestion .—Diminution in prac¬ 
tice goes hand in hand with a lessened value set upon 
■professional services. But the worst aspect of the whole 
position is the further decline in dignity and emolument 
due to the fact that, small as may be the pittance, it has 
its market, and any competition oan only lower its 
figures. The low value which is thus forced by contract 



6 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


Jan. 4. 1899. 


reacts upon the remuneration of others, who but for i 
this would have been in a position to resist the un¬ 
merited depreciation of their services. Thus special cor¬ 
rectives are needed against the evils known as the 
tyranny of the clubs, the lowering of the fees by compe¬ 
tition, the exploitation by medical aid societies, the 
underselling of medical work, the insufficient wage 
limit, and also the admission of women and children at a 
lower subscription than men, though they need more 
attention, and previously contributed to private practice. 

The Rbhedy. 

Where is the remedy to come from ? Its possible 
sources are: State interference, corporate action, inde- 
ndent combination within the profession, which might 
purely local or more general, and education. 

Some action has already been taken, especially in the 
direction of local combination. Much credit is due to 
various local groups for their energy and success, and 
their example may tell at a distance. Indeed, it has 
suggested the idea of an extended combination, which 
might include representatives of all local associations, and 
through them of all practitioners interested in the provi¬ 
dent system. 

A totally distinct action has also been proposed, that 
of State aid in this difficult matter. This is a remedy 
not without a danger, for if the State is to come to our 
assistance it is possible that its inelastic control might 
fall heavily upon us, and trammel us, when it vould be 
much to our advantage to be free. 

But leaving State control aside, their remains the offi¬ 
cial action of the professional governing bodies, who 
alone oan speak for the entire profession If I mistake 
not, there is a strong feeling abroad that these difficul¬ 
ties should be notioed officially ; but others are inclined 
to think that the profession ought not to be committed, 
and that independent combination should be able to 
provide a remedy. 

Between courses bo different it is difficult to choose. 
One of them pledges the profession, the other allows free 
scope to self-government without the assumption of too 
onerous a responsibility. * 

Self-help is sound policy, but in this matter it is re¬ 
garded with good reason as unequal to the task. There 
is a difficulty in repudiating arrangements firmly rooted 
in localities; and any efforts in that direction are but too 
likely to be defeated by the action of members of the 
profession who are outside these local combinations. To 
meet this difficulty, it is not to be wondered at that the 
General Medical Council Bhould be appealed to for an 
exercise of their power to approve those arrangements 
which have been found most suitable in the various dis¬ 
tricts, and to restrain registered practitioners from an 
unprofessional intrusion which tends to render joint 
efforts nugatory. This would doubtless afford the easiest 
way out of the present complication, provided it could 
safely be resorted to without prejudice to future advan¬ 
tage. It must not be forgotten that a march has been 
stolen upon the profession owing to too isolated 
action, and it is to be feared that the local com¬ 
binations must remain hampered by the influence 
of these unfortunate beginnings, and that their 
proposals might not come up to the level which 
the profession may have in prospect when the time 
comes for corporate and truly representative action. 
In view of that object it might be undesirable that the 
profession should stand committed to any adjustment 
arrived at locally or even by a combination of many local 
groups. Indeed, there might be a danger lest any larger 
combination might wear in the eyes of the public an im 
portance other than that which it claimed for itself, and 
De thought to carry a mandate from the profession. In 
this respect there is perhaps an advantage in combina¬ 
tion preserving for the present its purely local character. 

The Reasons for Delay .—In favour of a policy of wait¬ 
ing the fact should be remembered that we are still 
within the period of transition, and that we cannot yet 
foretell the proportions which the co-operative treatment 
may ultimately attain. One point appears to be clear. 
Any final settlement should be made on an independent 
basis. A privilege usurped, however unintentional the 
usurpation, is not from the standpoint of the injured i 
party a fair basis for negotiation. All local attempts at 


readjustment must suffer from this disadvantage.It 
must be made evident that the profession repudiates the 
estimate which has unfortunately been placed upon the 
value of the services of its members. Though I may 
not have much support in leaning towards cautious 
delay in any comprehensive handling of the difficulty, I 
feel sure that I am with all of you in thinking that its 
study cannot be safely postponed, and that it should 
engage the earnest and early attention of our authori¬ 
ties. 

The Remedy from Education of the Public and the Pro¬ 
fession. —There is a different remedy, most effectual, but 
slow—the teaching and the appreciation of that which 
we owe to ourselves and which is due to us by the publio. 
On onr side, the great body of the profession are guided 
by those high principles which are being universally 
taught. The dangerous few must be either educated up 
to its level or kept out. 

It is difficult to overrate the influence which can be 
exercised on the minds and dispositions of our pupils 
whilst they are passing through the medical schools. 
More may be done perhaps to raise in their youthful 
mind a superior ideal of the dignity and of the unity of 
the profession. Men cast in this mould might be 
allowed to shape the higher interests of the profession 
wherever they go. 

Much more general is the lack of due appreciation on 
the part of the public, especially among the lowerelassee, 
who are not unlikely at times to misinterpret the most 
charitable intentions. Literature might do much to 
enlighten them as to our position; and in the recent 
lofty achievements of the profession there is a theme 
which, if properly handled, might work in the direction 
which is wanted. 

The remedy would thus consist first and foremost in 
the cultivation of a high ideal in the study of medicine, 
and, in the second place, of the authoritative influence 
which combined action might exercise upon the Press. 

Medical Education. 

Examinations are a necessary evil. The public must 
be protected, and a mass of important facts must be 
grasped by the student. But under this load the freedom 
both of study and of teaching suffers, and imagination 
and original thought are less developed than memory. 
We have recently hoard from authorities thst the burden 
of scientific facts is becoming intolerable foi the student 
of medicine, and that some part of the burden must be 
removed ; and, in anticipation of a yet distant revision, 
it may be permitted me to bring forward impressions 
gathered from some observation of the student and of 
his work, especially in their clinical aspects. 

Clinical work is for us all essential, and the difficulty 
is how to give to its study a share not altogether dis¬ 
proportionate. 

The Preliminary Examination and the Recruiting of the 
Profession. - In the student's own interest, our gates 
should not be thrown open too widely, lest he should be 
caught in a groove, in which, as time wears on, he may 
fii d neither success nor escape. Medical students need 
not be picked men, but tried men they should be; and to 
ensure this is the chief office of the entrance examina¬ 
tion, which might also be a means of checking an exces¬ 
sive supply 

Our opportunity is to frame an entrance examination 
which should test men as to their fitness for their future 
labours, but should not demand of them anything 
wasteful from the point of view of their life’s work. On 
the contrary, the entrance examination might be ren¬ 
dered practically useful in the direction of relieving as 
much as possible the overloaded curriculum. 

The utilitarian reform which we have witnessed seems 
to have stopped short at the sacrifice of the classics Yet 
there are studies now neglected in the curriculum, the 
rudiments of which should not be entirely unknown to 
members of a learned profession. I refer to the elements 
of botany, of zoology, and of geology, which are n ost 
desirable. If made compulsory in the schedule of the 
Preliminary Examination, these subjects, together with 
physics and chemistry, would be useful to the student, 
and educationally they would be some compensation 
for the loss of a classical training 

The Curriculum .—The greatest improvement in medical 




Jan. 4, 1899. TRAILS ACTIONS OF SOCIETIES. Medical Press. 7 


education is the recently introduced five-years’ curricu¬ 
lum. This extension has already produced the best 
results. Yet much pressure remains, and the question 
has been asked whether the best use is made of the addi¬ 
tional time, and whether a special claim could not have 
been established in favour of our profesaional training, 
so long and increasingly sacrificed to the preliminary 
subjects. 

The old-fashioned apprenticeship wasgiven up long ago 
without any equivalent as a substitute. It is impossible 
that we should ever return to it. Yet it was a thoroughly 
practical though primitive method of learning as much 
of the profession as the local opportunities allowed. In 
that arrangement the supply of scientific knowledge was 
scanty, but there was little waste from the point of view 
of utility. 

This distribution of the student’s work has been come 
pletely reversed, but the partial sacrifice of the practical 
rofessional studies was an unintended result, due to the 
esire to cultivate a higher science in the service of 
medicine. Unfortunately, for a long period the teach¬ 
ing of the sciences had to be theoretical and by lectures 
without any practical participation on the part of the 
learner. Thus the student, deprived of the apprentice¬ 
ship, spent his early days in studying practical science in 
an unpractical way. When he joined the country 
practice as a qualified man it was the old apprenticeship 
over again—most things practical yet to be learnt—only 
the apprenticeship was at the wrong end of his time. 

(To be continued ) 


Clinical Jiearrba. 


Can of Fibroid Tumour Complicated with Pyo-Salpinx 
Removed by Sub-Peritoneal Hysterectomy, (a) 

Under the care of Dr. J. Macphbbbon Lawbie. 

Mbs. S., set 40, consulted me on October 21st on 
account of excessive abdominal pain, which incapacitated 
her from her duties, and a swelling occupying the right 
side of the abdomen. On examination, the swelling was 
accounted for by a fibroid tumour of the uterus, and as 
her sufferings were great, an operation for its removal 
was advised. This took place on November 6th. The 
tumour was exposed by a long incision, and found to be 
complicated with a pyo-salpinx in the right side. Both 
appendages were diseased, with numerous adhesions, 
and completely matted to the surrounding parts. The 
tumour itself was firmly adherent to the great omentum, 
as well as to the bowel and appendix, and considerable 
trouble was experienced in the proce-s of separation. 
The broad ligaments were then divided externally to the 
ovaries and tubes, and the uterine arteries secured. The 
cervix was divided by a wedge-shaped incision, and 
brought together with catgut. The peritoneal flaps 
were laced across the pelvis and over the stump. After 
careful sponging, the abdomen was closed without flush¬ 
ing or drainage. 

Patient made a good recovery. 

Case of Fibroid Uterus undergoing Malignant Degenera¬ 
tion Removed by Vaginal Hysterectomy, (a) 

Mrs. F., set. 29, consulted me on September 9th, 1898, 
on account of severe continual uterine haemorrhage and 
leucorrhcea for two years, accompanied by violent pain. 
On examination the uterus was found much enlarged, 
and a polypus about as large as an orange presented at 
the os. 

On September 25th the uterus was dilated and the 
polypus removed. This gave room for a more complete 
investigation, and disclosed the presence of another 
swelling occupying the fundus and bulging into the 
uterine cavity. The capsule was freely divided and a 
soft tumour shelled out. This was sent to the Clinical 
Research Association for examination, who reported that 
it consisted of malignant tissue. 

The uterus was accordingly removed on November 13th 
by vaginal hysterectomy, the ovaries and tubes being 

(a) Cues read and specimen* shown at the laat meeting of the 
British Gynaecological Society. 


taken away at the same time. The patient made an ex¬ 
cellent recovery from both operations, and is now in 
good health. 


^ransacturttB of §ockties. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Pathology. 

Meeting held Fbiday, Decembeb 2nd, 1898. 


J. A. Scott, F.R.C.S., in the Chair. 

SOME BKCENT X-BAY WOBK. 

Db. Haughton drew attention to the recent suc¬ 
cesses of the prooess in regard to normal changes 
in bone structure as well as in congenital and acquired 
deformities of bone, in diagnosis, prognosis, and treat¬ 
ment of fractures and their sequelse, dislocations, epi- 
physiary separations, diseases of bone in dentistry, and 
especially in the localisation of foreign bodies. 

Dr. Scott considered the reducing to figures the com¬ 
parative lengths of exposure of different tissues was very 
interesting. 

Dr. Lane Joynt said that the question of causing der¬ 
matitis was most important, but he thought a good deal 
of false blame had been laid to the charge of the X-rays; 
he himself had never seen a cose of dermatitis from this 
cause. 

Dr. E. J. McWeeney asked what effect caseous and 
caloified material had upon the rays ? Also what amount 
of opacity calculi of different kinds bad? Was it pos¬ 
sible to get shadows from those soft cholesterin and 
cholesterin pigmentary calculi found in the gall-bladder ? 
He had seen some X-ray photographs of tuberculous 
subjects in which the bones showed a remarkable amount 
of transparency, which might be due to the anatomical 
fact that the spaces in the cancellous tissue were larger 
than normal or to a smaller deposition of lime salts. 

Dr. Maunsell asked whether in the skiagraphs of 
Pott's fracture the author had found that the astragalus 
was dislocated slightly backwards as well 

Dr. Knott remarked that at the last meeting there 
were two specimens illustrative of the fact that the 
olecranon normally had two, and sometimes three, 
centres of ossification. In cases of epiphysiary disjunc¬ 
tion the solution of continuity always ran through the 
bone near the cartilage. 

Dr. Haughton. in reply, said that he had been unable 
to obtain any good photographs of tuberculous consolida¬ 
tion in the apex of the lungs owing to the movements of 
respiration. Caseous material was rather transparent, 
considerably more so than pus, the latter being nearly 
as opaque as water. In calcareous deposits very con¬ 
siderable opacity resulted, as the calcareous salt con¬ 
tained lime whose atomic weight is about 40, and the 
higher on the atomic scale the greater the opacity. 
Phosphatio calculi were rather transparent, oxalic were 
the most opaque, and uratic intermediate. Cholesterin 
was extremely transparent. Regarding the relative 
transparency of tuberculous in comparison with normal 
cases, strumous subjects were often found with very 
transparent bones, probably due to a condition of mal¬ 
nutrition. There seemed to be possibly a smaller deposi¬ 
tion of lime salts, perhaps associated with an enlarge¬ 
ment of the cancellous tissue; but he himself thought 
the cancellous tissue presented a normal outline, while 
the transparency was greatly increased. In reply to 
Dr. Maunsell he said he had not observed dislocation 
backwards in Pott’s fracture. In X-ray photographs he 
had not been able to establish more than one centre of 
ossification for the olecranon. 

RUPTURE OF ASCENDING AORTA. 

Dr. Maunsell read the notes of a case of “ Multiple 
Aneurisms in a Young Woman,” and showed the 
specimen. The woman was tet. 37, married, and gave a 
history of having dead bom children, which suggested 
syphilis. The aneurisms were two fusiform dilatations of 
the thoracio aorta, and a sacculated dilatation of the cceliao 


Diai 


-oogle 




8 The Mbdical Press. 


TRANSACTIONS OF SOCIETIES. 


Jan. 4, 1899. 


axis. The latter was the only one diagnosed during life, 
and its clinical history was very puzzling, as in many 
ways it simulated a pyloric growth. The woman died of 
syncope three weeks after coming under observation. 

SPONTANEOUS RUPTURE OP FIR8T PART OP AORTA. 

Dr. J. Lumsdkn. —The young woman (set. 23) from 
whom the specimen was taken was brought dead into 
Mercer’s Hospital in June, 1898. She was evidently in 
the act of lifting a heavy box when she suddenly dropped 
dead. On opening the thorax the pericardium when 
incised was found to be quite full of clots. A small 
linear rupture, which just admitted an ordinary cedar 
pencil, was discovered at root of the ascending aorta on its 
anterior aspect, immediately above the anterior sinus of 
Valsalva. When the interior of vessel was examined a 
rent was found in the aortic tunics, commencing just 
above junction of right and left posterior aortic cuspus, 
encircling the aorta parallel to free margin of the valves, 
about 1J inches in length. Exoept at the point of 
rupture in front only the intima and media were appar¬ 
ently involved in the rupture, and, doubtless, had not 
the outer coat given way anteriorly a dissecting 
aneurism might have resulted. Macroscopically 
there was no evidence of any extensive degenera¬ 
tion of aortic walls, or, indeed, of the heart 
either, but a few small opaque yellowish-white super¬ 
ficial and irregular patches in the endothelium and sub- 
endothelial tissue were to be seen. They projected 
slightly above the surface, and could be rubbed off in 
places from subjacent layers, which presented a normal 
appearance. There was no dilatation of the aorta, and 
no evidenoe of valvular lesion was to be found. 

ANEURISM OP ASCENDING ARCH OP AORTA EXTENDING 
INTO LUNG. 

Dr. W. J. Thompson.— The patient was a man, rot. 46, 
a builder’s labourer, who was admitted to Jervis Street 
Hospital on November 13th, 1898 He was carried in by 
the police in a collapsed state, having had a severe 
attack of haemoptysis while walking along the street 
The upper part of the right lung, as far down as the 
fifth rib in the nipple line, was dull on percussion, no 
tumour or pulsation, but a slight thrill could be felt on 
palpation. The veins on right side of thorax were pro¬ 
minent and distended ; there was no swelling of arm or 
neck, and total absence of pain. The radial pulse on 
right side was much weaker than on left, and occa¬ 
sionally the patient completely lost his voice. 
There was no difficulty in diagnosing aneurism 
of ascending arch, extending into right lung. 
The patient died suddenly after being three days in hos¬ 
pital. The specimen shows a sacculated aneurism, 
embracing the upper half of ascending arch, lying more 
posteriorly and laterally than anteriorly, behind superior 
vena cava. It extended in an upward and outward direc¬ 
tion for about two inches, its width being about the same 
as its length. The sac seemed at its commencement to 
be made up of j/ericardium and pleura, but at its apex it 
was made up of semi-consolidated lung tissue. The 
whole length of the aorta was studded with atheroma¬ 
tous patches, varying in size from that of a sixpence to 
that of a two-shilling piece. Evidently the aneurism 
had its origin in one of those patches, and had suddenly 
burst into lung tissue. The two upper lobes of the right 
lung were consolidated. 

ANEURI8M OP DESCENDING ARCH OF THE AORTA PER¬ 
FORATING GC80PH AGU 8. 

Dr. W. J. Thompson.— The subject of this aneurism 
was also a builder’s labourer, set. 47. The history given 
was that when going to lift some weight he suddenly 
collapsed, blood coming from his mouth. He had never 
oomplained of anything. At the post-mortem the 
stomach and intestines as far as the ileo-ctecal valve were 
found full of blood. Corresponding to the level of the 
Beventh dorsal vertebra there was a ragged opening in 
the oesophagus about the size of a sixpence, placed 
rather posteriorly, laterally, and to the left. This com¬ 
municated with an aneurismal sac which sprung from 
the aorta anteriorly, laterally, and towards the right. 
The opening between the aorta and sac had a diameter 
of about three-quarters of an inch. The sac itself was j 
Bmalf, had thin walls, which seemed to be made of the 


outer covering of the aorta. There was only one small 
atheromatous patch situated in the transverse portion, 
of aorta. 

Dr. Scott, Dr. Knott, Dr. E. J. McWeeney, and Dr. 
Lumsden discussed the causation of this condition, and 
Dr, Thompson briefly replied. 

The Section then adjourned. 


EDINBURGH MEDICO-CHIRURGICAL SOCIETY, 
Meeting held Wednesday, December 21st, 1898. 

Sir John Battt Tuke, President, in the Chair. 


Prjfbssor Chiene showed (1) a case of coxa vara in a 
lad of 16. It was apparently due to trauma received in 
childhood, and there was evidence of past rickets; (2) 
double congenital dislocation of the hip and symmetrical 
ununited fracture of both clavicles in a girl of 11—also 
ricketty. 

Mr. Caird showed (1) a patient after removal of a 
rectal carcinoma by the para-sacral incision. In order 
to discover the exact relations of the growth laparotomy 
was previously performed. Now—three and a half 
months after operation—there was complete control of 
the rectum. 

Dr. Melville Dunlop showed (1) a child suffering 
from diplegia with athetotic and choreiform movements. 
The condition was not congenital, but had developed ah 
the eighteenth month. There was a certain degree of 
imbecility ; (2) a case of muscular dystrophy, combining 
the features of the atrophic scapulo-humeral and the 
pseudo-hypertrophic forms of the disease. 

Dr. James showed (1) a case of scleroderma combined 
with Raynaud's disease; (2) a case of localised syphilitic 
giantism; (3) angio-neurotic oedema of the tongue. 

Dr. G. A. Gibson showed cases of bulbar ana pseudo¬ 
bulbar paralysis. 

Dr. Affleck showed (1) a brother and sister suffering 
from Friedreich’s ataxia; and (2) a case of Addison’s 
disease, which had improved very greatly under treat¬ 
ment with suprarenal extract. In a former case the 
extract caused such severe collapse that it had to be dis¬ 
continued. 

Dr. John Thomson showed a patient suffering from 
hemiatrophy of the tongue. 

Dr. George Elder showed (1) a case of hemiatrophy 
of the face, with malformation of the ear; and (2) a 
patient, set. 60, suffering from chorea. The disease had 
lasted for five years, and now there was considerable mental 
impairment. Save in the absence of an hereditary 
tendency, the case resembled Huntingdon’s chorea. 

Dr. Allan Jamieson showed (1) a oase of papulo¬ 
squamous eczema, apparently syphilitic, affecting the 
palms; (2) a case of urticaria pigmentosa; (3) a case of 
psorospermosis follicularis vegetans (Darier’s disease); 
(4) the result of treatment in a case of tylosis; and 
a case of elephantiasis. 

r. Graham Brown showed a case of Addison’s dis¬ 
ease. 

Mr. Hod8don showed a case of plexiform neuroma, 
associated with multiple subcutaneous neuromata. 

The following specimens were exhibited:— 

Mr. Wallace: (11 Renal calculus; ( 2 ) kidnevs with 
calculi tn situ; (3) fibro-adenomata removed from 
prostate; (4) portions of prostate removed by supra- 
public cystotomy; (6) four kidneys (three tuberculous, 
one carcinomatous) removed by operation; (6) dermoid 
cyst removed from floor of mouth; (7) biliary calculi 
removed by cholecystotomy; and (8) microscopic speci¬ 
mens of tumours and of prostate. 

Dr. Logan Turner : Skull showing unusual develop¬ 
ment of frontal sinuses. 

Dr. Dow den : (1) Plexiform neuroma, with micro¬ 
scopic specimens; and (2) specimens of hydatids. 

Mr. Cathcart : (1) Abdominal aneurism; and (2) 
multiple absoesses in brain. 

Mr. Caird: Preparations and drawing from unsuc¬ 
cessful case of enterectomy and suture for carcinoma, 
j Dr. William Elder: Heart and intestine from a 
case of dysentery with ulcerative endocarditis ; (2) 



Digitized 


-oogle 


JAN. 4, 1899. 


GERMANY. 


The Medical Press. 9 


brain showing haemorrhage into the occipital lobe; and 
(3) brain from a case of word blindness. 

Mr. Caird exhibited a needle-case for sterilising 
needles and sutures. 

Mr. Cathcart exhibited improvements on his micro¬ 
tome. 

Dr. Graham Bbown demonstrated a new form of 
sesthesiometer. 


cfraitce. 

[from our own correspondent.] 

Paris, December 31st, 1898. 

Ablation of thb Spleen. 

At the meeting of the Soci6t4 de Chirurgie, M. Le 
Denta presented a patient who had been operated on for 
rupture of the spleen produced by the shock of the shaft 
of a car driven at great speed. The man was brought to 
the hospital in a fainting condition, and when examined 
rupture of the intestine was believed to be the result of 
the accident, and laparotomy advised accordingly. When 
the abdomen was opened it was found that it was the 
spleen that had been torn to the length of three inches. 
A large quantity of blood filled the cavity of the abdo¬ 
men, but the ruptured vessels had ceased bleeding. It 
being found impossible to ligature, it was decided to 
remove the organ completely, and for that purpose a 
damp was placed on the pedicle. 

The patient made a very rapid reoovery, and was at 
the time of speaking in perfect health. 

Intermittent Hydronephrosis. 

M. Bourcy spoke on the case of a woman, set. 
62, who for many years suffered periodically from 
severe pain over the left renal region, radiat¬ 
ing towards the left groin, and accompanied by 
vomiting and a sudden cessation of the urine. 
After one or two days the pains disappeared, and the 
flow of urine returned with more or less abundance. 
Several times gravel was found in small quantities. The 
symptoms were evidently those of renal colic. However 
three years ago matters took another turn; instead of 
subsiding in one or two days, the pain persisted, the 
urine remaining very scarce, while the abdomen increased 
in size, especially towards the left side, where an unbear¬ 
able sensation of tension and fulness was felt and the 
vomiting as well as the headache continued. In this 
oondition the patient applied to one of the hospitals, 
where she generally got relief by having the tumour 
tapped. A few days ago she came under the care of M. 
Bourcy, who, on learning the history of the case, had 
no difficulty in pronouncing it to be a case of intermit¬ 
tent hydronephrosis. At the time of entry she had 
already been suffering four days, the whole left side 
seemed to be the seat of a large fluctuating tumour, 
while the urinary secretion was reduced to almost sup¬ 
pression. By means of a Potain trocar the speaker 
drew off over a quart of liquid containing all the 
elements of urine. As in former operations relief was 
immediate, but M. Bourcy believed that if the symptoms 
returned in a short time ablation of the kidney should 
be practised. 

Artificial Anus. 

M. Lejars presented a girl, ®t. 13, who was bom with 
an imperforation of the anus. M. Pean made an artificial 
anus two days afterwards. Several attempts were made 
by different surgeons to cure this artificial anus, but all 


failed. M. Lejars made an effort in his turn, but at first 
failed, however, having opened the abdomen, he found 
that the fistula of the artificial anus communicated with 
a large cavity reaching to the sigmoid flexure, having 
destroyed this, the fistula was easily closed. 

Arterial Sclerosis. 

Two important and almost pathognomonic signs of 
hypertension of the arteries are, according to Professor 
Huchard, diastolic sonorous bruit heard at the base of the 
heart and on the right side of the sternum, that is to say» 
over the aorta, and the stability of the pulse regardless of 
position. In the normal state, the pulse diminishes by 
six to eight beats in the horizontal position of ordinary 
individuals, where sclerosis of the arteries is present the 
pulsation remains the same as in the vertical position- 
The treatment should take into account the cause and 
the effect of the hypertension. For the former he pre¬ 
scribes a rigorous diet composed chiefly of milk and 
other diuretics with a little white meal, and for the 
latter trinitrine as follows:— 

Solution of trinitrine, l 0 / o ... 40 drops ; 

Water . 3*- 

A tablespoonful every 3 or 4 hours 

Besides this treatment he orders baths, massage, dry- 
frictions, Ac. 

(Strmang. 

[from our own correspondent.] 

Berlin, December 30th, 1898. 

At the Medical Society Dr. Brasch brought forward 
the subject of 

CHANOE8 IN THE GaNOLIONIC CELLS IN FEVER. 

! At a former meeting he had shown nerve cells changed 
by high temperatures. They were from a preparation 
taken from a child who had died from scarlatina, in 
whom the temperature reached 41 C. Dr. Klemperer 
had suggested that the changes might be of a toxic 
nature and due to the heat alone. In order to 
meet the objection the speaker showed further 
preparations for comparison (1) a human gang¬ 
lionic cell from the anterior horn, (2, 8, and 4) 
sections of the spinal cords of children with pre-mortem 
high temperatures, one dying of gastro-enteritis, the 
second of pyaemia, and the third of broncho-pneumonia, 
the pre-mortem temperature being respectively 39 - 5 
41'6, and 42 C. The degrees of change as regarded the 
protoplasm, the Nissl's corpuscles, and the cell processes 
were interesting, inasmuch as they corresponded to the 
height of the temperature Thus where the temperature 
was 39 5 the Nisei oell corpuscles were swollen, at 41 - 6- 
they were disappearing, and at 42 they had vanished. 

The preparations were made from one to two hour® 
after death, death being due to various causes, the 
only common feature being a high temperature. The 
changes closely resembled those taken from over-heated 
animals. For the production of these phenomena certain 
conditions were essential:—1, A certain height of 
temperature, at least 3 degs. C. above the normal -, 2, the 
fever must be continuous; 8, it must be in association 
with some acute affection; in chronic diseases the cells 
seemed to aooustom themselves to the raised tempera¬ 
ture. For the rest the different oells were variously 
affected; the distribution alto, in different individuals 
was not constant. With lengthened duration of high 


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AUSTRIA. 


Jan. 4, 1899. 


temperature the changes were general and almost without 
exception. 

I>r. Treitel had a paper on 

The Nature and Significance of Chronic Tonsillar 
Abscesses. 

It was known that chronic suppuration in any part of 
the body constituted a danger to the whole system. 
Praenkel first pointed out the danger of tonsillar 
abscesses. Later, cases became known where articular 
rheumatism had commenced in the tonsils, and a similar 
relation was observed with regard to other diseases, 
cryptogenetic pyaemia, for instance. In simple angina, 
micro-organisms, such as streptococci, might enter the 
blood and set up disease in a locus minoris resistantise. 
The question now arose whether pathogenic germs could 
pass through the tonsils without setting up local inflam¬ 
mation. It appeared as if this were so; at least, the 
local inflammation was unnoticed, according to Praenkel 
in a case where death occurred from streptococci, in 
which they were found in the tonsils, but without 
inflammation thereof. It was a question whether 
the intact mucous surface of the tonsils would allow 
them to pass, and in most cases this would be 
destroyed in places. Generally there was swelling of 
the gland, and later a tonsillar abscess which could be the 
starting period for general suppuration. These abscesses 
were usually so small as not to be distinguishable 
during life, as they did not lead to general swelling of 
{he tonsils. The question would often arise as to 
whether these abscesses were primary or secondary. 
In some cases, however, their primary nature was evi¬ 
dent. The speaker then related the following case: A 
man, 63, had often formerly suffered from tonsillar 
abscesses, and more recently hoarseness and shortness of 
breath had come on. A few [days before, difficulty of 
swallowing had presented itself. On examining the throat 
no symptoms of acute inflammation were observed. The 
laryngoscope showed cedema of the glottis, of the arytenoid 
oartilage, and of the aryepiglottic folds. The troubles got 
worse in spite of ice and other applications. Tracheotomy 
was performed. A foul abscess was then discovered around 
the cricoid cartilage, and the patient died. The autopsy 
revealed chronic tonsillar abscesses. As regarded treat¬ 
ment, this could only be prophylactic, as the small 
abscesses could not always be discovered. In case of 
recurrent inflammation he advised splitting the tonsils, 
and careful attention to the cleanliness of the mouth. 

Dr. A. Fraenkel sa ; d that septicemia was a tolerably 
frequent disease in his wards; that the source of infec¬ 
tion was always sought for, and but rarely found, but 
when found was mostly in the tonsils. During life 
nothing could be found in the tonsils; the oentre of 
disease was generally discovered only after death. A 
woman in the thirties was admitted into hospital with 
bad jaundice and pysemic fever. Nothing abnormal was 
discovered at the heart beyond a short systolic murmur. 
The abd<«nen was swollen, the liver enlarged, but nothing 
abnormal in the fauces. He thought it might be a case of 
pyelophlebitis arising from perforation of the vermiform 
appendix. Death took place in forty-eight hours. The 
autopsy showed small abscesses in the tonsils and com¬ 
mencing ulcerative endocarditis. In another case a 
pericardial effusion could be traced back to a primary 
tonsillar abscess. An interesting observation had been 
made that day. In a case of sepsis that had been diagnosed 
during life by examination of the blood, there was a 


large splenic tumour and continuous fever. The incuba¬ 
tion blood showed sepsis, streptococci in such numbers 
that Bpeedy death might be expected. The autopsy 
showed that the point of entrance was the genital tract, 
following abortion. 

Dr. Benda objected that Treitel had grouped two 
things together that pathologically should be kept sepa¬ 
rate:—1. A group of infections, the point of entrance of 
which was often difficult to discover, as generally only a 
few micro-organ isms were formed at first, but which after¬ 
wards mult : plied in the oiroulation. 2. Actual pyaemia, 
when a spot was always found where a thrombosis had 
taken place, in which the germ had developed. Fraenkel's 
case was one of valvular inflammation, set up by strep¬ 
tococci, when as a rule the exit point of these strep¬ 
tococci was difficult to determine, in that case streptococcus 
thrombi were found in the small veins of the valves. 

Somatose Again. 

Dr. Fried. K&ebl, u D. M. Z.,’’ No. 86, considers sonuu 
tose to be the best nutrient material we possess, in con¬ 
sequence of its high percentage of albumen. In aneemia, 
chlorosis, in milder cases of tuberculosis of the lungs, in 
debilitated neurasthenics, in convalescents after exhaust¬ 
ing illnesses, after operations, and in women in childbed 
it is of the utmost possible service. In the majority of 
cases increase in weight and in the number of red blood, 
corpuscles was brought about. In infants a more favour¬ 
able relation of the casein to the albumen was procured 
by the addition of somatose to cow’s milk. When oo- 
agulation takes place the gastric juice acts more readily 
after somatose is added, and by this means its value as 
a food is increased. The somatose preparations (Bayer 
Elberfeld) of cocoa, chocolate, kola, Malaga wine, &c., 
have proved agreeable and strengthening, both for the 
healthy and the unhealthy. 


Austria. 

[from our own correspondent.] 

Vienna, December 30th, 1808. 

A would-be Suicide. 

Schnitzler produced another man who had been 
brought into hospital immediately after attempting 
suicide by means of a knife, which he had inserted at 
the left mammilla. On examination, the area of cardiac 
dulness was tympanitic, and when the body was shaken 
a metallic splash was to be heard. After an hour had 
elapsed the temperature rose, this was accompanied with 
severe pain in the left side of the abdomen—not the thorax 
—which according to French authors would indicate a 
wounding of the intestine. With such a hypothesis in 
view the wound in the chest wall was freely opened to 
explore its extent and direction, which had evidently 
escaped the heart and passed through the diaphragm, 
but no injury was done to the bowel or abdominal 
contents. After a slight reaction the wound healed and 
the patient perfectly recovered. 

Laboratory and Pest. 

A little consolation is taken by the Viennese as a seda¬ 
tive for the late excitement that Vienna is not the only 
place where the laboratory is a source of danger. It 
seems that Versin infected the town of Nha-Tsang (Indo¬ 
china) in a similar manner, where he had been injeoting 
1 mice with the pest serum. From these mice the infeo- 


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THE OPERATING THEATRES. 


The Medical Press. 11 


-tion reached man, bat was not so easily checked as it has 
t>een in Vienna. 

At the Vienna Medical Club, Nov. 16th, 1898, Dr. R. 
Kienbock gave a further account of the results obtained by 
Rontgen Examination of Cases of Pyopneumo¬ 
thorax. 

The first paper on this subject, read at the Vienna 
Medioal Club on April 20th, 1898, is published in the 
Medical Press and Circular, p. 617, May 18th, 1898. 

He has examined a certain number of young people of 
'the male sex suffering from tuberculous pyopneumo- 
'thorax—both on the left and on the right sides—with 
large empyemata, showing the signs of free movement. 
In every case there were to be seen on the Rontgen 
screen movements of the exudations, even when the 
patient remained quite still, viz., respiratory and pulsa¬ 
tory phenomena—exactly as described in the first article 
with the experience of a single case (1) inspiratory ascent 
.and expiratory descent of the fluid level, (2) waves on the 
upper margin of the fluid carried by each contraction of 
-the heart This pulsation of the empyema was less 
marked in the case of pyopneumothorax of the right 
than of the left side as might be expected. There was no 
■concussion of the thoracic wall either on inspection or on 
palpation. The paradoxical respiratory movement of 
the surface level is to be explained on the assumption 
that this half of the diaphragm was paralysed, and 
therefore the inspiratory desoent of the sound half raises 
the other one, carrying with it the fluid, by the inter¬ 
mediary of the contents of the abdomen. He calls this 
phenomenon the “ alternating respiratory movement of 
the two halves of the diaphragm.” The author lays stress 
upon the fact that both phenomena appear to be patho¬ 
gnomonic in cases of the kind just described. 

Dr. R. Kienbock, at the Vienna Medical Club 19, x. 
1898, exhibited a Rontgen demonstration of a young 
man (from the Medical Klinik of Professor v. Schroetter) 
with 

Revolver-Shot Lesion in the Region of the Heart. 

He had tried to commit suicide the previous day by 
means of a revolver of 7 mm. oalibre, aimed at the wall of 
the thorax three fingers breadth below the left nipple. 
The situation of the ball could only be detected by 
skiascopy. It had been reflected under the skin from the 
sixth rib in the left mammillary line and had proceeded to 
a depth of two centimetres. It was situated either in the 
eubstanoe of the diaphragm—viz., in the anterior 
descending part which helps to form the anterior pleural 
sinus or else in the lung which fills the latter depression. 
In any case it w as situated in the middle line below the 
apex of the heart and in close proximity thereto. (The 
ball could easily be seen on the screen against the light, 
air-filled stomach which forms the background.) It was 
remarkable that the ball showed two sorts of movements, 
respiratory and pulsatory; for it followed both the move¬ 
ments of the diaphragm and of the apex of the heart 
moving in directions corresponding thereto. No 
important injury appear to have been caused by the 
ball. 


‘Ih* (Derating theatre®. 

GUY’S HOSPITAL. 

Deep Sarcoma of the Neck. —Mr. Abbuthnot Lane 
operated on a man, set. 34, who had been suffering for 


nearly a year from a lump «vhich appeared at first imme¬ 
diately above the right clavicle, and gradually extended 
upwards into the neck as it increased in size. It had 
not led him to obtain medical treatment till recently 
owing to the fact that it caused him no inconvenience. 
Lately, however, he had complained of pain in the arm, 
sometimes in the shoulder and at other times in the 
entire arm. He had lost flesh within the last month. 
The lump, which was as large as an orange, was situated 
beneath the stemo mastoid, it could not be moved about, 
on the subjacent structures. The trachea and oesophagus 
were displaced by its pressure. There seemed little 
doubt that the mass was a sarcoma which arose in the 
spinal oolumn. It was freely exposed; the brachial 
plexus then was seen to enter it and probably traverse 
it; it was quite impossible to remove it in its 
entirety owing to its deep attachments; consequently 
Mr. Lane incised it, and was able to shell out the soft, 
cheesy-like growth from the interior of the ramifying 
spaoes, and from about the nerves which passed through 
it. It was then possible to remove much of the capsule. 
The cavity was plugged with sulphur and gauze in order 
that any residual growth might be destroyed. Mr. Lane 
feared that it was hopeless to expect other than consider¬ 
able temporary alleviation from this procedure, though it 
offered the patient a chance of complete recovery. 

HOSPITAL FOR 8ICK CHILDREN. 

Intussusception. —Mr. Arbuthnot Lane operated on 
a child who had been suffering from intussusception for 
a little more than twenty-four hours. A large elongated 
mass was felt, placed vertically to the left of the middle 
line and extending downwards almost to the anus. On 
opening the abdomen the intussusception was reduced 
with sufficient difficulty to convince the operator that most 
probably reduction could not have been effected by 
inflation. This applied rather to the evolution of the 
last t wo inches of bowel, which were very thick, and 
required considerable direct firm pressure between 
the thumb and fingers to restore the thin con¬ 
cave aspect of the cacum to itB normal convex form. 
A careful examination of the part showed that the intus¬ 
susception had started as a dimpling inwards of the 
outer aspect of the ctecum on a line with the ileo-cscal 
valve, and it was the convexity found by this intrusion 
into the bowel that formed the summit of the intrusion. 
Mr. Lane believed that this was the manner in which 
intussusceptions usually arose. He had seen as many as 
four intussusceptions in the same case arising from the 
intrusion of Meckel’s diverticulum into the ileum, where 
it formed the summit of the highest of the four intus¬ 
susceptions, which was compound in character. At first 
the large round cherry-like mass in the bowel, formed 
by the inverted and swollen diverticulum, suggested 
the presence of an adenomatous polyp, such as he 
had met in a somewhat similar condition. 

Mr. Lane pointed out that as the operation was done 
at a comparatively early date in the history of the aoci- 
dent the manipulative procedures were effected with 
ease, and with little shook to the patient. 

ST. THOMAS’S HOSPITAL. 

Unusual Case of Hernia of the Appendix. —Mr. 
Battle operated on a woman, set. 60, for a swelling in 
the right groin. The history she gave was that five years 
ago she had pain in the groin, and that a lump formed 
there. She was afterwards in bed at home for a fort- 

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LEADING ARTTCLR8 


Jan. 4, 1899. 


12 The Medical Prksb 

night, and then in a London hospital for a month The 
Swelling gradually disappeared and caused no further 
trouble. Ten days before the present operation a some¬ 
what similar swelling had appeared in the same situa¬ 
tion, and had caused a good deal of pain and discomfort; 
there had been no vomiting, and all her symptoms were 
referred to the groin. On examination there was a pro¬ 
minent, somewhat irregular swelling in the right femoral 
region. It was tender, firm, gave no sense of fluctuation, 
and was without impulse on coughing. Its size oould not 
be reduced on pressure, nor could it be moved from the 
deeper parts. It appeared, however, to have a neck 
which passed to the femoral ring. The diagnosis lay be¬ 
tween hernia, inflamed glands, and a combination of the 
two. The surface of the tumour suggested inflammatory 
enlargement of the glands, as did also the tender¬ 
ness and fixation of the parts. In favour of 
hernia as a somewhat unusual history of the previous 
attack, together with the rapid onset of the present 
attack, and the fact that there appeared to be a 
neck to the swelling in the situation of the femoral ring. 
Against hernia was the complete absence of tumour 
between the two attacks and the absence of impulse on 
coughing at the present time. A sign which Mr. Battle 
has sometimes found of use in doubtful cases was how¬ 
ever present. When a hernia is irreducible pressure in 
the iliac fossa from below upwards will frequently cause 
a sensation of dragging in the tumour, and this the 
patient experienced in the present case. Exploration was 
advised and readily agreed to. After incision of the 
superficial structures the lump was found to consist of 
an inflammatory mass to which adhered several inflamed 
glands. No hernial sac oould be found by direct incision, 
so the mass was turned outwards and peritoneum lining 
a hernial sac was discovered. Inside this, was a fatty 
process like one of the appendices epiploic® about the 
thickness of the little finger which ran to the bottom of 
the sac where it became lost in the inflammatory mass; 
it could not be drawn down any further, and on exami¬ 
nation a rounded portion of bowel was found 
aooompanying it: this was the appendix vermiformis 
inflamed and adherent to the inflammatory mass 
before mentioned. The fatty process was the 
mesentery of the appendix, and its division necessitated 
the application of one or two ligatures to bleeding 
points. The appendix was removed by the coat-sleeve 
method, and the hernia returned into the abdomen. The 
neck of the sac was quite small, the sac itself so adherent 
to the surrounding parte that it could not be dissected 
up. The greater portion of it was cut away with the in¬ 
flammatory mass and adherent glands and the opening of 
the sac closed with silk sutures. Sutures were also 
passed between the fascia over the Pectineus and 
Poupart's ligament. The case, Mr. Battle said, was a 
specially interesting one. the exact diagnosis being diffi¬ 
cult, if not impossible. Further, he pointed out, hernia of 
the appendix alone is a very rare occurrence, and it is still 
more rare for the appendix to become inflamed when out¬ 
side the abdomen. Such an appendicitis is less dangerous 
than when it takes place in the iliac fossa, but this happy 
arrangement cannot always, unfortunately, come to pass. 
The appendix showed a condition of catarrhal inflamma¬ 
tion, its apex being cicatricial in character and incorpo¬ 
rated with the surrounding inflammatory mass. 


RWH8TBBED fob Transmission Abroad. 


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Published eveiy Wednesday morning, Price M. Post free, Sid. 

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Letters in this Department should be addressed to the Publishers. 


^Tke JRcbical frees anil Circular. 


“ SALUS POPCLI SUPRKMA LEX.” 


WEDNESDAY, JANUARY 4, 1899. 


THE GENERAL MEDICAL COUNCIL: AN 
IMPEACHMENT. 

Tn endeavouring to realise the present position of 
affairs we must first ask what are the duties of the 
General Medical Council. According to their own 
definition the chief functions imposed npon them are 
the regulation of medical education, and the 
maintenance of the purity of the Register. These 
self-defined duties have admittedly been fairly 
well discharged in the matter of education,, 
although it may be doubted whether any 
scheme can be altogether satisfactory unless 
based upon a one-portal system. As to maintaining 
the purity of the Register, the Council’s administration 
may be described as a depressing failure. It seems 
tolerably certain that statutory powers exist whereby 
registration may be made indispensable. At present 
the Council keep a tight and often needlessly irri¬ 
tating control over registered medical men, while 
those that are qualified, but unregistered, are allowed 
to work any evil they like with impunity, so far as 
the Council are concerned. As to the safeguards 
for protecting the Register from fraud, they 
are non-existent. As pointed out in the MedioaL' 
Press and Circular ten or a dozen years 
ago, there is no organisation whatever to prevent 
personation as regards either the obtaining or the- 
holding and registering of qualifications to practise. 
A week ago the possibility was demonstrated to the- 
hilt in a London polioe-oourt, where one Rowland 
was charged with personating a licentiate of the Irish 
Colleges of Physicians and Surgeons, who left England 
in 1895. In the course of the proceedings Dr. A. G.- 


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LEADING ARTICLES. 


The Medical Press. 13 


Bateman, the well-known Secretary of the Medical 
Defence Union, swore that in the summer of 1895 he 
communicated with Rowland, and then advised the 
Council not to register any person under the 
name of E. G. Nugent. But in their wis¬ 
dom the General Medical Council admitted 
Nugent to that Register which it is their pride 
and their chief function, according to their 
own showing, to maintain in a state of spotless 
purity. At their next meeting it is to be hoped that 
the full history of this transaction will be made 
public, and that the necessary papers will be produced 
to show what steps, if any, were taken to test the 
evidence of qualification produced by the so-called 
E. G. Nugent after the receipt of the warning by a 
responsible body like the Medical Defence Union. 
Unless a clear explanation be forthcoming the scandal 
should be enough to break the back of any public 
body that has a healthy regard for its repu¬ 
tation among the community. In another 
direction an attempt has been made to maintain 
a high ethical standard among the registered prac¬ 
titioners by charging a licentiate of the Society of 
Apothecaries, the late Mr. H. K. Hunter, with falsely 
assuming the title of physician. Unfortunately, Mr. 
Hunter died soon after that prosecution, which we 
have sinoe learned was authorised by members of the 
Council on the representation by the Penal Cases 
Committee that the accused was an unqualified prac¬ 
titioner. Again we say, that if the facts be as repre¬ 
sented they point to a reckless want of organi¬ 
sation and of recognition of responsibility. But 
the sins of omission on the part of the Council 
are in the minds of the bulk of the profession not 
lees weighty than those of commission. The 
Council, for instance, make no serious attempt to 
defend the interests of those on the Register by 
resisting the inroads of unqualified practice. That 
important subject, however, cannot be discussed here 
further than by stating that there is a strong proba¬ 
bility, amounting, in point of fact, to little short of 
certainty, that the Council possess ample powers for 
the suppression of unqualified practitioners. We 
believe, on that and other grounds, that we simply 
re-echo the wishes of the vast majority of medical 
men in demanding an exhaustive inquiry into 
the constitution and work of the Council, with 
a due sense of responsibility and with a full 
recognition of the difficult, and often delicate, nature 
ef the duties devolving upon such a body. We never¬ 
theless venture to submit that the Council have 
failed to grasp the issues at stake, that they have 
endeavoured to evade all efforts at healthy and 
desirable reforms, that their methods are cumbrous, 
costly, obsolete, inefficient, secret, and auto¬ 
cratic, and at times unjust, and that the hour 
has come when in the interests of the profes¬ 
sion the General Medical Council should be 
superseded by a body more in touch with 
the times and with the representative principle 
that underlies all sound administrative government. 
If the Council cannot forthwith be bom again, then ] 
let it perish. A Government inquiry may perhap 


be desirable, but reform of some sweeping kind must be 
insisted upon if medicine is to gain the position of a 
self-respecting and properly governed profession. A 
consolidating and amended Medical Act is urgently 
needed, but meantime much can be done, as Mr. 
Horsley has repeatedly shown, by putting existing 
legal machinery into action. Things have gone so 
far, and the patience of a long-suffering profession 
has been so sorely tried, that the only alternatives 
left to the Council are either straightway to amend 
their ways or to look to their weapons. 


THE FUTURE MASTERS OF THE PRO¬ 
FESSION IN IRELAND. 

Some months ago we were handsomely abused by 
one of the introductory lecturers in Dublin, because 
we had expressed our grave apprehensions that under 
the new Local Government scheme, the last state of 
Irish Poor-law medical affairs might be worse than 
the first. We were roundly told that we should put 
our trust in Providence and welcome the chosen of 
the new elector as, at least, the makings of a capable 
administrator and an honest man. Remembering 
what long experience has taught us of the qualities 
of the elected committeeman and guardian, and 
seeing no reason whatever to suppose that the 
leopard would change his spots because his official 
name happened to be changed by Act of Parliament, 
we felt unable to participate in the sanguine hopes of 
the lecturer or of the newspapers which echoed him. 

The recent prosecution of not one but many of the 
Kilrush Guardians for wholesale and persistent 
bribery and corruption in the election of successive 
officers of the Union in which they were voters is an 
object lesson which cannot be ignored. The evidence 
has proved that, without a shadow of doubt, not one 
but more than a dozen of these chosen administra¬ 
tors of the public trust of the Union, not on one 
occasion only but regularly, as a matter of business 
whenever an election came off, sold their votes as 
openly as votes were ever sold in the old corrupt 
elections; they higgledfor theirprice, and were assisted 
in their market by officials of the Union and others. 
This system extended over a series of years, and 
covered the election of medical as well as other officials • 
and the culmination of the rascality was when the 
mother of one of the candidates [appeared in 
public to demand the restitution of £460 whioh 
she had paid in bribes at the rate of £40 or 
£50 per head to the guardians for the election 
of her son. These persons, together with 
their agents, have been sent to gaol for varying 
periods, and for the present the Kilrush scandal is at 
rest. Nevertheless, we want to ask two questions. 
Where were the inspectors of the Local Government 
Board all the time this was going on P Is it to be 
believed that they went their rounds to the Kilrush 
Union without hearing a whisper of this corruption P 
If so, in our opinion, they were totally unfit for their 
inspectorial position. Is it to be supposed that the 
Local Government Board knew all about it, yet kept 
its tongue in its oheek and refused to move P 


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LEADING ARTICLES. 


Jan. 4. 1899. 


We shall, no doubt, be answered by the asser¬ 
tion that Kilrush is an isolated case, and 
that all Ireland’s guardians outside that district are 
as pure as the driven snow, to which we reply that, 
from information which we possess, we hold the 
opinion that the elected guardian and committeeman 
is just as ready to accept, and does accept, bribes in 
other districts as in Kilrush. We have been told 
lately by a candidate for a medical officership that when 
lie went down full of hope to canvass the electors for 
an appointment a friend took him aside and presented 
him with a list of fifteen names of guardians with the 
price opposite each, at which he could be bought 
with a certainty. If these things are done in the 
green,tree what may be done in the dry P ” 


THE CONSUMPTION CRUSADE. 

Since the immortal Jenner elaborated the system 
of prophylaxis against small-pox which a pusillani¬ 
mous Government has recently abandoned in defer¬ 
ence to the political influence of a crowd of noisy 
ignoramuses, no such far reaching and, may we say 
glorious a movement has been started as the National 
Crusade for the extinction of tuberculosis, which was 
inaugurated, under the aura of sovereignty, at 
Marlborough House a few days since, and to which we 
have already briefly alluded. Heretofore, the terrible 
extent of tuberculous disease was fully realised by the 
profession but., until Koch isolated the specific 
bacillus, scientists were simply groping in the dark. 
It was before that time universally accepted that tuber¬ 
culosis was a disease of heredity—that it was futile to 
attempt to prevent or anticipate it, and that the last 
hope of preventing its progress was to protect the 
inflamed lung by confining the patient to warm 
rooms or warm climates. We now know, Heaven 
be thanked! that all this is nonsense, that 
heredity has nothing to say to it except that it 
may produce a constitution in a patient which 
is peculiarly prone to any form of contagion. 
We know that climatic conditions, save to this 
extent, have little or no influence, and, to be 
brief, that the one and only thing which can 
produce consumption is the ingestion by the 
viotim of the tuberculous microbe. Happily this 
consideration brings the prevention of consumption 
(to a very great extent) within the reach of sanitary 
law. Imprimis, it is quite possible to prohibit the 
sale of tuberculous meat and milk, which have been 
shown to be among the most potent disseminators of 
consumption. The process may be troublesome, 
expensive, and as unpopular with butchers and cow- 
keepers as the suppression of pleuro-pneumonia was, 
but it can be done and, without doubt, it will be done 
as soon as the new Crusade brings it home to the 
comprehension of the nation that thousands of lives 
and untold thousands of pounds annually depend 
upon it. The third essential of prevention is much more 
difficult to attain— i.e., to prevent the dissemina¬ 
tion of the disease by the expectoration of 
phthisical patients, but, even in this direction, vast 


good may be achieved by the education of the public, 
which is the principal purpose of this Crusade 
Patients may be drilled into the conviction that, in 
their own homes, and, when they can, elsewhere, they 
should carefully disinfect their expectorations, but it 
is hard to expect the multitude of working people 
to call attention to their own infirmity by carrying a 
Bpit-cup with them to their work and elsewhere. As 
for the ultra-sanitarian suggestion that, should they fail 
to do so, they should be collared by a polioeman 
and conveyed to jail, we may, at least for the next 
quarter of a century, put it aside. 

The last of the proposals submitted to the 
Prince’s meeting and adopted as part of the 
work of the new Crusade, is the establishment 
of sanatoria for consumptives in favourable sites 
in the United Kingdom, and we regret that, 
however we may approve of such a project, we cannot 
look upon it as a potent means of exterminating 
tuberculosis from our community. That such sana¬ 
toria conduoe to the recovery of phthisicals and do, 
in fact, produce a gratifying proportion of actual 
cures may be taken as proved, and, this being so, the 
multiplication of such institutions would be an 
unalloyed benefit for which reason, the capitalist who 
contributes his money, as Messrs. Beit and Wherner 
have done for this object, may be assured that he has 
spent it for the best advantage of the public. More¬ 
over, very much may be done by the establishment 
of sanatoria for upper and middle-class people who can 
afford to pay a minimum maintenance contribution, 
and by these means, perhaps subsidised to some 
extent by public funds, a large section of the phthi¬ 
sical centres of contagion may be eliminated from 
our midst, but when we learn from Sir William 
Broadbent that 70,000 persons die annually in Eng¬ 
land and Wales alone from tuberculosis, we cannot 
but recognise that sanatoria, however well organised, 
can do little for our overwhelming phthisical popu¬ 
lation. The example of one such sanitorium which 
we believe to be, in every sense, well and economi¬ 
cally worked will serve to illustrate our meaning. 
Phthisis is a disease the treatment of which is neces¬ 
sarily very prolonged, and the “ turn over ” (so to 
speak) of the bed accommodation of such institutions 
is extremely Bmall. The sanatorium of which we 
speak has twenty-four beds, and its maintenance 
income (irrespective of building and all other extrar 
ordinary charges) tots up to £56 per bed. Each bed 
“ turned over ’’ a patient, on an average, in 109 days, 
so that each patient, including those who did not 
require to be detained in hospital, cost the institution 
over £14. Supposing that the number of actual 
deaths from consumption throughout the Kingdom 
in a year as stated by Sir William Broadbent 
(70,000) only represent half the number of those 
requiring sanatorial treatment, we have an army of 
>20,000 to be accommodated, who, at the rate of £14 
a head, would cost somebody £1,680,000 a year, not 
to mentian the enormous initial outlay for providing 
the. requisite buildings and accommodation. We 
should not regard such an expenditure as by any 


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NOTES OJS CURRENT TOPICS. 


The Medical Press. 15 


means too high a price to pay for the extinction of 
tuberculosis, even if the payment extended over a 
score of years, but until public opinion is thoroughly 
aroused, we apprehend that the taxpayer will regard 
this method of dealing with consumption as altogether 
Utopian. Whether there may be other less expen¬ 
sive methods of dealing with the tuberculous popula¬ 
tion remains open for discussion. 


^tcrtes on Current ‘Copies. 

The Awards of the Prince of Wales’s 
Hospital Fund. 

The list of awards of the Prince of Wales's Hospi¬ 
tal Fund was published on Saturday last, and the 
London Hospital Charities now know the worst or 
the best, respecting the financial assistance which they 
will derive therefrom. With the approval of the 
Prince the operations of the Fund have this year 
been limited to hospitals lying within a radius of 
seven miles from Charing Cross, an arrangement 
which we believe to be satisfactory for several 
reasons. We learn also that of the hospitals which 
applied for grants, and whose claims were con¬ 
sidered, all but twelve were included in the list of 
awards. The explanation vouchsafed for withholding 
the awards in the twelve instances is that some of 
the institutions were deemed to be adequately pro¬ 
vided for by the Hospital Saturday and Sunday 
Funds, while a few more, by reason of their 
management — presumably mismanagement — were 
ruled to be undeserving of support. Coming 
next to the list of the hospitals benefiting by 
the Fund, we find that twelve institutions are 
classified as requiring an annual grant, of which 
nine are general hospitals and three are special, 
the latter being the Seamen’s—always the Seamen’s 
now - the Hospital for Sick Children, Great Ormond 
Street, and the National Hospital for the Paralysed. 
It is not difficult to understand, having regard to the 
composition of the Committee of Distribution, 
how it is that these three charities should 
have been included in the annual list. But what 
does the annual list mean P A-e we to under¬ 
stand that in the future the hospitals named therein 
will be paid large grants before the claims of any 
other institutions will be considered ? Further, are 
we to conclude that the list is final, and that, in suc¬ 
ceeding years should the fund continue, no other addi¬ 
tions will be made to it P These aie questions to 
which answers should be forthcoming in the interests 
of the hospitals generally, and in the Fund in particu¬ 
lar. Of the general hospitals mentioned two, the 
London and Guy's, receive an award of £5,000 each. 
This amount we believe to be a mistake. Practically 
speaking a third of the whole fund is thus 
awarded to two institutions, an arrangement which 
is not omy unjust but inexpedient. We think that no 
award should exceed, say, two thousand five hundred 
pounds. Clearly the object of the Fund should be to 
do the greatest good to the greatest number of 
the charities concerned, but such an object is 


obviously an impossibility when two or three especially 
favoured institutions are allowed to absorb the bulk 
of the proceeds. The next detail to which attention 
may be directed is with respect to the conditions 
attached to the grants awarded to certain other hos¬ 
pitals, and the first which claims notice in this 
regard is the award of £500 to the West London 
Hospital. A grim satire is contained in the 
condition that the overcrowding in the insti¬ 
tution must be abolished. The committee of 
inspection who visited this hospital found that the 
wards were undoubtedly overcrowded, but they also 
found that a new wing, c .attaining seventy-five beds, 
was ready to be opened as soon as funds permitted. 
Instead, however,of enabling the hospital authorities to 
obviate overcrowding by opening the new wing, the 
distribution committee merely award a 6um of £500, 
with an intimation that the overcrowding must cease. 
In curious contrast, however, with the above is the 
award of £750 to the Great Northern Central Hos¬ 
pital, on condition that fifteen beds be reopened. 


Quackery Rampant in Houghton-le-Spring. 

The recent failure of the prosecution of the 
“ botanist” Steel drives home the lamentable failure 
of Clause XL. of the Medical Act to convince the - 
average bench of magistrates. This notorious quack 
has carried on a flourishing practice in spite of a 
former conviction, and is at present the proprietor of 
a club with upwards of four hundred members. 
Unfortunately, when the magistrates decide a case of 
this kind upon a question of fact there is no further 
chance of appeal. Certainly if the General Medical 
Council had possessed any decent amount of energy or 
interest in the law which they were created in order to 
administer they would long ago have secured final 
decisions in the High Courts upon all debateable - 
readings of the Medical Acts. Th^n, where the 
wording of the clauses was at fault, or the intention 
of the legislature vague, they would have taken steps 
to get the law amended and strengthened. As it is' 
all is chaos, and the medical profession is the happy 
hunting ground for all kinds of interloping 
marauders, and here, at the end of the nineteenth 
century, the law is powerless to stop such a shame- - 
less quack as Steel from flaunting his illegal medical 
practice in the face of the community. This fellow 
actually has the impudence to print his own death 
certificate forms, and the branch Registrar of the 
district admitted he received them. Why is this- 
allowed? Such a proceeding looks like a direct 
sanction of quack practice by Government. At least 
let an inquest follow every death that takes place 
under an unqualified man. Why should not the : 
signing of death certificates by an unregistered 
person be made a penal offence ? 


The manufacture of Fellows (save the mark) of the 
Spectacle Makers Society, goes on swimmingly. It is 
announced that there are now two hundred crafts¬ 
men as members of the Guild, besides thirty livery-- 
men. 


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16 Tbk Medical Prchs. 


NOTES ON CURRENT TOPICS. 


Jan. 4. 1899. 


Hospital Abuse in Bradford. 

Our attention haa been drawn to a long letter 
from a medical man addressed to the Bradford 
Observer, and pointing out a number of hospital 
abuses in that town. The name of the writer is a 
sufficient guarantee for the accuracy of the facts, and 
as it stands this communication forms a damning 
indictment of the way in which charitable funds are 
squandered in the relief of well-to-do persons. The 
pith of his matter lies in its sharp specific instances, 
■wherein he forms a notable exception from the 
usually diffuse and general nature of such criticisms. 
The following instances may be selected:—“Will 
jour readers be surprised/' he asks, “ to hear of a 
gentleman residing in an expensive house in a 
select locality in the West End of Bradford 
being attended for charity ? Of course he would not 
condescend to go for it, to be jostled by the crowd 
waiting in the infirmary, so the infirmary sent one of 
its staff to the house to dispense medical charity. In 
another case, a man suffering from dyspepsia, the 
result of his drinking habits, was attended gratuit¬ 
ously at the same institution, while he lived com¬ 
fortably on the income derived from his property. 
Another patient was a consumptive girl, whose 
father *• was a commercial traveller in a good situa¬ 
tion, with whom resided two unmarried adult 
children, both earning good wages, while a third un¬ 
married child earned £400 a year in another town.” 
Again, the infirmary relieved a boy, the son and 
grandson of well-to-do persona, who could afford to 
pay £13 to that institution and six guineas to a 
consultant, in addition to their ordinary medical 
Attendant. In another case, a woman on a 
pleasure trip from America received many weeks 
free treatment for her son, who suffered from 
“ spots ” on the back of his hand. All this and very 
much more to the point is concisely stated by the 
writer, who pertinently asks how these abuseB have 
escaped the notice of the “ keen business men on the 
board,” who, according to the public statement of the 
chairman, inquired into and dealt with every case 
brought to the infirmary. Clearly there is a good 
field for the labours of such a body as the Hospital 
Reform Association in this same keen business 
locality of Bradford. What are the medical men of 
the town thinking about to allow these abuses P It 
is more than likely that a united and vigorous protest 
on their part would bring about a desirable reform in 
this most unfair form of subsidised competition. 

The Indian and Colonial Pharmacopoeia. 

A praiseworthy desire is expressed by the 
General Medical Council to produce “ sooner or 
later” a Pharmacopoeia which will be equally useful 
in every pari of the British Empire. The Council 
also desires to recognise special articles for special 
colonies or dependencies in such a m ann er as to 
avoid undesirable substitution of one drug for 
another distant parts of the Empire. The report of 
the Pharmacopoeia Committee appointed with this 
object has alrei ly been received and adopted by the 
General Medical Council, and will shortly be issued. 


We have been favoured with an advance copy of this 
Addendum. The first drug on the list is Agropyrum, 
our old familiar friend, couch grass, the 
Triticum repens of the United States Pharma¬ 
copoeia, which has long been used as a d9mulcen 
diuretic and sedative. It is frequently prescribe 
in cases of chronic cystitis, irritable prostate and 
gleet. Datura leaves are suggested by the Indian 
Government Committee as an equivalent in India for 
Belladonna leaves,and by the Hong Kon« authorities for 
use in addition to Stramonium leaves. Datura seeds, the 
seeds of Datura fastuosa will also be recognised as a 
substitute tor stramonium seeds. Exacum will be 
made official in India in place of Chiretta. One of 
the most notable additions is that of Cotton root bark, 
the Gossypii Radicis Cortex which has active 
emmenagogue and oxytoxic properties. Some years 
ago, if we mistake not, in a trial for criminal abortion 
it was shown that the prisoner was in the habit of 
prescribing this drug, and it was stated by the 
medical experts engaged in the case that this remedy 
had no known legitimate use. It would appear 
that the pharmacological knowledge of the accused 
was somewhat in advance of that possessed by those 
who condemned him. It is indeed to be feared that in only 
too many caseB the so called expert is a person who 
knows less about his subject than the majority of his 
professional brethren. Jasmine, which in India has 
a reputation as a lactifuge, is another new introduc¬ 
tion whioh may prove useful, while Ajowan oil, which 
contiin8 thymol and cymol, will in India take the 
place of peppermint, caraway, and other drugs con¬ 
taining essential oils. Oil of lemon grass, the Indian 
oil of verbena, is new, and will be found useful in 
cases of chronic dyspepsia attended with flatulence. 
Grindelia robusta is recommended provisionally, and 
we are told that “ the books ” allude to it as a remedy 
in bronchitis, asthma, and whooping-cough. As a 
matter of fact it has been extensively used both in 
England and in the United States for the last twenty 
years. The Pharmacopoeia Committee seems to be 
a little bit behind the times, but we have no doubt 
that the Addendum when published will prove useful. 

Taste Depravity of Inebriates. 

The use as a beverage of “ finish,” a weak solution 
of shellac in spirit employed by French polishers, is 
an old story, but we believe that its use for that pur¬ 
pose has fallen into abeyance in consequence of new 
regulations made by the In ’and Revenue to prevent 
its sale for the purpose of drinking. Similarly the 
drinking of methylated spirit, a horribly nauseous con¬ 
coction, increased, nevertheless, until it became 
necessary to add a stronger dose of methyl. A 
still more inconceivably repulsive form of tipple was 
the spii*it drawn off museum preparations, and yet we 
believe that the drinking of that beverage has been 
the death of many museum porters, and it is a 
long-time reminiscence that the Royal College oi 
Surgeons, Ireland, on the appointment of a new 
Museum Curator, discovered that several hundreds 
of pounds worth of its specimens had been destroyed by 
the abstraction of the spirit from the bottles, the past 

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Diai 



Jan. 4, 1899. 


NOTftS ON CURRENT TOPICS. 


The Medical Pbiss. 17 


curator having been a confirmed inebriate. The 
latest advance in the direction of a new intoxicant ie 
the drinking of petroleum oil a practice which is 
stated to be rapidly growing to the dimensions of a 
great national vice in France. The taste of the liquid 
is absolutely repulsive, but to the Britisher who has 
tasted the abominations which are drunk with avidity 
and craved for by the French working classes, it will 
be obvious that nauseousness is not, of itself, a bar 
to the use of any beverage onoe that the taste has 
been broken-in to tolerate the liquid. The worst of 
the new intoxicant, from a social point of view, is 
that petroleum, taken in any reasonably quantity 
does not appear to be greatly detrimental to health. 
It is said that the drunkenness which it produces is 
of the morose and quarrelsome type, and not of the 
jolly character which arises from alcohol, but the fit 
is quickly slept off, and the victim awakes apparently 
not much the worse for his “ outing ”. 

The Marriage of Ovariotomised Patients. 

Many years ago, in commenting on some statistics 
then before us concerning the subsequent history of 
patients who had had both ovaries removed, some of 
whom had married “ and been happy ever after,” we 
ventured to suggest that marriage under these 
circumstances was of the nature of a fraud unless 
the bridegroom had been duly informed of the 
mutilated condition of the otherwise eligible woman 
of his choice. We suggested, moreover, that the 
absence of the organs essential to reproduction which, 
according to the Church Service, is the aim and 
object of the institution of marriage, would not 
improbably be considered by the Courts to constitute 
a ground for declaring such marriages null and void. 
This point has recently been judicially considered by 
the American Courts with a somewhat curious result. 
The Supreme Court of New York apparently dis¬ 
sents from the view that inability to procreate, arti¬ 
ficially induced, infers a disability “ to enter the 
married state." This strange view is based on the 
physiological fact that women who have passed the 
menopause are equally incapable of procreation, and 
it has never been urged that such marriages are, or 
ought to be, stricken with nullity. It is argued that 
there is no essential difference between a woman who, 
through no fault of her own, has lost her ovaries 
through a surgical operation, and one whose ovaries 
have become functionally inactive through the opera¬ 
tion of natural causes, and if one be held incapable 
of marrying there is no process of reasoning 
by which the other can be considered capable. 
The Court, therefore, expresses the opinion that 
the possession of the organs necessary to conception 
cannot, as a matter of law, be held to be essential to 
entrance to the married state so long as there is no 
impediment to the indulgence of the passions inci¬ 
dental to that state. Unfortunately, this judgment 
is beside the mark, for it leaves on one side the 
crucial question whether, if a man marries in ignor¬ 
ance of his wife’s mutilation, he is not entitled to 
relief. We know of no authorised view of marriage 
other than that it is an institution for the procrea¬ 


tion of children, and for the vast majority of persons 
this is, we presume, the ultimate object of the 
self-imposed sacrifice of sexual liberty. Under 
these circumstances we feel confident that the Courts 
in this country would take a somewhat different view 
of the responsibilities which marriage entails and 
infers, and would hold that the aggrieved husband 
had not receivedthe “ nature, quality and substance ” 
whioh he contracted for. 

The Insurance Offices and Vaccination. 

The practice of taking out life insurances has of late 
years become more and more popular, so much so, that 
the offices concerned therein have added greatly to 
their business and incomes. The increase in the 
number of insurances, however, has manifested itself 
mainly in connection with children. Among the lower 
classes especially, the practice of insuring children’s 
lives has spread to an extraordinary and, from one 
point of view, disquieting extent. In view ot all these 
facts the question arises—How will the insurance 
companies regard the action of the conscientious 
objector in refusing the protection of vaccination to 
his children F This matter is attracting some notice 
in the insurance offices, and a rumour is current that 
the companies are contemplating the refusal in the 
future of policies upon the lives of unvaccinated 
persons. An unvaccinated person is regarded as a "bad 
life,” and as such too risky to accept. If this plan of 
action were agreed upon by all the large insurance 
offices, no doubt the effect would be foratime to check 
the wily designs of the conscientious objector. But 
human nature is such, and the competition for busi¬ 
ness so great between the offices, that we have not 
much faith in the policy being successfully carried 
out. We should imagine that even if all the exist¬ 
ing offices were to refuse unvaccinated persons a 
new concern would at once be floated ready to take 
at the usual rates every person in the kingdom who 
had neglected to be vaccinated. 

Contra-Indications to Breast Feeding. 

The indications for bringing up an infant at the 
breast are too numerous and too manifest for it to 
be necessary to dwell upon them, but it must not be 
forgotten that there are conditions in which this plan 
is contra-indicated. Tuberculosis, for instance, ought 
to be regarded as disqualifying the mother for the 
post ofnurse. The objections that apply to the use of 
the milk of a tuberculous cow apply equally to that 
of a tuberculous mother, at any rate when the disease 
has passed the initial period. An anajmic mother is 
not likely to furnish a recommendable supply of milk 
for her offspring, who is very probably already suffering 
from physiological impoverishment as the conse¬ 
quence of a debilitated pregnancy. The various 
cachexise again formally contra-indicate suokling as 
well for the sake of the mother as of the child. 
Epilepsy and chorea are what may be termed 
mechanical contra-indications, in that they expose 
the child to the risk of injury. It seems hardly 
necessary to add that hereditary syphilis is a contra- 
' indication, but we doubt whether it is regarded 


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18 The Medical Press. NOTES Oft CURRENT TOPICS. Jan. 4, 1899. 

as such by the majority of practitioners at the assimilable nitrogen. At most the difference is but 


present time. Local oontra • indications consist 
in deformations of the nipples or lesions which 
render suckling painful or impossible. Lastly, it 
must be borne in mind that the milk of a mother who 
is taking certain drugs may become poisoned. Iodide 
and bromide of potassium, for instance, have been 
known to set up the characteristic skin lesions in the 
infant in a severe form, although the mother may 
have been quite free from any symptom of the 
kind. The infant, being much more sensitive than the 
mother, suffers in a disproportionate degree from the 
effects of such drugs. 

Post-Mortem Examinations. 

Mb. Bbaxton Hicks, the coroner who was so un. 
graciously handled the other day by Mr. Plowden 
the metropolitan magistrate, on the hearing of the 
charge of perjury against a surgeon, has, we are 
pleased to see, received the support of Mr. Thomas 
Bond, the well-known medico-legal expert. This 
gentleman, in a letter to the Times, commends the 
coroner’s conduct in this case, and adds some very 
pertinent remarks and anecdotes concerning the 
more than perfunctory way in which post-mortem 
examinations are sometimes carried out. Mr. Bond 
amply confirms the protest which we have often felt 
it our duty to make against the practice of entrusting 
these exceedingly important duties to the nearest 
practitioner, without regard to his competence in the 
matter. Unfortunately, it is not only ignorance 
which we have to fear at the hands of these amateur 
medico-legists, but, possibly even more frequently, 
gross negligence and carelessness, of which Mr. Bond 
gave several salient instances. We fully concur in 
his opinion that the gross injustice to which Mr 
Braxton Hicks was subjected should be officially 
brought to the notice of the Home Secretary, and the 
proper person to do this would seem to be Mr. Hicks 
himself. 

White v. Brown Bread. 

A reaction has set in in certain quarters against 
the use of brown bread, on the ground that it is much 
lees nutritious than white. This may be the case, and, 
it may perhaps be conceded, moreover, that white bread 
iB theoretically, at aDy rate, much more digestible 
than brown.; but the reformers seem to overlook the 
fact that brown and whole-meal breads are not 
selected on account of any fancied superiority 
in these respects over white bread. On the 
contrary, it is precisely because there is a larger 
undigested residue to stimulate the intestines 
to action that these brown breads owe their 
popularity. Constipation is one of the commonest and, 
in a minor degree, one of the most distressing ailments 
incidental to civilised life, and is responsible for a 
good deal of the dyspepsia and ansemia which are met 
with in daily practice. The ingestion of whole meal 
breads of the “ Hovis ” type materially assists in 
overcoming this tendency, and their use is not 
likely to be discontinued merely because, weight for 
weight, white bread contains a larger quantity of 


trifling, and would be amply compensated by an extra 
Blice of bread and butter, and the passage of the 
undigested portion along the alime itary tract does 
not entail any appreciable strain on an organism 
which usually works at low pressure with an ample 
margin for contingencies. 

The Deadly Low Flash Oil. 

We sincerely trust that the campaign against the 
deadly low flash oil will this year be carried to a buc* 
oessful issue. In the course of the year just closed 
no fewer than 100 persons lost their lives in this 
country directly in consequence of the explosive 
qualities of the dangerous oil. Our contemporary, 
the Star, which has done so much to bring public 
opinion to bear upon this question, has just published 
some startling facts relating thereto, and urges that 
the raising of the flash point is the most important- 
social reform of the hour. Everyone who has paid 
the smallest attention to the subject must admit that 
legislation is imperatively demanded in this direc¬ 
tion. The low-flash oil is not allowed to be used in 
America; the Russian manufacturers will not pre¬ 
pare it, and, significantly enough, the barracks, 
docks, and lighthouses in this country are never 
lighted with it. Therefore, apart from other testi¬ 
mony altogether, we should have thought that the 
Government ought to be satisfied with these facts, 
and raise no difficulty in acting upon them in the 
interests of the large population to whom mineral 
oil is a necessity. 

“ Private and Confidential.” 

We have recently criticised the new policy of 
hugger-mugger and secrecy which has been developed 
in the administration of the General Medical Council 
since Sir William Turner succeeded the late Sir 
Richard Quain as President and Mr. Allen succeeded 
Mr. Miller as Registrar. We have entered our protest 
against a system of dealing with the business of an 
important public body in whispers or by hole and corner 
coteries, and we are glad to believe that the good 
sense of a large majority of the Council will be 
manifested against the methods sought to be estab¬ 
lished by a small party of the executive of the 
Council. We speak again to-day in order to repudiate 
emphatically any obligation to regard as confi¬ 
dential the official communications and reporta 
set forth in the Council’s programmes It is nob 
because the President or Registrar pleases to direct 
the printer to put “ private and confidential ” in the 
corner of the programme that they can thereby with¬ 
draw its contents from public knowledge and dis¬ 
cussion, nor indeed is there anything in the agenda. 
of the Council which would justify secrecy exoept r 
perhaps, the details of a case upon which the Council 
has to sit in judgment upon an indictment for 
“ infamous conduct.’ The School Board or the 
County Council would have as much right as the 
General Medical Council to hide away the data for 
its public business and neither conclave has ever 
thought of doing so. 


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Jan. 4, 18«9 NOTES ON CURRENT TOPICS. _Thb Medical Breus. 19 


Now Tear Honours. 

The list of New Tear honours comprises a fair 
number of representatives of the medical profession. 
To begin with, Sir Henry Thompson is awarded a 
baronetcy, which we hope he may be spared to enjoy 
for many years to come. Dr. Herman Weber carries 
off a knighthood, doubtless in return for his active 
collaboration in the anti-consumption movement. 
Sir Charles Cameron, the well-known Medical Officer 
of Health for Dublin, is made a C.B., upon which we 
offer him our congratulations; and Dr. T. E. Mac- 
pherson is created C.M.G. as a member of the Uganda 
administration. Of Indian officials Colonel W. P. 
Warburton, M.D., and Colonel D. Sinclair are 
nominated Companions of “ The Most Exalted 
Order of the Star of India,” while Lieut.-Colonel 
H. K. McKay and Major W. B. Browning are 
made Companions of the “Most Eminent Order 
of the Indian Empire.” Dr. Plunkett O'Farrell, 
Commissioner of Control and Inspector of Lunatic 
Asylums in Ireland,is to be made aKnight. Lastly,the 
Queen has been pleased to approve the following 
appointments in the Order of the Ho-pital of St. John 
of Jerusalem in England, in recognition of distin¬ 
guished services rendered during the plague epidemic 
in India: — 

To be enrolled Honorary Associates of the Order:— 
Captain J L. T. Jones, Captain W. E. Jennings, < aptain 
A. F. W. King, Lieutenant W. J. Niblock. The follow¬ 
ing ladies have been selected as Honorary Serving Sisters 
of the Order:-Mis8 Lillian M. Robinson, Bombay; 
Miss Maud B. Kendall, Bombay; Miss Jane Eleanor 
Wheatley, Poona ; Miss Emma Ann Moles, Poona: Miss 
Jessie E. Blair Hitchman, Sholapur;. Miss Marion Hale, 
Cutch ; Miss Harriet Jane Home, Karachi; Sister Heri- 
berta, Karachi; Mrs. Dyson, Surat. 

The Proposed New Imperial University 
for India. 

The Provisional Committee appointed to carry 
out the preliminary steps to give effect to Mr. J. N. 
Tata’s munificent offer for the foundation of a new 
University or “ Research Institute ” for India have 
interviewed the new Viceroy, with the object of 
securing his “sympathetic adhesion” to the scheme, 
towards the maintenance whereof the Government 
will by and bye be asked to contribute. Lord Curzon 
did not withhold his sympathy, but he showed 
diplomatic caution when asked to endorse the pro. 
posals laid before him. He evinced a desire to 
Teceive information on two very important points— 
viz., whether, when the professors had been appointed, 
a sufficient number of pupils would be forthcoming to 
justify the new departure; and, seoondiy, whether, 
assuming an adequate at ten dan oe of students, posts 
could be found for them when they had fully availed 
themselves of the facilities which the institution 
would offer. Mr. Justice Candy, in his reply, made 
it clear that they looked especially to medical and 
sanitary scienoe students for their alvmni, and these, 
it was confidently anticipated, would find ample 
eoope for useful and remunerative activity. Mr. 
Tata's offer of 30 lakhs of rupees is one which it 
would be a pity to allow to lapse, but a little caution 
on the part of the Government in committing itself 


to approval of a particular scheme iB perhaps com¬ 
mendable, as so many contingencies have to be borne 
in mind. 

The Dublin Orthopaedic Hospital. 

A notice appears in the Dublin newspapers of a 
somewhat unusual character, being an intimation that 
the executive of the Dublin Orthopaedic Hospital has 
made application to the Board of Trade to register 
i as a limited liability institution. As is the manner 
of all who manage concerns which apply for official 
recognition, the executive of the hospital applies for 
most expansive powers empowering it to fit out hos- 
P'tals of unlimited extent, to pay the staff, to deal with 
the assets of the existing institution or any other 
assets which may accrue, and, in fact, to do a thousand 
things which, we apprehend, the existing executive 
has no intention of doing. We notice the public 
announcement only as a new departure, and reserve 
further criticism of the prospectus, in case such may 
seem necessary. 

The Latest Sham Diploma. 

A Yorkshire chemist, who. it would appear, is 
indisposed to submit himself to the excruciating 
ordeal of the examination for “ Fellowship ” of the 
Spectacle Vendors’ Company, has improved upon the 
diploma granted by that august body. He announces 
himself as a “Doctor of Refraction” (Ref. Doct.) 
duly examined and graduated (in absented) by the 
Philadelphia Optical College. This trustworthy 
institution says that he has “ passed a most satis¬ 
factory examination in the theory and practice of 
refraction,” and is, therefore, “ entitled to the highest 
honours which the College can bestow,” which is not 
saying much. But we await with interest some indi¬ 
cation of the nature of the evolution described as 
the practioe of refraction.” 

The St. Petersburg: Academy of Medicine 

The Czar is delighted to honour thief Academy, 
for he has addressed a letter, on the occasion of its 
centenary, eulogising and congratulating it. Several 
British physicians and surgeons have been chosen as 
honorary members, including Sir William Turner 
Sir William McCormac, Sir William Stokes, Mr. 
MacEwen, Lord Rayleigh, Dr. Thompson, and Dr 
Brunton. 


The meeting of the British Pharmaceutical Con¬ 
ference is to be held this year in Plymouth in the 
month of July. 


A wave of salubrity is passing over Dublin just 
now. The total death-rate, which stood at 301 per 
1,000 of the population in the first week of December, 
came down to 24‘6 in the last week. Scarlatina, 
enteric, and diphtheria have all decreased in preva¬ 
lence. The same may be said generally of the 
twenty-three town districts of Ireland, the aggregate 
death-rate of which came down, within the month, 
from 25*7 to 215, 


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20 The. Mjumcal Pkkss. 


SCOTLAND. 


Jan. 4, 1899. 


Coroner v. Doctor. 

A youno man, while playing football, suddenly 
experiences pain in the abdomen 8nd is taken to the 
hospital, where he is found to be suffering from 
strangulated hernia, and an operation was done, 
which, however, did not avert a fatal issue. The 
surgeon, naturally enough, delivered a certificate to 
this effect, but is called to account by the coroner 
(Mr. S. Langham), who holds that he ought to have 
been consulted before the death was certified. With 
all respect to Mr. Langham we cannot assent to his 
contention that the question whether or not death 
was accelerated by the football was one for the jury 
and not for the surgeon to decide. This is essen¬ 
tially a medical question, and the possibility of 
injury does not come in at all, so that Mr. Booker, 
the surgeon referred to, was acting well within the 
limits of discretion when he arrived at the conclusion 
that the case was not one calling for inquiry. 

Menelik’s Diversion. 

Menelik is devoting himself to watching surgical 
operations. In the hospital at Addis Ababa attached 
to the Russian mission there, he never loses an op¬ 
portunity of watching the surgeons in their work. 
Their skill often calls forth from him expressions of 
admiration. His great desire is to act the part of an 
assistant, and, for example, hold the limb when an 
amputation is being performed, So much interest 
does he take in the proceedings that many times he 
has be»n heard to call out “ Oya gut! Oya gut! ’ 
(admirable, admirable) as the surgeon displays some 
modern detail of surgical art. 11 is stated that he is 
kept informed . of everything that takes place at the 
hospital, and that he never misses being present at 
an operation. Bravo, Menelik ! 

Army Medical Requirements. 

The Manchester Guardian says that the condition 
of the military Medical Service is far from being 
restored to equilibrium by the recent concessions to 
the demands of the officers, and that the anticipated 
rush of candidates has by no means satisfied the 
military authorities. It lays the blame for this upon 
the arrangement which, to economise the services of 
officers serving abroad, puts them on prolonged 
foreign service, and fills up their places at home with 
reserve men. This can scarcely be the true explana¬ 
tion of continued abstention of candidates, inasmuch 
as incoming candidates may be supposed to know 
not much and care less for the prolongation of the 
foreign service of the senior officers. 

A Mismanaged Hospital. 

Sebious allegations have been made public 
affecting the Guildford, Godaiming, and Woking 
Joint Hospital Board. It seems that some newly 
appointed nurses had resigned on the ground that 
they had to live in the “ scarlet fever kitchen,” and 
sleep in the diphtheria room, while the general 
arrangements as to cleanliness, &c., left much to be 
desired. The allegations have been referred to a 
committee for investigation, and we trust the local 


Press will take care that all legitimate grounds for com¬ 
plaint are removed. It should be borne in mind that 
nurses are entitled to special protection in view of 
the risks associated with their duties, and proper 
provision for their comfort and well-being ought to 
form an integral part of any hospital scheme. 

Non-Compliance with the Notification Act. 

Mb. John Patbick McNeil, surgeon, of 
Filmer Road, W., was fined at the West London 
Police Co art last week for having neglected 
to notify a case of scarlet fever. He defended him¬ 
self on the ground that he bad not examined the 
child and was not aware of the nature of v the illness. 
We cannot extend the sympathy which we have some¬ 
times expre-aed for the victims of this legislation to 
Mr. McNeil, who -appears to have only himself to 
thank for this occurrence. 


The Educated Herbalist. 

A man died last week in Southampton after treat¬ 
ment for leprosy by a local herbalist, who admitted 
in the witness-box that he kept no books, did not 
know what he had given to the deceased, and could 
neither read nor write. Nevertheless he said that he 
had been in practice for sixty years, and had “ cured 
not hundreds but thousands of patients.” He got 
off scot free. 

The Standard of last Saturday records an extra¬ 
ordinary fatality within one family, and within a few 
days. On November 26th died, at Blackheath, the 
mother, set. 80; on December 10t.h, suddenly at- 
Yokohama, the youngest son, ®t. 59; on the 21st, at 
Blackheath, the daughter, set. 34; and on the 27th, in 
Australia, the third son, tet. 50. Obviously these 
deaths did not result from any epidemic, and had no 
immediate connection with each other, which makes 
the coincidence the more remarkable. 


The measures to be adopted to stamp out tuber¬ 
culosis are to be the subject of a Congress which will 
be held in Berlin from May 23rd to 27th next. 

Db. James Hunter, of St. Catherine's, Linlithgow, 
has been presented with a testimonial expressive of affec¬ 
tion and esteem, in the shape of a horse and brougham 
with harness complete, subscribed for by his patients. 


gtotlaitb. 

[FBOM OUB OWN COBBE8PONDENT.] 

THE PAST YEAR. 

The prominent feature in Scotland of the year just 
ended was undoubtedly the annual meeting of the 
British Medical Association, held at Edinburgh, in the 
last week of July. For nearly a year beforehand the 
various local committees had been hard at work arrang¬ 
ing details, and were fortunate enough to see their 
labours rewarded in the success attendant upon the 
general run of the proceedings. Unfortunately, owing 
to the record attendance of members, and of their rela¬ 
tions, many of the entertainments could not be rendered 
comprehensive enough to allow of all those desirous of 
taking part obtaining admission. It must be said, how- 


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Jan. 4, 1899. 


CORRESPONDENCE. The Medical Press. 21 


ever, that there were always other functions available 
in place of the more popular attractions, which those 
unable to gain admission to the latter oould attend. The 
impossibility of securing accommodation for more than 
a limited, though very considerable, number occasioned 
the ascription of blame to the arrangements, not to the 
real cause. Favoured with brilliant weather, received 
with admirable hospitality, honoured by numerous 
foreign guests, and provided with interesting topics for 
discussion, the meeting in Auld Reekie was a great 
success. 

Otherwise not much of note has marked the passing 
year. The College of Medicine in Dundee has been pro¬ 
viding for the professorships authorised by the Univer¬ 
sities Commissioners on its affiliation with the Univer¬ 
sity of St. Andrews. Occupants of the chairs in 
pathology, materia medica, chemistry, &c., having been 
elected. 

Professor Fraser, of Edinburgh University was 
appointed in October to the presidentship of the Plague 
Commission sent by the Government to Btudy the various 
scientific subjects connected with the etiology and pre¬ 
vention of that disease. The manner of his going and 
the arrangements made for the conduct of his work led 
to some acute frictional symptoms, both in the Edin¬ 
burgh University and Royal Infirmary, which, however, 
rapidly subsided. 

Influenza continued to attack many persons through¬ 
out the year, not at any time in severe epidemic form, but 
in quite definite enough numbers. 

Perhaps the meteorological conditions which have pre¬ 
vailed throughout the entire year form the most notice¬ 
able point. Although the occurrence of greater warmth 
than usual has been marked, the extraordinarily great 
decrease of any pronounced cold has been its chief 
characteristic. Up to the end of November the decrease 
in accumulated day degrees below 42 degs. F. amounted 
to nearly as much as 30 ppr cent, of the figure expected. 


Lower Damnun, 2 100 persons were inoculated, while 
three times the number refused to submit, and between 
March and the end of May, 1,400 deaths occurred among 
the uninoculated. This large number of deaths, when 
compared with the 2,100 inoculated week by week, and 
supposing that they remained as susceptible to plague as 
the former, should have lcBt at least 332 individuals \ 
whereas the actual number of deaths was only 36, repre¬ 
senting a reduction of 89 2 per cent. A striking and con¬ 
vincing enough statement in favour of inoculation, 
giving encouragement to the hope that the termination 
of this third outbreak of plague is not far off. 

The Plague Commission at Bangalore examined many 
witnesses as to the efficacy of Professor Haffkine’s 
serum and the consensus of opinion as to its efficacy i» 
considered to be very satisfactory. Two lady doctors, 
indefatigable at work among the women and children, 
spoke strongly in favour of inoculation. In the North¬ 
west Provinces, the sanitary commissioner reports 
periodical outbreaks of a disease the symptoms of which 
correspond very closely to the less known form of 
plague, the pneumonic form. It is in most districts 
termed “Maha-mari.” In the Mysore State there is 
little abatement of plague, which still shows a high death- 
rate. In the Hyderabad States there is no marked 
remission. In the Madras Presidency and the Central 
Provinces the disease, although pursuing a persistent 
course, is of a less severe character. In Bangalore, 
where for a time it raged so severely, a satisfactory and 
gradual decline is reported, while in Belgaum and Hubli 
it is fast disappearing. The Plague Commission held 
three sittings in Calcutta, and will make a second tour 
of the plague stricken districts of Bombay. 


CorrcsponOcnce 

Wo do not hold ourselves responsible for the opinions of oar 
correspondents. 


PLAGUE IN INDIA. 

Wb learn by the last mail that a marked decline of 
plague has been brought about throughout the Bombay 
Presidency, and at length we may hope for a rapid dis¬ 
appearance of the infection, at any rate in the epidem c 
form. This has been brought about chiefly by the more 
favourable reception given to inoculation, and to the 
efficacy of Professor Haffkine’s newer prepared serum. 
He seems to have attained better success by appealing to 
the people through their own religious leaders. On 
Wednesday last a very successful meeting was convened 
by the ex-Sheriff of Bombay, Adamjee Peerbhoy, at which 
some five thousand persons were present. The High 
Priest of the Bohras, whose word is law among his co¬ 
religionists, declared that there was nothing opposed to 
religion in the Professor’s system, and therefore, his people 
could no longer object to inoculation as a preventive 
against the plague. The ex-sheriff and his son 
thereupon at once submitted themselves for inoculation, 
and a large portion of those present followed the good 
example. Professor Haffkine has, it appears, quite 
recently discovered a new and more promising mode of 
inoculation, whereby the after-effects are very much 
modified, and less disturbance of the general health 
follows. The success attendant upon the experiment of 
persuasion, will, it is hoped, facilitate and smooth the 
work of the medical profession in their efforts to stay the 
plague. This, however, is not the first success of the 
kind which has attended the exhausting labours of Pro¬ 
fessor Haffkine since he landed in Bombay some two or 
three years ago with the intention of studying cholera. 
When the plague found its way to the Byculla House 
of Correction, Bombay, the professors and Btudents of the 
Grant Medical College volunteered to go to the jail and 
submit to inoculation in the presence of the prisoners. 
This had the effect of inducing the greater number of 
the inmates to follow their example. 

Of the 175 uninoculated. Professor Haffkine reported 
“ twelve took the plague and Bix died, while of the 148 
inoculated, two only were attacked and both recovered.” 
In the course of a few weeks some 8,000 persons sub¬ 
mitted themselves for treatment. In another town. 


THE EXAMINING BOARDS AND PRELIMINARY 
EDUCATION. 

To the Editor of The Medical Pbbss and Cihculah. 

Sir,— In the letter of the Registrar of the General 
Medical Council, which appears in your last issue, the in¬ 
correctness of the figures given in the report of the 
Education Committee with regard to cases of “ deficiency 
in general education,” reported by the Examining Boards 
of the “ Navy, Army, and Indian Medical Services.” is 
admitted, and it is explained that the limitation of these 
reports to the three services was due to an oversight in 
the drafting of the report which has, however, already 
been issued to the public in the half-yearly volume of the 
Council’s minutes, has been made the subject of 
general comment in the Press, and has been officially 
communicated to this College. The oversight is, to say 
the least, unfortunate, as the report, in the form in 
which it was presented to the Council, was calculated to 
convey a most erroneous impression as to the extent of 
the alleged “ deficiency in general education ” attaching 
to persons who had registered as medical students on the 
certificates of this College. 

It is now stated that the figures given in the report 
comprise the whole of the cases reported by the various 
Examining Boards, “ including those for the Navy, 
Army, and Indian Medical Services,” and that out of 
these 14 are those of candidates who had passed their 
preliminary examination at the College of Preceptors. 
With regard to the accuracy or otherwise of the 
figures given in the table in the registrar’s letter, 
it may be sufficient to say that the total number 
of cases reported is, after the most careful exami¬ 
nation of the published minutes, found to be, n t 58 
but 84, or exclusive of cases not traced, 65. The 
number of the cases attributed to the College of Precep¬ 
tors is apparently arrived at by including some cases in 
which undpr the oltj, ‘ piecemeal ” regulation of the 
General Medical Council candidates were registered on 
certificates obtained from more than one examin ng 
body. As it would be impossible to say whether the 
subject of “ English,” in which the spelling test is 
usually included, was passed at one or the other exami- 


Digitized by 


iOOQ l€ 




22 Tub Medical Press. 


nation,,it seems only fair that ail such oases should be 
eliminated, and the number for which the College of 
Preceptors may be held to be responsible would then be 
reduced to 11—11 cases in seven years out of a total of 
2,133 candidates who, during that period, have oome on 
the Medical Students’ Register by means of College of 
Preceptors’ certificates. The proportion of cases traced to 
the College is therefore represented by the fraction 
11-2,133, or about J per cent. The total number of 
medical students registered during the past seven .years 
amounts to 12,526. The average of traced cases of 
deficiency would therefore be 1 in 193, or \ per cent., the 
same proportion as that attributable to the College of 
Preceptors. But if only the number of those who have 
qualified on one or other of the junior or preliminary 
examinations in the United Kingdom be considered, the 
roportion would be 65 out of 8,467, or 1 in 130, or about 
per cent. 

The proportion of repotted cases of “ deficiency in 
eneral education ” among candidates who have qualified 
during the same period on certificates of the Irish Inter¬ 
mediate Education Board is represented by the fraction 

3- 166, or nearly 2 per cent., which is a somewhat dif¬ 
ferent ratio from 11 2,133. Nevertheless, this exami- 
nation is retained on the list, as are also the public 
entrance and other pre-graduate examinations of Trinity 
College, Dublin, with a proportion taken together of 

4- 150, or nearly 3 per cent The mere statement of these 
facts reduces the whole matter to its true proportions, 
and exhibits in the clearest light the triviality of the 
charge that has been brought against the College of 
Preceptors’ examination, and made so prominent a 
feature in the report drafted, as was stated by the chair¬ 
man of the committee, Dr. MacAlister. 

I am. Sir, yours truly. 

H. W. Eve. 

Dean of the College of Preceptors. 
College of Preceptors. Bloomsbury Square, W.C. 


PRINCE OF WALES’S HOSPITAL FUND. 

To the Editor of Thk Medical Press and Circular. 

Sir, -A curious thought occurs to me with regard to 
the distribution of this Fund which is generally supposed 
to be under the direction of Sir Henry Burdett. This 
gentleman has been for many years an uncompromising 
advocate of uniformity in relation to all hospital matters, 
and publications are issued under his auspices for the 
furtherance of this praiseworthy principle. 

One is forced to ask what is -the basis of uniformity 
which has guided the award ]bo two hospitals—(“the 
London" and “Guy’s”)—of a third of the whole sum 
intended—at least, according to the ideas of subscribers 
for the relief of some eighty or ninety. 

I am. Sir, yours truly, 

January 2nd, 1899. X. 

» - 

BOGUS MEDICAL DIPLOMAS. 

To the Editor of The Medical Press and Circular. 

Sir, - It is certainly alarming to medical practitioners 
who have industriously spent the greater part of their 
lives and fortunes in acquiring a license to practice their 
profession, to see day after day companies and mechanics 
such as the Spectacle makers and nurses of the Obstet¬ 
rical Society successfully placing themselves before the 
public—so far as the general public can judge by their 
high sounding titles—with Fellows and Members of the 
different departments or branches of the Medical Pro¬ 
fession. It is my experience when the public hear of a 
midwifery nurse with a diploma that they regard her 
in every tespect, owing to her training of which the 
diploma is accepted as a guarantee, to be as capable 
of seeing a woman through the intricacies of her confine¬ 
ment as any registered medical practitioner, and needless 
to add this little simple-minded fallacy has the nurses 
fullest connivanoe. 

It is to be feared, too, that ophthalmic surgeons, with 
their hard earned Fellowships and degree honours, will 
experience similar trouble from the Diplomats or Fellow 
of the Spectacle Makers’ Company, and that the titles 


• c - ' :<v, v, n >. <*t. 

Jan. 4, 1890. 

will be simply sought in many ease$ to parade before the 
public with a view to deception, However, anything 
that would tend to misoonstrue the ^honour attached to 
the present day hard-earned medical;or surgical Fellow¬ 
ship is to be deprecated in itself, bu.tjif ; “ faked "honours 
of the obstetrical and spectacle class should lead, as 
some would suggest, to the abandonment of such justly 
honourable titles, the result would be an enormous loss 
to medical education, as with such post-graduate honours 
would disappear all incentive* to further medical educa¬ 
tion, and members of the profession would have to con¬ 
tent themselves with the cbplottiifts of their final students’ 
examination. Unqualified assistants are a thing of the 
past but the Spectacle Makers' Company and Obstetrical 
Society are reviving them in an infinitely worse and 
more dangerous form'. F«w. if any, of the unqualified 
assistants were ever so ignorant of the science of their 
business as the midwife with the diploma, why then not 
allow them to get a diploma in this branch of the pro¬ 
fession and practice it? Why should the unqualified 
assistant labour under sexual disabilities ? 

I am, Sir, yours truly, 

Mbdicub. 


5Citrotturc. 

CATTLE TUBERCULOSIS (o). 

This little work is all it pretends to be, and more, 
since it is not only a guide to laymen, but also to medical 
men and veterinary surgeons, for it gives them in a con¬ 
cise and readable form all they require to know about 
this dire malady for everyday practice. 

It points out very truly that the general professional 
man and the public are just beginning to wake up to the 
importance of this disease respecting public health. A 
faot which Professor Gerlach. late director of the Berlin 
Veterinary School tried to bring prominently before the 
ublio more than twenty years ago from the experiments 
e had then carried out; and this was followed up in 
this country by a pamphlet on “Tuberculosis from a 
Sanitary and Pathological Point of View,” by Dr. George 
Fleming, F.R C V.S., late Principal Veterinary 8urgeon 
to our Army in 1881. Dr. Creighton, we believe, con¬ 
clusively demonstrated some fifteen years or more ago 
the identity between human and bovine consumption, 
still, it is only within the last few years, we may even 
say months, that this has been generally accepted. How¬ 
ever, we think a perusal of this little work of 
77 pages, will do a good deal to convince those who still 
have any doubts on the subject, if they will only take 
the trouble to read it. especially with regard to the 
dangers of f eding young children and animals on milk 
containing the bacilli of tubercle, which hitherto has 
received so little attention from those in authority. 

It is divided into chapters dealing with the causeR, 
symptoms, and prevention of tubercle, the inspection of 
such meat, and how tuberculous carcasses should be used, 
and last (but not least, to the owners of such animals) 
the necessary means of preventing any very great loss, 
and stamping the malady out from our herds. 

There are also some very instructive statistical tables 
showing the percentage of animals affected, as well as 
its distribution in the various organs of the body. Alto¬ 
gether the work is carefully collected and put together, 
m fact it is a multum in parvo on tuberculosis, and we 
strongly recommend *11 those connected with public 
health, Btock raising, and dairy work to obtain a oopy 
and carefully read it. 


TAYLOR’S MANUAL OF THE PRACTICE OF 
MEDICINE. (6) 

This popular text-book of the Practice of Medicine has 
now expanded to the dimensions of 1,002 pages. The 

(а) " Cattle Tuberculosis. A Practical Guide to the Fanner, 
Butcher, and Meat Inspector." By T. M. Legye, M.A., M.D., and 
Harold Sessions, F.B.U.V.8. London: Bailliere, Tindall and Cox. 
1888. Price 2s. 6d. net. 

(б) “A Manual of the Practice of Medicine.” By Frederick 
Taylor, M.D., F.B.C.P., Physician to, and Lecturer on Medicine at, 
Guy's Hospital, Ac., Ac. Fifth editions London i J. and A. 
Churchill. 1898. 


LITERATURE. 



Jan. 4 1899. 


MKDICAL NEWS. 


Thb Medical Pbesb. 23 


pontinuoua popularity of its, progress is the very .best 
evidence that can be supplied of its importance as a guide 
book to the student and the practitioner. 

Besides the revision of the general text, the “ intro¬ 
ductions to Diseases of the Nervous System and to Dis¬ 
eases of the Blood, and the subjaots of Aphasia and Ring- 
worm," we have additions to the text of the former editions 
in the articles on Glandular Fever, Diver's Paralysis, 
Enthromelalgia, Angeioneurotic (Edema, Hypertrophio 
Pulmonary Osteo-arthropathy, and Tubercle of the Skin. 
A separate section is devoted to Diseases of the Medias¬ 
tinum ; and Filarial Diseases and hsmo-globinuria have 
been transferred to Diseases of the Lymphatic System 
and of the Blood respectively. 

In addition to the textual modifications, by which the 
author has carefully and conscientiously brought his 
subjects up to the present standard of scientific attain¬ 
ments and practical requirements, we are told in the 
closing paragraph of the preface that “It has been 
thought advisable to make a change in the style of the 
printing of the work, and it is hoped that the larger 
p*ge, with a clearer type, will be found an improvement.’ 
We congratulate Dr. Taylor on the result of his labours, 
and feel assured that this convenient and beautifully 
printed manual will continue to enjoy its well-merited 
popularity. 


Btfkqphead / 14, Birmingham 19, .Blackburn 17, Bolton 
21, Bradford 16, Brighton 18,’ Bristol 17, Burnley 13 r 
Cardiff 10, Croydon 13, Derby 13, Edinburgh 18, 
Glasgow 18, Gateshead 15, Halifax 19, Hudders¬ 
field 14, Hull -15, Leeds 17, Leicester 12, Liverpool 22, 
London 17, Manchester 23, Newcastle-on-Tyne 18, Nor¬ 
wich 15, Nottingham 20, Oldham 20, Plymouth 18, 
Portsmouth 14, Preston 21, Salford 25, Sheffield 18, 
Sunderland 17, Swansea 30, West Ham 14, Wolver¬ 
hampton 12. The highest annual death-rates per 1,000 
living, as measured by last week’s mortality, were:—From 
measles, 2 6 in Bolton and 2 9 in Nottingham ; from 
whooping-cough, 11 in Halifax and 13 in Preston; from 
“fever,” 10 in Salford, 13 in Brighton and in Bolton, 
and 14 in Norwich : and from diarrhoea, 11 in Plymouth. 
In none of the large towns did the death-rate from 
scarlet fever reach 1 per 1,000. The 116 deaths from 
diphtheria included 46 in London, 17 in Leeds, 10 in 
Swansea, 7 in Sheffield, 6 in West Ham, 6 in Liverpool, 
4 in Brighton, and 3 in Cardiff. No death from Small¬ 
pox was registered in any part of the United Kingdom. 

, PA8S LISTS. 

University of London. 

The following are the official lists of candidates who 
passed the examinations this month under the specified 
headings:— 


Medical Reform. 

At a well-attended mee'ing of practitioners of Roches¬ 
ter, Chatham, Strood, New Brompton, Sittingbourne, 
and districts, he'd at St. Bartholomew’s Hospital on the 
23rd ult., at which a paper was read by Mr. R. B. Ander 
son, F.R.C.S., explaining the policy of the Corporate and 
Medical Reform Association, the following resolutions 
were enthusiastically and unanimously passed: —*• That 
this meeting of registered medical, practitioners of 
Rochester, Chatham, Strood, New Brompton, Sitting- 
bourne, and district, supports the principles and policy 
of the Corporate and Medical Reform Association, 
Limited, and will cu-operate collectively and individually, 
by every constitutional means, in promoting its 
measures” “That this meeting of registered prac¬ 
titioners, members of or joining the Association, hereby 
resolves itself into a district society of the Corporate and 
Medical Reform Association, Limited, for that district.” 
A memorial to the General Medical Council on the sub¬ 
ject of the illegal granting of certificate* having been 
signed by the twenty-three members present, the meet¬ 
ing terminated with votes of thanks to Mr. Anderson 
and the chairman, Mr. Vincent Bell. 

The Mortality of Foreign Cities. 

Thb following are the latest official returns, and repre 
sent the last weekly death-rate per 1,000 of the several 
populationsCalcutta 22, Bombay 40, Madras 41, Paris 
In. Brussels 19, Amsterdam 16, Rotterdam 17, The Hague 

13. Copenhagen 16, Stockholm 16, Christiania 19, St 
Pet n sburg 24, Moscow 30, Berlin 16, Hamburg 16, 
Dresden —, Breslau 22, Munich 26, Vienna 20, Prague 
26, Buda-Pesth 20, Trieste — Rome 15, Turin (10 days) 

14, Venice 19, Cairo —, Alexandria —, New York 
(including Brooklyn) —, Philadelphia 16. 

Royal London Ophthalmic Hospital. 

Sib Squibb Bancroft has kindly promised to tell the 
story of Charles Dickens’ Christmas Carol at St. Martin s 
Town Hall on Thursday afternoon, January 12th, at 
3 o’clock in aid of tho Royal London Ophthalmic Hos¬ 
pital. The Right Hon. Sir John Lubbock, Bart.. M.P, 
F.R.S., Sec. (president of the hospital) will preside. 
Tickets can be obtained from the Secretary, Royal Lon¬ 
don Ophthalmic Hospital, Moorfields, E.C. 

vital Statist**. 

Thb deaths registered last week in thirty-three great 
towns of England and Wales corresponded to an annual 
rate of 17 8 per 1,000 of their aggregate populations 
^hich is estimated at 11,218,378 persons in the middle 
of this year. The deaths registered in each of. the last 
four weeks in the several towns alphabetically arranged, 
corresponded to the following annual rates per 1,000:— 


oi.AF. examination.—Medicine. 

Percy Edward Adams, Arthur Percy Allan, B.8., John Harvey 
Bodmin, B 8., William Francis Victor Bonney, B.S., John Arthur 
Oswald Briggs, Maud Mary Chadburn, Frederick Nesfleld Cookson. 
Montague Dixon, B.Sc., Robert William Dodgson (Gold Medal) ; 
Edward Guy Dru Drury, B.8., George Richard El win, Arthur Henry 
Evans B.8., John William Haines, B.S.,Arthur Heath,Alfred Howell,- 
Tom Harold Hunt, B.8., James Hussey, William Henry Jewell, 
B.S., John Llewelyn Jones, B.S., Cuthbert Henry Jonee Locyker, 
B.8., Antony Alexander Martin, B.S., Elizabeth Jane Moffett B Sc., 
p BS - Wiliam Thomas Gordon 

Pugh, B.8., Alfred Wilham Sanders, William George Savage B Sc . 
Herbert John 8charlieb, B.S., Alfred Walter Sikes, bTs., B.Sc., 
Edmund Ivens Spriggs: William Henry Butter Stoddart, B.S., 
Francis Huge Thiele, B.Sc., Evan thomas, B.S., Edwin Josiah 
T?y e j B.S.. B.Sc., Ethel May Vaughan, B.S., Wilfred Brougham 
Warde, Thomas Henry Wells. 

B.S. Examination.—First Division. 

Thomas Varlev Cunliffe, Joseph Geo. Emanuel, B.Sc., John 
Freston Maxwell Donald John Munro, Winifred c-ecretan Patch, 
B.Sc., Ernest William Spink. 

Second Division. 

Louisa Garrett Anderson, John Smedley Boden, Elizabeth Honor 
Bone, Harold Wilson Bruce. Arthur Stanlmry Cobbledick, Ernest 
Coleman, Lucinda Catherine E. Forster, Leonard Gilbert, Ernest 
Geo Leopold Goffe, Arthur Stanley Green, Joseph Percy Hall, 
Lionel Edwin Charlee Handson, Harry Edward Hewitt, John Davhi 
Jenkins, Jn. Cyril H. Leicester, M.D., B.Sc.. Prank Charles Lewis, 
James Laidlaw Maxwell Mary Elizabeth Pailthorpe, Francis Rilev 
Harry Simgar, M.D., Florence Ada Stoney, Bussell Henry Jocelyn 
Swan, Walter Hy. Maxwell Telling. 

M.S. Examination. 

Charles Herbert Fagge, Charles E. Mackenzie Kelly, M D *- 
John Stretton Sloane, B.Sc., William Turner. 

M.B. Examination.—Examination for Honours._ 

Medicine. 

First Class/- Thomas Jeeves Horder, B.Sc., Gold Medal, St Bar- 
tholomew s Hospital: Henry Gwynne Lawrence, .-cholarship and 
Gold Medal St. Mary’s Hospital; Bussell Henry Jocelyn.Swan, 
Guy s Hospital. ’ 

Second Class. - Frederick Fenn Elwes, Middlesex Hospital Wil¬ 
liam Bayard Griffiths. B.Sc., University College ; Frank Charles 
Lewis, St. Mary s Hospital. 

^ThW Class.-Elizabeth Honor Bone, Royal Free (Hospital 1 
Harold Douglas .- inger. St. Thomaa'a Hospital. P 1 

Obstetric Medicine. 

FireS Class—Thomas Jeeves Horder, Gold Medal. St. Bartholo- 
mews Hospital; Henrv Gwynne Lawrence, St. Mary's Hospital; 
J. Preston Maxwell, Scholarship and GoldMedal, St. Bartholomew’s 
Hospital* 

Second Class— Joseph George Emanuel, B.Sc., Mason C and 
Queen a and Gen. Hospitals, Birmingham ; Frank Charles Lewis,- 
ou Ma»y 8 Hospital. 

Third Clasa.-Victor Evelyn Collins, Guy’s Hospital; Donald 
» Hospital; Henry Peet Yorkshire Oollegei 
Arthur Geo. GrantHumley, Med. 8oh. and 6niv. C. Bristol and 
Guy a Hospital; Francis Biley, WestminsterMeepital. 

Bmscmo Medicine. 

Hospital. 


24 The Medical Press 


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Jan. 4. 1B90. 


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" MU8IC HATH CHARMS,” ETC. 

A correspondent sends the following festive effusion It has 
been suggested that music might prove a useful adjunc t (in some 
cases, at least) where the usual routine treatment by medicine had 
not proved satisfactory. I venture to suggest the following well- 
known airs as being suitable for the cases enumerated, viz.:— 

Retarded labour from inertia (“ Coming through the rye ”). 

Chronic aphonia (“ The lost chord ”). 

Melancholia (" The heart bowed down ”). 

Epilepsy (•• Let me like a soldier fall ”). 

Cases of chronic deafness (“ Come back to Brin ”). 

Pyrexia (** McCoolin ”). 

Cases of doubtful diagnosis (“ Oh dear, what can the matter 
beP”) A. D. 

Indig nan a.—You are quite right in your supposition. Any 
private person is entitled to have an article analysed by the 
Public Analyst, on payment of a fee not exceeding naif a guinea 
{Sale of Pood and Drugs Act. 1875, Sect. 12—14). At the time of pur¬ 
chase he must inform the vendor of his intention to have the article 
analysed, and must offer to divide it into three parts, to be then 
and there separated, marked, sealed or fastened up. One portion 
is then to be handed to the vendor, one sent to the analyst and 
the third retained by the purchaser. If the article be found 
.adulterated such private purchaser may prosecute. Should the 
local authorities neglect their duty it is thus possible for a private 
individual to set the law in motion in the interests of the public 
Before undertaking any such step, however, he will do well to 
make himself thoroughly acquainted with the conditions and out¬ 
lines of the special Act above quoted. 

Rbgidb.—T he endeavour to stamp oat quacks or quackery has 
never been remarkably succes- f ul. Even before the days of Henry 
VIII. the charter of the Royal College of Physicians of London 
gave them power to restrain all pe sons from practising the faculty 
of medicine in the City of Londou or within seven miles thereof 
without the college licence, under a penalty of £5, and by a 
statute In the reign of Henry VlII. which confirmed this charter 
it was further enacted that “ No person shall be suffered to exer¬ 
cise or practise in Physick through England without a licence 
from the college, except he be a graduate of Oxford or Cambridge, 
which hath accomplished all things for his form without any 
grace.” but U is to be noted that n > mention is made of any 
penalty. Somewhat similar provisions were made as to the prac¬ 
tice of surgery, but whether these antiquated statutes could now 
be enforced is a matter which experience alone can settle. 


Jftertmgs of the godetieo mb lectures. 

Wbdnotdat, Jandart 4th. 

Obstetrical Society of London.— 8 p.m. Specimens will be 
-shown by Dr. Lea, Dr. Addinaell, and l>r. J. Philltps. Papers:— 
Dr. Donald : A Case of Ectopic (Intra-ligamentous) Gestation at 
the 8eventh Month in which the Foetus was Extracted by 
Vaginal Incision. — Dr. D. Robinson: Vulval Discharges in 
Children. 

Thursday, January 5th 

Harvrian Society of London (Stafford Rooms, Titchborne 
Street, Edgware Road), 8.30 p.m. Mr. H. Marsh: On the Subse- 

a uent History of Cases in which Adhesions have formed in Joints, 
ie Peritoneal Cavity, and other parts. 

Friday, January 6th. 

Wbbt London Mrdico-Chirurgical Society (West London 
Hosplt&i, Hammersmith W.).—8.80 p.m. Mr. R. Lake: The 
Treatment of Laryngeal Phthisis.—Mr. J. R. Lunn: Two C>ses of 
. Optic Neuritis associated with Mastoid Disease.—Dr. J. Allan: A 
Beries of Twelve Tracheotomies for Laryngeal Diphtheria in 
Vfinog Children, with Nine Recoveries. 


Labyngologioal mocibty of London (20, Hanaro* MquEre, 

W.).—4.30 p.m. Ab*ual "General Mooting Election of Officers and 
Annual Reports. Cases wiH be shown by Dr. 8. Spicer. Dr. D. 
Grant, Mr. C. Hymonds, Dr. B. Baron. Mr. M. Agar, Dr. Tilley, Sir 
Felix Be moo, Dr. W. williams, Mr. W. Wingrave, Mr. A. Thorne, 
Dr. 8t. Clair Thomson, Dr. W. Hill,and others. 8 p.m. Dinner at 
the Cafe Royal. 

koYAL Academy of Medicine of Ireland.— Dr. Purefoy: 
Myomatous Uterus. Dr. Glenn: Intra-lig-imentous Cyst of Left 
Ovary; Tuberculous Tube and Cystic Right Ovary; Removed by 
Abdominal Section. Dr. Jellett: Mymatoos Uterus undergoing Car¬ 
cinomatous Degeneration, removed by Psnhysterectomy. Papers: 
1. Report of Rotundo Hospital Maternity for past year. 2. Re¬ 
port of Rotunds Gynaecological Hospital. 3. Dr. More Madden: 
Treatment of Malignant Disease of the Uterus. 

Tuesday, January 10th. 

West-End Hospital for Diseases of the Nervous 8ts- 
tbm (73, Welbeck 8treet).— 4 p.m. Dr. Harry Campbell: Cases 
of Locomotor Ataxy, with Observations on its Treameut. 


laomrieo. . 

Birmingham City Asylum.—Junior Assistant Medical Officer un¬ 
married. Salary £100 a year. Nith 'boAId. lodging, Ac. i 

County Asylum. Bainhill, near Liverpool.—Assistant Medical 
Officer. Salary commencing at £100 per annum, with fur¬ 
nished apartments, board, attendance, and washing. 

Finsbury Dispensary. Goswell Road. London.—Resident Medical 
Officer for one year. Salary £100 per annum, with furnished 
residence In the institution, attendance, coal*, and gas. 

Go van District Asylum.—Junior Assistant Medical Officer. Salary 
£100 a year, with board and residence. Applications to the 
Medical Superintendent, Hawkhead Asylum, Paisley. 

Kensington Dispensary.—Resident Medical Officer, unmarried. 
Salary £125 per annum, with furnished apartments, coals, ga«, 
and attendance. ' Applications to the Honorary Secretary, 21, 
Lower Philllmo'e Place. Kensington, W. 

National Hospital for the Paralysed and Epileptic (Albany Memo¬ 
rial), Queen Square, London — Pathologist. An annual hono¬ 
rarium of 50 guineas. Also House Physician. Salary £100 per 
annum. 

Nottingham General Hospital.—House Physician. Salary £100, 
rising to £120, with board, lodging, and wa-hlng. 

Royal Southern Hospital, Liverpool.—Resident Junior House Sur¬ 
geon. Salary £60 per annum. 

Royal United Hospital, Bath.—House Surgeon. Salary at the 
rate of £60 per annum, with board, lodging and washing. 

Somerset and Bath Lunatic Asylum. Ootfurd, Taunton. A sets ant 
Medical Officer for five years, single. Salary commencing at 
£120 per annum, with furnished apartments, board, fuel, 
lighting, and washing. 

8underland Infirmary.—House Physician. 8alary £80, rising £10 
annually to £100 with board and residence. 

Townshipof Toxteth Park.—Senior Assistant Medical Officer for 
the workhouse and Infirmary. Salary £100 per annum, 
with board, washing, apartments. Applications to the Clerk 
to the Guardians, 15, High Street, Liverpool. 


^tppoitrtmeirtB. 

Bubd, Cyril P.. M.R.C.S., L.R.C.P. Assistant House Surgeon for 
the Salop Infirmary. Shrewsbury. 

Colb, J. W. E, L.R.C.P.Lond., M.R.C.8., Assistant Medical 
Officer for the Infirmary of the City of Loudon U nlon. 

Davies, Richard, M.D., Ch.M.Bdln., M.R.C.H., L.R.C.P.Lond., 
Medical Officer of the Cheltenham Union Workhouse. 

Gard. Bbnry, L.R.O.P., L.R.C.S.Ediu., UP.P.S.Glasg., Medical 
Officer for the Northern District of Devonport. 

Hogg, J. B., L.R.C.P., DR.CS.Ed.. Inspector of Hospitals for 
the Insane in Queensland and Medical Superintendent for 
the Goodna Hospital for Insane, Queensland. 

Hutchihson, M, m. L., L.R.O.P., L.R.C.S.Irel., Medical Officer 
for the Bucknnrst Hill Sanitary District of the Epplng Union. 

Jones, R.. L.K.Q.C.Irel. L.R.C.8.. Health Officer ana Puolic Vac¬ 
cinator for Baglehawk, Victoria, Australia. 

MacDonald. M., M.B., Ch.B.Glasg.. Officer of Health for the 
Burgh of Greenock. 

Macgbboob, G. R., M D.Aberd., Medical Officer of Health for 
theBlngley UrbanDl-trict. 

Mason, J. J.. L.R.C.P. L.R.C.8.Ed , Medical Officer for the Bol- 
lington Sanitary District of the Mtcciesfleld Union. 

Mblland, C. H., M.K.Lond., M R.C.S., Resident Medical Officer 
for the Manchester Royal Infirmary. 

Roberts, E. U. D., M B., L.R.C.P., M.R.C.8., Medical Officer 
for the Workhouse and the First Sanitary District of the 
Dursley Union. 

Scholefibld, G E., M.D.Ed.. D.P.H.Vict., Medical Officer « 
Health by tha West Lancashire Rural District Connell. 


girths. 

Wright.— On Dec. 24-h, the wife of W. Southey Wright B.A., 
M.R.C.S., of Park View, Oarshalton, of a son. 


garths. 

Magoris.—O n Dec. 26th, at the Seamen’s Hospital, Royal 
Albert Docks, Nicnolas Magoris, M.D.. aged 30, late Surgeon 
to the P.' and O. Steatn Navigation Co. 







®he Miditiil gtrcss anil Circular. 


“SALUS POPULI SUPREMA LEX.” 


Vol. CXV11I. WEDNESDAY, 


Original dTommunications. 

THE SURGERY OF THE GALL¬ 
BLADDER. 

By J. McARDLE, F.R.C.S., 

lecturer la Surgery, St. Vincent's Hospital. 

(Continued from page 644, last vol.) 

Hydatid Cyst Simulating Distended Gall- 

Bladder AND CAUSING OBSTRUCTION. 

Case YI.—Miss C. B.. rot. 24, came under my care 
suffering from severe pain in the abdomen, and chiefly 
in the right lumbar region. She had had severe 
vomiting, and had become greatly emaciated. The 
bowels could not be pot to act properly, although 
flatus passed occasionally. On examination I found 
a tumour occupying the right hypochondriac region, 
and extending downwards to the anterior superior 
spine; it was tender on pressure, dull on percussion, 
and could be moved upwards and laterally with free- 



Fig 6. 


dom, but could not be drawn downwards below inter- 
spinous line. It moved up and down with the respira¬ 
tory act. ‘ An indistinct fluctuation could be detected, 
and, although the tumour felt ovoid, the dulness was 
encroached upon below and on the left side by an 
irregular area of resonance. Owing to the ease with 
which the tumour could be felt through the quad- 
ratus lumborum it was thought to be of renal origin, 
but bimanual examination under ether enabled me 
to discover the kidney, normal in position and size, 
lying well behind and on a higher level than the 
tumour. There had been no jaundice, no history of 
recurring colicky pains, and so gall-stone trouble was 
unlikely. I decided that it was a hydatid connected 
with the under surface of the liver, or a distended gall¬ 
bladder. 


January i 1 , 1899. No. 2 . 


Operation .—Assisted by Mr. Tobin and Dr. Alfred 
Smith, I opened the abdomen in the right semilunar 
line. I found the omentum adherent to the abdomi¬ 
nal wall, and with some difficulty detached it, to find 
that it was closely connected behind to the tumour. 
So firm were the adhesions that I was obliged to 
resect a portion of the omentum. On turning down 
the stump of the omentum the tumour was exposed. 
It proved to be a hydatid as large as a fair sized 
melon, and somewhat like it in shape. It was sur¬ 
rounded, as in Fig. 6, by the colon, which was firmly 
adherent to its lower and left surface. The gall¬ 
bladder presented, as at G. Fig. 6, green and dis¬ 
tended, and the tumour could be traced to the fissure 
of the gall-bladder, where it compressed the cystic 
duct and caused partial obstruction, leading to the 
distension observed. 

The cause of intestinal trouble was very apparent 
when the colon (C, Fig. 6) was exposed. 1 found 
it dark purple in colour and firmly adherent to 
the lower and left lateral aspects of the tumour. 
The adhesions were very vascular, and during separa¬ 
tion, rather free bleeding occurred. Most of this 
was controlled by packing with very warm gauze 
sponges, but at several points double ligatures were 
necessary before section of unusually firm attach¬ 
ments could be carried out. The most difficult part 
of the operation was the separation from the fiver 
and gall-bladder, and one very large vessel—a branch 
extending from the cystic artery—was with difficulty 
secured; at the root of the tumour many vessels 
required ligature. When the tumour was removed a 
great cavity existed below the liver, into which the 
colon bulged. This cavity was tamponed with iodo¬ 
form gauze, and the greater part of the abdominal 
wound closed with silk-worm gut sutures. 

Owing to the low vitality and the protracted nature 
of the operation the patient did not rally rapidly, but 
on the second day after the procedure she seemed 
nothing the worse of its gravity. For some days 
there was rather free sero-sanguineous discharge. 
This ceased after removal of the gauze drain, and on 
the thirteenth day, when the sutures were removed, 
the wound was soundly healed. 

From this time recovery was rapid, and since there 
has been no vomiting or intestinal distress of any 
kind. 

Case VII.—Miss B., set. 22, came under my care on 
March 3rd, 1898. She had been operated on several 
times for the purpose of relieving what appeared to 
be at one time ovarian trouble, at another intestinal. 
Obtaining no relief she consulted me, and on exami¬ 
nation I found her looking at least 36 to 40 years old. 
dragged, worn and ashen grey, in ap pen ranee she was 
much wasted and complained that after any exertion 
acute abdominal pain set in a little above and to the 
right of the umbilicus, and any food, especially meat, 
also brought on this pain. There was not much 
vomiting, but she suffered greatly from flatulence, 
and after the pain persisted for any length of time 
an uneasy sensation occurred between her shoulders 
and down her back ; the urine was loaded with lithates, 
and she found it very hard to overcome persistent 
constipation. There was deep-seated tenderness 
under the right costal arch ana in this neighbour 
hood an ill-defined tumour could be felt. 


Digitized by v^.ooQle 



26 Thi Medical Peess. ORIGINAL COMMUNICATIONS. Jan. 11 . ib99. 


Operation: I made a vertical incision in the right 
semilunar line hree inches in length. Immediately on 
opening the peritoneum the gall-bladder presented in the 
wound, it was greenish in colour and much larger than 
normal I laid itopen freely there was a copious discharge 
of fairly normal bile, and with the flushing scoop I 
removed 24 good sized calculi. The course of this 
case waa uneventful, the wound was completely healed 
n the third week, and from the date of the operation 
until the present she has never bad the slightest 
return of the old trouble, and now eight months 
after operation she has gone back to her proper age 
so far as her appearance goes. 

Case YIII.—Mrs. C. B. was sent to me by Dr. 
Moorhead, of Tullamore, on May 14th, 1898. For 
years she had had recurring attacks of abdominal 
pain, of late these had been so frequent and annoying 
that her life became intolerable. Jaundice was very 
marked, and the history showed that it had varied 
in intensity. During the last few months she was at 
times perfectly free from pain, but suddenly a fit of 
vomiting would come on to be followed by inter¬ 
mitting attacks of violent pain under the right costal 
arch, free purgation, followed by morphia, used to 
relieve her, but only temporarily. Worn out with 
distress, she consented to have anything done that 
would give her a chance of relief. She was so wasted 
that many people thought that the jaundice was the 
result of carcinoma of the liver, but on examination I 
found the liver dulness normal, and I could detect 
the gall-bladder projecting as low as the umbilicus. 

Operation on May 20tli. ~Expecting to find many 
adhesions, I made a free opening after Billroth's 
method, and thoroughly freeing the colon, pylorus and 
the gall-bladder, I drew the latter, which was very 
mucn enlarged, well into the wound, and passing my 
finger along the duct I discovered a large stone fixed 
therein. I now opened the gall-bladder, and gave 
exit to a considerable quantity of muco-pus scarcely 
Btained with bile, with this twenty-four fair-sized 
calculi came away, and after some difficulty I was 
enabled to remove the one which was fixed in the 
duct. The cause of difficulty in its removal was the 
peculiar projections which were fixed in the mucous 
membrane. This stone is depicted at A Fig. 7. For 
many days bile discharged in very large amount, and 
owing to the low vitality of the patient several weeks 
elapsed before recovery was complete, but from the 
moment the gall-bladder was emptied pain ceased, 
and a gradual restoration of health set in, and she 
left hospital well on June 17th. 

Case IX.—On May 30th, 1898, Mrs. L., set. 40, was 
sent to me by Dr. Keelan, of Dunl* er, who diagnosed 
the case as one of gall-stones. The h'story extended 
over some pears and the attacks were typical only 
that the pain was of a more excruciating character 
than usual. This I found as in Case No. XI. was 
due to the fact that the calculi were mulberry in 
shape (B Fig. 7), and they must in passing have 
greatly irritated or even torn the gall-ducts, owing to 
their roughness. Jaundice had been intermittent in 
this case, and when she came to me she was deeply 
bile stained. 

Operation , June 3rd .—In this case I adopted 
Kocher'8 incision and on reaching the gall-bladder I 
found much difficulty in bringing it to the surface 
Its walls were thidk and greyish blue in colour. Fix¬ 
ing it with toothed forceps, and packing well round it 
with gauze sponges I opened it freely, much semi- 
gelatinous material came away, and flushing out with 
sterile water removed seven mulberry calculi. They 
were very rough, and no trace of facet on any of them 
(vide Fig. 7). I sutured the peritoneum carefully 
round the wound of the gall-bladder, as ic could not 
be brought to the surface, then closed the remainder 
of the peritoneal opening by buried suture, a long 
strip of iodoform gauze waa now placed in the gall¬ 


bladder and the rest of the abdominal incision was 
closed with silkworm-gut suture. Recovery was very 
rapid, the patient being up and about on the 11th 
dap. She left the hospital on June 23rd the wound 
being thoroughly healed. 

Case X. —Mrs. M. C., £Bt. 38, came under my care 
on November 1st, 1898, complaining of persistent pain 
under the right costal arch, it was particularly 
mapked after eating meat, and came on about half an 
hour to an hour after meals. There was rarely any 
vomiting, but still patient gradually emaciated and 
became exceedingly weak. She also complained of 
pains across the umbilical region, especially after ;my 
exertion. Double ovariotomy had been performed on 
her by Lawson Tait some years ago, since that 
time the pains above referred to seemed to increase. 
She now consulted Treves, Cullingworth, and others, 
all of whom believed her troubles were due to the 
adhesions. Laparotomy was twice carried out on 
her, adhesions being broken down on each occasion, 
but without any relief of the symptoms. When she 
consulted me her face was dark in colour, drawn and 
anxious-looking, the very sight of food caused nausea, 
and the pain was so great after taking anything that 
she practically avoided nourishment altogether. On 
examination I found the right rectus muscle rigid, 

C A 



• r • * 
*** ♦ 


Fia. 7. 

there was no tenderness on pressure, the stomach was 
resonant and much distended. The pain had now 
become paroxysmal in character, and looking upon it 
as a case of gall-stones, I opened the abdomen by 
Kpcher’s subcostal incision; I found numerous ad¬ 
hesions of the colon to the lower edge of the 
liver and front of the pylorus, and on reaching 
the gall-bladder I found it distended, here and there 
a stone could be felt floating in the fluid. 
On examining the cystic duct l found an ovoid 
calculus impacted as shown in Fig. 8. I opened the 

S ill-bladder in the ordinary way, and removed a num- 
ir of medium-sized facetted calculi. Grasping the 
duct between the index and middle finger of the left 
hand and insinuating a blunt - pointed elevator 
between the large calculus arid the wall of the duct I 
was enabled to prize it into the bladder and remove 
it; now bile welled up into the wound showing that the 
duct was free, and after flushing the gall-bladder 
thoroughly with sterile water I sutured it in the 
oi dinary way to the abdominal wound. There was a 
copious discharge of bile for the firat few days, this 



ORIGINAL COMMUNICATIONS. 


The Medical Peess. . 27 


Jan. 11, 1899. 

gradually lessened, and by the third week the wound 
was fairly healed. From the day after the operation 
the patient had no pain whatever, and in the fourth 
week she left for home able to take her ordinary 
meals without experiencing any inconvnnience. The 
large stone found in the duct is depicted at c. Fig. 7. 
It is rough and round at both ends, there is an 
attempt at facetting. 

Case XI.—Mrs. S., set. 30, consulted me ir. 
February, 1898, about an uneasy feeling she had in 
the epigastrium which at times became unbearable. 
Her friends noticed that when this pain was severe 
profound collapse occurred, and for days after she 
was very prostrate. They did not at the time men¬ 
tion to me that the seizures were epileptic in form; 
there was no jaundice, but before these attacks 
vomiting was very troublesome. On examination of 
the abdomen I found a fulness under the right costal 
arch, which disappeared on elevating the hips and 
making pressure from the front; it would suddenly 
reappear when the patient was raised into the erect 
posture. The diagnosis I made at this time was that 



the attacks were brought on by gall-stones of very 
irregular outline being caught in the ducts in their 
passage to the intestines. The doctor in the country 
did not see his way to agree with this diagnosis, and 
so the patient was kept under observation by him 
until early in November, 1898, when she came to 
Dublin looking very much worse than when I first 
saw her. A few days after her arrival in 
town I was called to her hotel to see her 
in one of these attacks, I found her in a most 
deplorable condition, with a pulse too quick and 
Bmall to count, a dark ashen grey look in her face, 
screaming with pain, which came at intervals and 
caused her to twist into a heap on the bed. Under 
the influence of morphia this pain subsided, and on 
November 20th I admitted her to the private hospital, 
No. 10, Holies Street, where on the 23rd l opened 
the abdomen by an oblique sub costal incision. There 
were numerous adhesions of the gall-bladder to the 
abdominal wall and the colon; on drawing the gall¬ 
bladder into the wound it was exceedingly dark in 
colour and very tense; on opening it a black gela¬ 
tinous mass rolled out into a tray placed to receive 
it, and with it many gall-stones were expelled, the 
shape of these is depicted in Fig. 9. Several of them 
were fixed in the cystic duct, and owing to their- 
shape I had great difficulty in removing them : ulti¬ 
mately with the aid of a scoop I was enabled to 
displace them and flush them out. After thorough 
flushing I sutured the gall-bladder to the wound as 
usual, laid a short drainage tube and closed the inci¬ 
sion. During the evening, after operation, she had 
several epileptic seizures, which yielded to proper 


treatment. Next day found her with a normal 
temperature. Since that time there has been no 
recurrence of the troubles which made her life so 
miserable before. In this case I found a lai’ge stone 
encysted in the wall of the gall-bladder, as shown in 
drawing. 

Case XII.—Mrs. H. came under my care on March 
1st, 1898, complaining of intense pain in the right 
side and extending inwards as far as the umbilicus. 
This pain was greatly increased after walking for any 
length of time, and was frequently attended by 
vomiting of considerable quantities of bile-stained 
fluid. The bowels never acted without physic, and 
sometimes many days elapsed before aperients would 
have any effect. She was greatly cyanosed, wai very 
breathless and corpulent. Examining under ether I 
found the right kidney displaced inwards and for¬ 
wards. but could not detect tne gall-bladder, although 
I had suspected trouble there. On March 11th I 
made a long oblique sub-costal incision. The liver 
projected below the ribs a considerable distance, and 
was adherent to a great mass of the omentum which 



Fio, 9. 

was spread out along its anterior border. On sepa,' 
rating the adhesion I found the hepatic flexure o 1 
colon greatly thickened and fixed to the front of th e 
right kidney by dense bands of adhesion. On sepa' 
rating these, and drawing the colon downwards, I 
found strong bands fixing the pylorus and gall¬ 
bladder (which was thick and shrivelled up) to the 
back of the transverse colon. These adhesions were 
now separated, and pushing the large intestines well 
in the abdomen I foundthe stomach enormously down 
distended with thickened walls an dcovered by greatly 
engorged vessels. On exploring the gall-ducts I 
could discover no calculi, and as the gall-bladder was 
empty and much contracted I did not think it wise to 
do more than free it thoroughly and push it up into 
its proper position. Replacing the kidney in the loin, 
and seeing that the pylorus was thoroughly freed, I 
closed the abdominal wound entii-ely. 

In this case there was pain and distress for some 
time after operation ; it was difficult to secure proper 
action of the bowels, but by the persistent administra¬ 
tion of alkaline aperients, matters progressed favourably 
although slowly ; and on May 5th she left for home 
in good health. This was evidently a case in which 
■abscess in the gall-bladder had excited a localised 
peritonitis ajid then discharged into the intestine. 

Case XIII.—S. L., ret. 52, came under my care on 
May 4th, 1998, complaining of epigastric pain, fre¬ 
quent fits of vomiting, rapid loss of flesh, and general 
prostration. There was no jaundice, but her face 
was dark-grey in colour, and her eyes were suffused 
her tongue was brown and dry, and she suffered 


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28 The Medical Press. 

from persistent constipation. For some weeks paid 
had increased and extended to the right side under 
the ribs. This region was now tender on pressure 
and there was a fulness below the right costal arch. 
The temperature was high in the evening, up to 99*; 
and was sub-normal in the morning, as low as 97'2. 
On examination under ether I found a fluctuating 
tumour which presented between the right costal car¬ 
tilage and the umbilicus. Upon the history of the 
general condition I looked upon this as a case of suppu¬ 
ration of the gall-bladder. On May 11th I opened 
the abdomen by vertical incision in the right semi¬ 
lunar line, brought the gall-bladder to the surface. 
After breaking down adhesions and opening it I gave 
exit to twelve ounces of thin muco purulent material. 
After flushing out with warm boracic solution I 
explored the ducts and found them thickened but 
containing no stone. I fixed the gall-bladder in the 
ordinary way to the abdominal wall, and enclosed the 
incision at its lower part. For the first twenty four 
hours only thin sero-purulent fluid came away, then 
some bile appeared in the dressings, the discharge 
of bile continued until the 24th. On the 30th, the 
wound being quite healed, the patient left for home 
relieved of all ner distressing symptoms. 

Case XIY.-E. O. came under my care on June 
8th, 1898, having been in another hospital under 
medical treatment for six months. She was set. 19, 
well developed and healthy looking. She com¬ 
plained of intense pain under the right costal arch, 
occasional attacks of vomiting of clear bitter fluid. 
Constipation had been marked all through the case, 
and her strength had failed very much, owing to 
inability to take food regularly. There was great 
resonance under the right ribs and extending across 
the abdomen and upwards as high as the left nipple 
where the sound was tympanitic. Distension of ihe 
stomach with gas proved it to be enormously dilated, 
and on auscultation this gas passed through 
the pylorus with a continuous whistling sound 
showing that something interfered with the proper 
action of the valve. I could detect no tumour in the 
bypochondrium, but believing that the trouble in this 
case was the result of adhesions succeeding either 
gastric ulcer or gall-bladder, I carried out a 
laparotomy on June 20th, the incision being in the 
right semi-lunar line. The large and small intestine 
were so twisted up and adherentjon the right side that 
I found great difficulty in separating them. On 
pushing the small intestine downwards, and excising 
a large mass of greatly thickened omentum, I was 
enabled to free the colon from adhesions deep down 
in the fissure of the gall-bladder. The withdrawal 
of this portion of the intestine enabled me to see the 
cause of the intense pain. In this case the pylorus 
was thickened, exceeding vascular, and there were 
numerous adhesions fixing it, and the beginning of the 
duodenum to the lower aspectof the gall-bladder which 
was empty, grey in colour, and small in size, but 
very thick walled. After freeing the pylorus 
thoroughly, I closed the abdominal wound. On the 
eighth aay the wound had healed completely, and from 
the time of the operation no vomiting occurred. 
There was still some pain complained of |in the right 
side, bufiafter a fortnight this completely disappeared, 
and then mild aperients were effectual. This patient 
made satisfactory progress, and the trouble which 
had rendered her miserable for several years occa¬ 
sioned her no further uneasiness. 

(To be continued .) 


Mr. Mitchell Banks, of Liverpool, opened last 
week a new operating theatre in the West Derby Union 
Infirmary. 


Jan. 11 , 1899. 

Vienna CHlinical lectures. 
PSBUDOTETANUS. 

By Prof. ESCHERICH, 

Graz 

Gentlemen,— I present to you a case of consider¬ 
able interest, illu-trating in a forcible manner, a 
series of papers which I contributed some time ago 
to the Fren.-h medical press, unde- 1 the title “ Traits 
des Maladies de l’Enfance.” In these essays I endea¬ 
voured to prove from cases coming directly under my 
own observation, that there are many spurious forms of 
traumatic tetanus which I ventured to designate 
“ Pseudotetanus,” a form that is neither tetanus or 
tetanic, but probably more nearly allied to the former 
than the latter. The principal features of the disease 
are the tonic intermittent contractions of the trunk 
muscles leaving the arms comparatively free, differing 
in this respect from tetanv. The following case will 
better illustrate my remarks than a lengthy discourse 
on abstract principles. 

Sanetti, S., set. 5, with no hereditary weakness in 
the family history, had had typhoid fever last year 
from which he had quite recovered. On July 10th, 1898, 
the mother observed the boy had a stiff neck, of which, 
however, little notice was taken that day. Next day 
this stiff or cramped condition extended down the 
back to the lower limbs. Vomiting of brown-coloured 
matter accompanied these phenomena. On the third 
day the jaws became fixed, which led to his being 
brought to hospital. 

He was admitted on July 12, 1898. He was 
well nourished and healthy looking, except for the 
characteristic phenomena of traumatic tetanus. The 
boy lay in bed with all the muscles of the neck, back 
and legs perfectly tense, giving him the appearance 
of a statue. The muscles of the face were stiff, the 
teeth tightly locked, and the lower extremities, the 
feet being in the pede-equino position. The arms, 
however, were under voluntary control, though the 
movements were slow and limited. At first these 
tonic stiff contractions were continuous, but later on 
the attacks were separated by intervals of varying 
duration, of which advantage was taken to feea the 
patient, 

On the recurrence of a paroxysm an unusual 
phenomenon occurred which was photographed at the 
time, and is now reproduced in the accompanying 



illustration. Whether this was due to spontaneous 
action or psychical irritation extending along the 
spinal muscles cannot yet be determined, but it was 
observed at the time that the features of the 
face were drawn or contracted as when it is 
exposed to a strong blinding sunlight. The 
head was drawn back, th» spine curved, with ihe 
centre of curve posteriorly, till the crown of the 
head and point of the toes supported the whole body 
making the typical arc en cercle of hysteria. In this 
condition the upper part of the arm was pressed 
against the body, while the lower part was flexed or 
extended, sometimes alternately, while no tetanic 
symptoms were observed in the fingers. The muscles 


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ORIGINAL COMMUNICATIONS. 


JaX. 11, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 29 


of the entire body were as hard as marble, and stood 
out under the skin as firm ridges, the cutaneous 
surface meanwhile being covered with a cold clammy 
perspiration. These attacks ranged in duration from 
a few minutes to hours at a time, while the diaphragm 
would become so rigid as to endanger life from a 
similar condition existing in the other respiratory 
muscles. As might be expected, the breathing was 
irregular, ceasing either with inspiration op expira- 
ration, but at no time were there laryngo-spasmodic 
sounds to be heard. 

During the height of a paroxysm the child would 
become cyanotic, the lips and eyelids having a red¬ 
dish blue colour, the eyes projectinr, as if under the 
influence of carbonic acid narcosis. These attacks 
continued with more or less intermission from 
July 14th to 24th. 

The patient preferred to lie on his side or in a prone 
position which he seemed to think relieved his suffer¬ 
ings. During the whole of this period he had little or 
no sleep from the frequency of the attacks, while food 
and fluids had to be introduced into the stomach by 
means of a tube. The physical exertion he under¬ 
went really demanded a larger supply than in ordi¬ 
nary health. 

On July 24th the contractions and attacks sub¬ 
sided so much that he could be fed with a spoon. On 
August 1st the greater part of the trunk was relaxed 
though the feet were still stiff. Slight attacks con¬ 
tinued off and on till August 5th, when the patient 
seemed for the first time to be “ himself again ’ 

On August 20th, the patient could stand without 
assistance, but with the legB wide apart; movements 
in the arch of the foot being now possible. On the 
24th he was discharged from the hospital apparently 
healthy and well. 

During the whole time of these attacks there was 
no fever and no disturbance of the vegetative 
functions ; the sensorium was perfectly clear though 
the patient articulated speech with great difficulty 
and in a bnef, jerky manner. Occasionally spasmodic 
contractions were observed of the muscles of degluti¬ 
tion, but these were not constant. The facial phe¬ 
nomena could not be tested oft account of the 
rigidity, neither could Trousseau’s symptoms be 
elicited. The galvanic stimulus showed no altered 
condition of reaction either during chloroform 
narcosis, or in the interval of rest. No exalted state 
was detected by this means, but with mechanical 
stimuli the result was different. If the hand were 
firmly rubbed along the muscles of the arm an idio- 
muscular wave was immediately observed. The skin 
and tendon reflex were decidedly increased. During 
the severest attacks he complained very little of pain, 
except on several occasions in the neck. 

Treatment .—This consisted mainly in tentative 
measures. Antispasmine in doses of O'3 grms. was 
given without any perceptible benefit. After this 
bromide of potassium was administered in doses 
amounting to 4 and 5 grms. per day, i.e., from 60 to 
80 gre,; this acted as a sedative, but did not check 
the attacks. In severe attacks chloral hydrate enemata 
roved beneficial but their effect was very evanescent, 
t may safely be asserted that medication had little 
or no effect on the disease. 

The connection between tetanus and tetani may be 
distinguished in this case by the absence of hyper¬ 
excitability to the galvanic current, and the absence of 
the pathognomonic phenomenon of Trousseau. On the 
other hand the reaction to mechanical stimulus, as 
well as the tendon reflex, was decidedly increased. 
The wide distribution of the spasms with lock-jaw, 
forcibly reminded one of traumatic tetanus, though 
the etiology was decidedly against this assumption. 

On referring to my former records I find that this 
case, in common with the others, was associated with 
severe phenomena and a favourable result, and oc¬ 


curred, like all the others, in the hottest season of 
the year. 

We cannot fairly estimate the frequency of occur¬ 
rence of these cases, because so few of them have 
been recorded in the whole range of pediatric litera¬ 
ture, yet I am inclined to believe that in milder 
form they are not very infrequent, though it; is 
probably rare to meet with cases as well marked as 
the above. 


^hc Damian lectures, 1898. 

ON DISEASE AND ITS TREATMENT 


PROFESSION OF MEDICINE 


YEAR 1899. (a) 


By WM. EWART, M.D., F.R.C.P., 

Senior Physician to St. George’s Hospital, and Joint Lecturer on 
Medicine to the Medical School; Senior Physician to the 
Belgrave Hospital for Children. 

Lectubb III.—EDUCATION AND MEDICAL 
PRACTICE.— (Concluded.) 

The Academical and the Utilitarian Idea. 

The present system might be regarded as “ academi¬ 
cal ” to a fault. The subjects are dealt with, as it were, 
in oompartments. The pupil is taken through each of 
them from ite beginning to its end. But often he might, 
perhaps, have done more for himself had he attempted 
less. 

Too often, also, the teaching of valuable elementary 
subjects is practically divorced from their uses; and 
when the time comes when the chemical, the physiologi¬ 
cal, and the biological learning and methods might have 
been of practical value they have been forgotten. This 
would seem to suggest the desirability of associating, 
though not at too early a date, a medical purpose with 
the teaching of anatomy, physiology, biology, and 
chemistry, and to render their applications more clinical. 
Method, which represents the academical idea, is essential. 
Any of the sciences well learnt, but particularly anatomy 
and physiology, wonld serve this educational need. 
But the utilitarian or professional idea looks to those 
few great principles and facts without which no physi¬ 
cian or surgeon ought to trust himself to work, as those 
upon which the main stress ought to be thrown in the 
teaching of the sciences. With these at his command, 
the pupil might progress by imperceptible degrees to a 
higher level of scientific and clinical efficiency, and the 
acme of his scientific training would be the study of 
practical pharmacology, which combines all the other 
clinical sciences. We do not notice any progression of 
this sort in our present system. Whilst elementary 
physiological matters are imperfectly grasped, some of 
the most difficult probl-ins, those which tax the expert, 
are made the study of the beginner. There is much to 
be said in favour of reserving these higher subjects as a 
reward for the veteran student. 

The younger student's practical work in laboratories 
might with advantage be concentrated upon those 
methods which are of practical use. further knowledge 
being added upon a firm foundation of facts previously 
known. Thus, whilst avoiding the risk of a premature 
entry into the wards it might be useful to shift a great 
deal of the practical physiological work from the physio¬ 
logical to the clinical laboratory. 

Work performed there in connection with the examina¬ 
tion of the urine, of the blood, of the physical conditions 
of the normal organs, the study of the heart sounds 
independently of murmurs, of the respiratory sounds 
when uncomplicated by disease, of the position of viscera 
as reoognised by palpation and auscultation, would never 
be regarded as wa sted either by the student or later on 

(a) Lecture delivered before the Harveian Society of London 
Dec. 15th, 1866. 


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30 Tj:e .Medical Bless. ORIGINAL COMMUNICATIONS. Jan. 11. 1S99. 


by the practitioner, and would be useful additions to the 
practical work of physiology. 

Clinical laboratories in connection with teaching hos¬ 
pitals are a great need for students and for research 
Whilst in this country most philanthropists have made 
it their ideal to supply a sufficient number of beds and 
have overlooked the real pauper in the hospital—science 
—and the real need, that of a knowledge how to cure the 
diseases which are put into those beds, a much clearer 
view of things has long prevailed on the other side of the 
ocean. Practical sense has made it obvious that the 
object of hospital treatment is not euthanasia, but 
recovery, the secret of which cannot be learnt without 
the means of study. When this need is more widely 
-understood among us generosity will soon flow in this 
neglected channel. 

Clinical Medicine. 

The cry from the obstetric side is, “ Give us more time 
to train the clinical pupil in the most responsible and 
important part of his future practice "—a justifiable 
demand, but how can it be granted when clinical medi¬ 
cine itself is starved? Nominally three years are pro¬ 
vided for clinical training. But too often aftor upwards 
of two years absorbed in preliminary studies, these 
subjects are forgotten, and may have to be learnt again 
at the expense of time properly belonging to clinical 
work. 

The elementary clinical work seems to be too long 
delayed. After much time devoted to pure science and 
to examinations the pupil suddenly enters the wards 
unprepared. To him all clinical things are new. He iB 
yet unfitted to utilise the advantages of a clinical clerk¬ 
ship which too often is conferred upon him at this stage. 
General elementary clinical practice is what he needs, 
and this he would quickly gain in the wards by contact 
with others of greater experience whilst completing his. 
knowledge previously acquired in the practical work of 
physiology and chemistry, until he became able to take 
up with full profit the privileges of a clinical clerk, and 
study disease and its treatment in association with the 
physician, whose functions do not include the teaching 
of elementary methods. For lack of this, the most im¬ 
portant part of his advantages as a clerk are often lost to 
nim, and this accounts for the unfinished clinical con¬ 
dition in which so many have entered upon practice. 

Medical Education.—Medical education would gain 
much in being made continuous by blending the clinical 
idea from a relatively early date with the scientific 
studies, and by keeping up a progression in the higher 
studies of anatomy andphysiology. The student would find 
interest and meaning in each laboratory method, because 
shown to be connected with some clinical point, and his 
clinical anatomy and clinical physiology would remain 
his valued and lasting possessions. 

Clinical Anatomy. —Anatomy, the “ mathematics of 
medicine,” will never cease to be indispensable and 
paramount among preliminary subjects, a fitting intro¬ 
duction to the most laborious profession. No part of 
anatomy is superfluous; but we cannot forget that entire 
subjects are being thrown overboard. Some parts of ana¬ 
tomy are of supreme importance throughout professional 
life, and the final examinations wisely require a 
knowledge both of surgical and of medical anatomy. 
But the average student has to learn these parts of the 
subject twice, because meanwhile he has been allowed to 
forget them. If this is the upshot, too much time has 
been claimed by anatomy at the beginning. The first 
year might suffice for undivided attention to the founda¬ 
tions of anatomy, whil-t further instalments might be 
added by degrees and with a practical bearing. A study 
of the relations of parts might thus coincide with the 
teaching of operative surgery, and medical anatomy with 
that of practical medicine and of clinical work. 

The long anatomical curriculum ought to lead as a net 
result to an accurate knowledge of those parts of the 
body with which we shall be professionally concerned. 
If the rest is to be finally forgotten, might not its teach¬ 
ing be compressed ? 

For the higher examinations, a late application to 
anatomy has always been necessary, and this shows 
that the suggestions thrown out are not absolutely 
unpractical. 


Clinical Phytxology .—Similar considerations apply to 
what I may term “ clinical physiology.” In physiology 
we use too little our great opportunities of studying 
man. What might not Harvey have accomplished had 
he been armed with our present instruments and 
methods of investigation ? What should we think of a 
practical course on the circulation which did not include 
listening with the stethoscope to the heart sounds and 
learning accurately where they are to be listened for ? 
Or shall we deal practically with splanchnology, and not 
make ourselves familiar by palpation and by percussion 
with the position of the various organs ? 

All this is the physiology which is essential; not 
abstruse, not difficult nor repellant; and these physio¬ 
logical observations, though so important and indis¬ 
pensable, are of a purely elementary nature They 
might afford an easy rise to the higher, truly difficult 
physiological inquiries for which many a young student 
is at first totally unprepared, and remains to the last 
unappreciative, whilst the living body appeals to every 
intelligent youth. The advantages of such a system 
would be great and would tell at both ends. Early in 
his career the student would be awakened to a profes¬ 
sional interest in studies which would henceforth 
assume for him in all their theoretical details a practical 
purpose. The gain at the other end would be incalcu¬ 
lable. Instead of his helplessness in approaching the 
bedside, the novelty of the situation and its strangeness 
would have long been removed. He would feel the con¬ 
fidence of an observer, and might proceed to truly clini¬ 
cal studies of disease instead of wasting the clinical 
opportunity upon mere instrumental practice at the 
wrong time. 

Centralisation and the Onb-pobtal System. 

The continued agitation for reform has been a pro¬ 
minent feature of recent years. In this the profession 
has shown its earnestness in the cause of progress. Cen¬ 
tralisation is the question of the day; it lies behind 
most of our present problems, and in particular of those 
relating to University teaching, to the multiplicity of 
schools, to the variety of examining bodies, and to'the 
relative value of the titles conferred by examination. 
But we may be well advised in not departing more than 
is unavoidable from the opposite system, perhaps less 
perfect in its form, but more fertilising, a system to which 
we owe that which we are. Let us beware of sacrificing 
the vitality and spirit of our great professional bodies 
to the doubtful advantage of a monotonous uniformity. 

The one-portal system was some years ago even more 
urgently needed than it now is. Further improvement 
is necessary, but it is a question whether any radical 
change is indispensable. All that is practioally wanted 
might be attained by all the corporations raising the 
standard of their examinations to a uniform level which 
would obviate any downward competition between them, 
and at the same time would exclude from the profession, 
if possible at the entrance examination, those who are 
not thoroughly equal to its responsibilities, so that none 
but the fittest could get their names on to the Medical 
Regieter. 

The Place op the Profession, its Services and its 
Rewards. 

The Service to the Individual and to the State .—I ha ve 
dwelt upon the altruism of the profession in its oonBtant 
war against disease. The character of the personal ser¬ 
vice rendered by its individual members'is well known to 
us. It is often true, and not alone on the field of battle, 
that life itself is offered in the hope of saving life. There 
is little wonder that our profession should supply a 
shorter aveiage of life than any other. Alone, the 
med cal men is never allowed to be ill; and he is singular 
in continuing to work while ill. No other profession 
claims that its labour shall be carried on at night and 
on holidays, and to this must be added the constant 
exposure to infection and to other risks. 

But it is not sufficiently realised that the work done 
by the profession in saving the lives of individuals and in 
checking the spread of disease is a direct service and a 
direct gain to the State Has its practical value been 
fully recognised? We enjoy, it is true, and are thank¬ 
ful for the favour and the protection of the State. But 


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Jan. 11, 1899. 


CLINICAL RECORDS. 


The Medical Press. 31 


beyond charters and privileges such as are granted to 
great commercial associations working for their own 
fit and only indirectly for the good of others, little has 
n bestowed upon us. On the basis of this service we 
might as a profession have been in a position to treat 
with the State. This was the custom with the ancient 
guilds. No such bargain has ever been submitted from 
our side. Men of medicine have parted with their 
" mystery ” without even thinking of an equivalent, 
which has not been proposed from the other side in the 
shape of any practical recognition. 

Thus whilst other professions act on the principle do 
u t des, the great fruits of medical science which prosper 
•our days of peace and ensure the success of our wars are 
a free gift to the State. And that profession which alone 
shares with the'Church the direct care for the welfare of 
the community has little share in its honours. 

The Deserts of the Profession. —Yet, having regard to the 
value which the individual sets upon his own life, to the 
actual value which the lives saved represent to the State, 
and to the untold boon conferred upon suffering 
humanity, it is difficult to see what recognition could be 
adequate. In a younger world, with such a record, 
healers of the sick would have walked as gods among 
men. 

From the individual, the medical attendant receives 
an honorarium only, in acknowledgment of a debt which 
•cannot be entirely paid. By the State this acknowledg¬ 
ment of debt is hardly made and the honorarium is 
scantily bestowed, though statesmen admit that without 
a healthy population there can be no national greatness. 

The Place of Medicine among Professions. —Prece- 
-dence between professions and their social status are 
regulated by custom, and there is no desire among us to 
-disturb these ancient traditions. It may be said of all 
professions that they have risen in dignity. In the case 
of medicine, the rise in worth as estimated in vastly in- 
-ct eased knowledge, in usefulness as judged from the 
amount of human life saved, and in influence as regards 
the practical reforms administered by the State under 
our guidance, has been out of all proportion to any posi¬ 
tion which it has ever held. 

The end of the last century witnessed a revolution in 
France which brought to the front tumultuously the 
•social layers by whom the chief work of the world had 
been carried on without recognition. Less hastily, but 
with unfaltering step medicine has been marching 
towards its proper place in the front rank of the profes¬ 
sion. What is the medical profession in the State P 
Nothing. What should it be ? The chief and most 
important influence; for it was truly said, “ Sanitas 
JSanitatum et omnia Sanitas.” 

The Reward: its Deeds and its Dignity. —The power 
silently wielded by our profession is ever increasing, and 
must give it importance and ultimately a foremost 
position. For the present its reward lies in tho con¬ 
sciousness of this fact, imperfectly realised by our 
fellow men; and also in its dignity, in its intellectual 
work, and in a knowledge that its ministrations are in¬ 
dispensable as well as beneficent. In this isolation and 
this consciousness of power there is a superiority. 

The profession is a self-made aristocracy of usefulness, 
-whose distinction iB not exclusiveness but the widest sym¬ 
pathy, whose strength is not privilege, but prodigal 6e’f- 
sacrifice. Let the estimate placed upon it by its members 
never fall beneath its great aims and achievements. Our 
part as its representatives is one of increasing loyalty 
and self-dignity. This duty lies before each of us, and 
its fruits are within our own grasp, as may be seen by 
the 8 UC 0688 of combined action whenever it has been 
attempted. 

In addition to Pandora’s legacy to our r*ce, there is 
for our profession a large inheritance of charity as well 
as of faith in the progress of humanity, and in its own 
destinies. These things that we see and know cannot 
much longer escape the notice of the people and of their 
leaders. 


Sir James Reid, Bart., K.C.B., has been appointed by 
-the Prince of Wales Physician in Ordinary to His Royal 
Highness, in succession to the late Sir William Jenner. 


Clinical Jiccorbs. 


WESTMINSTER HOSPITAL. 

Enteric Fever without Symptoms. 

Dr. Murrell called attention to a case of enteric 
fever in which there were practically none of the 
ordinary symptoms of that disease. The patient, set. 24, 
was admitted on the sixth day of illness, and complained 
of (nothing but slight headache, a little cough, and 
some dryness of the throat. The temperature at 4 p.m. 
on admission was 101-8, and at 12 p.m. 102-4. On the 
following day the lowest temperature, at 8 a.m., was 
100-2, and the highest, at 8 p.m., 102 4. On the next 
day, the 8th of the illness, the temperature at 8 am. was 
98-0, and at 8 p.m., 102-6. On the 9th day the highest 
temperature was 101"4- On the 10th day it was 97 - 8 in 
the morning, and 101-6 in the evening. From that day 
until the 16th day the temperature was always normal 
in the morning, and rose to 101 deg. in the evening. 
After the 16th day the temperature was never above 
100 deg., and from the 21st day onwards was normal. 

During the whole of the 42 days the patient was under 
constant observation he looked perfectly well. He was 
bright and cheerful, and complained of nothing but the 
inconvenience of being kept on a diet of milk and 
beef-tea. 

His bowels were regular, and there was not a single 
motion indicative of typhoid. 

No Bpots were seen either on the abdomen, or on any 
other part of the body. 

There was no fulness in the abdomen, and no gurgling 
in the iliac fossa. 

There were no abnormal Bigns in the chest. 

The only definite sign was a slight enlargement of the 
spleen. 

Widal’s reaction was obtained on the 14th day. 

It was thought that the fever might be tuberculous in 
origin. Against this were the facts that (1) there were 
no abnormal signs in the chest, and (2) that repeated 
examination of the expectoration failed to detect tubercle 
bacilli. 

The patient was hoarse, and it was suggested that there 
might be tuberculous disease of the larynx. The cords 
were examined, but no indication of tubercle could be 
detected. The hoarseness was probably the result of his 
occupation—a street-hawker. It was suggested that the 
fever might be syphilitic in origin, but its duration was 
against it, and there was no history or indication of the 
presence of the disease. The only conclusion that could 
be arrived at was that it was a case of enteric fever of so 
mild a description that there were no symptoms and no 
signs, with the exception of (1) the temperature; (2) 
the enlargement of the spleen, and (3) the typhoid 
reaction. 

Cases of ambulatory typhoid are well-known, but 
many of these ultimately run a very unfavourable course. 

Cases of apyrexial typhoid have been recorded by 
Dreschfeld, but in most of these there were other 
well-marked symptoms, such as diarrhoea and hemorrhage 
from the bowels Cases of typhoid in which so few 
symptoms present themselves from first to last are rare, 
or at all events, are rarely recorded. 


Sir W. McCobmac, Bart., K.C.V.O., Sir William 
Turner, F.R.S., Dr. Lauder Brunton, and Dr. W. McEwen 
have been elected honorary members of the St. Peters¬ 
burg Academy of Medicine. 


Mr. T. T. Bucknill, Q.C., who has been appointed a 
judge of the High Court, in succession to Lord Hawkins, 
is the second Bon of the late Sir J. C. Bucknill, M.D., 
F.R.S., the pioneer of the volunteer movement. The 
new judge was bora in 1846, and is at present the Member 
of Parliament for the Epsom division of Surrey, in the 
Conservative interest. 


Digitized by 



LL. 


32 The Medical Press. TRANSACTIONS OF SOCIETIES. Jan. ll, 1899. 


^ranjeactions of §orieties. 


OBSTETRICAL SOCIETY OF LONDON. 
Meeting held Wednesday, January 4th, 1899. 

The President, Dr. Cullingworth, in the Chair. 


SEVEN MONTHS' EXTRA-UTERINE FOETUS REMOVED BY 
VAGINAL INCI8ION. 

Dr. Donald, of Manchester, related the case of a 
patient, ®t. 33, admitted July 20th, 1898. Married. Since 
about a year she had been regular until January 30th. 
She had a slight discharge in February, and in March 
there was bleeding for three weeks. The abdomen began 
to swell and the breasts enlarged, and lastly the foetal 
movements became perceptible. On admission there was 
marked abdominal tenderness, the patient was very thin 
and anaemic, and there was an abdominal tumour 
reaching four inches above the umbilicus, firm below but 
elsewhere somewhat indefinite in outline. A loud 
souffle was audible, but the foetal heart could not be 
heard. By vaginal examination the posterior fornix was 
found to be occupied by a haid mass, evidently the foetal 
head. These facte were made out while she was resting 
in the hospital for a fortnight. He experienced some diffi¬ 
culty in deciding what would be the best course to pursue, 
the patient suffering considerably from pressure symptoms. 
Before deciding to remove the child through a vaginal 
incision, he thought it best to make an abdominal in¬ 
cision in order to ascertain the whereabouts of the 
placenta. He operated on August 18th, and immediately 
on opening the abdomen he came down upon a large 
blniBh mass, which was unquestionably the placenta, and 
this he took every care not to disturb. He then intro¬ 
duced a large sterilised pad into the abdominal wound, 
and made an incision through the posterior fornix with 
scissors. He came upon the fcetal head, which it was 
evident could not be directly removed without consider¬ 
able damage to the soft parts, so he perforated and 
crushed^ it, after which the foetus was removed. The 
cavity lelt was plugged with gauze. There was con¬ 
siderable haemorrhage from one corner, which was con¬ 
trolled by large pressure forceps. The patient made an 
uninterrupted recovery, except that on the removal of 
the gauze alarming haemorrhage occurred, which was 
arrested by the reposition of the plug. Sloughing and 
suppuration of the placenta did not take place for 
several weeks, and then some weeks elapsed before it 
had all come away. At no time, however, did her con¬ 
dition give rise to any anxiety. She was discharged well 
on November 12th. He commented on the unusual posi¬ 
tion of the foetus. The peritoneal covering of the gesta¬ 
tion sac was continuous below with the parietal layer of 
peritoneum, in fact its relations were exactly those of an 
intra-ligamentous cyst. It was evident that pregnancy 
had developed in the folds of the broad ligament, and that 
in all probability rupture had occurred at the time when 
she had the haemorrhage lasting three weeks in March 
The objections to the vaginal method were that the 
operator was liable to tear through the placenta or cut 
into some of the large vessels ; it was also asserted that 
the risk of sepsis was greater than by the abdominal 
method. The fitBt of these objections was the only serious 
one, and for this reason he thought it was advisable to 
make out the situation of the placenta before operating 
per vuginam, even if in order to do so an abdominal 
incision was necessary. When this point had been 
cleared up he thought that the vaginal method was a 
comparatively easy and safe way of removing the fcetus. 

Mr. Alban Doran agreed on the importance of ascer¬ 
taining beforehand the site of implantation of the 
placenta, which indeed was the main point of the paper. 

Dr. Galabin thought the vaginal incision offered cer¬ 
tain advantages in comparison with the abdominal 
method. By the latter method it was generally necessary 
to stitch the gt station sac to the edges of the abdominal 
wound, thereby greatly prolonging convalescence. This, 
moreover, left a weak point in the abdominal wall. These 
objt-otions did not apply to the vaginal method, and if a 
sinus remained for a time it was not productive of any 
great inconvenience. 


The President observed that with regard to the in¬ 
cision through the roof of the vagina the author might 
claim to be somewhat of a pioneer in this country. The 
author was, he believed, the first to remove early ectopio 
gestations through the vaginal roof. He recalled a case- 
of peculiar interest which the author had placed on 
record, the patient being a danseure who had professional 
reasons for wishing to avoid a scar on the abdomen and 
the sac was therefore opened through the vagina with 
success. He asked what the author supposed was the 
source of the haemorrhage when the tampon was removed. 

Dr. Donald, in reply, pointed out that if one had 
attempted the operation in this instance through the 
abdomen the operator could haidly have avoided disturb¬ 
ing the placenta with disastrous results. Operating as 
he had done through the vagina the operation was prac¬ 
tically extra-uterine. The haemorrhage appeared to 
oorne from the edges of the sac. 

VULVAL DI8CHARGE8 IN CHILDREN. 

Dr. Drummond Robinson read a paper based on a- 
series of 54 cases of vulval discharges in children with 
clinical and bacteriological observations thereon. He 
described the gonococcus and the means of distinguish¬ 
ing it from other intra-cellular diplococci. He had been 
enabled to discover this organism in 41 out of the 54 cases. 
The affection was often markedly transmissible and thus 
epidemics occurred, the infection being passed on from 
child to child either by manipulations or possibly 
by the use of the same chamber utensils. The affection 
was most commonly observed under the age of five, and 
39 of the 54 of the patients observed by him were under 
that age, only four being over ten. It varied very much 
in respect of duration, and painful micturition was & 
common symptom. Vaginitis, on the other hand, was 
uncommon. He pointed out that he had had to rely 
mainly on the microscopic appearances as the gono¬ 
coccus was very sensitive to changes of temperature, and 
unless special precautions were taken its vitality would 
be destroyed before it could be cultivated. The culture, 
however, had been successfully carried out by several 
foreign observers. 

Dr. Handfield Jones said he had seen a large num¬ 
ber of these cases of inflammatory affections of the 
genitals in children. The inflammation was usually 
limited to the vulva or to the neighbourhood of the 
hymen, and in but a small proportion did it 
invade the vagina. He observed that if gonor¬ 
rhoea were the source of the trouble one would expect, 
as in the adult, to find a rapid extension of the 
disease along the whole length of the genital tract, 
causing salpingitis, &c He had remarked that a large 
proportion of the children affected in this way were deli¬ 
cate, and it was met with seldom in strong, healthy 
children, as for example, in country children. Although 
the disease was common, involvement of the inguinal 
glands was very rare, whereas, in ordinary gonorrhoea 
these glands were commonly involved. Moreover, it 
seemed that in a large majority of the cases very simple 
hygienic measures effected a cure in a short time, while 
in typical gonorrhoeal infection the cure was long and 
difficult. He had seen a few cases o f undoubted gonor¬ 
rhoeal infection where men had attempted to violate 
children. The contrast between the acute course of the 
one and the mild course of the other was very marked. 
On the whole he thought that in this connection nothing 
was more deceptive than “ facts.” 

Dr. Box all suggested that in view of the large pro¬ 
portion of these cases in which a diploooccus was found 
it was strange that so few instances of the conjunctiva 
being affected had been noted, especially as with children 
when there was pruritus such conveyance of infection 
was exceedingly likely. He thought that the clinical 
evidence was not much in favour of these cases being 
gonorrhoeal. 

Dr. A. Routh commented upon the comparative rarity 
of vaginitis in these cases, and when present he suggested 
that in some cases it was not improbably the result of 
infection conveyed by the finger of an incautious 
examiner. 

The President observed that even in adult" vaginitis 
was not common in association with gonorrhoea, indeed, 
it was quite exceptional. Gonorrhoea usually attacked 


Google 


Jan. 11, 1899. 


TRANSACTIONS OF SOCIETIES. 


-the vulva and the cervix uteri, the vaginal mucous mem- 
ibrane not lending itself apparently to infections. He 
had not remarked any particular tendency of the inflam¬ 
mation to attack the urethra. 

Dr. Robinson, in reply, agreed that vaginitis was a 
very rare complication of gonorrhoea in the adult female, 
hut he could not agree that the urethra was seldom 
attacked. His experience was that this was usually the 
•case, the cervix being attacked next in point of frequency, 
then the vnlvo-vaginal glands, and lastly the vagina. 

The President pointed out that the difference might 
he accounted for by the fact that the statistics upon 
-which the author relied were based on the examination 
of prostitutes, and not upon the ordinary run of out¬ 
patients. 

Dr. Robinson added that in his own experience the 
subjects had not been principally delicate or unhealthy 
-children. One could not be absolutely certain if one 
relied exclusively upon the microscope, but there were 
•difficulties in the way of culture tests. Nevertheless, 
when one found an intracellular diplococcus in a dis¬ 
charge from the genital tract the chances were greatly in 
.favour of a gonorrhoeal origin Personally he thought 
the evidence was in favour of a gonorrhoeal origin, and 
the cases showed that the disease in children differed in 
many respects from the disease as it occurred in adults 


JtOYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Surgery. 


Meeting held Friday, December 9th, 1898. 
The President, Mr. R. L. 8wan, in the Chair. 


ADJOURNED DI8CU8BION ON SIR THORNLEY BTOKER’s 
PAPER ON “ COXA VARA.” 

The President said he was doubtful whether as a 
-disease, or as a special disease, it was worthy of the 
-great argumentative accuracy and talent that had been 
spent upon it. Sir Thomley Stoker had said that they 
might couple these cases of osteo-malacia occurring in 
adults with coxa vara-a disease of childhood and 
.adolescence. He himself had never seen osteo-malacia, 
because his experience of any deformed condition of the 
femur had been an accentuation of the natural convexity 
-of the femur from the habit of leaning on the left leg. 
He did not think that any practical surgeon would mis¬ 
take morbus coxce for coxa vara in infants or children, as 
-coxa vara is a symptjm of rachitis, and there would be 
other conditions, he thought, to mark the difference. 

Mr. Lentaigne questioned whether some of the cases 
of so-called morbus coxse in early stages, which had been 
successfully operated on, were not merely cases of coxa 
vara He had recently seen a case of coxa vara, which 
he thought might easily have been mistaken for eirly 
hip-joint disease. 

Mr. T. Myles did not agree that the condition cf 
coxa vara was easily diagnosed from morbns coxae, for 
until the condition was described the mistake must have 
occurred a great many times. As yet the condition had 
not been accurately defined. Apparently it is applied to 
all cases in which there is a change in the normal angle 
of thefemur. If caused by osteo-malacia or rickets he 
thought that it could not be called a separate disease. He 
thought it extraordinarily like morbus coxse in the early 
stage. 

Mr. Croly said that he failed to see why coxa vara 
could not be diagnosed from morbus coxse. He had seen 
many dozens of cases of morbus coxse treated, and could 
not say that coxa vara had ever attracted his attention. 
What proof was there that cases which had been treated 
as morbus coxae were really coxa vara ? He did not 
believe that such had happened. He believed that cases 
which he had treated as morbus coxse were morbus coxse. 

Sir W. Thomson said that the condition had un¬ 
doubtedly been overlooked, and was different from 
morbus coxae. He did not see why—although he ad¬ 
mitted that there are certain cases in which there is 
plenty of evidence of this general condition—one could 
claim rickets as a cause when the condition is confined 


The Medical Press. 33 

to the neck of the femur, and there is no evidence what¬ 
ever in the rest of the skeleton of any rachitic oondition. 
But he was satisfied that any condition in the neck of 
the femur which would lead to softening, whether in¬ 
flammatory or pre-tuberculous, is sufficient to allow 
straightening of the neck oi the reduction of the angle. 

Sir Thorn ley Stokeb, in reply, said that the subject 
was a new one, and, of course, there was room for differ¬ 
ence of opinion. Those who had differed from him 
would, he thought, find their contentions answered if 
they read his paper. 

THE OPERATIVE TREATMENT OF HERNIA. 

Mr. M'Ardlb brought forward the subject of the 
radical cure of hernia, bising his communication on the 
results in 342 cases. The ages of the patients ranged 
from 8 months to 85 years. Of this number but one died, 
and that was an instance of umbilical hernia in a man 
of 65, very stout, and with weak heart and atheromatous 
arteries. Mr. M'Ardle advocated:—1. Free opening up 
of the inguinal canal, so as to have complete control of 
the internal ring. 2. Interrupted suture of the internal 
oblique conjoint tendon to Poupart’s ligament, leaving 
the cord in its normal position. The sao might be liga¬ 
tured, sutured, or drawn through the external oblique 
after Kocher’s method, but the fundus should be removed, 
as it could serve no useful purpose however placed. It 
was a grave mistake in Kocher’s method to bring the sac 
down, and cause it to act as a wedge in the anterior part of 
the inguinal canal, and in all these cases where the sac was 
puckered, twisted, or invaginated, its retention was a 
danger, as proved by many instances of necrosis of the 
sac, delay of healing, and even of death. Mr. M‘Ardie’s 
belief is that the method of dealing with the sac is of no 
moment so long as we exclude the dangerous and ineffec¬ 
tive methods mentioned. A Bantock’s ligature placed 
on the neck close to the internal ring brings the peri¬ 
toneum to its normal condition. Mr. M'Ardle stated his 
conclusions as follows:—1. Without opening up inguinal 
canal no complete operation can be performed. 2. It is 
a matter of little importance what you do with the her¬ 
nial sac; it has no bearing on the case; a new sac forms 
with the greatest readiness, if at any point the mid- 
stratum of the abdominal wall is defective. 3. There is 
no evidence in favour of opposing the arrangements of 
Nature by displacing the cord. 4. To properly recon¬ 
struct the canal, the internal oblique and conjoined 
tendon should be brought down to Poupart’s ligament, 
not merely to the edge of the external oblique. 6. The 
complete overlapping of the pillars of the external ring 
forms a firm basis of support for the healing of the 
underlying conjoined tendon. 

Mr. Croly believed that closure of the internal ring is 
the most important part of the operation for the radical 
cure of hernia. Slitting up the inguinal canal and 
suturing it without closing the internal ring is not suffi¬ 
cient, and would be followed by return of the hernia. 
He himself liked the displacement method of Kocher 
best, and his experience of that operation was that the 
method was excellent. 

Mr. T. Myles said that it had to be decided which of 
two fundamental principles one proposed to adopt in 
performing the rad’cal cure of hernia—whether it was 
intended to rely merely on reposition of the sac and 
super-imposition of an obstacle at the commencement of 
the inguinal canal, or whether it was intended to ignore 
the sac and rely on an attempt to restore a condition 
analogous to that of healthy persons. He believed that 
every case of acquired hernia has a congenital basis as 
its origin. The force which prevents the descent of a 
hernia, by the exercise of that same foroe occludes the 
channel through which the hernia would descend—in 
other words, the canal is valvular. The greater the 
pressure within the abdominal cavity in a properly 
formed individual the more forcibly will the posterior 
wall be applied to the anterior wall of the- canal. In 
every case of hernia the distance between the external 
and internal rings is diminished. The internal ring, in 
caseB of hernia, is always larger than normal owing to 
defect of development of the conjoined tendon. If this 
theory is correct, then any attempt to prevent descent of 
hernia by manipulation of the sac would end in failure. 
He failed to see exactly what Mr. Croly and Mr. Ball, 



34 The Medical Press. 


TRANSACTIONS OF SOCIETIES. 


Jan. 11, 1899. 


in a recent article, meant by cloaure of the internal 
ring, and the approximation of the supeificial and deep 
structures of the canal. The internal ring, as it existed in 
cases of inguinal hernia, really had only one border—viz., 
the edge of the conjoined tendon. So far as the mere 
dealing with the sac is concerned, he condemned Mr. 
Ball’s method. Twisting of the sac in Mr. Ball’s method 
produced a vortex and a smooth lining membrane over 
it. He thought that necrosis of the sac conld only occur 
when an enormous redundant mass of tissue is 
left below. In the first place, a tissue is left 
which is bound to die; and in the second place, a 
hindrance to the second step of the operation is left. He 
agreed with Mr. M’Ardle in the first part of bis opera¬ 
tion, except that he did not make the incision bo long. 
He did not like Halsted’s operation. His o vn opinion 
was that a radical cure could be made in a man who has 
an approximation to a normal inguinal canal. 

Mr. Ball did not believe a smooth surface of peri¬ 
toneum could be obtained by any method in which a 
ligature is applied to the neck of the sac, no matter how 
high up it is put, and there will be always left a depres¬ 
sion above the ligature through which a subsequent 
hernial sac can be produced. One should aim at the 
obliteration of any depression at the point where the 
neck of the sac originated from the peritoneum, and also 
at the efficient closure of the inguinal canal. He thought 
it improbable that any suture which brings the anterior 
pillars of the ring together will cause any union between 
them. But the fascia derived from the fascia trans- 
versalis, which comes down, as a rule, on the hernial sac, 
s a vital structure, and any operation dealing with a 
hernial sac must tear the sac away from this tube of 
fascia, and suturing of the inguinal canal must occlude 
this long canal of fascia. He was now in the habit of 
doing a slight modification of his operation as originally 
published, which was suggested to him by Kochers 
operation. After bringing down the sac, and twisting 
it till the sac and neck were sufficiently twisted to 
ooclvide the whole length, &nd to throw into folds the 
peritoneum Surrounding the inguinal canal, a silk suture 
is passed up through the inguinal canal and brought out 
through the entire thickness of the abdominal wall, and 
out through the skin. The needle is threaded on the 
other end of the silk, and is passed up, and brought out 
through the skin at a point on the same level about an 
inoh above the apex of the external abdominal ring. On 
dealing with that loop, what might be called the “ bite ” 
of the stump is caught, which is pulled up in the sub- 
peritoneal tissue at the back of all the abdominal 
muscles, and is fixed at a certain point by tying the 
suture over a little lead button, where it can remain for 
eight or ten days. If the fundus is of moderate size it 
will lie in the apex of the abdominal ring. In the further 
steps of the operation the fundus of the sac, together 
with the spermatic cord, is pressed backwards round the 
edge of the conjoined t-ndon towards the peritoneal 
cavity, and a curved needle, threaded with silk, is passed 
through all the lateral structures of the inguinal canal. 
By his method the sac was directed upwards to the point 
where it is fixed, and if that tends to dilate, it tends to 
dilate against the strong muscular abdominal wall, 
instead of against the weak inguinal canal. 

Mr. Tobin urged that one ought to try to get a new 
union and smooth closure for the opening in the radical 
cure of hernia, and attempt to bring back the parts to a 
condition in which, if forces were applied, there would be 
no spot on which there would be a particular drag. He 
thought that a more even surface could be obtained by 
applying a ligature round the sac than by Mr. Ball’s 
method. 

Mr. M'Abdle, in reply, said that he still believed the 
only way to cure hemu was to close the middle stratum 
of the abdominal wall. It was necessary to secure the 
neck of the hernial sac by all means, but that was not 
the one desideratum. Mr. Croly, he thought, had been 
mistaking the neck of the sac for the internal abdomnal 
ring. Ligature will not secure the ring, because there is 
nothing to ligature. It was to make the valvular condi¬ 
tion of the wall more perfect that he carried out his 
operation. He emphasised the fact that not alone did 
the structures which he bad mentioned join, but that the 


external pillar united to the internal pillar. This he had 
proved by subsequent dissection for other things. Re¬ 
garding the question of the fascia transversalis, in any ope¬ 
ration the needle used to bring together the conjoined ten¬ 
don, the transversalis, and the internal oblique take in the 
transversalis fascia, and also the subperitoneal fatty 
tissue. The similarity of Mr. Balls method to Cheyne’s 
was very marked as described by himself. The question 
of the bladder is very important. The bladder might be 
pulled up without any peritoneum behind it, so that the 
muscular tissue of the bladder comes out behind the sac. 
It could not be detached, for if this were done it would 
be detached from its peritoneal covering above. 

The Section then adjourned. 


WEST LONDON MEDICO-CHIRURGICAL 
SOCIETY. 

Meeting held Januabt 6th, 1899. 

Dr. S. D. Clippingdale, President, in the Chair, 


Mb. Lake read a paper on the 

treatment of lanbtngeal phthisis, 
based on a series of 160 cases. He did not enter into any 
discussion of methods of treatment he bad not tested. 
Clinically the cases could be resolved into groups, each 
of which derived benefit from slight modifications of 
treatment. 

He particularly dwelt upon the advantages of intra¬ 
tracheal injections in cases of superficial ulceration and 
slight swelling, but admitted of its uselessness alone in 
cases of greater severity. 

The case was discussed by the President, and Messrs. 
McAdam Eccles, James, and Atkinson. 

Mr. J. R. Lunn read a paper on 

“TWO CA8E8 OF DOUBLE OPTIC NEURITIS ” ASSOCIATED 
WITH MASTOID DISEASE. 

Case I. a boy, set. 11, complained of giddiness and 
severe pain in the right ear from which there was a little 
offensive discharge. He appeared to be quite deaf. 
Behind the right ear was a fluctuating swelling. In two 
days the patient became delirious and then maniacal, and 
the swelling behind the ear became larger. Under an 
anaesthetic a perforation of the membrana tympani was 
discovered. The mastoid cells were trephined and found 
to be full of offensive, cheesy material. The operation 
was necessarily extensive, and at the end of the excava¬ 
tion the pulsating lateral sinus could be seen. The 
patient made a good recovery and the optic neuritis soon 
cleared up. 

Case II. a girl, set. 14, who had suffered from ear 
trouble &ince an attack of measles and scarlet fever when 
7 years old. Behind the right ear was a fluctuating 
swelling, and from the meatus flowed an offensive dis¬ 
charge. Deafness was marked. The right membrana 
tympani was perforated, and both optic discs showed 
signs of optic Deuritis. The right mastoid process was 
trephined, and much sclerosed bone had to be removed 
before the offensive caseous matter could be reached. 
The patient made a good recovery, and the optic neuritis 
soon disappeared. 

The paper was discussed by the President, Mr. Lake, 
and Dr. Batten. 

Dr. James Allan showed a specimen of hypertrophied 
prepuce. Dr. Allan also read a paper on “ Twelve Cases 
of Tracheotomy for Laryngeal Diphtheria in Young 
Children, with Nine Recoveries.’’ The details of the 
operation were discussed, and stress was laid on those 
points which the author considered important. It was 
shown by reference to a case that tracheotomy some¬ 
times gives the most brilliant results in apparently hope¬ 
less cases. The indications for the operation were dis¬ 
cussed, and the dictum “When in doubt operate at 
once ” was quoted with approval. 

The paper was discussed by the President, Dr. Gibhes, 
and Messrs. Lunn, Lloyd, Atkinson, and McAdam 
Eccles. 


Jah. 11, 1899 . _ FRANCE. _ The Medical Press. 35 


BRADFORD ME DICO-CHIRURGICAL SOCIETY. 

Meeting Held at the Royal Infirmary, 
December 20th, 1898. 

The President, Dr. Berry, in the Chair. 

Dr. Enrich gave a demonstration of microscopic sec¬ 
tions from a senes of ovarian tumours. He mentioned 
that the malignant or non-malignant character of a 
tumour could not be determined until operation; also 
that in the same tumour there could be demonstrated a 
change of type from innocent to malignant; and further, 
that in the ovary itself, although it may not apparently 
be involved in the tumour, yet malignant disease may be 
demonstrated microscopically. 

Mr. Hall remarked that a tumour may exist for years 
without showing symptoms of malignancy, and advo¬ 
cated early removal of all tumours as soon as diagnosed. 

Mr. Hall read a paper on the 

OPERATIVE TREATMENT OF BREAST CANCER. 

He expressed the opinion that there was a brighter 
future for the surgical treatment of breast cancer than 
for that of any other form of malignant disease, provided 
only that the disease was recognised early, and that a 
thoroughly radical operation were performed. He con¬ 
tended that the bad results of operation in the past were 
the result of imperfect removal, and pointed o ut how greatly 
the percentage of cure had increased sinc9 the introduction 
of the more extensive methods of operating. The aseptic 
treatment of wounds rendered it possible to undertake 
these operations without grave risk to life. The reader 
of the paper then gave a summary of the results of dif¬ 
ferent surgeons from 1870 to 1896, and contrasted the 5 
per cent, of cures obtained by Billroth in the earliest 
decade with the 50-60 per cent, obtained by Halsted, 
Watson, Cheyne, and others in the last few years. 
Billroth’s cases, published in 1878, showed an immediate 
mortality of 24 per cent., while Halsted’s series of 133 
cases, between 1889 and 1898, recovered without any 
death from the operation. Bennett May recorded in 
1897 78 cases without a death. Allusion was made 
to the researches of Heidenhain, 8tiles, and others 
on the course of the lymphatics of the breast, 
and the conclusion was stated that no operation can 
be deemed satisfactory unless not only the breast and 
axillary glands are removed but also the lymphatic 
channels which run in the pectoral fascia. Halsted’s 
operation was selected as fulfilling these requirements. 
A description of Halsted's operation was then given, and 
diagrams shown illustrating the steps of the procedure. 
It was stated that very little loss of function followed 
the operation, and that it was generally possible, owing 
to the large mass of tissue removed, to cover in the wound 
without undue tension on the skin. Mr. Hall said that in 
the older method of operating the pectoral muscle, after 
being stripped of its fascia, became much infiltrated 
with fibrous tissue, and consequently suffered considerable 
loss of function. The idea that the operation would be 
accompanied by an increased immediate mortality was 
negatived by the results of operators who have used it. 
Mr. Hall contended that by no other method could the 
contents of the aiilla be so easily and safely removed in 
consequence of their being fully exposed to view and the 
possibility of employing scalpel and forceps instead of 
the finger. The question of operating on cases, which 
were too far advanced to hope for a cure, was then discus¬ 
sed. Operation aB a palliative measure was advocated in 
all cases where there was a reasonable prospect of remov¬ 
ing the whole growth, and in which the operation would 
not be exceedingly dangerous to life or leave a hopeless 
functional result. 

Mr. Hobrocks remarked that ho thought in most 
cases the operation was unnecessarily severe, and thought 
that the pectoral fascia could be removed without 
removing the whole muscle. He said that the results of 
operation in cases of atrophic scirrhus should not be 
grouped with the results in rapidly growing cases, as 
the prognosis was so much more favourable, and conse¬ 
quently statistics of mixed cases were unreliable. 

Mr. Althobpe said that the more favourable results 
of later years as compared with the results of earlier 
operations were in part due to improvement in operative 


technique, whereby the immediate mortality of operations 
was much reduced. 

Dr. Berry asked if it was a fact tliat cases in which 
suppuration occurred were more likely to be followed by 
a cure than those in which primary healing followed. 

Drs. Heine, Wood, Bell, and Arnold Evans also offered 
remarks. 

Mr. Hall, in reply, expressed the opinion that it was 
not possible to remove the pectoral fascia completely 
while leaving the muscle behind. He said that possibly 
the apparently better results in cases which suppurated 
were due to the circumstance that the suppuration might 
be produced by a very extensive handling and bruising 
of the tissues consequent on an extensive operation. 

Dr. J. H. Bell read notes of a case in which hsemato- 
porphyrin had appeared in the urine. The case was one 
of a nervous affection accompanied by insomnia, and 
sulphonal had been given to induce sleep. The sulphonal 
had been given in 10-grain doses, but the patient had 
continued the administration when no longer under 
medical advice. 



[FROM OCR OWN CORRESPONDENT.] 

Paris, January 7th, 1890. 

Typhoid Fever. 

A serious epidemic of typhoid fever is reported as 
existing among the troops at Cherbourg, especially 
affecting the Marines. The number of cases at present 
under treatment at the Naval Hospital exceeds 300. The 
infection is believed to be due to ingestion of water 
from the river La Divette, and instructions have been 
issued for precautions with the view to prevent the 
further spread of the epidemic. 

The Fever Scare at Nice. 

It is stated that the hotel proprietors of the South of 
France are suffering severely from the absence of the 
usual English and American winter visitors, and that 
the majority of the leading hotels are being carried on at 
a heavy pecuniary loss. The fever scare at Nice, I under¬ 
stand on good authority, arose thus: A certain rioh 
newspaper proprietor, who shall be nameless, rented his 
Riviera headquarters from the Mayor of Nice, whose 
private property it was. On expiration of the lease he, 
as landlord, doubled the rent, and refused to let it for 
less. Thereupon the former occupant removed to Monte 
Carlo, and threatened to have hiB revenge. Straightway 
there appeared letters in the Times and other leading 
English and American newspapers inaugurating the 
fever scare. It is obviously impossible to control the 
accuracy of this rumour, but countenance is lent to the 
assertion by the letters of Dr. Allan Sturge and other 
resident medical men utterly denying that there has been 
lately, or is, any fever in the Riviera. That there has 
been a mild attack of “ Fashoda fever ” cannot be gain¬ 
said, but this national ferment has ceased; indeed, it 
may be affirmed that among the thinking portion of 
Frenchmen it never existed, and from recent personal 
knowledge I can testify that the Riviera was never so 
well drained or so well supplied with pure water as now, 
whilst the hotel accommodation is all that can be desired. 
I have th.-.ught it well to make these remarks in the inte¬ 
rest of invalids and others seeking health who have been 
deterred from going to the Sunny South by newspaper 
correspondence which in any case is not above suspicion. 

Treatment of Arterio-sclebosib. 

M. Lancereau presented, at the meeting of the 
Academie de Mddecine, a young woman with generalised 

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GERMANY. 


Jan. 11, 1899. 


induration of the skin, and a man suffering from chronic 
rheumatism, gout, and arterio-sclerosis. In the woman 
the Bkin of the face had lost its elasticity, was smooth, 
brilliant, and indurated, while the teguments of the 
neck and trunk were so thickened that the movements of 
the arms and the respiration were considerably impeded. 
Under the influence of iodo-thyrine, administered in 
progressive doses (ten to sixty grains a day), the patient 
improved rapidly. After four months of this treatment, 
the skin of the face reoovered its normal aspect, that of 
the trunk and the neck became more elastic, and the 
movements of the arms greatfy facilitated, so that the 
woman, who for the last two years was incapable of any 
kind of work, could now use her needle without the 
slightest trouble. 

In the second patient, the iodo-thyrine aoted like a 
charm on the rheumatic pains and the osteophytes, while 
the arterial tension diminished, and the peripheric 
arteries lost their hardness and their sinuous appearance. 

Tuberculosis or the Testicle. 

M. Eeynier read a paper on a case of tuberculous 
disease of the testicle treated by castration and resec¬ 
tion of a large portion of the vaa deferens in a man, ®t. 
26. In order to be able to remove a sufficient length of 
the vas deferens, the operator had to incise the inguinal 
canal and turn aside the peritoneum. It should be 
remarked, the speaker said, that frequently in practising 
castration for tuberculous disease of the testicle the 
section of the vas deferens was not made high enough; 
persistent fistulas were the result. In three cases he was 
obliged to resect a second time the canal Generally 
speaking, he believed that one should not hesitate to 
operate as completely as possible in the above affection, 
which was by no means benign, for in spite of the best 
general treatment it might infect the lungs if allowed to 
develop. 

Lupus (Erythematous). 

A well-known professor recommends in the treatment 
of lupns (erythematous) applications of proof spirit. A 
young woman suffering from this affection was treated 
by cauterisation, but the patch always remained a 
bright red. Lotions of proof spirit were applied, and in 
a few weeks the malady disappeared completely. Of 
five other cases thus treated, four were chronic, the fifth 
acute. Three of the former were cured in a few weeks, 
hut the fourth was only slightly improved as the patient 
had not been able to treat himself properly. However, 
it was in the acute case that the alcohol seemed to have 
acted particularly well. The lupus occupied almost the 
whole surface of the face and invaded the neck, down to 
the sternum. At the end of four weeks of the alcohol 
lotions no trace of the eruption was left, and had not 
returned up to the time of writing (six months). 

The treatment consisted simply in passing over the 
parts a plug of cotton imbibed with proof spirit or, what 
was preferable, in a mixture of 

Proof spirit ■) 

Sulphuric ether > 3j. 

Spirit of peppermint ) 

The liquid is allowed to evaporate on the skin, and 
the lotion repeated as often as possible by the patient 
himself, during the day. 

HjEMOPTY8I8. 

Prof. Davezac, of Bordeaux, has treated with success 
hemoptysis in two tuberculous patients with sub¬ 


cutaneous injections of serum and gelatine (2 per cent.). 
In one case he injected into the outside of the thigh five 
cubic centimetres (one drachm) of the solution, and the 
haemoptysis ceased. Double this dose was injected in 
the second case, with a similar favourable result. 


(Hermaitp. 

[from our own correspondent.] 

Berlin, January «th. 1899. 

Principles of Treatment of Tuberculosis of thi 
Bones and Joints. 

In a paper on tbiB subject in the St. Petersburg Med. 
Wochentch. Dr. Paul Klemm lays down the following as 
fundamental points of treatment. Diagnosis in the earliest 
stages of the disease is of the highest importance. The 
most important primary treatment is absolute rest of 
the parts in bed and plaster of paris. On retrogression 
of the symptoms the plaster of paris dressings may be 
changed for such as allow of walking. Every manual 
redressment of any abnormal position involves an uncon¬ 
trollable serious danger as regards the patient. It is 
contrary to reason to be a partisan of either operative or 
conservative treatment. This does not depend on the 
taste of the Burgeon, but on the condition of the patient 
which demands varied therapeutical measures corre¬ 
sponding to the condition of the diseased limb. Injec¬ 
tions of iodoform are highly to be commended, if it is 
possible to bring the remedy into contact with the 
diseased parts. Tuberculous suppurations require re¬ 
moval of the pus by puncture or incision, with sub¬ 
sequent treatment by iodoform. Operation is justifiable 
when febrile movements were present or a suppuration, 
caused by advance of the tuberculous mischief, threatens 
to weaken the patient. Typical resection, with the 
exception of that of the hipjoints, is well avoided; 
arthro and arthrectomy, as well as local extirpation, 
should be preferred. In principle the formation of firm 
ankylosis is to be selected in preference to mobility 
General treatment is an important factor in the manage, 
ment of tuberculosis. - The highest ideal requirement in 
the treatment of surgical tuberculosis lies in the founda¬ 
tion of sanatoria standing midway between holiday 
colonies and hospitals, open the whole year, and devoted 
exclusively to the treatment of tuberculosis. 

Revolver Injury of Brain and Removal of Missile. 

In connection with the report of a successful case in 
which the site of the bullet was determined by Rbntgen 
illumination, and thereupon removed, Med. Rat. v. Burck- 
hardt, in the Med. Korrosep. Blatt, dee Wurtemb. JErtt.* 
Landesverei*, the operator passed on to discuss the sub¬ 
ject from a wider point of view. In 1854 Von Bruns 
published his work on the surgical diseases of the 
brain and its coverings. He therein shows that the 
principle of not searching too minutely for the missile in 
the brain, as had been shown by numerous observa¬ 
tion that the retention was not injurious,, was wrong. 
He was able to show that in the supposed reoovered cases, 
after a lapse of time varying from months to years 
changes took place, in consequence of the pressure of the 
bullet, that led to the death of the patient. The collec¬ 
tion of Bradford and Smith, which embraced the cases 
of gunshot injury to the brain, supported the views of 
1 v. Bruns. They found where the bullet was removed a 


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Jan. 11, 1899. 


THE OPERATING THEATRES. 


The Medical Pbess. 37 


mortality of 38 per cent.; where it was left in, a mortality 
of 64 per oent. 

V. Bergmann, in his work '* Ueber die Einheilung von 
Pistolenkngeln im Him nebst Bermerkungen zur 
Behandlnng von Schusswander," advocates strongly 
abstention from interference in recent injuries where the 
skin opening is small, and this even in times of fever, 
except in a few cases, as, for instance, where the menin¬ 
geal artery is injured, or when symptoms are present of 
irritation in the neighbourhood of the motor region. 

V. Burckhardt, on the other hand, in all cases of bullet 
injury to the brain, except those in which there is no 
hope of retaining life, lays open the bullet track. If the 
track extends into the brain he removes the bullet if its 
situation can be ascertained, and that is facilitated by 
the Rontgen rays. 

He then cleanses the wound with simple sterilised 
water, and always leaves in a drainage tube. He attri¬ 
butes great importance to leaving in the drain. He only 
recommends this plan of treatment, however, in times 
of peace, where every assistance and all necessary appli¬ 
ances are at hand. If these are not procurable he 
recommends the course of v. Bergmann, simple aseptic 
dressing. In the field especially this plan is the only 
proper one. 

The Degree or Doctor of Medicine. 

The decree of the Prussian Ministry, according to 
which the degree of doctor can only be granted after the 
Stoat's examen has been passed, the degree itself not 
being a legal licence, came into foroe on October 1st. The 
other German States have now followed the example of 
Prussia. The different governments are now seeking to 
establish uniform regulations for the granting of the 
M.D. degree. 

School Medical Officers. 

This subject is coming again to the front. The urban 
School Deputation having laid a series of proposals 
before the magistracy. These are to the effect that a 
school medical officer shall be appointed to every six 
schools; that all children shall be examined before ad¬ 
mission ; that sick children be examined and certificates 
granted where necessary; that every fortnight the 
medical officer shall attend at the school, when the 
teaoher can get advice and children be presented for 
examination. At the request of the master he must 
visit the school either daring or outside the hours of 
instruction, and he must communicate with him what¬ 
ever is amiss. Anything observed can only be published 
with the consent of the School Board. The honorarium 
proposed is £25 per annum. 


Jlustria. 

[FROM OUR OWN CORRB8PONDENT.] 

VIENNA, January 6th. 1899. 

Renal Colic. 

At the Gesellschaft der Aerzte, Schnitzler exhibited a 
patient, set. 18, who had suffered on many occasions from 
excruciating pain in the left fiank, in which a distinct 
swelling could be felt on palpation. During one of 
these severe attacks he was brought to hospital, after 
which it was observed that the quantity of urine was 
much reduced. This redaction culminated in painful 
anuria, and finally an operation was decided upon. 


After the kidney was exposed, the pelvis was found to 
be distended by a large number of calculi, one of whioh 
had entered the ureter, and become firmly impacted. 
After their removal the wound was packed with gauze> 
and the patient rapidly recovered. 

It may be well to call attention to a physiological 
phenomenon in this case which should not have occurred 
if the dicta of physiologists are to be accepted. 

The right kidney was, and still is, perfectly healthy; 
then why should such painful anuria have arisen, when 
one kidney can be removed altogether without any bad 
effects ? Reflex action is the positive reply, and this must 
be accepted in the absence of any other obvious cause. 
In opening the kidney, Schnitzler advises the incision to 
be made on the convex margin of the organ, where it 
always heals up quickly, leaving no fistula. 

Disposition and Predilection. 

Hofbauer read a paper to the society on the disposition 
to, and predilection of, disease in the human organism. 
Many diseases acted particularly on individual organs, 
either chemically or bacterially, and this could be pre¬ 
dicted as soon as the nature of the disease was known. 
Again, other diseases had a predilection to become 
metastatic, which was not uncommon in the infectious 
diseases. The fundamental principle of our assumptions 
is that a weakening change must be induced in the tissue, 
probably resembling that of a contused wound where no 
solution of continuity exists, although severe changes are 
induced. 

It follows as a corollary that these changes form a nidus 
for the microbe to germinate, and so fortify itself for a 
successful attack on the whole organism. It iB not neces¬ 
sary that the vitality of the cell should be reduced as in 
inflammatory centres; where the vital force is high we 
have the same disposition to take up the morbid virus. 
We are, therefore, forced to the conclusion that there are 
several factors in “ disposition and predilection,” but the 
most potent of these is “ active hypersemia.” 

Nothnagel complained that Hofbauer had not ap¬ 
proached this interesting subject with the comprehensive 
grasp that it deserved. Before proceeding to discuss 
“ disposition,” the properties and conditions of proto¬ 
plasm, its affinity for and antagonism to poisons whioh 
are circulating in the blood should be considered. 

Professor Neumann said that it was a notorious fact 
that the tertiary phenomena of syphilis had a “ disposi¬ 
tion,” or preference, to appear on the site of the secondary 
efflorescence. He had no doubt that the early changes 
in the tissue and vessels had reduced the resistance of 
those structures, rendering them liable to the subsequent 
attack. 


Operating theatres. 

ST. THOMAS’S HOSPITAL. 

Choledochotomy.— Mr. Battle operated on a female, 
aet. about 50, who had been under the care of Dr. 
Sharkey for symptoms of cholecystitis, which had been 
considered to be due to the presence of a gall-stone. 
The attack, about two months before the present admis¬ 
sion, had been accompanied by pain over the region of 
the gall-bladder and some fever. This had subsided, and 
the patient had returned to her work, but had been com¬ 
pelled to seek re-admission to'.the hospital on account of a 
return of the pain in the region of the gall-bladder. She 


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38 The Mbdical Press. 

had not had jaundice, nor was she known to have passed 
any gall-stone. On examination of the abdomen a 
rounded swelling the size of an egg conld be felt in the 
right linea semilunaris below the head of the umbilicus. 
This was very hard, and its surface slightly irregular; 
it was also very tender. Between this, which was evi¬ 
dently in contact with the abdominal wall, and the liver, 
there was an area of resonance. It was evident that the 
gall-bladder was distended and inflamed secondarily to 
a block in the cystic duct, and this was thought to 
be a gall-stone. At Mr. Sharkey’s request Mr. 
Battle explored the swelling through an incision in the 
right linea semilunaris. The gall-bladder was found 
enlarged and its wall much thickened; it was adherent to 
the omentum and to the hepatic flexure of the colon. An 
incision of its fundus (after care had been taken to isolate 
it from the peritoneal cavity by means of sponges and 
gauze), gave exit to mucus which was bile stained; the 
wall was about a fourth of an inch thick and rather 
friable; no stone was present in the gall-bladder itself, 
but when the finger was passed along the cystic duct a 
stone could be felt about four inches from the fundus ; 
the apex of the gall-bladder and its continuation into 
the duct, as well as the duct itself, was markedly tor¬ 
tuous, and the mucous membrane considerably thickened, 
for this reason no forceps could be made to grasp the stone 
when passed from within, as the mucous membrane over¬ 
lapped it so much. It was considered advisable to 
incise the duct over the stone and remove the calculus 
through the opening thus made ; this necessitated a re¬ 
arrangement of the gauze and sponge packing, the use of 
large retractors and the enlargement of the original in¬ 
cision ; even then it was difficult for Mr. Wallace 
(the Resident Assistant Surgeon) to lift the liver 
and bring the stone in such a position that the duct 
could be incised over it, and Btitches afterwards put 
in. A stone about the size of the last joint of the little 
finger was removed and the duct appeared quite free be¬ 
yond, so that the stitches were inserted after Lembert’s 
method, and the opening closed. It was considered best 
to suture the funduB of the bladder to the abdominal 
wall, and this was done in the usual way. There was 
some difficulty in attaching the gall-bladder as.it readily 
tore when the sutures were tied at all firmly. A drain¬ 
age tube was put into the gall-bladder and surrounded 
with gauze packing. The remainder of the abdominal 
incision was closed with interrupted sutures in three 
lay era. Mr. Battle said that the tumour before exami¬ 
nation at the operation felt as if it were full of 
gall-stones, the hard irregular surface conveying that 
impression to the touch. The removal of the stone 
was difficult, he pointed out, owing to its distance from 
the surface, whilst the swelling of the mucous membrane 
prevented its removal from within by means of forceps. 
Although the duct was apparently completely cleared, it 
was thought better to drain for a time through the 
fundus rather than close the opening at once, as it was 
possible that some swelling of the mucous membrane 
might result from the manipulation of the forceps. 

It is satisfactory to state that the patient has con¬ 
tinued to make satisfactory progress since the operation. 

ROYAL FREE HOSPITAL. 

Operation for the Radical Cure in which the 
Hebnia was associated with Latent Tubercle of the 
Pbbitonbcm and with Peritoneal Cyst.— Mr. Battle 
operated on a boy, ten years of age, for a left scrotal 


hernia of some months’ duration. Three years ago the 
patient had undergone an operation elsewhere for the 
radical cure of a hydrocele of the cord, and the scar of the 
operation was still visible. The hernia was a reducible 
one. On opening the sac it was found to contain a little 
fluid and also a large sized peritoneal cyst with flaccid 
wall. At the lower part of the sac was some cicatricial 
tissue, near which was situated a large nodule the size of 
a split pea; numerous other nodules of smaller size were 
scattered on the peritoneum lining the sac, and could be 
felt on the parietal layer when the finger was introduced 
into the peritoneal cavity. The sac was dissected up 
and removed, the method of Bassini being employed in 
closing the opening. Mr. Battle remarked that the 
general condition of the boy had not led one to suspect 
the possibility of the condition found, neither was there 
anything in his family history showing a tendency to 
tubercle, he had always enjoyed good health, and there 
had been no abdominal symptoms. 


BtOlSTEBED rOB TRAS8MI88IOR ABROAD. 


(Eht Jftcbical gress anb Circular. 

Fubliahed every Wednesday morning, Prioe 5d. Post free, 6jd- 

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Letters in this Department should be addressed to the Publishers. 


^hc Jftcbical grees anb Circular. 


8ALU8 POPULI SUPREME LEX.” 


WEDNESDAY, JANUARY 11, 1899. 


STATE REGULATION OF MARRIAGE.—I. 

Among the dreams of reformers there is one that 
has probably been often fondly dwelt upon, though 
few have had the courage to proclaim it. It is the plan 
of checking the growth of disease and crime by pre¬ 
venting the engendering of offspring by those who 
are diseased in body or in mind. In the present state 
of public opinion such a dream is undoubtedly 
Utopian, yet “ the thoughts of man are widened with 
the process of the suns ’’; and who knows whether the 
twentieth century may not see this somewhat misty 
dream crystallising into a reality? We should, perhaps, 
have to look to our cousins across the Atlantic for the 
actual framing of laws directed to this end; for many 
plans of social reform have taken bodily shape on that 
go-ahead soil; and if many of them have, like the Salt 


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Jan. 11, 1899. 


LEADING ARTICLES. 


The Medical Pbkss. 39 


Lake City, become dissolved in the overwhelming tide 
of popular feeling, some of more substantial struc¬ 
ture may perhaps abide. Our contemporary, the 
Journal of the American Medical Association, has 
three contributions to the subject in one of its 
December issues. Dr. A. H. Bun- writes on “ State 
Regulation of Marriage for the Prevention of Com¬ 
municable and Hereditary Diseases;” Dr. T. H. 
McCassy takes for his theme, “ How to Limit the 
Over-production of Defectives and Criminals; ’’ 
whilst Dr. D. R. Brower offers “ Suggestions on the 
Limitations and Treatment of Juvenile Criminals.” 
All three papers were read in the section on State 
Medicine at the forty-ninth annual meeting of the 
American Medical Association ; and among them we 
may count up four main plans for the improvement 
of the rising generation, as follows :—1. Better train¬ 
ing of children; 2. The reform of punishment 
so as to make it corrective rather than vin¬ 
dictive ; 3. Asexualization; 4. Regulation of 

marriage by exacting medical certificates from the 
contracting parties. Of the first two plans it may be 
said that there is everything in their favour, and 
nothing against them; and with this we may dismiss 
them from present consideration. The plan of 
asexualisation has no doubt arguments to support it ; 
but there is much to be said on the other side. Dr. 
McCassy himself acknowledges that it is not reliable. 
“Oriental people, including the Turks,” he says ( 
“have tried this treatment among the Eastern eunuchs 
and have no confidence in it as a method of reform. 
The eunuchs were shameless, melancholic, and often 
suicidal, as well as defective in courage, gentleness, 
and remorse.” Nevertheless, he advocates the prac- 1 
tice, which would, he thinks, speedily limit the disse¬ 
mination of disease, vice, and crime, if applied to 
defectives and criminals. He would approve of it 
also as a punishment for rape ; and of thiB it may at 
least be said that the punishment would fit 
the crime. But we venture to affirm that apart from 
all scientific objections, the rock on which any legis¬ 
lation directed to this end would split, is the one of 
sentiment in the mind of the public; and that it is 
no more likely to become a legal practice than would 
be the provision of a lethal chamber for the sup¬ 
pression of idiots. We have, lastly, the State regula¬ 
tion of marriage. Dr. Brower contends that “the 
marriage licence, in addition to present requirement*, 
should demand evidence that both parties are in 
good health, that they are not inebriates, not 
epileptic, not tuberculous, not insane, not ( 

criminals, not paupers, and that they have i 
no active venereal disease.” Dr. Burr holds ] 
the same view, believing that “ the public 
good demands that every candidate presenting him- f 
self or herself for a licence to marry should be re- c 
quired to file a certificate of health from a legally 
qualified examining physician, showing freedom from 
hereditary diseases, like insanity or epilepsy, from all 
active tuberculous infections, and from communicable 
venereal diseases." There is so much involved in j 
these two paragraphs that, to facilitate discussion, | s 
we must narrow down the subject. The disqualifica. c 


i tions enumerated fall into three distinct categories ; 
1. Inebriety, pauperism, and criminality; 2. In¬ 
sanity, epilepsy, and tuberculosis; 3. Gonorrhoea and 
syphilis in the communicable stages. Further, any 
legislation would have two objects in view : (a) The 
safeguarding of the health of the contracting parties; 
(b) The prevention of the birth of diseased children. 
Let us look at each of the three categories in this 
dual aspect. 1. Inebriates, Paupers, and Criminals •' 
As regards the first of the two objects, the safe¬ 
guarding of the health of the contracting parties, 
there is no occasion here for legal interference; for 
in the first place a person’s health is not afEected, 
except quite indirectly, by marrying a drunkard, a 
criminal, or a pauper; and in the second place, any 
person marrying such an one must do so with a full 
knowledge of the fact, and can hardly expect to be 
relieved of the responsibility of his or her folly. As 
regards the second object, it may be safely asserted 
that drunkenness, crime, and pauperism depend for 
their development much more upon early surround¬ 
ings than upon heredity; indeed, it is doubtful 
whether the assignment of responsibility for the 
fostering of criminal tendencies to heredity is not 
entirely due to the confusion of hereditary influ¬ 
ence with the influence of early vicious en¬ 
vironment in the parental home. 2. Insanity, 
Epilepsy, and Tuberculosis : Here also it may 
be affirmed that a person’s health is not 
affected by marrying an insane, epileptic or tubercu¬ 
lous individual; so the first object does not apply. On 
the other hand, there is no doubt that the children of 
the insane and epileptic have as their heritage a ten- 
1 dency to the development of these and other diseases ; 
and for this reason people so afflicted ought not to 
marry. But this result is hardly to be attained by 
legislation ; it is rather to be hoped for as the out¬ 
come of the education of the laity as to the dangers 
involved. Moreover, Nature provides her own safe¬ 
guard for the race by ordaining that families with 
the taint of insanity tend to extinction. Tuberculosis 
has to be considered rather by itself. In many cases 
it does not develop till after marriage, and it woul i be 
scarcely practicable to prohibit marriage to persona 
with a tuberculous history. Further, the children 
of tuberculous parents may be themselves healthy, 
especially if due attention be paid to their surround¬ 
ings. The effective working of such a scheme as that 
recently approved and patronised by the Prince of 
Wales will probably do more to limit the spread 
of this national scourge than could be hoped for 
from a law preventing the marriage of tuberculous 
persons. We must reserve the consideration of 
venereal diseases in an acute stage for a future article’ 
as they occupy a very different position to other 
diseases in regard to marriage eligibility. 


UNCHRISTIAN CHARITY. 

The announcement that managers of the Liver¬ 
pool Ladies’ Charity have decided to enlarge .the 
scope of the rules so as to admit “in exceptional 
circumstances, after careful investigation,” single 


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40 Tub Medical Pbcss. 


LEADING ARTICLES. 


Jan. 11, 1899. 


■women in their first confinement, brings into painful 
prominence the cruel and uncharitable rigour of the 
regulations of the majority of these institutions in 
respect of unmarried women. In some lying-in 
hospitals they are altogether placed under a ban and 
even the more liberal only concede accommodation at 
a first confinement. Under pretence of withholding 
assistance from the profligate, the Christian ladies and 
gentljmen who manage these institutions harden their 
hearts against sinning but unfortunate women in 
their hour of need, and leave them to the cold charity 
of the streets or the workhouse. Is this Christian 
■charity P Certainly not such as we understand it 
The true basis of Christian charity is to be 
found in the parable of the adulterous woman, and 
we would repeat for the benefit of these good persons 
the invitation extended to those alone who have not 
sinned. There is no obvious reason why the ethical 
standard which obtains in most general hospitals 
should not also obtain in lying-in institutions. We 
do not refuse admission to the drunken prostitute 
who has been ran over or who has been badly injured 
in a public-house brawl. We do not turn away the 
unrepentant burglar who has broken a limb in some 
nefarious exploit; nor do we decline to diagnose and 
-treat an applicant who is suffering from cerebral 
t um our as the result of immorality in the forgotten 
past. Why, then, this rigour against hapless women 
whose unhappy fate is often but the outcome of 
demoralising surroundings and the want of moral 
tr ainin g P The whole principle is wrong. Medical 
■charities have to do with patients, not persons, and 
it is not for us to re-enact the Pharisaic policy of 
walking by on the other side, avoiding all contact 
with impurity. Let us scrutinise the fear professed 
lest the assistance of unmarried women during labour 
should serve to encourage vice. Do these well-mean- j 
ing ladies and gentlemen imagine that girls delibe¬ 
rately, and with malice aforethought, become pregnant P 
Do they suppose that these girls in yielding to 
vicious instincts are influenced one way or the other 
by their prospects of admission, should occasion arise, 
into a lying-in hospital ? No, if a girl becomes 
pregnant, her first thought is to rid herself of her 
burden, even at the price of health and even life itself, 
and it ought to be our object to stem the rising tide 
of infanticide by providing an asylum for women who 
are tempted by so many, and such grave reasons to 
resort to criminal practices in order to obviate the 
prospect of having to trespass on the grudging hospi¬ 
tality of the lying-in hospital. The same well-mean¬ 
ing but misguided policy forbids the admission 
into the wards of our general hospitals of women 
suffering from primary syphilis, with the result that 
thousands of women who would gladly avail them¬ 
selves of an opportunity to place themselves under 
treatment are thrown back on the streets, there to 
infect countless thousands of the incontinent who, in 
their turn, infect many innocent and otherwise re¬ 
spectable persons. This pseudo-morality, which is as 
unchristian as it is cruel, should be cast aside in 
favour of a higher and more enlightened conception 


of our duties and responsibilities towards the frail 
and the unfortunate. There can be no better oppor¬ 
tunity of obtaining a hold on these women than at 
such a time. Their spirit is broken by the sufferings 
incidental to their condition, they realise, perhaps 
for the first time, that the ways of the trans¬ 
gressor are hard, and the moment is a favour¬ 
able one for appealing to whatever good remains 
in their nature. The hospital, indeed, is not the 
proper place for respectable married women. People 
should not be encouraged to marry until they are in 
a position to face this necessary sequel of marriage, 
and it is a sorry service to them to entioe them into 
engagements which they are not in a position to fulfil. 
We can understand a maternity charity to providing 
medical attendance for married women at their 
homes when circumstances justify this course, though 
even then the door is opened wide to the most flagrant 
abuse. The great argument however is, after all, that 
it is sheer brutality to refuse admission to a woman 
in labour simply because she is unprovided with her 
marriage lines or because experience has not imparted 
to her the virtue of continence. The profligate do not 
have children, or in but small proportion ; it is the 
silly artless girl whose passions are stronger than her 
reason, who commits herself, and her fate should 
appeal to us quite irrespective of her moral status. 

Comment le sauriez vous, kme chaste et tranquille 

A qui la vie est douce et la vertu facile. . . 

Vous ne comprenez pas, n’ayant jamais eu faim 

Qu’on renonce k l’honneur pour un morceau de pain. 


SCHOLASTIC HYGIENE. 

Onb of the most noteworthy discoveries of late 
years in connection with the spread of disease was 
the recognition of the influence of schools in the pro¬ 
pagation of certain infectious diseases. Even now, 
authorities are not unanimously agreed as to the 
influence of school aggregation in the dissemination 
of diphtheria in spite of the most conclusive statistics 
and of the fact that common sense would lead one to 
expect that every social circumstance which brings 
children into more or less intimate contact must 
needs favour the inter-communication of all diseases, 
including diphtheria, that are susceptible of this 
method of transmission. The law compels parents 
to expose their offspring to the risks inseparable from 
sohool life under existing conditions, with the result 
that a very large proportion of the money spent in 
isolating cases of infectious disease when discovered 
is wasted for the simple reason that very mild cases 
escape recognition, and therefore notification, though 
f ull y capable of infecting their immediate surround¬ 
ings. The habits of very young children and 
the promiscuous use of lavatory and other ap¬ 
pliances and utensils offer every facility for the 
propagation of disease, and as we can hardly 
hope to eradicate these habits some other means 
must be found to lessen the risks entailed by 
these huge aggregations of highly inflammable 
material. First of all, it is important that the 


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Jan. 11, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Fksss. 41 


teachers should be instructed in the principles of 
hygiene, so that they may be enabled to take an in¬ 
telligent interest in the application of the principles 
to school life. The subject ought to be made a 
compulsory one, or, failing this, special inducements 
should be offered to them to acquire a knowledge 
thereof by providing courses of lecturers by competent 
men, and by making efficiency in this subject a pass¬ 
port to advancement. A practical knowledge of this 
subject is conceivably more important in the teacher 
at an elementary school than the possession of an uni¬ 
versity degree, seeing that the one is of immediate 
practical importance, while the other, at any rata 
for primary schools, is not. We have already 
mentioned that the control at present exercised 
over the spread of the disease among the young is 
largely inoperative because of the fact that the disease 
may escape recognition for a time or, if mild, even 
altogether, leaving the sufferers free to spread disease 
far and wide without let or hindrance. The only 
effectual way of obtaining information respecting 
this class of cases is the systematic examination of 
scholars by a medical officer appointed for that pur¬ 
pose. There is the less reason for delaying this 
measure seeing that in other respects medical inspec¬ 
tion of the scholars is eminently desirable, notably in 
regard to defects of the eyesight and other special 
senses, as well as in regard to physical and mental 
shortcomings of a nature to call for special appliances 
and care. This obligation is beginning to be dimly 
recognised, but we are not yet, apparently, within 
measurable distance of the school medical officer 
becoming an established institution. The question 
of expense is unworthy of serious attention, first, 
because, as education is compulsory, it is the duty of 
the State to eliminate all avoidable risks, and, 
secondly, because prevention is always cheaper and 
more satisfactory than cure'. Among the minor but 
nevertheless important precautions the use of slates, 
slate pencils, and Bponges ought to be forbidden. 
Slates have long been incriminated as possibly fertile 
sources of contagion, in fact, as generally used, they 
are often plate cultures of pathogenic microbes. Lead 
pencils and pens should take their place, and each 
scholar should be taught jealously to keep his writing 
utensils for his personal use, the loan or transference 
thereof being strictly forbidden. All school property 
belonging to a scholar known to be suffering from 
an infectious disease left in a school should be 
forthwith destroyed or disinfected, and all books 
regularly taken home by pupils should be covered in 
brown paper, such covering to be renewed at stated 
intervals. Lastly, the school premises should be so 
constructed as to be readily and thoroughly -fieansed 
and the process of cleansing, at frequent and stated 
intervals, be effectually supervised by a responsible 
person. It is only by attention to such details as 
these that we can hope to stem the tide of disease and 
to reduce the mortality from this source. We cannot 
possibly remain with folded arms in presence of 
these unquestionable risks. Medical control is indis¬ 
pensable if we are to eliminate foci of infection and 
to graduate the measure of instruction to the intellec¬ 


tual calibre of each pupil. There are signs of the 
evolution of a healthy public opinion on these points, 
and in time no doubt sufficient pressure will be 
brought to bear to compel the attention which the 
subject requires and deserves. 


tfLatzs on torrent topics. 

The Royal Army Medical Corps. 

In a letter signed “ Pirwane,” addressed to the- 
Daily Graphic, the writer calls attention to certain 
facts that should be borne in mind by the fathers of 
young doctors aspiring to a military career. The 
recent warrant, although, perhaps, doing all that was 
necessary and desirable in the matter of corps and 
rank did not deal with anything else. It did not 
remove any of the anomalies referred to in the letter 
quoted. The chief among these are the financial loss- 
incurred by junior officers of the R.A.M.C. serving in 
India, the withholding of travelling allowance from 
officers in India, nothwithstanding the frequent moves 
to which the junior officers- in particular are subjected, 
the withholding of horso allowance from officers 
under field rank in India, where the climate and ex¬ 
tent of ground to be covered render a horse an abso¬ 
lute necessity for the proper performance of the 
duties, and the refusal to grant a charge allowance to 
officers in charge of station and section hospitals in can¬ 
tonments, and of section field hospitals on active ser¬ 
vice. These are obviously unjust, and might easily be 
rectified. It might be thought that the mere 
pointing out of these defects to the Government would 
ensure their removal. We know of the case of a 
medical officer who contracted fever owing to his 
endeavouring to perform his sanitary duties in can¬ 
tonments on foot. Had he waited till the cool (?) of 
the evening to make his inspections he could not 
possibly have got through with his work. One 
principle in the Army is the more responsibility the- 
more pay. Yet medical officers (R.A.M.C.) in charge 
of large station hospitals, or section hospitals, or 
section field hospitals, receive no extra remuneration 
regimental officers on detached command, or perform¬ 
ing duties of quartermaster, paymaster, &e., draw 
extra pay. Indian medical officers detached in 
charge of sections of native field hospitals, under 
identically the same circumstances as British field 
hospitals, receive extra pay. Why, then, not officers 
of the R.A.M.C. ? It is sincerely to be hoped that 
these matters will be properly adjusted so that the 
cadre of officers of the R.A.M.C may be filled without 
unnecessary delay. 

The Life Risks of Soldiers. 

An interesting paper is communicated to the- 
December number of the United Service Magazine by 
Captain Triggs, the purpose of which is to show that 
the rates charged by insurance companies on the 
lives of military officers is excessive. The author 
points out that, whereas the mortality of officers on 
foreign service is 15 per 1,000 annually, that of such 
officers on home duty is only 5 per 1,000. Thus the- 


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42 The Medical Press. 


NOTES ON CURRENT TOPICS. 


mean of the greatest and least risks is only 10 per 
1,000, which is admittedly not greater than that of 
the best lives, on an average, at home. Nevertheless i 
he complains that the insurance companies, while 
they impose heavy risks upon officers going 
abroad, make no abatement for them when 
at home, although, in consequence of the physi¬ 
cal examination to which they have been sub¬ 
jected before admission to the Service, and in con¬ 
sequence of the very favourable conditions of their 
lives when at peace and at home, they may be re¬ 
garded as very choice lives for the insurer. As to the 
risks of officers in actual war service, he points out 
that chances of death vary enormously, having been 
in the South African war of 1879, 64' per 1.000, and 
in the Egyptian campaign of 1885, only 1 per 1,000. 
Captain Triggs also dwells upon the fact that, of late 
years, the risks of transport and of foreign service 
has been greatly reduced, the carriage of troops being 
now almont as rapid, certain, and salubrious as that 
of passengers by the best liners, and the sanitary 
arrangements both at sea and in station being infi¬ 
nitely safer for the soldier than they ever were pre¬ 
viously. The exceptional risk of a general war might 
readily be covered by an additional rate, for the time, 
.of 5 per cent. 

A New Midwives’ Bill. 

Some more tinkering has been attempted in the 
direction of legislation for midwives. A new Bill has 
been drafted by the so-called Midwives’ Bill Com¬ 
mittee. In orief, the Bill provides that henoeforth 
no woman shall call herself, or habitually practice 
for gain, as a midwife unless she has obtained a 
licence; and that in order to be licensed, she must 
inter alia produce evidence either (1) of having 
undergone.a proper training and subsequent exa¬ 
mination, or (2) of having (at the time of the passing 
.of the Bill) been in bona-fide practice as a midwife. 
The Bill does not render it illegal for any person to 
assist a lying-in woman in an emergency. A central 
midwives’ board is constituted under the Bill, the 
.chief duties of which will be (1) to organise examina¬ 
tions of a uniform standard; (2) to regulate, super¬ 
vise, and restrict within due limits the practice 
of midwives ; and (3) to investigate charges of mal- 
•praxis, negligence, or ignorance against midwives, 
furthermore midwives under the Bill are licensed, 
.and not registered; also the habitual practice of mid¬ 
wifery for gain, by women not licensed, is declared 
.to be illegal; lastly, the area within which a midwife 
may practice is, in order to facilitate supervision, 
limited to that of the local supervising authority 
from whom she has obtained a certificate authorising 
her to practice. We note also that the Bill is not 
intended to apply to Scotland or Ireland, and that 
nothing in it applies to legally qualified medical 
practitioners. Inasmuch as the Bill has been drafted in 
.accordance with the recommendations of the General 
Medical Council, there is likely to be less opposition to 
it on the part of the profession than has been the case on 
former occasions. There is some difference between 
a “ Licensed ’’ midwife and a “ Registered ” one, at 


Jan. 11, 1899. 

all events in name, and this, such as it is, may dispose 
of the fear that the proposed new legislation will have 
the effect of introducing an inferior order of medical 
practitioners which has always been the primary 
objection to previous attempts of the kind. We have 
not space to publish the Bill in extenso; but those of 
our readers who are interested in the subject may ob¬ 
tain a oopy of it by applying to Messrs. Howell and 
Co., 87 Malden Road, Kentish Town, enclosing two 
penny stamps. 

The Abuse of Friendly Societies in 
Australasia. 

The Intercolonial Medical Conference, summoned 
to consider the relations between the medical profes¬ 
sion and the friendly societies, met in Melbourne in. 
November last, and several important resolutions 
were discussed and adopted. It will be remembered 
that, as a preliminary step to holding the congress, a 
schedule of questions was issued to all the practitioners 
jn the colonies bearing upon the points at issue, and 
replies were invited thereto. Question No. 9 in¬ 
quired for information respecting well-to-do patients 
who belonged to the friendly societies, and the evi. 
dence forthcoming upon this subject was remarkable. 
A few examples are here appended: “ A leading 
banker, with £5,000 per annum ”; “A retired publi¬ 
can, worth £20,000” ; “ahotel-keeper,worth £5,000 
(he paid a Melbourne consulant 50 guineas for 
one visit,” “ a solicitor, worth £1,600 per annum, who 
is also a large property owner.” “ A gentleman with 
probably the largest produce business in Victoria, ex- 
Mayor, splendid mansion in suburbs, pays me 
14e. 6d. per annum.” “ I have attended as a 
lodge patient a man worth £70,000.” Accord¬ 
ing to the societies’ rules, all the members are 
attended for an inclusive sum of 3d. per week; 
that is to say all the rich patients above men¬ 
tioned had for this sum a medical man at their 
beck and call throughout the year. The Intercolonial 
Medical Journal of Australasia, in discussing these 
facts in the November issue, asserts that the abuses 
of the friendly society system are of such a pro¬ 
nounced nature that it is a matter of astonishment 
that the practitioners concerned should have sub¬ 
mitted to them for so long. 

A Case of Poisoning by Hyssop. 

An inquest held last week at Birmingham on a 
woman who had died after taking an infusion of 
hyssop, and the case is of interest inasmuch as no 
previous case of death from this cause has, as far as we 
are aware, been recorded in this country. It seems 
that the deceased had taken hyssop during labour on 
a previous occasion on the advice contained in an old 
medical work in her possession. She was expecting 
to be confined again on the 31st ult., and sent for a 
penny packet of hyssop, of which she drank an 
infusion. Serious symptoms soon followed, and Dr 
Leech was sent for, but was unable to avert the fatal 
result. The chemist who sold the drug stated that 
the packet contained fifteen doBes. Dr. Leech des¬ 
cribed the symptoms from which the woman was 


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Jan. 11, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press. 43 


suffering when he was called to her. The lips were 
blue, the complexion dusky, and the hands were 
swollen. Labour was in progress, and the child was 
still-born. He had been unable to find any record of 
a similar occurrence in English literature, but he 
mentioned that in a French medical work which he 
had consulted he found an account of three deaths 
from taking hyssop (hyssopus officinale, N. 0. labiate), 
adding that a series of experiments on dogs showed 
that a much smaller dose than that taken by the 
deceased proved fatal to these animals. The dose 
actually taken in this instance was about 160 grains, 
including a largo proportion of the flowers. A verdict 
of death from misadventure was returned. 

The Fever Scare at Nice. 

Our correspondent in the Riviera, alluding to the 
rumours that typhoid is unusually prevalent this year 
in that part of France, throws discredit upon their 
authenticity, and relates an anecdote which may or 
may not afford an explanation of their currency. 
Such information as we have been enabled to obtain 
from private sources lends colour to the view that 
these rumours are the outcome of the mis¬ 
chievous tendency which afflicts so many people 
to write about things of which they know little 
or nothing. On the other hand, the French 
have largely themselves to thank if such tactics 
prove successful in deterring travellers from 
■visiting their sunny south. Reading between the 
lines, the denials of the authorities amount to this : 
•• There is no typhoid fever, and if there were, we 
should say the same thing.” It is, indeed, the fatal 
policy of persistently disguising matters of this sort 
until further secrecy is impossible that has shaken 
public confidence in duly authorised reassuring state¬ 
ments. In England, thanks to our system of notifi¬ 
cation, such tactics are impracticable, and the 
authorities of European health resorts in favour 
■with English and American travellers will do well to 
inaugurate a system which will enable them to 
authenticate their statements by statistics which 
shall command confidence. 

Consumptives as Hotel Visitors. 

The Bournemouth Guardian is naturally not a 
little agitated and distressed by a letter signed 
“ Bournemouth,” recently published in a London 
newspaper. The writer stated that a man in the 
last stages of consumption left his hotel, and that 
“ within an hour from his leaving the room it was 
re-let, this time to a young lady.” It is not clear 
that the incident thus narrated happened in Bourne¬ 
mouth, although the local editor evidently regards 
the matter in that light. Behind it all, however, lies 
the bare skeleton of a grisly tragedy that is being 
enacted every day of our lives, not only in the hotels 
of Great Britain, but throughout the civilized world. 
From the very nature of things a certain percentage of 
the travelling public mustalways, consciously or uncon¬ 
sciously, be affected with communicable diseases. To 
the credit of hotel management generally, it may be 
believed that the systematic order and cleanliness 


which stamps the latterday regime reduces to a 
minimum the risk of these undesirable infectious 
legacies from visitor to visitor. Fortunately, although 
phthisis is due to a specific bacillus, its ordinary 
routes of infection are such that it is not likely to 
be communicated in a bedroom that has been 
thoroughly cleaned and provided with clean bedding. 
At the same time it would be advisable, wherever 
possible, to disinfect the room and its contents. To 
put the matter plainly, an hotel patient is not likely 
to spit about his bedroom, and it is in the sputa that 
the chief danger lies. The public require education 
upon these points, for there can be no doubt that 
many worthy persons sin in ignorance, and have not the 
least idea they may hand on their terrible malady to 
others. We trust the day may not be far distant 
when every self-respectiog sufferer from pulmonary 
consumption will carry a small spit-flask charged 
with some antiseptic to disinfect the sputa. 

The Plague at Madagascar. 

The plague continues to rage at Madagascar, but 
fortunately it does not show any tendency to spread 
far from the regions where it first made its appear, 
ance. Since the beginning of November, at which 
date the epidemic broke out, there have been in all 
204 cases, with 132 deaths. This number is made up 
of 23 creoles, 69 natives,39 Asiatics, and 2 Europeans. 
A sanitary cordon is rigorously applied around 
Tamatava. and the great Government works are at 
a standstill. The capital has been placed under 
medical control, and drastio sanitary measures are 
strictly enforced. 

Poor-law Barbarity. 

Bumbledom, although happily more or less 
scotched, is, nevertheless, far from dead. The guid¬ 
ing principle that has prevailed under the regime of 
Sir Hugh Owen has been to make administration a 
harsh and repulsive, iron-bound system, with a view 
apparently, of frightening persons out of becoming or of 
remaining paupers. An excellent illustration of this 
position is afforded by the Marylebone Board of 
Guardians, who, in return for a night’s lodging 
jernand from a “ casual ” the breaking of ten 
hundredweight of stones or the grinding of ten pecks 
of corn. To perform that task means nine hours 
hard and continuous work. How an ill-fed man is 
to make that effort without sooner or later wrecking 
his constitution is a problem that does not appear to 
have entered into the consideration of the Maryle¬ 
bone Board. For a well-fed and strong man to set 
about such a labour would be unwise, and a thousand 
times more so for the tramp who is usually physically 
unfit for any sustained laborious work. There can 
be little doubt that many forms of aneurysm and 
other kinds of circulatory diseases, to say nothing of 
varying organic mischief, might be set up by the 
imposition of arduous manual work upon the waifs 
and strays of the casual ward. We say nothing about 
the iniquity of making a profit out of this 
pathetic class of human wreckage, for that is the 
effect of demanding a day’s labour in return for 


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44 The Medical Press. 


NOTES ON CURRENT TOPICS. 


Jan. 11, 1899, 


accommodation worth no more than a few pence. 
When shall we have a Local Government Board that 
will fix and control such matters as diet, exercise, and 
labour upon some scientifically ascertained medical 
data ? 


Adulterated Milk. 

Of all the mean and persistent frauds perpetrated 
upon the community there is none more cruel and 
deserving of condign punishment than the adultera¬ 
tion of food. To add to the irony of the thing, the 
offence can be readily detected, and all the legal 
machinery for successful prosecution is at hand. 
Therefore, it is, above all things, preventible; yet, 
like infectious diseases, it is not prevented. Take 
the case of milk, the adulteration of which is, beyond 
a doubt, carried on to an enormous extent throughout 
the kingdom, largely at the expense of the poor. 
This fraudulent practice is the source of profits that 
would make the mouth of an average Jew water, so 
that it is not surprising that certain milk-vendora are 
ready to encounter the odium and loss of repeated 
fines. At the Thames Police Court, last week, an old 
offender in that direction was fined £6, but we ven¬ 
ture to suggest that the penalties inflicted should be 
rapidly cumulative in severity up to a cer:ain point, 
when they should invariably be replaced by a long 
term of imprisonment. The present apathy of ves¬ 
tries has much to do with the prevalence of milk 
frauds. It is to be hoped that the new spirit of the 
Local Government will tackle this subject of adulter¬ 
ation firmly, and begin by overhauling the Somerset 
House analyst's department. 

Corporal Punishment of Lunatic Patients. 

The Hoxton House Lunatic Asylum has recently 
come in for an unpleasant share of public attention 
in connection with a police-court case. A female 
attendant at that institution was - charged with 
assaulting two of the patients, and it was proved that 
she whipped both of them in a bathroom with a cane, 
one on the body, the other on the hands. She 
did not report the circumstance to anyone 
in authority at the Asylum. The magistrate 
remarked that no doubt the patients were ex¬ 
ceedingly troublesome, but, as they did not know 
what they were doing, it was all the more imperative 
that they should have the kindest treatment. He 
allowed the defendant the full benefit of the Act by 
imposing the lowest penalty - namely, 40s. in each 
case. One would hardly imagine that nowadays such 
a barbarity as the whipping of lunatics could have 
existed outside the pages of a novel. What woo Id the 
late Charles Reade have said of this Hoxton lunatic 
attendant with her harridan temper ? 

Medical Fees at Inquests. 

In a letter addressed to the Western Morning News, 
Mr. Waterfield, practising at Stonehouse, calls atten¬ 
tion to an anomaly in the payment of fees to medical 
witnesses at inquests, of which we must confess we 
were previously ignorant. Having been called upon 
to give evidenca on two occasions - the inquest having 


been adjourned—he naturally expected to receive two 
fees, but, to his surprise, he was informed that how 
ever many attendances a medical witness may put in, 
he can only claim one fee. This decision is rendered the 
more absurd by the fact that the jury receive double 
sets of fees, but on the matter being referred to the 
County Council, the coroner’s decision was confirmed. 
Mr. Waterfield suggests that in future the only course 
will be for medical witnesses to refuse to give evidence 
on the second occasion before being paid their second 
fee, but in view of the powers possessed by the coroner 
to compel witnesses to answer questions, we doubt if 
this method would prove successful. The matter is 
one which should be taken up by some organised body 
of medical men with the view, first of all, of testing 
the legality of the decision, and if this be established 
to obtain an amendment of the law the injustice 
whereof is obvious. 

A Worm-Infected Gaol. 

Some interesting and curious facts have just been 
published by Captain Feamside, I.M.S., regarding 
the cause of a high mortality rate in one of the 
prisons in India, that at Cananore, with which he 
was connected. Before Dr. Fearnside took charge 
the death rate among the inmates from intestinal dis¬ 
orders had been very high for many years ; in 1893, 
for example, the mortality was as much as 47 per 
1,000 from this cause alone. However, while making 
a post-mortem examination upon a prisoner in 1894, 
who ha 1 died of diarrhoea, he found a mass of 37 
round worms at the ileo-cocal valve. Acting upon 
this hint he afterwards resorted freely to the use of 
santonin, as the result of which the cases of diarrhoea, 
enteritis, and dysentery at once underwent a con¬ 
siderable reduction. As showing the remarkable 
prevalence of the parasite in the gaol, he states that 
in 1896, 255 prisoners passed between them the 
huge number of 2,703 worms, an average of ten 
each. This plague of worms does not so far appear 
to have been amenable to preventive measures. 


When Chloroform is to be Preferred. 

Dr. Miron I. Marsh, in discussing the conditions 
in which chloroform is to be preferred as an anaesthetic 
insists on the following:—In organic diseases of the 
nervous system and in atheroma occurring in persons 
of advanced years. In chronic or acute inflammatory 
affections of the respiratory tract, such as severe 
bronchitis, asthma, emphysema, or advanced tuber¬ 
culosis. Also in protracted operations about the 
nose, mouth, or pharynx, which necessitate the nose 
and mouth being uncovered. In operations per¬ 
formed with artificial light (other than the electric 
incandescent), unless the source of illumination is at 
a sufficient distance. Even with chloroform, how¬ 
ever, it is undesirable to operate in the vicinity of 
gas lights on account of the irritating vapour to 
which its decomposition gives rise. The same reason 
applies when the galvanic cautery is to be used in 
the neighbourhood of air passages. Chloroform is 
preferable to ether in all cases of renal disease, 
whether acute or chronic, in chronic alooholism, and 


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Jan. 11, 1899. 

in both infancy and old age. It is much better than 
ether during labour, and in puerperal eclampsia when 
an immediate effect is required. 

Changes in the Blood after Removal of the 
Thyroid. 

Evbey detail—chemical, physiological, and patho¬ 
logical-bearing on the effects of removal of the 
thyroid gland is of interest in view of the importance 
which this gland has of late assumed in physiology 
and therapeutics. Dr. A. G. Levy has recently pub¬ 
lished the results of a series of observations made by 
him on the changes induced in the blood of dogs by 
removal of this organ. It is generally recognised 
that the numerous and diverse phenomena following 
removal of the thyroid are caused primarily by a 
pathological condition of the blood. This pathological 
condition consists in the absence from the blood of a 
thyroid secretion which is necessary either to the 
normal metabolism of the tissues or for the pur¬ 
pose of neutralising some poisonous product or pro¬ 
ducts of metabolism. The most salient feature cf 
his results is their inconstancy, and this indeed 
applies to all the phenomena following thyroidec¬ 
tomy. It is striking how one symptom often pre¬ 
dominates over others, sometimes even to the 
exclusion of the others. A diminution either in 
haemoglobin or red corpuscles, or in both, is a usual 
but not invariable result, but there does not appear 
to be any direct relationship between the intensity of 
the an®mia thus induced and the severity of the 
symptoms in general. The proportion of white 
corpuscles undergoes manifest increase almost from 
the first, and the specific gravity of the blood always 
falls after thyroidectomy, as might be inferred from 
the existence of anaemia. The percentage of fibrin in 
the blood of a thyroidectomised animal is invariably 
found to be increased, sometimes to a considerable 
extent. With regard to the solid constituents of 
the blood there appears to be a varying loss of certain 
ncn-proteid substances and a varying gain in others, 
for throughout the proportion of loss of proteids to 
that of solids is inconstant. It follows that an exact 
determination of the conditions which tend to pro¬ 
duce in some dogs a partial immunity from the 
evil effects of thyroidectomy is still to be effected, 
but it may be assumed that irregularities in the 
quantitative changes in the blood of different animals 
after thyroidectomy are analogous to the variation 
in the general symptoms which result therefrom. 

The Unqualified Dispenser. 

A woman died at Stockport last week from the 
effects of an overdose of morphia contained in medi¬ 
cine. The medical man in attendance states that his 
dispenser made a mistake in making up his prescrip¬ 
tion, he having put in fifty grains of morphine instead 
of one and a half. We should infer from this that 
the dispenser must have been totally ignorant of the 
lethal properties of large doses of the drug or he 
would not have committed such a fatal blunder. It 
is a fact that few, if any, of the dispensers employed 
by medical men have had any training to fit them 


The Medical Pekss. 4-5 

for the duties and responsibilities they undertake, but 
as medical men technically do not “ sell ” their medi¬ 
cines, unless they happen to keep an open surgery, the 
Pharmacy Act does Dot apply to their establish¬ 
ments. 


Pleas as Plague Carriers. 

Just as the common fly and the mosquito have 
been accused as being disease carriers, so a similar 
role is now being attributed to the ubiquitous flea. 
The particular disease for the dissemination of which 
the flea is being made responsible is the plague in 
India. The insect, it is stated, absorbs the bacillus, 
and then takes the first opportunity, in the ordinary 
course of business, of discharging the micro-organism 
into the blood of. a human being. Researches upon 
this subject have been undertaken by M. Simond, 
and the results published in the Annals of the Pasteur 
Institute. Whether the latter be accepted as trust¬ 
worthy or not, the suggestion is nevertheless one 
which is worthy of full inquiry by independent 
observers M. Simond claims to have determined 
by his investigations that the plague is only with 
extreme difficulty propagated by infection through the 
digestive tract, and that it is very exceptional for the 
disease to be disseminated by contact with cutaneous 
wounds or through infection of the mucous mem¬ 
brane of the lungs. Hence it would seem that by 
the method of exclusion, the author has been led to 
attribute the dissemination of the disease to the 
pulex irritans. 

Pulmonary Asymmetry. 

At an inquest held on Wednesday last at Ber¬ 
mondsey on the body of a man who had succumbed 
to tte rupture of an aneurism, Dr. Mulqueen, who 
made the post-mortem examination, stated that the 
deceased had only one luog, the deficiency being evi¬ 
dently congenital. This one lung seems to have 
answered the purpose however, for the deceased was 
42 years of age, and had never complained of any 
respiratory trouble. It is to be hoped that this 
apparently unique abnormality will receive the atten¬ 
tion which it merits by reason of its scientific interest. 

What is the Lunacy Law ? 

The conclusion of the case at Kingston-on-Thames, 
when a medical man was indicted for having received 
a lunatic in an unlicensed’house, comes as a surprise. 
An eminent lunacy expert came forward and stated 
that the action of the accused met with his sanction, 
and further admitted that he had started a subscrip¬ 
tion fund in a medical journal to defend the present 
action. This appears to amount to an open de¬ 
fiance of the law, which is based on a sufficiently 
clear and sound principle, namely, to prevent 
possible fraud and infringement of personal 
liberty in unlicensed houses. We confess it seems to 
us a mystery how any man of standing in the medical 
profession could come forward and practically im¬ 
peach that administrativa position and advise illegal 
opposition to the Lunacy Acts. Perhaps there may 
be some explanatory circumstances, legal or other- 


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Google 



MEDICAL SOCIETY OF LONDON. 


Jan. 11, 1899. 


46 The Medical Pbis$». 


wise, with which we are not acquainted. Any way, 
the counsel for the prosecution stated that his sole 
object was to ensure respect for the provisions of the 
Lunacy Act. That being so, an appeal may be confi¬ 
dently expected from the acquittal returned by the 
jury in this case at the Surrey Quarter Sessions. 


The Ninth International Congress of 
Ophthalmology. 

The Ninth International Congress of Ophthal¬ 
mology will take place in Utrecht on August 14th, 
and four following days. The work of the session 
will be divided into three sections: (1) anatomy, 
patholo.ical anatomy, and bacteriology; (2) optics 
and physiology ; (3) clinipal methods and operations. ; 
The-committee of organisation of the Congress are 
as followsPresident, Dr. Argyll Robertson, of. 
Edinburgh; Seoretary-General, Mr. George A. Berry, 
of Edinburgh; and Professor M. E. Mulder, Pro¬ 
fessor M. Straub, Professor W. Roster, Professor H. 
Snellen. The official languages will be English, 
French, and German. 

Court Appointments. 

The Queen has appointed Sir Richard Douglas 
Powell, Bart., M.D.. F.R.C.P. to be one of her 
Majesty’s Physicians in Ordinary, in succession to 
the late Sir William Jernier. Dr. James E. Pollock, 
and Dr. Thomas Barlow, Physician to the Household, 
have been nominated Physicians Extraordinary to her 
Majesty. 

“ In arduis fidelis ” is to be the new motto of the 
Royal Army Medical Corps. The old familiar emblem 
of the serpent and rod, representing the art and prac¬ 
tice of medicine, is to be discarded, and replace.d by 
the serpent alone as the future badge of the newly- 
created corps. This latter, with the motto already 
given, is to be entwined in a laurel wreath surmounted 
by the Royal crown. 

Lobd Lister, P.R.9., has been awarded the Harben 
gold medal for 1899, of the Royal Institute of Public 
Health, in recognition of his eminent services to preven¬ 
tive medicine. 

Dr. John B. Hamilton, of Chicago, editor of the 
Journal of the American Medical Association, died on 
Christmas Eve last. He was 51 years of age, and at the 
time of his death was Professor of Surgery in the Rush 
Medical College, Chicago. The cause of death was some 
aoute abdominal disorder, for which an operation was 
performed. 

gcotlanb. 

[from our own correspondent.] 

Thk InBbriate's Act. 1898.—This important statute 
came into operation on January 1st, 1899. Meantime a 
committee), to frame regulations for the proposed 
Inebriate Reformatories in Scotland, and generally to 
advise the Secretary for Scotland as to the methods of 
working the Act, is sitting. At first there was no 
medical man on thpt committee. The Royal Colleges of 
Physicians and Surgeons of Edinburgh and the Glasgow 
Faculty of Physicians and Surgeons pointed out this 


omission to bis Lordship, who at once requested the 
presidents of those Corporations to name a medical man 
who “ would command the confidence of the profession." 
They nominated Dr. Clonston, who accordingly has been 
added to the committe. 

Glasgow Royal Infirmary. —Lately this institution 
has with its sister institutions come in for very large 
sums for extension, the last donation being for ill,000 
from Mrs. John Elder, who by her munificent gifts has 
already placed Queen Margaret College on a firm founda¬ 
tion, and succeeded in raising sufficient funds in addition 
to establish the anatomical and other practical depart¬ 
ments of the College. The other large earns left to the 
Infirmary were bequests from deceased friends to 
the institution. Besides these, wh oh have been re¬ 
ceived as bequests and donations, the public have 
liberally subscribed, the latter may, however, be con¬ 
sidered aa for current expenses, in other words, what the 
directors name ordinary expenses, and may be used up 
in defraying the extravagance in which the institution 
is carried on, and no doubt at the next annual meeting 
the report will as usual show a deficiency both in the 
ordinary and also in the extraordinary accounts. Year 
after year these expenses increase. How is it ? Is it 
because the present class of nurses is of a higher 
standard ? The patients’ ailments greater and more 
serious and severe than formerly ? or that the “ bacilli,” 
the “ bacteria,” and the endless variety of “ vibriones,” 
“ micrococci,” et hoc genus are more expensive to bill 
and destroy them than formerly ? Miorobes getthe blame 
for a great many things done nowadays, although the 
invisible atoms may be innocent. In these remarks we 
may be stirring up a hornet’s nest, but this may be reme 
died by the simple process of crashing the said hornets. 
We have no wish to lessen the good that the Royal or 
any of the infirmaries are doing or may do, bat it may be 
stated as a fact that patients have left the infirmary 
simply because after going they not only obtain insuffi¬ 
cient aliment but are passed over from day to day with¬ 
out treatment. The matter and reason that Buch obtains 
should be well looked into, bat we fear will never take 
place as there is such an exclusive tenure of office of all 
the officials. 


MEDICAL SOCIETY OF LONDON. 

The meeting on Monday evening last (January 9th) 
was devoted to a paper by Sir William Broadbent, on 
“ The Conduct of the Heart in the Face of Difficulties.” 
He pointed out that a very large proportion of the cases 
of functional disturbance of the heart’s action were due 
to interference from without, as from a distended 
stomach and the like. More serious was the oondition 
engendered by peripheral obstacles as when there was 
high arterial tension. He insisted on the extreme sus¬ 
ceptibility of the heart to changes affecting the nervous 
system, and said it behoved them in each case to distin¬ 
guish which of the two factors, nervous and gastnc, pre¬ 
dominated, the better to direot treatment. He laid down 
the cardinal principle in the treatment of cardiac affec¬ 
tions, whether functional or organic, that mnch more 
relief could usually be afforded by devising means of 
reducing the stress or eliminating obstacles than by 
directly stimulating the heart to overcome them. He 
emphasised the value of venesection in the treatment of 
heart affections associated with heightening of blood 
pressure in the veins and right heart, especially if 
followed up by a calomel purge. 

Dr. Sansom insisted on the importance of the nervous 
factor in disturbance of cardiac function, and pointed out 
that the condition of the heart muscle was less important 
than was usually held. He alluded to the ill-effects of 
admioistering digitalis when the heart was under stress 
and concurred in the view that the great thing was to 
relieve rather than overcome that stress. 

Dr. T. Williams related cases to show the inflneneo 
of a dilated stomach on the cardiac function, and Dr. 
Morrison pointed out that the three factors in produc¬ 
ing cardiac disturbance were the muscle, the nervous 
system and the blood, any one of -which might pre¬ 
dominate in a given case. 

Dr. StHes Thompson pointed out the grave significance 


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Jan. 11, 1899. 


CORRESPONDENCE. 


Thh Medical Press. 47 


of irregularity of the heart's action, though the patient’s 
feelings in this respect were no guide to the severity of 
the lesion. 

Dr. Macguire discussed the assistance of the heart’s 
action afforded by the negative pressure developed on 
inspiration and explained the existence of the exagge¬ 
rated short breathedness in emphysematous persons by 
the reduction of this negative pressure. He also ex¬ 
plained the production of the pulsus parodoxus in the 
same way, as the effect of this negative pressure on a 
weakened ventricle. 

Dr. Calvert mentioned that senega, which was usually 
described as a stimulating expectorant, and was given in 
cases of chronic bronchitis, was contra-indicated in the 
presence of cardiac complications by reason of its depress¬ 
ing action on the organ. 

Dr. Robert Jones asked what was the relationship 
between the heart and the action of certain toxins, par¬ 
ticularly the toxins of fatigue. 

Sir William Bboadbent then replied. 


Clormpmtaentt 

We do not bold ourselves responsible for the opinions of oar 
correspondents. 


THE MARRIAGE OP OVARIOTOMISED 
PATIENTS. 

To the Editor of The Medical Press and Cibculab. 

Sib,—T here is a strange omission in the line of argu¬ 
ment you adopt in your leader on this subject, one of 
much importance, and for its illustration we may take 
the least complicated illustration at hand, a case of 
rapidly growing double cystoma; such as cystic disease 
of both ovaries, or of soft cedematous myoma in a young 
"woman. Of such I have a large collection of stories I 
could tell you if space permitted, which I think would 
prove that your view is wrong alike in the eyes of the 
church, the law, and of mankind. 

The argument used by the United States Court is per¬ 
fectly sound, and the position in which a woman is placed 
by senile atrophy is perfectly analogous. I have already, 
and in your own columns, narrated one instance in such 
full detail that I regret to say the case was identified by 
some persons interested, and I had a mild reproof for 
the fulness with which the case was given, it was a 
case where I convinced a prince of the Church that he 
was wrong in prohibiting the marriage of a young lady 
from whom the appendages had beeri removed, when he 
himself had performed the marriage ceremony when the 
bride had long since passed child-bearing. So much for 
the Church, and by Church I, of course, mean that of 
Rome, the only church which has ever discussed and 
draw n up decisions on such questions. 

I have a large number of stories I could tell you of 
the chivalry of men, many of the stories being extremely 
pathetic in detail, who not only married the women to 
whom they were engaged after it was explained to them 
that surgery had removed the last surviving hope of 
maternity, but of many who have had to be consulted 
as to the performance of such an operation, and who 
have willingly consented to a measure of necessity for 
the benefit of the women they loved, for the saving of 
their lives. I never knew one of those men break his 
troth. So much for the opinion of men. 

As for the law, the principle of the law on the matter 
in question is clear as day in England. If the hus¬ 
band could claim a reduction of the marriage, 
it could only be when fraud was perpetrated 
upon him deliberately, when he could prove that 
knowing that some operation had been performed 
on his intended wife he asked if both ovaries had been 
removed, he was informed that only one had been, or 
that nothing had been done to interfere with her chances 
of becoming a mother. But even here the difficulty 
would arise in the question. Would the disease for which 
the operation was performed have already induced 
sterility ! and we should have to answer, certainly, in the • 
two cases I have taken as illustrations, and in certainly ' 
ninety-five pei cent, of the cases in which removal of the 


appendages should be performed. Because, if this were 
not considered, and this is the serious omission you make, 
we should have to decide thi^t the cure of disease 
should result in divorce, whilst the disease itself 
would not. 

One In six of all adult women in England who marry 
prove to be sterile. A very large mass of these cases 
derive their sterility from arrest of growth of the 
uterus — infantile uterus. They do not know of 
any reason why they should not marry, and they 
marry and lead sterile lives. They are anxious to 
become mothers, and they wander from one obstetric 
physician to another, till some one divides the cervix 
and puts in a stem pessary, after which the case takes a 
surgical aspect, becomes one of doqble pyosalpinx, and 
the appendages are removed. These cases have come to 
me in hundreds. I operated on one yesterday, and I 
have seen two fresh ones this morning. The original 
disease or deformity caused the sterility, and should 
be as much a reason for annulling a marriage as the 
stem pessary, which made the sterility perfectly certain 
or the subsequent and necessary removal of the 
deformed and diseased organs. So with cystic ovaries. 
I have known them in existence long before marriage, 
and marriage take place while they were in a quiescent 
condition. Subsequent growth rapidly involved double 
ovariotomy and confirmed the already existent sterilisa¬ 
tion. But what a preposterous proposal it would appear 
to any Court of Law, to the merest tyro of a lawyer, to 
suggest that the remedy should justify a divorce decree, 
whilst the disease should not. The fact of the matter is 
that it is persistently ignored that the diseases for which 
ovaries and tubes are removed have already destroyed 
all chances of maternity, and that the surgical inter¬ 
ference only cont)rni8 yhat the disease has already 
established. 

To rule our divorce law in any other direction than 
tbat I have indicated would be to gp back to the old law 
of the Jew, in which sterility was ample justification for 
putting away one wife and taking a few more. Whether 
this would prove a happy reversion I do not know, but it 
is a step our law-makers are not at all likely to take. 

I am. Sir, yours truly, 

Lawson Tait. 

195, Newhall Street, Birmingham. 


HEMORRHAGE IN INTERNAL URETHROTOMY. 

To the Editor of The Medical Press and Circular. 

Sir,— I regret that through pressure of work I was 
unable to reply in last week's Medical Press and 
Circular to the letter of Mr. Myles published in the 
issue of December 24th on the above subject. 

In calling attention to the danger of haemorrhage after 
internal urethrotomy Mr. Myles was, I consider, per¬ 
fectly justified ; and I am entirely in accord with him in 
thinking that in the surgical text books and monographs 
on the subject of stricture of the urethra sufficient atten¬ 
tion is not directed to this danger, or the means by which 
it may be successfully combated. It was for this reason, 
tbat, in my criticism of his original paper, I gave in the 
Journal of December 21sf full details of a case of alarm- 
hsemorrhage that had occurred in my own practice after 
. performing this operation, and of the means that I had 
found effectual in controlling it. 

But my criticisms were entirely directed against his 
uncompromising condemnation of internal urethrotomy; 
his views as to the pathology of stricture, what happens 
when this operation is performed, and the object with 
which it is undertaken. These criticisms remain un¬ 
affected, and are in no way altered by Mr. Myles’s ex¬ 
planations, or by his erroneous imagination of my having 
limited my remarks to stricture in the anterior urethra. 

I did not consider it necessary to explain that my 
criticisms had reference to stricture of the deep urethra, 
because (1) my remarks were applicable to stricture in 
any part of the canal; and (2) Mr. Myles specificially 
limited his observations to stricture in the deep urethra, 
and it was, of course, to these observations that my criti¬ 
cisms were directed, otherwise they would be meaning¬ 
less. 

Mr Myles comes to the conclusion that my remark 


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48 The Medical Press. 


CORRESPONDENCE. 


Jan. 11, 1899. 


had referenoe only to stricture of the anterior urethera 
because l use only Tee van’s or Civiale’s uret^rotemer. as 
a rule; and he then goes on to state :—“ I maintain that 
a stricture of the deep urethra cannot be divided by a 
Civiale’s Instrument or any of its modifications, or by 
Teevan’s urethrotome.” Well, I must confess my utter 
astonishment that a surgeon of Mr. Myles’s position and 
standing should maintain anything so erroneous. Both 
of these instruments were introduced for, and are 
capable of, cutting strictures in any part of the canal. 
Surely Mr. Myles cannot imagine that when, in my paper 
published in the issue of this journal, of December 21st, 

I referred to 87 internal urethrotomies that J had per¬ 
formed in the previous two and a half year3 by Civiale’s 
and Teevan’s instruments, these were for stricture of 
the anterjor urethra only, and that I am in the habit of 
dealing with such cases to the exclusion of strictures of 
the deep urethra. 

That both these instruments are capable ef dividing 
strictures in any part of the ureth»al canal is witnessed 
by hundreds of visitors to the operation theatre of St. 
Peter’s Hospital annually, and if Mr. Myles, at his next 
visit to London, will do me the honour of being present 
at some of my operations in hospital or private practice, 

I shall be happy to demonstrate to him the capabilities 
of these instruments in this direction. 

I am, Sir, yours truly, 

P. J Freyer. 

46, Harley Street, London, W., January 7th 1899. 

. “CIDER AND MICROBES.” ... 

To the Editor of The Medical Press akD Circular. 

Sir, —Should the statement of the French agricultural 
chemist, quoted in your journal of the 28th ult., that 
cider is germicidal prove to be correct, it will explain 
the freedom from cholera and choleraic diarrhoea that 
drinkers of sound cider enjoyed during the cholera 
epidemio in Somersetshire during 1848-1849. Sound 
cider is neither acid nor sweet. 

In ah article entitled “ Cider for India,” which I . pub¬ 
lished in the Medical Times and Oasette, April 27th 
1867, at the suggestion of my friend, the late Dr. Robert 
Smith, ocours the following passage:—“In the early 
history of the Epidemiological Society, Mr Tucker drew 
attention to the remarkable fact that the cider drinkers 
of Somersetshire, during the epidemics of cholera in that 
county, were particularly immune from this disease. 
We can not only bear Mr. Tucker out in his statement, 
but. after twenty years’ experience, add another fact of 
equal significance - viz., that the same people are free 
from gout also, and in this respect afford a strong con¬ 
trast to their beer-drinking neighbours.” 

With regard to the freedom from gout observed among 
drinkers of sound cider, I will refer your readers to my 
remarks on this subject, and those of Dr. Woods, of 
Philadelphia, quoted by Sir Alfred Baring Garrod, in the 
second edition of his work on “ Gout and Rheumatio 
Gout,” 1863, p. 691. My article. “ Cider for India,” was 
written at the time when the regulation beverage of the 
JnJian soldier was being discussed in the House of 
Commons. 

I am, Sir, yours truly, , 

,<inuary 2nd, 1899. Alfued Haviland. 

HERNIA OF THE VERMIFORM APPENDIX. 

. Sir,— In tho “ Operating Theatres ” of The Medical 
Press and Circular of January 4th, a very interesting 
case of Hernia of the Vermiform Appendix from the 
practice of Mr. Battle, at St. Thomas’s Hospital, is 
recorded. 

The history given is a very typical one of hernia of the 
appendix in a femoral sac. This may occur in both the 
male as well as the female subject. It is not uncommon 
when it does occur for the appendix to become adherent 
at the neck of the sac, probably as the outcome of inflam¬ 
mation. The mouth of the peritoneal protrusion may 
thus be entirely blocked, and the communication with 
the abdominal cavity shut off. I have elsewhere (Trans. 
Path. Soc. Lond. vol. xlviii. p 87) recorded such a case. 

Hernia of the vermiform appendix alone in the sac is 


undoubtedly a rare occurrence, but I venture to think 
that it is not so infrequent as is generally supposed. 
Moreover, when so herniated, I believe that, instead of 
inflammation being still more rare as a sequela, it is 
common for am appendicitis to ensue. Many of the cases 
recorded have been described as exhibiting the symptoms 
that have been considered to be indicative of a strangu¬ 
lated hernia, but if these be carefully looked into, they 
will very often, as in Mr Battle’s case, show not the 
signs of intestinal obstruction but those of a local peri¬ 
tonitis, the consequence of a typical appendicitis, similar 
in every way to that which happens so frequently when 
the appendix is in its normal habitat. 

I have in a paper (St.. Barth. Hosp. Reports, vol. xxxii, 
p 93) collected seven instances where there was un¬ 
doubted inflammation of an appendix in either a femoral 
or an inguinal sac, and in the same paper sixteen other 
cases in which, although strangulation was said to have 
been present, I cannot help thinking that tho symptoms 
in evidence were really the result of inflammation rather 
than of nipping of the tube. 

Several other instances have been recorded since the 
publication of my short paper. 

In at least three cases a foreign body, in two a piece of 
bone, and in the other a pin, has been found in the pro¬ 
truded appendix, and may have been the chief cause of 
the inflammation. 

If strangulation does occur the signs and symptoms 
produced are those rather of a partial enterocele, or of 
strangulation of Meckel’s diverticulum than those of 
complete acute intestinal obstruction. 

I am. Sir, yours truly, 

W. McAdam Eccles. 

Harley Street, W., January 5th, 1899. 


CHLOROFORM AND ADENOIDS. 

To the Editor of Thb Medical Press and Circular. 

Sir, —The case of death from chloroform narcosis 
reported in your issue December 28th, 1898, like every 
previous death under an anesthetic reported, confirms 
the truth enunciated by 8now fifty years ago, that-unless 
the administrator of chloroform knows, at least approxi¬ 
mately, the percentage of vapour he gives with each 
inspiration, he is a dangerous administrator, and should 
be held responsible for his imprudent action in taking 
upon himself the duty of administering a potent agent, 
of which, according to Snow, the undoubted highest 
authority on the action and safe administration of 
chloroform, 1 minim in the respired air, equal to 4 6 per 
cent of vapour, may cause sudden death, and 2 minims, 
equal to 9’2 per cent.; and 3 minims, equal to 13‘8 per 
cent, of vapour, cause death with absolute certainty by 
paralysis of the heart, from which, according to this 
observer, recovery is impossible. 

Snow has shown, and Dr. Waller recently confirmed 
his results, that in a child net. 6, the slow and regular 
progressive administration of from 0 - 23 per cent., and 
not exceeding 1'5 per cent., of chloroform vapour, 
suffices to produce deep yet safe amesthesia, and ^.'minim 
doses are sufficient to maintain the anaesthesia once in¬ 
duced without risk to the subject. 

Last October it was my lot to witness two cases of 
Snow's systematic method of chloroform administration. 

1. Female, tet. 3 years. Opening and scraping a suppu¬ 
rating gland in neck ; under in four minutes ; 42 minims 
of chloroform used in 17 minutes; average 2'5 minims 
per minute, equal to (M2 per cent, of chloroform vapour. 

2. A very nervous boy, ast. 14 years. Removing adenoid 
growths ; under in about 8 or 9 minutes ; 1 i drachms of 
chloroform used in 25 minutes ; an average of 3 6 minims 
per minute, equal to 0 18 per cent, of vapour in the 
vapoured air. 

Neither of them was an ideal patient. They both 
resisted inhalation, especially the boy, who persistently 
held his breath. Their breathing was a series of spas¬ 
modic gasps. Much care was consequently needed to 
prevent the inhalation of an overdose. The chloroform was, 
therefore, given continuouslyin about or minims, and 
never more than £ minim doses, until perfeot anesthesia 
was obtained. In these cases nearly one-half of the 


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J an. 1 1, 1899. 

amount of chloroform used was wasted, for each dose 
meeting expiration is blown into the room. No sickness 
and no ill effect followed the inhalation. 

I am, Sir, yours truly, 

A Disciple of Snow. 

London, January 6th, 1899. 


THE DISTRIBUTION OF THE PRINCE OF 
WALES’S HOSPITAL FUND. 

To the Editor of The Medical Press and .Circular. 

Sir,— Those responsible for the financial condition of 
the Metropolitan hospitals will thank you for the public 
spirited manner in which you have exposed the fallacious 
and partial basis of the awards of this fund. 

In a letter to the daily press I took the position that 
many hospitals to whom awards were made are loaded 
with such conditions as to leave them “ no better off 
than before.” The editor of the Hospital for the current 
week remarks that my “statements and figures are 
equally inaccurate and unreliable/’ Permit me to quote 
for instances from two general and two special hospi¬ 
tals, which have received grants, to show that my state¬ 
ments are both accurate and trustworthy. I will do so 
in the form of a table, the figures being taken from 
“ Burdett’s Hospitals and Charities for 1898.” 


Name' of 
Hospital. 

Award. 

Condition. 

Cost per 
Bed per 
Annum. 

Total 

Cost. 

Deficit. 


£ 


£ 

s. 

d.l 

£ 

£ 

Great Northern 
Central 

London Tem¬ 

750 

to open 15 beds 

70 

0 

0 

1,050 

300 

perance 

City of London 
Cheat... 

500 

„ 12 beds 

95 

0 

0 

1,140 

G40 

1,000 

,, 15 beds 

90 

0 

0 

1,350 

350 

N. London Con- 






anmption 

1,000 

,, * 15 beds 

87 


0 

1,305 

305 


Thus these four hospitals have to find nearly half as 
much again as the amount of their award in order to 
fulfil the condition of its bestowal. 

I am, Sir, yours truly, 

A Hospital Secretary. 

January 7th, 1899. 


(DbituatP. 


DR. EDMUND DAVY, OF DUBLIN. 

W e much regret to report the death of Dr. Edmund 
William Davy, which took place on the 4th inst. at his 
residence at Rathgar, he being then aged 72. Dr. Davy 
was son of Edmund Davy, F.R.S., and an immediate 
descendant of the great Sir Humphry Davy. He was 
himself a distinguished chemist, and held the professor¬ 
ship of Chemistry in the Carmichael College, and that 
of Medical Jurisprudence in the College of Surgeon*, 
Ireland, for many years, having been also the usual 
adviser of the Government in medico-legal cases. He 
was a kindly gentleman, and greatly esteemed for both 
his professional and his social qualities. 


SIR JAMES MOUAT, K.O.B., M.D. 

The death is announced of Sir James Mouat, K.C.B., 
V.C., honorary surgeon to the Queen, who died on 
Wednesday last at his residence, Palace Gardens Ter¬ 
race, Kensington. He was born in 1815, studied at 
University College, and was admitted a member of the 
Royal College of Surgeons in 1837, and a Fellow in 1852. 
He entered the medical department of the Army as assis¬ 
tant surgeon in 1838, and after nearly forty years’ active 
servioe, retired in 1876. Sir James Mouat was surgeon 
to the 6th Dragoon Guards, and in the Crimea had 
medical charge of the general field hospital of the 3rd 
Division until the fall of Sebastopol. He was awarded 
the Victoria Cross “for having voluntarily proceeded to 
the assistance of Lieutenant-Colonel Morris, of the 17th 
Lancers, who was lying dangerously wounded in an 
exposed situation after the retreat of the light cavalry at 


The Medical PAesb. 49 

the battle of Balaclava, October 26th. 1854, and having 
dressed that officer’s wounds in the presence of the 
enemy." 


SURGEON-GENERAL STANHOPE BRUCE. 

We regret to announce the death, at the age of 68, of 
Surgeon General Stanhope Bruce, on the 2nd inst., at 
his residence in Ealing. Deceased, who was the son of 
the late Colonel Louis Bruce, was admitted a member of the 
Royal College of Surgeons, England, in 1853, and entered 
the Indian Medical Service. He was actively engaged 
both before and during the Indian Mutiny in 1858. In 
1880 he was engaged as Brigade-Surgeon in the Afghan 
War. He subsequently acted as Principal Medical 
Officer of the Second Division Kandahar Field Force, 
and later of the Afghanistan Field Force. His distin¬ 
guished services were recognised by various medals. 
In 1887 General Bruce showed symptoms of bulbar 
paralysis, and retired in consequence. 


Jabomtorg Jlotes. 


AERATED TABLE WATERS. 

The improvements in the manufacture of plant for 
making aerated waters has led to a great increase in the 
production, both on a large scale and at local factories. 
It is fairly certain that a considerable part of this in¬ 
crease is due to the impression that such waters are 
safer than ordinary water; and, indeed, the reputation 
in this respect of the aerated waters from some districts 
has led to a large demand for them in even distant parts 
of the kingdom. The general feeling that aerated 
waters are safer than non-aerated is correct to this 
extent, that the much smaller supply required by an 
aerated water factory can be provided under precautions 
which are never taken with the much larger volume of a 
public supply intended for all purposes. In recognising 
this advantage, however, it must be clearly remembered 
thnt the manipulation involved in bottling aerated 
waters introduces an element of risk which does not 
occur in the publio supply. A case in point, which 
occurred recently, was that of a manufacturer who, be¬ 
coming unwilling to use a polluted well for manufac¬ 
turing aerated waters, proposed to do so for washing out 
the bottles, a course which would have been entirely 
ncompatible with the purity of the water and was, in 
fact, abandoned on the advice of the analyst. Reputa¬ 
tions for purity, on the other hand, have over and over 
again been shown to be entirely untrustworthy. As an 
illustration of this it may be mentioned that in the town 
of Maidstone there was a thriving industry of old 
standing in mineral waters, based on a reputation for 
purity ; and this firm continued to export their pro¬ 
ducts to all parts of the kingdom until the actual out¬ 
break of the great epidemic. 

We therefore come to the conclusion that it is desirable 
for the information of our readers to put forward some 
authentic and trustworthy information as to some of the 
brands most before the public. Our purpose is rather to 
assist those who desire the protection to which they are 
entitled than to criticise the manufacturers who do not 
give it, and our list will therefore lefermore particularly 
to brands of the higher quality. The liability of aerated 
waters to convey infective disease has been thoroughly 
recognised for many years. The presence of carbonic 
acid in water, if it exercises any disinfectant effect, does so 
only after the lapse of considerable periods of time, and can¬ 
not be taken into serious account as a means of affording 
protection to the publio. The results which we are about 
to publish are intended to indicate rather the natural 
chaiacter of the water which is used in the brands under 
examination than the precise merit of the finished pro¬ 
duct. It cannot be too strongly recognised that the first 
line of defence against infection is the purity of the 
water supply, The purity is in almost all cases liable 
by accident to be impaired, and the demand for the adop¬ 
tion of uniform and trustworthy artificial means of 
bacterial purification, such as Pasteur filtration, hasbeen 
increasing, and, in our opinion; ought to increase until 


LABORATORY NOTES. 


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LABORATORY NOTES. 


Jan. 11, 1899. 


euch means are universally adopted. In this way the 
public will obtain, and indeed has already be {run to 
obtain, a Becond line of defence, and when it is uniformly 
adopted the impression that aerated waters are usually 
safer than the waters of a town supply will, for the time 
being, be justified. Our present figures bear on the first 
line of defence; and as the purity of a water supply, 
though not lying in the chemical composition of the water, 
is. best indicated by it, we confine ourselves to the results 
of chemical.analysis. 

“ Mineral waters ” are occasionally examined by 
public analysts under the Sale of Food and Drugs Act. 

We are only able to find records for one year—namely, 
1893, in which 168 samples were examined and 32, or 
19 per cent were adversely reported on. 

Unfortunately there does not seem to be any published 
record giving the reasons in all cases for their condemna¬ 
tion, the report only stating that in soTue cases lead was 
detected in small quantities. 

" CAMWAL ” 80DA WATER. 

The Chemists Aerated Mineral Waters Association, 
Limited, have factories in different parts of the country 
(London, Manchester, Birmingham, Bristol, Harrogate, 
and Mitcham; at which they prepare mineral waters. 
The samples we have examined were prepared from the 
“ New River ” water. Our analyses also included samples 
of the latter. 

Label.—Camwal Soda Water. 

Physical Characters. 


Colour . 

Faint Blue 

Taste ... 

Normal 

Smell (byBoudri- 
ment’* method)... 


8 us pended Matter .. 

None 

Normal 



Chemical Characters. 



Grains 
per Gallon. 


Grain* 
per Gallon. 

Total solid* (dried 

Saline Ammonia ... 

Traces 

at 120 deg. C.) 

37-0 

Albumenoid Am¬ 


Mineral Solids 


monia 

None 

carbonated) 

— 

OxygenAbsorbed (in 


Loss on Ignition 

— 

15 minutes) 

— 

Chlorides (as Chi 


OxygenAbsorbed (in 


rine) 

1-5 

4 hours) . 

Traces 

Hardness (total) 

16-0 

Poisonous Metals .. 

None 

Nitrites 

Nitrates (ns Nitro 

None 

Phosphate*... ... 

None 

gen) .. ... 

•27 



Label .— New 

River Water (used by “ Camwal”). 


Physical Character*. 


Colour 

Faint Blue 

Taste. 

Normal 

Smell (by Boudri- 
Igment's method ... 

Normal 

Suspended Matter... 

None 


Chemical Characters. 
Grains 


Total Solid* (dried 
at 120 deg. C.) ... 

Mineral Solid* (re- 
carbonated) 

Lose on Ignition ... 

Chloride* (a* Chlo¬ 
rine)... 

Hardness (total) ... 

Nitrite* 

Nitrate* (aa Nltro- 

fen)..., . 

THE IDRIS 


per Gallon. 

24*6 

18-2 

84 

1-5 

12-5 

None 

■275 


Saline Ammonia ... 
Album enoid Am¬ 
monia . 

Oxygen Absorbed 
(In 15 minntes) ... 
Oxygen Absorbed 
(in 4 hours i 
Poisonous Metals ... 
Phosphates. 


Grains 
per Gallon. 
•008 

Traoes 


None 

None 

None 


MINERAL WATER COMPANY, 
Pratt Street, Camden Town. 

The water used is derived from a deep well, and for 
the sake of comparison we examined the soda water and 
the well water also, the figures obtained being given 
below:— 

Label.—Idris Soda Water. 

Physical Characters. 

Faint bine | Taste. Normal 

Suspended matter... None 


Colour . 

Smell Iby Boudri- 
ment'* method)., 


Tour Solids (dried 
atHOder.. C .. 
Mineral Solid* (re- 
oarbonated) 

Loss on Ignition ... 
Chloride* (a* Chlo¬ 
rine) . 

Hardness (total) ... 
Nitrite* ' ' ... 

Nitrates (a* Nitro¬ 
gen) 


Normal 
Chrmical Characters. 

Grain) 
per Gallon. 


73-5 


9-8 

8-0 

Absent 

Traces 


Saline Ammonia ... 
Albumenoid Ammo¬ 
nia . 

Oxygen Absorbed (in 
15 minutes) 
Oxygen absorbed (in 
4 hours 

Poisonous Metals ... 
Phosphate*. 


Gra;ns 
per Gallon. 
0-0028 

Traoes 


Traoes 

Nona., 

None 


Colour . 

Smell (by Boudri - 
ment's method)... 


Label .— Water from Idris 'Well. 

Physical Characters. 

... Faint blue | Taste . 

j Suspended Matter ... 


Normal 
Chemical Chaeacters. 


Normal 

None 


Total Solids (dried 
at 120 deg. C.) ... 

Grains 
per Gallon. 

41*0 

Mineral Solid* (re¬ 
carbonated) 

350 

Loss on Ignition ... 

8-0 

Chloride* (as Chlo¬ 
rine) 

8-0 

Hardness (total) ... 

40 

Nitrites . 

None 

Nitrate* (as Nitro- 
fen) . 

Traces 


Saline Ammonia ... 
Albumenoid Ammo¬ 
nia .. 

Oxygen absorbed (in 
15 minutes) 
Oxygen Absorbed 
(in4 hours) 
Poisonous Metals ... 
Phosphates 


Grains 
per Gallon. 
None 

None 


None 

None 

None 


MESSRS. ELLIS AND SON, 

Mineral Water Manufacturers, Ruthio, Wales. 

The water used is derived from a deep spring, the 
figures we have obtained on the water are given 
below : — 

Label. —If llis's Soda Water. 


Oolour . 

Smell (by Boudri- 
ment's method) 


Total solids (dried 
at 120 deg. €.) 
Mineral solids (re 
carbonated) 
loss on Ignition 
Chlorides (as Ohio 
rine) 

Hardness (total) 
Nitrites 
Nitrate* (as Nitro 
fen) 


Physical Characters. 

Faint blue I Taste. 

I Suspended matter 
Normal | 

Chrmical Characters. 

Grains per 
Gallon. 

Saline Ammonia 
86'6 I Albumenoid a m • 

monia . 

Oxygen Absorbed (in 
15 minutes) 
Oxygen Absorbed (in 
1‘0 4 hours) 

10*0 Poisonous Metal* 

None Phoaphates 

014 


Normal 

None 


Grains per 
Gallon. 
Trace* 

■0056 


012 

None 

None 


Label.—Messrs. Ellis’s Spring, Ruthin. 

Physical Characters. 

(Colour .Faint blue I Taste. 

Smell (by Boudri- I Suspended Matter... 

ment’s method)... None | 

Chemical Characters. 

Grains 


Normal 

None 


per Gallon. 

140 

110 

30 

1-6 

9-0 

none 

•15 


Saline Ammonia ... 
Albumenoid Ammo¬ 
nia . 

Oxygen Absorbed (in 
15 minutes) 
Oxygen Absorbed 
(in 4 hours) 
Poisonous Metals ... 
Phosphates... ... 


Grain* 
per Gallon. 
Traoee 

Traoes 

Traces 

•01 

None 

None 


Total 8olid* (dried 
at 120 deg. C.) ... 

Mineral Solid* (re- 
carbonated) 

Boss on Ignition ... 

Chlorides (as Chlo¬ 
rine) . 

Hardness (total) ... 

Nitrites . 

Nitrates (as Nitro- 

' fe») . 

MESSRS. ROSS AND 80NS, LIMITED. 

’ Mineral Water Manufacturers, Belfast and London. 

The following figures were obtained on a sample of 
Messrs. Ross and Sons “ Doable 8oda Water." 

Label. - Ross's Double Soda Water. 

Physical Character*. 

Colour . Faint blue I Taste. ... Normal 

Smell (by Boudri- Suspended Matter... None 

ment's method)... Normal | 

1 Chemical Characters. 

Grain* 


per Gallon. 

Total Solid* (dried Saline Ammonia ... 

at 120 deg. C.) ... 187‘0 Albumenoid Am- 

Mineral Solids (re- monia . 

carbonated) ... — Oxygen Absorbed 

Los* on Ignition ... — (in 15 minntes) — 

Chlorides (as Chlo- Oxygen Absorbed 

rine) . 26‘0 (in 4 hours) ... •043 

Hardness (total) ... 0*5 Poisonous Metals... None 

Nitrite* . None Phoaphates. Non* 

Nitrates (as Nltro- 

' gen) . Traces ^ 

‘ Label. — Well Water used by Ross and Sons. 

Phtsical Characters, 

Colour.Faint blue I Taste. Normal 

Smell (by Boudri- Suspended matter ... None 

meat's method) ... None 


Grains 
per Gallon. 
•0056 

Trace* 


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Jan. 11. 1899. 


MEDICAL NEWS. 


Thb MEDICAL Pbebb. 51 


Total Solids ... 
Mineral Solids 
Loss on Ignition 
Chlorides 
HnrdnesB 
Nitrites 
Nitrates 
Saline Ammonia 


Chemical Characters. 


Grains 1 
per gallon. 
17-0 

Albumenoid Ammo¬ 

Grains 
per gallon. 

12-0 

nia . 

Traces 

5-0 

Oxygen Absorbed (m 
15 minutes) 

Oxygen Absorbed (in 


6-1 

None 

None 

4 hours) 

Traces 

Traces 1 

Poisonous metals ... 

None 

•002 : 

Phosphates. 

Nodb 


MESSRS. SCHWEPPE AND CO., 

Berners Street, London. 

The following figures were obtained on a sample soda 
water prepared by Messrs. Schweppeand Co.:— 

Label. — Schweppe's Soda Wale*. 

Physical Characters. 


Colour . Faint blue Taste. Normal 

Smell (by Boudri- I Suspended Matter .. None 

ment's method) ... Normal | 

Chemical Characters. 


Grains 
per Gallon. 


Total Solids (dried 
at 180 deg. C.) ... 66‘2 

Mineral Solids (re- 
carbonated) — 

Loss on Ignitibn ... — 

Chlorides (os Chlo¬ 
rine) . 4‘3 

Hardness (total) ... 19'0 

Nitrites . None 

Nitrates (as Nitro¬ 
gen) . 005 


Grains 
per Gallon 


Saline Ammonia ... 0-028 

Albumenoid Am- 
mohia ... 0-007 

Oxygen Absorbed (in 
15 minutes) — 

Oxygen Absorbed (in 

4 hours) . 0-043 

Poisonous Metals ... None 
Phosphates. None 


Label.—Well Water need by Schweppe’s Limited. 


Physical Characters. 


Colour. Faint blue I Taste.. Normal 

Smell (by Boudri- Suspended matter ... None 

ment's method) ... None I 

Chemical Characters. 


Grains 
per Gallon. 

Total Soli Is (dried at 

120 degs. C.l ... 25-0 

Mineral Solids (re- 
carbonated) 

Loss on Ignition .... 

Chlorides (as Chlo¬ 
rine). 

Hardness (total) ... 

Nitrites . 

Nitrates (as Nitro¬ 
gen) . 


G ains 
per Gallon. 


Saline Ammonia ... -001 

Albumenoid Ammo¬ 
nia . None 

Oxygen Absorbed (in 
15 minutes) ... — 

Oxygen Absorbed (in 

4 hours) . -05 

Poisonous Metals ... None 

Phosphates. None 


20-0 
50 

4-2 
12-5 
None 

Traces 

“ SALUTARIS.” 


As will be seen from the figures below, “ Salutaris ’’ 
is prepared from a distilled water. Sample “ A ” was 
furnished us by the manufacturers, while sample “B” 
was purchased by us without their knowledge :— 


Physical characters. 

“A" 

. B ” 

Colour . 

Faint blue 

Faint blue 

Taste . 

Normal 

Normal 

Suspended matter... 

Absent 

Absent 

Chemical characters. 

Grains 

per Gallon. 

Total solids. 

2-6 

. 2-0 

Loss on ignition ... 

1-2 

06 

Mineral solids 

14 

14 

Chlorine . 

0-2 

02 

Hardness . 

10 

10 

Nitrites 

Traces 

Traces 

Nitrates and poison¬ 
ous metals 

None 

None 

Saline ammonia ... 

•0028 

0056 

Albuminoid a m - 
monia . 

•0084 

•0084 

Oxygen absorbed ... 

•056 

•056 


From the results given above we conclude that in all 
cases the water employed in manufacture and the 
finished products are of high organic purity, and free 
from any trace of metallic contamination. 


Jftebical ^letos. 


The Gresham Lectures. 

Dr E. Symes Thompson, Gresham Professor of Medi¬ 
cine, will deliver a course of lectures in Gresham College, 
Basinghall Street, London, on the evenings of January 
17th, 18th, 19th, and 20th, 1899, at six o’clock, the sub¬ 


ject being “ Preventive Medicine.” These lectures are 
entirely free to the public. 

Vital Statistics. 

The deaths registered last week in thirty-three great 
towns of England and Wales corresponded to an annual 
rate of 191 per 1,000 of their aggregate population 
which is estimated at 11,218,378 persons in the middle 
of the year 1898. 

Birkenhead 15, Birmingham 20, Jllaekburn 23, Bolton 
23, Bradford 17, Brighton 18, Bristol 16, Burnley 16, 
Cardiff 14, Croydon 12, Derby 16, Gateshead 24, 
Halifax 14, Huddersfield 13, Hull 19, Leeds 18, Leicester 

16, Liverpool 23, London 18, Manchester 23, Newcastle- 
on-Tyne 21. Norwich 19, Nottingham 17, Oldham 23, 
Plymouth 22, Portsmouth 16, Preston 19, Salford 17, 
Sheffield 19, Sunderland 19, Swansea 21, West Ham 
19, Wolver-hampton 24. The highest annual death- 
rates per 1,000 living, as measured by last week’s mor¬ 
tality, were From measles, 18 in Manchester, and 2 6' 
on Nottingham ; from whooping-cough, 11 in Oldham 
and 13 in Preston; from “ fever,’’ 1 0 in Derby and itf 
Gateshead, and 13 in Bolton; and from diafrheea. 1 0 in 
Derby, and 18 in Wolverhampton. In none of the 
large towns did the death-rate from scarlet fever 1 ' 
reach 10 per 1,000. The J06 deaths from diphtheria 
included 47 in London, 8 in West Ham, 7 in Sheffield, 
6 in Birmingham, 5 in Swansea, 5 in Liverpool, 4 in 
Leicester, 4 in Leeds, 3 in Cardiff, 3 in Manchester, and 
3 in Blackburn. No death from small-pox was registered 
in any part of the United Kingdom. 

The Mortality of Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populationsCalcutta 26, Bombay 42, Madras 42, Paris 

17, Brussels 16, Amsterdam 14, Rotterdam ifi.The Hague 

16, Copenhagen 18, Stockholm 15, Christiania 13 , St 
Petersburg 25, Moscow 33, Hamburg 13,‘Breslau 14 , 
Munich 20, Vienna 19, Prague 27, Rome 16, Turin (10 
days) 16, Venice 18, New York (including Brooklyn)' 

17, Philadelphia 18. y * 

The Hospital Sunday Fund. 

The collections made in London for the Hospital 
Sunday Fund last year says the St. James’s Gazette, show 
a falling off from those made in 1897. The coni ributions 
in church are less by £629, while the chapel contributions 
have decreased by £313 The church now finds nearly 
four-fifths of the whole amount collected—namelv 
^29,106 out of a total of .£30,513. 

Jtr. K Rider Haggard and the Jenner Society. 

At the last meeting of the Executive Committee of the 
Jenner 8ociety held in Gloucester, the following resolu¬ 
tion was passed unanimously The members of the 
Executive Committee of the Jenner Society desire to 
express their appeciation of the recognition of the wbMt 
of the Society by Mr. Rider Haggard, in the dedication to 
its members of his powerful story, ‘Dr. Theme.' They 1 ' 
also desire to assure Mr. Rider Haggard of their warm 
sympathy with his just and vigorous protest against the 
dangerous agitation oarried on against vaccination, by 
Which many thousands of persona have been misled,*and 
have been induced to deprive their children of the only 
certain protection against a virulent and fatal disease. 
The committee congratulate Mr. Haggard upon his un¬ 
compromising exposure of this evil, and trust his book 
may have a large circulation, as being calculated to lead 
a considerable section of the public, who cannot be other¬ 
wise interested in the subject, to give serious considers- , 
tion to a matter of urgent and overwhelming importance, 
affecting, as it does, the health and lives of multitudes 
of hapless children who may be exposed to the infection ’ 
of, smallpox, without the protection afforded by vacci¬ 
nation.” 


University of London. 

The following candidates passed tho recent B.S. 
Examination for Honours.—Surgery. 

First Class.—John Presto* Maxwell, Gold Medal, St. Bart ho 
loinew s Hospital. 

Second Class.- Thomas Varley Cunliffe, Owens College and Mun- 
cheeter Koyal Infirmary ; Donald John Munro, Guy's Hospital. 

Third Class.—Winifred Sec re tan Patch, B.Sc., Royal Free Hoepital 
and London School of Medicine for Women. 


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NOTICES TO CORBESPONDENTS. 


Jan. 11, 1899. 


52 The Medical Press. 


to 

(Eomoponbento, gtat 'Jettm., &t. 


■V Oorbrspondrets requiring s reply in this column are par 
ticnlarly requested to make use i f a distinctive signature or 
initials, and avoid the practice of signing themselves ' Reader,” 
"Subscriber,** “Old Subscriber,” Ac. Much confusion will be 
■pared by attention to this rule. 

A CURIOU8 WILL. 

The will of the late vicar o ( Stapleton (Cambridgeshire), which 
was reontly admitted to probate, contains the following curious 
clauseI will that af i er my decease and within six hours of my 
burial a certificate as follows be given in writing to the person in 
charge by two members of the Royal College of Surgeons in Eng¬ 
land/’ The following certificate in the form prepared by the 
testator is attached to the will'* We Joseph Griffiths ana John 
Gay, duly qualified surgeons, and who are not in business partner¬ 
ship, certify that we have severed the right leg above the cnee o f 
a corpse shown mas that of the late Charles Henry Thom«s Wyer 
Daw, and which we beHeve so to be.—Joseph Griffiths, M.R.C.8. 
Eng.; John Day, M.B.C.t?.Fnir., l.R.C.H. October 26th, 1888.” 
The will continues: “I will that three guiie is be paid to each 
surgeon, but they may take the severed limb at the price of three 
guineas as part payment if they so chouse: the corpse will then 
pack in an ordinary coffin with or without the severed limb. I will 
that if the severing of the right leg be omi'ted and notcertifled by 
two snrgtoos that the whole of thi- rr v wi'l be cancelled and of no 
effect, etcent the p ovision for my danghtor Angela Mary Daw, 
which shall then be sdministered by the High Court of Justice, 
and shall include all available property at my disposal.” The 
greet value of the estate has been estimated at £4 230. 

We donbt v«ry much whet.hr r any member of the College of 
8urgeons would willingly accept a dead clergyman’s leg in lieu of 
three guineas. No Information is forthcoming as to whether thr se 
Instructions were complied with, but as probaba has issued, we may 
infer that the two gentlemen mentioned therein have been paid 
their honoraria. 

M. K. —The matter Is under consideration, and will be dealt with 
in due course. 

ExoB.-Wedonot pretend that our opinion has force of law. 
You asked fbr it, and it la for yon to decide whether or not to act 
on it The matter is of too exclusively private interest to justify 
our dealing with it editorially. 

Db. Ogilvib.— lour MS. has been received, and will be dealt 
with as requested. 

0. A. Scclbs (Driffield).—A correspondent under this signiture 
has favoured us with her views on ” The Dietetic Value of Plum 
Pudding,” which appeared in a recent number of this journal, and 
was quoted in hundreds of newspapers. As a vegetarian she avers 
that although they (vegetarians) would not outrage their humane 
feelings to procure tbeneceesary suet, which involves “ the life of 
a highly organised and sentient beast,” yet "there are many 
-vegetable oils and fats that may and do more wholesomely take 
its place.” In reference to the use of eggs she writes:—“It is 
usually the hyper sensitive reverence for life of those who love to 
cavil at vegetarianism, not vegr tar lane themselves, who would wish 
to bar the ggs.” 


JEteiings xrf the gorieties aith $erturefc. 

Wednesday, January 11th. 

Dermatological Society op London (11 Chandoe Btrect, 
Cavendish Square, W.).—MB p.m. Clinical Demonstration. 

South-West London Medical 8ocibty (Town Hall. Wands¬ 
worth. 8.W.).—8.80 p.m. Dr. J. B. Ball: Paroxysmal Sneezing 
and Allied Affections, their Causes and Treatment. 

Hunterian Society.— 8.30p.m. Pathological Meeting. Speci¬ 
mens will be shown by Dr. Oliver, Mr. Targett, Dr. F. J. Smith, 
and other Fellows of the Society. 

Thursday, January 12th. 

British Gynecological Society (20 Hanover Square. W.l— 
8.30 p-m. Annual Meeting for the Blection of Officers. Presi¬ 
dent's Address. 

Society por ms Study op Inkbhibty.— Quarterly Meeting 

4 Rooms of the Medical 8oclety of London) at 4 o’clock. Paper: 

'he Temperance Fallacy. A rejoinder to Dr. Norman] Kerr, by 
Archdall Reid, M.B., South sea. 

Friday, January 18th. 

School Dentists’ Society (Medical Society’s Booms, Chandoe 
Street, Cavendish Square, W.l. 7 p.m. Casual Communications. 
Paper:—Mr. W. T. Elliott (Birmingham): Classification of the 
Ages of Children for the purpose of Statistical Obtervation. 
Followed by Discussion. 

Clinical Society of London.—8.30 p.m. Clinical Evening. 
The following cases will be shown:—Mr. J. Hutchinson, jtln.r 
Localised Myositis Ossificans from Injury.—Dr. Crawford: 
Eularged Spleen with Thrill and Bruit.—Mr. Curtis: Anterior Dis¬ 
placement of Tnbeicnlous Carpus with Formation of a False Joint 
(skiagrams and stereoscopic photographs by Dr. M tekenzie David¬ 
son).—Dr. J. 8. Richards: Pemphigus of the Mouth, Pharynx, 
Larynx, and Skin.—Dr. Batten: Progressive Muscular Atrophy 
after Measles.—Mr. Eellock: Two Casesof Complete Hypospadias 
with Cleft Scrotum.—Dr. Perkins: (1) A Case of Progressive 
MuscuHr Atrophy of Unusual Disti ibutiou; (2) A Caseof Muscular 


Atrophy (Myopathic).—Mr. L. A. ilunn: Charcot’s Disease of the 
Hip. And other cases. Patients will be in attendance at 8 p.m. 

Royal Academy op Mfdicinb in Ireland.—Section op 
Pathology.- 1. Dr. Knott: Pathological Femora and Tibia:. 2. 
Mr. H. o. Croly: (a) Tumour of l eft Ovary, (b) Specific Fnngos of 
Test s, (e) Carious Os Calcis, (d) Tumour of Breast of eighteen years 
standi ng, («) Portion of Fractured Superior Maxilla 3. The Secre¬ 
tary : Note on the Agglutiliability of Different Races of the 
Typhoid Bacillus. 4. Dr, Oonolly Norman: Case of Peritoneal 
Tomonr. 5. Dr. Coleman: (a) Qbo-sarcoma of rvrebral Hemi¬ 
sphere, ( b) Tubercular Tumour of Cerebellum, (c) Abscess of Cere¬ 
bellum. 


larattcuB. 

County Asylum, Rainhill, near Liverpool.—Assistant Medical 
Officer, unmarried. Salary commencing at £100 per annum, 
with furnished apartments, board, attendance, and washing. 

Dorset County Hospital. Dorchester.—House Surgeon for twelve 
months, unmarried. Salary £80 To reside and board in the 
hospital. 

General Hospital, Nottingham.—House Physician for two years. 
Salary £100, rbing £10 a year to £120, with board, lodging, 
and washing. 

Kewcastle-on-Tyne Dispensary.—Visiting Medical Assistant for at 
least one year. Salary £120 for the flist year and £150 after¬ 
wards. 

Plalatow. 8t Mary's Children's Hospital. — Senior Resident 
Medical Officer for one year. Salary £80 per annum, with 
residence in the hospital, board, and washing. 

Tynemouth Victoria Jubilee Infirmary, North Shields.—Resident 
Home Surgeon. Salary £<» per annum, with board, lodgings, 
and washing. Applications to the Secretary, 43. Howard 
Street, North Shields. 


Appointments. 

Barter, William, M.D., M.Ch.. Medical Officer for the employe: 
of the liOndon District, Great Central Railway. 

Briscoe, John Chariton, M.R.C.8.,' L.R.C.P. Loud., Home 
Physician for King’s College Hospital, London. 

Campkin. P. 8., L.D.S.Eng., Dental House Surgeon for Guy’s 
Hospital, London. 

Colls, Pbbcy Cooper. M.R.C.S., L.R.C.P.Lond., House Surgeon 
for King’s Col'ege Hospital, London. 

Dickinson, Wm. Lbb, M D.Camb., Lecturer In Toxicology and 
Forensic Medicine to 8t. George's Hospital Medical 8chopl, 

Eden. Thomas Watts, M.D.Bdin., M.R.C.P.1 ond., an Assistant 
Obstetric Physician for the Charing Cross Hospital, London. 

Grbavbs, Frank, M.R.C.B., L.R.C.P., Home Surgeon for the 
Derbyshire Royal Infirmary, Derby. 

Hbnnbbsy, D., L.R.C.P., L.R.C.S.Edin., L.F.P.S.Glasg., Medical 
Officer, pro tent., for theClonakilty Workhnme. 

Lbvick, Percy, B.A., M.B., B.C.Cautab., House Surgeon for 
King’s College Hospital, London. 

Lewis, Colton Taylor. M.R.C.8., L.R.0.P.Lond., Home 
Accoucheur for King's College Hospital, London. 

Lynch, Stephen Frederick, M.R.C.8., L.R.C.P.Lond., House 
Surgeon for King's College Hospital, London. 

Mason, B. N., L.D.S.Eng., Dents! House Surgeon for Guy’s Hos¬ 
pital, London. 

Ogle Cyril, M.B.Oxon., M.R.C.P.Ltmd., T ectorer in Practical 
Medicine to St. George's Hospital Medical School. 

Owbn, Isambard, M.D., P.R.C.P.Lond , Joint Lecturer (with Dr. 
Ewart) in Systematic Medicine to 8t. Georges Hospital 
Medical School. 

Bobbrtb, George Augustus, M.R.C 8., L.R.C.P.Lond„ Assistant 
House Physician for King’s College Hospital. London. 

6t. John, Winbtan St. Andrew, M.R.C.S., L.R.C.P., House 
Physician for the Derbyshire Royal Infirmary, Derby. 

Saunders, Lbonard Dimock. M.R.C.8., L.R.C.P.Iond., Assis¬ 
tant House Accoucheur for King’s College Hospital, London. 


N Jftarriagcs. 

Batbman— Hicham—O n Jan. 8rd, at 8t. Paul’s Ohnrch, Bath, 
R. W. Bateman, Durham House. Bournemouth, LB.C.P.Lood., 
M.R.C.8.Eng., L.8.A., to Isabella Higbam, widow of the late 
William H. Higbam Brereton, Dean Park Bournemouth. 

Madob—Paul— On Jan. 4th, at St. George’s, Hanover 8quare. 
London, Edward Douglas Madge, M.H.C 8., L.R.C.P., L.8.A.. 
of Nottingham Place, W. to AnDie Chasten Paul, eldest 
daughter of J. J. 1 a*son Paul, J.P., Eaton Grove, Norwich. 

Hynes— Kkttlbwbll— On Jan. 3rd. at St. Paul’s Church, 
Bedford, Ernest Jemiyn Hynes, M.R.C.8., L.R.C.P., of Stock 
ton-on-Tees Hospital, to Florence Maud, daughter of Litut.- 
Col. G. Boche, Kettlewell, late Bengal Army. 

Willis— 1 Tubing— On Jau 6th, at St. Peter s rhurcb, Bourne- 
month, Oyril Hamer Willis. L.R.C.P.lnnd., younger 

son of the late M M. Willis, of Beckenham, Kent, to Annie 
Bertha, youngest daughter of the late Bobert Thring, of 
Winchester. 


garths. 

Bruce.—O n Jan. 2nd, at The Common, Baling, Lewis Stanhope 
Bruce. Surgeon-General, late Bombay Army. 

Davy.- On Jan. 4th, at his residence, St. Helen's. Bighfleld Road, 
Rathgar. Edmund William Davy, M.D., M.K.I.A.. aged 72 
years, eldest sou of ths late Edmuud Davy, P.R.8. 
Jefvrbb.—• u Jan. 3rd, at Howard Lodge, Clapham Park, John 
Jeffree, F.R.C.8.. L.S.A., aged 78. 


Digitized by G00gle 


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“SALUS POPULI 


Vol. CXVIII. WEDNESDAY, 


(Original Communications. 

THE CONDUCT OF THE HEART 

IN THE 

FACE OF DIFFICULTIES (a) 

By Sir WM. BROADBENT. M.D., F.R.C.P.Lond., 

Consulting Physician to St. Mary's Hospital; Physician in Ordinary 
to H.R.H. the Prince of Wales. 

I should like the Society to understand that I am 
in no way responsible for the title of this communica¬ 
tion, but that I accepted it at your dictation. There 
are appeals more imperative than commands. Such 
was yours when, as an old pupil become president of 
this Society, you requested me to read a paper on the 
conduct of the heart in the face of difficulties. I was 
bound to obey, but I ventured to point out that the 
word “ conduct ” in this phrase might have two dis¬ 
tinct meanings—the behaviour of the heart itself 
under difficulties, or the way in which it might be 
helped and guided through them by the physician, 
and to ask which of the two questions was to be dis¬ 
cussed. You promptly answered “ both.” It is by 
your command, therefore, that a double entendre is 
inflicted upon the Society In dictating the title you 
practically also decided the way in which the question 
was to lie treated. 

The difficulties which the heart has to face are 
sometimes of its own making, sometimes imposed 
"upon it from outside. An over-distended stomach, 
for example, pushes up the diaphragm and presses 
•upon the right ventricle ; the heart is carried to one 
side or other of the chest by effusion into the pleural 
cavity, or more rarely is displaced by a mediastinal 
tumour or aneurism; or the flow of blood towards 
the right auricle may be impeded by pressure on the 
superior vena cava. Difficulties of another kind may 
-arise from obstruction in the arterioles and capillaries 
—in the pulmonic circulation by emphysema or by 
acute affections of the lungs ; in the systemic circula¬ 
tion by the numerous conditions which give rise to 
high arterial tension. 

The heart adjusts itself to altered conditions in a 
wonderful fashion. It may be so much displaced by 
effusion into the left pleural cavity ©r by traction 
from a shrunken right lung that its beat is felt as far 
-out as the right nipple and yet we can trace very little 
inefficiency in the functional action. Time, however, 
is an element in this accommodation. The same degree 
of displacement occurring suddenly as in pneumo¬ 
thorax, will be attended with severe dyspnoea and 
great disturbance of the action of the heart will he 
occasioned by sudden and capricious distension of 
-the stomach. 

The difficulties arising out of flatulent distension 
of the stomach or colon or intestinal canal generally 
-will require some attention, since they are the cause of 
mostof the functional derangements to which the heart 
is subject, and give rise to the heart complaints 
which occasion in the aggregate perhaps more 
suffering than does actual htert disease. The 

(o) Paper read before the Medical Society of London, January 
1899 . 


SUPREMA LEX.” 


January is, 1899. n 0 . 3. 


heart often tolerates a considerable degree of upward 
pressure of the diaphragm, and it is not uncommon to 
meet with stomach resonance as high as the 5th 
space, and to find the apex beat displaced upwards 
and outwards to the 4th space and outside the nipple 
line without conspicuous symptoms. But the heart 
behaves very differently in different subjects in the 
presence of flatulent distension of the stomach. It 
partakes of the general constitutional condition of 
the individual; in the strong, therefore, it is virorous, 
in the wt-ak it cannot be anything but weak. Then 
the heart has very special relations with the nervous 
system; it reflects every emotion, teats high with 
courage, is palsied by fear, throbs rapidly and 
violently with excitement, acts feebly under nervous 
depression, but it is not only through the cerebro¬ 
spinal system that the heart is influenced, it is 
in immediate relation with the vaso-motor nervous 
apparatus, and in a scarcely less degree with 
the sympathetic system genei*ally. Normally 
afferent impulses are brought from the viscera to the 
central nervous system by means of which their blood 
supply is regulated, and their functional activity 
governed. These afferent impulses when perverted 
by functional derangement or disease may become 
serious disturbing influences. But the nervous sys¬ 
tem in a large and increasing proportion of people is 
unduly sensitive and excessively mobile, and the 
reactions to influences of every kind are exaggerated. 
A little emotional excitement gives rise to palpita¬ 
tion, a piece of bad news or the bang of a door seems 
to stop the heart altogether. There is in such sub¬ 
jects no form or degree of cardiac disturbance which 
may not be caused by indigestion, scarcely any symp¬ 
tom of cardiac disease which may not be simulated. 
Add a touch of hysteria on the lookout for symptoms 
and for someone to give ear to the relation of the 
unparalleled agonies of the sufferer, and the difficulties 
of the heart, and it may be added of dealing with 
them, are complete. 

It is of course of the greatest importance that we 
should be able to distinguish these functional affec¬ 
tions of the heart from troubles due to organic dis¬ 
ease, and this is especially the case where there is 
severe pain in the cardiac region. The absence of 
physical signs of valvular or structural change will be 
a help, but murmurs may be present at one or more 
of the orifices during palpitation when there is no 
valvular affection, and thei'e may be actual mitral or 
tricuspid incompetence when all the symptoms are 
really of neurotic or dyspeptic origin. 

Angina pectoris is one of the cardiac affections 
which may be closely simulated by the effects of dila¬ 
tation or functional derangement of the stomach. 
The first question to be put in a case of cardiac pain 
of anginoid character is “ As to the circumstances 
under which it comes on ? ” Whether as an effect 
of exertion or during repose ? The earlier attacks of 
true angina are practically always provoked by ex¬ 
ertion, while spurious angina is specially liable to 
come on during repose. It is true that angina when 
established may come on in the night, or may be in¬ 
duced by the act of undressing and the contact of 
cold sheets, but there will be a history of attacks 
during exertion. Pain and a sense oi suffocation 


google 


Digitized b’ 







54 TH* Mkdical Pares. ORIGINAL COMMUNICATIONS. Jan. is. 1899. 


may also be brought on by the pressure of the abdo¬ 
minal viscera reinforcing that of a distended stomach 
on lying down whether the heart is diseased or sound, 
and a weak heart may actually be brought to a stand¬ 
still in this way. Speaking generally, angina pectoris 
in a woman is always spurious, ana the more minute 
and protracted and eloquent the description of the 
pain the more certain may one be of the conclusion. 
Again, when palpitation or irregular action of the 
heart, or intermission of the pulse, or pain in the 
cardiac region, or a sense of oppression follows certain 
meals at a given interval, or comes on at a certain 
hour during the night, there need be little hesitation 
in attributing the disturbance, whatever it may 
be, to indigestion in one or other of its forms. 
Nightmare from indigestion is not a bad imi¬ 
tation of true angina. So also if airy cardiac 
symptom or pain can be walked off, it may 
usually be set down as functional, and due to some 
outside disturbing influence or to nervous irritability. 
The same may generally be said of intermission of 
the pulse, of which the patient is conscious, and, 
though with less confidence, of irregularity of the 
heart’s action—if the patient feels it the irregularity 
is usually temporary, and not the effect of organic 
disease. 

In these functional affections, it is not the heart 
which is to blame; it is more sinned against than 
sinning, and if its difficulties are removed there will 
be nothing to find fault with in its conduct. The 
difficulties are, as has been said, the state of 
the nervous system, on the one hand, and 
of the digestion on the other, and according 
as the neurotic or the dyspeptic element pre¬ 
dominates will be the treatment required. No details 
need be entered into, but one observation may be 
made. Patients suffering from these functional 
derangements of the heart usually make them a pre¬ 
text for avoiding exercise and fresh air and often for 
taking stimulants or dru^s whereas exercise and fresh 
air are what he or she most needB. The best way to pre¬ 
vent the expenditure of superfluous energy on the part 
of the heart in the form of palpitation is to give it a 
fair amount of legitimate physiological work to do and 
to relieve one attack of palpitation or faintness by 
alcohol is to invite another, while the terrible danger 
of drifting into alcoholism is incurred. 

One of the most common difficulties with which the 
heart has to contend is high arterial tension, or 
rather the obstruction to the onward movement of 
the blood in the capillaries and arterioles which is 
the cause of the high pressure in the arteries. While 
dyspeptic troubles and other reflex sources of irrita¬ 
tion give rise merely to functional affections of ihe 
heart, high arterial tension when persistent is a fre¬ 
quent cause of actual disease. The resistance in the 
peripheral circulation has to be overcome and the 
near! rises to the occasion. It puts forth the increased 
energy required and in dome so becomes hyper¬ 
trophied. Hypertrophy is not disease, though some¬ 
times the heaving impulse and powerful throb of the 
apex are complained of by the patient and looked 
upon with suspicion by the medical man, but the 
development of additional muscular fibre is accom¬ 
panied by the development of increased connective 
tissue, and when in the decline of life the nutrition 
of the more highly organised structures is no longer 
vigorous, the fibroid element may gradually pre¬ 
dominate over the muscular, or fatty degeneration 
may take place. 

But the valves may suffer before the muscular 
walls. Where greater force is required to propel 
the blood into the aorta there is greater strain upon 
the mitral valves during systole, and a more violent 
recoil upon the semilunar aortic valves during 
diastole. This gives rise to chronic inflammation 
of the valves, with thickening and contraction, and, 
in the long run, insufficiency. 


It was necessary to mention high arterial tension 
on account of its frequency ana importance as a 
source of cardiac difficulty, but I have dealt with it so 
often and so recently that I will forbear from further 
dwelling upon it on the present occasion, only re¬ 
marking that the recognition of unduly high pres¬ 
sure in the arteries affords one of the most valuable 
indications for treatment in a great variety of con¬ 
ditions. 

I am afraid it often escapes recognition, and some¬ 
times digitalis is given for the relief of the cardiac 
discomfort which may attend it. This is like knock¬ 
ing the head against a stone wall, for digitalis not 
only acts on the heart, but tightens up the vessels, 
and so increases the obstruction already too great. 

Coming now to the serious difficulties to which the 
heart is exposed by reason of damage to one or other 
of its valves, we discover, say, a systolic murmur at 
the apex or at the right second intercostal space, 
indicative of leakage of the mitral valve or of inter¬ 
ference with the blood current at the aortic orifice. 
What are we to do P Frighten the patient out of 
his life or out of his peace of mind ? Condemn him 
at once to live on one floor, and forbid him exercise 
and excitement and all that makes life tolerable, and 
give digitalis? Certainly not. Or shall we ignore 
the murmur on the chance that it may not be 
serious, which is a not uncommon proceeding when 
a medical man has predicted sudden death once or 
twice, and found the patient to go on living for ten 
or twenty years P This would be equally unreason¬ 
able. 

The first thing to be done is to ascertain what the 
murmur really means; whether, when it is mitral, 
there is much or little regurgitation, or, if aortic, 
whether it signifies mere roughness or actual con¬ 
struction. Numerous considerations enter into the 
determination of these questions, of which we need 
specify only those arising out of the conduct of the 
heart. If, in the case of mitral incompetence, there 
is any considerable reflux into the left auricle, the 
first effect will be damming back of the blood 
entering it by the pulmonary veins, and the 
obstruction thus created will make .itself felt 
in the pulmonary artery, raising the blood pres¬ 
sure within it. There is no branch of the pul¬ 
monary artery on which we can place our finger or a 
sphymograph but the high pressure is at once accused 
by accentuation of the pulmonic second sound. 
It' the circulation is to be maintained under 
these circumstances something must be done to over¬ 
come the obstruction in the pulmonary circulation 
and neutralise the mitral reflux. This can only be- 
by increase in the capacity and strength of the right 
ventricle. The right ventricle accordingly becomes, 
dilated and hypertrophied, and the dilatation and 
hypertrophy which we call compensatory, be¬ 
come for us the measure of the regurgitation. This 
is the conduct of the heart in the face of this particu¬ 
lar difficulty, and we learn from the amount of com¬ 
pensatory change required to neutralise the effects of 
the valvular lesion whether the lesion is severe or 
slight; our conduct then will be guided by the degree 
of efficiency of the compensation. When there is no 
appreciable hypertrophy of the right ventricle or 
marked accentuation of the pulmonic second sound, 
and the patient has no heart-symptoms, the murmur 
means nothing, and there is no need to interfere in 
any way with the patient’s mode of life even if this 
include hunting or climbing, or swimming, or cricket. 
I should draw the line of football or training for races 
of any kind. 

If with marked hypertrophy and dilatation there 
is still no breathlessness on ordinary exertion or other 
circulatory symptoms the regurgitation is consider¬ 
able, but it is neutralised by the compensatory 
changes. We are not called upon to do anything 
but the patient must be warned that the compensa- 

D,g,tizedb7LiOOgIe^ 


Jan. 18, 1899. 


ORIGINAL COMMUNICATIONS. 


Thi Medical Press. 55 


tion may easily be broken down, and that a single 
imprudent act of violent or sustained exertion may do 
irreparable injury. 

Cardiac symptoms, such as breathlessness on slight 
provocation, snow that the compensation is inade¬ 
quate, and it is only by great carefulness that the 
serious effects of the valvular lesion can be put off. 
Let us suppose that we have the heart landed in ex¬ 
treme difficulties from incompetence of the mitral valves, 
the liver enlarged till its lower border crosses the 
abdomen at the level cf the umbilicus, the veins of 
the neck distended and pulsating, the face and lips 
livid, the lungs congested, the legs dropsical, the 
ur ne scanty, turbid, and albuminous, the patient 
gasping for breath and unable to lie down. It is in 
mitral incompetence that digitalis and such like 
remedies find their opportunity. But first the right 
side of the heart must be relieved from the over 
distension which is paralysing its efforts. Unless 
this is done the digitalis may simply help the strain¬ 
ing ventricle in the work of self-destruction. The 
nearest approach to a modern therapeutic miracle is 
seen on bleeding in a good case of this kind. When 
I say a good case I mean one in which the onset of 
the seve e symptoms has been sudden under the in¬ 
fluence of some adequate exciting cause such as over 
exertion or chill in a fairly robust subject with a 
powerful right ventricle. The venesection must 
be followed up by a good calomel purge, two or three 
grains of calomel with, say, five of colocynth and 
nyoscyamus, and perhaps a dose of white mixture. 
Bleeding, however, is too heroic a method for these 
degenerate days, and it is not always easy to say 
whether it is i eally demanded. A good alternative 
is 6, 8, or a dozen leeches over the enlarged liver 
followed up of course by the calomel purge. In less 
severe cases we may content ourselves with the mer¬ 
curial aperient. 

The right heart having been relieved, digitalis may 
be given with excellent effect in different combina¬ 
tions, according to the condition, with nux vomica 
and ammonia and perhaps ether, or with acetate of 
iron and potash, if the oedema is considerable it 
should be drained off by Southey's tubes, and any 
pleural effusion should be withdrawn by aspiration at 
an early stage. 

Mitral incompetence will serve as an illustration of 
the difficulties imposed upon the heart by disease of 
the valves. They differ in the different valvular 
affections, and the heart responds in a special way 
for each one. It is unnecessary to go into details with 
regard to all of them and the time at my disposal 
would be quite insufficient. The principle which I wish 
to emphasise is that when the heart is in difficulties, we 
can generally do more for the relief of the patient 
indirectly by removing the difficulties than directly by 
aiding it to overcome them. This is the case whether 
the disturbing influence is external to the heart, as, 
for example, a dilated stomach, or distended colon, or 
resistance in the peripheral circulation, or is a 
secondary effect of disease of the heart itself, as 
illustrated by over-distension of the right ventricle ; 
or, to take another instance, if the heart is in a state 
of fatty degeneration, it is useless to give cardiac 
tonics; but its work can be diminished by keeping 
down the arterial tension, and a fatal issue mav be for 
a time averted by preventing distension or dilatation 
of the stomach. Such illustrations might be multi¬ 
plied indefinitely. 

When, therefore, we are considering the treatment 
of cardiac disease or disturbance, the first question 
to engage the attention is how we can relieve the 
labouring or harassed heart by the removal of some 
condition which is causing or aggravating the diffi¬ 
culties with which it is contending. In doing this we 
often put an end to the symptoms which have given 
rise to suffering and anxiety, and in all cases we 


make the action of digitalis or other cardiac tonics 
more efficacious. 


INFLUENCE OF THE MILK 
SUPPLY 

ON THE 

8PREAD OF TUBERCULOSIS. 

Based upon an Investigation of Sixteen Milk Supplies 
in Cambridge. 

By A. A KANTHACK, M.A., M.D., F.R.C.P., 

Late Fellow of King's College, and Professor of Pathology in the 
University of Cambridge. 

AND 

E. SYDNEY ST. B. SLADEN, M.A., B.C., M.D., 

Cambridge. 

Last April the late Professor Kanthack suggested, 
as a subject for research, the study of the effect upon 
the spread of tuberculosis produced by the various milk 
supplies to the different colleges in Cambridge. He 
very kindly offered his assistance. It is, therefore, 
under his guidance, and with his help and advice, 
that the following record of results has been com¬ 
piled. 

This paper is limited to a nairat ve of our joint 
work—the investigation of the tuberculous lesions 
and the presence of the tubercle bacillus found in 
guinea-pigs as the result of inoculation of milk, no 
notice being taken of other points of interest outside 
the immediate subject. This is due to the fact that 
the present article, though complete in itself, is only 
a preliminary paper. We are now carrying out a 
further and exhaustive investigation on the milk 
supplies in Cambridge, leading, we hope, to the 
near future of buying milk which comes from cows 
certified to be free from tuberculosis. 

Experience and observation have convinced us that 
infantile tuberculosis is by no means uncommon in 
Cambridge; and s nee the danger now generally 
recognised abroad, of spreading tuberculosis by milk, 
is gradually being appreciated in this country, all 
that is needed is to rouse people at home to the con¬ 
sciousness of this danger and make them understand 
that it is their duty to insist on being supplied with 
milk free from tuberculous infective material. 

Similar investigations have been made in other 
parts of the world, and they are already bearing fruit. 
We may thus mention the work of Professor Bang 
of Copenhagen, of Professor Delepine in Manchester, 
and the well-known researches of the Royal Commis¬ 
sion. 

Professor Delepine’s work has already induced the 
late Lord Veraon to follow the example set by the 
Danes and Germans, namely, to stamp out tuber¬ 
culosis in his own herds. We hope that once the 
Colleges have recognised the true state of affairs they 
will insist on obtaining a pure milk supply, and will 
assist the dairymen in bringing about improved con¬ 
ditions. The manner in which this may be done 
will be discussed in the fuller report, which unfor¬ 
tunately has been delayed by Professor Kanthack's 
illness. 

The object of this paper is to set forth the evidenoe 
upon which the fuller report is mainly based. To 
collect such evidence is a matter of some difficulty, 
and, at any rate, requires a considerable amount of 
time and labour. It may be noted that Professor 
Kanthack saw every animal which was dissected, and 
in every instance the diagnosis was accepted and 
confirmed by him before it was placed on the records. 

1. Method of Work.— Early in May, arrangements 
were made as regards collection of the milk and & 
regular supply of healthy guinea-pigs. 


Diai 


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56 Tftk Medical Pres®. 


ORIGINAL COMMUNICATIONS. 


Jan. 18. 1899. 


During the firBt three days only twelve guinea-pigs 
were inoculated, four each day; afterwards, when a 
routine method had been devised, the number was 
increased to six each day, and this number was 
adhered to throughout the remainder of the work. 

It was decided to inoculate two guinea-pigs with 
each sample of milk, and to continue this for two 
successive days using fresh guinea-pigs each day, so 
that each separate supply was thus passed through 
six guinea-pigs : the only exception to this arrange¬ 
ment was H.’s supply, wliich was inoculated into four 
guinea-pigs, owing to forgetfulness on the part of 
one of the College pointers to have the bottle left with 
him filled with milk. 

• It was found more convenient to use the morn¬ 
ing delivery of milk in place of that obtained in the 
afternoon, owing to the work sometimes occupying 
much time. 

Thus, although more time was lost between collec¬ 
tion and inoculation, still by putting off the staining 
of any cover-glass preparations until after all the 
inoculations had been made, this loss of time was 
inconsiderable. 

Some of the samples of milk were collected as early 
as 6 a.m., and as it was impossible to start work 
before 9 a.m.. some time elapsed before the inocula¬ 
tions could be made, the greatest difference between 
the time of collection and inoculation being four 
hours, and the smallest being fifteen minutes; an 
average taken of all the experiments shows the differ¬ 
ence to be just under two hours. This, however, is 
immaterial, since we are here dealing with the 
tubercle bacillus only. 

2 .—Method of Collection of the Milk. — (a) A glass 
stoppered bottle having been well washed, done up in 

J >aper and tied with string, was placed in the steri- 
iser and st-rilised half an hour at a temperature of 
115 Centigrade. 

(6) The bottle when cold w as usu lly taken to a 
College (the permiesi n of the College Authorities 
having been previously obtained) and left with the 
porter or at the kitchen some hours before the 
p irticular milkman arrived. 

(c) In the presence of the milkman the bottle was 
opened and then filled by the milkman direct from 
hiB can : it was immediately shut again, done up in 
paper and tied with string; the milkman’s name was 
then written on the paper covering the bottle. 

Thus the milk, as it was received for examination 
at the Pathological Laboratory, was in exactly the 
same condition as that in which it was while in the 
milkman’s can, the only difference being in respect of 
the time lapsing between collection and examination. 

The milk was of course “mixed," i.e., derived from 
different cows. Later, it is intended to examine the 
milV from individual cow.--, in order to gain an idea as 
to how many cows proportionately are tuberculous. 
Here we ai-e dealing with the question of the milk 
generally, and it is our intention, to go no further in 
this paper than the investigation of the “ mixed ” milk 
of each supplier. 

3. Method of Inoculation .—Previous to all inocula¬ 
tions all instruments and vessels had been sterilised 
by heat, and after each operation were at once placed 
in strong lysol solution, so that it was quite impossible 
that these could be held liable for any accidental 
infection with tubercle bacilli. A fresh syringe and 
needle, both carefully sterilised, were also employed 
for each separate sample of milk. 

With the exception of two cases each inoculation 
was made into the right groin of a guinea-pig. 

Two tubes of a Metzger centrifugal machine were 
filled up to the 10 c.c. mark with milk taken from 
each sample, these were then centrifugalis d for five 
minutes, the time being always accurately kept by 
reference to a clock placed just over the centrifugal- 


ising machine. The machine was usually worked at 
the rate of 3,000 to 4,000 revolutions per minute. 

The average yield of cream from 10 c.c. of milk 
after centrifugalisation was found to be 0'93 c.c. 
Later in this paper it was stated that 3 c.c. of the 
“ creamy layerwere inoculated ; that is to say, as 
much cream as possible was collected from each of 
the two glass tubes, the remainder being made up of 
the milk floating next to the cream. 

The “ sediment ” refers to the deposit found at the 
bottom of the glass tube; to this part all solid particles 
should have been driven, but as will be noticed later 
this does not apply to all the tubercle bacilli whe a 
present in milk, some remain in the sediment, but a 
considerable number are carried up and remain in 
the creamy layers. 

Two guinea-pigs wex-e then inoculated, one with the 
creamy layer, another with the milk at the bottom of 
the glass tube. 

The following is an example of the method em¬ 
ployed for each sample of milk, being taken from 
notes recording the inoculations of the 67th and 68th 
guinea-pigs: 

(1) Time of reception from dairyman, 4 pm. 

(2) Time of oentrifugalisation (two tubes each con¬ 
taining 10 c.c.), 4.30 p.m. 

(3) Yield of cream after centrifugalisation from one 
tube, 0’25 c.c. 

(4) (a) 3 c.c of creamy layer (taken from the two 
tubes) were inoculated into right groin of one 
guinea-pig. (Label L. 67 a.) Rough haired, fawn 
and white. 

( b) 3 c.f'. of sediment were inoculated into 
right groin of another guinea-pig (Label L. 68. b.) 
Black and fawn. 

(5) Cover-glass preparations were 'hen made from 
the sediment which, after allowing sufficient time 
for drying in the air, were stained by carbolised 
fuohsine and counter-stained by methylene blue in 
the usual way in order to differentiate the tuber.-le 
bai illus from other bacilli. 

On examination with the aid of a -j^ oil immersion 
the results were:— 

(a) Co ■< i and diplococci, but only few in number. 

( b ) Tubercle bacilli (two present in one prepara¬ 
tion) 

The amount inoculated ranging from 1'5 c.c. to 3 
c.c. was determined in accordance with the size of 
the guinea-pig, if of large size then 3 c.c. were used. 

An average of all the quantities inoculated gives 
this result: 2'4 c.c. for the creamy layer, 21 c.c. for 
the sediment. In the guinea-pigs that died of tuber¬ 
culosis the average amount inoculated was 2'28 for 
the creamy layer and 2 07 for the sediment. 

4. Method of keeping Animals uuder Observation .— 
For the first three days all the guinea-pigs inoculated 
on those days were kept in one cage, having celluloid 
labels fastened by lead wire round their necks (a con¬ 
trivance Dr. L. Cobbett very kindly suggested). 

Besides this means of recognition a detailed 
account of the colours and peculiarities of the guinea- 
pigs was made in case the labels should chance to get 


lost. 

When the cage contained eighteen guinea-pigs, 
each group of six, i.e. each group of animals belong¬ 
ing to each particular dairy, was picked out, and 
placed in a separate cage, the labels being afterwards 
removed, and this method was adhered to to the end 
of the investigation. 

The guinea-pigs were kept in the country under the 
best possible conditions and were examined twice a 
week. After having been under observation for 
several weeks, when any showed marked enlargement 
of the inguinal glands, these were killed by ether or 
chloroform. 

5. Method of Examining the Guinea-pigs.— Each 


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ORIGINAL COMMUNICATIONS. 


Thx Medical Press. 57 


guinea-pig after death was carefully opened and 
examined for any signs of tuberculosis. If any signs 
of tuberculosis were present they were noted and a 
general description written down. Cover-glass pre¬ 
parations were at once made, the part to be stained 
oeing taken from an abscess or a nodule in the spleen 
or a caseous lymphatic gland: these were stained for 
tubercle bacilli in warm carbol fuchsine, passed 
rapidly through HC1 (1 in 4) decolorised in /0 per 
cent, of methylated spirit and counter-stained with 
methylene blue. Parts of the spleen, liver, lungs, 
and glands were then bottled in Muller’s fluid, a label 
be ing placed on the bottle. 

When hardened sufficiently, small portions were 
removed and embedded in paraffin. Four sets of 
sections were stained, two with hsematein and eoein, 
and two others (as above) for tubercle bacilli. 

In many cases several sets bad to be cut and 
stained before positive results could be obtained. 
This is important because it is known that in milk, 
and especially in butter, pseudo-tubercle bacilli may 
occur which in the guinea-pigs produce lesions 
macroscopically resembling tubercle, but micro¬ 
scopically differing from the true tubercle, in that 
the histological elements of tubercle are absent. 
Cultures were not made from the various organs, 
since this is very laborious, difficult and uncertain; 
and the other tests taken altogether were sufficient 
to establish a correct diagnosis. 

By microscopic examination, out of the 33 guinea- 
pigs suspected of having contracted tuberculosis, 10 
were found to be not affected with tuberculosis, 23 
showed typical histological tuberculous lesions, whilst 
in 16 of the 23 the tubercle bacillus was plainly 
demonstrated. 

Following the example of those who made experi¬ 
ments upon guinea-pigs for the Royal Commission 
on Tuberculosis and discarded from their results all 
guinea-pigs which died within twenty-one days of 
inoculation, we have deducted four guinea-pigs from 
the total number inoculated, these died as follows :— 

(a) One on the 1st day after inoculation. 

(b) One on the 2nd day after inoculation. 

(c) One on the 3rd day after inoculation. 

(d) One on the 5th day after inoculation. 

Three out of the four belong to groups in which two 
or more eventually became affected with tubercu¬ 
losis due to inoculation of milk, thus :— 

(a) belonged to a group in which 2 out of 6 died 
of tuberculosis. 

(b) belonged to a group in which 2 out of 6 died 
of tuberculosis. 

(tf) belonged to a group in which 4 out of 6 died 
of tuberculosis. 

It is reasonable to suppose that had they lived one 
or more of these guinea-pigs might have come under 
the heading of those that died of tuberculosis. 

It has been found necessary to deduct a whole 
group, namely K It was noticed at the time of 
inoculation that K bore the name of the same dairy 
as C, and later, post-mortem examinations and the 
construction of the tables of results disclosed the 
fact that two guinea-pigs, one from C and one from 
K, showed similar internal lesions. This led to an 
inquiry being made as regards the dairy, when it 
was found the same milkman supplied the two col- 


Therefore out of the 100 guinea-pigs originally 
inoculated the following have wen deducted: — 

(а) Four that died within twenty-one days of 
inoculation. 

(б) Six that belonged to Group K, which subse¬ 
quently was found to be the same as C. 

Results. —1. Of the 90 guinea-pigs inoculated, 23 
died of tuberculosis, giving a percentage of 25*55. Of 
these 23 guinea-pigs 13 were inoculated with the 
creamy layer and 10 with the sediment. 


2. Of the 16 dairies examined, the milk of 9 caused 
tuberculosis, i.e., the milk supply of more than half 
of them was tainted and capable of spreading tuber¬ 
culosis. 

These results may be given in tabular form. 


Dairy. 

Number of guinea-pigs infected with 
tubercle, as the result of inoculation with 

Bvidence 
of Tubercle 
bacilli in 


Creamy Layer. 

Pediment. 

the milk. 

A 

None 

None 


B 

1 out of 3 

1 out of 3 

+ 

C 

None 

None 

— 

D 

2 out of 3 

3 out of 3 

+ 

E 

None 

None 

_ 

F 

1 out of 3 

1 out of 3 

+ 

G 

1 out of 3 

None 

+ 

H 

1 out of 2 

1 out of 2 

+ 

I 

None 

None 

_ 

J 

None 

None 

_ 

L 

1 out of 3 

2 out of 3 

+ 

M 

None 

None 

_ 

N 

2 out of 3 

2 out of 3 

+ 

O 

None 

None 


P 

3 out of 3 

None 

+ 

Q 

1 out of 3 

None 

+ 


It is thus evident that more than half of the 16 
dairies examined, now supplying ten of the colleges, 
send out milk containing tubercle bacilli in sufficient 
quantities to cause tuberculosis in guinea pigs when 
these animals have been subjected to inoculation : it is 
therefore not unreasonable to regard these dairies as 
a source of grave danger. Again, these dairies supply 
not only colleges but the town as well, here the 
danger is much more marked as regards : 

(а) Hand-fed infants, 

(б) Yonng children, 

(c) Delicate people, 

( d ) All people suffering from acute diseases. 

In these cases a milk diet is often considered neces 
sary, in some it is the sole diet. Some of these 
people cannot drink boiled milk, and therefore it is 
most important that they should not use milk con¬ 
taining tubercle bacilli. Whilst some authorities 
consider tuberculosis to arise solely from inhaled 
tubercle bacilli, it is probable that a very much 
larger number of human beings, and certainly of 
infants, contract that disease by drinking milk con¬ 
taining living tubercle bacilli. 

Now it may be argued that almost half the dairies 
of Cambridge supply milk free from tubercle bacilli. 
Such argument would be extremely unsafe, for 

(a) before we can speak favourably of a dairy we 
should have to examine every animal separately, and 

(b) a dairy which three successive days sends out 
milk free from tubercle bacilli, a few days later may 
issue milk containing these bacilli. 

The fact that more than half the dairies examined 
sell milk containing living tubercle bacilli shows how 
serious the matter is at the present time. Therefore, 
if we are asked how to avoid all danger of infection 
we answer, 

(a) under existing conditions nothing but boiled or 
carefully sterilised milk should be consumed, and 

(b) cream, unless obtained after boiling or scalding, 
should not be given to infants or delicate persons. 

Ideal conditions demand that we should not rest 
content with anything short of the certainty that no 
milk is offered for sale except that obtained from 
cows known to be free from tuberculosis. We must, 
in fact, aim at introducing the system which Professor 
Bang has so successfully carried out in Denmark; at 
any rate it is our duty to protect those who cannot 
protect themselves. 


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58 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


THE LES80N8 IN GYNECOLOGY 
OF A YEAR, (a) 

By H. MACNAUGHTON-JONES, M.D., M.A.O., 
M.Ch, F.E.C.S.I. and E., 

President of the British Gynaecological fociety. 

Gentlemen, —In bringing to your notice some lessons 
in gynaecology learned during the year that has passed, I 
am induced before doing so to say a few words on the 
ration d'etre of a gynecological society in this, the last year 
but one of the nineteenth century. At the recent Annual 
Dinner of this Society, the venerable and distinguished 
President of the General Medical Council, in proposing 
the toast of the British Gynecological Society, made the 
pertinent inquiry, “ What are the attributes which call, 
in its particular interest, for such a toast ? ” In other 
words, what has this Society done, and what is it doing, 
to entitle it to the esteem of the profession at large, and 
the respect of those who at the present time are working 
in the van of that department of medical science with j 
which it has especially to say. I think it can be affirmed 
with absolute truth, that in no field of surgery have 
advances been more rapid and striking than in that of 
gynaecology. The workers of this century have handed 
on to those of the next, from out of the crude and chaotic 
elements in which they worked for many years, a system 
of treatment founded upon a solid basis of well ascer¬ 
tained anatomical, physiological, and pathological facts. 
Not only have we given to us a fairly complete codifi¬ 
cation of the different diseased conditions which attack 
the various structures entering into the component 
parts of the pelvic organs of women, enabling us to 
apply well-defined rules of surgical treatment, palliative 
or radical, but these surgical procedures themselves have 
been most critically differentiated, so as to adapt them 
with the greatest safety to the woman, and the most 
skilful removal or conservation of the affected parte. A 
modern gyntecological operation, from its inception to its 
close, prooeeda on well pre-determined lines in the execu¬ 
tion of all its details, into which no haphazard methods, 
.or any leanings on chance, are permitted to play a part. 
It would be superfluous to show the truth of this state¬ 
ment by referring to the many surgical procedures 
resorted to from the external organs of generation to 
the uterine adnexa, with which you are familiar. And it 
is well that a Sooiety such as ours, professing to take its 
place in the forefront of progressive gynaecology, should 
realise clearly its position. It is with a scientific society 
as with any slowly evolving art: the developing 
stages consequent upon new acquisition of knowledge 
find technique leave behind them, imperceptibly it may be 
at the time, evidences of the disregarded practices and 
appliances which have gradually lea up to its more com¬ 
plete,, though possibly not perfect, development. It fol¬ 
lows that at any particular time, when such evolutionary 
process is at work, we must have transitional phases between 
such obsolete views or practices, and the more perfect 
applications of the art which has grown out of them. 
Behind us is a well-defined line of demarcation separating 
now totally disused and antiquated modes of practice; 
before us hes a period of future possibilities, at which we 
aim through our instinctive dissatisfaction with even the 
most complete of our present procedures and results A 
Society lives in this passing phase of dissatisfaction and 
distrust of itself, and its sole object is by record, observa¬ 
tion and experiment, to advance still more to faultless 
and finished procedures. A Society does not exist to 
disinter dead hypotheses and practices, and of all the 
aggravating and useless expenditures of time, that of 
flogging the dead carcase of some jaded argument for 
the purpose of self-glorification is the worst. In gynae¬ 
cology, for example, it is a fact established by many 
thousands of experiments that removal of every form of 
uterine tumour can be safely conducted by hysterec¬ 
tomy 5 that, with or without the uteruB, the most 
extensively diseased adnexa can be removed by celio¬ 
tomy ; that ovarian tumours, with every conceivable 
complication, can be dealt with successfully by ovario- 

-(a) Presidential Address delivered before the British Gynaeco¬ 
logical Society, January 12th, 189P. 


Jan. 18, 18 99. _ 

to my; that myomata of a certain kind can be most 
successfully ablated by the vaginal route; that certain 
adnexal conditions can be best dealt with in the same 
manner, and that conservative operations on these organs 
can be most successfully carried out by colpotomy, 
anterior or posterior; that canoer of the uterus, 
save in very rare conditions, such as malignant disease 
complicated by a large myoma, is best attacked by vaginal 
hysterectomy; that drainage is not necessary, save 
under conditions which are fairly defined and settled, 
and that once having decided upon drainage, the mode 
of carrying it into effect, whether after laparotomy or 
vaginal hysterectomy, has been absolutely determined, 
and is a matter of every day routine. 

To exhibit specimens merely to prove any of these 
points is an unjustifiable expenditure of valuable time. 
Also, it may with truth be said, that every argument 
that can conceivably be advanced in regard to certain 
details before, during, and after operative procedures, 
has been debated and written of to the death. I might 
take, for example, the preparation of the patient, so far 
as diet, the preparation of the bowel, the disinfection of 
the parts, and narcosis are concerned; the advantages 
of the Trendelenburg position and the employment, in 
emergency from collapse, of artificial serum ; the method 
of closing the abdominal wound, and the abdominal 
toilette generally; the after treatment of a patient, and 
all the various complications which are incidental to all 
serious cases of abdominal or vaginal coeliotomy. It is 
rather humiliating for a man to find that he has been 
absorbing time in discussing and ventilating his 
views upon subjects which he can—if he will only take 
the trouble—learn have been all exhaustively considered 
some few years before. 

But turning to these very points that I have taken for 
illustration, let me indicate some perfectly justifiable 
matters for discussion, which the exhibition of otherwise 
uninstructive specimens may warrant. We may broadly 
divide under three heads the exceptional circumstances 
or conditions connected with a case, which attach to it 
sufficient interest to make it worthy of discussion:—( 1 ) 
Clinical facts, signs and symptoms, leading to difficulty 
and errors of diagnosii; ( 2 ) unique, serious, and unex¬ 
pected complications arising during operation, which 
have to be dealt with by improvised methods calling 
for original suggestion and application on the part of 
the operator: (3) pathological conditions, the interest of 
which depends upon their rarity, or the bearing they may 
have upon treatment and the demand for, or the nature 
and extent of, operative procedures. In uterine fibroids 
there are still such debatable questions as the mode of 
securing hemostasis in certain exceptionally difficult 
cases of hysterectomy, complicated by the presenoe 
of broad ligament tumours and inflammatory 
affections, or with growths of the adnexa; the man¬ 
agement of pregnancy complicated with fibroid; 
extra - uterine fcetation associated with myoma 
and adnexal disease and tumours; conservative treat¬ 
ment of the uterus by myotomy or enucleation of 
fibroma to us tumours, as advocated before the Society 
recently by Dr. William Alexander. With regard to 
diseased adnexa, there are many interesting points 
bearing upon symptomatology on which much light may 
be thrown by more careful examination of the tissues 
removed, for it is a certain fact that pain, difficulty of 
locomotion, and various disturbances of the nervous 
system, are caused in some women by pathological 
changes in the ovary in no way proportionate to tnese 
symptoms, and for which no relief can be found save by 
removal of the diseased organs. Evidence is required 
drawn from the after history of cases of conservative 
surgery of the ovaries and tubes as to the resul's of 
efforts to save cystic and cirrhosed ovaries and tubes that 
have suppurated, -or have been distended with serum or 
blood. Adnexal tumours whioh have a bearing on the 
question of the vaginal or abdominal routes of operation, 
through the adhesions which have formed, the size and 
character of the tumours, their association with fibro¬ 
mata or malignant disease of the uteruB, have also a 
special interest. There is the question, both pathological 
and operative, of ovarian and broad ligament hsematoma 
and blood cysts, with the bearing which these have no 




Jan. 18, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 


the occurrence, as well as the histological and patho¬ 
logical sequences, of ruptured tubo-ovarian and tubal 
gestation. 

Ovariotomy for ovarian cystoma must have occasionally 
certain complications which so involve the operation of 
ovariotomy that the narration of the case, independent 
of any specimen for exhibition, cannot fail to be of 
importance. I refer to various types of blood cysts, 
suppurating and malignant oystoma, and such difficult 
complications as extensive peritoneal, omental and 
"bowel adhesions, an extreme instance of which, occurring 
recently in my own practice, I shall presently refer to. 
And here I may advert to what appears to me to be a 
most important want in the proceedings of our Society, 
namely, the backwardness of our Fellows in bringing 
forward cases which have presented special features of 
clinical interest. There appears to be an idea that unless 
the proof of a surgical triumph can be obtained in the 
shape of a pathological specimen, such cases should be 
allowed to pass unrecorded. May I be permitted to say 
that there is a certain acknowledgment of defeat asso¬ 
ciated even with the greatest triumph in the removal of 
important organs. After all is told, it is but a demon¬ 
stration that disease has baffled the physioian and that 
nought save radical removal and mutilation have saved 
the patient. It would be easy to instance a number of 
affections of all parts of the sexual organs of supreme 
interest to the gyntecologist, and more especially to the 
practitioner who may not look upon himself in the 
light of a special operator, which rhonld find a place 
in our debates and Transactions, and which would 
give rise to most instructive discussion. Proofs of 
truly conservative gynaecology would here find 
their appropriate place, and general therapeutics, 
including the administration of remedies, would at least 
be thought worthy of mention at the meetings of our 
Society. At present we Beek in vain in our Transactions 
for evidence that any form of general treatment and 
medication, not to speak of any special drug, is of use in 
resisting the inroads of pelvic disease in women. Not 
long since I heard an able and distinguished gynaeco¬ 
logist, for whom I have the greatest respect, and 
whose operative skill is beyond question, declare 
jocularity, that he “knew nothing of physic.” Surely 
prophylaxis, and treatment other than purely opera¬ 
tive, have their appropriate place in anticipating and 
resisting the inroads of disease. Were it possible 
to show in the Gynaecological Society, by some radio- 
graphic method, organs which had been threatened 
with, or passed through some critical and serious morbid 
change (during the stages of which the life of the 
patient had been in grave danger) now restored, physio¬ 
logically and histologically to a condition of health, we 
must acknowledge that at least such an exhibition of 
living pictures would be more satisfactory to our patients 
than any number of dead specimens — though, of course, 
pathologically and financially, we should be the losers! 
Those of our Fellows largely engaged in general practice, 
as many of them are, could by such records considerably 
advance the interest and value of our debates. 

In this direction the value of the ovarian secretion as a 
therapeutic agent is worthy of the most careful considera¬ 
tion. Indeed, the correlation between unstable protagon 
compounds, as lecithin, and the phoaphatic compounds in 
the tissues, with the influence of both on nutrition and 
metabolism generally, has not yet been sufficiently 
studied. However this may be, the experiments of 
Curatulo and Turalli prove that distinct effeots on oxidi¬ 
sation are caused by the removal of the ovaries and more 
curious still are the experiments of Krauer, which prove 
that even transplantation of the ovaries to distant parts 
does not affect the development of the Graafian follicles, 
nor does it change the normal structure, while Chrobak, 
with the ovarian extract of«the cow, produced most im¬ 
portant effects on symptoms due to the induced climac¬ 
teric. Others, including Stehmen, of Chicago, influenced 
by the analogy existing between the thyroid secretion 
and that of the ovary, by the administration of thryoid 
tablets affected in a striking manner patients suffering 
from a variety of symptoms, mental and other, assumed 
to be due to deficient ovarian Becretion. To Dr. C H. 
Routh is due the credit of having been the first in the 


United Kingdom, and in this Society, to draw special 
attention to this physiological function. 

I might instance questions of such common occurrence 
as the treatment of pruritus and eczema vulva;, the 
management of granular vaginitis, the results of curet¬ 
tage in cases of haemorrhagic endometritis, fungous 
endometritis, chronic suppurative endometritis, asso¬ 
ciated with suppurative conditions of the adnexa, and 
the all-important bearing of gonorrhceal infection on 
inflammatory conditions of the uterus and adnexa. I 
include those facts of etiological and bacteriological 
moment which bear upon the life history of the gono¬ 
coccus, its struggle for existence in the generative 
organs, the question of latency, survival, and reproduc¬ 
tion, as well as the effect which the failure of detection 
of the organism may have upon our diagnosis and 
prognosis. 

In this connection I may say that I view a negative 
result following the examination for the gonococcus as 
in no way disproving the specific nature of a discharge, 
its presence being dependent upon the date of infection, 
its duration, or fresh exacerbations and recurrent infec¬ 
tion of the genital canal. But I believe that in the great 
majority of cases in which there is suppurative endome¬ 
tritis with double pvosalpinx, recent or latent gonorrhceal 
infection is the cause of the mischief. 

The last example I referred to was drainage, and here 
again the relative advantage—under certain exceptional 
conditions—of different methods may be demonstrated, 
while, on the other hand, instances of harm following 
upon its adoption, and the best means of dealing with 
such ill consequences, might be shown. Mr. Jessett's 
ingenious method of dealing with a large rent in the 
bladder, which he brought this year before the Society, 
is a case in point. 

And speaking of the bladder reminds me that there 
is a large field open to the gyntecologist, and especially 
to our younger Fellows, to perfect themselves in the 
exploration of the bladder by cystoscopy, by repeated 
experiences derived through frequent examination. Two 
rival methods are in the field. The one which is familiar 
to all is that of Howard Kelly. This has the dis¬ 
advantage of requiring an anaesthetic, which is but a 
slight one, and the dilatation of the urethra in order to 
explore the bladder, or to catheterise and sound the 
ureter and kidney. The other method is that by means 
of the cystoscope of Dr. Kolischer, of Vienna, practised 
also by Professor Winter, of Berlin, which I here show 
you. Recently, through the kindness of Dr. Kolischer, 
I had the opportunity of seeing him demonstrate various 
morbid conditions in the Krankenhaus in Vienna, in 
Professor Schauta’s Klinik, affections of the vesical 
mucosa, and exploration and catheterisation of the 
ureters. This was done without an anaesthetic, and 
without dilatation of the urethra, and thus medication 
was applied to the bladder wall without any difficulty. 
It is not necessary to say of what vital moment it is in 
diagnosis to determine the condition of a ureter, to 
catheterise a kidney, to asoertain which ureter or kidney 
is involved, and to perform certain operative procedures 
on the wall of the bladder, all of which can be done by 
means of this convenient applianoe of Dr. Kolischer's. 

Before passing from this brief sketch of some of the 
paths along which our Society may advance in the direc¬ 
tion of original observation, research and operative 
technique, there is a matter that I will very briefly allude 
to, for it is a topic of such supreme importance to the 
profession that nought save a mere reference would be 
warrantable on an occasion like the present. Nor will I 
cere express any opinion or enter into a discussion of my 
reasons for suergesting that it is such a Society as this 
which ought to seriously consider the propriety of review¬ 
ing the present position, in its medical or medico-legal 
bearings, of the whole subject of accidental oi intentional 
abortion. Without, as I have said, pronouncing any 
opinion, I will ask the Fellows of this Society if they 
consider that the expert scientific evidence constantly 
brought forward is satisfactory, and such as is calculated 
to fulfil, without favour or prejudice, the ends of justice. 
Leaving out of consideration incidental oircumstano. s, to 
which are given by ignorant minds peculiar and possibly 
strained significance, are there not points of vital moment 



Jan. 18, 1899. 


60 The Medical Press. TRANSACTIONS OF SOCIETIES. 


both clinical and pathological, which are most loosely 
and inaccurately adjudicated upon ? If this be so, would 
it not be well that a committee, composed of expert 
pathologists and men with large clinical experience, 
should be nominated to report on the entire subject, 
such report being founded on a careful investigation 
of published cases bearing upon it ? It would take into 
consideration all the pathological points at issue needful 
to arriveat a correct oonclusion, and, finally, it would 
sift all the clinical facts which have to be reviewed in 
such cases, and apportion to each its proper value 
when weighed in relation to all the antecedent and 
accompanying facts. It might be possible to associate 
with this body in its deliberations a few medico-legal 
experts, and one of our experienced medical coroners. 
Such a committee would require to sit periodically for 
some months, and should then furnish its report through 
the Council to the Society, which might amend it before 
endorsement, and this authoritative expression of opinion 
should then be forwarded to the proper quarters. I 
venture to throw out this suggestion. 

Before answering the natural question, “ What has the 
British Gynaecological Society done during the past year 
to promote and advance our art ? ” I will in a few sen¬ 
tences summarise its work. I find that the following 
operations have been illustrated by interesting specimens 
exhibited by the Fellows: abdominal pan-hysterectomy, 
nine; vaginal pan-hysterectomy, ten ; hysterectomy by 
oceliotomy, seven; oophorectomy, colpotomy, and ovario¬ 
tomy for cystoma, seventeen; extra-uterine fcetationa, 
three; myomectomy, one. Special discussions have 
taken place on the treatment of djsmenorrhoea, on 
haemorrhagic endometritis, the question of the enuclea¬ 
tion of uterine fibroids, on risks to the ureters during 
hysterectomy, and on the after treatment of cases of 
abdominal section. 

Addressee have been delivered on the operative treat- 
men of extra-uterine gestation, “ the position of gynaeco¬ 
logy to-day,” and combined abdominal and vaginal 
ovariotomy. If we now reply to the query I have asked, 
I think we may thus briefly summarise and condense the 
more important results of our work. Attention has been 
drawn to the necessity for a clearer differentiation in the 
etiology and treatment of haemorrhagic endometritis, 
and inquiry into the etiological s’gnificance of syphilis 
in this disease; instructive suggestions have been made 
on the diagnosis and symptomatology of extra-uterine 
foetation; there has been an exhibition of a unique col¬ 
lection of microscopical specimens illustrative of the 
more rare pathological conditions of the uterus and 
adnexa: specimens have also been shown demonstrating 
the more frequent occurrence of sarcoma of the ovary. 
We have discussed the consideration of the comparative 
value of enucleation of uterine fibroids as a conservative 
operation, and as an alternative to hysterectomy and 
pan-hysterectomy; the importance of operation on uterine 
fibroma complicating pregnancy ; the value of immediate 
opening of the abdomen when constriction or injury of 
the ureter is suspected after hysterectomy, and the com¬ 
parative rarity of injury to the ureter wbw> considered 
with the number of operations performed (only ten cases 
in several thousand of operations having occurred in the 
practice of such men as Martin and Landau of Berlin, 
Doyen of Paris, and Kufferath of Brussels), have been 
noticed. The question of the relative importance of 
Dudley’s operation has been raised in cases in which it 
is specially indicated for dysmenorrhoea. Some debatable 
points in the after treatment of patients on whom 
abdominal section has been performed, and the considera¬ 
tion of the combined abdominal and vaginal operation 
in cases in which there are inflammatory states of the 
adnexa present, as well as a better understanding of the 
grounds on which the vaginal route is selected, have 
been before us. 

I should not forget to mention an interesting demon¬ 
stration which was given before the Society by Dr. 
Newman, of the different organisms which are found in 
the female genital organs. The address of Professor 
Martin, to which I have incidentally referred, and which 
has now appeared in full in the Journal of the Society, 
was listened to with deep interest by a large number of 
Fellows at a meeting at which such distinguished 


gynecologists as Professor Sanger, Dr. Theodore 
Landau, Dr. Howard Kelly, Professors Lapthom, 
Smith Gardiner, Jacobs and others, were present. 
Finally, you have had published 645 pages composed of 
Transactions of the Society, original communications, 
records of clinical cases, reviews, and summaries of con¬ 
temporaneous gynaecological work and research, in the 
Journal of the Society, 

I think we may summarise, as a few of the more solid 
acquisitions in gynaecology of the past year, the follow¬ 
ing :—There has been a clearer differentiation of the 
cases in which vaginal fixation, ventio-fixation, or 
shortening and fixation of the round ligaments 
(Alexander’s operation) should be performed. The last, 
it must be acknowledged, is every day gaining additional 
ground on the Continent, both in France and Germany. 

The most important contribution to this question made 
during the year 1898 has been that by Dr. Doldris, of 
Paris, who has published the analysis of ninety cases of 
treatment of retroversion of the uterus by shortening of 
the round ligaments by the inguinal method. In four 
instances laparotomy was also performed for affections 
of the adnexa, and the round ligaments were fixed in the 
abdominal wound. In the ninety cases there were two 
deaths, but these ninety only made portion of a series of 
four hundred operations, and one of the two was attributed 
to iodoform intoxication; the other occurred in a neuro¬ 
pathic hysterical woman in whom the autopsy showed 
that strangulation of the colon in the neighbourhood of 
the foramen of Winslow existed, there being no perito¬ 
nitis. In twelve cases there were temporary vesical 
troubles; iodoform erythema occurred in a few, phleg¬ 
masia dolens in one. The particulars of seven cases he 
records, in which the results were not satisfactory, but 
these seven had associated with the failure, pregnancies, 
and the shortening of one ligament alone, a mode of 
operating which he had resorted to thirteen times in 
cases of moderate retroversion. In only two cases was 
there complete failure. Such testimony as this to our 
distinguished Fellow’s operation is one that he may well 
be proud of. 

There has been a more frequent resort to subcutane¬ 
ous injections of artificial serum in cases of oollapse 
during operation, or continued tendency to it after. The 
value of this treatment in cases of oollapee in tubal 
pregnancy should be remembered. Further researches 
tend to prove that deciduoma malign urn is a maternal 
endothelium, developing either during pregnancy or 
immediately after labour; that it is characterised by 
metastasis. The substitution (after curettage) of ampu¬ 
tation of the diseased portion of the cervix (after Mar¬ 
tin's method), for repeated and doubtful cauterisation is 
a substantial gain, so is the determination of the beet 
method of closure of the abdomen by the triple suture, 
and the importance of the isolated fascial suture with 
careful adaptation of the cut edges of the fascia, so as to 
secure primary union in the prevention of hernia. 

(To be continued.) 


^raneactiotte of glodctieo. 


CLINICAL SOCIETY OF LONDON. 
Meeting held Friday, January 13th, 1899. 


The President, Mr. Langton, in the Chair. 


Clinical Evening. 


LOCALISED MY08ITI8 088IFICAN8 FROM INJURY. 

Mr. J. Hutchinson, jun., showed a woman, set. 36, who 
dislocated her elbow in 1890. Six weeks later there was 
bony thickening in front of the elbow beneath the 
brachial artery, in the brachialis anticus muscle, check¬ 
ing flexion and limiting pronation. A skiagram showed 
that the humerus was free and that the swelling was not 
due to displacement of the coronoid process. 

Mr. Eve showed a large irregular bony plate removed 
from the vastus muscle following a kick by a horse in 
the thigh, attended by extensive hematoma. A skia- 



Jan. 18, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Medical Pbesb. 61 


gram showed osseous growth separated by an interval 
from the femur. On cutting down they found a cyst of 
true bone, showing that the growth was not an ossifying 
sarcoma He thought it was an example of ossification 
in fibrous tissue from organised blood clot. 

KHLABGED SPLEEN WITH THBILL AND BBUIT. 

Dr. Chawfubd showed a man with a typical filarial 
history extending over fifteen years, under observa¬ 
tion for eighteen months. At times a persistent thrill 
oonld be felt round about the umbilicus, which was in¬ 
tensified by pressure, the maximum point being just 
inside the spleen border, with a continuous venous hum 
over the spleen extending into the epigastrium. He 
discussed the various possible explanations of these 
phenomena. 

ANTEBIOB DISPLACEMENT OP TUBEBCULOU8 CABPU8 
WITH FOBMATION OF A FALSE JOINT. 

Mr. H. Curtis showed a young woman with anterior 
displacement of the carpus consequent upon tuberculous 
disease, dating from 1895. the radius being most affected. 
The result was the formation of a false joint. Skiagrams 
and stereoscopic photographs were shown by Dr. Mac¬ 
kenzie Davidson of this case. 

PEMPHIGUS OF THE MOUTH, PHABYNX, LARYNX, 

AND SKIN. 

Dr. J. S. Richabds showed a man, set. 62, with a bul¬ 
lous eruption of the mouth, pharynx, larynx, and skin. 
A remarkable feature was that it had originated in the 
larynx, and had remained limited to that region for six 
months before attacking the skin. It began with a 
" roughness ” in the throat, with cough and dysphagia, 
and he expectorated mucus tinged with blood. The 
mucous membrane presented numerous red patches 
which readily bled on being touched. After improving, 
a recrudescence took place in September, and bullae 
appeared the arms, &c. 

Sir Felix Semon recalled a case which he had seen 
many years ago which illustrated the difficulty of dia- 1 
gnosis in these cases when the eruption did not extend 
to the Bk*'n. As the patient had a specific history it was 
thought to be due to syphilitic disease, but anti-syphili- I 
tic treatment produced no effect. The conjunctivas 1 
then became involved, with ultimate loss of sight of both 
•eyes. 

PBOGBE 88 IVE MU8CULAB ATBOPHY AFTEB MEA8LE8. 

Dr. Batten showed a case of progressive atrophy of 
the peroneal type after measles in a boy, aet. 7. Three 
months after recovery from measles, which was followed 
by bronchitis and pneumonia, his mother noticed that he 
dragged his left foot in walking, and a few months later 
the right became similarly affected. The weakness had 
been progressive. Six months ago he began to lose 
power in the hands. No hereditary history. There was 
marked wasting of the muscles of both legs below the 
knee. He was unable to extend or dorsi-flex the foot, 
which tended to assume the position of equino-varus in 
walking, he raised the legs high to prevent the toes drag¬ 
ging on the ground. The knee-jerks were present and 
-equal. Recto-vesical functions, normal. There was 
marked wasting of the thenar, hypothenar, and interossei 
muscles. Sensation normal, no fibrillary tremor. Elec¬ 
trical reactions under chloroform showed complete 
absence of response to Faradism in all the affected 
muscles with diminished reaction to galvanism. He 
referred to other recorded cases of the kind in which, 
when examined, changes had been found in the peri¬ 
pheral nerves and in the postero-median columns of the 
cord. 

Dr. Obmbbod mention other cases of the kind occurring 
after measles, observing that as the disease was a rare 
one it was unlikely that the sequence was a mere coin¬ 
cidence. 

TWO CASES OF COMPLETE HTPO 8 PADIA 8 , WITH CLEFT 
8CBOTUM. 

Mr. Kellock Bbowed two children with complete hypo¬ 
spadias and cleft scrotum. The family comprised 
seven other children, most of them males, two being 
daughters, all normal. The elder of the two patients 
Was six and a half years old. Labour attended by mid¬ 
wife, who remarked that genitals were much swollen. 


Was thought to be a girl, and christened as such. Six 
months later, however, a testicle was noticed in the right 
“ labium.” After miscarriage she had another child four 
years later, who also presented something abnormal 
about the genitals. This child was christened as a girl, 
and was being brought up as such. There was a fairly 
well-marked penis. The under surface was marked by 
groove lined by mucous membrane. The scrotum in 
both cases was divided The perineum in both was well 
formed and strong. Per rectum nothing like a uterus 
could be detected. He remarked that the diagnosis of 
sex in the younger child would have been difficult had 
they not the older child as a guide. The pseudo-labia 
were evidently composed of dartos, as evidenced by their 
contractility to cold, &c. 

The President, Mr. Godlee, Mr. Robinson, and Mr. 
Morgan, mentioned other cases of the kind, Mr, Robin¬ 
son's cases being females. 

A CASE OF PBOOftSSSlVg kr8CULAR ATROPHY OF UNUSUAL 
DI8TBIBUTION. 

Dr. Pebkins showed a man, set. 48, who had malaria 
sixteen years ago in America. Seven years ago he had a 
bad fall, and four years ago he noticed a sensation of 
coldness with alternations of heat around the loin, 
followed by gradually increased weakness in the legs. 
Occasional incontinence of nrine. No history of lead or 
syphilis. The case was unusual, in that atrophy affected 
the trunk muscles more than the limbs. He also showed 
a boy, eet. 16, in whom the disease was either congenital 
or so early that onset was not marked. He presented 
general muscular atrophy. No change in electrical re¬ 
actions, and knee-jerks active. 

CASE8 OF 8HOBTENING AND EVEB8ION OF THE THIGH. 
Mr. Godlbe said that in showing these caseB his 
object was not to suggest that there was not such a 
disease as coxa vara, but only to show that the conditions 
described as associated therewith might be dependent 
upon entirely different conditions. He confessed that 
he did not know what was meant by coxa vara. Case 1. 
—Boy, let. 6, symptoms began a few months ago, family 
history possibly suggestive of tuberculosis. Never any 
pain or trouble, but there was one inch shortening of 
femur with rotation of the foot outwards. Skiagrams 
showed that the shortening was in the neck of the bone. 
Movements at hip very free. Case 2.—Boy, set. 18, with 
one inch shortening and eversion, but hip was almost 
completely ankylosed. Tuberculous family history. 
Began after a blow, but never any pain. Case 3. (not 
shown)—Man, set. 23, conditions as above. Skiagram 
showed no mischief in the head of the bone, but neck 
was almost at right angle with shaft. 

Mr. Raymond Johnson objected to coxa vara being 
described as a disease instead of as a deformity. 

Mr. H. Bertram Robinson exhibited a case of 

8 CIBBHU 8 CABCINOMA OF THE PABOTID GLAND 

in a man, set. 65, under his care at St. Thomas’s Hospital. 
The tumour was first noticed some six months ago, but 
he had not sought advice owing to t he absence of pain. 
The tumour in the right parotid region extends from the 
zygoma above to below the lower normal limit of the 
gland, pressing backwards on the external auditory 
meatus, and extending forwards on the masse ter, as a 
nodular projection, with a well defined anterior margin 
situated in the socia parotidis. The tumour extends 
deeply behind the jaw, but does not interfere with the 
movement of the latter; there is slight bulging into the 
pharynx on the right side, and the growth possibly 
reaches into the zygomatic fossa, and has involved the 
upper jaw, for by transillumination there is only a very 
faint crescent of light on the right side below the eye. 
The gl tnds in the neck are extensively involved as far 
as the supra-clavicular region. No secondary growths. 

Mr. Babkeb was not convinced that it was a case of 
carcinoma at all, pointing out that the enlargement 
might be due to senile tuberculosis. The nodular 
character of the growth was against its being carcino¬ 
matous. 

A CASE OF P8EUDO-HYPEBTBOPHIC PARALYSIS. 

Dr. Voelckeb showed a boy, set. 5, who was at first 
thought to be suffering from pseudo-hypertrophic para- 


O* AHB Medical PRESS. 


TRANSACTION b OF SOCIETIES. 


..AN. 18, 1899. 


lysis, but subsequent observation in hospital had led him 
to doubt the correctness of the diagnosis. When eleven 
months old he had Bcarlet fever, and at two years bron¬ 
chitis and convulsions. He never walked. On rising 
from the ground he did so in the pseudo-hypertrophic 
way. The only enlarged muscle was the triceps. The 
back was very arched, and there was a great tendency to 
fall backwards. The knee-jerks were present, and the 
ankle-jerk brisk. He thought it might be a case of cere¬ 
bral sclerosis. 

RLZPHANTIA8I8 OF ON* LKG. 

Sir Dyc* Duckworth showed a gitl, set. 20, a native 
of Yorkshire, in whom transient attacks of swelling of 
the left leg, commencing three years ago. had been fol¬ 
lowed by permanent enlargement. The limb up to the 
groin was enlarged, hard, and brawny, and did not pit 
on pressure. She had been under treatment for ten 
weeks. Massage, electricity, and a liberal dietary had 
effected marked improvement, but the circumference of 
the limb was still markedly in excess of the other. As to 
its causation, she had never before been out of Yorkshire, 
the blood was about normal, and no filaria had ever been 
discovered. There was no evidence of visceral disease, 
and no signs of lymphatic involvement or of enlarged 
glands. 

EPITHELIOMA FOLLOWING LUPUS XRTTH1MATOSC8. 

Dr. Pringle showed a woman, ®t. 45, with “ Multiple 
Epithelioma of the Scalp, which had followed upon 
Lupus Erythematosus.” 


EOYAL ACADEMY OF MEDICINE IN IRELAND. 
8ection of Medicine. 


Meeting held Friday, December 16th, 1898. 
The President, Dr. J. W. Moore, in thle Chair. 


CHYLURIA. 

8ir George Duffey called attention to the great 
similarity between cases of chylous ascites and of chyluria, 
but he found that there was much difficulty in tracing 
their causes. In some cases of chylous ascites, rupture 
of the reoeptaculum chyli had been discovered, but, on 
the other hand, most careful post-mortem examination 
had sometimes failed to show any rupture of the lym¬ 
phatics, or of the reoeptaculum chyli. He mentioned 
that Charcot and other French observers had described 
several cases in which there was chronic peritonitis, 
advancing this as a possible cause of chylous ascites. 

Dr. Knott related the case of a male, ®t. 53, a 
widower, who had had syphilis about five years ago, and 
gonorrhoea in 1 he early part of this year. Coincident 
with an eruption of the syphilitic type, he got chyluria, 
and the specimens of his urine at present were very rich 
in fat globules. He could find no trace of the filari® in 
the blood. The patient had complained of pain in the 
lumbar region, and a certain amount of uneasiness, but 
not actual pain, during micturition. Up to the present, 
there was no sign of clotting of the chylous urine. 

Dr. Parsons mentioned a case of ascites in which Dr. 
Purser, who made the post-mortem examination found 
the fluid to be perfectly opaque and resembling milk. 
Dr. Purser recognised the nature of the fluid, but could 
not determine the cause. There was nothing to indicate 
a rupture of the receptaculum chyli. Dr. Purser then sug¬ 
gested that, owing to the increased pressure in the veins 
on account of the failure of the right aide of the heart, the 
thoracic duct was unable to empty its contents into the 
veins, and consequently some of the lymph or chyle 
became extravasated into the abdominal cavity, hence 
the turbidity of the ascitic fluid. 

The President thought enough had been said in this 
discussion to establish the existence of a non-parasitic 
chyluria, as well as a parasitic form, though most of ihe 
cases described in books were, no doubt, due to the 
Fxlarix Bancrofli. 

MERCURY IN BEART DISEASE. 

Dr. Wallace Beatty read a paper on mercury in 
heart disease. He quoted extracts from Stokes’ work on 


“ Diseases of the Heart and Aorta,” in which the value 
of mercury in some forms of heart disease is emphasised. 
The cases in which mercury is of special value are those 
in whioh there is general venous engorgement, due to 
chronic mitral valve disease. He prefers to give mercury 
in small doses repeatedly, in order toproduoe its diuretic 
effect. The plan he has found generally most effectual 
is to give about half a grain of calomel with or without 
digitalis, and squill, according to the state of the pulse 
every four hours, for from ten to fourteen days, and to 
counteract any tendency to free purgation byjif necessary, 
combining the mercury with small doses of opium. He 
noted the remarkable diuresis whioh follows such a 
method of administration, and how again this mercurial 
course may be resorted to with success when recurrences 
of failing compensation occur. He has seen mercury 
given in the above way suooeed when it failed when 
given in only occasional purgative doe6a. 

Dr. Bewley remarked that it used to be taught that 
in cases of Bright’s disease, the worst thing the physician 
could do was to administer mercury, and also that opium 
was undesirable in the same disease. The author had 
shown, however, that mercury was good in small doses 
in chronic heart disease due to Bright’s disease, using it, 
of oourse, with proper caution. 

Dr. Martley said that having been Sir William 
Broadbent’s house physician he was imbued with a great 
love for calomel, his teaching being that a good purge of 
calomel would clear the kidneys, and put them into 
working order by lowering venous pressure. 

Dr. Langford Symes related a case of a lady, who, 
some years ago, used to have periodic attacks of cardiac 
dyspnoea, anasarca, and other evidences of cardiac lesion. 
After trying other remedies, she was treated almost ex¬ 
clusively with calomel, and since then, now four years 
ago, she had never had a recurrence of the disorder. 

The President doubted whether mercury, in the form 
of calomel, blue pill, &c., had any direct action on the 
liver at all. It acted on the duodenum and unloaded 
the liver by sweeping the bile through the duodenum— 
that is to say, it had only an indirect action on the liver. 
He mentioned the case of a little girl suffering from 
chronic mitral stenosis, with every symptom of back¬ 
wash. She derived great benefit from leeching round 
the anus, and he intended, after hearing Dr. Beatty’s 
paper, to try calomel in her case. 

Dr. Beatty, in reply, said that when he commenced to 
practice he had the same dread of morphia and mercury 
in Bright’s disease as Dr. Bewley. He remarked, how¬ 
ever, that Dr. Roberts, in his work on diseases of the 
kidneys, speaking of drugs useful in relieving pain, 
mentioned morphia, but makes no allusion to any danger 
connected with its use in those diseases. With reference 
to the larger doses which he was told Sir W. Broadbent 
employed, he recalled one case in particular where 
calomel was given successfully in purgative doses when 
small doses had not succeeded. It seemed strange that 
when they got patients well once with mercury that 
they continued well for a considerable time, a point to 
which Dr. Stokes had drawn attention in his work on 
heart disease. 

A CASE OF RECOVERY FROM INNOMINATE ANEURYSM. 

Dr. Craig read notes of a case of innominate 
aneurysm in which recovery had taken place after pro¬ 
longed treatment by rest, a limited dietary, and large 
doseB of iodide of potassium. The patient, ®t. 65, had 
suffered from “ bilious attacks ” all his life, but there 
was no history of syphilis. The immediate cause of the 
aneurysm was attributed to straining efforts in endea¬ 
vouring to secure an evacuation of the bowels on April 
11th, 1897. Ten days later there were present unequi¬ 
vocal BignB and symptoms of the aneurysm, which were 
attested by Sir William Stokes, Sit C. J. Nixon, and Mr. 
Wheeler. The patient was kept in bed in the recumbent 
position for three months, during which period the diet 
was limited chiefly to milk, gruel, and fruit, ice was 
regularly applied to the tumour, a daily evacuation from 
the bowels was secured, and iodide of potassium (in doses 
amounting to a drachm daily) was administered, with 
occasional intermissions. The tumour became smaller, 
the pain and throbbing lessened, but the heart’s action 
was variable, irregular, and intermittent. The second 


Jan. 18, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Medical Press. 63 


period of three months he spent at Monte Carlo, and 
here the treatment was persisted in, but, instead of re¬ 
maining in bed, he spent his days in the garden of the 
hotel reclining on an American rocking-chair, to and 
from which he was carried night and morning. Here 
his symptoms entirely disappeared. At the com¬ 
mencement of the present year he went to the 
Italian Riviera, where he began to walk about, 
and subsequently he migrated to Marienbad, where he 
indulged in plenty of walking exercise and in a more 
liberal diet. He returned to Dublin during the autumn, 
and when he was carefully examined on November 28th 
—eighteen months after the onset—there was no trace 
of the aneurysm to be found, except a slight prominence 
and diminished resonance where the tumour had existed 
He still continued to take iodide of potassium, but in 
lesser doses and with longer intervals of abstention. 

Dr. Thompson, referring to the use of chloride of 
oalcium in the treatment of aneurysm, mentioned the 
case of a patient who was admitted into Jervis Street 
Hospital some years ago suffering from aneurysm of the 
arch of the aorta. 8 he was put on large doses of chloride 
of calcium (20 grs. three times a day), due care also being 
taken to secure absolute rest. After remaining in hospi¬ 
tal for about six weeks she left, the aneurysm having 
then diminished considerably in size. 8he returned 
twelve months afterwards with the aneurysm back again 
to its original size, and was once more treated successful 
with chloride of calcium. 8he then left once more, and 
died on her return this year. On post-mortem examina¬ 
tion two sets of fibrin deposits were found in the 
aneurysm, the first evidently corresponding to the first 
time she was in hospital, and the second to her subse¬ 
quent sojourn in hospital. 

Dr. Craig, replying, said that with regard to Dr. 
Thompson's case he thought that the two layers of fibrin 
within the sac of the aneurysm were accounted for by the 
fact that the patient got two periods of rest. 

Dr. J. Ldmbdkn exhibited two cases of fsvus. 

The Section then adjourned. 


LIVERPOOL MEDICAL SOCIETY. 


Meeting Held Thursday, January 6, 1899. 


Dr. Maofie Campbell, President, in the Chair. 


OPERATIVE TREATMENT OP GASTRIC ULCER. 

Mb. Robert Jones related two cases where he had 
operated for gastric ulcer, one of which recovered and 
the other lived for fourteen days. In the first case, a 
girl of 19, the perforation had existed for three 
hours, and was situated on the anterior aspect near the 
pylorus. Some partially digested milk had eiuded. 
There was no peritonitis, lhe ulcer was inverted and 
stitched, and the wound closed without drainage. She 
made an uninterrupted recovery. From the appearance 
of the ulcer, absence of anaemia, and previous history of 
tubercle, Mr. Jones suggested the possibility of the 
tuberculous nature of the ulcer. The second case, a woman 
of 21, was operated upon fourteen hours after perfora¬ 
tion. 8he was very collapsed. A large indurated 
perforation was found near the cardiac end of the lesser 
curvature on the anterior aspect. There was exudation 
of partially digested food. Adhesions had formed with 
liver and abdominal parietee. There was considerable 
exudation of lymph, which had to be forcibly scraped. 
The ulcer was obliterated by a purse string suture, 
fortified by Lembert’s stitches, and completed by 
stitching omentum over area. She did fairly well for 
fourteen days, when she vomited pus. Incision was 
made, and a peri-splenic abscess containing foul-smelling 
pus was discovered. She was very collapsed, and died 
twelve hours later. Post-mortem showed perforation to 
have quite healed. There was no communication between 
the wound area and the peri-splenic and sub-diaphragm¬ 
atic absoess cavities. The diaphragm was burrowed 
through, and the lung opened into. There was no ulcer 
on the posterior aspect of the stomach. Mr. Jones quite 
agreed with the recent suggestion of Turner that the 
lesser sac of peritoneum should be irrigated, and the 


posterior aspect of stomach inspected in nearly all cases. 

Mr. Paul made some remarks. 

Dr. Buchanan demonstrated a case of myxosdema in a 
man, aet. 64, treated with *‘ Colloid " matters, according 
to Dr. R. Hutchinson’s formula. The disappearance of 
symptoms was shown to be remarkable, and after four 
months’ treatment the restoration to health was com¬ 
plete. The case was illustrated by lantern slides. 

Dr. Alexander related a case of “ gunshot wound of 
brain.” 

Dr. Briggs exhibited a fibroid (weight 13J lbs.) 
removed on November 26th, 1898 (from a single lady, 
set. 33), through an abdominal incision by hysterectomy, 
of which enucleation was the first step, because of the 
large thin-walled veins in the capsu'e and the difficulty 
of getting at the cervix and main arteries with the 
tumour in situ. The tumour reached low down on the 
cervix, and encroached on the right broad ligament. 
The riyht ovary was cystic. As soon as the tumour was 
released from its capsule, the large veins emptied their 
contents into the general circulation. There was little 
shock. The capsule and uterus appeared too big and too 
loose to be left behind with safety. The growth and 
uterus were originally equal in size to the eight months’ 
pregnant uterus. In smaller growths the capsule and 
uterus might be left behind with safety, but enucleation 
alone of large tumours has not yet been shown to be 
equally safe. 

Dr. A. E. Roberts read a paper on the 
VACCINATION ACT, 1898, AND THE LOCAL GOVERNMENT 
BOARD OBDER OF OCTOBER 18TH. 

He deplored lhe attitude of hostility which large sec¬ 
tions of the community had assumed towards vaccina¬ 
tion. There could be no doubt that these good people 
had given us a fall, and repudiated us and our work in 
this matter of vaccination. Not until some great 
calamity occurred would the insane agitation be stifled j 
meanwhile we are drifting into a position of grave 
danger. On the question of compulsion he was of opinion 
that, living under democratic institutions as we do, we 
must not be surprised if now and again the drawbacks of 
our methods of government should become manifest as 
well as its blessings. The duty of the profession is dear. 
It is, by every legitimate means, to instruct the people 
in this question. Probably we have been too lax in that 
respect, and allowed our friend the enemy to occupy the 
field. He particularly deplored the fact that a large 
number of objectors were animated by something re¬ 
sembling a high enthusiasm. They regarded their move¬ 
ment as a kind of holy war. We read of thousands in a 
neighbouring town crowding for exemption certificates 
singing “Christians, awake,” and other appropriate 
hymns. It suggested, on the humorous side, a town’s 
meeting gathered to denounce the multiplication table 
as an unholy invention of the devil; but it had its 
element of pathos in it. This potential, unconscious 
slaughter of their innocents by loving parents. He 
explained the provisions of the Act and order, and 
appealed for cordial relations between the public 
vaccinators and the private vaccinations under the some¬ 
what trying circumstances of the public officer having to 
visit the homes. 

The President, in opening the debate, remarked that 
probably n« • more retrograde step had ever been taken by 
Parliament, a step by which the majority had been 
handed over bound hand and foot to a fanatical minority. 
Calf lymph he found was responsible for a certain amount 
of insufficient vaccination. He had used calf lymph ex¬ 
clusively during the last fifteen years, and required to 
operate a second time in about 16 per cent. This gave 
rise to dissatisfaction among the friends. What, again, 
w is to be done with cases in which only one or two marks 
took ? He generally recommended revaocination at four 
or five years. The importance of cleanliness in skin and 
instruments was now well understood, and everything 
should be done to remove prejudice against the 
operation. 

Mr. Rushton Parker remarked that in spite of the 
disinterested advocacy and practice of vaccination by 
the medical profession the public seemed determined in 
| England to take the risk of small-pox for some of their 
children. He, in common with the rest of our profession 


■oogl 




64 The Medical Press. 


FRANCE. 


Jan. 18, 1899. 


had felt at first greatly disappointed at the recent Vac¬ 
cination Act. Bat whether the Government were wise 
in adopting it, or not, he deprecated blaming them, for 
it was evident that they were as individuals staunch 
adherents of vaccination, and only adopted this appar¬ 
ently lame and impotent device as being in their expec¬ 
tation more likely in the long run to maintain the practice 
of vaccination, than the order for its compulsion, which 
had unfortunately not been administered successfully, 
owing to laxity on the part of the officials deputed to 
enforce it, upon a democratic community who largely 
refused to be coerced in this matter. He desired to com¬ 
pliment Dr. Roberts on the matter and style of his paper. 

Dr. Hugh Jones called attention to two statements 
in the report of the Royal Commission that vaccination 
was protective against small-pox, and that vaccination 
could not be replaced at present efficiently by other pre¬ 
ventive measures. There was, however, another side, 
isolation, notification, disinfection, as subsidiary measures 
ought to receive their full credit, and the hope of the 
future for the extinction of infectious diseases depended 
chiefly upon efficient sanitary measures. 

Dr. Hope considered that the present grave condition 
in respect to vaccination was contributed to by the long 
period, extending over many years, which the Royal 
Commission took before publishing their conclusions. 
During those years the opponents of vaccination were 
extremely active, and, unfortunately, very successful. He 
pointed out that the Bill introduced by Mr. Chaplin 
differed very widely from the Act which was ultimately 
passed, an Act which was in absolute and direct antago¬ 
nism to the carefully considered recommendations of the 
Royal Commission, whose exact words are:-“Weare of 
opinion that the State ought to continue to promote the 
vaccination of the people.” "We can Bee nothing to 
warrant the conclusion that in this country vaccination 
might safely be abandoned, and replaced by a system of 
isolation.” 


NORTH OF ENGLAND OBSTETRICAL AND 
GYN2ECOLOGICAL SOCIETY. 

Ordinary Meeting held at Owens College, 
Manchester, December 16th, 1898. 

The President, Dr. J. W. Martin (Sheffield) in the 
Chair. 


• Db. Donald (Manchester) showed a “ myoma of the 
uterus,” about the size of an adult’s head, removed by 
abdominal myomectomy. There was considerable diffi¬ 
culty in enucleating the tumour, the capsule measuring 
half an inch in thickness, and being composed of hyper¬ 
trophied uterine wall. There was very small haemor¬ 
rhage from several vessels in the capsule. 

Dr. Donald also showed an “ uterus removed by vaginal 
hysterectomy,” after perforation by sounds. The cervix 
was being dilated preparatory to curetting. There was 
no resistance at any part, and the sound passed easily 
six or seven inches. An examination of the abdomen 
showed that the point of the instrument was in the 
abdominal cavity. A No. 12 dilator was introduced with 
the same result. As it was evident the uterine wall was 
perforated, and as the contents of the uterus were un¬ 
doubtedly septic, the anterior vaginal fornix was opened 
up, and the fundus uteri brought into view. Two large 
apertures which had evidently been made by the dilators 
were found in the fundus, and the uterine tissue was so 
friable that vulsellum forceps very easily caused tearing 
Vaginal hysterectomy was performed as the safest 
method of treatment. Probably the degeneration of the 
uterine wall was due partly to frequent chi'dbearing, 
and partly to septic processes following miscarriage. 

CASE OF PUERPERAL SEPTICEMIA TREATED 8UCCE88FULLY 
BY INJECTIONS OF ANTISTREPTOCOCCIC SERUM. 

Dr. Grimsdale read notes of a case of the above. The 
woman, set. 35, had an easy labour, followed by a rigor 
in forty-eight hours. Her medical man treated her 
energetically by washing out the uterus and curetting it, 
but the symptoms of high temperature, quick pulse, 
rapid wasting, and general serious illness persisted. On 


the ninth day of the disease Dr. Grimsdale saw her, and 
admitted her to the Royal Infirmary. Streptococci having 
been found in the blood serum, injections of ten cubic cen¬ 
timetres were made into the flanks. After two injections 
the patient, from having a temperature 104” F., and pulse 
120, became apparently convalescent with normal pulse and 
temperature. The injections were stopped. The tempera¬ 
ture remained normal for 24 hours, but rose gradually, 
so that in three days it was 103 degs. F and pulse 120, 
while the temperature was normal. Streptococci were 
found to be present in the blood. After the recurrence 
of the fever injections of 10 cc. of the serum were given 
for fifteen days oonsecutively. The micro-organ isms had 
then disappeared from the blood and the injections were 
discontinued. At this time the temperature was raised 
to 101 degs. F, but gradually fell, and the patient was 
discharged, cured. After admission to hospital no treat¬ 
ment was directed to the uterus, and beyond quinine 
no drug was used. Urticaria and severe pains in the 
limbs were complained of towards the end of the serum 
treatment, but this subsided in about a fortnight. 

Dr. Nesfield (Manchester) thought that the treatment 
of puerperal septicaemia by anti - streptococcic serum, 
seemed scarcely a natural plan, inasmuch as it was 
using an alternative solution of the same ’-poison as 
produced the disease, and that those cases which 
lasted a long time usually ended in recovery under 
very varied plans of treatment. 

Dr. Arnold Lea (Manchester) considered that since 
at one period the streptococci disappeared entirely from 
the blood and returned again in a few days, a local source 
of infection must have been present, and that this was 
probably in the uterus itself, since there was no evidence 
of local pelvic trouble. He thought that if in similar cases 
the serum treatment failed, and the patient was losing 
ground, removal of the uterus through the vagina would 
be the best treatment. 

Dr. Fothergill (Manchester), seeing that there was 
no physical sign or symptoms of any pelvic trouble, and 
that there was no foul discharge, considered this might 
be one of those cases of infection by the bacterium colt 
commune, through the wall of the intestine. Vaginal 
and uterine douching would be quite unnecessary in such 
a case, and when the streptococcus had once got into 
the blood, the use of the serum was the proper 
treatment. 

Dr. Grim8dale, in reply, stated that the streptococci 
were present in the blood continuously; there was no dis¬ 
appearance and reappearance. 

Dr. Bishop (Manchester) read a note on the vagino¬ 
abdominal incision versus morcellation, in some cases of 
pelvic surgery. 


Jraitcc. 


[from our own correspondent.] 

Pabi8, January 15th, 1899. 

The Danger of Thtboid Medication. 

At the Acaddmie de Medecine M. Franck read a paper 
in which, after enumerating the good effects obtained from 
the administration of the thyioid gland in affections due 
to suppression or insufficiency of the functions of the 
thyroid gland, insisted on the dangers which could 
result from the employment of this treatment where no 
trouble existed in the function of the gland, and notably 
in cases of simple obesity. It should not be forgotten 
that the thyroid juice is an extremely toxic product, 
producing somnolence, coma, Ac., which caused the death 
of a certain number of patients from cardiac collapse. 
Consequently the speaker proposed that the Academy 
should pass a vote pronouncing thyroidian products as 
extremely dangerous, and forbidding the sale except on 
a doctor’s prescription. 

M. Lancereaux said that he agreed completely with 


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GERMANY. 


Jan. 18, 1899. 


The Medical Preb6. 65 


his colleague on the danger of the substance, and thought 
that the sale should be restricted. For his part he 
always suspended its use when the pulse beat over 100 
times in the minute. M. Potain observed several 
patients in whom the administration of preparations of 
the thyroid gland provoked very serious symptoms. It 
was the more important not to leave these preparations 
at the disposition of the public as they can never judge 
of the counter indications of their employ, and when 
accidents occur it is frequently too late to arrest them 
M. Huchard considered the employment of thyroid pro. 
pa rations as extremely dangerous where the heart was 
affected, and said that he would vote the proposition of 
the first speaker. 

GA8TROTOMY. 

M. Ligars presented a young girl, set. 21. who in an act 
of folly swallowed a pile of pence. Three weeks after" 
wards she expelled three penny pieces, and then told 
_ what she had done. She complained of great difficulty 
in swallowing and of pain in the epigastrium, while she 
vomited incessantly. By the radiographic examination 
an agglomeration of foreign bodies was observed at the 
■cardiac extremity of the oesophagus and another in the 
centre of the stomach. Gastrotomy was practised on 
December 12th, and six coins removed with great diffi¬ 
culty from the inferior extremity of the oesophagus 
Recovery was rapid. 

Senile Pruritus. 

Professor Parisot, of Nancy, considering that auto¬ 
intoxication plays an essential role in the etiology of 
generalised senile pruritus, has recourse to intestinal 
antisepsis in the treatment of this obstinate affection 
After purging the patient he puts him on milk diet, and 
prescribes daily doses of half a drachm of benzonaphthol 
This treatment, of which the first favourable results are 
witnessed at the end of twenty-four hours, rapidly 
removes the violent and tenacious itching. 

Acute Rheumatism. 

Salicylate of soda, 5 j. 

Iodoform, 3 ij. 

Ext. of hyosciamus, 5 j. 

Vaseline, 5 iij. 


(Setmang. 

[from our own correspondent.] 

Berlin, January 13th, 18»9. 

At the Society for Internal Medicine Dr. Benda had a 
note on the 

Point of Entrance in Ulcerative Endocarditis. 

It was to be looked upon as a secondary disease, but 
the connecting point between it and the primary was 
only rarely demonstrated, and the transmission of the 
disease germ from any ulceration into the circulation 
could only occasionally be proved. Ho showed two cases in 
which this transmission could be followed. One was a 
case of ulcerative endocarditis with suppuration in the 
pelvis of the kidney, and a foetid abscess in the region of 
the kidney from a case of renal calculus. By Gram’s 
prooess non-colourable bacteria belonging to the group 
of bacterium coli were found, which were the cause of the 
endocarditis. The second case was one of uloerative 
endocarditis, set up by streptooocci from a tonsillar 
abscess. Here numerous streptococcus thrombi wer 


found in the smallest veins and accumulation of cocci 
around them. 

The Treatment of Obesity with Thyroid Gland 
Preparations. 

Such as the thyroidine pastilles of Bayer ( Wien. Med. 
Woehensch.), in 03 doses. For six to ten days two 
pastilles a day were given, then a three days’ pause; 
then for six to ten days two and a half were given, then 
another pause of three days, and then three were given 
daily from Bix to ten days. 

Unpleasant symptoms were only due to faulty prepara¬ 
tion, and not to the thyroidine, and the writer had 
never observed any. E ven in the case of a woman who 
suffered from cardiac insufficiency, no ill effects on the 
heart appeared, but a distinct improvement in the 
function took place from the unburdening of the heart of 
its mass of fat. The diminution in weight from melting 
of the fat and excretion of water was never at the 
expense of the muscular tissue, for the patient became 
much stronger. This was in accordance with exact 
investigation into tissue changes. 

Caution was necessary with the above doses, as, indeed, 
in all other methods of treatment of obesity. In the 
plethoric form of obesity the diet should be regulated 
along with the treatment, while in the anaemic form iron 
should be given. In old people, patients with valvular 
disease, arterio-sclerosis, albuminuria, and diabetes, thy¬ 
roidine was contraindicated. The pastille treatment 
was not absolutely reliable, as one of the cases proved 
quite refractory. 

The Pathology of Mtxocdema. 

Dr. W. Mura tow, in the Neurolog. Cbl. describee the 
carefully carried out examination of a fatal case of this 
disease. The patient was a girl of six, and the disease 
was congenital. The body showed the following 
changes:— 

1. Toxic affections of the cortex (swelling of Nisei's 
corpuscles, and patchy dark blue staining of the basic 
substances). 

2. Affection of the subcortical association tracks 
(delayed development starting from the cortical cells). 

3. Complete absence of the thyroid gland. 

The psychical symptoms peculiar to the disease were 

explained by the serious anatomical lesion of the cortex 
According to Horsley, the functional activity of the 
thyroid began from the sixth to the eighth month of 
embryonic life. The higher nerve centres were in pro¬ 
cess of development at this period. The toxins here not 
only set up functional disturbance but arrested develop¬ 
ment. For this reason the psyohical function suffered 
more in the case than in that of an adult. In the case 
of the latter, thyroid treatment removed the chronic 
toxsemia, and with it the psyohical symptoms. In infancy, 
in spite of the elimination of the toxin, the psychical 
activity only corresponded to that of an imperfectly 
developed brain. 

At the Medical 8ociety, Hr. Pick shows I macro- 
microBOopic preparations of 

Syphilis of the Peritoneum and Amylsid of the 
Female Genitals. 

The patient, a woman, »t. 56, taken ill in December, 
1896, with palpitation, pains in the head, Ac. The 
medical attendant found amentia, a syphilitic saddle-nose, 
and a large nodular liver that reached three to five 
finger-breadths beyond the ribs. The woman knew 
nothing of any infection, but the diagnosis was not in 


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66 The Medical Press. 


CONTINENTAL NOTES. 


Ja». is, 1890. 


doubt. Eight years after marriage she had sore throat 
and the bones of the nose sank, and other symptoms 
were present. Potasaio iodidum was not well borne, and 
inunction failed to do any good. Atrophy of the liver 
took place, and ascites came on, for which she was tapped 
twice. Then homoeopathic treatment was carried out 
until the day before her death. The post-mortem 
examination showed oedema and ascites (18 litres^ 
typical syphilitio liver and spleen, fatty degeneration of 
the kidneys, and above all, on the parietal peritoneum* 
between the umbilicus and symphysis pubis, miliary, 
flattened nodules, the size of hemp seeds (some 
larger), of a yellow opaque character. All showed 
a central depression like molluscum contagi- 
osum. Microscopically, they resembled tubercle, but 
this they were not. Gumma tons peritonitis offered 
many analogies to gummatous periostitis. Literary 
observations on the subject were, however, rare. Amyloid 
degeneration of the genital organs was also very rare; 
in this case it affected the uterus, tubes, ovaries, the 
small arteries, capillaries, heart and lymphatics. 
Clinically it was noteworthy in so far as it gave a striking 
denial to the views of the anti-mercurialista, who would 
attribute cachexia and amyloid degeneration to the 
mercurial treatment itself, as, at the time these changes 
appeared, the patient had had no mercurial treatment at 
all. It showed that the pure virus alone had been the 
cause of all the amyloid changes. 

Hr. Virchow, to whom the preparations had been pre¬ 
viously shown, had Bought through the specimens of the 
Pathological Institute for similar cases, and had found a 
preparation from the year 1856 of a woman who had died 
of Bright’s disease with dropsy, who presented a condi¬ 
tion analogous to Pick’s case. There was circumscribed 
tuberculosis, not on the peritoneum but on the pleura, 
but no traces of the disease anywhere else. There 
was further widespread amyloid disease in the prin¬ 
cipal organs, the intestines, stomach, spleen, liver, 
'heart, and uterus. The parallel of the case with that 
shown by Pick was a far-reaching one. The 
speaker could not at the time make up his mind 
as to a diagnosis; in the catalogue he called the case 
" tuberculosis idiopathica P ” He had now no doubt that 
it was a case of either miliary gumma formation or 
syphilitic tuberculosis. 


Continental Jlotcs. 

[FROM OCR OWN CORRESPONDENT.] 


The Riviera.—Hteres. 

The Fashoda and subsequent diplomatic discussions 
between France and Great Britain, the Dreyfus disputes 
and monarchical manifestoes at Paris, and the continued 
controversy about the health of Nice in the Standard 
Eerald and local journals have not added to the number 
of British visitors this winter to the Riviera. Since the 
advent of the New Year, however, the incoming trains 
have been better laden with passengers, and there is yet 
abundant time for a profitable season. The municipal 
authorities at Cannes and Nice are making extra arrange¬ 
ments for a more than usually brilliant carnival season 
and will doubtless be successful in attracting to thig 
ooast a large number of visitors for February and March. 


Some of the quieter hibernal stations, like Hydrea 
Grasse, and Antibes have a steady cliantile of winter 
guests, and have not so much cause of oomplaint as the 
gayer resorts. Hy&res is always in favour with many 
people, who thoroughly appreciate its unquestionable 
advantages, and who enjoy its dry, warm, and mild, ye^ 
tonic climate, its luxuriant foliage and beautiful flora, its 
picturesque situation, and convenient excursions. 

The comparative economy of residence either in the 
excellent hotels, or the pretty villas and comfortable 
apartments of Hydros, recommends it to many families 
who can find the oomforts of English home-life, and the 
amusements of an English country life cheaper at 
Hy&res than at any other equally desirable winter resort 
on the French Riviera. For invalids and delicate 
constitutions Hy&res can be strongly reoommended 
because of its exemption from too sudden changes of 
temperature. 

Bordiohrra. 


The first winter station across the Italian border, Bor- 
dighera, is rising into favour. It is more economical 
than many of the French Riviera towns, and although 
near, less depressing than Mentone. You see fewer 
invalids here than at Mentone, and while life is less gay 
than at Monte Carlo or Nice, those who seek it can find 
abundant amusement; for in addition to its beautiful 
walks and interesting environs, its proximity to San 
Remo on the one ride, and Monte Carlo on the other 
side, make Bordighera a convenient centre for those 
desiring the “ distractions ” of Riviera life. 

Bordighera as a health resort is a modern creation. 
Ruffini’s novel of “ Don Antonio ” earliest attracted 
English attention to the place by its eloquent descrip¬ 
tions of the charms of its surroundings. Since the 
patriot-author’s day other writers have likewise made the 
spot known; as Mr. Fitzroy Hamilton in his interesting 
work on the Italian Riviera, Mr. Clarence Bicknell by 
his standard books on the flora of the coast, and the 
genial Scotch novelist by selecting it as his winter home. 


The old town is situated on a bold, green eminence, 
and around the railway station on the plain below to 
the westward, on the seashore, a modem village has 
gathered, containing the banks, post-office, libraries, some 
hotels, and shops. Half-way up the slope of the hill are 
most of the villas, the museum (free to all visitors) of 
Mr. Bicknell, the English church, and the newest 
hotels. In the principal of these new hotels, the 
Grand Hotel Angst, the Empress Frederick has engaged 
apartments for herself and suite. The hotel has 
fine grounds and groves of olive and orange trees 
interspersed with rose gardens and flower beds extend¬ 
ing far up the hill behind the hotel. Into these grounds 
and gardens a private bridge leads from the Imperial 
apartments, so that the illustrious guest can promenade 
with strict seclusion. From the baloonies on the front 
of her salons the prospect is one of great beauty, extend¬ 
ing far out to sea, and taking in the picturesque coast¬ 
line from San Remo to the Esterel range ; on clear days 
Corsica is clearly visible, and the Manxes Mountains 
beyond Hyferes. 

Bordighera has a pretty English church (become too 
small for its growing congregations), a large free 
library, and, what is very desirable for British residents 
abroad, four English physicians ; one of them Dr. Guilio 
Hamilton, very favourably known in medical circles in 
London and Dublin. 


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Jan. 18, 1899. 


LEADING ARTICLES. 


The Medical Press. 67 


‘Che Operating ‘Cheatm. 

ST. PETER’S HOSPITAL. 

Cases of Internal Urethrotomy.—Mb. Swinford 
Edwards operated on two cases by internal urethro¬ 
tomy. The first done was complicated with a perineal 
fistula; it was that of a man, set. 55, who was admitted 
to the hospital with a discharging sinus in the perineum 
and a high temperature; he looked very ill and com¬ 
plained of great difficulty in passing water. On examina¬ 
tion of the urethra a tight stricture was found in the 
sub-pubic region; there was also considerable contraction 
of the meatus. The patient was kept in bed, and placed 
on boracic acid mixture with a view to sterilising 
his water. After two or three days internal urethrotomy 
was performed in spite of his temperature bqing still 
above normal. A meatotomy was first done, the 
meatus being cut downwards with a blunt-pointed 
straight bistoury. Mr. Edwards then passed a filiform 
corkscrew pilot bougie to the end of which a Teevan- 
Maissonneuve's instrument was screwed and pushed on 
into the bladder; the knife having been placed in position 
was passed along the director and made to divide the stric¬ 
ture upwards in the roof of the urethra. The instrument 
having been withdrawn, a series of steel sounds were 
passed, ranging from twelve to seventeen English, and 
the operation was completed by washing out the bladder 
through a silver catheter with 1 in 6,000 sublimate solu¬ 
tion. The patient having now been placed in the 
lithotomy position, the operator turned his attention to 
the perineal fistula, which was laid open on a director; 
two or three branching sinuses were discovered, which 
were similarly dealt with ; when the finger was placed 
in the wound a' steel sound in the urethra could easily 
be felt, though in this case it was not absolutely exposed. 
The sinuses were all thoroughly scraped, the over¬ 
hanging edges of skin trimmed off, and the sinuses 
packed with gauze, the wounds being thus left to heal 
by granulation. 

The second case was that of a young man, set. about 30 
who had several strictures in his penile urethra with a tight 
one at the junction of the bulbo-membranous urethra. 
Internal urethrotomy was performed on this patient in 
the same manner as in, the preceding one, the only hitch 
in the proceedings being that there was some little 
difficulty in getting the screw connection between the 
director of the urethrotome and the pilot bougie to pass 
through the veryftight aub-pubio stricture, although this 
screw connection only equalled No. 9 French gauge. 

Mr. Edwards drew attention to the small amount of bleed¬ 
ing which took place in both these cases, and what little 
there was in the first case was almost entirely due to the 
meatotomy. It was his experience that by this method of 
operating no serious haemorrhage was to be feared; he con¬ 
sidered that no matter whether a stricture situated in the 
deep urethra was divided on the roof or the floor, there was 
never any danger of serious haemorrhage as long as the 
stricture was not out beyond 22 French gauge. In order 
to get further dilatation, a series of conical steel sounds 
are passed, which probably further ruptures aDy stric¬ 
ture tissue which may have escaped the knife, that is to 
say, in a longitudinal direction, the rupture caused by 
the sound being limi ted to the longitudinal wound 
already made by the knife. When a larger cutting 
blade, such as one of 24 or 26 French gauge, is used, he 
had seen serious hemorrhage follow. Indeed, he recol¬ 


lected a case in the practice of a friend where death from 
haemorrhage followed the employment of a 26 blade. 
He remarked also that in the first case he con¬ 
sidered that the high temperature was no bar to an 
operation, but. on the contrary, rather called for it; as be 
had several times seen urinary fever due to stricture give 
way immediately after complete division of the stricture 
accompanied by antiseptic treatment of the bladder. It 
would be noticed, he said, that no attempt at a plastic ope. 
ration was made for the cure of the perineal fistula, for 
these cases generally made a rapid cure when treated by 
the method employed, the key-stone to the whole proce¬ 
dure being the restitution of the normal calibre of the 
urethral canal which was effected by the internal 
urethrotomy, and by the following dilatation. With 
regard to the second case he said that had 
he not been successful in following the pilot with the 
urethrotome, one of two methods would have been open 
to him: the first being to have left the pilot t» situ for a 
matter of twenty-four hours, by which time the stricture 
would probably have dilated sufficiently to allow the 
passage of the urethrotome; the second would have been 
to have withdrawn the pilot and endeavoured to have 
effected some slight dilatation by the passage of one of 
Bang’s conical whalebone bougies, a proceeding which 
he had employed successfully on several occasions; 
internal urethrotomy would then forthwith be completed 
in the usual manner. 


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“ SAL US POPCLI SUPREMA LEX.” 


WEDNESDAY, JANUARY 18, 1899. 


THE LOCAL GOVERNMENT BOARD. 

The resignation of the Permanent Secretary of 
the Local Government Board, Sir Hngh Owen, is an 
event of no little importance to the community in 
general, so far as the progress of local administration 
is concerned. This event affects the medical pro¬ 
fession chiefly in the Poor-law and the public sani¬ 
tary services, both of which strike deep down into 


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68 Thb Medical Press. 


LEADING 

-the life and welfare of the nation. As an indivi¬ 
dualist and a man of great abilities and character. Sir 
Hugh Owen acquired an almost supreme influence in 
the Department which he has served for so many years. 
It is to be hoped, however, that the individual sway 
of public t-ervants in Government offices will, ere 
long, give way to that of recognised pri nciples en¬ 
forced by an educated Parliament, and by strong and 
able ministers. That the present policy of the Poor-law 
is halting and erroneous is a doctrine firmly held by 
many thinking persons. The pauper poor, who are 
always with us, have been recognised as having a 
moral and legal claim to support from the more 
fortunately placed members of the community. Hence, 
any enlightened interpretation of the Poor-law 
would cede the relief thus granted as a right rather 
than as a dole to be extracted in fear and trembling 
and at thecostof heavy civil disqualifications. If that be 
true of pauperism in general, it is a thousand times 
more so as regards the aged and the sick poor, for whom 
help becomes simply a righteous demand and a 
bounden duty. Yet the evils of proper classification, 
of pauper nursing, of unskilled attendance upon 
lunatics and imbeciles, of understaffing of nurses, and 
of other gross defects of medical administration, are 
at this day flourishing rampant throughout the 
length and breadth of the United Kingdom. As to 
outdoor medical relief, it is only in a few towns re¬ 
duced to anything like a proper system; while in 
most places it savours of the worst forms of parochial 
arrogance, delay, and degrading disqualification. Any 
system, indeed, stands self-condemned that entails 
upon a hard-working man of irreproachable character 
the loss of his parliamentary vote if he happen to be 
treated for, say, pneumothorax or enteric fever, in a 
Poor-law infirmary. The first duty of any strong 
and conscientious central board should be to classify 
paupers, and to simplify, amend, and codify the 
present chaotic rules of administration. An attempt, 
as everyone knows, has recently been made by 
Jlr. Chaplin to introduce a rational treatment of 
metropolitan pauper children disabled in various 
physical directions. His action, however, affords an 
excellent instance of Local Government Board 
dilatoriness and want of judgment. His famous 
order placed the carrying out of a much-needed 
reform in the hands of an already cverburdened 
body, the Metropolitan Asylums Board, with the 
result that some years later the matter appears to be 
more or less at a standstill. Indeed, dilatoriness is 
one of the chief indictments that can be brought 
against the policy of Sir Hugh Owen. Reports of 
responsible and highly-qualified Government in¬ 
spectors have been neglected year after year, until 
the occurrence of some grave scandal has necessitated 
an official investigation. In some cases inquiry after 
inquiry has been held, schemes submitted, altered, re¬ 
investigated, and in the long run carried out only 
after the lapse of years, or even shelved altogether. 
Then, when a dispute has arisen between some local 
authority and its medical officer, the latter has only 
>n the rarest instances received any atom of help 


ARTICLES. _ Jan. 18, 1899. 

from the Local Government Board, no matter bow 
zealous and efficient his services, or how just and 
righteous his case. That attitude, indeed, may be 
said to sum up in a nutshell the main principal of 
Sir Hugh Owen, namely, that the lo'al authorities 
bhould be let alone as far as possible to attain sal¬ 
vation after their own light and after their own 
methods. It is to be hoped that hencetoith a new 
spirit will come over this Department, which is 
in many respects one of the most impor¬ 
tant to the future of Great Britain. That 
the Local Government Board has done magnifi¬ 
cent work in the past no one can deny. At the same 
time we suggest that their machinery is now a little 
rusty and out of date, and that their methods are not 
quite up to modern and reasonable democratic 
standards. It seems likely that a first necessary step 
towards reform would be the entire separation of the 
Poor-law and the public sanitary services, with, 
possibly, the establishment of national scientific 
research laboratories. To attempt to bring all these 
diverse functions within the grasp of a single board 
is to court inefficiency, extravagance, and the hundred 
and one evils of an iron bound, non-progressive 
officialism. 


STATE REGULATION OF MARRIAGE. - II. 

In our previous remarks on this subject we dis¬ 
cussed some of the disqualifications for marriage 
under the heads of:—1. Inebriety, Pauperism, and 
Criminality; 2. Insanity, Epilepsy, and Tubercu¬ 
losis. We now pass on to consider. 3. Gonorrhoea 
and Syphilis in the Communicable Stages: Here 
we have to do with quite a different subject, 
and we may say at once that we believe that 
the help of legislation is urgently needed.’ Not 
for the sake of men; it is well known that the 
great majority of men suffering from syphilis or 
gonorrhoea have contracted the disease before mar¬ 
riage ; they knew the risks of illicit intercourse, and 
have paid the penalty of their folly. It is mainly for 
the sake of innocent wives and children that the law 
should step in. A woman can tell if she is marrying 
a lunatic, a drunkard, or a man in consumption, but 
she cannot tell whether the man she is about to 
marry is suffering from active syphilis or gonorrhoea. 
And yet the results to her and to her children, if she 
has any, are of the most appalling and far-reaching 
character. What is the indictment against these 
diseases P We quote Dr. Burr, who has understated 
rather than overstated it:—“ That gonorrhoea is 
accountable for most of women’s pelvic woes; that 
it is the greatest cause of sterility in both sexes 
(Keherer); that ii is the grea'est single cause of 
blindn- ss—18 5 to 23 5 per cent, of all the blind in 
early life being from this cause alone (Magnu?, Fuchs 
and Lucius Howe); that it often kills, and that from 
this cause alone a license to marry may prove a death- 
warrant to a confiding bride. That syphilis, of all 
diseases, is the greatest cause of abortion; that one- 
third of all syphilitic pregnancies abort or are still¬ 
born ; that one-third of those bora alive die during 


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Jam. 18, 1899. _NOTES ON CURRENT TOPICS._ The Medical Press. 69 


the first six months (Carpenter and Grassowitz); 
that the remainder are more or less enfeebled, 
deformed, or short-lived through lowered vital resist¬ 
ance; that locomotor ataxia and certain forms of 
insanity are almost synonymous with so-called 
tertiary syphilis.” All medical men can te>tify that 
these things are true, and all those who have had 
experience of gynecological out-patient practice 
at hospitals can form an estimate of the extent- 
of the evil. The subject, unfortunately, does 
not lend itself to popular exposition; the revolt¬ 
ing forms of suffering endured by many innocent 
women, and forming, within a few months of mar¬ 
riage, a heartbreaking awakening from their early 
love-dreams, cannot be openly spoken of, they can 
only be borne in silence by those whose health and 
ideals have been shattered at one blow. But the law 
provides a remedy—separation, divorce! What 
remedy is it to a man whose eyesight has been de¬ 
stroyed by violence that his aggressor is separated 
from him ? Prevention is what is wanted; and this 
might be secured by a law providing that an appli¬ 
cant for n arriage should produce a certificate that he 
was not suffering from gonorrhcea or syphilis in the 
communicable stages. Dr. Burr sketches out the 
working model of a Bill for this purpose. As it is a 
definite attempt in the right direction, its reproduc¬ 
tion here needs no apology. 

A Bill 

for an Act to Revise the Law in Relation to Marriage. 

Section 1.—Be it enacted, by the ... of tne 
State of . . . That it shall hereafter be unlawful 
to issue a license to marry to anv applicant for such 
license who fails to present with his application a cer¬ 
tificate, as hereinafter provided, setting forth that the 
applicant is not the subject of acute or latent gonor¬ 
rhoea, or syphilis in the communicable stages. 

Section 2 .—The certificate required shall be accepted 
from any reputable physician who is a member in 
good standing of the National, State, County, City, 
or other similar recognised organisation of the school 
of practice to which he or she belongs [that is, for 
Bntieh requirements, from any registered medical 
practitioner], and shall be in form and substance as 
follows, to wit: 

State of . , . County of . . . 

I . . . M.D., a legally qualified physician and 
member in good standing of the . . . whereof 
. . . M.D. (address . . . ) is Secretary, do 
hereby certify that I have examined . . . resident 
of ... an intending applicant for license to 
marry, and that my examination, made with due 
skill and thoroughness, and during a sufficient period 
of time, fully satisfied my professional jadgment 
that said intending applicant is not the subject of 
any of the disqualifications for marriage specified in 
Section 1 of the Act to revise the law in relation to 
marriages, approved . . . 189... in force . . 

189... I do, hereby, further certify that this 
certificate is given with a full realisation of the 
sufferings entailed upon wives and offspring by 
marriage with the subjects of said disqualincations. 
Witness my hand this . . . day of . . . 189... 

. . . . M.D. Address .... 

Section 3.—The physician's certificate shall be dealt 
with in the same manner, as to registry, endorsement 
and preservation, as is now presen bed for the certifi¬ 
cate of marriage. 

Section 4.—All Acts or parte of Acts inconsistent, 
or in conflict, with this Act are hereby repealed, and ‘ 


this Act shall take effect and be in force from and 
after its passage. 

Legislation on these lines would, apart from'its 
direct results, be of incalculable benefit by drawing 
public attention to its objects. Something at least 
would become known concerning the prevalence of 
these maladies and the frequency of their distribution 
to innocent, unsuspecting wives and their helpless 
babes ; and thus “ the public would learn the truths- 
concerning evils which the profession knows full well 
but upon which it is powerless to give public instruc¬ 
tion, and against which, unaided by law, it is power¬ 
less to enforce protective measures.” 


on Current topics. 

Popular Bacteriology. 

It is, no doubt, desirable that the public should be 
afforded facilities for becoming acquainted with the 
general principles of bacteriology, as far as they 
apply to the dissemination, the cure, and the pre¬ 
vention of disease. Some caution is, however, neces¬ 
sary in the choice of materials, and the lecturer 
would be well advised to avoid as far aa possible 
■undue optimism and hasty generalisations. The - 
inhabitants of Camberwell were recently treated to a 
lecture on the subject by Mr. Bousfield, the recently 
appointed bacteriologist to the parish. Curiously 
enough Mr. Bousfield repudiates any desire to pose- 
as a specialist, though one would have supposed that 
a gentleman who holds a public appointment as a 
bacteriologist must of necessity be a specialist. The- 
lecture in question, though embellished by lantern 
projections of the more common organisms of infec¬ 
tious diseases, was really almost entirely restricted 
to the subject of diphtheria, and in this connec¬ 
tion the lecturer delivered himself of sundry state¬ 
ments which appear to us somewhat in advance of 
contemporaneous science. He is reported to have- 
said that “ vaccination sank into insignificance when 
compared with the beneficent results of the antitoxin- 
treatment of diphtheria,” a statement which will not 
commend itself to our readers either by reason of its 
accuracy or of its opportuneness. It is absurd to- 
pretend that the benefits that have accrued from the 
use of antitoxin are in any way comparable with 
those resulting from vaccination. The latter, more¬ 
over, is a trustworthy preventive of small pox, and 
the immunity thus engendered lasts for many years,- 
whereas the immunity against diphtheria afforded by 
previous inoculation with antitoxin is doubtful, and 
probably of short duration. Collective statistics 
leave no doubt in the minds of unprejudiced persons- 
as to the extreme utility of the antitoxin treatment 
of diphtheria, and we agree with the lecturer 
that a medical man who, in presence of an un¬ 
doubted case of diphtheria, abstains from the 
use of this agent, incurs responsibility little- 
short of criminal. When Mr. Bousfield talks, as he’ 
is reported to have done at a subsequent “ inter¬ 
view,” about reducing the mortality from diph¬ 
theria in his parish from 15 to 5 by antitoxin*- 

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70 The Medical Press. 


NOTES ON CURRENT TOPICS. 


Jan. 18, 1899. 


thereby saving 100 lives annually, we can only 
suggest that he is counting his chickens before they 
are hatched. We cannot, moreover, follow the 
lecturer when, with an enthusiasm which is explained 
but not justified, by his not being a specialist, he goes 
onto assert that, in time, every infectious disease will 
be stamped out by the aid of antitoxins, a doctrine 
which, even if true, would render sanitary legiolation 
supererogatory. Lastly, quite unintentionally no 
doubt, the lecturer threw an unmerited slur on the 
vaccine at present in use by expressing a hope that it 
would be possible to provide an absolutely pure cul¬ 
ture of vaccinia free from the possibility of its con¬ 
taining the germ of any other disease. This is 
precisely what is claimed for glycerinated lymph, 
and though the possibility of septic contamination 
can never under any circumstanoes be absolutely 
obviated, it may safely be asserted that we have now 
reached a point approximating the irreducible 
minimum of risk in this direction. 

Vulvitis in Children. 

Dr. Robinson’s paper on “Vulvitis in Children,” 
the discussion on which, before the Obstetrical 
Society, was reported in our last number, opens up a 
very vexed question. This condition is tolerably com¬ 
mon and often presents great and even painful interest 
from a medico-legal point of view. The causes of vul¬ 
vitis as given in the text-books are numerous and 
varied, but according to the author bacteriological exa¬ 
mination of the discharges in a large number of cases 
revealed the presence of an organism indistinguish¬ 
able from the gonococcus in 76 per cent. This result 
is so startling that, rather than accept the other¬ 
wise inevitable conclusion, one is tempted to question 
•the diagnostic value of the presence of the dip- 
lococcus in question. In the crowded dwellings of 
certain classes of the population it is conceivable that 
gonorrhoeal infection may be readily spread by the 
use of a common chamber utensil or, between children, 
by digital exchanges. These discharges, however, 
are met with in nil classes of society, though doubt¬ 
less they are more common among the unwashed, 
overcrowded, ill-nourished offspring of the poor. 
Clinically the evidence is opposed to the gonorrhoeal 
origin of the affection unless we concede that 
gonorrhoea in the young runs a much milder course 
than in the adult, no proof whereof has as yet been 
furnished. The inguinal glands are very rarely 
enlarged in children suffering from vulvar discharge, 
and there is a singular absence of con j unctival complica¬ 
tions, though as the irritation is productive of itching 
one would have expected frequent transference of the 
virus. Observed cases of unquestionable gonorrhoea 
contracted by children as the result of rape do not 
support the assumption that the disease is milder in 
them than in adults, and we are driven to challenge 
the identity of the organism upon which the author 
based his conclusions. 

Dr. Lawrie on the Plague. 

It cannot truthfully be said that the evidence so 
far given before the Plague Commission in India has 


thrown any further light on the etiology and mode of 
dissemination of this fell disease. As to this, how¬ 
ever, we shall be better able to form an opinion when 
we are in possession of the report which will not be 
accessible for a long time to come. The most sensa¬ 
tional statements have been made by Dr. Lawrie who, 
with a recklessness and impetuousness peculiarly his 
own, has fulminated against the Haffkine system of 
preventive inoculation. Now this remedial and pre¬ 
ventive measure is on its trial and, on the whole, the 
tenor of the reports that have so far reached us of the 
results obtained are decidedly in its favour. It behoves 
us, therefore, to preserve an open mind and to avoid 
j um ping to a conclusion one way or the ot her. Dr. Lawrie 
is in no better position to form a trustworthy opinion at 
this juncture than anyone else, and common sense 
would have suggested a prudent reticence in respect 
of his opinions, although he would have been fully 
justified in alleging all facts that had come to his 
knowledge. It is not his facts—for these were remark¬ 
ably few—which we object to, but his inferences and 
ex parte statements, based on sweeping generalisation 
and random assertion. This is not the spirit in which 
scientific questions of this magnitude should be 
approached, an attitude of dispassionate scepticism 
best becomes the investigator, not violent denuncia¬ 
tion and hasty generalisation. Dr. Lawrie ought to 
have learned this lesson from his misguided precipita¬ 
tion in the matter of the malarial parasite, the exis¬ 
tence whereof he boldly denied, but the existence 
whereof has since been almost universally admitted. 
Dr. Haffkine is engaged in carrying out a gigantic 
experiment on data which have been thoroughly 
worked out, and it is unjust to him and to his co¬ 
adjutors to declare urbi et orbe that the treatment is 
a dangerous delusion. 

A Wicked Fraud. 

An inquest was held a few days ago at Modbury, 
n< ar Plymouth, on the body of a man who had been 
treated by a quack, of the name of Roberts, for 
diabetes. This unqualified person advertises that he 
can cure cancer and diabetes, and it was in conse¬ 
quence of these advertisements that the deceased had 
consulted him. A sum of £210s. was paid at the first 
interview, in exchange for which the deceased was 
given a number of powders, ascertained by analysis 
to consist of common salt, soon after taking which he 
became comatose and died. The jury found that 
death was due to natural causes, but added a rider to 
the effect that the treatment was absolutely useless, 
and “ was nothing but a fraud.” Roberts was 
cautioned as to his future conduct, but we trust 
the matter will not be allowed to rest there, for he has 
impudently infringed the Apothecaries’ Act, and 
there ought to be no difficulty in obtaining a con¬ 
viction. 

Charges of Malpraxis. 

A drawback, of no mean degree, to the medical 
profession, is undeniably the annoyance caused by 
dissatisfied patients bringing charges of malpraxis 
against its members. In the present day, unfor- 

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Jan. 18, 1899. 


NOTES Ofl CURRENT TOPICS. 


The Medical Press 71 


tunately, these charges seem to be of more frequent 
-oocurrenoe than used to be the case, and almost 
without exception the legal reports in the newspapers 
show them to be absurd and without any foundation. 
No doubt in some cases an ignorant and poor person 
having some grievance of the lcind, backed up by an 
enterprising but not over scrupulous solicitor, thinks 
that a medical man is “ good game ” to make an attack 
upon. The proceedings are consequently commenced; 
notice is piven to the doctor, all his patients hear of 
the action pending against him, and thus his troubles 
and annoyance increase until the t'ial. Then 
the jury, possibly without leaving the box, 
nonsuit the plaintiff, and virtually intimate that 
the action should never have been brought. The 
result, in a measure, may be consoling to the prac¬ 
titioner, but the experience is one which costs him 
dear. Apart from the unavoidable anxieties attend¬ 
ing such an ordeal, he also soon probably finds that 
there will be no chance of recovering his costs of 
the trial, owing to the plaintiff being a person without 
means. In the past, medical men have frequently 
found themselves in this predicament, and no one 
can deny that it constitutes a hardship, the occurrence 
of which should not be legally possible. In regard 
to these cases of alleged malpraxis the law of the 
land is—and it is only common-sense law—that a 
medical man cannot be held responsible fora mere error 
of judgment, provided that he uses reasonable skill 
and care. Unless this were the case, medical practice 
would become well-nigh impossible, and the result of 
it would be that the public would be left to look after 
their own illnesses and accidents. 

The Wark Case. 

The Medical Press and Circular was the 
first of the professional journals to call in question 
the verdict and sentence on this unfortunate man_ 
Since the appearance of our comments, the whole 
press of the country has been with us, and have 
quoted our views, in protest against injustice in the 
name of justice and law, and the final denouement 
has done but little to quiet matters. At the trial 
before Judge Phillimore, Lieut. Wark was sentenced 
to death for a crime he could not possibly have com¬ 
mitted, and concerning which there was distinct 
evidence to show that he was not guilty. All this 
has now been altered, and he has been sentenced 
for a crime for which he was not tried, for it is 
absurd to contend that three years’ imprisonment is 
a punishment for murder—the only crime he was 
charged with. What with biassed judges and weak- 
kneed Home Secretaries, well—the ways of justice 
are past finding out. 

Vivisection in India. 

The anti-vivisection paity have succeeded in dis¬ 
covering another mare’s nest, in which the absurdity 
of their protestations is again woefully exposed. 
They have alleged that the Pasteur Institute to be 
shortly founded in India will be entirely opposed to 
the religious sentiment of the natives, so much so, 
that it may be expected to cause another Mutiny. 


An anti-vivisectionist must be a person possessing a 
lively imagination, otherwise he would not be 
qualified to maintain the tenets of his party, and to 
say that a Pasteur Institute in India will cause a 
mutinous outbreak among the natives is just 
the kind of lively imaginative excrescence likely 
to be evolved from an anti - vivisectionist’s 
mind. Unfortunately, however, for the anti-vivi¬ 
sectionist party the facts as to this allegation are 
entirely against them. The Pasteur Institute in India 
will be founded and supported by the Nizam of Hyder¬ 
abad, a prince of great and acknowledged intelligence 
who is fully conversant with all the objects that the 
Institute will seek to attain. Moreover, as it has 
been pointed out, experiments upon animals are not 
repugnant to the feelings of the natives. As a matter 
of fact, they have infinitely less objection to experi¬ 
ments being performed on dogs, rabbits, and cats than 
they have to Englishmen eating beef. Despite the 
fact that the cow is a sacred animal among the 
natives, the slaughter of cattle in India has, up to 
the present, not been accused of having caused a 
mutiny. 

The Vaccination Act and the Payment of 
Vaccination Officers. 

Harmony has not reigned among all boards of 
guardians upon the subject of the payment of the 
vaccination officers under the new Act. The mini¬ 
mum fees allowed by the Local Government Board 
have in some instances been refused by them, and 
this has been followed by the guardians giving them 
a month’s notice to terminate their appointments. 
We doubt, however, whether this step will lead to the 
solution of the difficulty, inasmuch as it is scaroely 
likely that other medical men will be prepared to 
accept the offer of unremunerative fees. 

The Sanitation of Belfast. 

Some months since we noticed from week to week 
the barbarous condition of the second city in Ireland 
as regards sanitation. We took our information from 
the debates in the local papers not supposing that 
the reality could be worse than the disorganisation 
therein reported, or that the sordid greed of the jerry 
builder, encouraged by the Corporation, could be 
more disgraceful to the latter body than was repre¬ 
sented. Our contemporary, the Lancet, has, however, 
dragged the foulness of the city and its public health 
organisation into the light in a series of reports by 
its special commissioner, published in its issues of 
December 31st and previous weeks, and, if these 
reports are to be trusted, it is clear that Belfast is 
nothing better than a sort of Sodom and Gomorrba, 
in a sanitary sense, and that no milder remedy than 
fire and brimstone would be effectual treatment 
for its condition. Considerations of space preclude 
our giving quotations from these reports except the 
concluding paragraph, which runs as follows: — 

After all these investigations I must confess to 
being overwhelmed with a deep sense of despair. 
When even such easy trifles as the cementing of a 
closet-pan on its syphon trap are so generally 
neglected, though the presence of typhoid fever in 


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72 The Medical Phess. 


NOTRS*ON CURRENT TOPICS. 


Jan. IS, 1890. 


the houses should have caused all such defects to be 
promptly detected and remedied, it is impossible to 
hope with much confidence that the great and sweep¬ 
ing measures of sanitary reform urgently needed will 
be efficaciously applied. Is it likely that an adminis¬ 
tration which, at any rate in the past, has displayed 
such crass incapacity and has been guilty of such 
palpable life-destroying neglect will ever be able to 
produce a Hercules capable of cleaning out these 
Augean stables ? Does this not rather suggest that 
a higher and outside authority should interfere, so 
that the law shall at last be enforced, and that the 
work of efficient sanitary supervision shall be no 
longer neglected ? 


A New Opening for Quacks. 

Quacks and the compounders of patent medi¬ 
cines desirous of pushing business, and anxious for 
a cheap advertisement should make a point of being 
enrolled upon a coroner’s jury. At an inquest last 
week a juryman showed that a coroner’s court could 
be most successfully utilised in the attainment of 
these objects. The inquiry was held for the purpose 
of ascertaining the circumstances of the death of a 
man who had as the evidence showed, suffered for 
tw^ years from pulmonary phthisis. Before the 
verdict was given of “natural death,” a juryman 
observed, “ I should like to say a few words on 
consumption. I can cure consumption, whether 
in the first stage or the last, and I can cure 
spitting up of blood as well. If any gentle¬ 
man suffers from it, I shall only be too happy 
to cure him.” The juryman subsequently assured the 
coroner that he cured a gentleman of consumption 
after the latter had spent a fortune in trying various 
medical men. This was undoubtedly a startling piece 
of information, to come from a bootmaker, which the 
juryman stated was his occupation. Unfortunately, 
however, this bootmaker’s philanthropy did not 
extend so far as to inform the Court regarding the 
precise composition of his remedy. An expectant 
British public thus has its appetite for information 
whetted in a remarkable manner without any chance 
of having it appeased. The bootmaker has clearly 
intimated that he will not divulge his secret, and 
from the free and extensive advertisement which he 
has just received through the coroner’s court, he is 
now probably making arrangements for a very large 
increase in business. 


Tropical Diseases at Netley. 

The letter in the Times of January 6th from Dr. 
John Anderson, of the Seamen’s ( Dreadnought) 
Hospital, respecting the cases of tropical disease 
which are usually under treatment at Netley, unmis¬ 
takably indicates that if the scheme for a school of 
tropical medicine be carried into effect Netley Hos- 
pit *1 is the only place where the clinical material 
available for the purpose could be forthcoming. Dr. 
Anderson’s figures very effectually dispose of the sug¬ 
gestion found a school of tropical medicine at 
the branch hospital of the Seamen’s Hospital Society 
at the Albert Docks. We trust that Mr. Chamber- 
lain will see the futility and inexpediency of main¬ 
taining his sanction to this suggestion. It would 


simply be a waste of public money to attempt to 
organise the undertaking in this particular form, and 
if this Bcheme is still persisted in the matter 
should be brought under the notice of the House of 
Commons early in the ensuing Session. 


The Increaee of Lunacy, 

The county authorities of Somerset, in common 
with a good many others, are beginning to find that 
the problem of providing accommodation for the 
increasing number of lunatics is becoming a very 
serious one. With respect to the Yeovil Union, for 
example, it was recently stated that the increase in 
lunacy during the past twenty years amounted to 200 
per cent. In order to meet the demand for more 
accommodation an asylum was built at Cotford, near 
Taunton, and this institution was only recently 
opened. But arrangements, we believe, are already 
being made with a view to enlarging it. With the 
present rate of augmentation of the lunatic population 
throughout the country, the time seems to be 
approaching when the sane persons outside of the 
asylums will be required to devote a large measure of 
their earnings merely to the maintenance of 
lunatics. There is no doubt that one of the most 
serious aspects of this question is the enormous 
burden which will eventually fall upon the country of 
making due provision for the care of the insane. 


The Abortion Charge Against a Nurse. 

Charges of criminal abortion continue to bulk 
largely in the courts of law. The most reoent case 
is that of the London nurse, Birmingham, who has 
been committed by a coroner's jury for trial upon a 
charge of wilful murder for causing the death of a 
woman in Oxford Street by an illegal operation. At 
the present stage of the proceedings it would 
obviously be unfair to offer any comment upon the 
case. However, the offence with which the prisoner 
is charged has other aspects, which may be touched 
upon with something more than a featherweight 
and generalising pen. First and foremost, how is 
it that nurses and other unqualified abortionists 
Recure their victims ? The answer to that pertinent 
question is undoubtedly that for the most part they 
cany on their illicit traffic through the medium of 
advertisement in the public newspapers. Now, the 
police have shown most commendable zeal in follow¬ 
ing up and bringing home offences of the kind. Will 
they not in future go to the root of the matter and 
prosecute for inciting to felony the newspapers that 
admit this abominable class of advertisement ? One 
successful action of this sort, we firmly believe, 
would do more to check abortion than the yearly 
hanging of a score of miscreants caught and con¬ 
victed here and there among the multitude. What 
an opportunity for a strong Home Office administra¬ 
tion. — 

Dr. George Foy, Dublin, delivered a lecture last 
week before the Irish Pharmacists’ Assistants' 
Association, upon the subject of “ Anaesthetics.” The 
lecture was profusely illustrated by original manu¬ 
scripts, cartoons, and old-time engravings. 


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Jan. 18, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press. 73 


The X Raya in War. 

Last week a valuable contribution to the literature 
of military surgery was made at the Rontgen Society 
by Major Battersby, R.A.M.C., the Medical Officer 
recently in charge of the Rontgen ray department in 
the Soudan expedition. After the battle of Omdurman 
the rays were successfully applied in 20 cases, where 
other methods of examination failed. The carrying 
out of the work was attended by great difficul¬ 
ties, chiefly on account of the heat, which 
varied from 100 degrees to 120 degrees F, in 
the shade. However, the resulting photographs, 
although hardly on a level with ordinary exhibition 
work, nevertheless answered every surgical require¬ 
ment as regarded both diagnosis and exact localisa¬ 
tion. The coils were packed in boxes cased in felt, 
which was constantly wetted, so as to keep the 
contents cool. The necessity of these steps is clear 
when we reflect that the insulating agent of the coil 
is paraffin. The generation of electricity was effected 
by means of a tandem bicycle, connected with a 
dj namo, from which the storage batteries were 
charged. Altogether Major Battersby triumphantly 
proved the absolute value of this new method of 
diagnosis in military work. 

Death Under Ether. 

An inquest was held on the 12th instant at 
Xingston-on-Thames on the body of a man, aged 52, 
who had succumbed to the effects of ether adminis¬ 
tered for the purpose of an operation. It transpired 
that he had been suffering from bronchitis and heart 
disease. Dr. Woolley, who gave the anaesthetic, said 
he bad only (?) administered about two fluid ounces of 
ether when the patient vomited and respiration 
ceased, and all efforts to restore animation failed. 
Deaths from ether are tolerably rare, at any rate in 
this country, possibly because chloroform is still the 
favourite amesthetic with tLe many. In any event, 
ether is generally held to be contra-indicated in cases 
where there is any tendency to bronchitis, and if, as 
stated, the deceased suffered from this disease, some 
surprise may be felt that chloroform was not pre¬ 
ferred. 


An “Appendicitis” Controversy. 

There is no doubt that in many respects our 
nomenclature of diseases is far from correct. Never¬ 
theless, who can dispute the force of fashion or 
custom in this matter? A name is given to a par¬ 
ticular disease, and it comes at once into general use ; 
then some one finds that it is etymologically quite 
erroneous, and presses for the substitution of a new 
and, perhaps, more correct word. Despite, however, 
the strenuous efforis made in this direction, nothing 
ever comes of them, for it is quite impossible to 
undermine the popularity which general use has 
gained for the first, though admittedly erroneous, 
term. Apropos of this subject, some controversy is 
now taking place with regard to the word appendi¬ 
citis—described as a verbal monstrosity. It has been 
suggested that eephyaditis is the best name for the 
disease, but we question whether, even from the 


first, such a term would ever have commended 
itself for popular professional use. But epityphlitis 
suggested by Kiister, of Marburg, is better, although 
one cannot see that it has much to recommend it in 
comparison with appendicitis. As a matter of fact, 
appendicitis is a useful, even if it be an incorrect 
term. Its meaning is well understood, and it is not 
likely to be superseded. 

Epithelioma of the Uvula. 

Primary epithelioma of the uvula is a very rare 
affection, and for this reason a case of the kind, 
reported by Dr. W. Downie in the current number 
of the Scottish Medical and Surgical Journal, is of 
special interest. The patient was a blacksmith^ 
fifty-six yeais old, and when he came under observa¬ 
tion his uvula was greatly enlarged, and the greater 
part of its surface ulcerated; it was als? hard and 
firm on palpation, and slight manipulation caused 
the surface to bleed. No lymphatic enlargement 
could be detected. The disease was diagnosed to be 
epithelioma, and the appendage was at once ex¬ 
cised, under cocaine. Healing of the wound took 
place in a few days, and since then, now seven¬ 
teen months ago, the patient has enjoyed perfect 
health without any signs of recurrence. Micro¬ 
scopical examination of the growth confirmed the 
diagnosis, but the literature of the subject only 
contains the record of one other case of primary 
malignant disease of the uvula. 

Aortic Aneurysm and Cardiac Hypertrophy. 

Hitherto there has been a curious difference of 
opinion as to whether or not aneurysm of the aorta 
entails hypertrophy of the left ventricle. Seeing 
that the aneurysm is virtually a dilatation of part of 
the vascular system, it is not obvious why hyper¬ 
trophy should result, and the statistics based on an 
examination of the post-mortem records at St. Bar¬ 
tholomew’s Hospital, recently compiled by Dr. Cal¬ 
vert. seem to show that hypertrophy is, at any rate, 
not the rule in aneurysm. Of 124 cases of aortic 
aneurism, hypertrophy of the left ventricle was only 
found in 47, and much the same proportion was dis¬ 
covered by Dr. L. Barlow at St. George’s (5 out of 
13). We may therefore dismiss from our minds the 
idea that there is any essential connection between 
the presence of aneurysm and left ventricle hyper¬ 
trophy. Even when hypertrophy is present, it by no 
means follows that it is caused by the aneurysm* 
Aneurysm is usually consequent upon atheromatous 
degeneration, and atheroma is specially prone to exist 
in the subjects of high arterial tension, i.e., patients 
suffering from some form of kidney mischief, an affec¬ 
tion intimately associated with marked hypertrophy. 
Of course, if the aneurysm be so situated as to interfere 
with the closure of the aortic valves, the resulting 
regurgitation will lead to hypertrophy of the ven¬ 
tricle, but even then the aneurysm is not the direct 
cause of the hypertrophy. The old idea was that the 
loss of elastic recoil, consequent upon an athero¬ 
matous condition of the large vessels, threw more 
strain upon the heart, and led to muscular hyper- 


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74 The Medical Pbkhs. 


NOTES ON CURRENT TOPICS. 


Jan. 18, 1899. 


plasia, bat this very hypothetical view is not borne 
out by actual observation, and while hypertrophy 
may conceivably cause aneurysm, it has now been 
conclusively shown that aneurysm does not cause 
hypertrpohy. 

Nugent’s Borrowed Diploma. 

The man Rowland, who recently practised as a 
medical man at Barking, has been sentenced to 
three years’ imprisonment, for manslaughter, and 
three for personating a registered practitioner, to 
wit, one Nugent, the two sentences to run con¬ 
currently. For the prisoner it was urged that, 
although the Medical Defence Union had challenged 
bis qualifications so far back as 1895, yet no pro¬ 
ceedings had been undertaken by the General Medi¬ 
cal Council. We fancy that thU delightfully candid 
statement will be read with mixed feelings by those 
members of the Council, who have hitherto sat in the 
seat of the scornful, and played the part of laisser 
faire with haughty contempt of the outside world. 
Where is now the purity of the Register, the main¬ 
tenance of which we were always taught was the 
highest and most sacred duty of that august bojy ? 
This extraordinary case is bound io come before the 
Council next session, and it is to be hoped that the 
medical profession will insist on sifting the matter in 
broad daylight. No good can come of half measures. 

The New Spectacle Sellers’ Diploma. 

Hebe is what the Spectacle Makers' Guild and its 
professional agents have brought us to. The annexed 
advertisement appeared in a recent issue of the Daily 
Mail :—“ H. L , F.S.M.C. (Sight Specialist), Cer¬ 
tificated Optician by Examination, . . . Street. 

Mr. L-’8 treatment of Defective Eyes is entirely 

successful. Headache, Neuralgia, Pain in the Eyes, 
due to Eye Strain, Permanently Cured. Eyes 
Examined, Sight Tested, and all information Free of 
Charge.” It may be recollected that, when we entered 
our emphatic protest against the prostitution of the 
function of that ancient brotherhood by the wholesale 
selling of so-called diplomas in spectacle-making, 
the Master of the Guild assured us that if it were 
found that any diplomats was using his parchment 
to attract medical or surgical business the company 
would at once withdraw the diploma. We now invite 
the Master to fulfil his promise, as there can be no 
question that this advertiser seeks to utilise his docu¬ 
ment for such purpose. 

Biz Months in Gaol for Belling Bad Meat. 

At last the reign of justice, reasonable and even- 
handed, appears to have been established in the king, 
dom of the Metropolitan magistracy, and, indeed, 
more or lees also of their provincial brethren as 
regards the punishment of bad meat offences. For 
many years past the futility of mere fines inflicted 
upon this class of offender has been insisted upon in 
the columns of The Medical Pbess and Cibculab. 
Eveii now there is too great a tendency to substitute 
a heavy money penalty in place of imprisonment, but 
we are glad to see an increasing number of sharp and 


salutary sentences recorded Last week, for instanoe r 
a Cambridgeshire butcher was haled before the 
London Guildhall Police Court charged with sending 
to the Metropolitan market unsound pork, which was 
described in evidence as “ in a filthy condition.” The 
defendant was notorious for bis bad meat transac¬ 
tions, and had previously suffered imprisonment for 
a similar offence. On this occasion he was very pro¬ 
perly sentenced to hard labour for six months. From 
the point of view of preventive medicine it is difficult 
to over-estimate the necessity for the maintenance of 
a high standard in the food supplies of the com¬ 
munity. 

Lunacy, the Poor-law, and Delirium 
Tremens. 

Two occurrences were reported last week in 
Metropolitan Poor-law Institutions, things that 
would simply be impossible under any strong and en¬ 
lightened system of Local Government Board control. 
The first was a protest of the Chairman of the St. 
Olave’s Board of Guardians against the detention of 
an epileptic boy, set. 9, in a lunatic ward where he had 
remained for five months, in spite of the protests of the 
Medical Officer. Where are the Lunacy Commissioners, 
where is the Local Government Board Inspector, 
where are the necessary formalities preliminary 
to confining any person among lunatics ? The second 
incident was the treatment of a patient suffering from 
delirium tremens, who, according to the newspaper re¬ 
ports, was admitted to Poplar Infirmary, put first into 
a straight jacket, and then into a padded room, where 
he died. No one who is acquainted with the modern 
practice of medicine will doubt for a moment that a 
patient under such circumstances would not be placed 
under the best conditions for recovery. Indeed, the 
use of such brutal and obsolete methods of restraint 
at once condemns the institution which has resort to 
them. Tales of deaths in padded cells have before this 
come from East End infirmaries. Again we ask, 
where are the responsible ceutral administrators of 
the Poor-law ? 


Tea Cigarettes. 

The physiological effects of smoking cigarettes 
made of tea are very graphically described by a 
devotee The feeling in the mouth, he says, is pecu¬ 
liar, but so is the taste of an ordinary cigarette to the 
beginner. It is not, he adds, as disagreeable as might 
be supposed, but the result in a tyro is to bring about 
a sense of thickening of the head, and a disposition 
to take hold of something or to sit down, symptoms 
which have also been noted in the early stiges of 
nicot ne poisoning. If the trial be persevered with f 
the thickening feeling gives place to one of intense 
exhilaration, which however only lasts as long as the 
smoke—in fact, it ends in smoke. The after-effects are 
said to be too dreadful, the agony of the opium 
smoker being but a shadow to that of the victim of tea 
cigarettes. There is utter lose of appetite, despon¬ 
dency, with more or less muscular tremor, and it is 
some hours before the repentant sinner begins to 
revive. If any misguided young person takes to 


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Jan. 18, 1899. 


SCOTLAND. 


smoking tea after this warning it will not be our 
fault! 

The Henley-on-Thames Board of Guardians have 
resolved to memorialise the Government to repeal the 
Vaccination Act. In coming to this decision one of 
the guardians stated that it was the most rotten A"?t 
which he had ever known. 

PERSONAL. 

Dr. H. Macnauohton Jones has been re-elected Pre¬ 
sident of the British Gynaecological Society for the 
ensuing year. 

Db. Robert Barnes has been elected honorary Presi¬ 
dent of the Gynaecological Congress which is to take 
place at Amsterdam in August 

H.R.H. Princess Christian will distribute the 
prizes to the London Companies of the Volunteer Medical 
Staff Corps on Friday, January 27th. 

Dr. Macpie Campbell, Consulting Surgeon to the 
Northern Hospital, has been elected President of the 
Liverpool Medical Institution. 

Mr. Cadqe, F.R.C.S.E., has given another .£10,000 to 
the Norwich Hospital, this donation making £20,000 with 
which he has endowed that institution. 

Dr. Georoe Plunkett 0‘Farrell, Inspector of 
Lunatic Asylums, received last week the honour of a 
Knighthood from the Lord-Lieutenant of Ireland. 

Thb knighthood previously announced in this journal 
as about to be conferred on Dr. Hermann Weber, was 
personally bestowed by her Majesty at Osborne on Satur¬ 
day last. 

Dr. Henry E. Armstrong, Medical Officer of Health 
for Newcastle-on-Tyne, has been elected a corresponding 
member of the Royal Medico-Chirurgical Academy of 
Madrid. 

Mr. Timothy L. Welford, the oldest member of the 
profession in Reading, died there last week, aged 86. 
At the time of his death he was the senior magistrate on 
the local bench. 

Dr. C. R Marshall, Assistant Downing Professor 
of Medicine in the University of Cambridge, has been 
appointed Professor of Materia Medica at University 
College, Dublin. 

Dr. Hill, Master of Downing College, and Vice- 
Chancellor of the University of Cambridge, has been re¬ 
appointed University Lecturer in advanced Human 
Anatomy till Michaelmas, 1903. 

Dr. C. P. O’Connor, of March , Cambs., has been pre¬ 
sented with a silver salver on the occasion of his 
marriage, subscribed for by nearly 300 employes of the 
Great Eastern Railway engaged in that district, as a 
token of esteem. 

Db. Murrell, Physician to the Westminster Hos¬ 
pital, has been appointed Examiner in Medicine, “ with 
special reference to Materia Medica and Therapeutics,” 
in the University of Glasgow, vice Dr. F. D. C. Phillips, 
whose term of offioe has just expired 


The Medical Press. 75 

Db. Wyllie, who was appointed to carry on Professor 
Fraser’s duties in the Edinburgh Royal Infirmary during 
his stay in India, has, we have been informed, gathered 
round him an almost record number of students, 
attracted by the excellence of his teaching. 

Dr. Manuel Tapia y Serrano died a few days ago 
of pulmonary trouble, contracted by excessive work in 
his laboratory. As a pathologist and bacteriologist he 
was known thioughout Spain. He was a member of the 
Royal Academy of Medicine of Madrid, and of the Society 
Los Escolare8 Medicos. 

Dr. C. H. Martin, of Mobile, Atalanta, whose death 
is announced, was one of the best known of Southern 
surgeons. He was Medical Director of the Army Corps 
commanded by Leonidas Polk during the inter-States 
war in America. In 1875 the University of Pennsylvania 
conferred on him the honorary degree of LL.D. 

Wa understand that Surgeon-General J. A. Woolfryes, 
C.B , will be appointed Honorary Physician to the Queen, 
in succession to the late Surgeon-General A. Smith. He 
entered the Army Medical Service fifty years ago, and 
has seen much fighting, being mentioned in despatches 
and receiving several medals and clasps for services 
rendered. 

Surgeon-Colonel Pbingle, who died at Blaokheath 
last week, was one of the few survivors of the Cawnpore 
massacre, all his brother officers being killed, but he 
escaped through being called off to attend the wounded 
elsewhere. He retired on pension in 1883, and has since 
been engaged in local and philanthropic work in the 
neighbourhood in which he resided. 


gcotlani). 


[from our own correspondent.] 


The Consumption Campaign. —The rapidly growing 
opinion that the community might combat the ravages 
of the destructive little bacillus of tubercle with some 
measure of the success which has followed the measures 
taken to lessen the effects of typhus, typhoid, and small-' 
pox, if only facilities for proper treatment and the 
spreading of a true conception of the manner in which 
the organisms may be baulked, or their effects removed, 
if treated early enough, is holding out promise of bearing 
practical fruit within a short time in Edinburgh. The 
Town Council has appointed a committee to investigate 
and consider the question One of the suggestions 
made is that the new City Hospital for infectious cases, 
nearly completed, and with greater accommodation than 
will for some time be called for, for the reception of 
cases of the common zymotic diseases, should be in part 
set aside for the reception and treatment of consump¬ 
tive cases. Its site, high above the sea on the siae 
of Craig Lockhart Hill, one of Edinburgh’s many heights, 
favours the idea of treating patients with this disease 
by the pure air method. On an average 42 medical beds 
in the infirmary of Edinburgh’s medical wards are occu¬ 
pied each year, day and night, by tuberculous cases, if 
the total number and the duration of their stay in 
hospital be expressed in terms of beds occupied per 
annum. Many are in the early stages which are so often 
curable or inhibited by proper surroundings, to which 
the general wards of a hospitil cannot aspire. 

The Late Db. W. H. Murray. —After an illness last¬ 
ing several months, W. H. Murray, M.DEdin. (M.B., 
C M.. 1874), died last week at his residence in Galashiels, 
at the early age of 46. He was one of the best known 
practitioners in the Scottish Borders. In addition to an 
extensive practice, Dr. Murray found time to interest 


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76 The Medical Press. 


Jan. 18, 1899. 


CORRESPONDENCE. 


himself in public affairs, both municipal and political. 
He was one of the leading Conservatives in Galashiels. 

--♦- 

Correspondence 

We do cot hold ourselves responsible for the opinions of oar 
correspondents. 


THE CASE OF LIEUT. WARE. 

To the Editor of The Medical Press and Cibcclar. 

Sib,—T hough perhaps some of your medical readers 
may demur, I trust you will permit me to call the atten¬ 
tion of the public to the vast progress that medical 
science has made among the educated classes during the 
last forty years. Indeed, even at a later date, the man 
would have been ridiculed who predicted that before the 
end of the century not only the Home Secretary and the 
judges, but even our common jurors would know more 
about the most abstruse branches of the science than the 
doctors themselves. Just forty years ago occurred the 
famous case of Dr. Smethurst. It revealed to the public 
the scandalous deficiences of the Home Office at that 
period. The jury may, indeed, have been in advance of 
the doctors (or of some of them) but the Home Secretary 
was literally unable io form any opinion for himself as 
to the cause of Miss Bankes's death, and was driven to 
the painful expedient of calling in a physician—the late 
Sir Benjamin Collins Brodie—to decide the question. 
Sir Benjamin, however, could not decide it. He 
merely said “ I doubt,” and by a strange mis¬ 
application of the legal principle that the prisoner 
is entitled to the benefit of the doubt (which in reality 
means that he is entitled to the benefits of such 
doubts as the judge in his charge may consider irremov¬ 
able) the prisoner was actually set at liberty. Nor was 
the action of the Home Office in the Maybrick case in 
1889 free from objection. The doctors were divided in 
opinion as to the cause of death. The jurors, with their 
more advanced knowledge of toxicology (under the direc- 
tionof a judge whose ironical disclnimersof any knowledge 
of that science concealed a skill far exceeding that of Sir 
Benjamin Brodie) entertained no doubt whatever. Yet the 
weak Home Secretary actually consulted other doctors 
on the subject, and arrived at the astonishing result that 
the cause of death was actually doubtful! But by an 
important advance over his predecessor he naturally and 
justly decided that under the circumstances the Crown 
was clearly entitled to the benefit of this doubt. The 
Work case, however, marks a new era. Drs Briggs and 
Paul had an advantage over the judge, the jury, and the 
Home Secretary in having made a careful post-mortem 
examination of the body which the others had not seen 
Yet notwithstanding this disadvantage, the judge, the 
jury, and the Home Secretary all saw clearly that death 
had resulted from an illegal operation which the 
doctors with their inferior knowledge of obstet¬ 
rics had failed to discover. It will be recol¬ 
lected that the Home Secretary was the Minister 
in attendance when the heir to the throne w s born, 
and I have no doubt that his knowledge of the sub¬ 
ject proved of great'ad vantage to the accoucheurs on that 
occasion. The lesson of the Wark case is that doctors 
should keep abreast of the age—that they should not be 
ignorant of the proofs of poisoning or violence, which 
are known to every man on the jury (at least as soon as 
he has heard the judge). Every physician or surgeon 
should recollect that he is placed in the witness-box 
for the same purpose, that according to the judge the 
Maybrick jury had been impanelled—that of solving an 
intellectual problem of great difficulty. If he cannot 
solve that problem he should not enter the witness-box 
at all. Why should he pester the public with doubts 
that never enter the heads of men who know far more 
about medicine and surgery than he does—too much 
about it indeed to make it worth “their while to take out 
their diplomas?. We do not want doubt. We want cer¬ 
tainty. We can to a certain extent combat the unwill¬ 
ingness of the doctors to give us certainties by giving the 
benefit of their doubts to the Crown. We know that the 
proofs of murder are present in the body and that 


nothing but the ignorance or negligence of the doctors 
prevented these from being detected. If doctors cannot 
give us something better than doubt we had better 
disperse with their evidence altogether. It is their 
business to know, and a confession that they do not know 
is an admission that they do not understand their busi¬ 
ness It is fortunate for the public that we have a Home 
Secretary who cares as little for the doctors as he cares 
for the Chief Justice. He is as superior in medical 
knowledge to the former as he is in legal knowledge to 
the latter. 

I am Sir, yours truly, 

Gabdez Bien. 


CENSURABLE. 

To the Editor of The Medical Pbess and Cibcclah. 

Sib,—I see that the dispenser to the Stockport prac¬ 
titioner who recently killed a woman by putting fifty 
grains of morphine into her medicine, the dose whereof 
he inadvertently changed from teaspoonfuls to table¬ 
spoonfuls, has been declared “ censurable,” while his 
employer was censured for having written his prescrip¬ 
tion in an incomplete form. There does not appear to 
have been at.y excuse for so grotesque an error. All the 
culprit had to say in extenuation of his conduct was that 
he was “ confused ” by neuralgic and domestic trouble. 
We all know what that means, and the question of 
diagnosis may safely be left to your readers. 

The point I wish to call attention to is the inadequate 
protection to human life which the law affords. In any 
other country than this such an incident would, of a 
certainty, have entailed upon the delinquent a term of 
imprisonment, and his employer would have been 
mulcted in heavy damages in a civil court. Here they 
are both simply declared “ censurable.” 

A medical man who employs an unqualified dispenser 
incurs a heavy moral responsibility, but it appears to me 
to savour of ‘ infamous conduct ”—a point which I com¬ 
mend to the notice of the General Medical Council. 

I am. Sir, yours truly, 

Observer. 


THE CENTENARY OF NITROUS OXIDE AS AN 
ANAESTHETIC. 

To the Editor of The Medical Press and Cibcdlab. 

Sib,—W ith your permission I would call the attention 
of your readers to the fact that this year is the centenary 
of the discovery of the anaesthetic properties of nitrous 
oxide gas. The discovery was made in the laboratory 
of the Hotwells Hospital, Clifton, Bristol, which Dr. 
Thomas Beddces built, with the pecuniary aid of Mr. 
Edgeworth and Mr. Wedge wood, to test the therapeutio 
values of “ factitious ” airs. 

It was probably the last week in November, 1799, that 
Mr. Humphrey Davy, as we learn from his letter to Mr. 
Davies Gilbert, made his celebrated statement:—“As 
nitrous oxide in its extensive operation appears capable 
of destroying physical pain, it may probably be used with 
advantage during surgical operations.” 

Wordsworth, Southey, Coleridge,tbe younger Priestley, 
James and Gregory Watt, Wedge wood. Count Rumtord. 
and many other distinguished individuals, watched over 
the birth of modern anesthetics, and of all these Davy 
alone suggested the practical application of the discovery. 

One of the first to inhale the gas was Anna, the wife 
of Dr. Thomas Beddoes, Sister of Maria Edgeworth, the 
novelist, and daughter of Honora Sneyd, who married 
Richard Edgeworth in 1773. 

Three years previously M iss Sneyd rejected tbe suit of 
John Andre, who was shot as a spy by George Washing¬ 
ton’s orders in 1780, for whom the whole British Army 
went into mourning, and of whom a tablet, in West¬ 
minster Abbey, tells: He “ fell a sacrifice to his great 
zeal for his king and country, when employed in an 
important and hazardous enterprise.” 

I am, Sir, yours tiuly, 

January, 1899. George Fov. 


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Jan. 18, 1899. 


LITERATURE. 


|Thk Medical Press. 77 


^Literature. 


PLAYFAIR’S MIDWIFERY, (a) 

A new edition of such a standard work as this, calls 
more for welcome than criticism. Dr. Playfair writes 
not only with wide scientific knowledge, but with the 
indefinable quality of wisdom which renders his text¬ 
book of great value to practitioners, while the easy flow¬ 
ing style and the marginal notes at each paragraph 
make it sppreciated by the student. The present edition 
has been largely revised and partly re-written, and some 
new plates and wood-cuts added. Several of the older 
wood-ents might, however, have been altered with 
advantage, as they depict the obstetrician performing 
various operations, such as version and the application 
of forceps, with his coat and shirt sleeve down to his wrist. 
It is surely indispensable, from the point of view of 
aseptic midwifery, that the forearms should be bare and 
well disinfected, and it would impress this on the 
student’s mind if the plates represented the sleeves well 
rolled up. 

But on the score of asepsis most English text-books on 
midwifery seem to be woefully behindhand, and 
we fear that any student who told his examiner 
that he would douche the uterus with a Higgin- 
son's syringe would score badly, yet this is what Dr. 
Playfair recommends, and we can find no reference to the 
infinitely superior syphon douche. Again, in view of the 
excellent results at the Rotunda Hospital from plugging 
in accidental haemorrhage, it is strange that this treat¬ 
ment is not even mentioned in discussing this most 
dangerous complication. But even when one differs with 
the author the charm of his style disarms an opponent, 
and one can only offer congratulations on the continued 
popularity of his treatise. 


POCKET DICTIONARY OF HYGIENE. (6) 

In this neat little pocket dictionary the authors have 
given concise and up-to-date information on a great 
number of matters relating to hygiene, and though the 
little work is primarily intended as a pocket companion 
for medical officers, sanitary inspectors, and those 
interested in hygiene, there is little information in it 
that would not be of use and interest to every house¬ 
holder. 

As might be expected the preventive measures that 
should be adopted in the case of infective disease have 
received a large share of attention, though not to the 
neglect of other matters. If we were to single out a 
particular section for special mention, it would be the 
monograph on “ Water,” in which the more important 
considerations involved in securing a safe supply are ably 
set forth. The advice given as to the general procedure 
to be adopted in the care of patients suffering from 
zymotic diseases is thoroughly sound and practical, and 
the student will find the tables and other data given at 
the end very convenient for reference. The little book 
is evidently intended for hard wear, as it is bound in 
flexible leather, and the paper, though thin, is exceed¬ 
ingly tough to handle, and the moderate price at which 
it is issued (2s. 6d.), should place it within the popular 
reach. 


RAMSAY’S ATLAS OF EYE DISEA8E. (<-•) 

Of special diseases none are so dependent, for their 
delineation and understanding, as those of the eye and 
of the skin. Outlines with appropriate shading are suffi¬ 
cient to portray anatomical conditions and surgical 
affections, and even most medical diseases, but there is 
so much in the way of diagnosis to learn from the tints 
of colouring of an inflamed iris, or the minute distortions 
of a disintegrated cornea or lens, that the visits erudit us 

(ui " A Ti.wtiae on the Science and Practice of Midwifery.” By 
W. S. Plavfair, M.D. London: Smith, Elder and Co. Ninth 

Edti'.n. f v 'rf. 

IA " P' -ket Dictionary of Hygiene.” By C. T. Kingiett, F.I.C., 
and D. Homfray, B.Sc. London : Bailliere, Tindall and Cox. 1898. 

ir) “Atlas of Diseases of the Eye.” 48 full-page plates of the 
<-y«t in colour and ^photogravure. By A. Maitland Bamsay, M.D., 
Professor of Ophthalmology, St. Mungo's College, Glasgow, Glas¬ 
gow : MacLehose and Sons. Quarto, pp. 194; plates, 48. 


cannot be attained otherwise than by prolonged observa¬ 
tion of multitudes of bad eyes. The diagnostic faculty 
can be acquired only upon the observation of hundreds' 
of patients, but the acquirement can be greatly assisted 
by the study of a well illustrated volume, such as Dr. 
Ramsay 's. The portrayal of eye diseases by the agency 
of the lithographer iB attended with great difficulty, be¬ 
cause, no matter how well selected the subjects may be, 
no matter how accurate the draughtsman and the colour 
artist, the printer is sure to overdo the colouring. It is, 
in fact, impossible to get in the half-tones and other 
minutiae on the printing press, and, for this reason, all 
illustrations of eye disease are too blatant, and leave 
something to be desired. The only thoroughly satisfy¬ 
ing pictures of eyes affections which we have ever seen 
are those of James Wardrop, of Edinburgh, published in 
1898. Wardrop was a professional artist before he 
became an eye doctor, and, while he wrote an excellent 
resume of what was then known of eye diseases, he 
was forced to illustrate them with his own hand, and 
that of his daughters who were also professional artists. 
He had copper plate outlines printed in his book, and he 
and his assistants coloured them with the brush, with 
both the ttetus eruditus and the visits erudxtus, and every 
copy of the book is ued was thus, actually, from the - 
artistic brush of the expert himself. We advise any 
ophthalmic specialist to pounce upon a copy of Wardrop s 
book if one can be found. 

Of the illustrative atlasses of eye disease which we 
have 3een Dr. Ramsay s is one of the best, the sub¬ 
jects of illustration being, on the whole, well selected 
aud, generally speaking, well depicted. Photogravure is- 
availed of in many instances, and it is quite satisfactory 
in depiction of ptosis, oedema palpebrarum, and paralytic 
conditions, in which outline is everything and colouring 
is nothing, but we suggest that it was a mistake to seek 
to convey the idea of interstitial keratitis, or strumous- 
ophthalmia, or Jacob’s ulcer, or chronic glaucoma, by a 
method which does not admit of colour illustration, On 
the whole, as we have said, we feel that Dr. Ramsay has' 
done good service in the publication of his atlas—that it 
will prove to be a first-class clinical book and a great 
help to the working practitioner, and, moreover, does 
credit to the enterprise of the author who has thus 
shown his familiarity with the multitudinous forms 
of eye disease. 


WEBSTER’S DISEASES OF WOMEN, (a) 

Of the making of books there is no end, and we regret 
that in the volume before us we are unable to find any 
reason for its issue. As is usual with the Scotch school 
of gynaecologists much of the book is taken up with- 
anatomy, which, though fully recognising its extreme 1 
importance, we think could better be found in Qnain or 
Gray. Speaking generally, the book is a poor imitation 
of Hart and Barbour’s “ Manual of Gynaecology.” 

In “ points to be observed before passing the sound ” 
no mention is made even of douching the vagina, much 
less sterilising it, and yet this is one of the first lessons 
now impressed on the student; also it is a retrograde 
step to find a modern gynecologist advocating the side 
position in examinations with fingers anointed with 
vaae'ine or oil and introduced under the clothing. 

Shall we ever see the last of that dreadful Zwanck’s 
pessary which is here figured as usual ? 

We are pleased to note that the author is apparently 
a believer in asepsis from the chapter on antisepsis and 
asepsis, but we would point out at the same time that 
considering his book is published in 1898, this chapter 
should have been brought up to date, this branch of 
medical science moves rapidly, besides it is not only in 
operative work that asepsis is indicated, probably there 
would be less occasion for resorting to this if more care 
were exercised during examinations per vaginam, &c, 

The credit of introducing ventro-flxation is due to 
Koeberle and Olshausen, and not to Howard Kelly, 
though we would wish to give him every credit for 
perfecting the operation. In conclusion, we regret to 
say though the book is clearly printed and well got up -foiff* 


(a) ” Diseased of Women.” By 
Edinburgh: Young J. PentUnd. 


J. C. Webster. Pp. 688. 


Digitized 


VjOOg 


le 


78 Tax Medical Press. LABORATORY NOTES. 


Jan. 18, 1899. 


the author has failed to establish a claim when there are 
so many better, sounder, and more up-to-date books 
available. 


WAKING’S OPERATIVE SURGERY, (a) 

We have looked into this book with great care, and 
have subjected it to the test which an operator may 
regard as the most severe, namely, that of using it 
frequently as a book of reference about matters on which 
the memory of even the most busy surgeon requires to 
be refreshed. It is pleasant to be able to report in its 
favour in a very unqualified way. Whether regard is 
had to itB matter, text, or illustrations, it will be found 
alike satisfactory in all. It is a full, and yet a very con¬ 
cise, compendium of up-to-date operative work, clear 
without being tedious, and exact without waste of words. 
Whether as an educational instrument for students, or 
as a book for hasty reference by informed but busy opera¬ 
tors, we can strongly recommend its use. It deals 
thoroughly with recent questions and method", and with 
the exception of some minor matters, such as vasectomy, 
is really a complete compendium of the Bubjeots it treats 
of; and it is right to remember that this operation may 
be regarded by the author as not yet being one of estab¬ 
lished reputation. The operation given for the cure of 
varicose veins, is certainly not the best, and we have 
seen results from the very simple proceeding described 
first by Sir Thornley Stoker in the Dublin Journal of 
Medical Science (March, 1895) superior to those of any 
other method. 


GUBB’S MIDWIFERY FOR MIDWIVES AND 
MONTHLY NURSES. ( b) 

This little work, which does not extend beyond a 
hundred pages, has, we are told, been compiled specially 
in view of the requirements of candidates for the certi¬ 
ficate of the Obstetrical Society of London. That it will 
oover those requirements we can readily believe, indeed, 
we may congratulate the author upon not having kept 
too strictly to the somewhat narrow limits of the 
schedule. The amount of knowledge which a candidate 
midwife possesses on passing her examination by no 
means represents all that she may usefully acquire, not so 
much for the purpose of trespassing upon the field of 
activity which properly belongs to the medical man, but 
in order that she may understand better when to requi¬ 
sition skilled assistance, and also in order that she 
may be in a position to render intelligent aid to 
the doctor in operating procedures. If the midwife of 
the future will only conform to the advice here given 
there can never be any friction between her and the 
neighbouring doctors, and for her sake we trust she will. 
A midwife, who has carefully studied and thoroughly 
grasped this manual, will certainly be in a position to 
.distinguish between a normal and an abnormal labour, 
and she will be prepared to deal with the ordinary emer¬ 
gencies of the lying-in room as they occur, and to cope 
with such as are within the scope of her duties ; while 
in respect of the others she need never be at a loss to 
know what to do pending the arrival of the doctor. The 
subject is dealt with in plain English, and the text is 
copiously illustrated. It is printed in large type, and is 
altogether very easy reading. What more can the most 
fastidious student ask ? 

EARL’S "LIVING ORGANISM.” (c) 

The author, recognising that biology has profoundly 
influenced ourrent thought, and that biological dis¬ 
coveries are influencing philosophy, has attempted to lay 
down the true foundations of the study and to show how 
far conclusions may be drawn from them and how far 
speculations may be made. He defines the science of 

(а) “ Manual of Operative Surgery." By J. Waring, M.B., 
B.Sc.Lond., F.B C.S.; Demonstrator of Operative Surgery, 8t. 
Bartholomew's Hospital, Ac., Ac. Edinburgh: Young J. 
Peatl&nd. 1898. 

(б) " A Handbook of Midwifery for Midwives and Monthly 
Norses.” By Alfred S. Qubb, M.D. (Paris), Ac. Aberdeen: Mr. 
James Bisaet. 1898. 

(c) " The Living Organism.” an IntroInction to the Problems of 
Biology. By Alfred Earl, M.k. London: Macmillan and Co. 
1898. Pp. xill.-S71. 


biology as "a certain body of connected knowledge, 
which is derived from the observation of living objects 
and from reflections based on that observation." 

An important caution is: “ Ideas derived from our 
own experience of life are too readily transferred to other 
forms of life,” and the author warns his readers that 
the utmost we are entitled to do is to infer for the lower 
forms of life a nebulous state of something resembling 
feeling. 

The anther first gives a general outline of the scheme 
of biology, taking methods of alimentation as a guide ; 
then deals with classification, surroundings, form, 
energy, development, sensation, Ac., showing in each the 
permanent limits to knowledge. 

On the whole, the book is interesting and suggestive, 
and it may keep eager biologists from too strongly advo¬ 
cating theories; but its real value is not to the biologist, 
but to those who are applying biological methods to 
other branches of research. 


BOTTONE ON X-RAYS, (a) 

This little volume is one of many that have appeared 
since Prof. Rantgen’s famous discovery of the X-rays. 
Its author ha9 contented himself with giving a short 
acoount of the principles involved and the apparatus 
needed in the work of practical radiography. Wisely, 
as it seems to ns, he has kept out of the field of medical 
and surgical work, into which some non-medical writers 
have recently shown a tendency to plunge with more or 
less disastrous results. He appears to have worked 
chiefly with a Wimshurst influence machine, a source of 
electricity that has hardly received the attention it 
deserves at the hands of practical Rontgen ray workers 
in this country. Among the illustrations is a useful one 
illustrating the effects of over-exposure and under ex- 
poeure of the sensitive plate by comparison with a third 
that has been properly timed. The book will be found 
useful to those who want a short summary of the subject, 
but is not full enough to be of much service to the ad¬ 
vanced worker. 


jAiboratorg Jlotes. 


READY-MADE SOUPS. 

The triumph of antisepsis by sterilisation is nowhere 
seen and appreciated to better advantage than when 
applied to articles for use in the culinary department. 
We have been afforded an opportunity of examining and 
testing various preserved soups prepared by the well- 
known West end caterer, Mr. Venant Benoist, of 36, 
Piccadilly, among them being “Real Turtle Soup” and 
“Consomm6 de Volaille.” We first tested their keeping 
properties, and are enabled to state that, even in the 
absence of any special precautions as to temperature, 
Ac., they were perfectly edible two mouths after 
receipt thereof, and provided high quality soups not 
differing, from a gastronomic point of view, from the 
freshly-made articles. So far as our experience of real 
turtle soup goes, the special properties and savour which 
make this la reine dee potagee are found in their entirety 
in the products contained in these sealed glass recep¬ 
tacles. Being preserved and sterilised in glass, there is 
no risk of contamination by the action of organio acids 
on a metal container, and analysis yielded no trace of any 
chemical preservatives. As the preparation of these 
soups in the ordinary way is a somewhat tedious and 
difficult procedure in the average kitchen, we are pleased 
to refer our readers to a means of obtaining them on less 
onerous conditions. 


Thk death is aunonnoed from Paris of Dr. Dumont- 
pallier, who has acquired considerable notoriety, and 
even fame, as an authority on diseases of the nervous 
system more particularly in respect of the phenomena of 
hypnotism. 


a ” Radiography, in Practice and Theory.” By S, B. Bottone. 
on: Whittaker and Co. 1889. Price 3e* 


Digitized by Vj ooQle 



Jan. 18, 1899. 


MEDICAL NEWS. 


The Medical Press. 79 


Jftebical 


Liverpool Medical Institution. 

At the annual meeting, held Thursday, January 12th, 
-the following list of offioe bearers, members of Council, 
and Committees was adopted:—President, W. Macfie 
-Campbell; Vioe-Presidents, R. S. Archer, H. Harvey. 
•A. Bernard, and *T. B. Grimsdale; Hon. Treasurer, 
James Armstrong; Hon. General Secretary, J. M. Hunt ; 
Hon. Secretary to Ordinary Meetings, W. Thelwall 
Thomas j Hon. Librarian, # W. Permewan; Council, F 
H. Barendt, E. A. Browne ; R. Caton, F. Johnston, Leslie 
Roberts. Arthur Wallace, * William Alexander. *R. A 
Bickersteth, *T. M. Dawson, # J. C. Davey, *J. Burns 
Gemmel, and # J. J. O’Hagan; Auditors, *H. Harvey and 
•C. J. Macilister ; Pathological and Microscopical Com¬ 
mittee, J. H. Abram, F. H Barendt, R. A. Bickersteth, 
R. Boyce, A. W. Campbell, F. C. Larkin, C. J. Macalister, 
G. P. Newbolt, F. T. Paul, and C. S. Sherrington; 
.Journal Committee, Hon. Sec Ordinary Meetings, Hon. 
Sec Pathological Section, *F. T. Paul, F. H. Barendt, T 
B. Grimsdale, C. G. Lee, C. J. Macalister, G. P. Newbolt, 
and W. Permewan. Those marked (•) did not hold the 
-same office last yerr. 

Medical, Sickness, and Aoddent Society. 

The annual monthly meeting of the Executive Com¬ 
mittee of the Medical, Sickness, Annuity, and Life Assu¬ 
rance Society, was held at 429, Strand, London. W.C., on 
-the 30th ult. There were present Dr. De Havilland Hal 
in the chair, Dr. J B. Ball, Dr. M. Greenwood, Dr. Walter 
8mith, Dr. Alfred S. Gubb, Dr. J. W. Hunt, Dr. W. 
Knowsley Sihley, and Dr F. J. Allan. The amounts pre¬ 
sented showed that the business of the year 1898 would 
be no exoeption to the rule of prosperity which has 
Attended the operations of the Society since it started in 
1884. A large sum has been paid away during the 
twelve months as sickness allowance to the members 
incapacitated by illness or aocident, bub the total is 
well under the amount expected and provided for, and 
the year’s working shows a considerable increase of the 
funds of the Society which now amount to over .£120,000. 
Prospectuses and all information on application to Mr. 
F. Addiscott, Secretary, Medical, Sickness, and Accident 
Society, 33, Chancery Lane, London, W.C. 

Chelsea (Hospital for Women 

Baronnx de Hibsch has contributed £200 towards 
the £4,000 required for the new Nurses’ Home, the 
■enlargement of the operating theatre, and other improve¬ 
ments contemplated in connection with this institution. 

New Coroner’s Court. 

In accordance with the policy of the London County 
Council, a new coroner’s court was recently opened for 
public use at Hammersmith. It is described as the 
largest and most complete building of its kind in the 
metropolis. By an arrangement of passages the jury 
will only have to view the bodies through glass windows, 
and besides post-mortem rooms, it is fitted with a 
disinfecting-house, shell-house, and laboratory, together 
with a special mortuary for infectious cases. The total 
■cost of the building, which is lighted throughout with 
electric light, is £3,743. 

British Gynaecological Society. 

The annual meeting of the Society was held on 
January 12th, 1899, the president, Dr. MacNaughton- 
Jones, in the chair. The following officers and Council 
for the year 1899 were elected .-— 

Hon. President.—R. Barnes, M.D , F.R.C.P. (London). 

President.—H. MacNaughton-Jones, M D., F.R.C.S. I. 
(London). 

Vice-Presidents.—G. G. Bantock, M.D. (London), 
A. E. Cordes, M.D. (Geneva), G. Elder, M.D. (Notting¬ 
ham), R. H. Hodgson, M.D. (London), F. Bowreman 
Jessett, F.R.C.S. (London), J. Macpherson Lawrie, M.D. 
(Weymouth), J. J. Macan, M.D. (London), R. Milne 
Murray, M.D. (Edinburgh), R. D. Purefoy, M.D. (Dub¬ 
lin), F. F. 8chacht, M.D., B.A. (London), W. Travers, 
M.D., F.R.C.S. (London), and Professor Hector Treub, 
M.D. (Amsterdam). 

Treasurer.—J. A Mansell-Moullin, M.D. (London). 

Council. — W. Armstrong, M.R.C.S. (Buxton), N. 


Whitelaw Bourns, M.D. (London), Professor Murdoch 
Cameron, M.D. (Glasgow), John Campbell, M.D., F.R.C.S. 
(Belfast), G. Ro«e Carter, M.R.C P.I. (London), A. Donald, 
M.D. (Manchester), T. Eastes, M.D. F.R.C.8. (Folkestone), 
F. Edge, M.D.. F.R C.S. (Wolverhampton). C. H. Gage- 
Brown, M.D. (London), H. Bellamy Gardner, M.R.C.S. 
(London), C. Godson, M.D. (London), H. S. Howell, M.D. 
(London), J. Fumeaux Jordan, F.R.C.S. (Birmingham), 
Skene Keith, M B., F.R.C.S.Ed. (London), Christopher 
Martin, M.B., F.R.C.S. (Birmingham), T. Morton, M.D. 
(London), W. H. Newnham, M.B.Cantab. (Clifton), Pro¬ 
fessor A. W. Mayo-Robson, F.R.C.8. (Leeds), C. H. F. 
Routh, M.D. (London), W. Slimon, M.D. (London), E. T. 
Smith, L.S A. (London), Heywood Smith, M.D. (London), 
R. T. Smith, M.D. (London), and D. Thomson, M.D. 
(London). 

Editors of Journal.—F. F. Schacht, M.D., B.A. 
(London), Arthur E. Giles, M.D., B.8c. (London), and 
J. J. Macan, M D., M.A. (London). 

Hon. Secretaries.—George E. Keith, M.B. (London), 
and Arthur E. Giles, M D., B 8c. (London). 

The President gave his Annual Address on " Gynaeco¬ 
logical Lessons of the Past Year." A conversazione 
followed, at which some 150 Fellows and visitors were 
present. Recitations by Mr. M. B. Spurr. and selections 
of vocal music by the Misses and Mr. Isidor de Solla 
were much appreciated. 8ome new and interesting 
gynaecological instruments were shown by the President, 
including Dr. Kolischer's operating cystoscope. Dr. 
Doyen’s Ucierpince for producing haemostasis by pressure 
and crushinsr, in vaginal and abdominal hysterectomy. 
Professor Schauta’s ligature tightener for securing 
ligatures in difficult positions in the pelvis; and various 
other gynaecological appliances. 

Dr. M. K. Hargreaves, of Wimbledon, was last week 
the defendant in an action for malpraxis brought by a 
carpenter who claimed damages on the ground that after 
an accident he had been treated by the defendant for 
fracture of the tibia, whereas the fibula was also broken. 
Evidence was given in plaintiff’s favour by Dr. David 
Findlay, who asserted that extension ought to have been 
employed to prevent displacement, but after hearing 
professional testimony on the other side the jury un- 
1 hesitatingly gave a verdict for the defendant. 

Society for the Relief of Widows and Orphans of Medical 
Men. 

At the quarterly oourt of directors of this Society, 
held on Wednesday last, Dr. Stamford Felce, V.P., in the 
chair, one new member was elected, and the deaths of 
seven reported. Among the deaths the directors had to 
regret those of three old and valued members, viz., Sir 
William Jenner.V.P.. Dr. Hare, and Dr. Munk. One 
application from a widow was received, and a grant at 
the rate of £50 per annum made. It was resolved to 
distribute the sum of £1,216 10s. among the fifty widows, 
ten orphans, and six recipients from the Copeland Fund. 
The expenses of the quarter were £77. A Christmas pre¬ 
sent of £551 had been given to the widows and orphans 
on December 18th, and a special grant of £20 had been 
made to a widow suffering from malignant disease. 

An unqualified person called Thomas Owen Davies was 
last week sued under the Apothecaries’ Act on the 
ground of the illegal practice of medicine, and a penalty 
of £20 and costs was inflicted, it being intimated, how¬ 
ever that the penalty would not be pressed for if the 
defendant would undertake not to repeat the offence. 

West London Msdlco-Chlrurglcal Society. 

A discussion on “The Treatment—Medical and Sur¬ 
gical—of Acute Inflammation of the Vermiform Appen¬ 
dix ” will take place at the next meeting of the Society 
on Friday, February 3rd, at 8.15 p.m., in the Society’s 
Rooms at the West London Hospital, Hammersmith, W. 
It is expected that a large number of members and 
visitors will be present. Any medical man is invited to 
attend as a visitor if not already a member of the Society. 
The discussion will be opened by Dr. Seymour Taylor and 
Mr. McAdam Eocles, and, among others, the following 
have promised to take part: Dr. Donald Hood, Mr. C. 
B Keetley, Dr. Stanley Smith, Mr. L. A. Bidwell, Dr. H. 
A. Caley. 


The Medical Press. 


NOTICES TO CORRESPONDENTS. 


Jan. 18, 1899. 


^ottcte to 

Corns})onbents, Short Otters, &£. 

•8T Correspondents requiring a reply in this column are par 
tlcnlarly requested to make use of a distinctive signature or 
initial 1 , and avoid the practice of signing themselves ' Reader,” 
“Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
•pared by attention to this rule. 

M. N. O.—The marriage rate for London sho*s a steady in¬ 
crease, being higher in 18!»7 than for twenty-two years pr. viously. 
Curiously enough, there is far from being a corresponding increase 
In the birth rate, which has progressively fallen for the last thirty 
years, and now stands at SO. The cause of this diminution is pro¬ 
bably social rather than physiological, and it is a manifestation 
of a tendency which appears to be characteristic of existing 
civilisation. 

Dr. Ooilvie.—W e will endeavour to comply with your request 
In the near future. 

Dr. P.—We are unable to publish your communication, partly 
by reason of its inordinate length, partly by reasou of its 
excessively personal nature. 

Dr. Matgribr (Pari*).—The receipt of Prof. Maygrier’s clinical 
lecture on “ The Treatment of Fissures of the Nipples,” from our 
French correspondent is hereby acknowledged with thanks. 

THE CONVICT COLLIN8. 

“ Sir,” writes T 426, " I find it stated that Dr. Collins has been 
transferred from Chelmsford to Portland. Sir, this is an error. 
Dr. Collins was transferred to Dartmoor. He is doing well as a 
member of No. 38 party (Med. Officer’s party). All prisoners in 
No. 38 get full diet anu full marts, and thesupposed-to-be lightest 
labour in the prison. I left Collins and the party last week ” My 
esteemed correspondent, says the Sun, Is, as you see, an ex-convict, 
and has just done the best part of seven years' penal servitude. 

JENNERIAN LITERATURE. 

To the Editor of the Medical Press and Circular. 

Sir,—I t has been suggest* d to me that the members of the 


T W V V ' ”** *’**’" "MMUg-'UUUB, WLIOIO mey 

might be seen by their patients and others. The Jenner Society 
will be happy to supply such literature to anyoue who will apply 
for it. 

I am glad to find, from communications I am increasingly 
receiving, that the member of the profession are beginning to take 
much more active part in this good work than they havenitherto 
done, by giving lectures and addresses on the subject, by corres- 

f ondence in the public papers, and by joining In debases on it. 

shall be pleased to give any assistance in this direction to any 
who may desire it. 

I am. Sir, yours truly, 

Francis T. Bond, M.D., 

Hon. Secretary, Jenner Society. 
The Jenner Society, Gloucester, January 3rd, 1899. 

[Dr. Bond sends us a large number of pamphlets which bear 
eloquent testimony to the good work done by his 8odety. Every 
medical man should have copies of these, whtch he can distribute 
among his patients.— Ed., M. P. A C.] 

Reeling* of the §atittits aitb JCertuves. 

Wednesday, January 18th. 

Royal Microscopical Society (20 Hanover Square, W.).—8 
p.m. President: Annual Address. 

Rotax Meteorological Society (Institution of Civil Engineers. 
Gt. George Street, Westminster. 8.W.).—7.30 p.m. Ordinary 
Meeting. 7.46 p.m. Report of the Council. Election of Officers 
and Council. Mr. F. (J. Bayard (President): The Government 
Meteorological Organisttious in Various Parts of the World (illus¬ 
trated by lantern slides). 

North-West London Clinical Societt (North-West London 
Hospital).-8.30 p.m. Monthly Demonstration of Clinical Cases 

Thursday, January 19th 

Harvbian 8ocibty op London (Stafford Rooms, Titchborne 
8treet, Edgware Road).-8.30 p.m. Annual General Meeting. 
Elec ion of Officers. Presidential Address. Annual Conversazione. 
Friday, January 20th. 

Epidemiological Society op London (11 Chandos Street 
Cavendish Square, W.).-8.30p.m. Paper:-Dr, B. Low: Epidemic 
Cerebro Spinal Meningitis. 

Royal Academy op Medicine in Ireland.—Section op 
Surgery.— (Royal College of Surgeons).—Papers: -1. Mr. Henry 
Gray Croly: Dislocations and Fractures of the Astragalus. 2. Mr. 
John Lenttigne: A Case of Chronic Intestinal Obstruction treated 
by Laparotomy, with Bnterotomy and formation of Intestinal 
“ ' ’ V. 

fm 


location of the head of the femur on the transverse ranus of the 

S ubes (skiagraph before and after operation exhibited). 4. Mr. 

.. Glasgow Pattison.- Recent fracture of Patella treated by new 
method. 5. Mr. John Lentaigne: (a) Girl, ag»d 12, t r eated for 
chronic intestinal obstruction oy laparotomy with enteiotomy 
and formation of iutestinal fistula, with subsequent excision of 
csccum for stricture at region of iliocmcal valve. (6) Cases of frac¬ 
ture simple of astragalus, with displacement of head of bone up¬ 
wards snd outwards. Card Specimens: —1. Mr. R. Glasgow 
Pattison: Tumour of Breast. 2. Mr. John Lentaigne: (a) Ctecum 
and part of ileum removed for stricture at ilioceecal valve with 
polypoid tumours projecting Into crecum. (6) Ca t of foot in case 
of fracture of astragalus, with displacement of head also skia¬ 
graph (both taken before operation). 

Society of An .ksthetists (20 Hanover Square, W.).—8 30 p.m. 
Cootiouation of Adjourned Discussion on Selection of an 
Anesthetic. 

Royal Institution of Great Britain.- 9 p.m. Professor 
Dewar: Liquid Hydrogen. 

Vacancies. 

Finsbury Dispensary. Brewer 8treet. Goswell Road, London. E.C 
—Resident Medical Officer. Salary £120 per annum, with 
furnished residence in the Institution attendance, coals, and 
gas. 

General Hospital, Nottingham.—House Physician. Salary com¬ 
mencing at £ 100 , with board, lodging, and washing. 

Jaffray Branch of the General Hospital, Gravelly Hill, near 
Birmingham.—Resident Medical and Surgical Officer. Salary 
. £160peraunum. with board, residence, and washing. 

Newcastle on-Tyne Dispensary. — Visiting Medical Assistant. 

Salary £120 for the fl>sc year and £150 afterwards. 
Northampton General Infirmary.—Assistant House Surgeon, un¬ 
married. Salary £100 per annum, with furnished apartments, 
bo .rd. attendance, and washing. 

West Derby Union.—Resident Assistant Medical Officer for the 
Workhouse, Walton-oa-the-Hill, Liverpool. Salary £100 per 
annum with first cla«s rations, apartments, &c. Applications 
to the Union Clerk, Brougham Terrace, West Derby Road. 

^poiniments. 

Benson, Fbancis Alotsius, L.R.C.8. L.R.C.P.T., Public Vac¬ 
cinator for the Ormesby District of the Middlesbrough 
Union. 

Cooper, 0. W., M.B., M.ILC.P.Lond., Honorary Consulting Phy¬ 
sician to the Leicester Infirmary. 

Gray, 8arah, L.R.C.P., L.R.C.S.Edin„ L.F.P. and 8. Glasg., 
Assistant Surgeon for the Nottingham Hospital for Women. 
Greenwood,Frank R„ M.R.C.8., L.RC.P.. Resident Surgical 
Officer for the Birmingham and Midland Free Hospital for 
Sick Children. 

Knox, J. e., M B., C.M.Edln.. Medical Officer for the Molesey 
Sanitary District of the Kingston Union. 

Osborne, O., L.R.C.P.Lond.. M.B.C.S., Medical Officer of Health 
by the Bexbill Urban District Council. 

Peck, H., M.B.Edin., L.R.C.P., L.R.C.8., D.P.H.Camb., Medical 
Officer of Health for the Chesterfield Rural District, 

Pratt, Rkginald. M.D.Lond., M.R.C.8., an Honorary Physician 
to the Leicester Infirmary. 

Pugh, Robt., M.B., Ch B.Edin., Junior Assistant Medical Officer 
for the City Asylum, Birmingham. 

Hargreaves.—O n Jan. loth, at Akaroa, N.Z., the wife of W. H- 
Hargreaves, M.R.0.8.Lond. (late Middlesex Hospital), of a 
daughter. 

Jones.— On Jan. 13th, at Bunbury Vicarage, Tarporley, the wife 
of Clement Royds Jones, M.B., of a son. 

WoRNUM.-On Jan. 8th, at Belsize Park. N.W.,the wife of Georg* 
Porter Womnm, M.R.C.S., of a daughter. 

Pulham-Turnbr—Elbrs. —On Jan. 10th, by licence, at All Saints' 
Parish Church, Leyton, Essex, Harry Fulham-Turner. 
M.R.C.S., L.R.C.P., son of the late E. Ful&am-Turner, M.B., to 
Margaret, eldest daughter of Walter Warin< Elers, solicitor. 
Hastings—Mundella.- On Jan. 5, at St. Mark’s, Regent’6 Park, 
London, Edwin Birchall Hastings, M.D., youngest son of the 
late William Hastings, of Huddersfield, to Theresa, second 
daughter of the late John Mundella, of Nottingham. 
Nightingale—Collison.- On Jan. 7. at St. Mary Abbot's, 
Kensington, Percy Athslstan Nightingale, M.D., son of the 
late Percy Nightingale, to Murid Stoughton, third daughter 
of the late Charles Stoughton Collison, of Ken-ington, W. 
Tatlor—Pbrch.— On Jan. 7th, at Holy Trinity Church, Roe- 
hampton^ 8.W., Alfred Ernest Taylor, M.8., B.S.Lond., 
lraster Gate, W., to Mary Emma, eldest 
Peech, of Fern Bank, Roehampton Park, 

































Ste 3§Mtal 'gtm and (Circular. 

“SALUS POPULI SUPREMA LEX.” 


Vol. CXVIII. WEDNESDAY, 


(Elitraal Jerture 

ON 

DYSPEPSIA OK GASTRIC 
DILATATION? 

Delivered at the Westminster Hospital. 

By WILLIAM MURRELL, M.D., F.R.C.P., 

Physician to, and Joint-Lecturer on Medicine at the Hospital. 

Thebe is no doubt that many patients who are 
supposed to be suffering from chronic dyspepsia are 
in reality the victims of dilatation of the stomach 
and could readily be cured by an operation. The 
symptoms are similar and might easily be incorrectly 
interpreted. Moreover, in these cases, patients often 
come with a ready made diagnosis, and when a 
patient says that he is suffering from indigestion it 
too often happens that a prescription is written 
without any detailed investigation into the na'ure of 
the symptoms and without any examination into the 
condition of the abdominal organs. There are, of 
course, many varieties of dyspepsia, such as nervous 
dyspepsia, gouty dyspepsia, and alcoholic dyspepsia, 
but the most common form is that due to gastric in¬ 
sufficiency. In these cases there is not only a 
diminished and inadequate secretion of gastric juice, 
but the motor activity of the organ is impaired. It 
is common enough in people who lead a sedentary 
life, take but little exercise, and work their brains 
inordinately. 

The symptoms of gastric insufficiency and of 
gastric dilatation or gastrectasis have many points 
in common, although they differ in matters of detail. 
In the first place, there is the p tin or discomfort 
which in cases of dyspepsia usually comes on soon 
after taking a meal. It is usually referred to the 
epigastric region, but may extend over the whole of 
the abdomen, and even to the interscapnlar region 
or some distant part of the body. It is not an 
acute pain, such as we get in biliary, renal, or in¬ 
testinal colic, but is of a dull, aching character. It 
may persist for hours, especially after a full meal, or 
when food is taken of an especially indigestible 
character. It is usually accompanied by consider¬ 
able depression of spirits, and the patient displays 
a marked disinclination for either mental or 
physical exertion. There is often drowsiness, with 
a feeling of oppression, and the patient, if dis¬ 
turbed, is apt to show signs of irritability. Some¬ 
times the pain is of a burning character, and an 
acid bitter fluid, which sets the teeth on edge, regur¬ 
gitates into the mouth. The patient calls it heart¬ 
burn, and says that he has an attack of acidity. It 
is not in reality due to excess of hydrochloric acid in 
the stomach, but arises from the lactic acid formed 
by bacterial decomposition of carbohydrates or from 
butyric acid and other products of fermentation. The 
pain of gastric dilatation is of a somewhat different 
character—is not experienced immediately after 
food, is rarely acute, is not associated with pyrosis or 
eructations, and is independent of the kind of food 
taken. It is purely mechanical in origin, and is 


January 25, 1 8 99. No. 4. 


promptly relieved by vomiting or by syphonage. 
Vomiting is not a constant symptom of dyspepsia, 
but many patients intentionally make them¬ 
selves sick for the sake of the relief which the 
evacuation of the contents of the stomach affords. 
When, however, there is vomiting it usually takes 

f lace soon after the indigestible meal has been taken, 
n dilatation of the stomach the vomiting is long 
delayed. For instance, in a case recently under my 
care, the patient dined at 2 p m., and vomited at 7 or 
8 o’clock in the evening. Impairment of appetite is 
common to both conditions, and in gastrectasis it is 
especially capricious. In one of our cases the patient 
haul long ceased to take meat, and lived almost 
entirely on milk and tea and bread and butter. In 
dyspepsia the evacuations are usually eolid, dry, and 
hard, and they may be light in colour, whilst in 
dilated stomach they are usually shrunken and hard. 
Thirst is nearly always a prominent symptom 
of gastrectasis, and may De so pronounced as to 
lead to a suspicion that the patient has diabetes. 
The distended stomach is incapable of absorbing the 
fluid poured into it, and the patient is dry and 
parched. This symptom has often to be relieved by 
copious eneraata of water, which the rectum absorbs 
with avidity. Loss of flesh is another prominent 
symptom of dilated stomach, and the patient becomes 
rapidly emaciated. One of our patients on admission 
weighed 104 lbs., and another only 72 lbs. The tem¬ 
perature is subnormal, and the patient is feeble and 
constantly complains of chilliness. The urine is 
scanty and contains triple phosphates in abundance. 
Tfte vital condition is low, the pulse is weak, the face 
is pale and pinched, and the patient is capable of but 
little exertion. The spirits are depressed, and sleep 
is often disturbed by distressing dreams. Headache, 
tinnitus, vertigo, and other nervous phenomena are 
complained of, and the patient often presents indica¬ 
tions of auto-intoxication due to the retention of 
unassimilated food, a condition resembling that so 
often seen in cases of long continued constipation. 

Dyspepsia and gastrectasis have many symptoms 
in common, but there are many points of difference. 
The delayed vomiting, the thirst and the rapid ema¬ 
ciation in a case supposed to be dyspepsia, should 
excite a suspicion of the existence of a dilated 
stomach. 

Any stomach is dilated whatever may be the 
capacity when its propulsive power is so diminished 
that the passage of the food is abnormally delayed. 
There is no standard stomach for a givtn size of body, 
and the capacity of an adult’s stomach in a condition 
of health ranges from 9 ozs. to 60 ozs. The average 
is from thirty-five to forty ounces, and anything over 
sixty ounces is abnormal. Gastrectasis is usually 
associated with some form of pyloric obstruction, 
possibly malignant, but more probably due to con¬ 
traction of the cicatrices of gastric ulcers.. The 
ordinary treatment of gastric ulcer is notoriously 
inadequate, and many patients who have been con¬ 
fined to bed for six weeks or more, and who have 
been religiously fed on peptonised food or by rectal 
enemata, return in a few weeks with a recurrence of 
all their old symptoms, and in a large proportion of 
cases, with superadded gastrectasis. Gastric ulcer 

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82 Ths Medical Press. 


ORIGINAL COMMUNICATIONS. 


Jan. 25, 1899. 


is the common starting point of dilated stomach, 
especially in young women, hut it may arise from 
exceptional causes, such as torsion due to disloca¬ 
tion. adhesions to neighbonring structures, such as 
the liver or gall-bladder, and even to enteroptosis. This 
enteroptosis or visceroptosis is a very curious con¬ 
dition, the term being applied to those cases in which 
the various abdominal organs have become displaced 
from their normal position. As this displacement is 
nearly always in a downward direction, the term 
“dropping of the viscera” has been applied to it, 
and it is analogous to the “ falling of the womb ” with 
which we are familiar in women. Enteroptosis was 
originally described by Gllnard in 1885, and is often 
spoken of in accordance with the very prevalent but 
by no means commendable custom of naming every 
pathological condition or group of symptoms after 
some particular individual, as Gl^nard’s Disease. 
This displacement is especially apt to occur 
in cases of dilated stomach associated with 
obstruction of the pylorus, and it is both 
a cause and an effect. The stomach is usually dis- 

E laced to the left, and the enlarged pylorus if it can 
e detected by manual examination is found to be 
well over the left of the median line. Normally the 
pylorus is opposite a point just below the xiphister- 
num and just outside the parasternal line. This form 
of displacement of the stomach is, however, rare, 
and for all practical purposes dilatation of the 
stomach as a chronic affection is due either to malig¬ 
nant disease of the pylorus or to the contraction 
resulting from the cicatrices of gastric ulcere. Gas- 
trectasis may, however, assume a more acute form, 
and is met with iu the course of rheumatic fever and 
pneumonia, or as a complication of phthisis, diabetes, 
and other diseases. The enlarged abdomen of rickety 
children is in some cases due to this condition. 

Chronic dilatation of the stomach occurs chiefly in 
women, and usually in women of middle age. When 
it is met with in persons over fifty it is commonly 
due to or associated with malignant disease of the 
pylorus. The physical signs are of the greatest value 
m arriving at a diagnosis. It is often said that it is 
difficult to map out the stomach by percussion, but I 
have not found this to be the case, and we have never 
had to resort to the expedient of distending the viscus 
by carbonic acid, formed by the administration first 
of an alkaline carbonate and then of an acid. The 
“ splash ” sign is not always obtainable, but when 
present it is an indication of considerable importance. 
Syphonage may be employed for diagnostic purposes, 
but it is not essential. In many of our cases the 
diagnosis was so clear that there was no necessity for 
putting the patient to the pain and discomfort of in¬ 
troducing a tube. 

The treatment of cases of dyspepsia usually pre¬ 
sents no difficulty.. If there are from time to time 
failures it is from the neglect to recognise certain 
elementary facts which are familiar enough to every¬ 
one who has had much experience of out-patient 
work. In the treatment of dyspepsia it is necessary 
to remember that alkalies increase acid secretions 
and decrease alkaline secretions, and that acids 
increase alkaline secretions and decrease acid secre¬ 
tions. This is the key-note to the situation. Then, 
again, many prescribere have no facility in manipu¬ 
lating their bitter-tonics. They order some one 
particular member of the group with which they 
are familiar and ignore the others. If they prescribe 
gentian they prescribe gentian always, and never use 
its congeners quassia, calumba, chiretta, and so on. 
Then again many people have very little practical 
acquaintance with the value of oil of ca jeput in the 
treatment of dyspepsia accompanied by flatulence. 
In a well-known book on diseases of the stomach I 
find a long list of antifermentatives, including 
reeoscin and Beta-naphthol, but not a word about 


cajeput. Three drops of oil of cajeput on a piece of 
sugar or on a crumb of bread taken frequently is 
worth all the others put together. It is not only 
antiseptic but it is agreeable to take. Glycerin, too, 
is an excellent remedy, and a teaspoonful in a wine 
glass of water flavoured with a few drops of lemon 
juice will in many cases effect a speedy cure. 
Very often I use equal parts of glycerine and glyce¬ 
rine of borax. A useful prescription is boro-glyceride, 
half a drachm, glycerin half a drachm, spirit of 
chloroform, fifteen minims, syrup of lemon, half a 
drachm, and water to an ounce. Capsicum is most 
useful in alcoholic dyspepsia and in the gastritis of 
drunkards. Minim, or two minim doses are ample, 
but the tincture must never be given in an effervescing 
mixture or you may blind your patient. The custom 
of stimulating the mucouB membrane of the stomach 
by the application of tincture of iodine is a good one. 
I order ten minims of tincture of iodine in an ounce 
of water, with half a drachm of glycerine. It is 
administered before food, and the patient is directed to 
roll over from side to side once or twice so as to diffuse 
it evenly all over the lining of the stomach. It gives rise 
to no pain but only to a pleasant sensation of warmth, 
and I have never known it do any harm even when there 
has been reason to suspect the existem e of ulceration. 
Bichromate of potassium is another drug which it is 
impossible to ignore. Prof. T. R. Fraser, of Edin¬ 
burgh, to whom we are indebted for the introduction 
of lliis remedy has shown that it is capable often 
in a short time of removing the entire group of 
symptoms encountered in dyspepsia especially ano¬ 
rexia, pain, nausea, vomiting, and gastric tenderness. 
It should be administered fasting in doses of from 
one-iwelfth grain to one-sixth grain three times a day 
either in solution or in the form of a pill. The solution 
may lie conveniently flavoured with syrup of 
tolu or syrup of orange, and the pills are best 
made up with kaolin ointment. In cases of 
gastric ulcer the results are just as favourable 
as in simple cases of dyspepsia with the exception 
that in acute gastric ulceration with hsematemesis the 
bleeding from the stomach is not checked. Probably 
the woret fault of all in the treatment of dyspepsia is 
the custom of prescribing pepsin without explicit 
directions as to the kind or make of pepsin which is 
to be dispensed. There are pepsins and pepsins; 
some are excellent whilst others are so inactive as to 
be practically useless. The estimation of the com¬ 
parative value of different preparations of pepsin, 
although simple in theory is bv no means easy in 
practice. The essential action of pepsin is proteolytic 
—the conversion of proteids into peptoneB—and this 
is taken as the test of the value of the specimen. The 
observation may be made on fibrin or egg-albumin, 
but the latter is more convenient. The eggs must be 
quite fresh and should be boiled in a uniform manner. 
The best way is to boil the water first, and then put 
the eggs in altogether, and let them boil for ten 
minutes. If a shorter time is allowed, the white will 
not separate from the yolk nicely and cleanly. Fif¬ 
teen eggs will yield 7,000 grains of coagulated albu¬ 
min, or perhaps a little less. The best test is the 
weight of albumen which one grain of pepsin will 
digest in four hours in eight ounces of 1 per cent, 
hydrochloric acid of sp. gr. 1T50 at a temperature of 
38 deg. C. Some time ago I tested all the pepsins in 
the market, English as well as foreign, and the differ¬ 
ence in activity was so startling that now I never 
prescribe pepsin without indicating the particular 
make required, and I never prescribe any special form 
of pepsin without previously ascertaining for myself 
exactly what it will do. Another mistake commonly 
made with respect to pepsin is to give it in doses 
which are too small and are powerless to exert any 
beneficial action. 

The treatment of dilated Btomaoh is a much mor 


Jan. 25, 1899. ORIGINAL COMMUNICATIONS. Tme Medical Press. 83 


serious matter. Electricity is useless, and massage 
often fails to give good results. Lavage or syphon- 
age is useful, but it is a slow, tedious, and disagree¬ 
able process. To have to wash out your stomach 
every night and morning is a serious addition to your 
other toilet requirements. The best plan is to have 
an operation, and to get cured at once. You remem¬ 
ber a woman recently in the Hospital, the cubic 
capacity of whose stomach was eight pints. She 
bad been under treatment for six months, and 
for the greater part of that time had had 
syphona^e, but in spite of this she was 
steadily losing ground. I remembered that 
in cases of relaxed scrotum, I had seen a large fold of 
useless tissue removed in order to leave a serviceable 
bag in which to contain the testicles, without the 
necessity for constantly wearing a suspensory ban¬ 
dage, so I asked Mr. Spencer if he coula not take a 
reef out of the woman’s stomach, or, at all events, 
run in a few tucks so as to reduce its size and improve 
its motor power. He suggested that what I wanted 
was a combination of pyloroplasty and gastrorrhaphy 
—pyloroplasty to enlarge the pylorus, and gas¬ 
trorrhaphy to reduce the stomach to its normal size. 
The words seem formidable, but the operation itself 
in his skilled hands fortunately presented no 
difficulty. The pyloric end of the stomach and the 
pylorus were found to be involved in a mass of 
scar tissue, with inflammatory bands outside. 
The bands were first divided between two ligatures, 
and then the mass of scar-tissue in the pylorus by 
means of longitudinal incisions. The pyloric aper¬ 
ture was stretched, and tucks were made in the wall 
of the stomach by interrupted sutures running along 
the whole of the anterior snrface so as to reduce it to 
the normal size. The operation lasted over two 
hours, chiefly in consequence of the unsatisfactory 
condition of the patient, but she made an uninter¬ 
ruptedly good recovery. The temperature never rose 
above 100’4 F., there was no vomiting, and practically 
no pain or discomfort. Three weeks after the 
operation she was up and about, and could take 
meat, fish, pudding, bread and butter, jelly and 
eggs, without the slightest difficulty, and she had 
gained a stone in weight. The publication of this 
successful case (a) brought other patients desirous 
of obtaining relief, many of them being sent in 
especially with a view to operation, and Mr. Spencer 
now performs gastrorraphy almost every week. We 
are not yet in a position to publish statistics, but I 
may say that so far we have not had a single failure. 
As an illustration of the benefit to be derived from 
this mode of procedure, I will give you an outline of 
a case still in the hospital, which presents many 
features of interest. The patient, a single woman, 
»t. 48, was sent in under my care by Dr. Stonely 
Hill, on November 30th, 1898. She is a cook by 
occupation, and had suffered from flatulence for ten 
years, but with this exception had fairly good health 
until nine months ago, when the flatulence became 
worse, and she suffered from vomiting and pain re¬ 
ferred to the epigastric region. The pain was not 
acute, but was of a gnawing character. At this 
time she bad dinner at 2 p.m., and a cup of tea and a 
slice of bread and butter at 4 p.m. The pain always 
came on between 6 and 7 p.m., and was followed by 
vomiting. The vomited matter consisted first of her 
dinner and tea mixed, and then of white frothy fluid. 
The pain was relieved by vomiting, and did not return 
until the same time the next day. Her appetite was 
extremely poor, but even if she took no food all day 
she vomited large quantities of the white frothy fluid 
in the evening. About six months a^o these symptoms 
increased in severity, the pain radiated all over the 
abdomen, and extended to the inter-scapular region. 

(a) Medical Press akd Circular, Nov. 2nd, 1898. 


The flatulence and discomfort were more severe 
vomiting was more violent, and she suffered 
greatly from thirst. She rapidly lost flesh 
until she was reduced to 5 st. 2 lbs., and 
was unable to follow her occupation. On admis¬ 
sion she was carefully examined but no tumour 
could be detected in the abdomen. The stomach was 
percussed out without difficulty. The highest limit 
of gastric resonance was the sixth rib in the nipple 
line, whilst its liver boundary extended to the sub¬ 
costal line. Its greatest curvature extended in rela¬ 
tion to the sixth, seventh, eighth, ninth, and tenth 
ribs to the subcostal line, whilst the lesser curvature 
was in the epigastric region the gastric note merging 
into a hyper-resonant area extending into the 
umbilical and right hypochondriac regions. The 
area of the stomach, however, varied from time to 
time, and not infrequently the gastric note could be 
detjcted as low as the umbilicus, The “splash’* 
could be obtained, although not always. There was 
no doubt as to the diagnosis, and it was obviously a 
case of gastrectasis. The fact of the patient 
having been three years under observation 
and the absence of hsematemesis practically 
excluded malignant disease and ulcer of the stomach. 
We were so certain about the nature of the case that 
we did not think it necessary to pass a tube into the 
stomach. Mr. Spencer decided to operate at once. 
The stomach was enormously distended, and there 
were old scars in the neighbourhood of the pylorus, 
which was attached by thickened bands to the under 
surface of the liver. The mode of procedure adopted 
was that already described, the operation lasting an 
hour and a quarter. The highest temperature was 
100 4 degs., and on the third day the patient was able 
to take food by the mouth, and ten days later she 
was taking pounded meat and fish. 

The prognosis in the case on which Mr. Spencer 
operated yesterday was considered to be less favour¬ 
able. The following was the opinion given on admis¬ 
sion : The patient is a woman of middle age who 
some years ago had a severe attack of gastric ulcer 
during which she vomited large quantities of blood. 
For the last thirteen weeks she has suffered from 
severe pain in the abdomen, coming on about half-an- 
hour after each meal and followed in about two hours 
by vomiting. When she lies on the left side there is 
a dull aching pain, which is quite independent of the 
pain excited by food. She loses flesh rapidly, and 
is greatly emaciated. The stomach is dilated, 
and its greater curvature extends well below the 
umbilicus. In the right hypochondriac region 
and in the upper part of the umbilical region 
a thickening can be detected both by pal¬ 
pation and by percussion. She has probably malig¬ 
nant disease of the pylorus, which may have 
attacked the site of old cicatricial tissue. Gastro¬ 
jejunostomy will probably have to be performed. 
This unfavourable prognosis fortunately turned out 
to be incorrect. Directly the abdomen was opened it 
was seen that there was no tumour. The stomach 
was constricted some little distance above the pylorus 
by old cicatricial tissue,- which had resulted from the 
healing of an ulcer, but there was no malignant 
growth. The stomach was adherent to the under 
surface of the liver, and there were firm bands of 
attachment running between the stomach and the 
duodenum. The bands were divided between liga¬ 
tures and the stomach was opened, but it was not 
thought necessary to run in tucks. You will have an 
opportunity of watching the progress of the case, 
wnich I have no doubt will be favourable. This 
patient affords a good illustration of the fact that a 
condition presenting all the clinical features of cancer 
of the stomach may turn out to be non-malignant, 
and may be relieved by a comparatively simple opera¬ 
tion. 

Digitized by GOOgle 


84 Tin Medical Press. ORIGINAL COMMUNICATIONS. 


I am told that the operation of gastrorrhaphy ia 
“ unsurgical,” but that is a matter of perfect indiffer¬ 
ence to me as long as it saveB the lives of my patients. 
I am informed that it is just as absurd as it would 
be to treat stricture of the urethra by making tucks 
in a man’s bladder. I do not see the analogy, for the 
bladder is simply a receptacle for urine, whilst the 
stomach is a secreting organ. Moreover, in our cases 
we always stretch the pylorus in addition to reducing 
the size of the stomach. But granting the analogy, 
I hardly think that our critics would propose dilating 
the pylorus by passing a bougie into the rectum. 

My points are that many cases supposed to be 
chronic dyspepsia are in reality cases of dilated 
stomach, and that they can be cured by an operation. 


garis Clinical lectures. 

TREATMENT OF FISSURES OF 
THE NIPPLES BY ORTHOFORM. 

By Prof. MAYGRIER, 

Paris. 

[From our French Correspondent.] 

Few affections exist for which so many remedies 
have been proposed as that of fissure of the nipples. 
This apparent abundance in therapeutics is in this case, 
as in almost every other, a proof of our poverty in 
respect of a really effectual medication. It appears to 
me, on the other hand, superfluous to remark how re¬ 
grettable itwouldbe to seem to despise this little lesion, 
which, although temporary and in general benign, is 
none the less extremely painful and frequently con¬ 
stitutes a point of entry to infection of the mammaiy 
gland; infection, needless to state, serious to the 
mother and dangerous to the infant. In most cases 
maternal nursing is jeopardised, and that is a result 
which it is the duty of the medical attendant to avoid 
if possible. 

Antiseptic dressing, wet, dry, or astringent dress¬ 
ing, cicatrising varnish, local anesthetics, all have 
been tried with variable results ; tincture of benzoin, 
tannin, collodion, &c„ nothing has proved definitely 
and constantly effective. I may add, however, that 
nothing is so variable as the conditions in which the 
treatment is habitually earned out, for the fissures 
may lie more or less numerous and more or less 
infected in each case. 

Up to the present, the alcohol dressing recom¬ 
mended by M. Budin, has given us the best results ; 
but the painful phenomenon remains none the less, 
and we know that this fact has a real importance. 
Cocain used by Herrgott in this special point of view 
has not given all that was expected from it; even 
though washing of the nipple be insisted upon before 
resenting it to the infant, the cocain constitutes a 
angerous poison for the latter, as its existence is at 
the mercy of a negligent mother. Further, cocain 
is not devoid of action on the physiology of the 
lacteal secretion. Various practitioners, among others, 
Guenel of Nantes, who published an instructive 
observation on the subject, state that they have 
witnessed a decrease and even a complete suppression 
of the milk under the employment of cocain. One of 
my colleagues used it twice in private practice to 
suppress the secretion at the period chosen for 
weaningthe child, and with success. This fact is not so 
surprising when it is considered that the stimulation of 
the papillae of the nipples in the act of nursing plays a 
manifest rSle in the function of the gland ; to suppress 
its excitability by an anaesthetic closes the door to an 
essential reflex. It was with these facts in mind 
that I thought of employing orthoform, which had 


Jan. 25, 1690. 

already given proof of its anaesthetic properties in 
its local application to cutaneous or mucous exooria- 
tions in the hands of Edaussner, Hirschbuch, Gines- 
tons, Kallemberger, Neumayer, Yonge, &c. 

Without devoting time to the chemical history of 
orthoform already given by all the above authors, I 
•will Bimply remind you that it is the methyl ic ether 
of para-amidomela-oxy-benzoic acid, a synthetic pro¬ 
duct belonging to the same chemical family as 
cocain and different eucains described sometime ago. 
Orthoform is a crystalline yellowish power, insipid 
and inodorous, scarcely soluble in water, very soluble 
in alcohol, and especially so in ether, and by no means 
toxic. Einhom applied in one week fifty grammes 
of orthoform to a large ulcer of the leg without pro¬ 
voking any symptoms of poisoning; more recently 
Soulier and Gurnard, of Lyons, made a special 
study of the poisonous proportions of the drug and 
found it to average to one gramme per kilogramme 
of the weight of the body. Orthoform was introduced 
by its inventor as an antiseptic, but Lichwitz and 
Sabrayes made experiments with it and declared it 
to have but a moderate action in this direction, con¬ 
sequently it would not be well to place too much 
reliance on it and neglect the ordinary rules of asepsis. 
Can it by itself constitute a vehicle of germs and 
carry with ic infection ? In a word, is it necessary 
to submit it to disinfection before using it P I do 
not think so. 

The most interesting point in the history of ortho¬ 
form is its local analgesic action. It is very power¬ 
ful, since the deepest burns become under its contact 
almost immediately painless, and Blondel was able 
to practise curettage under its application without 
causing much suffering. Beraoud and Garel, of 
Lyons, have used it with success to relieve dysphagia 
caused by tuberculous ulceration of the pharynx, and 
in certain small operations in this region. Yonge 
eased by its influence the burning pains of open 
wounds, while others have produced remarkable 
relief by applying it to the vesicles of intercostal 
zona. Its action is much more lasting than that of 
cocain, and in all the cases published, the prolonga¬ 
tion of the anaesthesia was counted, not only by 
minutes, but by hours. Its average iB twelve hours, 
but it extends sometimes to twenty-four and excep¬ 
tionally to forty-eight hours (Einhom). But this 
action i6 not exercised on the intact epithelium as is 
the case with cocain; placed on the tongue, orthoform 
does not produce the numbing sensation of the latter. 
The dermis must be exposed so that the powder 
can lie brought in direct contact with the nerve 
terminals. Its essential indication is, therefore, 
the existence of a raw surface, however slight; under 
these conditions, orthoform produces absolute sup¬ 
pression of sensibility. It is necessary also that 
the contact with the wound be continuous as long as 
the desired effect is needed; it would appear that its 
slow solubility in the liquids of the human economy 
is the cause of the duration of the effect. 

For the last six months I have employed orthoform 
in the maternity of the Chai-itd Hospital in forty 
cases of fissure of the nipples. All the patients 
without exception experienced almost instant relief. 
I tried it in four different ways ; the powder with wet 
dressing; the powder in the dry state ; and lastly, a 
saturated alcoholic solution. The first mode of appli¬ 
cation was employed in 29 cases, and consisted simply 
in the direct application of the orthoform to the fissure 
and covering with a compress moistened with a solu¬ 
tion of boric acid, with a piece of oil silk over all; the 
dressing was removed each time the child was put 
to the breast, and replaced after that function. 
The dry application was followed in six cases, 
and differed only from the former by the 
j gauze being applied in the dry state; whilst the 
alcoholic dressing consisted in pouring four drops 


Digitized 


oogle 



Jan. 25, 1890. 


ORIGINAL COMMUNICATIONS. 


Thb Medical Pr*88. 85 


of a saturated alcoholic solution of orthoform on the 
fissures, followed by a dry compress. Each time the 
patients experienced a slight burning sensation for a 
few moments, but the operation of nursing was ren¬ 
dered almost painless—especially when the alcoholic 
dressing was applied. As the effect of the orthoform 
lasts several hours, it is not necessary to apply it each 
time the breast is given. One point worthy of men¬ 
tion, in conclusion, is the cicatrising action of ortho- 
form. Under its influence, I have seen the fissures 
heal more rapidly than with any other dressing. In 
the cases above mentioned, the time taken was, on 
the average, four days without stopping the nursing, 
whilst with other treatments it took from ten to twelve 
days, and, moreover, nursing had to be suspended. 

In short, orthoform seems to me to render good 
service in the treatment of fissure of the nipples, no 
matter how extensive, and of all the preparations it 
is to the alcoholic solution that I would give the pre¬ 
ference. Four drops are sufficient to bring about the 
desired effect in the space of from five to ten 
minutes. 


THE UPPER TERMINATIONS OF 
THE ANTERO-LATERAL AND 
DIRECT CEREBELLAR TRACTS.(a) 

By ALEXANDER BRUCE, MD, F.R.C P.Ed., 

lecturer on Pathology in the Edinburgh School of Medicine, Assis¬ 
tant Physician to the Edinburgh Royal Infirmary. 

The symptoms of cerebellar disease were divisible 
into two classes:—those ordinarily present in cere¬ 
bral lesion —headache, vomiting, optic neuritis, and 
the like; and lo alising symptoms, such as vertigo, 
ataxic gait and movements of the eyes. The varia 
tions in the symptoms met with in cases of cerebellar 
tumour were due, not to differences in the nature of 
the lesions, but to differences in their situations. 
Nothnagel was one of the first to point out that dis¬ 
turbance of equilibration was present only in lesions 
of the middle lobe, not in affections of the lateral 
lobes. This statement, however, required qualifica¬ 
tion, since slow growing tumours of the middle lobe 
might remain latent, while those of the lateral lobes 
might produce alterations of equilibration. The 
cortex of the middle lobe receives fibres from the 
comma tract, from the direct lateral cerebellar tract, 
and from the posterior columns of jthe cord These 
afferent fibres are probably chiefly concerned in the 
conduction of muscular sense impressions; they do 
not convey the sensations of touch, pain, or tempera¬ 
ture. None of the fibres of these tracts pass into the 
lateral lobes of the cerebellum, with the possible ex¬ 
ception of a few' which may gain entrance indirectly 
from the pons. The afferent fibres from the semi¬ 
circular canals end in the nucleus of Deiter’s, and this 
nucleus has extensive connections with various parts 
of the base of the brain. It c nsists of large cells, 
very like those of the anterior cornua, and gives off 
efferent fibres to the third and sixth nuclei on both 
sides, and also two descending tracts, which run 
in the anterior and antero-lateral columns re¬ 
spectively, and end in the anterior horns of grey 
matter. Thus there is, through Deiter’s nucleus, 
a connection between the muscles of one side 
of the body and the ocular muscles of the same 
side, and to a slighter extent, the ocular muscles 
of the opposite side. The two systems of fibres 
above-mentioned—the afferent fibres entering the 
middle lobe of the cerebellum, and the afferent 
and efferent fibres connected with Deiter’s nucleus— 
are united by tracts running from the middle lobe to 

(a) Abstract of paper read before the Edinburgh Medico-Churigi- 
cal Society, January I8th, 1899. 


the roof nucleus, and from the roof nucleus to the 
nucleus of Deiter’s. In order that equilibration may 
be maintained, it is necessary that this chain of 
fibres be intact. There are also fibres running from 
the dentate nucleus (which is connected with the 
middle lobe) in the cerebral peduncle to the optic 
thalamus and cerebral cortex of the opposite side. 
The lateral lobes of the cerebellum get fibres only 
from the pons. 

Lesions of the superior and inferior cerebellar 
peduncles cause falling to the side of section ; divi¬ 
sion of the lateral lobes brings about a similar result, 
but this is because of the impossibility of dividing 
these latter structures without injuring the superior 
and inferior peduncles as well. An exactly mesial 
division of the middle lobe causes little disturbance 
of equilibration, because of the symmetrical nature of 
the lesion ; equilibration as a whole is weakened, but 
not otherwise affected. Total ablation of a lateral 
lobe causes falling to the side of the lesion, but only 
because of the injury to the inferior and superior 
cerebellar peduncles. Slight injuries to the lateral 
lobe cause little or no disturbance. Tumours of the 
middle lobe affect equilibration by destroying the 
chain of afferent and efferent tracts, and do so 
especially if a little to one side of the middle line. 
Tumoure of the lateral lobe remain latent until they 
press upon the dentate or Deiter s nucleus or resti- 
orin body. 


THE LESSONS IN GYNAECOLOGY 
OF A YEAR. 

Br H. MACNAUGHTON-JONES, M.D., M.A.O., 
M.Ch , F.K.C.S.I. and E., 

President of the British Gjna-cological Society. 

( Concluded .) 

Parsing on to consider the circumstances and local 
conditions which determine the surgeon to perform 
laparotomy, or posterior vaginal coeliotomy in the treat¬ 
ment of extra-uterine pregnancy, these have been most 
clearly laid down during the past year. The indications 
for drainage in the abdominal operation, and the necessity 
for efficacious drainage in both instances, with a large 
rubber tube of a T shape in the case of a vaginal opera¬ 
tion, have been emphasised. After the paper I have re¬ 
ferred to, by our late President, Mr. Mayo Robson, on 
extra-uterine pregnancy, perhaps the two most important 
contributions of the year to this subject have been those 
of Mr. John Taylor, who chose it as his subject for the 
Ingleby Lectures, which have appeared in full in our 
journal, and the papers by Professor Bouilly, with an 
analysis of fifty personal observations, contributed to the 
journal, La Gyniecologie. It is noteworthy that if we 
take the entire number of cases recorded by these three 
authorities, under all circumstances, propitious or other¬ 
wise, making a total of 110, there have been but six 
deaths—surely a splendid triumph for our art! Of those 
six deaths, it is noteworthy that three occurred where 
the abdomen was full of blood, the patients dying from 
embolism and the consequences of collapse ; a fourth died 
of septicaemia, ths re-ult of foetal decomposition, and two 
others from septic peritonitis, the consequence, appar¬ 
ently, of the debris of coagula, which became septic. Four 
of these deaths occurred in the fifty cases reported by 
Professor Bouilly, and two in the sixty cases recorded by 
Mr. Mayo Robson and Mr. John Taylor. 

Doyen, following up his new method of performing 
abdominal hysterectomy, securing haemostasis and the 
control of the broad ligaments without the aid of clamps, 
brought before the Surgical Congress of Berlin the use 
of his powerful lever forceps in vaginal hysterectomy, by 
means of which the cellular .tunic '.of the arteries is 
united under a pressure of from 400 to 1,200 kilo¬ 
grammes. This instrument, firmly closed for thirty 
seconds on each broad ligament, allows the operator to 
cut between it and the uterus, after which the forceps 

D 


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06 Thu Medical Press. 


ORIGINAL COMMUNICATIONS. 


Jan. 25. 1890. 


.can be removed without any risk of hemorrhage. The 
fundus of the uterus being drawn down, the attachments 
of the adnexa and the pedicles of the ovaries are treated 
in the same manner, only a few fine ligatures being used 
to check the venous hemorrhage. Doyen states that in 
a great number of laparotomies, and sixty vaginal hyster¬ 
ectomies, he has used this instrument, and has never had 
a case of secondary hemorrhage. By the kindness of 
Dr. Doyen I show you the appliance. 

Such, gentlemen, are a few of the lines on which 
advance in our department has progressed during the 
past year. They are but a small proportion of the sugges¬ 
tions and successes recorded by a legion of distinguished 
gynaecologists working in all countries. 

vl ay I now state how I have personally been influenced 
by my own experience during the same period. This 
may well include the impressions made upon me by a 
: month’s visit to the Klinik of Professor Schauta in the 
Krankenhaus in Vienna, and to some private operations 
by him at the magnificent and thoroughly equipped 
.sanatorium of Dr. Lowe. 

First, I may venture a few remarks on the preparation 
.of the patient, and some aseptic details generally. I 
may premise that I am more than ever convinced of the 
absolute need for the strictest observation of all the 
minute details of aseptic surgery. This term, of course, 
embraces such antiseptic aids as are essential and indis¬ 
pensable in the carrying out of asepsis. I have grown 
to be more searching in my general precautions, more 
exacting in the stringent regulations I impose on all who 
assist me in an operation. I have realised that perfection 
in the methods can only be obtained by the closest criti¬ 
cism of one's own personal precautionary measures, and 
the application of the same stringent rules to others. 
Allow me to cite a few common sources of danger. Final 
preparation of the arms and hands before the ordinary 
wearing apparel is covered by a clean overall: incom¬ 
plete disinfection of the arms well above the elbows; the 
presence of finger nails ; the short time spent over the 
sterilisation of the patient’s abdomen, and particularly 
the umbilical depression; the preparation of the vagina. 
Let me, in consequence of a recent discussion at this 
Society, make a few observat ons on this simple matter. 
The patient is brought into the usual hysterectomy 
position, well to the edge of the table. The hair of the 
entire genitals has been previously shaved off. The 
abdomen and the flexures of the groins have been 
sterilised; the fingers with some sponge material well 
soaked, are now introduced into the vaginal canal 
which is subjected to a good lather, and, the 
perinaeum being well depressed, this process is repeated 
several times, while the nurse, standing at the side, 
keeps up a stream of sterilised water from a douche and 
pipette on the parts from time to time. Finally, the 
entire vagina is subjected to a douche of 1 in 3,000 of 
mercuric perchloride. It is important to secure the 
thorough sterilisation of the external parts before the 
vagina is thus attacked. For sponging and compression 
with sterilised gauze and tampons, I have abandoned the 
use of any holder save an extremely light and long clamp 
forceps, which can be rapidly opened and closed on the 
tampons, and these latter, with the sponges, I have 
drawn out at the time and cut in the manner you see 
from tin boxes similar to those used for hairdressers' 
wool, according as I require them, in three sizes. These 
boxes are thoroughly disinfected before operation, and 
the sterilised bandages, m. folded, are then placed in 
them. Sterilised iodoform gauze, unrolled straight 
from the bandage, for tamponning the vagina (a) is 
similarly used. It may appear unnecessary to even hint 
at a caution which everyone is supposed to take with 
regard to catheterisation of the bladder after operation, 
when such a step is necessary. Still, it is remarkable 
how much laxity appertains in this matter. Sterilised 
glass catheters should be kept in perchloride solution, 
and two be used for each patient, one to be sterilised and 
kept ready to replace the other when required Many a 
case of cystitis would be avoided if this precaution were 
taken, and early and gentle washing out of the bladder 


• (a) All *0011 sterilised bandages can now be had in hermetically 
scale 1 boxes ready for use. 


practised when the condition of the urine indicated this 
step 

We are constantly hearing of the importance of 
rapidity of operation, both abdominal and vaginal. 
Personally, if there be one thing more than another that 
I am convinced of, it is this, that it is perfection of 
detail, and not rapidity of execution, that all and espe¬ 
cially young operators, should aim at. Doubtless there 
are parts of every operation which should be done as 
expeditiously as is possible, consistently with accuracy 
and neatness, and every appliance which helps us in this 
direction is to be welcomed. As much in this respect 
possibly depends upon the assistant who supervises the 
instruments as on the opeiator, but I am certain that in 
the cautious protection of bowel throughout an opera¬ 
tion, in the perfect adaptation of peritoneal surfaces and 
edges, in the complete and certain stasis by ligature of 
every bleeding vessel and point, no matter how fine, in 
the cleanliness cf exposed parts and surfaces before final 
closure of the wound, the safety and ultimate perfect 
recovery of the woman depend rather than upon rapidity 
of manipulation on the part of an operator. 

I have recently operated under the following condi¬ 
tions, which I shall but briefly enumerate, as I hope to 
refer to the cases on a future occasion. A woman, set. 
30, was confined five weeks before I saw her in consulta¬ 
tion. The delivery was followed within forty-eight 
hours by an elevation of temperature, and it was noticed 
that the abdomen was swollen, and appeared to con¬ 
tain fluid. The temperature remained erratic, vary¬ 
ing in a range between 102 deg. and 105 deg. until 
I saw her, when she was undoubtedly very ill 
I confirmed the view that we had to deal with 
a fairly large ov irian cyst which had probably sup¬ 
purated, and that immediate operation wa3 called for. 
Accordingly, within forty-eight hours I operated Dr. 
Allen, of Stanmore, assisting me. The cyst wall was 
greatly thickened, closely adherent to the entire parietal 
peritoneum, which had literally to be peeled off at both 
sides, after the cyst had been tapped and syphoned of 
pus. Most difficult was the approach to a very broad 
pedicle, adhesions having been formed between the 
rectum at the left side, and the sac and an elongated 
and greatly enlarged Fallopian tube. The pedicle, how¬ 
ever, was secured in three portions, and then came the 
most difficult part of the operation. The sac was firmly 
adherent posteriorly all over its surface to the bowel, the 
colon and meso-colon were plastered to it above, with 
the omentum, requiring the greatest care in separation, 
and considerable difficulty in the arrest of bleeding. 
However, finally the sac was removed in its entirety, all 
bleeding was arrested, the abdominal and pelvic cavities 
were left perfectly clean, and an operation, which lasted 
two hours and a half, was completed. The anaesthetic 
was ether ; the patient suffered from no shock, and has 
made a good recovery. The bowel was protected all 
through as carefully as possible by small napkins of 
flannelette wrung out of warm sterilised water. 

Quite recently I had an abdominal hysterectomy for a 
medium-sized fibroma, in which the left broad ligament 
was involved with ; n the growth. The patient was 
exceptionally fat, and though the delivery of the tumour 
was rapid, I met with extreme difficulty in carrying out 
haemostasis, which was, however, in the end most 
completely secured, though the operation occupied a 
period of over two hours. There was no shock, and 
there was a rapid recovery. I believe that if there be 
shock, directly resulting from an operation conducted 
under profound anaesthesia, it is much more likely to 
j follow upon rough manipulation, injury to vital parts, 

| unnecessary dragging and possible laceration of sensi¬ 
tive structures, than upon a necessarily increased dura- 
J tion of the operation. More recently still I operated by 
I vaginal hysterectomy on a case of old and extreme pro¬ 
cidentia, in which the bladder contained in the tumour 
had to be freed from firm adhesions, which reached to 
within half an inch of the margin of the os uteri There 
was a large retroverted uteru*. The operation was 
very prolonged, and there was subsequently shock; but 
here haste would have been disastrous—in all proba¬ 
bility involving me in serious trouble with the bladder 
or ureters. 



Jan. 25, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 87 


As to the material which I use for ligatures and 
sutures. I have had the most complete satisfaction for 
the last three years in all cases in which I have used 
gut prepared after the method adopted by Martin, 
of Berlin. Silk I now sterilise by Howard Kelly’s 
method. This gut is perfectly pliable, is strong enough 
for any purpose, and has no liability to slip. I adhere 
•with perfect confidence to the triple suture for closure 
of the abdominal wound, fine silk for the peritoneum, 
stronger for the well-adapted muscle and fascia, and 
silk-worm gut for the sVin. 

Hitherto I have had but one solitary experience of 
•ventral hernia. This occurred in a patient mentally 
Affected and who twice did all in her power to force open 
the abdominal wound, both before and after the sutures 
were removed. When I last saw her the protrusion was 
quite cured, after a dissection out of the entire cicatrix 
and readjustment of the layers. 

If I presume to say what my personal feeling is with 
regard to a few disputed points connected with operative 
gynaecology, I do so from no egotistical desire to parade 
my own views. I may alter my present convictions, but 
those which I now feel are the results not only of my 
own experience, but the work which I have seen done by 
such advocates of different methods as Doyen, Hartmann, 
the Landaus, Olshausen and Winter, Martin, Schauta, 
and others. In all cases where there is doubt as to the 
feasibility of removal of th€ adnexa through adhesions, 
tumours, or collections of pus, by the vagina, laparotomy 
is the safest and most expeditious mode of operation. 
The same rule applies to myomata of a certain size, and 
to myoma complicating cancer of the uterus. Laparo¬ 
tomy still remains the safest and most classical method 
of dealing with ovarian cystoma. In small adnexal 
tumours, dependent upon their situation, anterior or 
posterior colpotomy is the most direct, as well as the 
safest means of operative diagnosis. For all cases of 
small adnexal tumours, vaginal cceliotomy is the route, 
which, both anatomically and clinically, should be fol¬ 
lowed, and the same remark applies to movable and 
small myomata and ovarian dermoids. In certain cases 
in which unexpected or insuperable obstacles are met 
with in the vayinal method, resort should be had to the 
combined operation. Operation by ligature is the most 
satisfactory, as it is the safest method in vaginal 
hysterectomy. While intra-peritoneal myo-hysterectomy, 
leaving the cervical stump, and carefully uniting the 
severed peritoneum, is in certain cases an admirable 
operation, it is not as complete nor as classical a step as 
total hysterectomy. This latter operation should be com¬ 
pleted by careful adaptation of the peritoneal flaps, cover¬ 
ing of the.ovaries with the peritoneum, and shutting out 
of the vaginal canal by suturing the peritoneum 
anteriorly and posteriorly to the cut vaginal edges, 
followed by their adaptation. Only in exceptional cases, 
such as those complicated by adnexal tumours with fluid 
contents, need vaginal drainage be resorted to. The 
classical operation for a large double pyo-salpinx is 
laparotomy, with ablation of the diseased sacs, total 
hysterectomy, and completed as I have just said, by 
vaginal drainage by iodoform gauze. 

A. few words descriptive of the work I saw in Professor 
Schauta’s Klinik this year in Vienna may interest the 
Fellows. Besides various minor operations, plastic and 
other, there were twelve vaginal hvstero-oophorectomies, 
one for myoma with adnexal tumour, one for double pyo- 
salpinx, six for various adnexal tumours, one for tubal 
gestation and haematoeele, two for malignant conditions 
of the endometrium, one for chronic metritis with der¬ 
moid tumour of the ovary ; three operations for abdo¬ 
minal total hysterectomy, two for simple myoma, and 
one for myoma and malignant disease ; two operations of 
abdominal salpingo-oophorectomy, both for tubal gesta¬ 
tion, with rupture and haematoeele; two ovariotomies, 
one abdominal, the other vaginal, both for cystoma, and 
one abandoned laparotomy for tumour of the adnexa and 
peritoneal adhesions. 

I followed for several days the course of all these 
caees. Without exception they all did well, and I have 
since heard from Dr. gchmit the final result, which has 
been recovery in every instance. One of the cases of 
abdominal total hysterectomy was interesting, as occur¬ 


ring in a patient, aged 73, in whom the myoma was com¬ 
plicated with malignant disease of the uterus. In 
another, bi-lateral pyo-salpinx occurred as a complica¬ 
tion of haematoeele, the consequence of an extra- 
uterine foetation. Here the fimbriae were spread out 
in characteristic fashion over the interior of the 
sac In a third case, an extra-uterine foetation 

had been operated on two years previously, and 
a portion of the adnexa had been left. The operation 
was most difficult, in consequence of firm and extensive 
adhesions. It will be noticed that of twenty major 
operations, thirteen were performed per vaginam, and 
Professor Schauta is emphatic as to his preference for this 
route over the abdominal one whenever it is feasible to 
adopt it. It is more difficult, he says, but it is the most 
natural and the safest for the patient. I saw him remove 
a fair-sized ovarian cyst by the vagina, performing 
anterior colpotomy, tapping the cyst, withdrawing the 
sac, subsequently stitching the parietal peritoneum to 
the uterine peritoneum, and the vaginal wall to the 
uterus. One case of large bi-lateral pyo-salpinx was 
operated on by posterior colpotomy, the cceliotomy being 
rendered extremely difficult through the adhesions. The 
time occupied in performing the vaginal hysterectomy 
varied. One I saw completed in about twenty minutes, 
while the more difficult ones occupied over an hour, and 
on one or two occasions an hour and a half, and even 
more. The anaesthetic employed is a mixture of chloro¬ 
form 1 pt., ether petrolei 1 pt.. ether sulphine2 pts. Pro¬ 
fessor Schauta uses no clamps. Having made the usual 
incision, he opens the anterior peritoneum, ligatures the 
uterine vessels at either side, and frees the cervix com¬ 
pletely, sometimes dividing it, or occasionally removing 
it altogether. The adnexal vessels aro next ligatured at 
one side, and if the adnexibe removed they are brought 
through the posterior opening. This is repeated at the 
other side. Occasionally, if there be difficulty, the fun¬ 
dus is divided so as to permit of either half being 
grasped, thusallowingof greater feeedom of manipulation, 
as well as increase of room. Silk is the material used 
altogether, both for ligature and for suture. I should 
mention that as soon as the peritoneum has been opened, 
its edge is carefully stitched to the vaginal wall in front. 
Subsequently, the posterior section is treated in a 
similar manner. A roll of sterilised iodoform gauze of 
some twenty to twenty four inches is passed up through 
the peritoneal opening, and tied with a string to dis¬ 
tinguish it before it is severed, and then the vagina is 
loosely packed with more iodoform gauze. The vaginal 
sutures are left long, and are removed in about three 
weeks. This is very easily done. The internal strip of 
gauze is not removed for eight or ten days. Only on one 
occasion, after any of these vaginal operations, did I see 
a clamp remain for security’s sake, in a difficult case of 
haemostasis. Abdominal hysterectomy is not performed 
by Doyen’s method. The tumour is delivered, severed 
and freed by ligature and section at either side from 
above down. The vagina is then opened, and the cervix 
is freed; most accurate adaptation of all peritoneal 
edges is obtained, the cut and exposed surfaces of the 
adnexa are covered carefully, iodoform is passed from 
above down into the vagina, and the peritoneum, with 
the vaginal opening is closed. 

If there be any associated purulent condition of the 
adnexa an iodoform drain is pushed through into the 
vagina as usual. Speaking generally of his operations, I 
may say that they are performed under the strictest 
aseptic precautions; that there is no evidence of haste, 
but from first to last the most cautious and deliberate 
manipulation to secure the most complete haemostasis 
and perfect cleanliness of all the parts exposed during 
operation. The toilette of the abdomen is secured by 
triple suture, and the patient is laid on a portable couch, 
on which is spread ready the waterproof sheeting, an 
outward swathe and an inner one of demette to make the 
tail bandage. ’Thus she is dressed with the least dis¬ 
turbance before being rolled into the ward. I have here 
a few appliances of Professor Schauta's which are inter 
esting. His needle-holder for vaginal hysterectomy, 
curved, as you see, in the handle, which makes it more 
convenient than the straight instrument for carrying the 
needle laterally; and his ligature tightener, which 


Di« 




88 ths Medical Press. 


TRANSAU’i’iU in & OF SOCIETIES. 


Jan. 25, 1899. 


enables the surgeon to tighten effectually a ligature 
placed on a deep-seated or inaccessible vessel. As a rule 
ne uses Deschamp’s needles for carrying the lateral 
ligatures, but for the Control of special vessels and 
sutures he employs this holder. 

I would wish, bad there been time at my disposal, to 
say a word of the arrangements at the magnificent sana¬ 
toria of Lowe and Fiirch. In the former, especially, the 
suites of operating theatres, with their adjacent rooms 
for ansesthetisation and washing purposes, as well as 
dressing-rooms for the surgeons and assistants, make one 
envious of the splendid facilities which a Vienna surgeon 
has for operating in private. No conceivable want is 
here left unfulfilled, and under an able directorate and 
staff, the patients are secured the very best attention. 

Gentlemen, may I conclude this very imperfect sum¬ 
mary of some of the lessons learned during the past year, 
and the reflections they have given rise to, by the 
expression of the hope that during our debates and dis¬ 
cussions throughout the coming Session, the tone and 
character of our proceedings may be stamped by the 
recognition of our high aims and aspirations. A Society, 
like an individual, to be accounted worthy must be incited 
by ambition, and that is a poor ambition which site down 
to follow afar off the lead of others who struggle in the 
same direction. Gynaecology, doubtless, is one of the 
younger handmaidens of medicine, yet so rapid has been 
her growth that the has outstripped in the importance 
of her discoveries and her art many of her older sisters 
in the race of advance. Let it be our justifiable boast 
that in our Transactions will be found work that entitles 
us to a foremost place among the many medical and 
scientific societies labouring ever unselfishly in the cause 
of progress and humanity. 


transactions of gocictics. 

EDINBURGH MEDICO -CHIRURGIC AL SOCIETY. 

Meeting held January 18th, 1899. 

Dr. P. A. Young, Vice-President, in the Chair. 

Exhibition of Patients. 

Mr. Greig showed a case of congenital symmetrical 
perforation of both parietal bones. Two openings 
measuring 2 by 3J cm. could be felt at the posterior 
superior angles of the bones, just in front of the lamb- 
doidal suture. Firm pressure on these caused vertigo 
and flashes of light before the eyes. Otherwise the 
patient suffered no inconvenience ; he had served in the 
army as a driver of artillery, and the condition had in no 
way interfered with the performance of his duties. Five 
such cases had been previously recorded, but the lesion 
had never before been discover, d during life. 

Mr. Caird and Mr. Guy showed a case of extensive 
destruction of the nose and palate due to tertiary 
syphilis. 

Exhibition of Specimens. 

Dr. Harvey Littlejohn showed the following speci¬ 
mens from medico legal cases:—(1) Three hearts, two of 
which were hypertrophied; one of these (weighing 49 
ozs.) was as large as any recorded The third prepara¬ 
tion was an example of spontaneous rupture of the mus- 
culi papillaies and inner wall of the left ventricle. (2) 
A specimen of effusion of blood on the surface of the 
brain. 

Dr. Alexander Bruce read a paper on the 
upper terminations of the ascending antero¬ 
lateral AND DIRECT CEREBELLAR TRACTS. 

An abstract of which will be found in another column. 

Dr. Shennan and Mr. Miles read a paper on 

A CASE OF APHASIA. 

The patient had suffered from left sided otorrhcea and 
deafness for three months. For three days before admis¬ 
sion he had had acute pain in the ear and leftside of the 
head. As the symptoms pointed to mastoid disease the 
antrum was drained, but signs of cerebral abscess 
developed. Mr. Miles trephined over the temporo- 1 


sphenoidal lobe, and found an abscess at its lower part. 
After the operation the patient improved greatly, bub 
was noticed to be paraphasic; he cons'antly misplaced 
words, especially substantives. There were neither 
word-deafness nor word-blindness; he could read, write, 
and copy well. He progressed satisfactorily for a fort¬ 
night, and then became stuporose on account of the 
abscess not draining properly. After some pus was 
evacuated he again improved, but first facial paralysis, 
and then a hernia cerebri developed. Eventually he 
died two months after admission. He remained para- 
phasic throughout, the symptom beiDg practically 
limited to the perpetual misuse of substantives. The 
diagnosis made was that an abscess was cutting off the- 
fibres running between the auditory centre and Broca's- 
convolution, and this was confirmed post-mortem. 

Dr. Wm. Elder, in discussing the case, expressed the 
opinion that the ordinary speech centres were capable of 
further subdivision. From cases he had seen he believed 
that the memories of nouns were stored in an “ annexe ” 
of the word-hearing centre, and that this annexe was 
connected with the visual centre in the occipital lobe. 
Similarly, he thought that there was a special centre for 
the memory of verbs, and that this was connected with 
the motor areas. 

-♦ 

SHEFFIELD MEDICO-CHIRURG1CAL SOCIETY. 

Meetings Held December 8th and 22nd, 1898. 

The President, Dr. Alfred Robinson (Rotherham), 
in the Chair. 


Dr. Arthur Hall showed cases of seborrhoeic eczema, 
Addison’s disease, and hydros of pregnancy with 
photographs. 

Mr. Archibald Cuff demonstrated peculiarities of 
gaits and other abnormalities in a ricketty dwarf. 

Dr. Sinclair White exhibited and made remarks oa 
(1) a case of movable hydronephrotic kidney cured by 
nephropexy, (2) gall - stones-cholecystotomy with 
choledochotomv, (3) large cartilage removed from the 
knee-joint, (4) traumatic aneurysm of brachial artery 
treated by the method of Antyllus, (5) spinal 
meningocele treated by excision of the sac, (t>) cancerous 
uterus removed by colpo-hysterectomy. 

Mr. Rupert Waterhouse showed a brain with old 
cyst and recent blood clot causing right and left 
hemiplegia respectively at an interval of a year. Mr. 
Waterhouse also related a case of skin eruption, 
following the administration of a simple enema. 

Dr. Adams showed a specimen of malignant growth 
of oesophagus with secondary growths on liver, and ga^ 
clinical and other particulars of the case. 

Dr. Bardswill read a paper on “ Supra-renal extract 
as a local anaesthetic.” 

Mr. Wilfred Stokes read a paper on “ Synovitis a«so- 
ciated with interstitial keratitis.” 

Mr. Priestly showed a case of sporadic cretinism 
with photographs before and after treatment by thyroid 
extract. 

Mr. Tull introduced a young man, from whose retina 
of right eye a piece of metal had been extracted with the 
electro-magnet. The fragment had been observed with 
the ophthalmoscope in the retina, and the result after 
removal was excellent. 

Dr. Smith on a case of 

progressive muscular atrophy commencing in 
the legs. 

Mrs. C., art., 53, married, one child (stillborn), con¬ 
sulted me in May, complaining of weakness in legs. 
Illness commenced five years ago, when she noticed 
first a difficulty in dorsiflexing the feet, particularly on 
going upstairs. She also states that previous to this 
she had had a good deal of mental worry in connection 
with her family affairs. Examination shows both feet 
in the position of “ drop foot.” and considerable wasting 
of the muscles in front of the legs, the thigh muscles, 
and the glutei. Dorsiflexis of toes and feet is completely 
lost, and movements at knees and hips are feeble. 
Patient cannot walk without assistance, e.g., by support- 

Digitized by LjOO 




Jan. 25, 1899. 


FRANCE. 


The Medical Paisa. 89 


ing herself by a table or chair. She cannot rise from a 
chair without assisting herself with her arms. The right 
side is worse than the left. The upper extremities are 
unaffected. Sensation is unaffected, although the limbs 
are cold and often livid. Bladder and rectum are 
normal. The muscles have not been tested for the R.D. 
Fibrillary tremors have not been observed. Both knee 
jerks are absent. From the fact that this patient first 
noticed a difficulty in dorsiflexing the feet, the disease 
probably started in the peronei and anterior tibial 
muscles. Treatment has been strychnine, iron and 
arsenic, and friction of the muscles She has also been 
using a Faradic machine. The patient fancies she has 
slightly improved. 

Mr. R. Favell related a case of pan-hysterectomy 
which he had performed for myoma of uterus. The 
woman was aged 42. and during the last few months the 
periods had been very profuse. Three months before she 
was operated upon the hiemorrhage was so great that 
she thought she would have died. The uterus when 
removed weighed six and a half pounds. The myoma 
was found to be undergoing myxomatous degeneration, 
and a small fibroid in the wall of the uterus was under¬ 
going calcification. The patient had made a good 
recovery. 

Also, a multilocular ovarian tumour removed from a 
young woman. The tumour was disease of the left ovary, 
and to this the fimbriated end of the Fallopian tube of 
the opposite side had become firmly adherent. Also, a 
parovarian cyst removed from a woman. a?t. 24. 

Dr. Arthur Hall showed a case of 

HERPES ZOSTER 

of the left side of the thorax in a little boy who had 
been undergoing a prolonged course of arsenic for 
enlarged glands. After the first appearance of the 
eruption, owing to a misunderstanding on the part of 
the parents the medicine had not been omitted, with the 
result that in spite of the rash being dressed with 
sedative ointment and well protected, it had gone on to 
severe serpiginous ulceration. As soon as the arsenic was 
left off the ulcers began to heal rapidly. 

Dr. Hall also showed photographs of double primary 
syphilitic sores of the hand in a midwife. The two sores 
appeared the same day and ran an exactly similar course. 
The secondary symptoms appeared a few weeks later. 

Dr. Hall also related a case of papulo erythematous 
rash due to boracic acid. The patient had been taking 
half a drachm per day for about two weeks when it 
appeared. The irritation at night was considerable, and 
remained unrelieved by various sedatives, lotions, Ac. 
The boracic acid was then left off, and in the course of a 
few days the rash disappeared altogether. On resuming 
the drug, an irritable scarlatiniform rash appeared within 
forty-eight hours, which again subsided on the drug 
being left off. The patient was suffering from old 
stricture with cystitis. There were no other symptoms 
of boracic acid poisoning. 

Mr. Makeig Jones showed a boy, ret. 19, with con¬ 
genital hypertrophy of the three middle toes of left foot 
—a condition known by the name of giant toes ; also 

A man, ait. 55, with amyotrophic paralysis of right 
arm and leg, coming on three weeks after slight injury 
to the right elbow and ankle joints fourteen months ago. 
The condition was now improving, but there had lately 
supervened contracture of the calf muscles. He had 
shown several similar cases at the Society and described 
them as a progressive muscular atrophy duo to atrophic 
changes at the motor nerve root. He also suggested that 
many of the cases of ruptured nerves during reduction of 
shoulder dislocations were really similar trophic lesions. 

Dr. Robertson read a paper on 

INFANT-FEEDING AND EPIDEMIC DIARRHCEA, 

in which he pointed out that there wa< ample evidence 
to show that epidemic diarrhoea was mainly due to 
ignorance and carelessness in the feeding of young 
children, while much might be done in the way of 
limiting the disease by improving the sanitary surround¬ 
ings of the dwelling and enabling a clean milk to be pro¬ 
curable. Yet the real point to be attended to was the 
greater attention to cleanliness in feeding and rearing of 
infants. Such an object was extremely difficult to attain. 


but theie was reason to believe that much could be done 
by the general distribution of leaflets on the subject to 
persons registering the birth of children. Such leaflets 
if well drawn up formed the basis on which the work of 
lady visitors rested and in time became the accepted 
model for the particular district. 


Jraitce. 

[FROM OUR OWN CORRESPONDENT.] 

Paris, Janus-y 22ud., 181*9. 

Prophylactic Measures for the Plague. 

M. Proust read a paper at the last meeting of the 
Academic de Mddecine on the prophylactic measures to 
be taken against the invasion of the Indian plague into 
Europe, in which he Baid that the plague continued to 
ravage with intensity India, and more particularly in 
Bombay ; it had also made its appearance in some parts 
of China and in Madagascar. It was of the utmost 
importance that the different measures already advised 
against the importation of the plague into Europe should 
be perfected and completed. Sanitary measures should 
be taken on the land frontiers and on the sea. 

The attention of Europe should be drawn to the Per¬ 
sian Gulf, where no protection existed in spite of the 
neighbourhood of the contaminated districts, for if the 
plague traversed the Gulf Europe would be soon 
threatened. The prescriptions of the sanitary con¬ 
ferences were not executed sufficiently. The institution 
of the medical visit at Suez would be effectual if properly 
carried out, but false declarations on the part of the 
doctors ^nd of the captains of vessels have been known 
to have been made. When a plague epidemic broke out on 
board ship, the patients should be brought to shore as 
quickly as possible and placed in the sanitary station, while 
the rats, which were powerful agents of contamination, 
should be utterly destroyed, and the vessel completely 
disinfected. 

To accomplish these different desiderata, it is not 
necessary to call a new conference, as all the important 
prescriptions concerning the prophylaxis of plague and 
cholera were to be found in the conventions of Venice, 
Dresden, and Paris. What was necessary, however, was 
that the Governments should combine to execute 
seriously what the conferences had decided. 

The Rontuen Rays. 

At the Societe de Dermatologie, M. Bulzer presented 
a patient, who for the last year was submitted every day 
in a museum to the action of the X-rays The result was 
cutaneous lesions on different parts of the body. The 
right hand and forearm were the seat of red and hard 
cedema; the skin of a violet tint, cracked and covered 
with a yellowish crust. The nails had fallen, but grew 
again thick and clubbed, The neck and right side of 
the face were also the seat of lesions, but in a less 
marked manner, while complete alopecia was found over 
the parietal region of the same side, and the beard and 
moustache had also disappeared. 

M. Bartbelemy said that alopecia was alway 
observed following repeated expositions to the Rontgen 
rays when the tube was not held at a sufficient distance. 
He had remarked that individuals whose skin was natur¬ 
ally moist were particularly subject to these accidents. 
M. Brocq said a patient came under his notioe suffering 
from acnea with hypertricosis She had come from 
Vienna, where she was treated by the X-rays seventeeq 


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90 The Medical Pbrss. 


GERMANY. 


Jan. 25, 1899. 


consecutive times, being assured that a cure was certain. 
Although the acnea had rather increased under the 
treatment the hairs were dead and seemed ready to fall 
off. He asked his colleagues if they thought that they 
would not grow again. He was replied to by M. 
Barthelemy, who said that in the seven or eight cases of 
alopecia he had observed, he always found that the hair 
began to grow again after two months. 

Injections of Calomel and Orthoform. 

M. Daulos presented a patient who suffered from sclero- 
gummatous glossitis of syphilitic origin. Some time 
ago his tongue had increased so much in volume and 
had become so painful that his life was in danger. Every 
kind of specific treatment had been tried without result, 
and injections of calomel were advised, but the patient 
dreaded the pain produced by the treatment. In order 
to satisfy him the speaker thought of trying orthoform 
with the calo mel, and employed the following formula:— 

Calomel, j gr.; 

Orthoform, ii gr.; 

Vaseline oil, xx drops. 

The therapeutic results were excellent, and, what was 
worthy of remark, the patient suffered no pain, only a 
little soreness on the fourth day, the period when the 
injections of calomel provoke generally intolerable suffer¬ 
ing. He had thus practised five injections with the 
same success. He thought that as orthoform was 
without danger his formula was worthy of further trial. 

Tincture of Iodine 

Prof. Grosch strongly recommends the administration 
of tincture of iodine in the treatment in all kinds of 
gastro-intestinal affections, and especially in the diarrhoea 
of typhoid fever both in children and in adults. In 
children suffering from typhoid fever he gave four drops 
of the tincture overy eight hours in sugared water. 
The temperature fell rapidly and the diarrhoea dis¬ 
appeared in four days. In adults he administered six 
drops three or four times a day. Of the forty cases thus 
treated none succumbed, and the favourable symptoms 
appeared at the outset of the treatment. 

In acute gastro-intestinal affections of an infectious 
nature the results were signally favourable in the cases 
where the fever ran high, with vomiting and fetid 
diarrhoea. In infants the author gave one drop of the 
tincture of iodine three times a day. 

Lunatics and Habitual Drunkards. 

A Bill has just been introduced in the Senate for the 
establishment by the Government of institutions devoted 
exclusively to the incarceration and treatment of 1 unities, 
habitual inebriates, and dangerous patients. The 
grounds on which incarceration may be decreed by the 
Courts are stated, and the measure compels the placing 
in the asylums of criminals acquitted at Courts of 
Assizes on the ground of irresponsibility. It further 
provides that *' Incarceration in a Special State Asylum 
shall be ordered when the lunatic has exhibited homi¬ 
cidal intents or a bent towards disgraceful assaults or 
arson, or when his depraved morals or perverse habits 
render him dangerous to other people.” It is high time 
that such a law should be passed, for it is intolerable 
that lunatics and inebriates, forced despite themselves 
into the commission of crime, should be allowed to run 
about the streets, leaving death and dishonour in their 
track. 


(Hermans. 

[from our own correspondent.] 


Berlin, January 20th, laetr. 

Adulteration. 

The adulteration of articles of food appears to be* 
practised on a large scale in certain parts of Germany. 
Some statistics recently to hand from the municipal 
laboratory of Dresden show that out of 143 samples of 
butter analysed by the authorities, no less than 33 were 
condemned by reason of their admixture with foreign* 
fats, the presence of an excess of salt, or by reason of 
advanced decomposition. This kind of adulteration,, 
says the municipal chemist, is carried on in “a most 
unblushing fashion.” Next to butter, honey seems to be 
a favourite object of fraudulent adulteration. In, 
Dresden, as elsewhere, milk is still largely adulterated, 
in spite of the severe penalties directed against the 
practice. As might be expected in a country where 
sausages form a staple article of daily consumption, 
adulteration in various forms is rampant. The principal 
adulterant is potato flour, enabling the merchant to- 
make use of dry or poor quality meat. To mix it with 
meat the addition of a considerable quantity of water is 
neoessary, rendering sausages thus compounded pecu¬ 
liarly liable to undergo decomposition. The proportion 
of the adulterant varied between 1 and 13 per cent It 
would seem, indeed, that in respect of fraudulent 
adnlteration the Germans “ have accomplished really 
remarkable progress.” 

At the Medical Society Hr. A. Baginsky read a paper 
on 

Pericarditis in Childhood. 

Pericarditis in common with a number of other 
diseases was formerly considered to be infrequent in child¬ 
hood. Recent and more thorough observation had, how¬ 
ever, taught to the contrary. Data varied and it was 
difficult to give a correct estimate of the frequency of the 
disease. He had made the observation that pericarditis was- 
highly dangerous for childhood. He had observed sixty- 
four or sixty five cases of the disease in children under 
the fourteenth year in the K. K. Friedrich Hospital. 
Primary or accompanying diseases were twenty-four 
times rheumatic polyarthritis, eleven times tuberculosis, 
eleven times pleuro-pneumonia, seven times erysipelas 
and phlegmon, six times purulent pleuritis, five times 
severe diarrhoea, six times measles or pneumonia, twice 
scarlatina, twice meningitis, twice otitis, twice diph¬ 
theria, Ac. In some cases decided septic processes were 
in play. Rheumatism was more frequent in children 
than was believed. During the period under notice he- 
had seen 145 cases (with or without chorea). The 
exudation was either serous, fibrinous, hsemorrhagic, or 
purulent. There might be or might not be obliteration 
of the pericardium in the fibrinous cases. The serous 
form was observed in nine boys and seven girls. The 
symptoms were severe, especially in the arthritic cases. 
The diagnosis was very difficult. Dislocation of the 
heart with change of position were very small. The most 
important sign was the pericardial murmur. Purulent 
exudation was still more difficult to diagnose, a consider¬ 
ation of the accompanying symptoms was necessary. 
The speaker found pus in connection with erysipelas, 
grave angina, caries of the ribs, diffuse peritonitis, 
broncho-pneumonia, gastroenteritis, furunculosis, phelg- 


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Jan. 25, 1899. 


AUSTRIA. 


The Medical Perm. 91 


mon of the neck, and double empyaema. The grave 
general symptom here predominated. He had seen 
septic diseases at the earlier ages (once in a child ten 
days old, twice at two years). Sudden rises of tempera¬ 
ture pointed to the presence of a malignant process. 
Bacteriologically he had found bacterium coli, streptoc. 
staphyloc. pyocyaureus. Tuberculous pericarditis was 
much more rare, but when it did occur very malignant. 
He had seen eleven cases. The most frequent form was 
the polyarthritic. In childhood the early participation 
of the heart was the rule (according to Broadbent it was 
constant). Not infrequently later relapses took place, 
and these were often fatal. Children who had suffered 
from these diseases in childhood were in danger of recur¬ 
rence in adult age, and often died in them. Salicylic 
acid often failed in these cases, inf digitalis, with large 
doses of diuretin (4 to 5 grm. daily) was better, especially 
if symptoms of stasis came on (dropsy, with tendeney to 
suffocation). In place of digi^lis strophanthus was 
useful. 

Hr. Leop. Casper gave a further report on 

Catheterisation of the Ureters, 
comprising three interesting cases he hid met with 
during the past four years. In the first case, after 36 
hours’ anuria, the ureteral catheter was passed. Five 
ctm. above the bladder opening the instrument came on 
an obstruction that could not be removed. Oil was then 
injected, and less came away than was injected. The 
patient was then put to bed. In 20 minutes’ time 
200 grm8. of fluid were removed, and the following morn¬ 
ing six litres. The second case was that of a young 
woman, with enlarged pelvis of the kidney and purulent 
urine. The kidney pelviB was washed out 13 or 14 times 
at intervals of six days, with silver nitrate solution. The 
kidney tumour gradually disappeared, and all the other 
symptoms subsided. The third case was one of pyelone- 
phrosis in a man of 24. The pelvis was washed out, but 
a rigor and high temperature followed. After nine 
washings out the urine was thicker than ever, and it was 
decided that the kidney was tuberculous. At this point, 
however, all changed: the urine became c'ear, the 
kidney tumour subsided, and at present the man was 
well and fit for work 


JUietria. 

[from our own correspondent.] 


Vibnna, January 21st, 1899. 

Vibration Thebapy. 

We have again to discover the genius who devised 
the vibratory theory of treatment which is now set forth 
in the Clinical Review, by Herschell, who strongly advo¬ 
cates this method of treatment in obstinate constipation, 
and who seemingly lays claim to it being his own inven¬ 
tion. No one can doubt the original description of his 
apparatus as peculiar to himself when an Austrian is 
told that it resembles the “ stocke ” or baton, carried by 
a “ constable in England.” 

I often wonder how many Austrians will profit by this 
resemblance ! This baton, or “ stocke,” is connected and 
kept in motion by an electric motor when applied to the 
bowel. 

The novel “Vibrateur” is discovered to be nothing 
more than a modification of the Abb6 Saint-Pierre method, 


who practised this form of treatment one hundred years 1 
ago for migraine and gastralgia, with a “ vibratory instru-- 
ment.” At a later period Zander revived the treatment, 
and more recently Charcot devised a “ vibrating 
chair” for a similar purpose. Whatever the English cons¬ 
table's baton may accomplish, it is evidently not a 
novelty in principle. 

Thrombus in Transvxr8E Sinus. 

At the Gesel'schaft der Aerzte, Biel showed a man 
whom he had operated on for “ Thrombophlebitis sinus 
transverei ex otitide.” The sinus was reached by an 
opening made through the mastoid portion of the 
temporal bone, aud in order to enlarge the opening the 
jugular vein was ligatured. The wound healed and_ 
recovery followed. The first surgeon who performed 
this operation was Zaufal, who met with considerable 
success. 

Keratomalacia. 

Elschnig showed preparations and photogrammes to 
the Society from a case of keratomalacia. This disease 
was first fully described by Graefe in 1866 as a morbid 
condition frequently occurring in infantile encephalitis- 
It has recently been established by different authorities 
as of bacterial origin. 

The preparations were taken from the cornea of a 
woman, set. 51, who was brought to hospital complaining 
of icterus and enlargement of the liver. On the cornea 
of the right eye was a large cicatrix, while the left had a 
deep circular ulcer ; in both conjunctives ths xerosis was 
promi- ently present. 

She died shortly after admission The post-mortem 
revealed a carcinomatous condition of the ductus chole - 
dochns. A closer examination of the cornea disclosed 
long bands across its surface containing large groups of 
cocci. The xerosis had an undoubted effec‘- on the 
keratomalacia, as it prevented the complete closing of 
the lids, and thus the proper moistening of the cornea, 
which would hasten the retrograde process. 1 he effects 
of ths icterus was to produce well marked xanthelasma 
of the lids. 

In the discussion that followed, Prof. Kaposi thought 
the morbid process was inverted in this case, that the 
icterus was the consequence of xanthelasma and not the 
canse of icterus, as the xanthelasma process finally 
attacks the liver. 

Prof. Paltauf remarked that xanthelasma not infre¬ 
quently accompanied cirrhosis of the liver which might 
have been the case in the present instance. 

Ectopia Vesic,*. 

Frank brought forward a youug lad on whom he had 
operated for ectopia of the bladder. He made an open¬ 
ing through the wall of the bowel at the sigmoid flexure 
into which he attached the ureters, where they have 
united and healed. 

The recovery was a perfect success; nothing but a 
slight oozing was observed for a short time after the 
operation, which soon disappeared. 

The boy can now hold his urine in the rectum for 
three or four hours at a time. This interval he hopes 
will yet be further extended, as nature becomes accus¬ 
tomed to the abnormal habit. 


Sir William Bboadbent, Bart., had conferred upon 
him, on Monday last, the honorary degree of LL.D. of the 
University of St. Andrews. 


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Jan. 25, 1899. 


z ©pcratiug theatres. 


SEAMEN’S BRANCH HOSTITAL, 

Royal Albert Docks. 

Operation for Fractured Patella.-M r. William 
Turner operated on a man, set. 43, who had been 
admitted the same morning for a fractured patella 
-caused by a fall whilst pulling a truck. The right 
patella was fractured transversely a little below the 
middle, the separation between the fragments was 
about the breadth of two fingers ; there was no swelling 
of the joint nor any external marks of violence. The 
limb was shaved and cleansed with soda and turpentine, 
and purified with 1 in 20 carbolic lotion and 1 in 2,(XXI 
perchloride solution. The operation was performed 
eight hours after the patient’s admission. The limb 
having been again purified on the operating table a 
curved incision about four inches long was made on the 
outside of the patella, and the joint opened, continuous 
irrigation of 1 in 5,000 perchloride solution being kept 
up. The bone was found to be fractured transversely 
about its middle; covering each fractured surface was a 
strip of fascia like a curtain. A silver wire was next 
passed on each side of the middle line by means of a 
grooved drill, and in this manner the parts of the patella 
were brought into good apposition, the wires being 
passed so as not to injure the articular cartilage and the 
knots carefully imbedded in the periosteum, care also 
being taken to turn upwards and downwards respectively 
the curtain-like pieces of fascia into which also incisions 
were made over the bone, so as to allow the wire to rest 
next to the osseous surface, the fascia being finally sewn 
over the wire and the edges of the bone. The joint was 
made as dry as possible, and the skin wound sewn up 
A back splint was applied, and the patient taken back to 
bed, where the whole limb would be elevated nearly at 
right angles to the trunk by means of a sling and an 
inclined plane. Mr. Turner said the man had 
been admitted immediately after the accident, 
and this allowed rest and ice to be applied at 
once, thus diminishing the amount of extravasation 
into the joint. He had performed the operation on the 
same day as the accident, which is not recommended by 
all surgeons, but in his opinion, by this e irly operation 
the damage to the tissue by the extravasated blood is 
diminished, the chances of traumatic synovitis are 
lessened, and there is a distinct gain to the patient of 
one week in the convalescence. Another point also in 
favour of early operation, he remarked, was that 
the quadriceps extensor had not time to waste to 
any great extent Mr. Turner said he always advo¬ 
cated the open method in cases of displacement 
of the fragments, particularly on account of the 
curtain of fibrous tissue which is invariably found 
between the broken surfaces. He prefers the external 
incision to any of the others usually employed as the 
scar is not knelt upon afterwards, the cicatrix does not 
stretch with early movement of the joint, and it is far 
removed from the silver wire. He drew attention to the 
grooved drill he had employed, which had the advantage 
of simplifying the passage of the wires, these being 
passed down the groove of the instrument without re¬ 
moving it. He pointed out that the man after being 
transported to bed would have the whole limb 
elevated nearly to a right angle with the body 
by means of a sling to the head of the bed. 


the back splint resting 
this position, he said, 
mended by Lord Lister, 
advantage of lessening the 


on an inclined plane ; 
was originally recom- 
it had the particular 
amount of effusion into 


the joint. He pointed out that in the dressing of the 
case on the operating table it is important to bandage on 
the dressing before applying the splint, so that when 
the splint is removed the dressing remains intact. 
In about four days the limb would be brought right 
down and the splint removed, thus allowing the patient 
to move his leg a little in bed. Passive move¬ 
ment is then carried out every day until the tenth day 
when the stitches are removed and collodion dressing 
applied; the joint is then flexed to a right angle. The 
patient is generally able to walk round his bed unaided 
on the fourteenth day, is discharged on the nineteenth or 
twenty-first, and is able to do full work before three 
months with perfect safety. 

It is satisfactory to record that tho above patient was 
discharged perfectly well on the nineteenth day. 


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“ SAL US POITLI Sl/PREMA LEX.” 


WEDNESDAY, JANUARY 25, 1899. 


COLONIES FOR EPILEPTICS. 

Much has been written of late in the lay press 
with regard to the proper treatment of the epileptic. 
By epileptic we mean of course the sane epileptic, 
and for the present we will consider the matter 
only in this limited sense. Unfortunately, as 
pointed out by one writer, the law does not allow 
County Councils to devote money to making public 
provision for the treatment of the sane epileptic 
two courses are possible, the one is to agitate for 
beneficent legislation in this direction, the other is to 
co-operate privately so as to obtain the necessary 
funds for the purpose. There seems to be no doubt, 
judging by the results at the Home for Epileptics 
founded by Lady Meath at Godaiming in 1892, and at 
two other homes in this country, that the wore 


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LEADING ARTICLES. 


The Medical Press. 93 


possible fate that can befal an epileptic is to be found 
in the same room with lunatics. That seems to be 
•the opinion stiongly expressed in the correspondence 
referred to. Now there are three classes to be 
considered here; there is the juvenile epileptic, the 
-adult epileptic who is sane, and there is the insane 
•epileptic. It goes without saying, and most medical 
men are familiar with this fact, that where there is 
epilepsy there is sooner or later more or less mental 
aberration. In the great majority of cases the aber¬ 
ration may be of a very transient character, so 
trifling as to mark a mere insignificant episode in the 
life history of the individual, but the fact remains 
that in a great many cases it is a mere stretch of 
■courtesy to call many epileptics sane. In advancing 
this statement it must not be supposed that we are 
by any means out of sympathy with the idea that, if 
possible, the epileptic should be treated apart from 
the insane, under different, more promising, and 
more salutary conditions of treatment. We simply 
wish to point out that one must discriminate 
carefully so as to obtain the best results by a 
proper selection of cases. There can be no doubt, 
and those who have experience of the insane epileptic 
will confirm this statement, that even the insane 
epileptic in his lucid intervals, which are sometimes 
prolonged for weeks, and even months, is a most 
agreeable, amenable, helpful and sociable unit of the 
society in which he is placed. And if it is so of the 
insane epileptic it must be still more so of the sane 
epileptic, who, therefore, deserves our utmost com¬ 
passion and the best efforts we can put forward for 
the amelioration of his condition. With regard to 
the juvenile epileptic, unfortunately he is too often 
afflicted with idiocy and imbecility sis well, but there 
are sometimes cases of juvenile epilepsy well kno^n 
to physicians in extensive practice, who have made 
astonishing recoveries from the disease during 
puberty or adolescence, and have passed through the 
remainder of their lives with little or no mental or 
nervous stigmata whatever. The treatment of the 
epileptic has been considered in a more generous and 
advanced way in Germany and America, but of late 
years evidence has been accumulating in this country 
that the public mind is wakening up to its responsi. 
bilities and giving more sympathetic consideration to 
the subject. It is earnestly to be hoped that this move¬ 
ment will grow, and that a differentiation will be 
made between the different classes, so that the proper 
treatment for each class of cases may be provided. The 
legislative machine is considerably overtaxed, yet it 
is quite possible that in the preparation of a new 
Lunacy Bill and in its passage through the Houses j 
of Parliament a clause may be inserted giving the 
requisite power to County Councils to effect a real, 
solid improvement in the classification and treatment 
of the epileptic, whether sane or insane. 


THE OPERATIVE TREATMENT OF 
MYOPIA. 

Since Fukula revived in 1889 the method of treat¬ 
ing cases of high myopia by removal of the lens the 


procedure has acquired a large measure of popularity, 
and a good deal of literature has accumulated upon 
the subject. In the present day, however, there are 
not wanting signs that the inexpedient policy is 
being pursued of resorting to the treatment indis¬ 
criminately, and of failing to observe the necessity of 
selecting the cases for its practice. Under these cir¬ 
cumstances it is easy to see that, unless proper care 
be taken, untoward results are bound to ensue, and, 
at the same time, the danger is incurred of again 
bringing this special form of treatment into disre¬ 
pute. A word of warning, therefore, in this regard 
seems undeniably opportune. Even under the most 
favourable circumstances, a highly myopic eye is by 
no means a desirable organ upon which to operate. 
The condition of its tissues generally is far removed 
from that of the normal, and thus it comes to pass 
that the result of operative mtei-ference for the relief 
of high myopia must always largely be a matter of 
speculation, apart from any contingencies in 
regard to the operation itself. The specu¬ 
lative nature of the result, we fear, is pre¬ 
cisely the reason which is now tending to the 
indiscriminate performance of the operation. The 
eagerness of the surgeon, of course, under the circum¬ 
stances is natural. He is desirous of putting in 
practice a treatment which has resulted so brilliantly 
in many cases, and thus he is apt to allow his zeal to 
override his discretion. In such cases the disappoint¬ 
ment attending failure is a matter which neither 
surgeon nor patient are likely to forget. Again, it is 
scarcely fair on the part of the surgeon recommend¬ 
ing the treatment not to fully represent to the 
patient the risk associated with its practice. In 
appearance, perhaps also in fact, nothing is easier 
than to needle a lens; nevertheless, it is well known 
that eyes have been lost by suppuration after this 
simple pr'-cess, despite the most rigid antiseptic and 
aseptic precautions. Clearly, therefore, it is impos¬ 
sible to assert that no risk exists, although in the 
majority of cases, perhaps, that may l>e small. In a 
practical and thoughtful piper upon this subject, 
published by Mr. Adams Frost in the December 
number of the Edinburgh Mcdiccd Journal, another 
note of warning is sounded. “ It is possible,” he 
says, “ that the liability of myopic eyes to suffer from 
opacities in the vitreous, and detachment of the 
retina, is increased by the operation, but further ex¬ 
perience is needed to determine this. In view of 
these facts it would seem advisable to confine 
the operation to one eye, at any rate until we 
have seen that the results remain good after 
the lapse of several years.” Meanwhile, it is clear 
that the proper policy to pursue is to be careful in the 
selection of cases for the treatment. Given a suitable 
case a patient may be well advised to incur the risk 
of failure in view of the possible advantages in the 
event of success. A brilliant improvement in the 
vision has been many times attained at the removal 
of the lens in high myopia, and this has been asso¬ 
ciated with the no less advantage of enabling the 
patient to dispense altogether with the use of specta- 


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cles. Patients with 15 dioptres or more of myopia 
are much inconvenienced by the massive concave 
lenses which the correction of their defect requires 
them to wear. The relief, therefore, which they 
derive from the operation when it enables them to s- e 
clearly without glasses, may be readily understood. 
Upon the whole, then, prudence dictates caution in 
the adoption of this line of practice, until a more 
lengthened experience has been gained of its effects. 
While admitting that oftentimes the immediate effects 
have been brilliant, nevertheless it must be conceded 
that there is much yet to be learnt of its ultimate 
results. Until, therefore, this point has been deter¬ 
mined, the operative treatment of high myopia 
cannot be otherwise regarded than as still upon its 
trial. 


THE UNQUALIFIED DISPENSER 
The fatality at Heaton Norris, near Stockport, 
where a woman died in consequence of an inexcusable 
blunder on the part of the unqualified dispenser of a 
local practitioner, has had for effect to direct atten¬ 
tion to the risk inseparable from the employment, as 
dispensers, of persons who have undergone no train¬ 
ing to fit them to discharge the responsible duties 
which they have undertaken. The notice of the 
Privy Council has been directed by an associa¬ 
tion of retail chemists to the circumstances of 
the case with the object of inducing that body to | 
initiate legislation for the purpose of placing the dis¬ 
pensers employed by medical practii ioners on the 
same footing as those employed by dispensing j 
chemists, that is to say, to prohibit the compounding 
of scheduled poisons save by persons possessing a 
pharmaceutical qualification. It must be admitted 
that the quasi-legal status of these unqualified dis¬ 
pensers is very irregular. There is no obvious 
reason why the regulations with which the law hedges 
in the manipulation of poisons should not apply to the 
dispensers employed by medical practitioners, indeed 
the privileged position occupied by the latter in res¬ 
pect of the certification of death has been suggested 
as of itself a reason for insisting on special pre¬ 
cautions. This argument is not without weight, 
although, as this ver y instance shows, medical men 
would be unlikely, as well as extremely ill-advised, to 
attempt to hush up an accident of this kind. Still, 
if a qualification be thought necessary for the pro¬ 
tection of the public in chemist’s shops and open 
surgeries, it does not appear less necessary in private 
surgeries. The employment of such persons is not 
authorised by law but is established by long custom. 
As a matter of fact, the point, as far as we are 
aware, has never been raised before the General 
Medical Council, but one result of the communica¬ 
tion which has been forwarded to the Privy 
Council may well be a request for the opinion 
of the Medical Council on the ethics of the 
question. Should this forecast prove correct, what is 
likely to be the attitude of the Council ? We cannot 
without difficulty imagine the Council formally en¬ 
dorsing and approving the employment of persons 


Jan. 25 , 1899. 

who have not undergone any training in the manipu* 
lation of poisons, and whose knowledge of drugs and' 
their doses may be, and probably usually is, of the 
slightest. Nor could the Council disclaim its respon¬ 
sibility in the matter, which is essentially one for its ; 
consideration. Should the matter come officially 
before the Council, especially if it be brought forward 
from high quarters, we apprehend that regulations 
of some kind would have to be made. It is extremely 
unlikely that any legislation will be initiated of the 
kind for which the Privy Council is now asked to 
stand sponsor, but the General Medical Council might 
< onceivably prohibit the employment of persons as dis¬ 
pensers unless, if medical students, they had passed the 
examination in materia medica and pharmacology, or, 
in respect of others, unless they possess a certain 
minimum qualification in pharmacy. It must be 
admitted that accidents of this kind are extremely 
rare, but as only fatal cases are ever likely to 
become public there are no means of knowing 
to what extent public safety is jeopardised or 
compromised by the dispensing of medicines 
being left in the hands of unskilful and possibly 
ignorant perso: s. On general principles when 
we spy a danger we take such precautions as may 
appear necessary to prevent mishaps without wait¬ 
ing for mishaps to occur. We must not forget, 
however, that any sudden change in this direction 
would dislocate the practice of medicine throughout 
the land, for it would be no easy matter to replace the 
thousands of unqualified dispensers who at present 
discharge these humble but responsible functions- 
The matter, however, was certain to demand solution 
sooner or later, and very few catastrophes of the kind 
which furnishes the text of this article would suffice 
to awaken public opinion on a subject in which the 
public are primarily and immediately concerned. 


fiotts on Current topics. 

Catching Cold. 

The old-fashioned cold has been ousted to some 
extent from its former position in domestic medicine 
by the more modern influenza. An attack of influ 
enza is a much better excuse for non-attendance at 
the office or shop than a cold, the latter being com¬ 
monly regarded as an accommodation bill drawn by 
laziness on idleness. There is unquestionably such a 
thing as a cold, that is to say, a deviation from health, 
obviously consequent upon, and due to, exposure t> 
cold and damp. The initial sensation of cold is 
followed by more or less pronounced physical dis¬ 
comfort, possibly by more definite signs and symptoms 
of bronchitis or other disease a frigore. With that 
predilection for inexorable logic which characterises 
the undiscerning, the average citizen regards every 
illness commencing with a chill as a cold, losing sight 
of the fact that there are chills, i.e., sensations of 
cold, which are in no wise due to the action of low 
temperatures. This vulgar error has been productive of 
serious consequences in more than one direction. Take 
•or instance, the case of the parturient Mrs. Smith up to 

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The Medical Pbxss. 95 


twenty or thirty years ago. Two or three days after 
having presented Mr. Smith with an addition to his 
family, she shivers, and is forthwith declared to have 
caught a cold, for which Mrs. Gamp, who is in charge 
of the case, is probably blamed, though she protests 
with the energy which characterises most of her 
utterances, that she is at a loss to explain how this 
has come to pass. Mrs. Smith gets worse, and ulti¬ 
mately dies or passes many weary weeks on a sick 
bed, all on account, says the vox populi, of a cold. 
Thenceforth, it is laid down as a cardinal maxim in 
dealing with these cases, that fresh air quo cold air 
must at all cost be excluded from the lying-in 
chamber. The results were most disastrous, and, 
indeed, could hardly be otherwise, for the prevailing 
stuffiness of the chamber, the too-copious use of 
hangings to ward off draughts, and the total absence 
of ventila'ion, constituted conditionseminently favour¬ 
able to the retention and multiplication of disease-pro¬ 
ducing microbes, from the effects whereof, and not from 
cold, the unfortunate Mrs. Smith succumbed or not 
as the case nfay be. Nowadays, and rightly, we are 
all for fresh air. We fear no foe save the ubiquitous 
microbe, and we fight him with fire and poison, with 
results that amply suffice to justify this war u 
Voutrance. It may, on the other hand, lea person 
with a weak chest who experiences a “ chi’l ” and, as 
it is theoretically impossible ever to exclude the in¬ 
fluence of cold, he or she attributes the symptoms 
which follow—the cough, the sweating, the expectora 
tion, &c., to incautious exposure, whereas this chill 
merely heralded a rise of temperature incidental to an 
outburst of tuberculous disease. It would surprise 
many intelligent people to be told that a chill is a 
sign that there is fever, and that sweating is usually 
a sign that the fever is abating. Yet such is the 
unvamis 1 ed fact, and it would be well for it to be 
generally known. Cold is merely a debilitating 
agent, the effects whereof will vary according to the 
individual. It throws a strain on the organic 
machinery and the weakest part gives. If the 
machine as a whole is in good trim, nothing happens 
beyond a little temporary discomfort. In a rheu¬ 
matic person it may determine pains in the joints ; in 
another, bronchitis; in a third, kidney trouble; and 
so on—in short, it picks out the weak spots, and 
converts weakness into disease. Colds are notoriously 
infectious and the places where colds are most fre¬ 
quently caught are places where ventilation is defec¬ 
tive and where microbes abound, as in theatres, 
churches, railway carriages, and the like, so that even 
the symptoms of the old-fashioned cold are for the 
most part the result of microbial infection and not 
of exposure. 

The New Asylum for East Sussex. 

The East Sussex County Council have now ad¬ 
vanced so far in the practical contemplation of the 
erection of a new asylum that we are able to form 
Borne conception of its size and arrangement. In 
approaching the consideration of this scheme 
they have been largely guided by Dr. Hayes Newing¬ 
ton, as be is specially qualified to advise in matters of 


this kind from his long experience of lunacy and 
lunacy administration. As a preliminary, it appears 
that a Committee of Council has made a most exhaus¬ 
tive inquiry as to the best methods of construction, 
administrative arrangement, and treatment in vogue 
in other asylums, notably in the newer asylums of 
England and Scotland. Thereafter a report was 
drawn up giving a summary of the results of 
inquiry and inspection, with recommendations as 
to the best means of achieving the best results. 
A few days ago the County Council by an unani¬ 
mous vote homologated the action of their committee, 
and we endorse the rema’ks of Mr. Campion, the 
chairman of the visiting committee for many years 
at Hayward's Heath, that in taking up the matter 
so heartily, and in passing the committee’s recom¬ 
mendation so unanimously they had behaved in a 
patriotic and noble way. Mr. Campion also paid a 
high tribute to Dr. Newington, who brought the 
membere of the committee into connection with a 
great many doctors and others skilled in lunacy 
matters both in Scotland and England. Dr. Newing¬ 
ton, with his usual zeal and energy and common 
sense, has brought the preliminary stage of matters 
to a most satisfactory conclusion, and the County 
Council are to be congratulated on having had his 
rare experience and judgment in these practical 
matters. As he points out, the ideas in the report 
circulated in the beginning of last year have been 
faithfully carried out as to the principal facts and in 
many mattere of detail. The principal idea here is 
to break up the great mass of insanity such as in 
many asylums in the past had beeu huddled together. 
Provision will be made separately for those cases 
which have a chance of recovery, and also for the 
proper treatment of the sick and infirm. Into the 
many improvements we need not enter, but it is 
evident that little that is new in asylum manage¬ 
ment has escaped the observation of the manage¬ 
ment, and we recognise in the width of Dr* 
Newington’s scope of investigation a wide unpreju¬ 
diced view, from which he has carried into practical 
effect all that is good and excellent in the lunacy ' 
administration of to-day. We shall look forward 
with interest to the further development into stone 
and lime and actual working of this new scheme. 

The Lunacy Commissionerahip in Scotland. 

In a few weeks a change will take place in the 
personnel of the present Scotch Lunacy Commission 
by the retirement of Dr. John Sibbaldwhohas been on 
the Board as deputy and full commissioner for nearly 
twenty-nine years. It is a critical time in the history 
of Scotch lunacy administration, for Dr. Sibbald has 
been identified with all the best features of the so- 
called Scotch lunacy system. Since he became super¬ 
intendent of the Argyle Asylum nearly forty years 
ago, Dr. Sibbald lias never been a place seeker, nor 
has he put himself much to the front for the sake of 
mere personal promotion, and it is to be regretted 
that there are not more men of his stamp, actuated 
by the highest principles, charged with indefatigable 
industry, and a vigilance and enthusiasm which dis- 


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NOTES ON CURRENT TOPICS. 


Jan. 25. 1899. 


tinguishes him to the last. He has never slackened 
his pace for work and to-day is as keen on the scent 
of new developments in lunacy administration and 
treatment—perhaps even keener than he was thirty 
years ago. This is saying a good deal for his virility 
and conscientiousness and it makes us feel all 
the more regret that an inappreciative Government 
has not extended his time service. If Dr. Sibbald 
had been forward in his own interest, he might by his 
importunity have forced upon the Governmmt 
a due acknowledgment of his claims ; but 
he lias been one of the quiet, undemonstrative 
workers who have achieved a great deal, for the like 
which other men would have been quick to claim 
the reward. The poli?y of the Scotch board has been 
largely decided by Dr. Sibbald, and his level-headed 
way of looking at things, his finely balanced and care¬ 
ful judgment, his impersonal sense of justice, have 
done much to raise the board in the esteem of all who 
have been engaged in this special department 
whether in the higher or lower walks of the lunacy 
work in the country. In determining his successor, 
Lord Balfour of Burleigh, the Secretary of State for 
Scotland, has undoubtedly a delicate task, and it is 
not our purpose to say anything of any of the indivi¬ 
dual candidates, but we fervently express the hope 
which is agitating this special department of medi¬ 
cine, that not only in the interest of Scotch lunacy, 
but of the general lunacy administration of the king¬ 
dom, Lord Balfour will exercise the wisest judgment 
and be happy in his choice of a successor to Dr. 
Sibbald. We express what we are sure must be the 
unanimous feeling of this special branch of our pro¬ 
fession, that all good wishes go with Dr. Sibbald into 
his retirement, and that it will be exceedingly diffi¬ 
cult to find such a man for such work again. 

Syphilis in the Army: 1812 and 1890. 

In a little monograph on “Syphilis among British 
Troops—Portugal 1812, India 189<i,” Dr. George 
Ogilvie has brought together some very interesting 
facts, which should be read by everyone who has the 
interest of our Army at heart. It has evidently 
already borne fruit, judging from the fact tbat the 
subject for the next Parkea’ Memorial Prize will he, 
the “Prevalence and Prevention of Venereal Diseases 
in the British and Indian Armies/’ The author 
proves beyond doubt that Fergusson’s statement of 
the gradual 6elf-extinction cf Byphilis in the Penin¬ 
sula is a mere fable, and it follows, therefore, that all 
theories built upon this assumption are worthless 
He alsogives prominence to the fact that Fergusson 
himself discovered some years later that the cause of 
his deplorable experience in Portugal was injudicious 
reatment, and with commendable candour he him¬ 
self published this fact in 1843. Dr. Ogilvie further 
points out that a similar cause may possibly be 
operative in India. He is, however, careful to state 
that “the term treatment must be taken in its widest 
sense, not merely as a question of an under, or an 
overdose of mercury, but as comprising all the 
means to effect a cure, especially hygienic measures 
and conditions.” He adds :—“ little weight ought 


to be attached to all suggestions of particular modes 
of administering mercury, such as injections* 
&c., which, in preference to all others, are supposed 
to solve this deeply-rooted difficulty.” Perhaps now 
as formerly, as Fergusson points out, “ the error lies 
in the abuse, not in the use of the mineral.” An 
exhaustive inquiry into the whole details of the treat¬ 
ment, and the hygienic conditions is therefore neces¬ 
sary. It is sure to bear fruit if earned out in the 
spirit of unselfish veracity which made Fergusson lay 
aside all convenient theories of 6elf-exhaustion of the 
disease in Portugal, and place the calamities occur¬ 
ring among English soldiers at his own door 

The Punishment of Abortionees. 

It may be an optical delusion but it is difficult to re¬ 
sist the conclusion that trialsfor attempting to procure, 
or for procuring, abortion were never so frequent as at 
the present time. Hardly a day passes but the subject is 
brought to one's attention in the daily press, and the 
greatest interest is evidently taken in these gruesome 
dramas by the reading public. One point cannot but 
challenge attention, namely, the immunity accorded 
to women at whose guilty solicitations the accused 
persons have lapsed into crime. There is no legi¬ 
timate excuse for the inaction of the police in this 
matter. The law definis the responsibility of the 
woman without any ambiguity, but we cannot recall 
an instance in which she, perhaps the most reprehen¬ 
sible of the two parties to the offence, has ever been 
prosecuted. There have been several cases lately in 
which persons who procured or sought to procure 
abortion have been duly punished, while his or her 
partner in crime has been allowed to escape scot free. 
If it were brought home to such women that the very 
act of soliciting anyone to commit this crime is in 
itself punishable by a term of imprisonment, they 
would possibly display less alacrity in inciting 
others to forfeit character and liberty on their behalf. 
Every medical man has to decline such overtures 
many times a year, but while we can hardly go so far 
as to suggest that they should give applicants for 
abortion into custody, we most certainly urge upon 
the authorities the propriety of instituting proceed¬ 
ings whenever the solicitation has become a matter 
of public notoriety. 

Hospitals and Rates. 

A motion is shortly to be brought before the 
London County Council by Mr. J. B. Porter to 
exempt the eleven large general hospitals of the 
metropolis from the payment of rates, which at 
present absorb a sum of £8,000 per annum. While 
one cannot but sympathise with the spirit which 
prompts the proposal, we question the justice and 
expediency of saddling the ratepayers of particular 
parishes with the rates of the hospitals which happen 
to be within their limits. The general hospitals of 
London are by no means merely local institutions. 
They receive as out, and as in-patients, not only the 
inhabitants of neighbouring parishes, but from a 
large area of the country around, and there is no 
obvious reason why the local ratepayers Bhould be 


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Jan. 25, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press 97 


called upon to contribute to their medical needs. The 
payment of rates is a disbursement which differs 
in no essential respect from other expenses 
incidental to hospital management, and no valid 
reason has yet been put forward why rates should 
be treated differently from any other of the many 
items of hospital expenditure. A moderate measure 
of reform in the out-patient departments would at 
once place the finances of the large hospitals on a 
sound footing, and we are not anxious to remove an 
incentive thereto. 

The Rowland-Nugent Impersonation Case. 

It is somewhat reassuring to those who still retain 
any hope of the future consolidation of the profession 
of medicine into an united body of men with well 
recognised rights, privileges, and responsibilities to 
note the wave of indignation that has swept through 
the lay Press anent the recent sentence upon the man 
Rowland for personation. So great has been the earnest¬ 
ness shown that it even suggests the possibility of the 
outside public being one day roused to take an interest 
in the question whether their lives and limbs shall be 
entrusted to ignorant quack or to skilled professional 
handling. But do these lay editors, who wax eloquent 
with indignation over Rowland’s iniquity, reflect 
that it is mainly through the agency of their own 
columns that quackery gains the ear of the 
confiding crowd ? What is the alternate distinction 
between Rowland and, say, a charlatan who calls 
himself “ Doctor ” on the strength of a bogus Ameri¬ 
can diploma, and who advertises to cure cancer or 
who sends abortifacients to all and sundry ? What, 
indeed, except that the one has, so to speak, “ gone 
the whole hog,” and by felony secured a registrable 
diploma, which the General Medical Council pro¬ 
ceeded to place on its Register, apparently with 
touching confidence in human nature generally, but 
with entire mistrust of the adverse official warning 
conveyed by the Medical Defence Union. Now, for 
a little constructive criticism. Let Rowland work 
out his three years, and be thankful that his two 
terms of penal servitude run concurrently. Let the 
General Medical Council devise some commonsense 
means of protecting the Register; let the Medical 
Defence Union go to work with renewed vigour; let 
the lay newspapers cut out quack advertisements. 
Then—well—then let the general practitioner pluck 
up heart and organise. 

Hospitals Great and Hospitals Little. 

A certain section of the philanthropic world has. 
of late years, advocated a pernicious favouritism of 
the large hospitals to the exclusion of the smell. 
They are forgetful, seemingly, of the fact that most 
of the institutions now famous and flourishing once 
had their humble origin, although they ignore the 
circumstance just as carefully as the Hebrew million¬ 
aire omits any mention of his Whitechapel ancestry. 
This policy of neglecting the smaller hospitals has 
been adopted more or less by the Hospital Sunday 
Fund, but not by the Hospital Saturday Fund. A 
gross instance of the same tendency was shown last 


week in the London County Council, where a membei' 
gave notice of his intention to move that the eleven 
great general metropolitan hospitals should be 
exempted from the payment of rates. Why stop 
at eleven ? Why not every charitable medical insti-* 
tution in the metropolis ? Of a truth the great hos-* 
pitals and the great philanthropists know how to 
pull the strings ! So far as the medical profession is 
concerned the competition of the large general hos¬ 
pitals is disastrous, and now that at least four of 
them take money for their services, the evil is likely 
to increase like a rolling snowball in a not distant 
future. 

The Care of School Children. 

One of the chief characteristics of the modern 
conscience is the recognition of the paramount duty 
of the protection of the child. As in all great 
national readjustments, however, the generation and 
growth of the good seed must necessarily be more 
or less a matter of time. That has proved the case 
emphatically in the case of the disabled classes of 
the Pauper Metropolitan School Children, but 
perhaps the carrying out of the Departmental Order 
is one of the great social measures for the coming 
session foreshadowed the other day by Sir Michael 
Hicks Beach. Now that we have compulsory educa¬ 
tion and board schools the necessity of some kind of 
systematic medical supervision of the scholars has 
every year become more and more apparent, while 
suspicion as to the agency of school life in the 
spread of communicable diseases has been deepened 
into certainty so far as the incidence of diphtheria is 
concerned, There can be no doubt whatever, that 
our treatment of the board school lags far behind that 
of several continental nations. For instance, as 
recent writer on the subject has pointed out, Ix. 
Brussels every school child is medically examined 
once in every ten days, when eyes, teeth, ears and 
general physical condition are overhauled. If the 
child looked weak and puny, cod-liver oil and other 
appropriate remedies are promptly administered. 
At mid day a square meal is provided, partly by 
private benevolence and partly by the commercial 
funds. In short, the greatest care is taken to see 
that no child is ill-shod, ill-clad, or ill-fed. We wonder 
how long it will take Great Britain to rise to this 
standard of humane foresight, and to provide for the 
bodies as well as the brains of the children of the 
poor. 


A Curious Inquest 

An inquest which presented some unusual features 
was held last week at Liverpool on the body of a 
lieutenant in the Royal Niger Company's service, 
who had died at the infirmary from the effects of 
gunshot wounds, stated to have been received in a 
skirmish with natives on the West Coast of Africa, 
though of this there was only hearsay evidence. An 
open verdict was returned, but the peculiar circum¬ 
stances suggest the question whether an inquest is 
usually held to be necessary in all cases of death 
within a year of the receipt of wounds received in war- 


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98 The Medical Pbbss. 


NOTES ON CURRENT TOPICS. 


fore. II not, why not ? There must be many deaths 
every year—at Netley, for example—of soldiers who 
ultimately succumb to their wounds, yet we have 
never heard of an inquest being held to determine 
the circumstances under which the wounds were in¬ 
flicted. We know of nothing in the law regulating 
the holding of inquests which would exempt soldiers 
from its operation. Perhaps some member of Par¬ 
liament would ask the question with the view of 
elucidating a point which might conceivable acquire 
considerable importance under special circumstances. 

Gloucester and Vaccination. 

We notioe that the anti vaccinationists of Glou¬ 
cester have boldly announced that the recent epidemic 
of small-pox lias had no effect upon them beyond 
making them more determinedly anti-vaccinationist 
than ever. Intelligent persons of the general com¬ 
munity will only lie disposed to feel contempt for 
such individuals, whose courage, in many caseB, oozed 
out of them during the epidemic to so great an extent 
that they found it necessary to have some vaccine 
injected into them for fear that they might contract 
small-pox. It was a fact that in Gloucester many of 
the anti-vaccinationist party voluntarily submitted to 
vaccination while the epidemic was laying a violent 
hand upon the deluded community who had followed 
■their fatal teaching. The Gloucester “ delusionists” 
are now also proud of the fact that during the quarter 
ending September last, out of 415 births there were only 
twelve vaccinations—less than 3 per cent., and they 
have, in addition, stated that none of them made any 
application for exemption under the conscientious 
clause, and that they have no intention of doing so. 
Of course, it goes without saying that the anti- 
vaccination party in Gloucester feel exceedingly 
well satisfied with themselves, and they are likely 
to remain so, until the next epidemic comes and 
compels them to submit to vaccination. 


The Liverpool Tropical Diseases School. 

The School for Tropical Diseases at Liverpool is 
now practically established, and it is significant of 
the policy pursued in its organisation that everyone 
concerned therein appears to lie satisfied. Regret 
can, therefore, only be expressed that Mr. Chamber- 
lain has not so far used his influence to bring about 
a similar result in regard to the Tropical Diseases 
School scheme in London. Had the Colonial Secre¬ 
tary wisely submitted the scheme to competent 
authorities in the medical world instead of permitting 
himself to be guided in the matter by a body 
of laymen representing a local charity, there is no 
doubt that the London School for Tropical Diseases 
would have been just as successful in its inception a^ 
that at Liverpool has proved. There is, however, 
still time for Mr. Chamberlain to remedy his error of 
judgment. His only wish, no doubt, is to see the 
scheme carried out to the best advantage. But the 
only way of achieving this result is to place it upon a 
proper footing and then secure for it the confidence 
of the medical profession. 


Ja N. 25, 1899, 

A Disgraceful Affa r. 

At an inquest held before the Coroner for Lambeth, 
early last week, it transpired that in response to a 
message sent to a certain “ Medical Hall,” an un¬ 
qualified person named Bloomenthal, apparently the 
proprietor of the concern, visited the person and 
supplied medicine. Later on in the day a lady called, 
and finding the patient in a bad way, fetched 
Mr. Neville Holland, described as M.R.C.S., 
and L.S.A., who diagnosed fracture of the hip, 
being, it is asserted, at the time, under the 
influence of drink, an assertion which he dees 
not appear to have contradicted. The Coroner, 
at the instance of the jury, strongly censured Mr. 
Holland, whose conduct will be reported to the 
General Medical Council, while the attention of the 
Apothecaries’ Society will be directed to that of Mr. 
Bloomenthal. It io a mystery how so many unquali¬ 
fied persons contrive to go on practising medicine 
year after year in flagrant defiance of the penalty 
recoverable under the Apothecaries’ Act. One would 
expect neighbouring practitioners, who cannot well 
be ignorant of the character of these concerns, to call 
attention thereto, yet this 6eems to be but rarely the 
case. Mr. Holland has already been two years off 
the Register for “ covering,” and if this new offence 
be proved against him, it will go hard with him. 

A Windfall for the Hospital Sunday Fund. 

The Council of the Hospital Sunday Fund learnt 
something very much to their advantage at their 
meeting last week. The announcement was made 
that a late resident of Brighton, Mr. William Yokins, 
had bequeathed a sum of £50,000 to the Fund, which 
would be paid over on the death of his wife. From 
this it may be assumed that the testator possessed 
some confidence in the mode in which the Fund is 
administered, and the Council may, therefore, regard 
his action in the light of a compliment to themselves. 
That a sum of this magnitude should have been given 
for the purpose of benefiting the hospital charities in 
London is an especially noteworthy fact, and, of 
course, it imposes a great responsibility upon those 
whose duty requires them to administer it in order 
that the wishes of the testator may be duly carried out. 

Metropolitan Hospital Saturday Fund. 

The delegates of the above excellent body last week 
made their list of awards, amounting to the respect, 
able sum of £17,030. It is a matter of some regret 
that this year shows a falling off to the extent of 
£500, while last year, again, was £600 less than that 
of 1897. To some extent, however, these deficiencies 
may be attributed to temporary causes. We note 
that the largest grants have been made to the great 
general hospitals, several of which have received 
enormous sums from the public in recent years. It 
would be more reassuring to the medical profession 
and to the public if the Hospital Saturday Fund 
could announce that distribution was made with a 
constant eye to economy of management and to the 
curtailing of indiscriminate charity. Again, * hat is 
the attitude of the Fund towards the payment by 


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Jaw. 25, 1899. 

patients which, in defiance of professional opinion, 
was last year adopted by the London Hospital ? Mr. 
Acland, the chairman, has doce a vast deal in foster¬ 
ing sound principles in this most important body. 
"There is a still greater field before him in helping to 
secure justice in the relations of the medical charities 
to medical men. 


Salicylate of Bismuth. 

Investigations undertaken by a French pharma¬ 
cist on the salicylates of bismuth tend to prove that 
the composition of these salts is far from uniform. 
Many of them, it is stated, are not, properly speaking, 
salts at all, but merely molecular combinations of 
bismuth oxide and salicylic acid. The fact that the 
salicylic acid is washed out of these so-called 
salicylates in direct proportion to the solubility of 
the acid in the solvent employed supports this view. 
Some of the samples proved to be mere mixtures of 
subnitrate of bismuth and salicylic acid. It is quite 
possible that thiB mixture may produce the effects 
expected of the salicylate salt of bismuth, but even if 
this be so it would lie better for the prescriber to 
specify the proportions of the two constituents rather 
than leave this important detail to the whim or 
caprice of the manu'acturing druggist. 

The Wrong Tooth! 

An extraordinary action was tried at the Wolver¬ 
hampton County Court a few days ago, when u stable 
lad claimed £25 damages of Mr. Bebb, a medical 
piactitioner, for having extracted the wrong tooth. 
It transpired that there was a Ixmy growth at the 
root of the aching molar which projected beneath the 
adjacent one, dragging the latter out at the same 
time. The judge, of course, gave judgment for the 
defendant with costs. There are probably a large 
number of people who would be willing to have their 
teeth extracted at £25 apiece without costs. 


The Royal College of Surgeons and the 
Members' Gown. 

As might have been anticipated the Council of the 
Royal College of Surgeons of England has adjourned 
the consideration of a gown for members sine die, a 
very appropriate way to dispose of a suggestion which 
was simply ridiculous on the face of it. Gowns and 
stuffed alligators as appurtenances of the consulting 
room belong to a bye-gone age, and we have no wish 
to re8cuscitate them. 

The Guernsey Way of Dealing with Quacks. 

A person called Derentz, who was banished from 
Guernsey five years ago for malpractices, was sum¬ 
marily arrested last week and lodged in gaol, where 
he unsuccessfully attempted suicide. He is suspected 
of being in the habit of receiving young women in 
his house for the purpose of procuring abortion, 
keeping them under his charge until convalescence. 
Derentz is generally known as “the doctor,” but 
possesses no medical qualification. 


• The Medical Peeks. 99 

British Hospital for Rome. 

The British colony in Rome have decided to found 
a hospital in the city for the benefit of English 
persons. The estimated cost of the erection and 
equipment of the institution is £7,000, of which sum 
only a small proportion still remains to be raised. 
The hospital, it is expected, will be ready for 
patients early next year. 

A herbalist, named George Hare, 69, was found 
guilty of using an instrument with intent to procure 
abortion, and at the Old Bailey last week was sen¬ 
tenced to twelve yea re' imprisonment. In 1889 he 
was sentenced to a term of ten years’ penal servitude 
for a similar offence. 


According to the report of the Medical Officer of 
Health for the parish of Stoke Newington, published 
last week, the recorded death-rate of the parish for 
the four weeks ended December 31st, was only 10'8, 
while that for the whole of London during the same 
period was 17'2. 


Lady Elgin opened the Lady Dufferin Victoria 
Hospitul in Calcutta, last month. The building cost 
three lakhs of rupees, the bulk of the money having 
been subscribed by native gentlemen. 


PERSONAL. 

Surgeon-General H S. Muir has been appointed 
Deputy Director-General of the Army Medical Service. 


Surgbon-General W. Tatlob, C.B., has been 
appointed Principal Medical Officer in India. 


Surgeon-General W. S. M. Price has been appointed 
Principal Medical Officer with the Eritish Forces in 
Egypt. 

Mb. Alexander G. R. Foulebton, F.R.C.S.Eng., 
D P.H.Camb , F.C.S., has been appointed Bacteriologist 
to the Middlesex Hospital. 

Dr. Robert Barnes and Mr. Lawson Tait have been 
elected Honorary Presidents of the Gynecological Con¬ 
gress, which is to meet at Amsterdam in August. 

H R.H. The Prince of Wales has announced his 
intention of being present at the Hunterian Oration at 
the Royal College of Surgeons, England, on Tuesday, 
February 14th next. 

The President of the Royal College of Surgeons in 
Ireland entertained at his residence on Thursday last 
the Councillors of the College, with the addition of Sir 
Thornley Stoker and Dr. James Little. 


Dr. N. H. Choksey, medical officer in charge of the 
Arthur Road Hospital, Bombay, has been invested with 
the Order of the “ Crown of Italy,” by command of the 
King of Italy. The decoration was presented to Dr. 
Choksey for services rendered to the Italian representa¬ 
tives of the plague commission who visited India last 
year. 


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NOTES ON CURRENT TOPICS. 




100 The Medical Pr'fp, 


CORRESPONDENCE. 


Jar. 25. 1899. 


Dr. Molont, F.E.C.P.I., Senior Resident Medical 
Offioer of St. Patrick's Hospital, Dublin, has accepted the 
offer of the Governors to take charge of the newly 
acquired country branch at Lucan. The vacancy thus 
created has been filled by the appointment of Dr. Robert 
Richard Leeper, at present Surgeon to the Rathdrum 
Union Infirmary, and Visitor of Lunatics under the 
Lord Chancellor. Dr. Leeper’s contributions to psycho¬ 
logical literature are well known. 


(ftomBponOatce 

We do not bold ourselves responsible for the opinions of oar 
correspondent*. 


PRIMARY EPITHELIOMA OF THE UVULA. 

To the Editor of The Medical Pbbss and Circular. 

Sir,—R egarding your interesting note of Dr. Walker 
Downie's case of this nature reported in the current 
number of 2 he Scottish Medical and Snrgicctf Journal, 
you rightly say that it “is a very rare affection.” 

On referring to the original report, I find that Dr. 
Downie quotes from the third edition of my work, “ The 
Throat and Nose, and their Diseases/ to the effect that 
I had up to that time not seen an example. This is true, 
but in my fifth edition, on page 322. I report an example 
as Case XXVII, that of a male patient, aet. 48, who was 
first seen by me on the recommendation of Dr. Watson, 
of Tunbridge Wells in June 15th, 1897, just a month 
before the date of Dr. Downie’s case. The result of ex¬ 
cision has been equally satisfactory, nineteen months 
having elapsed without recurrence. The coloured draw 
ing of the appearance is given on Plate V., Fig. 37, and 
a microscopical section on page 323, as Fig. CLX1X , 
which showed the growth to be of the squamous variety 
of epithelioma. 

I am, Sir, yours truly. 


a less important discovery than that of antitoxin, whioh 
opens an entirely new avenue in medical research, since 
it indicates a possible method of treatment of all infec¬ 
tious diseases upon the same lines. It was not thus, a 
question of the benefits that have accrued from the small 
amount of work that has been done, but of the enormom 
possibilities of the method. 

The third source of information of which your con¬ 
tributor has availed himself is the " interview ” in the 
South London Press of last Saturday. This journal 
having copied the Telegraph verbatim, I wrote to the 
Editor, and he sent down a reporter, who naturally 
availed himself of the opportunity of acquiring fur¬ 
ther information, as well as making the correc¬ 
tions which I insisted upon. The statement aa 
to the reduction of mortality from diphtheria in 
Camberwell occurs in this, and I am at a loss to 
see what there is in it to which exception can be txken. 
Does your contributor deny my facts or my figures P 
That I have counted my chickens before they are 
hatched—or shall we say, killed?—is untrue. I have- 
been set to work to assist the Vestry in reducing the 
mortality, and the figure mentioned is what we aim at. 
Unfortunately, I know only too well that the chances are 
a thousand to one against its being attained at present^ 
since I know the difficulty which will be experienced in 
bringing home to medical men their duty in the matter. 
If we could do this, we should reduce the mortality to 
three per cent., and save 120 lives annually on the 
population of Camberwell, which is over a quarter of a 
million. 

I have never yet heard it claimed for glycerinated 
lymph that it was absolutely sterile, nor was this my 
point. The hope I expressed was that we might be able 
to supply lymph in a form which would “ satisfy the 
conscience of the most conscientious objector,” since, 
being manufactured in vitro, it would be free from any 
suspicion of animal contamination. Anyone who has 
had much to do with the conscientious objector knows 
that this point is the real “ refuge for the destitute” of 
the anti-vaccinationists. 


Mansfield 8treet, W., 

January 20th, 1899. 


Lennox Browne. 


POPULAR BACTERIOLOGY. 

To the Editor of The Medical Press and Circular. 

Sir, - In reference to the remarks contained in your 
last issue under this title, I beg to say, in the first place, 
that the writer nowhere makes it apparent that he 
bases them on material taken from three different 
sources. Of these, tho first, which contains my repu¬ 
diation of any desire to pose as a specialist, appeared 
in the Lancet of December 10th, and deals exclusively 
with the therapeusia of diphtheria, upon which point my 
experience, I repeat, does not justify my assuming a 
specialistic attitude 


Finally, may I suggest that your contributor, in 
denying the possibility of the extinction of infectious 
disease, in reply to a conjecture of mine, is ventuting 
into regions of prophecy into which I, for one, am disin¬ 
clined to follow him ? That is what is being aimed at, 
and the progress made in this direction, and the increas¬ 
ing number of means available in the conflict, justify the 
hope that -though not in our lifetime—this may be 
accomplished. Your contributor may, however, comfort 
himself with the reflection that, whichever of us is in 
the right will never be able to enjoy the triumph, dear 
to the heart of every Englishman, of saying, ‘ I told you 
so.” 

I am, Sir, yours truly, 

Edward C. Bousfibld. 

303, Old Kent Road, January 20th, 1899. 


The question of my appointment as bacteriologist rests 
upon an entirely different footing. I have no wish to 
boast, but, having devoted most of my spare time for the 
last ten years to this class of work, and having been suffi¬ 
ciently fond of, and interested in, it to maintain a labo¬ 
ratory at my own expense *or the last seven years for its 
study, my claim might reasonably lie a different one. 

The lecture was not a public one, but was delivered 
before the members of the Camberwell Vestry, and such 
medical men as accepted the Vestry's invitation to 
attend. It was reported, most inaccurately, in the 
Daily Telegraph of the following day, and the report in 
question has been taken by your contributor as the basis 
of his criticisms, a very rash, as well as a very unfair 
pioceeding. The time devoted to diphtheria may have 
been ten minutes out of eighty, and the absurd state¬ 
ment as to the relative virtues of vaccination and anti¬ 
toxin (even the Telegraph did not limit me to diphtheria 
in this connection, as your contributor does) really 
amounted to no more than a statement of the possibility 
that vaccination, which only provides prophylaxis 
against one disease, might in the long run, prove to be 


INACCURACIES IN THE MEDICAL REGISTER. 

To the Editor of The Medical Press and Circular. 

Sir, —Now that the question of the accuracy of the 
Medical Register is being ventilated, it may interest you 
to know that I recently accidentally discoverei several 
errors in it. One is that of a friend of mine who has 
been dead for several years, but his name and address in 
a foreign town still figure (in the Register of 1898. The 
name of his father who died more recently has, however, 
been removed. Three or four practitioners in this town 
are appirently liable to have their mines erased as their 
addresses are totally wrong, and another friend of mine, 
who has practised in London for several years, is still 
officially located in the Royal Infirmary, Edinburgh. 

These are merely random samples of inaccuracy from 
one cause or another, and doubtless many others could be 
added thereto. 

I am, Sir, yours truly, 

M. S. 

Cambridge, January 23rd, 1899. 


Digitized by V. :iOOQle 




Jak. 25, 1 899._ LITER ARY NOTES AND GOSSIP. The Medical Press. 101 


PERSONATION AND ERASURE FROM THE 
MEDICAL REGISTER. 

To the Editor of The Medical Press and Circular 

Sir,— May I point out that the periodical erasure of 
the names of registered practitioners who do not respond 
to the Registrar’s roll-call affords no protection whatever 
against personation. The p9reonator would of course 
take care to acknowledge receipt of the notice, and as the 
Registrar has no means of testing or controlling the 
authenticity of the signature, the fraud necessarily 
escapes detection. 

I am, Sir, yours tiuly, 

G. S. A. 

MEDICAL SOCIETY OF LONDON. 

At the meeting on Monday evening last (January 
23rd) Mr. Cuthbert Wallace read notes of three cases 
of appendicitis with diffuse peritonitis in which he 
had successfully operated. In two instances the peri¬ 
tonitis was general, but in the third it did not extend 
beyond the transverse meso-colon. In all three he had 
removed the appendix and turned out the intestines, 
flushing the belly cavity with sterile water. He made 
hiR incision through the right rectus muscle. All three 
cases recovered without a bad symptom. 

In the discussion that followed the author was warmly 
congratulated on his unprecedented success. Mr. 
Clutton referred to the bad results which formerly fol¬ 
lowed ex-ventration, but thought it might be revived 
with advantage. To obviate the difficulty in getting the 
bowels to act he recalled a suggestion to inject a solution 
of magnesium sulphate into the bowels high up by means 
of a hypodermic syringe. 

Mr. Stanley Boyd questioned the accuracy of the 
description of diffuse peritonitis in many of the recorded 
cases. He had inquired for a drug which would act on 
the bowels if injected hypodermically, but had not been 
able to find one. It must be impossible, under any 
circumstances, absolutely to cleanse the peritoneum, 
and much must depend on the patient’s powers of resist¬ 
ance. 

Mr. Bruce Clarke thought ex-ventration was, on the 
whole, a good thing, and he approved of the incision 
through the rectus. 

Mr. Battle mentioned a case of diffuse peritonitis in 
which he had operated. 

The President insisted on the prognostic value of 
thoracic breathing and abdominal hardness. 

Mr. P. J. Fbeyeb related “ two recent cases of success¬ 
ful operation for impacted stone in the ureter.” The 
first case was that of an officer, set. 23, who had suffered 
from renal colic and ha;maturia for nineteen months. 
He exposed and incised the kidney, but found no stone. 
He found one, however, impacted four inches down the 
ureter, and he incised the ureter and removed the stone. 
The patient made a perfect recovery. In the second 
case, a man with multiple stricture had suffered for 
many years from symptoms of kidney stone. The left 
kidney was explored by another surgeon in 1895 without 
result, and on his re-exploring no kidney could be found. 
He subsequently performed internal urethrotomy, still 
without affording relief. Later on, with the cystoscope, 
he detected a stone projecting from the right ureteral 
orifice into the bladder, and this he removed with the 
lithotrite, after which the patient gradually recovered. 

Mr. Bruch Clabkb related the case of woman from 
whom he had removed a stone impacted five inches down 
the ureter. 

THE 8WINEY PRIZE. 

The adjudicators of the Swiney prize, at the meeting 
held in the rooms of the Society of Arts on Friday the 
20th inst, awarded the prize for the present year to Dr. 
J. Dixon Mann, F.R.C.P., Professor of Forensic Medicine 
and Toxicology in Owens College, Manchester, for his 
work on “Forensic Medicine and Toxicology.” The 
prize, in accordance with the will of the testator, is 
awarded on every fifth anniversary of his death to the 
author of the beet published work on Jurisprudence. 
The prize consists of a silver goblet of the value of .£100, 
with money to the same amount. Dr. Swiney died fifty 


years ago—on toe 20th of January, 1844—and the awards 
has been regularly made every fifth year to the present 
time. The Society of Arte are the trustees of the fund, 
and the award is made by that Society and the Royal 
College of Physicians of London. Having regard to this 
fact, the prize has up to the present date been given 
alternately for works on General Jurisprudence and on 
Medical Jurisprudence. 

Sir William McGbegor, who has just been appointed 
Governor of Lagos, is M.D. of Aberdeen, but he early 
developed such striking administrative abilities that he 
does not seem to have practised his profession to any 
great extent. A medical education must, however, be 
valuable even to the governor of a colony. 

The Duchess of Albany last week opened the new 
Nurses’ Home of the Chelsea Hospital for Women, and 
afterwards paid a visit to the hospital. 

0bituarn. 

MR. ARTHUR HENRY WILSON, OF LIVERPOOL. 

We sincerely regreat to have to announce the death of 
Mr. Arthur Henry Wilson, which took place at his 
residence. 30 Rodney Street, Liverpool, on January 15th, 
in his 39th year. The deceased, second son of Mr. C. B. 
Wilson, an old and highly respected surgeon of that 
city, had a distinguished career as a student, gaining 
the Lyon-Jones scholarship and gold medal in anatomy, 
and the Derby Exhibition in clinical medicine. Later 
he filled the offices of house physician and house surgeon 
at the Royal Infirmary, Liverpool, where his father had 
also been house surgeon in his early days. Commencing 
private practice he was appointed honorary surgeon to 
the Stanley Hospital, Liverpool, and some years ago he 
received the appointment of surgeon to the Northern 
Hospital, which post he letained to the time of his death. 
Rather reserved in manner, he did not court friendships, 
but those he made were firm and sure, and perhaps no 
one had warmer friends than Arthur Wilson. It may be 
truly said that those who knew him best loved him most. 

As a surgeon he was able, clear-headed, and a skilful 
operator and his colleagues lose in him an esteemed and 
valued fiiend whose untimely end they deeply deplore. 
Some months ago he began to show signs of serious ill- 
health. At first the symptoms were far from pronounced, 
and considerable doubt existed as to the nature of the 
malady. Later on, however, symptoms of ulcerative 
endocarditis became evident, and to this he succumbed. 
The deceased was not married. 

The funeral, which took place on the 18th inst., was 
very largely attended, the officiating clergyman being 
his brother-in-law, the Rev. Stephen Gladstone, rector of 
Hawarden. 


yitcvavg <iIotcs anb ©ossip. 

We have received the first number of a new medical 
review, “ Les Archives Provinciales de Medicine,” edited 
by Dr. Marcel Baudouin, Paris. Among the contents is 
a valuable and exhaustive contribution, beautifully illus¬ 
trated with coloured drawings, entitled “ Mixed Tumours 
of the Parotid,” by Drs. Curtis and Proces, which will 
well repay perusal. This new publication promises well, 
and should prove successful. 

*** 

Several of our American contemporaries, just to hand, 
publish some comments upon the ne v departure in 
medical journalism which has been adopted by a medical 
journal, iecently founded in Philadelphia, of refusing to 
issue exchange copies. No doubt, as a piece of “ bluff,” 
the announcement of this change was, to use a vulgar 
phrase, “ smart,” and, in any other country than the 
United States, might prove in the end to be a successful 
move. But, judging from the remarks of oui contem¬ 
poraries, just the opposite effect is likely to ensue, as the 

Digitized by Google 


102 Th* Mxdical Press. NEW BOOKS AND NEW EDITIONS- Jan. 25, 1899. 


medical journal in question will probably, before long, 
find to its cost. 

*#* 

Under its new editor the English Illustrated Magazine 
has taken a new lease of life, and shows noteworthy 
improvement. The January number is a most interest¬ 
ing issue, containing many articles of the kind most 
likely to attract magazine readers. Moreover, a new 
feature has been introduced of coloured illustrations, and 
these are of a highly artistic and finished character. Mr. 
Bruce Ingram, the new editor, is to be congratulated 
upon the success with which he has inaugurated his 
assumption of office. 

• • 

tfc 

The new volume, July—December, 1898, of “Biaith- 
waite’s Retrospect of Medicine” just published, well 
sustains the reputation of the work. The valuable series 
of abstracts which it contains culled from the medical 
literature of the past half year renders it an essential 
volume to every practitioner desirous of keeping himself 
abreast with the times. Its usefulness is further increased 
by an admirable synopsis which shows at a glance the 
various subjects dealt with. 

%* - , 

Messrs. Keoan Paul and Company have just issued 

a revised edition of Mr. E. A. Reynold-Ball’s “Mediter¬ 
ranean Winter Resorts.” Although the characteristic 
features are unchanged the requirements of ordinary 
tourists are more fully met than in the previous edition, 
and in the case cf places of historic or artistic interest 
the principal sights are so fully described as to render 
the traveller independent of guide books. At the same 
time particular care is paid to the interests of those 
classes of visitors for whom the book is mainly intended, 
viz., invalids and winter residents, and great importance 
is given to the medical aspects of various winter stations. 

• * 

• 

Messrs. John Wright and Co., of Bristol, have sent 
us a new “ case paper,” designed by Drs. Couch and Lan¬ 
caster, which certainly offers some advantages over those 
in general use. It consists of four pageB, the first 
whereof gives headings under which the various items of 
information concerning the name, Ac., of a patient and 
the condition of his organs, can be entered, thus ensur¬ 
ing that no essential particulars are overlooked or 
omitted. The two centre pages are covered with tracings 
in faint red of the trunk, from the front and from behind, 
as well as in section, feet, hands, throat, larynx, Ac., on 
which observed morbid conditions can be readily re¬ 
corded. There remains a blank page for miscellaneous 
notes. These papers are supplied at 26s. per 1,000. 

• • 

• 

The “ Phonographic Outlines of Medical Terms,” pub¬ 
lished by the Society of Medical Phonographers is, or 
Bhould be, of use to those medical students who are dis¬ 
posed to avail themselves of the facilities afforded by 
shorthand for taking notes of lectures, Ac. As a matter 
of fact, however, this work does little more than show 
the easiest why in which a given scientific word can be 
written in full most of the outlines being, so to speak, 
tn toutes lettres. What we should have imagined the 
student to require would be useful grammalogues of the 
more frequently used medical terms. Skilled writers 
of shorthand can, of course, invent these for current 
use as and when occasion may require, but even they 
might be glad of a few hints. There is an appendix 
containing a list of words having the same shorthand 
outline and distinguishable only by vocalisation or 
position, but in the interests of legibility we should 
advise the student phonographer to rely on the former 
rather than on the latter. 

*#* 

An official organ of “ The International Commission on 
Adulteration ” has just made its appearance under the 
title of the British Food Journal and Analytical Review. 
Its objects are as foreshadowed by the title, and, by its 
aid the Association—branches of which exist in every 
capital in Europe—will doubtless accomplish a good deal 
towards the suppression of adulteration of food and 
drugs- The initial number is in itself a powerful plea 
for its raison d’etre, and few would-be adulterators will care 
to be pilloried in an organ which, by reason of its official 


character, will find its way throughout the civilised 
world. The names of members of the Commission are 

S '.ven in the number before us, the President being Prof. 

rouardel, of Paris, and the representatives for Great 
Britain: Sir Hy. Thompson, Bart.,; Sir Chas. Cameron, 
C.B.; Prof. Corfield. F.R C.P.Lond.; and Mr. Chas. E. 
Cassal, F I.C. The journal will be published monthly by 
Messrs. Bailliere, Tindall, and Cox. 

• • 

• 

The “ Plan and Plea for National Medicine,” by E. L. 
Garbett, of the Peculiar People, is a protest against 
“ the notion of a class of men learned in medicine and 
selling their advice ” as being utterly foreign to the Old 
Testament. It may be that in those days no one had any 
medical advice worth paying for, but this is hardly suffi¬ 
cient to justify the abolition of doctors now, in favour of a 
birth-tax, or rather an ante-natal tax, “ estimated at one 
halfpenny per week between the ages of 10 and 30, rising 
to threepence for the first year, twopence at 45, and an 
additional penny for every five years.” In discussing the 
parcelling-out of the “ health parish,” we are directed “ to 
multiply the number of persons in each age by that 
age’s units of vitality, and then equalise the whole sum” 

—Q.E.D. The author incidentally protests against 
medical fees, which he (or she) regards as “ percentage 
on outlay,” and this leads her to, or from, the remark 
that “ every farthing of interest on capital is damnable 
plunder of labourers,” which is not exactly ad rem —but 
no matter! 

*#* 

It is rather a pity that Dr. Robert Bell’s pamphlet on 
the safety of chloroform should be disfigured by such an 
intolerable amount of vehement rhetoric and abuse 
couched in biblical phraseology. Had he shown him¬ 
self more temperate in his advocacy, and more guarded 
in his language, we should have congratulated him on 
having attacked a subject which certainly calls for atten¬ 
tion. He has set himself the task of rehabilitating chloro¬ 
form as an anaesthetic, it having fallen into disgrace 
owing to the numerous fatalities following its use by un¬ 
skilled or careless persons who are unable, or for some ‘ 
reason unwilling, to adopt the only means whereby this 
powerful agent can be safely administered, viz , a regula¬ 
ting apparatus of an approved type. The statistics upon 
which the conclusion has been arrived at that ether is a 
safer anaesthetic than chloroform, are vitiated by the fact 
that they are mostly based on cases in which ether has 
been given by means of an apparatus, while chloroform 
has been given recklessly on a towel. The carelessness 
in each case being presumed equal, chloroform is 
obviously likely to prove more fatal than ether because 
it is much more powerful. That ether per se is not safe, 
is proved by the fact that no less than fifty-four deaths 
have been recorded in this country from that cause 
during the past year. 

NEW BOOKS AND NEW EDITIONS. 

The following have been received for review since the 
publication of our last monthly list: — 

Bailliere, Tindall, and Cox (London, Paris, Madrid). 

Dictionary of Medical Terms. Vel. I., English-French. By H. 
de M«?nc, M.K.C.S., Surgeon to the French Hospital, London. 
Pp. 39V Price 5e. 

Blackwood and Sons (Edinburgh and London). 

The Good Begent: A Chronicle Play. By Professor Sir T. 
Grainger Stewart, M.D., LL.D. Pp. 207. Price 6a. 

James Bowden (London). 

The Secret of Good Health and Long Life. By Haydn Brown, 
L.R.C.P., L.B.C.S.Edin. Second Edition. Pp. 172, 

J. and A. Churchill (London). 

Guy’B Hospital Reports. Vol. LIII. Edited by E. C. Perry, 
M.A., M.D , and W. H. A. Jacobson, M.A., M.Ch. Pp. 310. 

St. Thomas's Hospital Reports. Vol. XXVI. Edited by Dr. 
Hector Mackenzie and Mr. G. H. Making. Pp. 472, with addi¬ 
tional reports on special departments. Price 8*. 6d. 

W. and A. K. Johnston (Edinburgh). 

The Anatomy of Labour and its bearing on Clinical Work. By 
A. H. F. Barbour, M.D., F.B.C.P.Ed,, F.B.8.Ed Pp. 216 and 
146. 2nd Edition. 

8AMPSON, Low, Marston, and Co. (London'. 

Twentieth Century Practice. VoL XV. Infectious Diseases. 
Edited by Thoe. L. 8 ted man, M.D., New York Pp. 658. 


Digitized 


google 



Jan. 25, 1899- 


LITERATURE. 


Thr Msdical Press. 1C3 


The Scientific Press, Limited (London). 

Poison Romance and Poisou Mysteries. By C. J. S. Thompson. 
Pp. 255. Price 6s. 

Simpkin, Marshall, Hamilton, Kent and Co. (London'. 

The Retrospect of Medicine. Edited by Jos. Braithwaite, M.D. 
Lond., aud E. F. Trevelyan, M.D.,M.B.C.P.Lond. Vol. CXVIII. 
Pp. 440. 

Swan, Sonneschein and Co. (London). 

Sanatoria for Consumptives in all Parts of the World. By F. B- 
Walters, M.D , M.B.C.P. Pp. 371. Pnce 10s. 6d. 

John Wright and Co. (London). 

The Treatment of Disease by Physical Methods. By T. Stretch 
Dowse, M.D., F.R.C P.Ed. Pp. 412. Price 7s. 6d. net. 

T. Fisher Unwin (London). 

Life of Man on the High Alps. By Angelo Mosso. Translated 
from the Italian. By E. Lough Kicsow. Pp. 342. Illustrated. 
Price 21s. 


3Citeratmre. 


LOCKWOOD ON HERNIA, HYDROCELE, AND 
VARICOCELE, (a) 

Another work by this author cannot fail to give 
pleasure and instruction, and the more so since the 
-volume before us is the writer's verdict on his own prac¬ 
tical experience. It is the record of his operations for 
the radical cure of hernia, of hydrocele, and varicocele. 
He well says that the operation for the radical cure of 
hernia has no longer to be defended, though it is, perhaps, 
to be desired that the expression “ the operation for the 
radical cure of hernias ” might have given way to the 
leas cumbersome, and less dogmatic one of “ the radical 
operation upon hernias.” This needs no defence, because 
of its success, its low death-rate, and its freedom from the 
complication of suppuration, which latter fact we think 
is greatly due to the work and teaching of Mr. Lock- 
wood. In dealing with operations upon hernias, the 
author divides all such protrusions into three varieties 
—congenital, traumatic, and acquired. We think that 
this is a little unfortunate, Rince the terms used are 
generally somewhat differently employed. “ Congenital ” 
is correct if by it is meant, as Mr. Lockwood does, that 
the hernia is due to some failure in development, but 
“ acquired ” should include all other forms of hernise. 
Thus the variety “traumatic” is to be but a sub¬ 
division of “ acquired,” and even then should have 
two. meanings — namely, to indicate those protru¬ 
sions which are the result of operative procedures 
on the abdominal wall, and those which are caused by 
actual tearing asunder of fibres, true “ ruptures.” Mr. 
Lockwood is emphatic that in inguinal hernise one is only 
likely to secure good and lasting results in the ca«es of 
congenital and “ traumatic ” hernise, and this teaching 
is the outcome of all the experience of those who have 
had a large number of cases under their care. With 
regard to the congenital variety as it occurs in infants, 
he holds with many other surgeons, that a carefully 
adjusted spring truss will, in a large majority of the 
instances bring about a cure, but if it does not before 
the child begins the active enjoyment of athletic pur¬ 
suits, then operation should be advised. His directions 
for the performance of the operation, after his explana¬ 
tion of the preparation of the patient, leave nothing to 
be desired. He dwells on the very important point as 
to the manner in which an arrested testis is to be dealt 
with when encountered in the radical operation. His 
experience of returning it to the extra-peritoneal tissue 
is limited to one case, but others have found but little 
harm to follow such a procedure in instances where the 
organ cannot be brought into its natural resting place. 
Mr. Lockwood’s remarks on hydrocele, and varicocele 
are chiefly in connection with their complicating the 
operation for the relief of hernia, but the whole subject 
of these conditions is very carefully reviewed, especially 
in reference to operations for their radical cure. He 
advocates excision of the sac in the hydrocele, and steri¬ 
lised twisted 8 ilk in ligating'a varicocele. From every 
point of view we cannot regard this work otherwise 

(a) “On Hernia, Hydrocele, and Varicocele ” By C. B. Lockwood, 
F.B.C.8., Assistant Surgeon to St. Bartholomew’s Hospital, 8ur- 
to the Great Northern Central. Hospital. London and Edin- 
h: Young J. Pentland. 1890. 


than as one that will considerably help surgeons in the 
selection and treatment by operation of the many forms 
of scrotal swellings, designated by the terms hernia, 
hydrocele, and varicocele. 


OSLER’S PRINCIPLES AND PRACTICE OF 
MEDICINE, (a) 

New improvements in type and paper have been called 
in to increase the attractiveness of the present issue of this 
deservedly popular American text-book; the text his been 
in all parts revised, and in considerable proportion re¬ 
written. so as to bring the volume abreast of the present 
state of scientific and clinical knowledge. These modi¬ 
fications were very necessary, of course, as the former 
edition is three years old, which appears to be the maxi¬ 
mum degree of longevity which this progressive and 
unsympathetic age allows to any representative text¬ 
book of the science of medicine. 

“The following articles have been re-written or are 
new:—Vaccination, Beri-beri, the Bubonic Plague, 
Cerebro-Spinal Fever, Pneumonia, Malta Fever, Yellow 
Fever, Dengue, Leprosy, Glandular Fever, the Gonor- 
rhooal Infection, Cancer of the Stomach, the Gastric 
Neuroses, the Cirrhoses of the Liver, Jaundice, the 
Diseases of the Bile Passages, Diseases of the Pancreas, 
Diseases of the Thymus Gland, Diseases of the Spleen, 
Lymphatism, Addison's Disease, Encephalitis Neuras¬ 
thenia, Erythro-melalgia, and many other shorter 
articles, as Ether Pneumonia, Anrosthesia Paralysis, 
Pneamaturia, Albumenuria, Ac. 

“ Into the sections on Typhoid Fever, Tuberculosis, 
Rheumatic Fever, Diabetes, Gout, Parasitic Diseases, 
Diseases of the Blood. Heart, Lungs, and Kidneys, much 
new matter has been incorporated. The section on 
Diseases of the Nervous System has been rearranged, 
and an attempt ha» been made to group the diseases 
in accordance with the modern conceptions of the ana¬ 
tomy and function of the parts.” 

A text book, so well known to the professional publio 
of the period, assuredly requires no critical introduction 
through the medium of our pages. Accordingly, we 
think it only necessary to say that the author has used 
all his wonted care and skill in bringing the present 
issue fully abreast of the most advanced lines of our 
scientific knowledge, and has been well seconded by the 
efforts of the publisher, printer, and bookbinder in their 
respective spheres. They have succeeded in making this 
admirable manual of medicine attractive in direct propor¬ 
tion to its instruct!vensss. and the net result of their 
“ conjoint ” labours is the best hand-book in the English 
language of its subject that we know of. 


ANDERSON’S YELLOW FEVER. ( b) 

This little book of one hundred and six small ootavo 
pages contains an excellent clinical picture of yellow 
fever, and gives the author’s experiences of the disease; 
an experience gained in thirty-four years’ hard work in 
the West Indies. 

Like all physicians of his day, Dr. Anderson went to 
the Tropics without any knowledge of tropical diseases, 
but, fortunately, for himself he formed the acquaintance 
of two physicians who were very competent and quite 
willing to instruct him in the nature and treatment of 
these diseases. 

The book is intended for practitioners, and not for 
students reading for examination, and consequently there 
is nothing about the theories of the fever. 

As a record of the author’s personal experience of 
yellow fever in the West Indies, the book has a distinct 
value, and may be read with great advantage by phy¬ 
sicians who propose practising in the Tropics. He is 

(a) “ The Principles and Practice of Medicine." Designed for the 
use of Practitioners and Sludenta of Medicine. By William Osier, 
M.D., LL.D.Edin., F.R.S., F.R C.P., Professor of Medicine in the 
Johns Hopkins University, and Physician-in-Chief to the Johns Hop¬ 
kins Hospital, Baltimore; formerly Professor of the Institutes of 
Medicine, McGill University, Montreal; and Professor of Clinical 
Medicine in the University of Pennsylvania, Philadelphia. Third 
edition, largely re-written. Edinburgh and London: Young J. 
Pentland. 1898. 

(b) " Yellow Fever in the West Indies.” By Itett Anderson, 
M.D.Edin. London: H. K. Lewie. 1898. 


oogle 



104 Thk Mtoioal Pbiss. 


LTTBBATtTBB. 


Jan. 26, 1899. 


dear and brief in statement, telling his story plainly in 
idiomatic English, for which, and for the absence of pad¬ 
ding, we are truly grateful. The number of fatal cases 
is less when antitoxin is used early in the illness than in 
those who do not receive it until a later period. The 
frequency of the occurrence of paralysis is not diminished, 
but the percentage of recoveries in cases with paralysis 
is slightly increased. 

Rashes are produced in about one-third of the cases, 
and are attributable to the antitoxin. Pain and 
occasional swelling about the joints are produced in a 
small number of cases. Even when used in very large 
doses, no serious ill effects have followed the injection of 
antitoxin. 

Although we do not wholly acoept these conclusions, 
we recognise the value of the report as a most useful 
contribution to the study of this terrible disease ; an im¬ 
mense mass of facts have been collected, classified, and 
supplied to the reader in a form which enables him to 
draw his own conclusions and supplies him with a great 
body of information on the disease. 


THE CLINICAL SOCIETY’S TRANSACTIONS, (a) 

The present volume of Transactions, which was pub¬ 
lished on October 11th last, is one of unusual interest. 
In an appendix it contains the “ Report of the Committee 
on tbe Anti to »in of Diphtheria.” 

To similar reports published by this great Society the 
medical profession and the public are much indebted. 

The investigation of other medical problems under¬ 
taken by this Society have been carried out with a 
thoroughness that left nothing to be desired; the mem¬ 
bers who undertook the onerous task seemed to be one 
and all fired with an enthusiasm for scientific truth that 
carried them successfully through labours that would 
have deterred less fei vent students. 

These well-known facts give a great value to any pro¬ 
nouncement on medical matters the Society may make. 
It is, therefore, of the utmost importance that no opinion 
will be expressed by the Society without the most scru¬ 
pulous care being taken that the conclusion arrived at is 
based on the clearest proof. We wish we could see our 
way to the acceptance of the conclusions arrived at in 
the ‘‘Report of the Committee on the Antitoxin of 
Diphtheria.” We have a great respect for the labours 
of the Committee, and we acknowledge that the subject 
selected for investigation was worthy of the Society’s 
best effort for clue dation, and that it is one of the most 
pressing problems in the medical world. But all this 
said, all of which is distinctly creditable to the Society, 
does not alter our opinion on the conclusions, which are 
as follows:— 

The use of antitoxin reduces the mortality by one- 
third. 

The mortality in tracheotomy falls by one-half. 

Extension of membrane to the larynx rarely occurs 
after the adminis'ration of antitoxin. 

The duration of life in fatal cases is decidedly pro¬ 
longed. 

Of the thirty-six original articles in the volume wejhave 
not space to tell their value; they are a l of the high 
standard of excellence that characterised the proceedings 
of the Society from its beginning, and placed it in the 
first rank of scientific medical societies 

We may just a Id that the work has been carried on for 
over thirty years by honorary secretaries; a fact which 
speaks eloquently of the love of medicine for medicine’s 
sake. 


TOURETTE’S TREATMENT OF SYPHILITIC 
MYELITIS, (ft) 

This new series of short monographs— not exceeding 
100 small octavo pages —has for itB object to provide the 
student and general practitioner with such information 
concerning ourrent events in medical literature as is 
neoeesary for their “examination and everyday profes¬ 
sional work.” The present volume contains a brief and 

(a) “ Transactions of the Clinic&l Society of London.” Vol- 
XXXI. London: Longmans, Green and Co. 1898. 

(ft) " Formes cliniques” et trsitement dea my^lltes sypkllitiques 
Lm Actualitc* Medical eg. Paris : Bailliere et Fils. 1899. 


lucid sketch of the principal forms of syphilitic myelitis, 
their pathology ana treatment, by a writer of repute and 
competence. Most of the illustrative cases are taken 
from the stock of his personal experience. This subject 
is familiar to all who are cognisant of the dis¬ 
cussion which occupied two meetings of the Medical 
and Chirurgical Society of London in February 
and March, 1895; yet a few points are deserving 
of special mention. Under the designation, “ My41ite 
syphilitique, pseudo-taWtique,” attention has been drawn 
by the author to cases in which the meningo-myelitic pro¬ 
cess is in the main limited to the region of the posterior roots- 
of the cord, causing their compression by inflammatory 
products. Thus the picture of tabes may be closely 
mimicked. The author is of opinion that the rare cases 
of recovery from tabes after mercurial treatment belong 
to this category. Thin is hardly likely considering the 
difference in the clinical features of the two affection* 
with regard to reflexes and gait. In opposition to Erb, 
the author has found that pupilary symptoms are pretty 
frequently met with in Erb’s spastic paraplegia. In par¬ 
ticular, the so-called “ sympathetic ptosis,” due to impli¬ 
cation of the first dorsal pair, is declared to be by no 
means rare. This is explained by the circumstance that 
even in cases of apparently only dorao-lumbar localisa¬ 
tion, the microscope neaily always reveals the whole 
spinal axis to be involved by the myelitic prooess. A 
separate chapter is allotted to hereditary syphilis as a cause 
of myelitic affections, in particular, in adult age. Accord¬ 
ing to the imperfect state of our actual knowledge on 
this subject it is chiefly of a conjectural and controverti¬ 
ble de3crip*ion. With regard to treatment, subcutaneous 
injections of mercurial salts (exception is taken to 
calomel) are advocated in cases of urgency, while in the 
more chronic forms, preference is given to the inunctions. 
The handy little book is neatly got up, and well printed. 
Within its scope it is an altogether readable and 
commendable publication. 


MOULLIN ON INFLAMMATION OF THE 
BLADDER, (a) 

We are old enough to have heard the oft-told lecture 
on “ Catheter Fever,” and we remember the serious tones 
in which the lecturer told of the unavoidable risk atten¬ 
dant on such a simple operation as passing a catheter. 
Why the fever should follow in one case and not in 
another was, we were gravely informed, a mystery. In 
fulness of time the mystery has been solved, and we now 
know that a dirty catheter set up septic poisoning, which 
was attended with all the train of symptoms that are 
included under the name fever 

It appears, however, from Mr. Moullin’s monograph 
that there are some members of the profession still living 
who are not convinced of the truth of the theory that 
the fever is due to septic poisoning ; to try and convince 
these doubters is the principal aim and object of the 
book before us. Twelve chapters are devoted to the 
subject, and we are inclined to think that the doubter 
who reads the monograph and still remains unconvinced 
of the truth of tho theory can hardly be said to be 
capable of reasoning. The book well sustains the credit 
of the author for fulness of knowledge, and facility and 
clearness in teaching. 


MORRIS ON RINGWORM. (6) 

Of recent years a vast impulse has been given to the 
study of ringworm by the researches of Sabouraud, who 
first definitely established the plurality of fungus in that 
disease. In the book under review the author has trested 
the subject systematically and thoroughly from one end 
to the other, and has produced a concise, up-to-date, and 
accurate monograph. With practised literary skill he 
has drawn up a clear history of the gradual evolution of 
medical knowledge upon the subject. We note that he 
appears disinclined to follow Sabouraud in his well-nigh 
endless di fferentiation of fungi and of the distinct specie* 

(n) “ Inflammation of the Bladder and Urinary Fever." By C. 
Mansell-Moullin, M.D.Oxou., F.R.C.S. London: H. K. Lewis. 
1898 

(ft) “ Bingworm, in the Light of Beosct Research." By Maloolni 
Morris, Surgeon to Skin Department, St. Mary's Hospital. CaaaeQ 
and Co., London. 1898. 


Digitized by GoOglC 


Jaic. 25, 1899 

qf tricbophytio invasion. The ordinary practitioner of 
medicine will be inclined to agree .with hu view on the 
nenleeen—n of “ over-refining ’ in.etiology, and of tr a n a- 
oendental classification, for, after all, ae in the present 
volume, there is no correspondingly new or startling 
advance to be recorded in the treatment of the 
troublesome and refractory disease under notice. 
jLs the result of a wide experience, Mr. Morris 
answers the question as to when ringworm of the scalp 
«an be said to be cared in the following way:—“ My own 
rule is, after a careful examination, to leave the case un¬ 
treated for a month; and if no short hairs can be found, 
if the part is free from scalinees, and the new hair suffi¬ 
ciently grown to cover the patch, I pronounce the case 
cured." A chapter at the end of the book is devoted to 
^he highly important point of prophylaxis, and some 
practical recommendations are made as regards elemen¬ 
tary schools. The main principles laid down are the need 
cf systematic inspection, and of isolation without inter¬ 
ference with education, as a matter of fact, precisely on 
the lines now adopted in dealing with opht h a lm i a in the 
Metropolitan Poor Law schools. The book is illustrated 
irith over a score of artistio micro photographic repro¬ 
ductions, and is exceedingly well published and edited. 


British Medical Benevolent Fund. 

The annual general meeting of the above Fund was 
held on Friday, January 13th, at the residence of the 
Treasurer, Sir W. H. Broadbent, who occupied the chair 
in the unavoidable absence of Sir James Paget, Bart., the 
President. Dr. Samuel West, the Honorary Secretary 
for finance, presented the report of the committee and the 
financial statement for the past year. These showed 
that subscriptions amounting to ill,192 8s. 6d., and 
donations amounting to £492 7s. lid. had been received 
and distributed in grants varying from £5 to .£18 to 158 
out of 184 applicants. Interest on invested capital had 
yielded .£2,328 14e. lOd. from which annuities of £20 each 
had been paid to 108 recipients of tbeageof 00 and upwards 
One new annuity had been created, and twelve annui¬ 
tants elected during the year. The resignation, on 
account of continued ill-health, of Mr. Joseph White, the 
honorary secretary for cases, was received with great 
regret, and he was unanimously elected a vice-president, 
Mr. W. E. Sargant being appointed his successor. 
■Cordial votes of thanks were passed to all the officers of 
the Fund and to the Press, both lay and medical, the 
meeting being concluded by a special vote of thanks to 
Sir William Broadbent, who for many years has taken as 
treasurer a great and active interest in the affairs of the 
charity. Although the above figures show an increase upon 
the previous year’s receipts the grant department is still a 
source of anxiety, as most deserving cases have frequently 
to be passed over. The income of this branch is derived 
entirely from annual subscriptions and donations, and 
the committee earnestly appeals to the profession and 
others to become annual subscribers. A donation of £5, 
or a yearly subscription 10s., entitles the donor to the 
privilege of recommending cases. The books and 
accounts have been, as usual, exhaustively audited by a 
chartered accountant, Mr. B. F Yoelckher, who continues 
to act as honorary auditor of the fund, and who draws 
special attention in his report to the extremely small 
working expenses, which are again, as they have now 
been for some years, under 5 per cent, of the receipts, 

The “ Barker " Anatomical Prizes. 

The value of the prize is £21, and it is open for com¬ 
petition to any student whose name is on the Anatomical 
Class List of any school in the United Kingdom. The 
subject of this prize for 1899 has been announced by the 
Irish College of Surgeons as dissections to illustrate the 
anatomy of the larynx. 1. The preparation must be 
marked with a fictitious signature, and accompanied by 
a sealed envelope bearing outside the same signature. 
The competitor must make a declaration that the work 
has been carried out by himself. The printed form 
necessary for this declaration can be obtained on appli¬ 
cation to the curator. 2. The dissections are to be 
mounted in vessels fitted with glass covers. 3. No prize 
will be awarded unless sufficient merit he shown, 70 per 
cent, of the total marks being the minimum. The fol- 


Thb Medical Pbbm. 105 

'owing is the scale of marks:—(<*) For the merit of dis¬ 
section, 60; \b) for uxoellenoe of setting, 20; (c) for 
originality, 20: total, 100. Those dissections become the 
property of the College 4. Those competitors who enter 
dissections for which prizes are not awarded, but which 
show sufficient merit, may be refunded such amount of 
the coat of production as the examiners deem fit. 6. 
The cost and risks of transport must be borne by the 
student. The prize is awarded by the curator of the 
Royal College of Surgeons in Ireland, the President of 
the College, and the Professor of Anatomy of the Univer¬ 
sity of Dublin 

Bacteriological Department of King's College, London. 

The Secretary of State for the Colonies has intimated 
to the Council of King's College that, in selecting candi¬ 
dates for the Colonial Medical Services, preference will be 
given (other things being equal) to qualified medical 
men who have received such bacteriological or similar 
special training as King’s College provides. Mr, Cham¬ 
berlain has conveyed his thanks to the Principal and 
Professor Crookshank for the assistance they have given 
in promoting the scheme for instructing colonial candi¬ 
dates in tropical diseases, and the Council of King’s 
College and Professor Crookshank have promised to co¬ 
operate to the best of their power in carrying out Mr. 
Chamberlain’s scheme. 

Bradford and District Medico-Ethical Society. 

Thb annual general meeting of this 8ocieiy was held 
on Wednesday evening, January 18th inst., at the Mid¬ 
land Hotel, Bradford. There was a large attendance, 
the following gentlemen being present:—Drs. C. F. M. 
Althorp, S. Johnston, J. Mossop, E. G. Peck, R. Hamilton, 
P. E. Miall, Bell Graham, W. A. Evans, T. Curtis Denby, 
W. Horrocks, J. H. Bell, F. W. Enrich, D. Goyder, W. 
Parkinson, Ar. Manknell, F. K. March, H. J. Butler, R. 
Love, Basil Hall, A. Rabagliati, A. Bronner, G. H. 
Moorhead, and W. Handoock. 

The usual business of the Society was transacted, and 
the officers were elected for the ensuing year:—Presi¬ 
dent, P. E. Miall, Esq.; vice-president. Dr. T. Curtis 
Denby; treasurer. Dr. F. K. March ; secretaries, Mr. W. 
Horrocks, Mr. Ar. Manknell. Committee, Dre. C. F. M. 
Althorp, D. Goyder, J. H. Bell, J. Mossop, A. Rabagliati, 
i H. J. Butler. Auditors, Drs. W. J. Parkinson, and E. G. 
Peck. 

Tuberculosis In Milk. 

The question of the sale of milk infected with tuber¬ 
culous disease has recently been under the consideration 
of a committee of the Westminster Vestry. The com¬ 
mittee, having taken the opinion of the medical officer 
of health on the subject, will bring up a report at a 
meeting of the vestry on Wednesday, recommending 
that, in the interests of the public health, and with a 
view to preventing the spread of tuberculous diseases 
among children, a communication be addressed to the 
Local Government Board pointing out the need for legis¬ 
lation dealing with the sale of milk contaminated with 
tubercle bacilli; also that it be suggested to the other 
local authorities in the metropolis that their co-operation 
in the matter would be to the advantage of the public 
health. 

Death from Tetanus. 

An inquest was held on Saturday at St. Pancras, on 
the body of a man, aged 26, an ostler, who on January 
12th was passing through Russell Square when the gale 
was at its height His hat was blown off into the garden 
of the square. He thereupon mounted the rails, and a 
spike ran through an old shoe, penetrating the foot. He 
subsequently attended the Royal Free Hospital for treat¬ 
ment, and was admitted on January 17th. He died there 
last Thursday from tetanus, a result of his injuries. A 
verdict of “ Accidental death ” was returned. 

A special General Board of Governors of the St. 
John's Hospital for Diseases of the Skin was held at the 
Westminster Palace Hotel last week, on requisition, to 
consider the action of the Board of Management with 
regard to a letter addressed by them to Dr. J. Vinrace, 
dismissing him as physician of the Hospital There was 
a large attendance, and after an animated discussion the 
action of the Board was endorsed by the Governors, the 
voting being thirty-eight for and six against. 


MEDICAL NEWS. 


Digitized by tjOOgle 


106 The Mbdical Phbsp. NOTICES TO CORRESPONDENTS. - Jam. 25. 1899. 


4totic*6 to 

(ttorreoponiinto, Short fetters, & t. 

9tT Oorexspondxhts requiring a reply In this column are par¬ 
ticularly requested to make use of a distinctive signature or 
initiale, and avoid the practice of signing themselves " Reader,” 
*'Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
•pared by attention to this rale. 


1UROPHEN AS A SUBSTITUTE POR IODOPORM. 

To the Editor of the Medical Press and Circular. 

Sib,—I had recently under my care a patient suffering from 
extensive cancerous mischief of tae left breast. The breast hud 
been removed some twelve months previously, but the mischief 
returned and involved i he surrounding t issues. There was a large 
fonl smelling wound extending from the left axilla to the right of 
the middle line of the sternum, and about six inches long from 
above downwards. 

The patient could not bear the putrid smell of this terrible mass, 
but said that, though so very bad, it was preferable to the pun¬ 
gent smell of iodoform which teemed also to interfere with her 
breathing, which was already much impeded. Ail wet dis¬ 
infectants as carbolic acid, liq. hydrarg., perchlor, sanitas, Ac., 
seemed to make the wound worse, and could only be need for clean¬ 
sing night and morning. There was a distinct odour about the 
room, and even the house. On my using europhen the smell was 
quickly kept under, and after a few days the house and room had 
no taint in it. I can only add that europhen did all that is 
claimed for it, and rendered the remaining weeks of my patient’s 
life bearable. 

I am. Sir, yours truly, 

(Signed) 

Milbournb 8. B. Coombs, L.R.C P.Ed., L.R.C.B.Ed. 

St Nicholas House, Newport, I.W. 


Db. Brand.—T here is no ethical law against the custom, but we 
agree with our correspondent that it is an offence against good 
taste. 

A PAIR STUDENT’S DIFFICULTY. 

At a Clinique some time ago a genial physician had occasion to 
draw the attention of his class to a certain symptom commonly 
associated with the disease he was demonstrating. The class con¬ 
sisted of ladies, and one was asked to come forward and mark the 
symptom. This consisted of a specific tound beard in the neck 
region, and which proceeds from an arterial source; it is technically 
known as the ” bruit de dlable." The fair student expressed 
herself umatisfled; it had not appealed to her as being obvious 
at all, and certainly the sound belied its name. “Ah! I see.” 
said the physician, smiling, “ you have misinterpreted the French 
term. * Bruit de diable ’ does Not mean a * devil of a noise.’ 
Edinburgh Evening Despatch. 

Young Consultant.— The Cavendish Lodge (No. 2,620), founded 
in connection with the West London Hospital and the West London 
Medico-Chlrurgical Society, meets at the Royal Palace Hotel, 
Kensington, and is not exclusively medical. 

CONGENITAL ABSENCE OP LUKG. 

To the Editor of the Medical Press and Circular. 

Sib.—T he case of congenital absence of one lung is not unique, 
as reported at page 45 of your valuable journal, as reference to 
section 645, 2, of the “ Medical Digest ” will show. 

I am. Sir, yours truly, 

R. Neale, M.D.Ljnd. 

A MEDICAL GOLP TOURNAMENT 
has been arranged for 1899 on similar lines to that held last 
year. Entries, with lowest handicap and subscription 5s.. to be 
sent not later than February 6th to the hon. sec., Mr. Rolf Creasy, 
Wlndlesham, Surrey. 


Jfte*tings of the godetreo ant) $ertures. 


Mr. W. G. Spencer j Tuberculous Cavities in the Lungs giving rise 
to Gaseous Metastatic A be com es. 

British Laetnqological, Rhihological, and Otological- 
Association (11 Chandos Street, Cavendi»h Square).— 3 p.m. 
Cases will be shown and papers read by Drs. Barclay Baron 
(Bristol), R. H. Woods (Dublin), Dundas Grant, Mr. Lennok 
Browne, Wyatt Wingrave, Ac., Ac. 

Royal Academy of Medicine in Irbland.—Section of 
Medicine.— 8 p m. Exhibit*:—Dr. Langford Byrnes: A Case of 
Erb’s Juvenile Form of Muscular Atrophy. Dr. J. B. Ooleman: 
(a) A Case of Prog'essive Muscular Atrophy; (b) A Case of 
Anterior Cornual Myelitis. Papers: -Dr. Conolly Norman: Tha 
Clinical Features of Beri beri. Dr. H. C. Drury: Morphinomania. 
Dr. J. B. Coleman: Notes on a Case i f Addison’s Disease. 


BaxancuB. 

Cancer Hospital.—House Surgeon. Salary at the rate of £50 per 
annum, with board snd residence. Applications to the Secre¬ 
tary, Cancer Hospital, Brampton, before the 4th prox. (See 
advert.) 

Clayton Hospital and Wakefield General Dispensary, Wakefield, 
—House Surgeon, unmarried. Salary £90 per annum, with 
board, lodging, and washing. 

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the Workhouse and Infirmary. Salary £100 per annum, with 
board, washing, and apartmeats. Applications to the Clerk to 
the Guardians, 15 High Park Street, Liverpool. 


&FpoivctmtvdB. 

Bennett. Harry 0., M.B., M.R.C.8., L.R.O.P., House Physician 
at the Sunderland Infirmary. 

Butler, James, M.B.Glasg., Junior Assistant Medical Medical 
Officer for the Govan District Asylum, Hawkbead, Paisley. 

Chubton, John 0., M.R.C.S., L R.C.P , Junior House Burgeon for 
the Stanley Hospital, LivcpooL 

Coleman, Ernest, M.B.. B S.Lond., Assistant Medical Officer for 
the County Asylum, Rainhill, near Liverpool. 

FouLBBTON, A. G. R., F.R.C.S.Eng., L.R.C. I*. Lond., D.P.H.Cimb., 
Bacteriologist to the Middlesex Hospital. 

Henderson, k. G., M.A., M.B., Ch.B-Aberd., Senior House Sur¬ 
geon for the Stanley Hospital, Liverpool. 

Maynb. William Sydney. L.R.C,P.Lood, M.R.O.8., Assistant 
Medical Officer for the Plymouth Borough Asylum. 

Moore, F. H.. L.R.C.P., L.R.C.8.Irel., Medical Officer for the 
Sibsey Sanitary District of the Boston Union. 

Perbott, C. J., L.R.C.P., L.R.C S.lrel., Medical Officer for the 
Oldland Sanitary District of the Keynsham Union. 

Thomas, R. D., L.R.C.P., L.R.C.8.Ediu., L.F.P.S.Ulasg.. Medical 
Officer for the Guilsfleld District of the Llanfyllin Union. 


girths, 

Goddard.-J an. 18th. at 11 Norfolk Creecent, Hyde Park, London 
the wife of Walter Horace Goddard, M.D., M.A. (Cantab.), of 
a daughter. 


Wednesday, January 25th. 

Dermatological Society op Great Britain and Ireland 
(20 Hanover Square, W.).- 4.30 p.m. Informal Exhibition of 
Cases. 5 p.m. Paper:—Dr. Crocker: Recurrent bcarlatiniform 
Desquamative Erythema. 

Thursday, January 2sth. 

Ophthalmological Society of the Unitbd Kingdom.— 
8 p.m. Card Specimens. 8.30 p.m. Papers:— Mr. H. Grimsdale: 
Rapid Changes in Refraction in connection with Diabetes. Dr. M. 
Davidson: On the Stereoscopic Examination of Skiagraphs of 
Foreign Bodies iu the Eye and Orbit. Mr. C. D. Marshall: Epi¬ 
thelial Implantation Cysts of the Iris. 

BRITISH Balneological, a«d Climatological Society (20 
Hanover Square, W.).—8.30 p.m. Papers:—Dr. H. E. Crook 
(Margate): The Climate of Margate in Relation to Disease. Dr. B. 
Cruickshank (fsairn): Notes on Nairn—chiefly Climatic. Dr. W. 
Bain (Harrogate): The Action of certain Mineral Waters on the 
Quadriurate and Biurate of Soda. 

Friday, January 27tii. 

Clinical 8ociety op London (20 Hanover 8quare, W.).- 8.30 
p.m. Papers:—Mr. J. Hutchinson, jun.: Three Cases of Abdo¬ 
minal Section (a) for Ruptured Ovarian Cyst, (b) for Perforation of 
the UrlDary Bladder, (c) for Traumatic lntraperitone.il Hemor¬ 
rhage. Dr. Abrahams: Rheumatic Tonsillitis. Mr. H. Morison 
(introduced by Mr. Lockwood): Patients showing Results of 
stomich Surgery, with description of the operations performed. 


^forriages. 


Braine-Habtnbll— Barker.— Jan. 19th, at Havering, Essex, 
Christopher Braine- -’artnell. M.R C.8., L.R.C.P. of Chelten¬ 
ham, son of the late Rev. G. T. Braine-Hartneil, M.A., to Con¬ 
stance Lilian, daughter of the Bev. J. C. Barker, M.A., Vicar 
of H&veriug. 

Clarke—Geb.- Jan. 19th, at 8t. John the Baptist’s Church, 
Leicester, Astley Vavasour Clarke, M.D.Caatab., eldest son of 
Julius 8t. Thos. Clarke, M.D., of Leicester, to Ethel Mary 
^Mt^lei^ste daughter of H. Simpson Gee. J.P., of Knighton 

Evans—Chapple.— Jan. 17th, at Holy Trinity, Brook Green, 
Arthur Vernon Evans, M.R.C.8., L.R.C.P., second son of 
Samuel Evans, R.W.S., Eton, to Pauline Chappie, fonrth 
daughter of the late Robert Chappie, Deputy Surgeon- 
General. 


Blasson.— Jan. 17th, at Bourne, Lincolnshire, George John 
Blasson, M.R.C.S., L.S.A., aged 61 years. 

Bowbs.—J an. 18th, suddenly, at 8ymnel, Aldington. Kent. 
William Bowes, M.R.0.8, L.8.A., eldest s >n of the late William 
Bowes, of Eltham, Kent, aged 59. 

Cole.- Jan. 15th, suddenly, at Bath, Thomas Cole, M.D.Lond. 
F.B.C.P., aged 53 ye ire. 


Digitize 



Ie 



She IgMtal %fms and Circular. 


“ SALUS POPULI SUPREMA LEX.” 

Vol. CXVIII. WEDNESDAY, FEBRUARY 1, 1899. No. 5. 


(Original (Eommuntratioits. 

TWO RECENT CASES OF 
SUCCESSFUL OPERATION FOR 
IMPACTED STONE IN THE 
URETER, (a) 

By P. J. FREYER, M.A., M.D., M Ch., 

Surgeon to St. Peter’s Hospital. 

The short paper to which I invite your attention 
this evening is to be regarded as a mere fragment—a 
brief contribution to the surgery of the ureter. This 
latter is a subject which during the last few years has 
engaged the attention of surgeons; and, still, how 
few instances of operation for stone in the ureter 
have been placed upon record. I think you will 
agree with me that it is incumbent on evei’y surgeon 
who meets with such cases in his practice to publish 
details thereof, so that, in time, we may have accu¬ 
mulated a sufficiently large and varied number, as a 
basis from which to draw authoritative conclusions 
as to the best methods of dealing with stone impacted 
in any particular part of the ureteral canal. It is in 
this spirit that I venture to place before you details 
of two cases of operation for impacted ureteral calcu¬ 
lus which have recently fallen to my lot, each in its 
way, I venture to think, possessing some features of 
interest. 

Lieut. D., Royal Artillery, art. 23, sent by Dr. 
Blood, of Woolwich, consulted me on July 19th, 
1898. He had suffered, off and on, for 19 months 
from renal colic and hmmaturia. The symptoms 
first set in at Malta in January, 1897, in the form of 
coliky pains in both loins, extending across the 
abdomen, whenever he rode on horseback. These 
were at first considered to be due to indigestion; 
but on the third or fourth day on dismounting he 
found that his urine contained blood, so he went on j 
the sick list. The symptoms passed off in a few days j 
with rest and treatment. Three weeks later, his: 
duties being heavy and involving much riding, the 
symptoms returned, and he had again to go on the 
sick list. The pain at this period was mainly confined 
to the left side, commencing in the loin, shooting down 
to the groin, and sometimes across the abdomen, 
giving rise to the sensation of a string being tied 
tightly round the body. At no period did the pain 
shoot down into the testicles, nor was the organ 
retracted. 

The symptoms continuing, he came to England in 
May, 1897, and placed himself under the care of a 
well-known London physician. The renal attacks 
with hsematuria continued to come on periodically 
every fortnight or so, and, strange to say, two of his 
worst attacks seemed to have been brought on by 
short sailing trips, though he did not suffer from sea¬ 
sickness. Getting no better he returned to Malta in 
August, 1897, and during the voyage painless hsema- 
turia set in, which continued, off and on, till Septem¬ 
ber, when another severe attack of pain in the left 

t («) Paper read before the Medical Society of London, January 
23rd, 1899. 


oin occurred, and the hsematuria suddenly ceased. 
lHe was then seen by Major Swabey, R.A.M.C., 
who diagnosed the case as one of stone 
in the kidney. Unable to continue at duty 
he went to Sicily, but the voyage again brought on 
hajmaturia, accompanied by fever, which after lasting 
a week again wound up with severe colic. He 
returned to duty at Malta at the end of the month of 
October, but had to lie down for several hours in the 
middle of the day to relieve the pain. The re-drilling 
commenced on November 1st, and the first route- 
march brought on pain and haemorrhage. He was 
excused marching and rode in a carriage, but though 
the pain was less the haemorrhage continued. In 
December he passed two stones by the urethra, 
cylindrical in shape and like red sand-stone. The 
acute pain up to this was in the left side ; and from 
that period till July, 1898, though there was occa¬ 
sional hsematuria and the urine contained albumen, 
there was no severe pain, merely a dull aching in 
both loins. 

In May, 1898, he returned to England for duty at 
Woolwich. On July 10th he took a lot of exercise, 
and next day an acute attack of pain set in in the 
right side, which lasted seventy-two hours continu¬ 
ously, during which he was kept under the influence 
of morphia by Dr. Blood. The pain was excruciating, 
accompanied by restlessness, nausea, and vomiting, 
with constant desire to micturate, only a small quan¬ 
tity of high-coloured urine passing each time. For 
two days after this attack the urine was clear, but 
alter that became thick and bloody again. 

I found that there was a slightly movable tumour 
in the region of the right kidney as large as two fists, 
extremely tender on palpation both in the loin and in 
front. There was no stabbing pain on pressure at 
the back, but distinct tenderness at one spot in front, 
midway between the navel and the anterior superior 
spine of the ilium. Urine, colour of Madeira wine, 
acid, sp. gr. 1015, containing blood corpuscles and 
crystals of oxalate of lime, also albumen. The left 
kidney was normal. My diagnosis was—stone in the 
pelvis of the kidney, trying to pass down the ureter 
and causing obstruction oi urine. 

On July 30th the patient entered a surgical home, 
and on August 1st I operated, Mr. W. Braine giving 
the anaesthetic and Mr. B. Smeaton assisting. Drs. 
A. M. MacDonnell and H. T. Griffiths were also 
present. The kidney was rapidly exposed through 
an oblique lumbar incision 41 inches long, and the 
fatty capsule opened. No stone was detected on feel¬ 
ing it all over. The kidney, which was much 
enlarged and congested, was stripped of its fatty 
capsule and brought out on to the loin through the 
wound. I felt it carefully all over, but could detect 
no stone. The kidney was then opened through 
the convex border by means of a scalpel, 
and my finger passed into the pelvis, a rush 
of urine taking place through the wound, and 
the kidney collapsing much in size. No stone 
could be found, though my finger passed easily 
into the calyces, which, with the pelvis, formed a 
large, smooth-walled cavity. I then passed a cathe¬ 
ter down the ureter as far as four inches from the 
pelvis, where it was obstructed. A long silver proba 


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108 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


Feb. 1, 1890. 


was then passed, and a stone felt in the ureter at this 
point. 

The incision in the loin was at once extended down¬ 
wards and inwards for four or five inches, r.nd the 
peritoneum raised inwards from off the ureter by my 
fingers, till I could grasp the stone (which felt the 
size of a filbert), lying in the ureter between mv 
finger and thumb. I made several attempts to push 
the stone upwards into the kidney, but it was too 
firmly impacted in the ureter, so the ureter was 
incised longitudinally over the stone, which was 
pushed through the wound by the point of my 
finger. A bougie was then passed into the bladder 
through the ureter from the pelvis. I did not suture 
the wound in the ureter because (1) suturing of 
the ureter when a stone is removed extra-peritoneally 
is a debatable proceeding; (2) the ureter was so 
narrow that suturing would probably cause con¬ 
traction of the canal; and (3) though I could extract 
the stone with the limited incision already indicated, 
the successful suturing of the ureter at the bottom of 
a deep wound was impossible without a much more 
extended dissection. I contended myself, therefore, 
by placing a large drainage tube down to the open¬ 
ing in the ureter, along the back of the kidney, bring¬ 
ing the muscles together by buried silk sutures, and 
the superficial parts by silk-worm gut. The wound 
in the Kidney was partially closed by two sutures, the 
middle portion being left open so that the urine might 
flow freely through the loin, and thus avoid tension on 
the ureter till the wound in it should have healed. 

Bloody urine was passed freely by the urethra in 
the evening, showing that the ureter was patent; 
and bloody urine by both loin and urethra for several 
days. On the third day I began to shorten the drain¬ 
age tube daily, and this was completely removed on 
August 7th. On the 8th the wound was firmly united, 
save in the track of the drainage tube. On the 9th 
urine ceased to flow by the loin. 

The patient made a rapid recovery; was sitting up 
on August 28th ; went for a walk on September 2nd; 
and left the home on September 7th, travelling by 
train to Margate. Soon after he began to bicycle; 
he started to rejoin liis battery at Gibraltar on 
November 15th. He is now in excellent health, and 
wrote to me in the end of December last that he does 
five or six hours work daily with his battery, ascend¬ 
ing the Rock 1,800 feet. 

It may be of interest to mention, as bearing on the 
hereditary tendency of stone, that owing to the suc¬ 
cessful result in this case, the patient's mother, who 
for seventeen years had suffered from stone in the 
kidney, placed herself in my hands. On September 
28th, 1898, I performed a lumbar nephro-lithotomy. 
Dr. Dudley Buxton, anesthetist, and Mr. Swinford 
Edwards assisting me, removing one largish oxalate 
of lime stone from the pelvis, and several smaller 
ones from the calyces. The kidney, which was ex¬ 
tremely large, was sutured. No urine passed by the 
wound, and the patient made a rapid and successful 
recovery. Furthermore, this lady’s father suffered 
severely from gravel for many years before his 
death. Some years ago I operated successfully for 
stone in the bladder on three generations in the Bame 
year—son, father, and grandfather. 

The second case, a man, aet. 53, has been a patient 
at St. Peter’s Hospital, off and on, for thirteen years, 
suffering from multiple stricture of the urethra, which 
has been operated on several times, and symptoms of 
kidney stone. In 1895 his left kidney was explored 
for stone by another surgeon, but with a negative 
result. Temporally relief ensued, but the old sym¬ 
ptoms again returned, and in the summer of 1897 he 
was very ill, the pain in the left loin being very 
severe at times, radiating to the groin and testicle, 
and accompanied by hsematuria, which at times was 
very profuse; there was also occasionally pain in the 


right loin. The urine was extremely thick and offen¬ 
sive, and on standing deposited pus amounting to 
half its bulk. I determined under these circumstances 
toexplore theleft kidney again, which was accomplished 
on September 1st, 1897, by an oblique lumbar incision. 
A most careful search was made, but no kidney was 
found, though I passed my fingers well up under the 
ribs, down to the iliac fossa, and inwards to the 
aorta, pushing the peritoneum out of the way. 
The patient rapidly recovered from the opera¬ 
tion, but there was only a very temporary 
relief to the symptoms, which soon set in as bad as 
ever. Under the impression that the symptoms 
might in large part be due to backward pressure, 
resulting from the stricture, which had again con¬ 
tracted, so that a No. 6 bougie, English scale, was 
passed with difficulty, I performed internal urethro¬ 
tomy on November i8th, 1897, cutting three dense 
cartilaginous strictures up to 16 of the English scale. 
The patient was extremely ill after the operation for 
two days with severe rigors, the temperature rising 
to 106 degs. F., and the urine being very scanty; but 
he recovered, though slowly, leaving the hospital early 
in January. This operation, though it afforded a free 
flow for the passage of his urine, did not much 
diminish his other symptoms. Though the pain in the 
left loin gradually diminished, that in the right loin 
increased, and for months he continued to attend the 
out-patient department, his urine constantly contain¬ 
ing much pus, and at times a considerable quanti 4 y 
of blood. Occasionally the right loin became much 
swollen, and the disappearance of the swelling was 
always followed by an increase in the quantity of pus 
in the urine. In October, 1898, he began to complain 
of great irritability of the bladder; there was con¬ 
stant desire to pass water with pain at the end of the 
penis. He was admitted into hospital, and on Novem¬ 
ber 9th I cystoscoped him under an anaesthetic, and 
detected a long, narrow, rough, pencil-shaped stone 
projecting into the bladder from the right ureteral 
opening. The portion of stone projecting into the 
bladder appeared by the cystoscope to be about f in. 
long, and dark grey in colour. My colleague, 
Mr. Reginald Harrison, and others had an 
excellent view of the stone. I at once intro¬ 
duced a lithotrite, and after three or four 
unsuccessful attempts, eventually caught the stone 
between the blades, pulled it out of the ureteral 
opening, crushed it and removed the debris by the 
aspirator. The debris consisted of urates and 
weighed 12 grains. On November 23rd the patient 
was again cystoscoped. The bladder walls were 
coated with mucus; both ureters were seen to be 
acting, and flakes of pus were seen issuing from 
them. 

The patient has continued to improve steadily in 
health. The pains in the loins have disappeared; 
there is no hsematuria and scarcely any pus in his 
urine. He states that he is in better health than he 
has been for years. 

The history of this case presents many points for 
speculation which would, however, be foreign to the 
purpose of this paper; the case being now brought 
forward only for the purpose of illustrating what I 
believe to be a novel method by which a stone pro¬ 
jecting into the bladder from the ureter may pos¬ 
sibly sometimes be successfully removed. 

I will, in conclusion, briefly refer to five other 
instances of stone impacted or encysted in the ureter, 
which have been operated on by me—four of these 
during my experience in India. In three, the stone 
was impacted at the ureteral orifice, projecting into 
the bladder and felt by the sound. One occurred in 
a female, two in males. In each instance an opera¬ 
tion was undertaken, under the impression that I had 
to deal with an ordinary case of stone in the bladder 
and in each case the stone was dislodged from its 


Feb. 1, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 109 


position by introducing the forefinger through the 
dilated urethra in the female and through the ordin¬ 
ary perineal lithotomy wound in the males, scraping 
the orifice of the ureter by the finger nail, the stone 
being forced downwards and inwards by the hand 

S laced on the groin, and then r. moved by the ordinary 
thotomy forceps. 

In the British Medical Journal, May 9tb, 1891, 
page 1,005,1 have given details of a boy, mt. 15, from 
whom I removed, at two different sittings, by litho- 
lopaxy two separate stones, weighing respectively 
757 and 581 grains, aggregating more than 3 j ounces 
After removing the first stone from the bladder, I 
found that there was a second lying in the lower part 
of the right ureter close to the bladder. The second 
stone was felt as a hard tumour in the loin, about 
3 inches long, and could easily be felt in the ureter 
between a finger in the rectum and the hand on the 
groin. 1 determined to remove this stone by supra¬ 
pubic cystotomy as soon as the patient should have 
recovered from the first operation, but on the fourth 
day the tumour in the groin suddenly disappeared, 
and a stone was felt lying free in the bladder, and 
successfully removed by litholopaxy. Evidently 
this latter stone, lying in the ureter, rested on the 
stone located in the bladder; as soon as this support 
was removed the ureteral calculus was pushed into 
the bladder by the force of the accumulated urine 
behind it. 

The fifth case is recorded in the “ Medico-Chirur- 
gical Transactions," vol. 81. It was that of an obscure 
cystic tumour of the bladder, which contained two 
calculi, weighing 41 grains, removed supra pubically. 
My explanation of the case was this—that the stones 
descending from the kidney were arrested at that 
portion of the ureter which passes obliquely through 
the bladder wall, and that, unable to escape owing to 
a contracted orifice, they bulged the bladder wall 
inwards, forming a smooth cystic tumour which was 
recognised by the cystoscope, and successfully dealt 
with in the way indicated. 

Harley Street, W. 


THE ELECTROTHERAPY OF 
INFLAMMATORY AFFECTIONS ,OF 
THE EYE. 

By PERCY DUNN, F.R.C.S., 

Ophthalmic Surgeon to the West London Hospital. 

The eye is obviously, for anatomical reasons, an 
inconvenient organ for the efficient application of 
electricity. For the most part, therefore, the study 
of the subject of electro-therapeutics has never found 
much favour among ophthalmic surgeons. In 
America, however, a good deal of importance appears 
to be attached to the electrical treatment of eye 
diseases. On the other hand, in this country it is 
doubtful whether any ophthalmic surgeon regularly 
resorts to, or even recommends it. The object, never¬ 
theless. of this paper is to draw attention to some 
recently published observations upon the subject by 
Reuse of Vienna, which are not without interest. The 
originality, perhaps, in Reuss’s observations rests 
in the fact that they are confined to inflimmatory 
affections of the eye. and that he claims for the 
faradaic current a superiority over the galvanic cur¬ 
rent in the treatment of these cases. In 1898 he 
published the results of his ten j ears’ experience of 
this method of treatment, and in Graefe’s Archiv. f 
ophthalmol. for September 2nd, 1898, some further 
results appear, giving his most recent views as to the 
value and suitability of electro-therapies in inflam¬ 
matory ocular affections So far as the galvanic 
current is concerned his objections to it are: (1) 


That a galvanometer is required ; (2) that the current 
can only be applied by a medical man ; (3) that ex¬ 
coriations may be caused; (4) that harm results if a 
current of too high a power be u«ed. 

Reuss, therefore, enjoins that the faradaic current 
should be employed in all cases, save those of scleritis. 
With regard to the latter he recommends the gal¬ 
vanic current, as being more active and more useful 
than the faradaic current. 

The following is the method described as the best 
for applying faradaism to the eye. A small metallic 
electrode is uned, made in the form of an oval cup 40 
mm. by 28 mm. in size. Between the electrode and 
the closed eye a layer of moist cotton wool is placed, 
while the other electrode is held by the patient in one 
of his band8. The intensity of the current is regulated 
by the patient’s tolerance of the sensations produced. 
Seances lasting from fifteen to thirty minutes are 
recommended But in exceptional cases these may 
ke prolonged, even to an hour. Mention may now be 
made of the particular diseases for which Reuss has 
successfully employed electricity. 

In iritis and iridocyclitis he affirms that the treat¬ 
ment is strikingly beneficial in causing the relief of 
pain. The pain disappears as if by magic. "In 
order,” he says, “ to convince my class of this fact, I 
showed a patient suffering from an acute attack of 
iritis, accompanied by intense pain and blepharo¬ 
spasm. I applied faradaism there and then; and in 
the course of a minute and a half or so, the pain was 
relieved, and the patient opened his eye and gazed 
wonderingiy round the class.” However, he admits 
that the relief is only temporary, that is to say. the 
pain recurs if the current be not soon re-applied. 
According to Reuss the duration of the relief varies 
with the period during which the faradaism is 
employed, and he thinks that the latter should be 
applied for at least half an hour in bad cases. 

In this connection reference may be made to the 
experience of Alleman, of Brooklyn. Alleman 
holds that in cases of acute iritis the use of electricity 
is of doubtful benefit In some cases he lias seen the 
pain relieved by the application of the anode to the 
closed litis with a current of one milliampere for two or 
three minutes, but, he adds, “ this will often prove of 
no avail.” The difference, however, in these results 
may be due to the fact that while Alleman uses a 
galvanic current, Reuss uses a faradaic one. 

One of the advantages claimed for the use of elec¬ 
tricity in these cases is that it facilitates the absorp¬ 
tion of iritic exudations, and upon this point there 
seems to be a concurrence of opinion among authori¬ 
ties. Alleman, for example, states that- he has 
had the most satisfactory results from the use 
of the galvanic current in cases of adhesions 
and inflammatory deposits following iritis. He 
has found that the adhesions have given way, 
and that a manifest improvement in the vision 
has resulted. The most effective mode of appli¬ 
cation is to place the cathode with a current say, 
of two milliamperes, upon the closed lids for five 
minutes 

Reuss recommends faradisation for fifteen to thirty 
minutes in keratitis; he states that the photo¬ 
phobia and pain are marvellously relieved by this 
means, even before any other treatment has been 
employed. He further adds that faradaism may be 
employed to relieve the pain and photophobia in 
phlyctenular conjunctivitis. The application, however, 
of electricity for the relief of photophobia is not new. 
Many observers have alluded to the utility of this 
form of treatment, and among others Benson, of 
Dublin, has recorded thirty-two cases in which its 
value was markedly demonstrated. 

It would be interesting to test the value of a faradaic 
current upon a chronic vascular ulcer of *he cornea. 
Such ulcers are known in some cases to prove ex- 

C 

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110 Thb Mxdical Press. 


ORIGINAL. COMMUNICATIONS. 


Fkb. 1, 1899. 


tremely rebellious to treatment. I have elsewhere 
pointed out the treatment for these, which, in my 
hands, has proved most successful, (a) But every 
therapeutic measure may fail, as occurred in a case 
of a schoolboy, ajt. 14. who was lately under my care. 

Master A. was brought to me by his father in June 
last, with a small ulcer upon the lower part of each 
cornea. My usual treatment was prescribed, and for 
a time the result was quite satisfactory. But shortly 
after he retume 1 to school the ulcers relapsed. I 
therefore urged the necessity of sea air to complete ti e 
cure. The boy •‘as sent to Herne Bay, and after having 
bf en there for six weeks, he came back to town greatly 
improved in health, with one eye quite sound and the 
other (left) practically well. Within, however, a fort¬ 
night’s time the left eye again became deeply in¬ 
jected and painful, and the ulcer again resisted treat¬ 
ment. As it was useless for the boy to attempt to 
resume his school work, I advised his father to send 
him for a further term to the seaside. My patient, 
therefore, was sent to Broadstairs for nine weeks, and 
I recently saw him on bis return. He is now in every 
way fully restored to health, both eyes being quite sound. 
Itwould have been interesting in this case to have tried 
the effect of faradaism upon the intractable vascular 
ulcer of the left cornea. Local treatment, however, 
must be futile, unless and until the constitutional vice 
has been removed upon which the malnutition and 
the ulceration of the cornea depends. 

Another class of cases in which Reuse affirms that he 
has employed electricity with benefit is that of in¬ 
flammatory conditions of lost eyes, and he claims as 
the result thereof that he has been able to avert the 
necessity of surgical interference. But this must 
surely be a doubtful advantage. An inflamed and 
lost eye which is painful should be removed, and 
especially is this the case if the fellow eye l>e sound. 
Nothing is to be gained by retaining a lost eye under 
such circumstances, while the risk of sympathetic 
ophthalmia beirg excited by the useless organ can 
scarcely be overlooked, despite the fact that such an 
untoward contii gency would not accord, perhaps, 
with the modern views of the micro-organic origin of 
his fatal ocular affection. 

Upon the subject of the use of electricity in the 
treatment of vitreous opacities Reuss expresses him¬ 
self somewhat guardedly. “ The same can be said,” 
he asserts, “ of electrical treatment in these cases 
as can be said of other forms of treatment: 
in a certain number of patients the results are 
successful, with in others there is failure.” He believes, 
however, that electricity is an excellent adjuvant to 
other remedial measures. Incontradistinction to these 
remarks reference may be made to the published 
experie> ce of American and other authorities. Girard- 
Teulon states that the electiical current is the most 
effectual and also the most rapid remedy in the treat¬ 
ment of vitreous opacities, and Alleman also affirms 
that the current has been employed with much success 
in these cases. Again. Little (Philadelphia) has 
recorded in the Transactions of the Americ >n Ophtlial- 
mological Society several cases in which the electrical 
treatment was beneficial, and he believed it to be of 
use in any form of hyalitis. Similar results have 
been recorded by Le Fort. 

In the treatment of intra-ocular haemorrhage Reuss 
states that blood in the anterior chaml>er is quickly 
absorbed under the influence of a faradaic current, 
but he definitely admits that electricity is of no use 
in cases of retinal heemorrhage. Upon this point he 
and Alleman are again at variance. The latter 
expresses himself as follows:—‘ In haemorrhagic 
retinitis the galvanic current may be employed with 
the reasonable expectation of clearing up the htemor- 
rbages, and of preventing recurrences. In diabetic 


retinitis, with or without a central scotoma, the 
treatment is especially indicated.” 

The tragic accident which occurred to Duchenne, 
by which the sight was destroyed in a patient to 
whose eyes he applied electricity, was sufficient for 
some time to throw this method of treatment into the 
shade. But even apart from any consideration 1 ! of 
this kind there does not appear to be much field for 
the useful application of electricity in the treatment 
of ocular affections. Nevertheless, I thought that 
it would be of interest to call attention to some of the 
latest views expressed upon the subject, and thus 
this paper lias been compiled. 


$aris (Clinical ^ecturee. 

THE TREATMENT OF ACUTE 
INTESTINAL OBSTRUCTION. 

Delivered at the Hdpital de la Pitii, Paris, 

By Professor P. BERGER, 

Professor of Clinical Surgery. 

Among the problems which present themselves in 
clinical surgery there are some, the solution of which 
needs establishing in advance. These are cases 
where the necessity for prompt resolution leaves no 
time for prolonged study, and in which it is neces¬ 
sary to act according to rules already laid down. In 
no department of practice are such rules more de¬ 
manded than in presence of acute obstruction of the 
bowels. In cases such as hernial strangulation it 
is upon rapid action that success depends; but here 
ends analogy between the two conditions, in spite of 
the similarity of their symptoms. Cases of strangu¬ 
lated hernia can receive nothing but advantage from 
operative interference, and the operation ought to be 
performed not only in the most numerous cases in 
which diagnosis demands it. but even in doubtful 
cases, since the operation is simple, easily performed, 
rapid, and absolutely devoid of danger, and certainly 
efficacious in every instance in which it is resorted to 
in time. 

Very different is the solution in presence of 
a rapidly progressing case of internal strangu¬ 
lation. The chances of recovery, even in the 
absence of all operative interference, always exist; 
and operative intervention itself always seriously pre¬ 
sents to the surgeon two different courses, of which 
each belongs to a certain class of case, and is useless 
rr even hurtful iu others. These procedures are 
laparotomy and enterotomy—to use terms as classical 
as they are in appropria'e - by which are designated 
two operations, between which there has been estab¬ 
lished a distinction which exists only because wp are 
too often incapable of recognising the cases which 
one or the other ought to be reserved for. Before con¬ 
sidering these indications, let us first strive to balance 
them to explain their advantages and their dangers. 
The surgeon, in presence of an intestinal obstruction, 
ought to go straight for the obstrcle. To recognise 
and do away with this, such is the end to which 
laparotomy leads—the abdominal incision, which is 
itself merely a means of access, and to which has 
nevertheless been given the name of the method of 
intervention itself. This is the only rational opera¬ 
tion and the only one capable of yielding complete 
success from the surgical and practical aspect of the 
case. It is to this that the most brilliant successes 
ate due: the immediate termination of all complica¬ 
tions and a rapid cure in cases apparently desperate ; 
but this operation is dangerous, ana often inefficacious. 

Operative statistics bring out the enormous mor¬ 
tality which follows the procedure: 102 cures, 226 


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(a) Lancet, October 22nd, 1898. 



F«b. 1 , 1899. _ ORIGINAL COMMUNICATIONS. The Medical Pbebs. Ill 

■deaths, 69 per cent, of failures in Farquhard When I saw him nothing but gas had been passed 
Curtis’s hands, 25 deaths—that is, 605 per cent, mor- per anum for three days ; the belly was so distended 
tality in the practice of Obalinski; and we have that the abdominal walls seemed ready to burst; the 
lately heard our colleague, M. Schwartz, at the last distension was mainly towards the right side, where 
meeting of the Soci£t6 de Chirurgie, state that there also colon was most localised, and palpation revealed 
were only two cures in seven cases in his wards at the the greatest tenderness. 

Cochin Hospital. Only a little less unfavourable An operation was decided upon. I made alon^ the 
were the results communicated to the Congress of external border of the right rectus, an incision per- 
German surgeons by Z. Heidenhain. Out of 30 lapa- mitting admission of my hand. I found the cajcum, 
rotomy operations for acute intestinal obstruction per- the ascending colon, and the transverse colon enor- 
formed in the clinic of Prof. Helferich 11 only were mously distended, the caecum having at least the 
cured. At the Soci6te de Chirurgie this year also M.M. dimensions of an arm. The distension ceased suddenly 
Hartmann and A. Broca brought forward facts in in the left hypochondrium, and I examined the 
sufficient numbers giving a proportion of 45 to 50 junction of the descending and transverse colon with- 
per 1(M) recoveries from laparotomy. In spite of out discovering any stricture or material obstacle at 
these scarcely less discouraging statistics, the proper- that point. Fearing to compromise favourable 
tion of failures which follow laparotomy remains very chances by prolonged incisions and examinations, 
considerable. In appreciating these, though it is and taking great pains to maintain the bowel which 
necessary to bear in mind the gravity of the patient's tended to protrude. I resolved to form an artificial 
condition and his exhaustion at the time of opera- anus in the caecum. 1 closed the incision throughout 
tion, and to make these responsible within certain the greater part, fixed the ca'cuin at its lower angle, 
limits for the drawbacks attending the opera- and opened it by an incision one centimetre and a 
tion, one ought not to forget that the half long. An abundant discharge of gas and of liquid 
operation must in a good numl>er of cases matter occurred through this opening, and at the 
tend to precipitate a fatal termination. This end of eight days the obstruction, whatever it may 
it may do by its long duration, by the intra- have been, had disappeared, and two months later the 
abdominal manipulations which it necessitates opening of the intestine in the abdominal wall had 
which aggravate the collapse resulting from closed without operative interference. I saw this case 
nervous shock and exposure to the atmosphere of a within the last few days. The patient has had no 
large portion of the surface of the bowels—an ex- further trouble for a year and «, half. 
p 08 ure which it is not always possible to prevent in The establishment of an artificial anus thus gives 
searching for the seat of strangulation. The opera- immediate relief, averts the more urgent compli- 
tion is often ineffectual. Too frequently it merely cations, and makes life secure for a time, and sonie- 
establishes the met that the obstruction cannot be times makes possible a complete cure with or without 
removed, or at any rate not without performance of further operation. It is not necessary to dwell upon 
an operation so prolonged and laborious, as to be out the horrible and often permanent infirmity at the 
of the question in the precarious condition of the price of which these advantages are obtained. On 
patient. Of this, examples will be presently given, the other hand, there are many cases in which 
It even happens that minute search fails to discover artificial anus does no good; others in which it is 
the obstruction or demonstrates that no miterial hurtful If the obstacle is situated in the small in¬ 
obstruction really exists. In all such cases establish- testine at a point at a spot above the ileo-cajcal 
ment of an artificial anus is the sole resource; but : valve the artificial opening above the point will have 
this is accomplished when the patient, often exhausted the effect of suppressing the intestinal functions 
by the prolonged operative procedures, has lost the in the whole length of bowel below. Thus if the 
favourable chances which a more rapid selection of clinical facts brought forward by Trzebichy, 
operation might have preserved for him. and others prove that the function of the 

Nelaton's operation, enterotomy, the immediate es- bowels may be suppressed without serious con- 
tablishment of artificial anus, does not present itself sequences up to 2 m. 80 of the length of the 
under a more favourable aspect. Statistics show small intestine it is none the less certain that an 
a mortality following this operation almost as great artificial anus placed too high expo-es the patient to 
as that after laparotomy. And it must be noted that rapid malnutrition and death within a sort period, 
laparotomy is rarely practised except in favourable There are. moreover, cases of occlusion in which open- 
cases, cases in which the powers of the patient ! ing the bowel does not prevent a case taking a fatal 
are not exhausted, whereas artificial anus offers a course. 

chance of relief which ought not to be withheld from j Last year an elderly female was admitted to my 
the parient even in the most c ritical situation. ! clinic presenting all the symptoms of acute intestinal 
Statistics of this operation give a great number of occlusion lasting at least three days. She was already 
instances in which an unfavourable ending has been very weak, the pulse was raoid and small, expression 
due to the disease itself and not to the operation. ! much changed, anxiety extreme, the belly distended 
Practised under ordinary conditions establishment and painful, especially on the left side. After examin- 
of an artifi dal anus is a rapid and simple operation, j ing for hernia and finding none I considered that artifi- 
which may often be carried out even wi'hout an;es- ; cial anus gave the patient the best chance of 
thesia. It gives immediate relief, even if it does not 1 recovery. M. Reblant performed the operation with 
remove the obstacle to the passage of the con- great rapidity, but no improvement followed, and the 
tents of the bowels. The rapid emptyi g of the patient died within 24 hours. The autopsy disclosed 
intestines and subsidence of inflation of the belly a strangulated obturator hernia. Perhaps a more 
often after a few days enables discovery of the cause minute analysis of the clinical facts would have led 
of obstruction to be made, and creates more favour- to recognition of the real condition I'he patient 
able conditions for a new operation. In certain had complained of a pain in the thigh, and this ought 
cases the complete emptying of the higher end to recall the fact that it is not only the orifices which 
suffices io bring about in course of a few days give passage to common hernia; which ought to be 
spontaneous re-establishment of a normal passa.e examined in acute occlusion, but also the orificeB of 
with closure of the artificial opening soon after, exceptional hemiee. I shall return presently to this 
A case of this kind I saw last year with M M. point. 

Tapret and Nelaton. This was in a man, set. 40, who I had thus committed a fault of observation ; and 
some months before had suffered attacks of acute if the majority of surgeons, who have had cases of a 
occlusion which had yielded to medical treatment, similar kind, have in like manner eiTed, since only 


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112 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


Feb. 1, 1899. 


57 cases out of 135 of this character were correctly 
diagnosed, this does not diminish my error. But 
even admitting that the hernia could not have been 
recognised before the operation, the choice of that 
operation was quite ill-advised; the artificial anus 
had not relieved the strangulation; laparotomy 
would have permitted its recognition. Would this 
have saved the patient P It is very doubtful, 
but it would have obviated the regret of having 
missed the true cause of the trouble. The result 
must be the same in a large number of the class of 
cases properly termed internal strangulation*. In this 
variety, artificial anus, apart from the fact that it is 
most frequently established in the small intestine— 
that is, in too high a situation—does not stay the 
progress of t he malady, since the constriction persists 
in spite of it. 

The conclusion from what precedes is that it is 
necessary to recognise the nature and the situation 
of the obstacle to be dealt with. Laparotomy, which 
answers in some cases, is hurtful in others; artificial i 
anus, which alone is applicable to these, is insufficient ; 
to prevent ill results, and is consequently useless ! 
under the circumstances in which laparotomy alone 
is indicated. 

As we have just seen, laparotomy is alone applic¬ 
able in cases of true internal strangulation It 
answerein strangulation by bands, by adhesions, and 
in diverticular strangulations. If the intestine is 
nipped in an abnormal orifice of the mesentery 
created by a prior operation, or by an epiploic cord 
wound round it, the course of the mischief cannot be 
stayed except by releasing the intestine from the 
constriction. 

The same considerations apply even more forcibly 
to ail cases of deep hernia), of preperitoneal or retro¬ 
peritoneal hernia;; and of internal hernia?. Belonging 
to this category is the hernia which occurs in the 
posterior cavity of the omentum through the hiatus 
of Winslow, the hernia of Trentz, the hernia of 
Douglas’s pouch, and the retrosessile hernia of which 
Samter has published an interesting example, and the 
deep strangulated laparoceles such as Ferrier and 
Fumeaux Jordan have recognised and cured by 
laparotomy ; certain obturator hernia; of which we 
shall give an example, and the ischratio hernia; (hernia 
ischiatica incipiens, Langer) consisting of a lateral 
compression of the intestine; certain inguinal hernise: 
and especially cruro-peritoneal and even anomalous 
crural hernia; like the pectineal hernia of Alberti. In 
all these instances when there exist no external 
signs laparotomy alone can lead to recognition of the 
nature < f the case, and of the seat of the obstruction ; 
and if ther suits are often unsatisfactory it ; s mainly 
because delay has allowed grave injury to the bowel 
or hernial sac to supervene. 

Amenable also and solely to laparotomy are ca-es 
of occlusion due to impaction of a biliary calculus in 
the bile duct or even in the small intestine—acci¬ 
dents often very difficult to account for but which 
can be dealt with only by extraction of the foreign 
body by laparotomy. To l>e logical we ought also to 
group here torsions of the bowel, cases of volvulus of 
which the most frequent cause is intestinal oi 
mesenteric adhesions, but which would maintain and 
render permanent the effects of plastic peritonitis 
around the twisted portion of intestine. Logically 
also it is laparotomy which should be preferred in 
cases of invagination, for this operation alone allows 
of recognition of the amount of ulceration or irreduci- 
bility of the intestine, the seat of intussusception. It 
is after having seen and made out the state of things 
that the reduction of the invaginated bowel may be 
attempted or resection of the irreducible knuckle of 
intestine, or that the question of artificial anus may 
be considered. But the results of operations, however 
rational these may appear, do not always answer 


expectations. It is in cases of invagination that 
laparotomy has been followed by the highest mortality; 
the statistics are hardly better in volvulus, and the- 
enormous proportion of 80 per cent, mortality which 
accompanies these operations, shows that the most 
rational indications are not always those which 
succeed best. 

There is another group of cases which it may seem 
strange to describe as acute occlusions, but in which 
the symptoms of strangulation advance rapidly and 
render them difficult to distinguish from actual 
internal strangulations The-e are cases of compres¬ 
sion of the bowel by tumours; of stenosis; of cancerous 
narrowing and specially of these where the pheno¬ 
mena of occlusion appear suddenly. It has often 
happened to me to open the abdomen expecting to 
find a strangulation due to a band or some similar 
cause, and to come upon an annular cancer of the 
ibac flexure of the colon which had made itself known 
only by the crisis for which I was called upon to inter¬ 
vene. In these cases an artificial anus is the sole 
resource. Ablation of a tumour of the bowel and re¬ 
establishment of continuity by suture in an exhausted 
patient, and with the further lo ;al conditions 
involving enormous dilatation of the higher portion 
of bowel by gas and solid matter can hardly end 
otherwise than in failure. 

In Heidenhain's statistics, just quoted, laparotomy 
for deeply placed narrowing of the bowel give six 
deaths in six cases. Creation of an exit for matters 
as quickly as possible i3 the only thing to be done in 
these cases; and here it is that artificial anus affords 
a remedy, provided it is established without delay. 
Later, when the first danger has passed away, when 
the bowels have resumed their normal dimensions, it 
may be possible to attack the seat of mischief, and to 
remove the tumour causing the pressure; enterec- 
tomy and enterorrhaphy being done under more 
favourable conditions. The actual indication, and 
the only one to attend to first, is to give free vent to 
the contents of the bowel. 

Other cases, again, are met with in which the bowels 
are the seat of distension, for which no material cause 
can be discovered. I was called to a woman, 75 
yeare old. She had been in perfect health up to four 
days earlier. Following a mild attack of indigestion, 
the belly became distended. There was colic, and 
frequent desire to evacuate the bowels, but neither 
gas nor solid matters escaped. Vomiting followed, 
and the pulse became weak and small. She seemed 
dying, and the practitioner in charge of the case 
did not think her fit to bear the smallest opera¬ 
tion. Mr. Paul Regnier, however, resolved to 
give the patient a chance by making an artificial 
anus; but «n enema administered as a preliminary, 
joined to the effect of the emotion caused by the 
proposed operation, brought on an evacuation of old 
foetid contents of the bowels; and within a few days 
complete recovery took place. In this case obstruc¬ 
tion by freces had become in an aged, fee ole patient 
a cause of paralysis of the bowel which might have 
terminated fatally. 

M. Sejars has recently communicated to the 
Soeiete de Chirurgie five cases of the highest interest 
of patients attacked with symptoms of acute occlusion 
in whom laparotomy revealed enormous distension 
of the entire intestine without the existence of 
any appreciable obstacle. A small button-hole 
opening in the cfficnm, by allowing evacuation of gas 
and solids, sufficed to cure these cases - examp’es of 
pseudo-strangulation without discoverable cause. In 
cases of this kind electrical treatment methodically 
applied, according to the method of M. Boudet, some¬ 
times does wondere. When symptoms persist u 
small flap opening is the proper thing if the nature of 
the case can be made out. 

Side by side with the cases of pseudo-paralytic 



TR ANSACTIONS OF SOCIETIES. The Medical Press. 113 


Feb. 1, 1899. 

strangulation must be placed those of spasmodic 
strangulation. The existence of such a cause is 
doubted by some authorities, but seems placed beyond 
doubt by the observations of Helfericb who, in the 
course of the operations of laparotomy for relief of 
acute occlusion was able to establish the existence of 
spasmodic narrowing of the intestine, and the absence 
of any other obstacle save functional spasm. In 
cases of this kind it is hardly necessary to say that if 
medical treatment fail—opium is the drug indicated— 
opening of the bowel is the most suitable procedure. 

(To be continued.) 

-♦- 

RHEUMATIC TONSILLITIS. («) 

By Db. BERTRAM ABRAHAMS. 

The material upon which this paper is based is mainly 
composed of cases of rheumatic tonsillitis observed by the 
author during the last three years. A large number of cases 
of chorea, rheumatism, and cardiac disease, both in adults 
and children, have been investigated and tabulated, and 
the resulting statistics compared with those of previous 
observers, in order to ascertain as accurately as possible 
the relation of the throat affection to the rheumatism. 
The bacteriology of many of the cases has also been 
studied with a view to obtaining some light upon the 
aetiology of the disease itself. The bulk of the work, in 
so far as it relates to children, was done in the out- 
jiatient department of the Evelina Hospital for Children. 
Dr. George Carpenter was kind enough to permit the use 
•of the material, and also to allow the results to be com¬ 
pared with his own works for the last ten years. Details 
are given in the paper of a number of cases illustrating— 

(1) The occurrence of endocarditis after non-scarlatinal 
'tonsillitis without the intervention of arthritis or chorea; 

(2) tonsillitis immediately followed by a first attack of 
•chorea; (3) repeated attacks of chorea, each preceded by 
’tonsillitis; (4) the occurrence of sore throats at various 
points in the rheumatic serie3. Clinically, five varieties of 
rheumatic throat affection may be distinguished. (1) 
Faucial erythema,the pharyngeal inflammation described 
•by Trousseau as ushering in an attack of acute rheuma¬ 
tism. (2) Follicular tonsillitis. (3) Quinsy. Between 
•these latter no pathological distinction can be at present 
drawn, though it is notable that when a patient has re¬ 
peated attacks, they are almost always solely of one 
kind or the other, an alternation being rarely 
observed. As is also the case w'ith non-rheumatic forms, 
the follicular variety is commoner in children, the quinsy 
in adults. (4) The abortive form described by Singer 
(angine thumatismale of French authors), in which the 
joint and muscle pains are vague, is not so frequent as 
he states. No case should be included under this head 
in which there is not adequate personal or family history 
•of rheumatism. After making this observation a con¬ 
siderable number of instances remain, the most note¬ 
worthy point about which is their liability to die sud¬ 
denly from cardiac failure. (6) Chronic rheumatic ton¬ 
sillitis is described by Dr. Max Thorner; this affection 
is more probably gouty in nature. A statistical inquiry 
was made into consecutive cases of three distinct affec¬ 
tions, namely, 248 of chorea, 43 of acquired heart disea-e 
in children unassociated with chorea, and 66 of rheu¬ 
matic fever in adults. Of the choreas in which a reli¬ 
able history was obtainable, 53 4 per cent, had a family 
or personal one of sore throat. This history was not 
associated with any marked predisposition to either 
arthritis or heart disease. Of the cardiac cases 66 7 per 
•cent, gave a history of throat affections. Among the 
adults 45 5 per cent, had a definite throat history, 21'2 
per cent, had suffered from ulcerated throats within 
three weeks of the attack of acute rheumatism, and 47'2 
per cent, showed faucial erythema within two days 
from its onset. In childreo, where the commencement 
is insidious, faucial erythema is extremely rare. On the 
other hand, a large proportion of them had follicular 

(a) Abstract of paper read before the meeting of the Clinical 
Society of London, January 27th, 1899. 


tonsillitis when first seen, several being brought up on 
its account and either revealing cardiac disease when 
examined or developing chorea while under observation. 
There seems little reason to doubt that in many of these 
cases the tonsils may have been the channel of infection; 
this is, of course, by no means invariably true, as the 
sore throat is often a late term in the rheumatic series. 
Bacteriological examination of the tonsils and their 
exudation in a large number of cases revealed the con¬ 
stant presence of strepto- and staphylococci, the former 
more frequently, but the latter oftener in pure culture. 
Similar organisms were found in the urine drawn from 
the bladder with all antiseptic precautions. Taking 
these results together with the discovery of the same 
microbes in the blood and affected j >ints in acute rheu¬ 
matism by Sahli and others, the probability of the 
occurrence of infection through the tonsil becomes very 
strong. It is believed by many that the rheumatic 
patient is poisoned by the attenuated virus of a germ 
which when fully active leads to pytemia. The following 
conclusions are put forward:—1. The more common 
varieties of rheumatic sore throat fall into two main 
categories, faucial erythema and tonsillitis proper. 2 
Faucial erythema is most common in adults, rheumatic 
tonsillitis in children, in whom it usually assumes the 
follicular type, quinsy being more frequent in older sub¬ 
jects. 3. Faucial erythema is an initial manifestation of 
acute rheumatism, tonsillitis may be the actual primary 
lesion. 4. Many cases are now definitely on record in 
which endocarditis has followed a non-scarlatinal tonsil¬ 
litis unaccompanied by joint pains. In numerous other 
instances the tonsillitis has immediately preceded an 
attack of arthritis or of chorea. 5. The presence of the 
same micro-organisms in the tonsils, joints, blooi, and 
urine is evidence in favour of the participation of pyo- 
gt-nic cocci in the (etiology of rheumatism. 

- ♦- 

transactions of §octctics. 

CLINICAL SOCIETY OF LONDON. 

Meetino held, Friday, January 27th, 1899. 


Mr. La noton, President, in the Chair. 


THREE CASKS OF ABDOMINAL SECTION. 

Mr. J. Hutchinson, jun , read notes of three cases in 
which he thought it necessary to perform abdominal 
section. In none of them was there any external wound. 
Case 1. A man, set. 32, was run over and subsequently 
became collapsed. Slight abdominal distension and 
much tenderness with dulness beyond the left linea 
semilunaris which shifted on change of position. On 
the following day the temperature had risen to 102, and 
the abdominal distension had increased. On opening the 
abdomen he found it full of blood, but in spite of careful 
search he could find no vessel requiring ligature. Great 
relief followed the removal of the blood, but some oozing 
occurred, subsequently, as evidenced' by dulness in the 
flanks and the escape of blood into the dressings. He 
left the hospital a month la‘er. He raised the question 
whether the presence of effused blood within the peri¬ 
toneal cavity was likely to prove injurious, and he 
thought it was. Case 2. A single woman was brought 
to the hospital with symptoms pointing to intestinal 
obstruction. On opening the abdomen over two pints 
of clear, pale, yellow odourless fluid escaped. The 
intestines were slightly congested, the stomach di¬ 
lated, the uterus enlarged as at the third month 
of pregnancy. He was at a loss to discover the nature 
of the fluid, and closed the wound. In spite of a 
passing improve ment the patient aborted on the follow¬ 
ing day, and died soon after. Post-mortem the abdomen 
again contained a large quantity of the same serous 
fluid, and the intestines showed signs of commencing 
peritonitis. Exactly in the middle line of the posterior 
surface of the bladder, one inch above the peritoneal 
reflexion, and therefore hidden from view, was a small 
round perforation 1/7 inch in diameter, through which 

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114 thk Medical Press. TRANSACTIONS OF SOCIETIES. 


urine could readily be expressed. Bladder and urethra 
otherwise normal. If the nature of the fluid had even 
been suspected he thought it might have been possible 
to discover and repair the perforation. He surmised, 
under the circumstances, that the wound was caused by 
an unskilful attempt to procure abortion. From the 
history, it seemed likely that urine had been leaking 
into the peritoneum for at least four days. He discussed 
the effects of effused urine in the peritoneal cavity, and 
recalled that experiments on animals had shown that 
healthy urine may be injected into the abdomen without 
giving rise to much local reaction, that in moderate 
quant ities it may bo absorbed and the animal recover. 
Case 3. A woman, rot. 47, was admitted with the history j 
that, previously in perfect health, while lifting a basket 
on the preceding day she had been seized with pain in 
the left side of the abdomen, followed by vomiting 
and some collapse. A smooth, movable tumour 
could be made out to the left of the middle 
line about the size of a fcetal head. This was 
dull on percussion, but there was no dulness in the 
flanks. Nothing of interest was made out by vaginal 
examination. He diagnosed ovarian cyst, the seat of a 
twist or rupture. On opening the abdomen a quantity 
of characteristic glairy fluid escaped, and it was seen 
that the largest cyst of a multilocular ovarian tumour 
had ruptured. The fluid was sponged away, but the 
cavity was not irrigated. Recovery followed. Admit¬ 
ting that the thin serous fluid of an ordinary ovarian 
cyst might, if effused in the peritoneal cavity, undergo 
absorption without giving rise to much trouble, he 
asked whether this thick glairy fluid would prove equally 
innocuous. 

The President, commenting on the first case, ob¬ 
served that though blood in the peritoneal cavity need 
not give rise to septic mischief it would, nevertheless, 
be advisable to operate, because one could not know the 
conditions which had given rise to the effusion. He 
related the case of a man who had received a bullet 
wound tluee inches below the nipple. As there was in¬ 
ternal haemorrhage he opened the abdomen and found 
that the liver had been extensively lacerated, but ulti¬ 
mately he managed to arrest the haemorrhage, and the 
patient recovered 

Mr. Dunn pointed out that the blood which had oozed 
after the opera'ten, which appeared to have been con¬ 
siderable in quantity, did not seem to have done any 
harm. The President’s case was not altogether parallel, 
because the wound was or might be septic. 

Mr. Hutchinson, in reply, insisted on the great relief 
that had followed the operation in respect of the pain, 
adding that lie had purposely left the lower part of the 
wound loose so as to allow of the escape of any sub¬ 
sequent effusion of blood. 

Dr. Batty Shaw, in reference to the author’s third 
case, related the case of a woman who was admitted to 
hospital three days after labour. After delivery it was 
noticed that there was something abnormal in the 
abdomen, and she was sent into the hospital with the 
diagnosis of rupture of an ovarian cyst. She died on 
reaching the ward, and post-mortem they found a pale 
straw-coloured fluid in the abdomen without any sign of 
inflammation, and a collapsed ovarian cyst. He remarked 
that there had been no noteworthy increase in the quan¬ 
tity of urine passed since the accident. The fluid was 
thin, but that he suggested might be due to dilution 
with fluid secreted by the peritoneum. 

Mr. Charters Stmonds related the case of a child, ait. 
14, in whom he had recognised the presence of an ovarian 
tumour, but when they came to operate no trace of the 
tumour could be found, though there was nothing in the 
recent history pointing to rupture. He opened the 
abdomen all the same, and found the peritoneal cavity 
full of serous fluid, together with a ruptured ovarian 
cyst. The patient recovered. He also related the case 
of a woman, set. 35, who came in with a history pointing 
to rupture of an ovarian cyst. Owing to special circum¬ 
stances, there was a delay of some days in operating, and 
when this was decided upon she was in a serious condi¬ 
tion. She died of shock, and though there was much 
fluid in the abdomen, there were no signs of inflamma¬ 


Fbb. 1, 1899. 

tion. He thought that if he had not operated, this 
patient might have recovered. 

The President thought the extravasation of a thick 
viscid fluid with the things that it might contain might 
not improbably determine peritonitis. He related the- 
case of a lady with an ovarian tumour, in which spon¬ 
taneous rupture, followed by shock and ultimate re¬ 
covery, took place no less than four times. After the 
last rupture, he opened the abdomen and removed the 
collapsed cyst. There had never been any peritonitis nor 
any adhesions 

Mr. Hutchinson, in reply, asked what was the cause of 
death in Dr. Shaw’s case, as there was no peritonitis. He 
mentioned a case in which a lady ruptured an ovarian 
cyst, from being thrown forward m a cab. 

Dr. Bertram Abrahams read a paper 
on rheumatic tonsillitis 
an abstract whereof will be found on page 113. 

Dr. Kingston Fowler was glad to have the author’s 
confirmation of his own observations first published in 
1880. He agreed that tonsillitis might be followed by 
rheumatism or cholera or endocarditis. He questioned 
the accuracy of the term “ ulcerated sore throat ” adding 
that in ordinary tonsilitis no ulceration properly so 
called was present. He recalled the case of a man who 
was admitted with quinsy for which he was being treated 
with chlorate of potash and iron. He remarked at the 
time that if he had seen this patient on his admission he 
would have felt disposed to give him antirheumatic 
remedies. Eight days after this, while still in bed, this 
patient had an attack of acute rheumatism. He urged 
that if the rheumatic nature of these throats were 
recognised in good time and anti-rheumatic remedies 
administered the attack of rheumatism might be averted. 
He also mentioned the case of a gentleman who had a 
sore throat just before going on his holidays. He went 
mountain climbing nevertheless and was laid up in the 
high Alps with a severe attack of rheumatic fever. He 
deprecated the use of the term “ growing pains,” an 
expression which he suggested was a reflection on the- 
Creator and ought to be avoided, such pains being in 
reality rheumatic. 

Dr. Carr asked whether it was possible to diagnose 
these supposed rheumatic throats or whether they were 
to judge from the history or from the subsequent occur¬ 
rence of rheumatism. In one of the author's cases the 
interval between the sore throat and the rheumatism 
was a year, and in another seven teen years. He suggested 
that an ordinary tonsillitis might attack rheumatic as 
well as other subjects. He had not been able to convince 
himself that anti-rheumatic remedies modified the course 
of these tonsillites. He defended the use of the term 
“ growing pains ” which ho thought wer9 actually as 
described. He himself had suffered therefrom, yet he 
was not rheumatic. 

Dr. Lucas Henham thought any kind of sore throat 
might be followed by rheumatism, but the sore throat 
always seemed to precede the rheumatism, and even to 
be the cause of it. He related a case of a child who had 
ordinary tonsillitis lasting three days, and just when he 
was getting well there was a rise of temperature and a 
mitral murmur developed. He pointed out that when 
there was great oedema of the tonsils a slough might 
form at the point of contact which was followed by an. 
ulcer. 

Dr. Sutherland admitted that it was difficult to 
demonstrate the connection between sore thoat and 
rheumatism. but some still asked whether erythema 
nodosum and chorea were rheumatic manifestations. 
He suggested that the tonsils might not be the only 
structures attacked and ref-rred to cases in which there 
was headache, vomiting, and general malaise, without 
any localising sign in association with well marked 
tonsillitis in patients who subsequently developed 
rheumatism. He thought that the lymphoid tissue of 
the alimentary tract might share in the process, and 
called attention to the existence of “ rheumatic appen¬ 
dicitis.” 

Dr. Toogood said that according to his experienoe 
j most cases of follicular tonsillitis were of bacterial origin, 
and were markedly infectious. The organisms he had 


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Feb. 1, 1899. 


FRANCE. 


met with were streptococci and staphylococci, and some¬ 
times the short diphtheria bacillus. 

Dr. Abrahams, in reply, explained that growing pains 
and ulcerated sore throat were merely colloquial expressions 
which one had to make use of in questioning patients. 
He was not satisfied that the antirheumatic treatment 
of these throats had any beneficial effect, and he men¬ 
tioned a case to show that the administration of the 
salicylates could not be relied upon to avert the subse 
quent occurrence of an attack of rheumatism. He asked 
what could have been the cause of death in his case, 
assuming that the patient was not suffering from 
diphtheria. The non-success of antirheumatic treatment 
he thought was in favour of a bacterial origin. He con¬ 
curred in Dr. Sutherland's remarks as to the gastro¬ 
intestinal disturbance in some of these cases. He pointed 
out that the germs referred to by Dr. Toogood were not 
invariably present, and possibly the attenuated form was 
the true cause of rheumatism. 

-♦- 

HARVEIAN SOCIETY OF LONDON. 

The Annual Meeting, Presidential Address. Election of 
Officers, and conversuzione of this Society took place on 
Thursday, January 19th. 

At the close of the presidential address, the scrutineers 
of the ballot declared that the officers recommended by 
the Council had been duly elected. 

Votes of thanks were proposed and carried to the 
retiring officers. The meeting then resolved itself into a 
conversazione, instrumental and vocal music were pro¬ 
vided by the string bind of the Royal Horse Guards 
Blue, and by the Crichton Glee Singers, under the 
direction of Mr. Mervyn Dene A collection of sporting 
guns, past and present, was exhibited by Dr. F. W. Cock, 
and Messrs. Coieter gave a demonstration of the use of 
“ X ” Rays. 

The President, Dr. Jas. F. Goodhart, delivere l an 
address, entitled 

“ OPINION THE 8ALT OF FACT," 
in which he dwelt on the value of opinion in things 
medical as well as of verified fact. He held that the 
promise of success satisfied the human mind as finished 
success can never do. Hence the fascination which 
treatment based on theory always exercised. Such treat¬ 
ment might fail from various causes, but it did not follow 
that the theory was altogether wrong. He alluded to 
the recently advocated methods of treating cancer by 
electrical currents of high tension, by the use of toiins, 
and by oophorectomy. Such methods had all failed, but 
who could say that the ideas on which they were based 
might not be “ stepping-stones to higher things ’’ ? 

On the other hand, the theory on which treatment 
was based might be utterly wrong, and yet the treatment 
might be successful For instance, dilatation of the 
heart and stomach had been regarded as due to inability 
of the organs to drive their contents through obstruction 
ahead. But he believed that dilatation was a primary 
passive process, and that hypertrophy was the attempt 
to remedy this condition. Still, this view did not inter¬ 
fere with the success of treatment based on ai opposite 
assumption. 

The lecturer then referred to the statement recently 
made by Dr. Sidney Phillips that disease has changed in 
type. He fully concurred in this view, and illustrated 
the changes, not only in the case of enteric fever, but in 
other diseases, such as diphtheria, pneumonia, and appen¬ 
dicitis. He compared the accounts of influenza by Hux- 
ham, in 1733, and of morbilli, by Sydenham (1870), with 
the phenomeni of those diseases in their present type. 
The change of type was apparent not only in diseases 
but in man, and thought and even in the expression of 
thought. This was exemplified in the case of painters, 
novelists, and other writers. Man and his view of his 
environment were in a constant condition of change. 

One had only to look at the pictures by Rembrandt 
and other old masters, or read the novels of Burney, 
Thackeray, and Dickens to see how widely their outlook 
on nature differed from that of present-artists and 
writers. 

He had entitled his address “Opinion the Salt of 


The Medical Press 115 

Fact/’ In the ptudy of disease he believed there was a 
legitimate sphere for the nebulous phase of thought— 
although the fruit of speculation might often seem 
unripe. 


France. 

[from our own correspondent.] 

Paris, January 2!»th, 1809. 

A Novel Feature in Artificial Air. 

At the meeting of the Academie of Medicine M 
Laborde read a paper on a chemical substance which by 
its simple contact with air vitiated by respiration 
regenerates it completely, lestoring to it its first 
qualities. In other words this substance removes abso¬ 
lutely the carbonic acid from the foul air, as well as the 
water vapour, and irrespirable products, and renders 
to it in exchange the exact quantity of oxygen 
required. Fr >m the first series of experiments it was dis¬ 
covered that six or eight pounds of the substance would 
keep alive in a space hermetically sealed (a submarine 
boat or a diving bell, for instance) a healthy man during 
twenty-four hours. Besides, the product was capable of 
rendering good services to medicine, as with a few 
grammes of it a dozen litres of oxygen could be obtained 
instantaneously. 

Appendicitis. 

M. Schwartz said that he differed from the opinions 
expressed by some of his colleagues, approving early 
interference in every kind of appendicitis. He had seen 
over thirty cases get well without any operation, that 
was to say, where no absces< had formed. Otherwise 
they were all agreed on interfering where suppuration 
was suspected. In every other case he deferred operating 
as long as the pulse remained good and paralysis of 
the intestine had not set in. As to the operation, he 
followed the method of Max Schuller, which was to make 
the incision along the outer edge of the rectus muscle, and 
with this incision he had never witnessed eventration. 

M. Lejars said that there existed a tendency to believe 
that acute appendicitis should be treated medically, while 
an operation should be reserved to the period when the 
acute symptoms had subsided The idea might hold 
good in many cases, but sometimes immediate interfer¬ 
ence was necessary to save the patient, as the usual 
signs of the presence of an abscess were not necessary to 
the existence of extensive suppuration. Again, 
leaving aside cases of perforation which required imme¬ 
diate surgical treatment, thero were cases of septic 
appendicitis which killed rapidly patients if they were 
not operated on at once. M. Reynier said that as long 
as no alarming symptoms were present he treated the 
patient by rest and the application of ice to the abdomen. 

Whooping Cough. 

Whooping cough, according to M. Lagounne, is an 
in r ectious malady due to a special germ, transmitted 
directly through the expired air or indirectly by infected 
objects. Consequently its propagation is easy and rapid- 
Blache said that whooping cough attained its maximum 
of frequency between the ages of three and four—that was 
to say at the period when the children are thrown 
together in infant schools. 

Temperature and seasons had no influence on the germ 
itself, and if the affection was more intense in winter 
than at other periods of the year the cause resided 


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116 The Medical Press. 


GERMANY 


Feb. 1, 1899. 


solely in the fact that the patients were confined to the 
house more, and lived consequently in a vitiated atmos¬ 
phere ; the open-air diminished, on the other hand, the 
gravity of the disease. 

As to the treatment, it should be entirely external, as 
the administration of remedies usually prescribed in 
these cases arrested the fits of coughing by paralysing 
the expiratory muscles 

As soon as the affection is recognised, the bedclothes 
and all the wearing apparel in use, as well as the carpets 
and the curtains, should to sprinkled several times a 
day with an antiseptic solution, even that of corrosive 
sublimate (1—1,000). The patients should live as much 
as possible out of doors, and when feasible they should 
not occupy the same apartment night and day. 

All linen clothes, and, in fact, every object soiled with 
the expectoration, should be plunged into boiling water, 
and afterwards washed with antisep'ic solution. In order 
to prevent the production of the germ and to obtain the 
antisepsy of the respiratory apparatus and of the circum¬ 
ambient air, the clothes of the child in proximity with 
the mouth (the front of the chest, the sleeves) should be 
sprinkled several times daily, while the same should be 
done in the evening to the pillows, sheets, and coverings 
near the head of the patient. 

The solution employed by Dr. Lagounue is :— 
Sulphuric Ether, 400; 

Acetic Ether, 150; 

Proof Spirit, 300; 

Salol, 50; 

Phenic Acid Crist, 15 ; 

Essence of Lavender, 25; r’" ^ “ ' "5 

-of "Winter Green, 25. 


(kermanji. 


were not at hand, as scarcely any surgeon had the 
opportunity of investigating anatomically the urethra 
of a patient who had been treated with silver nitrate. 
His experiments were on dogs and rabbits, and the solu¬ 
tion employed were 1 to 2 per cent, solutions, the injec¬ 
tion being made in the usual way, and at the usual 
intervals of time. His investigations began in 1894- 
Thirty-five instillations were made on six animals, and 
two were killed at six months, two at nine, and two at 
twelve. On examination there were no traces of inflam¬ 
mation in either mucosa or submucosa, both layers were 
filled with nodules and flakes which were either silver or 
combinations of it. The flakes dissolved in potassium 
cyanide. In animals, on the other hand, that had fifteen 
1 per cent, solutions of chloride of zinc injected the epi¬ 
thelium was, in some cases, grown to the submucosa, in 
others the function of the epithelium was changed; the 
submucosa contained fresh round cell deposits in some 
places, in others the mucous surface was destroyed. 

Immediately after the silver application the upper 
layers of the mucous membrane were converted into a 
homogeneous brown cautery slough, and between the 
spots were collections of round cells. There were signs 
of inflammation also with deeper tissue layers. After 
four days nothing more was seen of the silver that had 
been applied, and eight days after every trace of inter¬ 
ference had disappeared. The speaker then passed on to 
the theory of the action of silver nitrate. It consisted in 
destruction of the upper layers of epithelium and con¬ 
secutive irritation. The irritation was a deep action, so 
that silver fulfilled the indications that were supposed 
to render the newer preparations preferable. His 
investigations had shown that the fear that Gyon’s 
instillation of silver would cause stricture was ground¬ 
less. The old tried remedy had now its justihcation 
experimentally. The note was illustrated by excellent 
microscopic preparations. 


[from our own correspondent.] 

Berlin, January 27th. 18M*. 

At the Dermatological Society, Hr. Rudolf Isaac 
spoke on 

Ives’ Colour Photography in Dermatology. 

Ives photographed the object three times through a 
green-violet-red slide, with a period of exposure corre¬ 
sponding to the actinic activity of the colour filter. 
Glass dia-positives were prepared from the negatives 
formed on plates which were receptive to colours. These 
were viewed either in the skiopticon or chromoscope 
through three correspondingly green, violet, and red 
colour filters. In the skiopticon were three objects, 
which gave three images which, superposed, gave an 
image in natural colours. The chromoscope was a kind 
of stereoscope that, by a peculiar arrangement of mirrors, 
permitted the three colours to be thrown over each 
other. Some dermatological photographs were shown, in 
which a certain amount of success had been attained. 
The hope was expressed that the present technique 
would be improved upon. 

Hr. Le Casper followed with a note on 
The Action of Silver Nitrate on the Urethral 
Mucous Membrane. 

The speaker had made experimental observations as to 
whether the instillation of strong solutions of silver 
nitrate produced permanent cicatrices in the urethral 
muoous membrane. Observations on the human subject 


Accidental Wounds of the Internal Jugular 
Vein. 

Two cases of this were observed by Dr. Oppel and 
reported in the Deutsch Med. Zeit. In both cases the 
vessel was only incised. The treatment consisted chiefly 
in double ligation of the vessel above and below. Both 
patients recovered without any serious complication. 
In studying the literature of the subject. Dr. Oppel 
found in thirteen similar cases all recovered, and under 
double ligation of the vessel. He also met with three cases 
that were treated with prolonged digital compression- 
These also did well. In four other cases the treatment 
was by tamponnade of the wound. Three of these died 
either from haemorrhage or sepsis, and only one recovered. 
One case was met with that was treated by ligature of 
the common carotid, and this also ended favourably. 
Twelve other cases were, however, met with, in which no 
treatment was carried out, and these all ended fatally. 
To these thirty-five cases the author adds the fifteen 
observed in the North American war. This gave a total 
of fifty cases, thirty of which were fatal. During the 
antiseptic era are eleven cases, nine were treated by 
ligature, and recovered, two had no treatment and died. 
The mortality here was 18 per cent., whilst in the pre¬ 
antiseptic era it was 68 per cent. The chief danger in 
these cases did not lie in the primary haemorrhage as 
may be expected, but n the secondary, which was mostly 
associated with infection in the wound. Admission of 


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AUSTRIA. 


Tub Mkdical Press. 117 


Fbb. 1, 1899. 


air into the vein was certainly a very dangerous com¬ 
plication, but it was one of very rare occurrence. 
Operation in Seventy-nine Cases of Extra-uterine 
Pregnancy. 

Wrateh contains a paper on the subject by Dr. 
Strauch, the whole forming a plea for operation, and 
early operation in such cases. After giving an account 
of the supposed aetiology of ectopic gestation and the 
diagnosis of the condition, he goes on to quote Martin’s 
statistics as to prognosis. These were to the effect that 
in 278 cases the mortality was 67 per cent, in those 
treated expectantly, whilst the recoveries were only 33 per 
cent. Of 636 cases operated on 20 per cent, died and 80 
per cent, recovered. In cases therefore in which a dia¬ 
gnosis of extra-uterine gestation had been made the clear 
course in duty was to operate at once. The earlier the 
operation was performed the easier it was and the better 
for the prognosis. If abortion or rupture has already 
taken place, the bleeding part should be made accessible, 
and an attempt be made to arrest the bleeding. It was 
a grave mistake to give stimulants in such cases. 
The feeble condition of the heart was a factor that 
favoured arrest of haemorrhage. Stimulants raised the 
depressed blood pressure, and excited fresh hsemor. 
rhage. Large quantities of saline fluid also should not 
be given before operation. The vessels should first be liga¬ 
tured and then the system might be filled up with salines. 
The ertravasated blood should be removed from the ab¬ 
domen, as much as possible. When the operation was by 
abdominal laparotomy a more careful examination can 
be made, and cleansing can be more thorough, while if 
from the vagina it was less dangerous, especially after 
decomposition has set in. In the second half of tubal 
pregnancy laparotomy w as the usual way. Among the 
author s 79 cases there had not been a single death. The 
youngest patient was 21 and the oldest 46. The oldest 
pregnancy was one of seven and a half months, the 
youngest one of a few weeks. In the first case the child 
lived for half an hour after extraction. The pregnancy 
was in the right tube 31 times, in the left 39. The 
operation was by laparotomy 63 times. Six patients 
had conceived and borne children after the operation. 

At the Society for Scientific Medicine, Kbnigsberg, 
Hr. Ascher showed a 

Stabbing Wound of the Heart, 

Along with other serious injuries in the left ventricle, 
there was also a perforating wound about 2 ctm. in 
length close to the septum, which was closed by a 
thrombus. The man lived 20 hours after the infliction 
of the injuries. 


Jluetm. 

[from our own correspondent.] 

Vienna. January 28th. 1899. 

Teucrin and Tuberculosis. 

At the Medical Club, Erbeim exhibited two cases 
which he had treated with teucrin Mosetig for tuberculous 
ulcers. The first was a boy of ten years, with an intract¬ 
able ulcer in the mucous membrane of the cheek; the 
second was a young woman, tet. 24, with a similar ulcer 
on the under lip. Both ulcers were treated by sub¬ 
cutaneous injections of the extract of teucrin (Extr 
teucri scordii depur.), which was injected into the circum¬ 


ference of the ulcerated tissue. The smaller sore healed 
in a few days, the larger began with the common cement 
of the injections to granulate rapidly, and healed up 
within fourteen days. This ulcer had existed for four 
months previous to the injections, notwithstanding the 
heroic treatment adopted before that time. He showed 
a third case of the same class, which bad not been pre¬ 
viously treated, that occurred on the under lip in the 
form of lupus, accompanied by lymphadenitis. The boy 
was 14 years of age. The half of the left lip was de¬ 
stroyed by the ulcer, which had a firm infiltrated base 
and margin; on the right half was a smaller ulcer of a 
similar character, which the microscopic examination 
proved to be tuberculous. H e was treated in the same 
manner as the two previous cases, with equal success. 

Max Kahane recorded a case of a large “ cold ” abscess 
which he had treated with teucrin injections, and which 
rapidly receded, leaving a small fistula leading into 
the spinal cord. He thought that the activity of the 
teucrin was instrumental in converting the chronic 
inflammation into an acute inflammatory condition. 

Operatons on Gall-stones. 

Schnitzler reopened the discussion on Riedel's paper, 
which was read some time ago before the Society, in 
order to criticise some of the opinions then ittempted to 
be established. He disagreed with Riedel when he would 
not operate on a lorg standing gall-stone which had 
become wedged in the neck of the gall-bladder in the 
cystic duct, or the ductus choledochus, which though not 
producing hepatic congestion may afterwards produce 
inflammation with colic attacks. He quite agreed with 
Riedel that large gall-stones lying in the gall-bladder 
seldom produce inflammation, though small ones 
in the former position will, and often do, produce in¬ 
flammatory conditions Schnitzler also believed that 
the “ perialienitis ” of Riedel wns provoked by the 
congestion which was the result of active inflam¬ 
mation in the fibrous tissues of the gall-ducts 
which may only have been temporary or transitory 
in its effect. This congested form of inflammation is not 
uncommon in other organs which is usually associated 
with fever and rigor where neither sepsis nor nephritis 
is present. Schnitzler himself had a case of this kind 
where high fever existed for months, but after the re¬ 
moval of the gall-stone it suddenly disappeared, leaving 
the kidneys entire and no sign of pus anywhere. 
Schnitzler cannot agree with Czerny that a large number 
of the cases of cholelithiasis contain sugar or some other 
reduced substance in the urine Ileus, or colic of 
the bowel, is also a rare condition after a gall¬ 
stone lias entered it. In proof of this he recorded four 
cases coming under his own observation. The first 
appeared with septic phenomena, while the stone was 
found by operation in a fold of the bowel, but nowhere 
was inflammation to be found. The post-mortem 
revealed an abscess in the gall appendages from which 
the sepsis originally entered the ducts, which led to the 
formation of the gall-stone. In another case operated 
upon the stone was found after a post-mortem examina¬ 
tion in a fold of the large intestine, while in the small 
intestine was observed a large decubitus ulcer, where the 
calculus had apparently lain for some time. 

Dr. Morley, brother of the Right Hon. John Morley, 
M.P., the oldest practitioner in Blackburn, we under" 
stand, is seriously ill. 


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118 The Medical Press. 

$lit)icni JDcalth Resorts. 

(From Our Special Correspondent.) 

NICE. 

The causes of the poor season (so far) on the Riviera 
have been variously assigned to the typhoid rumours 
about Nice, and to diplomatic difficulties about Fashoda, 
Madagascar, 

That the unusual drought of last summer shortened the 
well-water supply at Nice, and threw the poorer and 
less cautious classes of the population upon more or less 
impure sources for drinking water, thereby occasioning 
fevers in the older and in the outlying districts of Nice 
during the months of September and October, is beyond 
question. The rains of early November remedied this, 
and carried off any danger therefrom. When here late 
in November, I found the normal healthiness of the place 
fully re-established. Squabbles with a leading American 
journalist about rents and bulletin-boardings, want of tact 
and dilatoriness of the municipal authorities in some 
other matters, led to newspaper controversies far and wide. 
But if these local issues were the cause of the diminu¬ 
tion in the number of English and other foreign visitors 
to Nice, why did other Riviera resorts suffer ? 

Hyeres, with a saline-tempered atmosphere, yet with 
exemption from a too close proximity to the sea, and 
enjoying an enviable reputation for a century back, is a 
most desirable winter home ; Cannes, with its old time 
prestipe and English comforts; Valescure and Cap 
Martin with their pine-foiests; the Cap d’Antibes, a 
rocky and unmistakably healthy spot; Grasse, on its 
picturesque hill-slope amidst the purest mountain 
breezes—inland places with excellent sanitation, sea- 
washed towns equally well cared for, mountain side 
hotels, like the favourite Grand, of Grasse—situations 
of varied positions in the Riviera, and of acknowledged 
heathfulness, all alike have been short of guests. 

Even popular winter resorts, far distant from the 
Riviera, likewise suffered. The visitors were as scanty 
even at Pan, with its admirable climate and unquestion 
able salubrity, and at “ bright, beautiful, brilliant 
Biarritz,” with its atmosphere of rare purity, its many 
gaieties, and its health-giving ocean tides. One would 
have thought these and similar distant resorts should 
have benefited from any local difficulties at Nice 

Then as to diplomatic differences between France and 
England, if these kept our countrymen from French 
shores, why did not Italy profit ? All along the Italian 
Riviera come equally poor reports of few visitors this 
season. Except, perhaps, the recently enlarged and beauti¬ 
fied Hotel Angst at Bordighera and the popular Royal Hotel 
at San Remo, I know of no Italian hotels which have 
not had to complain of too few guests. Farther afield, 
also, from Corsica, the Canary Isles, Madeira, Cairo, from 
every winter resort the complaint is the same. 

And how about the English winter homes ? Are Bath, 
Hastings, Eastbourne, Brighton, Torquay, Falmouth, 
&c., having brilliant seasons ? Surely the thousands of 
our British people who usually fill winter residential 
stations abroad should this season have crowded the 
home stations to overflowing. Probably the true cause 
of a scarcity of English visitors and of tourists all over 
the Continent and elsewhere, is that the autumn and 
winter have been “ stay-at-home ” seasons. 


Feb. 1, 1899. 

Whatever the causes, the result should be beneficial 
to the future welfare of Nice. Improvements projected 
and promised years since, are now to be efficiently carried 
out by the municipal authorities and the leading land- 
owners, with the advice and assistance of local scientists 
and physicians. These improvements will be of great 
permanent value to Nice. And not Nice alone should 
benefit. The whole of the French Riviera has had an 
opportune 41 object lesson ”! In recent years the chief aim, 
apparently, of the authorities and managers has been to 
cater for their pleasure-seeking guests, and at the same 
time gratify the native populace who dearly love 
44 Pomp and Feast and Revelry, 

Mask and antique Pageantry.” 

As the Medical Press and Circular said a year ago, 
“the glitter and the glare of fashionable life on the 
Riviera has unfortunately of late years thrown too much 
into the shade the value of the merits and attractions 
of this coast for the invalid, the delicate, the 
world-wearied, the aged and the convalescent." Yet 
it is these who have created and who chiefly con¬ 
tribute to the prosperity of the Riviera They come 
here early each 44 season,” and remain the latest in the 
spring; while the more showy and noisy guests 44 on 
pleasure bent” flock hither only for February and 
March alone. The lessons of the present winter, with its 
scarcity of British and other long-residing visitors, 
cannot but make the more “serious,” influential, and 
reflecting property-owners, business-people, and hotel- 
proprietors along the Riviera recognise that it is the 
invalid, the delicite, the rest-seekers, the old, and the 
convalescent who constitute the main support of its 
financial prosperity, and that it is for them chiefly pro¬ 
vision should be made. 


^he (Operating theatres. 


KING’S COLLEGE HOSPITAL. 

Cholfcystotomt. —Mr. Carlbss operated on a woman* 
set. 40, who for some months had suffered from abdominal 
symptoms of some severity. She had been seized time after 
time with attacks of colicky pain referred to the right 
iliac region, and a lump of some size had been noticed 
there for a considerable time. It had, however, varied 
in size, and on examination a few days before operation 
it was much smaller than it had been previously, 
whilst on the patient's bowels being cleared by medicine 
immediately before the operation, there was no lump to 
be felt at all; at the same time, the patient had !oet 
flesh considerably, and the pain and colic had been so 
severe that there could ba no question as to the existence 
of some focus of obstruction somewhere in the bowel. 
After the usual purification of the abdominal wall, an 
incision was made somewhat similar to that utilised in 
the removal of the appendix, but slightly nearer the 
middle line, by which means the rectus was exposed, and 
the peritoneum opened after separating the fibres of the 
muscle longitudinally. The ciecum protruded at once, and 
although it and the neighbouring portion of the ascending 
colon were found to be healthy, yet the longitudinal 
muscular bands were so extremely hypertrophied as to 
cause the bowel to be curiously corrugated, evidently in¬ 
dicating that there was some obstruction to be overcome j. 
the small intestine was quite healthy, although portions 
of it were in a state of extreme spasmodic contraction 


THE OPERATING THEATRES. 


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LEADING ARTICLES. 


The Medical Press. 119 


which, however, could be overcome by applying hot 
saline solution and pressing flatus onwards. The uterus 
and its appendages were found normal, as also the kidneys 
and spleen. The large intestine was then traced round 
upwards from the sigmoid flexure and nothing was 
noticed till the hepatic flexure was reached, when the 
hand came in contact with a tense elastic swelling 
evidently a greatly distended gall-bladder. The parietal 
incision war promptly enlarged upwards to the costal 
margin, and after the intestines had been guarded by a 
suitable arrangement of cyanide gauze soaked in hot 
sterilised saline solution, the gall-bladder was drawn up 
out of the wound. It was found to have considerable 
adhesions to the hepatic flexure of the colon, thus 
explaining the colic and obstruction phenomena 
from which the patient had suffered; these ad¬ 
hesions were carefully divided, and by this means 
the gall bladder was traced back to the cystic duct 
in which a lsrge calculus was detected. The gall-bladder 
was now tapped with a large trocar and cannula, and an 
ounce or more of yellowish puriform fluid withdrawn ; 
after removal of the cannula the gall-bladder was opened 
sufficiently to allow of the introduction of the index 
finger, and, after a little manipulation with a lithotomy 
scoop, a rounded gall-stone, the size of a large marble, 
was withdrawn. A careful investigation with fingers and 
a long probe having led to the detection of no other 
calculi a large drainage tube was stitched into the gall¬ 
bladder, which was then fixed to the abdominal wall, 
whilst the rest of the external wound was closed with 
deep interrupted sutures and a superficial continuous 
suture of catgut. Mr. Carless remarked that in thin¬ 
case the diagnosis before operation was very uncertain^ 
and the woman had complained of some menstrual dis 
turbance, but Dr. John Phillips had carefully examined 
her, and found that the uterus and appendages were 
normal. There was also some doubtful history of 
heematuria, but nothing could be felt in either loin. 
The lump which the woman had noticed was evidently due 
to distension of the crncum, since it had varied from time 
to time and its presence had always been associated with 
severe colic. There had been no history of biliary colic, 
and no jaundice, and the gall-bladder, though distended, 
was not very obviously palpable, hen^e a provisional 
diagnosis had been made of carcinoma of the bowel 
(based on the loss of flesh, the existence of a lump, and 
the recurrent attacks of colic and pseudo-obstruction), 
or of some obstruction in the course of the colon. It was, 
therefore, obviously wise to commence with an explora¬ 
tion of the caecum and its adnexa, so the incision men¬ 
tioned above answered admirably this purpose, whilst it 
permitted the whole abdomen to be explored. The con¬ 
dition found round the gall-bladder sufficed to explain 
the chief symptoms of the patient, although not those 
connected with the menstrual disturbances. Only one 
calculus was found, and probably, since it was rounded 
and had no signs of facets, no other was present. In 
several preceding cases Mr. Carless had entirely closed 
the gall-bladder after removal of calculi, and preferred to 
follow that practice if possible, but in this particular 
instance the fact that the contents were puriform led him 
to make a temporary fistula. It has since been ascer¬ 
tained that pus cells were present in the fluid and also 
large numbers of diplococci. 


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“ SALL'S POIT'LI Sl'PREMA LEX.” 


WEDNESDAY, FEBRUARY 1, 1899. 


LUNATICS AS PRIVATE PATIENTS. 

A recent trial has brought into prominence the 
subject of the treatment of lunatics in private 
asylums The immediate object of the legal proceed¬ 
ings was the alleged reception of a persou of unsound 
mind by a medical man without a licence. With 
this more particular aspect of the larger question 
we propose, in the present instance, to deal 
because of certain occurrences connected with the 
trial, which seem to require plain-speaking on the 
part of the medical journals. The Lunacy Acts 
clearly accept the principle that no persou of 
unsound mind should lie confined in an un¬ 
licensed house, a precaution that is absolutely 
needed for the protection of the liberty of 
the subject against the most serious possible 
abuses Anything that is likely, therefore, to 
hinder or hamper the carrying out of the ma" 
ehinery of licensing and of its connoted inspection 
must lie regarded with instant suspicion and coun¬ 
teracted with firm authority. If we accept these 
propositions, which appear incontrovertible, it is not 
a little curious to witness the attitude of a leading 
lunacy expert arising out of the trial to which allu¬ 
sion has been made. Those who are interested 
in lunacy matters will readily recall the facts 
of the case. As the result of profound convic¬ 
tions only could a gentleman in so eminent a 
position publicly traveree one of the fundamental 
principles of the Lunacy Acts. That he should 
attempt to justify his active opposition to the salu 
tary measure that is framed to prevent the shutting 
up of a sane man as a lunatic, and start a public 
subscription to defend a medical man charged 
with an infringement of that provision, savours 


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120 The Medical Press. 


LEADING ARTICLES. 


Feb. 1, 1899. 


of a temerity happily not often met with in 
the law-abiding profession of medicine. In these 
latter days the violent methods of Wat Tyler 
have fallen into disrepute with those who seek to 
reform laws that are not to their taste. From our 
point of view', which we venture to imagine has the 
support of nine tenths of the medical profession, 
and the vast majority of the outside community, 
there can be no question as to the wisdom of 
establishing absolute official control of lunatics 
in order to prevent such conspiracies against 
property and personal freedom as formed the 
favourite tilting post of the once popular novelist, 
Mr. Charles Reade. Indeed, the question has often 
been raised, more especially in recent years, as to 
whether the private licensed house should be per¬ 
mitted to exist at all, and whether all insane persons 
should not be taken under direct State control in public 
asylums. The reasons, both for and against a radical 
and far-reaching step of that kind, are numerous and 
weighty. Without entering into them at length, 
however, it muy be stated that one of the most 
plausible adverse arguments is that well-to-do lunatics 
would not in that case be able to obtain the >>eRt con¬ 
ditions favourable to their recovery. It is not clear, 
however, why the State should be unable to conduct 
what is usually regarded as an extremely remunera¬ 
tive organisation and combination of special treat¬ 
ment and capital. Then, again, there is the ever 
present fact that it is againRt the interests of private 
institutions to lose their patients. At the same 
time, we are glad to believe that with few 
exceptions the private asylums of this country 
are above reproach, and we are willing to 
admit that the proposal to do away with 
them in favour of State institutions is, in the present 
stage of social progress at any rate, an unwork¬ 
able counsel of perfection. That the lunacy laws 
are not without flaws is pretty widely acknow¬ 
ledged, and it is to be hoped that Parliament will 
one day find time to pay a little attention to that 
and a hundred other important social matters con¬ 
nected with the medical profession that have long 
since been ripe for reform. The central control of 
the lunacy laws, like that of the Local Government 
Board, and of the General Medical Council, we 
regard as inefficient, slothful and conducted on more 
or less fossilised methods. So far as the Lunacy 
Commissioners are concerned, it would be im¬ 
possible to do the work of inspection pro¬ 
perly without multiplying the staff by several 
times its present strength. The “strongest 
Government of modern times ” has irons in 
the fire in all quarters of the world, but has 
hitherto done little for any of the matters affecting 
the medical profession, either directly or indirectly. 
Their only attempts in that direction, namely, the 
separate treatment of certain classes of disabled 
metropolitan pauper children, and the abolition of 
compulsory vacc nation have certainly not been cal¬ 
culated to stamp their administration as memorable 
in the annals of medicine But an opportunity still 
offers while Poor-law administration is wedded to that 


of the public sanitary service, while the General 
Medical Council remains practically autocratic, and 
while lunacy administration lags behind the times. 


MR. HUNTER S APPEAL. 

Me. Hunter, though dead yet speaketh, and he 
technically appeared before the judges of the Queen’s 
Bench Division on Tuesday of last week to urge his 
appeal against the decision of the justices who 
punished him for making use of the designations 
physician and surgeon, or, to be strictly accurate, for 
calling himself a physician, he being only a licentiate 
of the Society of Apothecaries. The question before 
the judges was whether the right to practise medicine 
conveyed by the licence of the Society of Apothe¬ 
caries implied the right to the description of physi 
cian, or. in other words, whether this title means 
merely a person who practises medicine or belongs 
exclusively to the holders of a particular diploma 
Two judges have now decided that the title 
belongs of right to “ persons in the highest 
grade of medical practitioners,” but this leaves 
much that is vague because it is not speci¬ 
fically declared what constitues the “ highest 
grade.” We are still at liberty to wrangle whether 
the title physician is restricted to fellows of the 
Royal Colleges of Physicians, whether members of 
those bodies share that privilege, or whether the 
possession of a degree in medicine does not establish 
a supremacy over the body of non-graduate practi¬ 
tioners. Even more, it would be brutal to refuse the 
title to licentiates of those bodies for they have 
received a licence to practise physic, and he who 
practises physic is presumably a physician. If not, 
what is he? St. Luke is described in Holy Writ 
as a physician—a title to which, in the view of 
Her Majesty'8 judges, he has no right—and we 
commend this observation to the notice of future 
editors of “ revised editions ” of the New Testament. 
Mutatis mutandum, if it be an offence for others 
than fellows or members of the Colleges of Phy¬ 
sicians to style themselves physicians, it must be 
equally obnoxious for persons to call themselves 
surgeons who are not members or fellows of a 
College of Surgeons, though this point has not come 
up for discussion on the present occasion. The 
judges have studiously and successfully avoided 
deciding more than they were asked to decide —viz., 
whether a certian licentiate of the Society of Apothe¬ 
caries w r as entitled to make use of the title physician, 
and, as already stated, they have decided that he 
had no such right. The fact that they quashed 
the conviction on the ground that the defendant had 
not “ wilfully ” made use of a false designation is 
interesting but not very instructive, but it may, 
perhaps, be construed as a rejoinder to the carefully 
worded circular issued by the Apothecaries’ Society 
informing all and sundry that their licence confers 
the right to practise medicine, surgery, and mid¬ 
wifery. For our own part we have no hesitation in 
expressing the opinion that the decision is absurd in 
principle, if sound in law. All it does is to withhold 


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Feb. 1 , 1899. NOTE S ON CURRENT TOPICS. _ The Medical Press. 121 


from licentiates of a certain qualifying body 
the right to use a particular designation which, on 
the face of it, only describes the'r calling as practi¬ 
tioners of physic. It stands from this point of view, 
on all fours with the popular prefix of “ doctor," 
which, by general consent, is applied to anyone who 
practises medicine, and even to those more or less 
distantly connected wi'h that calling. We see no 
objection to particular diplomas conferring each its 
particular titular designation, but we are not manifestly 
nearer this consummation in virtue of this decision 
Mr. Justice Channell made one remark which shows 
very clearly the confusion which exists in the minds 
of the laity on the merits of these intra-professional 
questions. Commenting upon the case of Regina 
t versus Baker, he mentioned that the qualification in 
that case was of an earlier date than 1886, and did not 
authorise the defendant to practise surgery “ which ’’ 
said the judge, “ is a department of the practice of a 
physician.” This is a reduclio ad absurd inn for the 
rules of the Colleges of Physicians expressly forbid, 
or at any rate forbade, the practice of surgery by their 
fellows and meml»ers. The General Medical Council 
has scored a point, it is true, but the painful circum¬ 
stances under which thiB particular prosecution was 
undertaken still remain to be explained, and we say 
explained, because justified they cannot be. 

THE SANITARY INSPECTION OF SCHOOLS. 

The right of a local sanitary authority to visit 
and inspect all and any buildings in the district has 
always been a moot point, that is, in the absence of 
the existence of “ a reasonable cause.” In the case 
decided by a metropolitan police magistrate last 
week in favour of the managers of the North Lon¬ 
don Collegiate S.-liool it is laid down that the 
sanitary inspector, as such, has no right of entry to a 
school building unless he can “ show cause.” We note [ 
with satisfaction that the opposition offered by the 
managers of this institution is not based on any 
abstract objection to sanitary inspection, but on a dis¬ 
trust of the particular sanitary authority whi-h, in 
their opinion, is ill-fitted to offer an opinion on th * 
subject. It will excite a feeling of surprise in the 
minds of many who are not conversant with 
the intricacies of our much-vaunted sanitary legis¬ 
lation to find that compulsory, methodical inspection 
of school premises does not find a place in 
the programme. If the health of our fa tory opera¬ 
tives is thought worthy of consideration surely that 
of the rising generation is not less so; indeed, it 
might well be considered to warrant closer scrutiny 
seeing that the scholars are not of ;ui age to 
form any opinion on the subject. The elementary 
schools are duly kept under observation, but private 
schools and secondary schools are regarded by the 
law as private houses, yet it is precisely in the ease 
of private or quasi-private institutions that effectual 
surveillance is most necessary. The time is probably 
not far distant when no buildings will be allowed to 
be used for school purposes until, after proper 
inspection, they have been admitted to registration, 


such registration comporting subsequent systematic 
supervision by the local sanitary authority. When this 
subject comes up it would be well to enact similar, 
or even more diastic, provisions in respect of 
private-adventure hospitals, which also presum¬ 
ably come under the heading of “houses." An 
Englishman’s house has long since ceased to be a 
castle as against the sanitary inspector, but even 
such mitigated rights as the householder may have 
preserved ought to be abrogated when he uses his 
house for other than private and residential pur¬ 
poses. It is obvious that special ’egislation is called 
for in the direction of completing and extending 
the powers at present possessed by sanitary authori¬ 
ties for the inspection of buildings for whatever 
purpose they may be used. How is the authority to 
become aware of the existence of unsanitary conditions 
unless every facility for inspection be afforded ? 
There are many things short of blood-boiling or soap¬ 
making that call for remedy, and the fact that 
nauseating emanations are not complained of by no 
means justifies the assumption that all is for the 
best from a sanitary point of view. 


4lotes on (Current topics. 

A Plea for All-Night Pharmacies. 

The large towns of Great Britain are singularly 
behind those of the Continent and especially of the 
United States in respect of the facilities available for 
procuring medicine at night. The medical practitioner, 
poor, man, has to comply with every request for 
assistance irrespective of the hour of day or night 
but when he has done his share of the work and has 
prescribed the appropriate remedies it may be next to 
impossible to get the prescription made up. We 
should be loth to add to the burdens of the followers 
of an already hard-worked and ill-paid calling, but 
one would have thought that the spirit of commercial 
enterprise would have prompted a certain number of 
pharmacists to cater for the night work. One or two 
attempts of the kind have been made in London, but 
they have, we believe, been abandoned in defer* 
ence to reasons of an extra-professional kind. Night 
work is, of course, not popular, and extra-remu- 
nerat’on would alone induce anyone to devote 
himself to this branch. Apart from this there 
appears to be a difficulty in exercising sufficient con¬ 
trol over the night operators, and this is prob¬ 
ably the most serious obstacle. Failing private 
enterprise we should, perhaps, be entitled to look 
to municipal authorities to provide the necessary 
facilities, the lack whereof may render nugatory the 
presence oF the doctor. We are aware that in many 
instances there is a resident assistant who is supposed 
to respond to night calls, but those who have had 
occasion to put this to the test of experience know 
to their cost how illusory this assumption is in point 
of fact. An instance is given by a correspondent 
who, armed with a presc. ration at 3 a.m., applied in 
vain at sixteen pharmacies. Such a state of things 


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122 The Medical Teesb. 


NOTES ON CURRENT TOPICS. 


constitutes a positive danger, and is little short of a 
scandal, and it is, moreover, a strong argument in 
favour of medical men retaining the dispensing of 
medicines in their own hands. 

Prevention of Unnecessary Noises. 

The inhabitants of cities and towns will read with 
interest the news that the proprietor of a certain 
noisy bird, to wit a cockerel, inhabiting the romantic 
shades of < v t. John’s Wood, has been fined for not 
having deferred to a warning request conveyed to him 
by three of his neighbours whose rest was disturbed 
by the animal aforesaid. Wo gather from the evi¬ 
dence that a cockerel is a male fowl, a fact of which 
we were ignorant, and which the dictionary did not 
assist us in discoveiing. Now anyone who has ever 
heard a cock crow at a distance of ltss than one 
hundred feet will agree that a rooster, to make use of 
an American equivalent, which begins to practise 
crowing at 3 a.m. is indeed an infliction not to be 
borne if any means are available of inhibiting 
the same. The magistrate appeared to apply 
the law with some reluctance, observing that the 
by-law was passed to meet the difficulty of a class 
of persons who, “ instead of deriving pleasure from 
the natural noises of animal life found these noises a 
source of exquisite torment and disquiet.” Does the 
worthy magistrate himself derive any pleasure from 
a cock-crow at 3 a.m. or even an hour or two later u 
Does he lie awake o’ nights savouring the long drawn- 
out sweetness of the amatory strains of feline marau¬ 
ders ? There are natural noises which are agreeable 
and others which are not so, but there are. indeed, 
few natural noises which are suave to the human ear 
in the early hours of the moniing. The wear and 
tear of life in great cities will be vastly lessened when 
all unnecessary noises are sternly repressed, and we 
thankfully accept this by-law as an instalment on 
account of further steps in the same direction. 

Medical Fees among Poor-law Medical 
Officers in Ireland. 

The misrepresentation, by the aid of uhiclr the 
Irish Local Government Board seeks to choke off the 
agitation for the reform of the dispensary ticket, has 
again been repeated in the Dublin papers by a “ J. P_ 
for two counties.” That misstatement is that the 
Poor-law medical officers of Ireland are prevented by 
professional etiquette, or some other cause, from 
accepting less than £1 a visit, or £1 for first visit. 
All we need say is that, if there be any such etiquette 
rule, it is almost universally disregarded, and there is 
not a district in Ireland in which difficulty would be 
experienced in obtaining medical relief at such 
reasonable fee as suits the patient’s capacity. We 
declare that the above statement is absolutely false, 
and we are astonished that the Local Government 
Board—whose inspectors must know that it is so— 
should use it as its excuse for resisting reform. 
Dispensary officers are not altogether fools. 
They know, as a rule, the financial calibre of every 
man in their district almost as well as he does him¬ 
self. They know that some are well able to pay £T 


Fbb. 1, 1899 . 

every visit, and others only £1 at first visit, and they 
are perfectly right to exact such fees from such per¬ 
sons, who, unfortunately, are very scarce in most dis¬ 
tricts. As for the other patients, is it likely that a 
dispensary doctor will drive them into the net of a 
rival practitioner, or force them to report to the 
‘‘ ticket ” by demanding an excessive fee ? In ninety 
cases out of every hundred he accepts ;is fee' any 
reasonable sum—even down to half a crown—which 
he knows the patient can pay, not what the patient 
says he can pay; a d in this way no deserv¬ 
ing pay case is ever left without medical attend¬ 
ance. But, in fact, this argument is entirely out¬ 
side the question. The Poor-law Medical Officers 
of Ireland have never objected to attend on ticket 
persons whom they consider unable to pay the full 
fee of £1. If any such officer is in such demand that 
it does not pay him to attend for le68 than that sum 
he can refuse to do so, but, in such case, he should 
not and does not complain of having to attend on 
“ ticket.” What he does complain of is that most of 
the patients whom he knows to be perfectly well able 
to pay many pounds are—through the corruption 
of the system maintained by the Local Government 
Board—enabled to obtain gratuitous attendance. 
We hope we have heard the last of the friction to 
which we referred. If it were ten times true it would 
not justify the scandalous abuses of the Irish Dis¬ 
pensary ticket system. 

Bath and its Fever Hospital. 

The sanitary administration of Bath is having a 
somewhat exciting time in consequence of the action 
of its able and energetic Medical Officer of Health. 
Dr. Symons, who has recently drawn attention to the 
management of the Fever Hospital. Of course, in a 
matter of this kind there is usually something to be 
said on both sides. The Bath Chronicle, however, 
says that something in a way that seems hardly 
worthy of a leading and responsible newspaper. Thus, 
m its issue of the 26th instant, it speaks of the 
“ traducers ” of the hospital. That is begging the 
question with a vengeance, and it says little for the 
candour of an editor who assumes an attitude cf that 
kind at the outset of criticism on a matter 
of public interest. The issue of Keene's Bath 
Journal, again, for the 21st ultimo contained 
an article on this same Statutory Hospital, 
in which the faulty state of the buildings was 
admitted. In discussing past work the following 
passage occurred:—“ The importance of the present 
system may be gathered from the fact that from 1882 
to 1894 no fewer than 1,734 patients were treated at 
the hospital, and out of this number there were only 
17 deaths.” That strikes one as a most favourable 
percentage, but on further inquiiy we find that lie- 
tween the yeare of 1884 and 1894 inclusive, there 
were not less that 71 deaths—a very different rate. 
Clearly, then, the citizens of Bath can hardly trust 
implicitly to the tone and accuracy of their journals 
in this matter. The Medical Officer of Health for the 
town, in the course of his plain and bounden duty, has 
passed various criticisms upon a public institution. 


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Fra. l, 1899. 


NOTES ON CURRENT TOPICS. 


Ths Mbdical Pr*S8 123 


to maintain the efficiency of which is one of the most 
important of his functions. An affair of this kind 
should be approached in a spirit of broad municipal 
progressiveness and not with the narrowness of the 
vestry partisan. Twenty years ago Bath ran up a 
number of huts in a panic when small-pox invaded 
the city. Those temporary buildings survive as the 
Statutory Hospital under the charge of a superin¬ 
tendent who, we learn, is a pluralist of a most 
exalted order. On general grounds we should say 
that it is unwise to appoint a sanitary inspector 
superintendent of a fever hospital. A staff of ten or 
thereabouts (the exact number is in dispute* hardly 
requires any supervision beyond that of the visiting 
medical officer. Why the latter is chosen from the 
local medical men to act as Dr. Symon's deputy is 
somewhat of a mystery. It is to be hoped that the 
whole facts of the case will be made public in some 
authoritative manner. 

Unionists and Non-Unionista. 

The medical profession may be broadly divided 
into unionists and non-unionists. Let us hasten to 
explain, in order to avert the wrath of those to whom 
trades' unionism is a thing accursed, that we speak 
of the members of the Medical Defence Union and 
kindred societies, and, on the other hand, of those who 
keep their half-guinea subscription in their foolish 
pockets, and fail to realise the concrete fact that in the 
Medical Union is strength. When one reflects upon 
the work of that body—and of its offshoots—it is a 
matter of never ceasing wonder that so much could 
have been accomplished within so comparatively 
short a period of time. During the last few years 
there has been a great diminution in the number of 
actions for malpraxis, and in blackmailing charges 
brought against medical men. What other conai- 
tion has come into existence to account for 
that happy change ? None that one can recall, 
save the birth and the strong and rapid growth of 
the defence societies. Where the busy practitioner 
was formerly exposed to the anxiety and cost of liti¬ 
gation which could not fail, whatever the issue, to do 
him damage both in purse and in reputation, he is 
now able to summon to his aid a powerful organisa¬ 
tion backed with unlimited money and special 
experience. That is to say, he may command that 
refuge if he be a member, and, although we speak in 
glowing terms of the increased roll of membership, 
yet it is well to note that a large majority of the pro¬ 
fession is still to be reckoned among the non- 
unionists. Let the coming generation see to it that 
every one cf them stands shoulder to shoulder with 
his brethren, at any rate in this elementary matter of 
insurance against blackmailing. 


During last year 5,920 persons committed suicide 
in the United States, 4,286 men and 1,634 women. 
This number includes 44 doctors. With respect to 
the quietus selected, 2,526 chose poison, 2,037 preferred 
firearms, 787 hanged themselves, 354 chose drowning, 
26 asphyxia, and 75 died as the result of self-inflicted 
stabe. 


The Municipalisation of London. 

The Government Bill for the municipalisation of 
London, which will be introduced early in the 
approaching session, deals with many matters of 
interest to the community generally, but there is one 
aspect of it which we may consider here, and that is 
the uses to which the various local municipalities 
might be put in furthering the interests of the hos¬ 
pitals within their districts. Under the Municipal 
Corporation Act each London hospital should be 
practically municipalised—that is to say, the local 
corporations should include within their duties the 
very important one of seeing that the local medica] 
charities are not allowed to suffer from lack of 
funds. It is impossible to doubt that were a local 
mayor to make the maintenance of the medical 
charities within his district a matter of prime con¬ 
cern during his term of office, immense good would 
result. The great drawback under which London 
hospitals suffer is that of the want of the organisa¬ 
tion of local support. If the local medical charities 
in the various districts in London were supported, as 
they should be, by the residents, there would be but 
little need for the three cosmopolitan funds whose 
awards, when made, cannot, for several reasons, 
be regarded as unmixed blessings. In re¬ 
flecting upon these matters one is at once 
reminded of the splendid manner with which 
the large medical charities in the provincial towns 
are maintained, among which may l>e mentioned the 
Royal Infirmary, Derby, the Leeds General Infir¬ 
mary, and the Royal Infirmary, Newcastle. In these 
and other examples the local esprit rfe corps which 
prevails in favour of the medical charities leaves 
nothing to be desired. At the same time, however, 
this no doubt is largely the result of efficient organi¬ 
zation, and, as such, it forms an instructive object- 
lesson to the residents in London who fail to do 
their part in the same direction. With the local 
London mayors, however, taking the lead in the 
organisation of the support of the London hospitals 
within their respective districts, the time should 
come when the financial position of many of these 
charities will cease to be a matter of deep concern. 
Th at which is accomplished so efficiently in the 
provinces, should not be a difficult matter in 
the metropolis, and we trust that the Munici¬ 
pal Corporation Act will be the means of ensur¬ 
ing that local support for London hospitals 
which is so essential in many ways to their well¬ 
being. 

The Turkish Government, in view of the approach¬ 
ing fetes, has sent police officers to all the druggists’ 
shops to seal up the packages of chlorate of potash, 
presumably with the object of checking the manu¬ 
facture of explosives. The Turkish anarchist must, 
however, be lacking in resource if the deprivation of 
chlorate of potash prevented his carrying out what¬ 
ever fell designs be may have conceived. In the 
matter of easily prepared explosives there is a posi¬ 
tive evi barras de riche see, and the puerility of this 
precaution is thereby rendered conspicuous. 


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124 The Medical Press. 


NOTES ON CURRENT TOPICS. Fkb. i, 1899. 


The Indian Medical Association. 

The fourth annual meeting of the Indian Medical 
Association was held in Calcutta on December 23rd 
hist, under the presidency of Dr. Lai Madhub 
Mookerjee. Rai Bahadur. The Association now 
numbers 1,151 practitioners of all grades, and is 
evidently flourishing. It was partly founded four 
years ago with the object of promoting necessary 
reforms, and of ameliorating existing grievances per¬ 
taining to the profession in India. The endeavours 
to obtain redress for the grievances of assistant 
surgeons and hospital assistants, both civil and 
military, have, we learn, so frr succeeded that the 
Government have promised to make considerable 
concessions in the direction demanded. But there 
remain many other reforms, some evidently vital, 
which the Association are pledged to advance. Men¬ 
tion may be made of a few of them. One burning 
question is that of Government surgeons monopolising 
private practice, which mainly concerns, we presume, 
the native practitioners; another is the existence of 
irresponsible and unauthorised diploma-granting 
societies in India—clearly a most important matter. 
Another is the necessity for uniformity in higher 
education and in medical diplomas. All these are 
closely concerned with the welfare of the profession 
itself, and their importance is such that it is difficult 
to see how the Government of India can avoid giving 
them their serious consideration. Again, the Asso. 
ciation has pointed out that there is no Act regulat¬ 
ing the sale of poisonous drugs, nor any system in 
vogue for State medical registration, and have urged 
the necessity of reform in both these particulars. 
Thus, judging from these evidences of official activity 
it is plain that the Indian Medical Association de¬ 
serves well of the profession in India. Its programme 
of reforms deals with matters afEecting the interests 
both of the profession as well as of the public, so 
much so that in this and other ways there appears to 
be a vast field of usefulness before it. 

Methylene Blue as a Kidney Test 

From a clinical point of view it is clearly a matter 
of importance for the medical attendant to be able to 
estimate the permeability of the kidney. For that 
purpose two agents have been mainly used, namely, 
iodide of potassium and methylene blue. The experi¬ 
ments of Bard and Bonnet show that permeability is 
greatly diminished in all stages of intestinal nephri 
tis, whereas, in the parenchymatous form of the 
affection it is usually normal. Curiously, in intersti¬ 
tial nephritis secondary to epithelial involvement 
it is said that the permeability is diminished to the 
iodide salt, but is normal or increased to the 
alternative test. The latter fact has a possible 
or probable bearing upon the good effects of 
methylene blue in the generalised malady, 
rheumatoid arthritis or, according to more modem 
nomenclature, chronic osteo-arthritis. The attention 
of the medical profession was, we believe, first drawn 
to this therapeutic procedure by Dr. J. R. Philpots, 
of Parkstone, whose original observation has Bince 
been borne out by many independent investigators. 


There is still room for research in the matter of 
kidney stimulation and prima facie it would seem not 
unreasonable to ascribe remedial virtues to an agent 
that is visibly excreted even in cases of advanced 
renal damage where iodide of potassium fails to effect 
a passage. .One explanation advanced is that the 
methylene blue acts as an organic or colloidal body 
and the other as a simple difEusible salt. That 
hypothesis, however, although good so far as it goes, 
nevertheless leaves a deal of the riddle unsolved. 


The Progress of Harrogate. 

This year Harrogate has the advantage of having 
a medical man as its mayor, and Dr. E. Solly who 
occupies that distinguished position has already 
proved the value of his appointment to the town. In 
1897 the corporation opened a magnificent suite of 
baths costing practically £120,000, but in order to 
make the equipment complete it was subsequently 
decided to send a deputation to visit most of the spas 
on the Continent, and especially the kursa&ls, with 
the particular object of obtaining hints so as to 
enable the town to provide more facilities than at 
present exist for entertaining the visitors. As the 
result of the report of this deputation, on which Dr. 
Solly was the medical representative, steps are now 
being taken to prepare a scheme for erecting a mag¬ 
nificent concert hall on the model of the Continental 
kursaals. There can be no question that the policy 
thus being pursued by the mayor and corporation of 
Harrogate deserves every commendation, inasmuch 
as it is only by enterprise of this nature that the 
English spas will be able to successfully compete 
with those on the Continent. 


Presentation to Mr. Alfred Cooper. 

Mr Alfred Cooper having reached the age limit 
according to the rules in force at St. Mark’s Hospital 
for Diseases of the Rectum (City Road, London), has 
just retired from the post of senior surgeon to that 
institution. His connection with the staff of the 
charity has been a long one, having continued with¬ 
out interruption for thirty-four years. Under the 
circumstances, therefore, it was natural enough 
that he was not allowed to sever his active 
work with the institution without some recog¬ 
nition. Accordingly, on January 25th, he was 
presented at the house of Mr. Swinford Edwards 
with a Chippendale clock and silver cigar - 
rette case, subscribed for by some members of the 
committee of the hospital, his colleagues, and old 
house surgeons. Upon the clock was a suitable in¬ 
scription in commemoration of the occasion. Mr. 
Edwards, in making the presentation, alluded to the 
immense amount of human suffering which Mr. 
Cooper must have relieved during his long term of 
office, and also pointed out how much of the financial 
prosperity of the hospital had been due to Mr. 
Cooper's influence He further stated that Mr. 
Cooper’s success and popularity were well known, the 
latter being largely due to his natural unselfishness, 
geniality, and sincere love for his fellow men. We 
understand that, in recognition of his services, it is 


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Feb. 1, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press. 125 


intended to appoint Mr. Cooper a consulting surgeon 
to the hospital. 

The Transposition of Corpses. 

From time to time the attention of the public is 
arrested by the gruesome tale of a confusion of corpses 
in the mortuary of some public institution. Now the 
report comes from the country and anon from the 
metropolis, but whatever its exact source the incident 
orops up every few months as surely as storm centres 
reach us from across the Atlantia or a labourer’s wife 
presents her long-suffering spouse with a threefold 
addition to his family. The latest affair of the kind 
hails from the Southampton Workhouse, where two 
bodies of dead inmates were awaiting burial. The 
friends of one of the deceased, who lived in London, 
expressed their wish to have their relatives 
buried near their home, and 6ent the money to 
cover the necessary expenses. The workhouse 
officials thereupon promptly despatched to Lon¬ 
don a coffin containing the wrong body, 
which was duly returned to them and the right 
corpse ultimately forwarded. All this points to a 
lack of the first simple principles of organisation 
and reflects most unfavourably on the institution 
where it is possible for Buch a scandalous mistake to 
be made. Is such a point as the management of the 
Poor-law mortuary, we wonder, beneath the notice 
of the all-knowing Local Government Board in¬ 
spector ? Arguing upon general grounds we may be 
tolerably certain that only a small proportion of such 
cases come to light. What becomes of the others ? 
Tet when a person like Mrs. Druce brings forward 
good prima facie evidence of the possibility of a 
fraudulent burial, the law of Great Britain permits a 
thousand delays to be interposed, and the plain com¬ 
mon-sense of opening the grave and seeing what is 
inside the coffin is adjourned sine die for months, or, 
perhaps, for yt ara, to the great profit of the legal pro¬ 
fession. 

Small-Pox and Breach of Promise. 

An interesting point was raised recently in the 
defence of an action for breach of promise of marriage 
brought against a miller's son in the Chelmsford 
Court. The defendant's mother, it appears, objected 
strongly to the proposed marriage, chiefly on the 
ground that the plaintiff had been rendered a 
4 ‘ fright ” by the ravages of small-pox. The con¬ 
sideration thus urged, however, failed to convince the 
jury, and a verdict of £25 damages was entered for 
the lady. In former days, when the disease men¬ 
tioned was as common as diphtheria or measles 
nowadays, almost every other person one met in the 
streets was more or less deeply scarred and pitted 
■with small-pox. Not a few instances are on record 
in which the disfigurement of the lady between 
the time of betrothal and that of marriage suggested 
grounds for the severance of the proposed contract. 
Whatever be the higher aspects of the case, there 
can be no doubt that there would be a fierce tempta¬ 
tion to retire from the position for any but a man of 
the strongest moral calibre, if suddenly required to 


marry a woman whose face had been transfigured 
from its former beauty into hideous repulsiveness. 
Thanks to Jenner and vaccination, this terrible 
human tragedy has in this generation disappeared 
However, now that the “ strongest Government of 
modern times ” has seen fit to do away with com¬ 
pulsory vaccination, it is quite possible that not a 
few of the present generation of medical practitioners 
will live to see many a fair woman in similar plight, 
on account of her marred beauty and ruined 
marriage prospects. 

Lunatio Attendants and Corporal Punish¬ 
ment. 

Op late, lunatic attendants have been unpleasantly 
in evidence as the administrators of unlawful punish” 
ment to the patients under their charge. A few 
weeks since a private asylum nurse was convicted in 
a London police-court for caning two of her charges. 
In the course of last week a ward attendant was fined 
40s. for striking in the face a patient at the Peckham 
House Lunatic Asylum. With regard to this offence 
it may he remarked generally that in view of the 
modern humane spirit of lunatic treatment the resort 
to violence is an unjustifiable abomination, calculated 
to destroy all attempts in a curative direction. The 
life of an attendant upon insane patients is 
admittedly of a most trying nature, and one that 
demands the most perfect control of temper combined 
with tact and experience. For all that, it seems 
that the average attendant drifts into his posi¬ 
tion as does the average policeman. Both are 
turned loose into responsible positions without pre¬ 
vious instruction, and left to pick up the necessary 
training knowledge according to their lights. During 
recent years it is true that a very commendable move¬ 
ment has been afoot to bring up the level of asylum 
nursing to modern standards, but a great deal yet 
remains to be done, especially in Poor-law institu¬ 
tions. Under any circumstances it would be well for 
all who undertake responsible duties as lunatio 
attendants to realise once and for all that under no 
circumstances are they justified in striking a patient. 
Otherwise they may find themselves in the uncom¬ 
fortable predicament of the two defendants in the 
above-mentioned prosecution—not only damaged in 
pocket, but also cut adrift from their calling. 

Medical Union. 

The prevalence of abuses in guise of medical chari¬ 
ties and the present unsatisfactory financial situation 
of a large proportion of medical practitioners 
throughout the country are unquestionably due to 
the unfettered competition which characterises the 
struggle for existence within the pale of the profes¬ 
sion. No progress can possibly be accomplished 
until medical men consent to forego petty rivalries, 
and join hands to impose reasonable conditions of 
remuneration. We note with pleasure here and there 
signs of a disposition to fall into line, of which the 
formation of a Medical Union among the medical 
practitioners of the County of Durham is 
an instance. The object of this Union is 


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126 The Medical Press 


NOTES ON CURRENT TOPICS. 


F»b. 1, 1899. 


to constitute an association for the purpose 
of considering all medico-ethical questions affect¬ 
ing the profession in the county and, in particular, 
to raise the contract price of sixpence per fortnight, 
which is the present usual contract rate between 
workmen patients and doctors in that part of England, 
to a minimum charge of ninepence per fortnight* 
We have been favoured with a copy of the rules 
which, though few in number, may well serve as a 
model for other similar combinations throughout the 
country. The new Union has our hearty sympathy, 
and this we shall be pleased to extend to all attempts 
to bring about that homogeneity of the profession 
without which no far-reaching improvement in 
material and social conditions is possible. 

Before the Days of Jenner. 

It is, of course, an impossible task to convince the 
anti-vaccinationist party of the error of their opinions, 
not even when appeal is made, as these faddists are 
always so fond of doing, to statistics. Still it is expedient 
that they should be, aB often as possible, reminded of 
their folly. In this connection an interesting commu¬ 
nication recently appeared in a morning newspaper 
respecting the various causes of death in a Yorkshire 
village one hundred and twenty years ago. From 
April 1777, as the parish Register showed, to April 
1778,122 burials took place, and the causes of death 
were as follows:—Apoplexy 1, dropsy 1,mortification 
1, colic 1, Budden death 2, cancer 2, infants 5, con¬ 
sumption 9, old age (from 71-92) 12, fever 13, small¬ 
pox 55 (from the ages of 1-29). Thus in one year, no 
fewer than 45 per cent, of the deaths in this village 
alone weiedue to variola. For comparison’s sake the 
author of these figures might, with advantage, make 
a further search of the parish Register, and publish 
the figures of recent years so far as they relate to the 
prevalence of small-pox. 

Nicholson’s Ear Drums. 

The Newspaper Owner issues to the press a warn¬ 
ing not to accept orders for the publication of the 
advertisements emanating from the person who calls 
himself Nicholson, unless they receive cash in 
advance. Our contemporary gives a roll of no less 
than fourteen aliases under which this person figures 
at different addresses from which he issues liberal 
advertising orders, but never—by any chance—pays 
if credit be given. One of these aliases was “ the 
Medical Press,” which, however, he had to abandon 
when we threatened him with prosecution. 


The Awards of the Prince of Wales’s Fund. 

A fortnight ago the editor of the Hospital replied 
to our remarks concerning the imperfections of the 
awards by the Prince of Wales's Hospital Fund, and 
he congratulates himself upon the fact that the di s 
tribution must have given general satisfaction, 
because the criticisms have been so few. In answer 
to this, it can only be said that he has probably found 
his way into that paradise which is not particularly 
associated with the presence of wise men. However, 


his statements are for the most part too quibbling 
and puerile to call for serious criticism, and to adduce 
further arguments in support of our criticisms would 
be wearisome to our readers. Nevertheless in pass¬ 
ing, we may remark that the matter has been claim¬ 
ing some attention in the lay press, and especially in 
the Daily News, as will be seen from a letter which 
we publish in our correspondence column. Whoever 
“ Hospital Secretary ” may be, it is evident that he 
is more than a match for the great Pandandrum 
of the hospital world. 

Venereal Diseases in India. 

A general order issued by the Commander-in- 
Ohief in India provides for (1) the medical inspection 
of British soldiers serving in India for the purpose of 
detecting and checking the spread of contagious 
disease, and (2) for the enforcement of punishment 
for concealment of such disease. The inspection 
will be made from time to time without warning, 
groups of men being examined in whose case there is 
reasonable ground for suspecting that they are suffer¬ 
ing from disease. The section of the Army Act pro¬ 
viding for the punishment of men who attempt con¬ 
cealment is to be rigidly enforced. 


Mortality of Russian Troops at Port Arthur 

There is now little room for doubt that the mor 
tality among the Russian troops at Port Arthur is of 
a very serious nature. The cause is said to be the 
impurity of the drinking water, but a medical Com¬ 
mission has been appointed to make a special investi¬ 
gation into all the circumstances of the case. The 
high death-rate has been maintained since November 
last. 


Dr. F. J. Waldo, Medical Officer of Health for 
the Temple and St. George’s, Southwark, has been 
appointed to the Milroy Lectureship for 1900 by the 
Royal College of Physicians of London. The subject 
selected is “ Summer Diarrhoea, with Special Relation 
to Causation and Prevention.” 


The President and Vice-Presidents of the Royal 
College of Surgeons of England will entertain the 
Lord Chief Justice (Lord Russell of Killowen) at 
dinner on Tuesday, February 14th. 

Dr. Waldo, Medical Officer of Health for St. 
George’s, Southwark, has stated that about one in every 
14 of the population of his district is born, brought 
up, lives, and dies within the four walls of a one-room 
tenement. 

Dr. Vallance, Medical Officer to the West Ham 
Union, on Monday last, obtained a verdict with £150 
damages against a meat salesman for slander. 

In the parish of Darrington, on Salisbury Plain, 
consisting of nearly four hundred inhabitants, no 
death occurred during last year. 


Db. Bbidgwatkb has resigned the chairmanship of 


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Feb. 1, 1899. 

the Medical Chaiities Committee of the British Medical 
Ass ociation. _ ■ - _ 

Mb. William Tatlob, F.R.C.S.I., has been appointed 
Visiting Surgeon to Cork Street Fever Hospital, Dublin, 
in room of Prof. Wm. Stoker, F.R.C.S.I., whose term of 
office expires on the 31tt proximo. 

Mb. F. T. Hkuston, F.R.C.S.I., President-elect of the 
Dublin branch of the British Medical Association, wil] 
deliver an address at the annual meeting of the branch 
on February 6th, entitled “ The Position of the Poor- 
law Medical Officers in Ireland.” 

Colonel Rooney, F.R.C S.I., Commander Royal Army 
Medical Corps, Scotland; Captain D. Hepburn, and 
Captain W. Bash ford, of the Edinburgh Company of the 
Volunteer Medical Staff Corps, have each received from 
the Royal Red Cross National Society of Spain a diploma 
in recognition of services rendered to the Society. 


(Eorrteptmfience 

We do not hold ourselves responsible for the opinions of our 
correspondent*. 

THE PRINCE OF WALES’S HOSPITAL FUND. 

To the Editor of The Medical Pbess and Cibculab. 

Sib, —Those of your readers who have followed the 
incidents associated with the distribution of this Fund 
cannot but be interested in the correspondence which 
has recently occupied the columns of the Daily News and 
Daily Chronicle, in which ‘‘A Hospital Secretary” 
has complained of the inadequate grants to various 
hospitals loaded with an undertaking to open further 
beds as well as to others, on condition of effecting struc¬ 
tural and other alterations, which would more than 
absorb the amount of the awards. 

Another writer, bearing the same signature but 
apparently a different correspondent, has, in the Charity 
Record, taken much the same line as you have, viz , that 
exceptionally handsome grants have been given to hos¬ 
pitals already, although possibly insufficiently, endowed, 
while many small hospitals have been altogether 
excluded. 

Comment has further been made on the great parti¬ 
ality shown in the grants to hospitals, even of the same 
class and claims, as, for instance, the awarding £1,000 
to one Chest Hospital, while another, which receives 
an equal grant from the Metropolitan Hospital Sunday 
Fund, is awarded only £100 from the Prince of Wales s. 

The incident which has led to the closure of the 
discussion in the above-mentioned journals is charac¬ 
teristic of the unfairness of those responsible for 
the administration of this Fund. The sub-Editor 
of “ Burdett’s Hospitals and Charities,” writing to 
the Daily News, accused ‘‘A Hospital Secretary” 
of a mis - statement of fact in saying that the 
figures supporting his argument were derived from 
the columns of that publication. This accusation 
was repeated in The Hospital of last week. 
“ A Hospital Secretary ’ answered this apparently 
damaging charge by stating that he had arrived .it his 
figures by simply multiplying the tables given in 
“ Burdett’s Hospitals and Charities ” which show the cost 
per day by the number of days in the year. But 
beyond this, as a matter of fact, the cost per annum 
is also to be found in other parts of this publication, 
and are found to be really in excess of that calculated by 
“ A Hospital Secretary. ’ 

The current number of The Hospital allows the accu¬ 
sation to go by default, for not only is there no with¬ 
drawal of the charge, but the matter is not further 
mentioned, nor has there appeared any acknowledgment 
of the error in the paper in which the accusation first 
appeared. 

I am Sir, yours truly, 

A Hospital Subgeon. 


The Mbdical Pre88. 127 

UNCHRISTIAN CHARITY.” 

To the Editor of The Medical Pbess and Cibculab. 

Sib, —My attention has been drawn to the leading 
article in your issue of January 11th, entitled 
“ Unchristian Charity.” While entirely agreeing with 
the views you have put forward, yet in the spirit of fair 
play and justic», I must take exception to one statement, 
which, if allowed to go unchallenged, might reflect 
injuriously on the charitable institutions of Dublin. I 
find the following statement in reference to unmarried 
women who are pregnant, “ In some lying-in hospitals 
they are altogether placed under a ban, and even the 
more liberal only concede accommodation at a first confine¬ 
ment.” In Dublin we have three well managed lying- 
in hospitals, and I believe I am right when I state that 
no such exclusion is practised. Of one of them—the 
Coombe—I can speak with authority, and in this case the 
only recommendation required to gain admission day or 
night is the f«ct of the applicant “ being in labour.” 

I am, Sir, yours truly, 

Fbed. Wm. Kidd. 

17 Lower Fitzwilliam Street, Dublin, 

January 23rd, 1899. 


(Dbituarn. 

SIR JOHN NUGENT, M.B., T.C.D. 

The death is announced, at the great age of 94, of Sir 
John Nugent, who for nearly half a century held, prac¬ 
tically, complete control of the Irish Lunacy Service. 
He received his appointment, as Inspector of Asylums, 
about the year 1845, having been forced upon the Govern¬ 
ment—which desired to give the place to another—by 
Dan O’Connell, then in the zenith of his power, whose 
body-physician Nugent then was. At that time, and 
until quite recently, the two inspectors were, in fact, the 
Irish Lunacy Department, and the “ Board of Control,” the 
Castle supervision exercising only nominal restrictions 
on their action. Nugent was a very remarkable man. 
Full of brains, with the determination and per¬ 
sistence of a bull-dog, he was a thorough auto¬ 
crat, and not being throughout life at all par¬ 
ticular about the means he adopted to carry his 
ends, he, within a short period after his appointment 
as inspector, swept out of his way everyone in the 
department who seemed likely to have a will of his own, 
and made himself, practically, the dictator. Thus he 
became known as one of the two “ Kings of Brentford ” 
in Ireland, the other being Sir Alfred Power, who had 
established himself in the same regal authority on the 
Irish Local Government Board. Needless to say that 
the exercise of this domination produced many conflicts 
with the Boards of Governors and resident physicians of 
asylums. On one occasion he tried to snub the Limerick 
Board, forgetting that among its members was the Hon. 
Spring Rice, afterwards Lord Montague, who was in 
close official relation with the Government, and who at 
once resigned his governorship and was followed 
by many of the leading members, and in the end 
Nugent sustained a h*avy fall. On another occasion 
his removal from office was nearly brought about 
by his using the cloak of his authority to protect an in¬ 
competent and negligent President-Superintendent, who 
had permitted one of the Asylum inmates to be drowned 
in a bath by two of the attendants. Upon the represen¬ 
tation of some of the Governors, the sham investigation 
held by Nugent was reopened, the President was dis¬ 
missed, the attendants were criminally prosecuted, and 
Nugent barely escaped dismissal. To the last his courage 
never deserted him When, at a great age, it was sug¬ 
gested to him that he should go out on a pension, he 
absolutely refused to move unless he got his full salary, 
and, being fortified by the uncertainty of the law, held 
on unguis et dentibus until the Treasury gave in. 

8ir John Nugent was a man to be feared and admired 
for his extraordinary individuality. He was a brilliant 
conversationalist, and a pleasant man to meet at dinner. 

As to his other characteristics, there are many past 


OBITUARY. 


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128 The Medical Press. 


LITERATURE. 


Fib. 1, 1899. 


officers of the Lunacy Department in Ireland who could 
say a great deal which we are not disposed to say. At 
the time of his death, Sir John Nugent was staying at 
the St. George’s Club, London, under the care of Dr. 
Mapother. _ 

PROF. COATS, M.D., OF GLASGOW. 

The death of this distinguished pathologist, although 
in the prime of life, was not unexpected, but Glasgow 
mourns her loss nevertheless with unfeigned regret. 
Our columns previously chronicled the fact that about 
a year ago Dr. Coats was compelled on account of a 
dangerous illness to relinquish his Chair of Pathology 
for a time for residence abroad. He subsequently took 
a voyage round the world, but the malignant internal 
disease continued to make progress, and although he 
resumed for a time his post of Professor in the Univer¬ 
sity, a few weeks since this had to be finally given up, 
and death came to release him after intense suffering on 
Wednesday last From the time he took his M D. 
degree, in 1870, he was engaged in the work of teaching, 
and was for a nnmber of years pathologist to the Glasgow 
Royal Infirmary. On the completion of the Western 
Infirmary he was appointed pathologist in that insti¬ 
tution, his lectures being recognised by the University 
authorities and by the Faculty. In the year 1890 he 
became Lecturer on Pathology in the University, and 
three years later a Chair of Pathology was founded in 
Glasgow University, to which with unanimous consent of 
the Senate, and to the special satisfaction of the mem¬ 
bers of the Faculty, Dr. Coats was appointed its first 
occupant. As a teacher Professor Coats was earnest and 
painstaking ; he was held in the highest esteem by the 
long succession of students who passed through his 
classes, and it may be truthfully averred that few Scotch 
students of the last decade did not take his “ Manual of 
Pathology ” as their guide on the subject. He was a 
frequent contributor to the medical journals, and was for 
some time editor of the Glasgow Medical Journal. He 
died at the early age of fifty-two, regretted by a wide 
cirole of friends. 


ICitemture. 


GANT’S GUIDE TO THE EXAMINATIONS BY 
THE CONJOINT BOARD, (a) 

The seventh edition of our old friend “ Gant’s Guide 
to Examinations,” duly brought up to date by Dr. 
Willmott Evans, will, doubtless, continue to stimulate 
the anxious curiosity of students who covet the diploma 
of the Conjoint Board of England. An honourable and 
successful career extending over upwards of sixty years 
is a great tribute to the author’s sense of fitness, and 
really no student can well afford to be without his guide 
to the Examinations. Extensive changes have been 
introduced into the curricula since the last edition, but 
the size of the book appears not to have been increased 
pari passu with the extension of the period of study. 
This result has been attained by the omission of many 
of the older Examination papers, which would not assist 
the student in preparing for the present examinations. 
The book is at once a handy guide and a friendly 
adviser, and we can imagine no better means of furbish¬ 
ing up one’s knowledge on the eve of an examination 
than by carefully running over the appropriate chapters. 
Dr. Evans’s share of the work leaves nothing to be 
desired. 


TOBIN’S SYNOPSIS OF SURGERY. (6) 

This Bmall book is marvel of cheapness and excellence 
from the publisher’s point of view. It is printed partly 
in new and partly in old type, on gilt-edged paper, and 
is interleaved so as to permit of complementary notes, 
while the binding is in limp morocco. In spite of all this 

(а) “ Gant’s Guide to the Examinations by the Conjoint Board 
in England and for the Diploma of F.R.C.S.,” with Examination 
Papers. 8eventh edition. Price 5s. Revised throughout by W. H. 
Evans, M.D., B.8., B.Sc.Lond., F.R.C.8. London: Bailliere, 
Tindall, ind Cox. 1899. Price 5s. 

(б) “ A Synopsis of 8urgery ” By R. F. Tobin, F.B.C.S.I, Lon¬ 
don : J. and A. Churchill, Price 6s, 6d, 


luxury it only costs six shillings and sixpence. Having 
said this much for the publisher it may not be out of 
place to discuss the merits of the text. This virtually 
consists of a synopsis of the author’s lectures, being in 
fact the headings used by him for his clinical demonstra¬ 
tions. There is a preface, followed by fifteen pages of 
introductory remarks which seem rather out of place in a 
cram-book. The notes are fairly comprehensive, and 
though not always “ up to date ” are sufficiently complete 
for general purposes. We note the absence of familiar 
terms such as coxalgia, coxa vara, and the like, and the 
author uses tubercular and tuberculous as exchangeable 
terms, though the latter is the appropriate one when 
speaking of tuberculosis. Mention is made of a disease 
called “ rhino-scleroma,” but no reference to it is con¬ 
tained in the index, though as it is unknown outside 
Austria this is no great loss. Hydrophobia again is 
indexed as “ rabies ” and on a wrong page. In the brief 
remarks on actinomycosis no mention is made of the 
specific, iodide of potassium. We might point out many 
other like omissions, but as the hook is interleaved the 
student can fill up any lapsus as he goes along. 


RIDEAL’S “ DISINFECTION AND DISIN¬ 
FECTANTS.” (o) 

This work deals with the difficult subject of disinfec* 
tion with a completeness never before attempted, and 
will be especially valuable to those on whom the 
responsibility falls of purchasing large quantities of 
disinfectants for the use of public bodies, who up to now 
have been practically without any work from which they 
could obtain information on the ever-increasing multi¬ 
tude of substances that are offered for sale as disin¬ 
fectants, some of them possessing a very slender title to 
the claims made for them. 

The book is divided into fifteen chapters and sundry 
appendices. The first chapter is introductory, the second 
deals with mechanical disinfection, then follows disinfec¬ 
tion by heat, chemical disinfection, two chapters each 
being assigned to the non-metallic compounds and 
metallic salts. The various organic substances are dealt 
with in the four following chapters. After this the 
practical applications of disinfectants are ably set forth. 
Chapter XIII. is devoted to disinfection as applied to the 
body, and to the consideration of food preservatives. 

Legal statutes and regulations are discussed in 
Chapter XIV., and the last chapter is occupied with the 
methods best suited for the valuation of disinfectant*. 
It is this chapter that we should wish to see amplified, 
because the author's experience is such that his observa¬ 
tions would have great weight, and be of practical value 
to many who have attempted experimental estimations 
of this nature. Many accounts of experiments as to the 
relative value of the best known disinfectants have been 
inserted, and the author has exercised a careful discrim¬ 
ination in including only such as are trustworthy. As 
a reference work on disinfection the book is unique, and 
should be in the library of every sanitarian. 


DIBDIN’S PURIFICATION OF SEWAGE AND 
WATER, (i) 

This work must be reckoned as one of the greatest 
practical importance to all engaged in the disposal of 
sewage. It is undoubtedly due to the efforts of the 
author that the old and erroneous notions of sewage 
disposal are being discarded and commonsense methods 
adopted in their stead. In this second edition now 
before us, Mr. Dibdin has corrected certain minor errors 
inseparable from a first edition, and has added much 
useful information as to the interpretation of analytical 
results in sewage analysis, more particularly in the case 
of certain variations in the amount of saline and albu- 
menoid ammonia found in a particular sewage by 
different observers. The chief novelty in the book is, 
however, a number of figures relating to the effects pro¬ 
duced by the application of the bacterial system of 

(a) " Disinfection and Disinfectants.” By Samuel Rideal, 
D.*c. (London), F.I.C., &c. Second edition. Price 12s. 6d. 
London: The Sanitary Publishing Company, Limited. 

(b) "The Purification of Sewage and Water.” By W. J. 
Dibdin, F.I.O., F.C.8.. Ac. Second edition, revised and enlarged. 
Price 21s. London: The Sanitary Publishing Company, Limited. 


Digitized by CjOO^Ic 


Fxb. 1. 1899. 


MEDICAL NEWS. 


The Medical Pbkss. 129 


sewage treatment to sewages of widely differing 
characters, some being of a purely domestic nature, while 
others contained trade effluents of almost every conceiv¬ 
able description. So good is this information that it is 
alone sufficient to induce all who possess a copy of the 
first edition to invest in a'copy of the present one. 

There is but one point on which we should like to 
have seen a clearer expression of opinion by Mr. Dibdin, 
because from his unique experience he is highly qualified 
to take a correct view of the whole aspect of the problem. 
The point we refer to is, how far can anything in the 
nature of standards of purification come into practical 
use ; or, putting the question in another form, what is 
the percentage degree of purification that a successful 
process should effect ? It may be that no definite answer 
can at present be given to these vital questions, but it is 
to be hoped that in the near future a direct answer may 
be formulated. 


THE SOUTH AFRICAN CLIMATE, (a) 

The book commences with a letter from Mr. Cecil J- 
Rhodes—the great Empire builder, who has given his 
name to so much of the Continent. He tells us that he 
induced the De Beers Company to spend £20,000 in 
erecting a sanatorium near Kimberley, and he mentions 
that “ Our Plateau has the advantage over St. Moritz 
and other places on the Continent (of Europe) of having 
a dry warm climate, free from mist and cloud; and, in 
addition, you are not exposed to the chills which natur¬ 
ally occur in the shade at similar altitudes in Europe.” 

The book consists of fifty- eight pages of letterpress 
and an appendix of about one hundred and fifty pages. 
The appendix is the essential part of the book, ana is 
made up of a series of eleven articles contributed by a 
corresponding number of medical writers, whose names 
are attached to their contributions. 

We think Dr. W. C. Scholtz would be more fittingly 
described as the editor of the book; for his share in the 
authorship is not easily recognised. The book is, how¬ 
ever, a useful addition to our knowledge of South Africa 
as a health resort. 




Royal College of 8urg«ons of England—Lec'.ure 
Arrangements. 

An announcement will be found in our advertisement 
columns of the forthcoming lectures to be delivered at the 
college between now and Easter. Professor Leonard Hill 
will commence a course of three lectures on “ Researches 
on the Influence of Gravity on the Circulation ” on Feb. 
6th. Dr. T. G. Brodie will deliver three lectures on 
“ The Chemical Pathology of Some Infective Diseases,” 
commencing on Monday, Feb. 20th Mr. B. G. A. Moy- 
niham will deliver three lectures on “ The Anatomy and 
Surgery of the Peritoneal Fossa?,” commencing on 
Monday, Feb. 27th. Professor F. G. Parsons will deliver 
three lectures on “ Joints of Mammals, contrasted with 
those of Man,” commencing on Monday, March 6th. 
And Professor Charles Stewart will deliver six lectures 
on “ Alternation of Generation and Recent Additions to 
the Museum,” commencing on Monday, March 16th. 
The lectures will be delivered at 5 o'clock p.m. each day. 
Fellows and members of the College are invited to 
attend; other members of the profession will be admitted 
free on presenting their private visiting cards. 

Vital Statistics. 

The deaths registered last week in thirty-three great 
towns of England and Wales corresponded to an annual 
rate of 18 2 per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of the year 1898. 

fa) “The Poufh African Climate, including Climatology and 
Balneology, and Discussing the Advantages, Peculiarities, and 
Capabilities of the Country and Health Resorts, more Particularly 
with Reference to Affections of the''host. ” By William C 8choltz, 
M.D.Bdiu., of Capa Town, London: Oassell and Company, 
Limited. 1898. 


Birkenhead 16, Birmingham 18, Blackburn 20, Bolton 1 
21, Bradford 19, Brighton 17, Bristol 18, Burnley 13,- 
Cardiff 16, Croydon 15, Derby 13, Dublin 28, Edin¬ 
burgh 20, Glasgow 22, Gateshead 23, Halifax 22, Hud¬ 
dersfield 17, Hull 20, Leeds 16, Leicester 14, Liverpool 21,- 
London 17, Manchester 21, Newcastle-on-Tyne 19, Nor¬ 
wich 21, Nottingham 19, Oldham 15, Plymouth 16, 
Portsmouth 17, Preston 22, Salford 16, Sheffield 18, 
Sunderland 21, Swansea 26, West Ham 15, Wolver¬ 
hampton 20. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were:—From measles, 2‘2 in Nottingham and 2'4 in 
Gateshead; from whooping-cough, if in Nottingham, 
and 1'8 in Birkenhead; and from “fever,” 13 in 
Bolton and in Preston, and 1'8 in Burnley. In none 
of the large towns did the death-rate from scarlet 
fever or from diarrhoea reach 10 per 1,000. The 72 
deaths from diphtheria included 30 in London, 5 in 
Liverpool, 4 in West Ham, 4 in Portsmouth, 4 in 
Leicester, 4 in Sheffield, 3 in Birmingham, and 3 in 
Leeds. No death from small-pox was registered in any 
part of the United Kingdom. 

Tribute to a Medical Editor. 

The Board of Trustees of the American Medical Asso¬ 
ciation recently passed the following resolutions on the 
death of the editor of their Journal ; —Whereas, in the 
wisdom of Divine Providence our worthy secretary and 
editor. Dr. John B. Hamilton, a loyal friend, a devout 
Christian, a great man, has in the prime of his manhood 
been called from his earthly labours to eternal rest, 
therefore, be it resolved, That the trustees of the Ameri¬ 
can Medical Association desire to express their deep 
appreciation of a faithful servant, one whose untiring 
energies in the interests of their Journal have received 
the recognition of the medical profession of the world. 
Resolved, That while his business capacity has been 
exemplified in all the undertakings of his life, and suc¬ 
cess had crowned hi6 every effort, notably as a sanitarian, 
a surgeon, and a surgical teacher, yet, above all, the 
position to which the Journal of the American Medical 
Association has attained through his efforts marked him 
as being possessed of superior executive ability and rare 
editorial genius. 

“ Why weep for him ? For him the angels came ; 

Ere yet his eye with age grew dim, or bent the stalwart frame; 

His weapons still were bright, his shield was lifted high 

To slay the wrong, to save the right—what happier time to die ? ” 
E. E. Montgomery ) 

Joseph Eastman > Committee. 

H. L. E. Johnston ) 

The Mortality of Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations :—Calcutta 29, Bombay 54, Madras —, Paris 
19, Brussels 18, Amsterdam 18, Rotterdam 17, The Hague 
18, Copenhagen 19, Stockholm 20, Christiana 18, St. 
Petersburg 30, Moscow 28, Berlin 16, Hamburg 17, 
Dresden 19, Breslau 24, Munich —, Vienna 21. Prague 
28, Buda Pesth 24 Trieste 33, Rome 22, Turin (10 days) 
—, Venice —, Cairo —, Alexandria —, New York (in¬ 
cluding Brooklyn 23, Philadelphia 27. 

West London Medlco-Ohlrurgical Society. 

At the meeting of this Society next Friday, February 
3rd, there will b« a discussion on “The Treatment— 
Medical and Surgical --of Acute Inflammation of the 
Vermiform Appendix.” The annual dinner of the Society' 
will he held on Wednesday, February 8th, at the Troca- 
dero Restaurant, Piccadilly, at 7 for 7.30 p.m. The Pre¬ 
sident, Dr. S. D. Clippindale, will preside. Prof. William 
Osier, F.R.S., of Baltimore, who has accepted the Caven¬ 
dish Lecture-hip for 185)9, who would have been the 
chief guest at the annual dinner, will be unable to be 
present. 

At a meeting of the trustees of the John Lucas 
Walker Studentship in Pathology, held on January 27th, 
1899, W. Myers M.A.M.B, B.C.Cantab., B.Sc Lond., was 
elected 8enior Student, and E. Sydney St. B. Sladen, 
M A., M.D.Cantab., was elected Junior S udent. Dr. 
Myers is working under Professor Ziegler at Freiburg ; 
Dr. Slad-m is working at the Cambridge Laboratory. 


Digitized by CjOOQI^ 


130 The Mbdical Press. 


NOTICES TO CORRESPONDENTS. 


Feb. 1, 1899. 


4 totia 0 to 

CH or respondents, Short fetters, 


ttT Correspondents requiring a reply in this column are par' 
ticularly requested to make use of a distinctive signature or 
initials, and avoid the practice of signing themselves " Reader,” 

‘Subscriber,” "Old Subscriber,” Ac. Much confusion will be 
■pared by attention to this rule. 

WANTED, THE CONSIGNOR. 

Messrs. Burroughs, Wkllcome and Co. inform ns that they 
recently received from Sydney a large packet of herbs which was 
put on board the “Thermopylae.” No advice was received in 
reference to it, and it W not known from whom t he parcel came. 
An attempt ha been made to identify the plants, but it has not 
proved successful. It is probable that they were dispatched to 
them for identification and investigation by a medical man or 
chemist who intended to write at the same time, but failed to do 
so. Should this meet the eye of the consignor he is requested to 
communicate with them. 

D. P. H.- The I.ocal Government Board have intimated that 
they have no intention at pre.-ent of favouring the suggestion to 
make tuberculosis a notifiable di-ease. 

AN UP-TO-oATE CONSCIENTIOUS OBJECTOR. 

There were several applicants to Mr. Plowden, at Maylebone 
Police Court last week, for certificates of exemption from vaccina¬ 
tion. One applicant gave as his reason for objecting to the opera¬ 
tion that if small pox was to come it would come; vacciuation 
would neither stop it coming nor diminish the risk, and the intro¬ 
duction of the “ animal lump ” into the child’s system would do no 
good. 

Mr. Plowden: Animal what ? 

Applicant: Animal lump - 1-u-m-p h. (Great laughter.) 

Mr, Plowden: Afterthat i really think I must refer you back 
to a little more extensive reading. v o lumps whatever are intro¬ 
duced. You talk of the child aa if it were a pudding. (Laughter.) 
—Daily Neics. 


Jftutings of thr §odettes aitb JCedurco. 

Wednbsday, February 1st. 

Obstetrical Society of London.—8 p.m. Specimens will be 
shown by Dr. J. Phillips, Dr. Cullingworth, Dr. Des Vccux, and 
others. Annual Meetitg. Dr. Cullingworth (president): Annual 
Address. 

Thursday, February 2nd. 

Harveian Society of London (Stafford Rooms, Titchborne 
Street, Kdgware Road.)—8.30 p.m. Clinical Evening. 

Neurological Society of London U1 Chandos Street, W.).— 
8.30 p.m. Annual General Meeting. Dr. W. H. Gaskell: The 
meaning of the Cianial Nerves. (President-elect’s Inaugural 
Address.) 

Friday, February 3rd. 

West London Mbdico-Chirurgical Society (West London 
Hospital, Hammersmith, W.).— 8.15 p.m. Discussion on the 
Treatment—Medical and Surgical of Acute Inflammation of the 
Vermiform Appendix, introduced by Dr. S. Taylor and Mr. 
McAdam Eccles, aud carried on by Dr. D. Hood, Mr. C. B Keetley, 
Dr. 8. Smith, Mr. L. A. Bidwell, Dr. H. A. Caley, and others. 

WBsr Kent Medico Chirurgical Society (Royal Kent Dis¬ 
pensary, Greenwich Rood, 8.E.).— 8.45 p.m. Clinical Meeting. Dr. 
D. Grant: Cases of Chronic Suppuration of the Frontal Sinus aud 
Autrum of Highmore treated exclusively through the Nose with 
good results. Council Meeting. 

Labyngological Society of London (20, Hanover Square, 
W.) —6 p.m Cases and Specimens will be shown by iho President. 
Dr. de H. Hall, Mr. Bowlby, Mr. Robinson, Dr. Potter, Sir F, 
Semon, Dr. Hill, and othe s. 

Royal Academy of Mbdicinr in Ireland.—Section of 
Anatomy and Physiology.— Prof. W. H. Thompson (Beiiast): 
Effects of 8odium Chloride on the Urinary Sei ration when Injec ed 
into the Circulation. Prof. A. Francis Dixon (Cardiff).- The 
Sensory Distribution of the Facial Nerve in Man. Communicated 
by Prof. Cunningham, F.R.N. Prof. Symington (Belfast): (a) On 
separate Acromion Process; (b) The Pelvic Viscera and the Pelvic 
Floor in two adult male subjects—a contrast; (<) 'I he Cetacean 
Larynx; (d) Specimens of Variation in the Skeleton. Prar. W. 
H. Thompson: Amesthetics and Urinary Secretion. Prof. Bir¬ 
mingham: Specimens Illu6iratiog the Topography of the Abdo- 
men. 

Monday, February 6th. 

Odontolooical Socirty of Great Britain —8 p.m. Paper 
by Dr. William Hunter, F.R.C.P.: “On the Kelalion of Dental 
Diseases to General Diseases.” Casual Communications by Mr. 
ueonard Matheeoo, Mr. W. Rushton, and Mr. Theodore Harris. 


Cancer Hospital (Free), Fulham Road, B romp ton.—House Surgeon 
for six months. Salary at the rate of £50 per annum, with 
board and residence. (See advert.) 

Clayton Hospital and Wakefield General Dispensary, Wakefield. 
—House Surgeon, unmarried. Salary £90 per annum, with 
board, lodging, and washing. 

Coventry and Warwickshire n< spital. Ooveutry.—Senior House 
Surgeon for not less than two years. Salary £100 per annum, 
with rooms in the hospital board, washing and attendance. 

Hastings, St. Leonards, and East Sussex Hospital, Hastings.— 
House Surgeon, unmarried. Salary £75 per aunum, with board, 
residence, and laundry expenses. 

Liverpool School of Tropical Diseases inconuection with University 
College, Liverpool, aud the Liverpool Royal Southern Hospital. 
—Lecturer in Tropical Disease. 8alarv £25‘i a year and pro¬ 
portion of students’ fees, with the right of private practice. 
Applica’ions to Professor Boyce, University College, LiverpooL 

Morpeth Dispensary, Beechfleld, Morpeh.-House 8urgeon. 
Salarv £120 per aunum. with furnished rooms, coal and gas. 

Sheffield Union.—Assistant Medical Officer to the Union Workhouse, 
Pitsmoor. Salary £100 per annum, with apartments, rations, 
and other usual allowances. Also Junior Assistant Medical 
Officer for the Workhouse Infirmary. Furnished apartments, 
board, and washing provided. Honorarium of £12 will be 
granted. Applications to the Cltrk to tue Guardians, Union 
Offices, West Bar, Sheffield. 


Appointments. 


Crawford, J. J., M.B., Ch.B.Univ. Dub., Resident Medical Officer 
to the Victoria Hospital, Burnley. 

Dent, D. A., M.B., C.M Ediu., Medical Officer for the Third Sani¬ 
tary District of the Cheltenham i niou. 

Eyres, H. M., M.B., C.M.Edin., Medical Officer for the Scortoo 
and Catterick Sanitary District* of the Richmond (Torks) 
Union. 

Farmbb, Gabriel William Stahl, M.A., M.B., M.Ch.Oxon , 
F. K.C S., Honorary Surgeon to the Radcliffe Infirmary, Oxford. 

Kendrick, G., L.R C.P.Lond., M.R.O.8., Medical Officer for the 
Bilstou ho. 5 Sanitary District of the Wolverhampton Union. 

MacConkby, A. T.. B.A , M.B.. B.C. Cantab., D.P.H., Assistant 
to the Bacteriologist of the Royal Commission on Sewage Dis¬ 
posal. 

Messenger, T., F.R.C.P., L.R.C.S.Edim L.F.P S.Gla«g. Medical 
Officer for the Bownese Sanitary Distric' of the Wigton Union. 

Proctor, J. A., L.8 A , Medical Office, for the Lydd Sanitary Dis¬ 
trict of the Romney Marsh Union. 

Rose, L., M.B., C.M.Edin., M-dical Officer for the Second Sani¬ 
tary Dislrict of Newport, salon. 

Stanwell, 8t. John, M.B., C.M.Edin., M.R.^.S., L R.C.P.Lond 
Assistant Surgeon to the Stamford and Ratland General In¬ 
firmary. 

Sutcliffe, E. H., M B.Durh., L.R.0.P.,Loud.. M.R.C.8.. Medical 
« fflcer for the Great Torrington 8anitary District of the Tor- 
rington Union. 

Woake8. Claud M.R.C.8., L.R.C.P., Surgeon to the London 
Throat Hospital. Great Portland Street. 

Davidson, James Mackenzie, M.B., C.M., has been appointed 
Honorary Medical Officer in charge of the X-Kays Department, 
Royal London Ophthalmic Hospital, Mcorfleld*. 


fiixths, 

Griffith.—J an. 27th, at 43, Park Square, Leed«, the wife of T 
Wardrop Griffith, M.D.. of a son. 

Morbis.— Jan. 27th at Gordon Lodge, Blackheath, the wife of 
Cl*rke Morris. M.R.C.S., of a son. 

Wilson.— Jam 28th, at Malvern, Kenley, the wife of Norman O. 
Wilson, F.R.C.8., of a daughter. 


^tarriagce. 

Gbimsuaw—Durbin.— Jan. 26th. at St. Stephen's Church Ealing 
K. Naher Grimshaw, of Ferrybauk, Arklow, son of the late 
Dr. Wrigley Grimshaw, of Dublin, 10 Ada'tue daughter of the 
late Rev. F J. Durbin, Vicar of Harston. C-imbridge. 

Skinner— **osk house.— Jan. 24th, at t., Cieuieu’s Church 
Hastings, JohnRutherfo-d Skiuner, M.K., C. M. of Winchelsea* 
Sussex, to Hi-len Charlotte, younger dangfiter of the laie Rev' 
John Monkhouse, of Oakley Rectory, Basingstoke, and Robert’ 
eon Terrace, Ha-tings. 

Stockwbi.l Dill n-Trbnchard.—J an. 2«th. at Brewham Parish 
Church. Komerse . Lieut. Hy. stovkwell. K.N., son of Frederick 
Stockweil, M.D., of Bruton, Somerset, to Laur 1 , eldest daughter 
of Dillon-Treuchard, Esq., of Lytcheit Maltravers, Dorset. 


Tuesday", February 7th. 

Hospital for Diseases op the Skin (Blackfriars Road.)— 
p.m. The First of a Course of Demoustrat.ons on Skin Diseases. 
By D. P- S. Abraham. 

The Roxtgbn Society (11 ChandoB Street, Cavendish Square, 
London).—7 p.m. The president, Mr. C. W. Mansell-Monllin, will 
introduce a discussion on the Rontgea Philosophy of the Soft 
Tissues. 


Barantifte. 

Belfast District Asylum.—Assistant Medical Officer, unmarried. 
Salary £100 per annum, with £50 in lieu of rations, furnished 
apartment*, fuel, lights, washing, and attendance. 


geaths. 

Coats.—J an. 24th, at 8, University Gardens. Glasgow, Joseph 
Coats, M.D., trofessor of Pathol gy, Glasgow University. 

Goodman.—J an. 20th, at his recideuce, Coouibe House, Weaver 
CullomptOD. Devon, Godfrey Goodman, Fleet Surgeon R.N 
(Retired), aged 63 years. 8 ’ 

Knight. -Jam 27th, at the Parsonarge, Raiuham, John Sladen 
Knight, M.D, M.C.C P.. aged 78. 

Schon. Jan 22nd at Bridge, near Canterbury, Charles 
Schon. M.R.C.S, L.8.A., fourth son of t e late Rev. 

Schon, or New Brampton, Chatham, a<ed 44. 

Tiley.—J an. 25th. at Fleetwood, Lancashire, Wm. George Tilew 
M.R.C.8.; aged 79. 


Henry 
J. F. 


Digitized 



F Peb. 8, 1899 


The Medical Press and Circular Advertiser. 


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TWYFORDS' 

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The Medioal Press and Circular Advertiser. 


Feb. 8, 1899 



S a preparation oi the purified cholesterin fat of 
lambs’ wool, nearly identical with the fat of 
the human skin and of the hair glands. It has 
been officially accepted for medicinal use be¬ 
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water and aqueous solutions of salts. For these reasons, and 
because it is the only trustworthy ointment basis for anti¬ 
septic purposes, it has been regarded as superior to all 
similar preparations. ‘Lanoline’ is supplied at 2S. 8d. per lb. 



‘Lanoline Preparations. 

TOILET 'LANOLINE' is an effective skin emollient 
and protective which can also be advantageously applied 
to any mucous membrane. It is supplied in small and 
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S% 1% 1% 1% f% f% 


.slLOini ^ynuip (Sugar Coated) 
(Iroa Phosphate with Qainiae and Strychnine) 

Is made in two strengths representing, in a 
soluble form, the amount of Iron, Quinine, 
and Strychnine contained in one fluid 
drachm ( 3.5 c.c.), or half a fluid drachm 
[1.8 c.c.] of the B.P. Syrup. “ Much pre¬ 
ferable to the syrup.” —Glasgow Medical Journal. 
In bottles of 25 and IOC. 

1/2 dr., 9d. and 7s. 6d.: 1 dr., 7 Od. and 2s. per bottle. 






ot 




%H 





Burroughs Olellcone 
and Co., 

Condon and Sydney. 



I* 'f* I* 


IT. 1-1/2 [0.097 gm.], or gr. 3 [0.194 gm.] 

Contains the combined Hypophosphites of 
Calcium, Potassium, Manganese, Iron, 
Quinine and Strychnine. Tfie strengths 
represent respectively one-half and one fluid 
drachm of standard Compound Syrup of 
Hypophosphites, containing gr. 1/64 of 
Hypophosphite of Strychnine to each 
drachm. “ Many of the drawbacks of the 
standard Compound Syrup are surmounted 
by this convenient preparation.- The Lancet. 

In bottles of 26 and 700. 

1-1 12 f r.. 94. and 7s. Od.; 3 gr., lOd. and 2s. per battle. 


OmCSIH IT 000 (Sugar Coated) 

(Phosphates Comp.), 2*1/2 gr [0.162 gm.] 
or 5 gr [0.324 gm.) 

Contains the combined Phosphates of Iron, 
Calcium, Sodium and Potassium, equiva¬ 
lent to 1/2 or 1 drachm of standard Com* 
pound Syrup of Phosphates. “ An excel¬ 
lent introduction.”-^ Lancet. 

In bottles of 25 and 100. 

2-1/2 gr., Od. and Is. 3d.; 5 gr., Od. and Is. Od. per bottle. 


r* r* 


IV r* f* 


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The Medloal Press and Circular Advertiser. 


Feb. 8, 1899 


XIV 



Third ip the Scries of the ‘Ailcpburys ' Foods for Infants 

A Cooked Food , to be made with Milk without either boiling or straining. 

T HIS FOOD is prepared by the action of Malt, after the method of 
Baron Liebig, upon a carefully-selected and cooked wheaten flour. 

It is not merely a mixture of these two constituents, as is generally 
the case in many of the so-called Malted Foods, but the starch of the latter 
is partially converted, while the irritating and diarrhoea-producing particles 
of ground malt are absent. For Liebig himself says : “ Malt, finely 
powdered, produces food causing diarrhoea. This originates from the sharp- 
pointed shafts of the malt which, in pounding, remain with the pounded 
malt, and affect the bowels of the child like fine needles.” 

This Food, when the purity of the milk supply is beyond suspicion, 
may be made up with the No. i Food and boiled water. It should be given 
from six months and onwards. For Invalids, aged people, and for 
patients recovering from typhoid and gastric disorders, this Food 
is especially valuable. 

If made with rice-water and milk, it is useful in helping to check 
diarrhoea, while the nutritious value may be enhanced by beating up with 
it a raw egg. 


The British Medical Journal writes : 

" We have taken some trouble to have 
this Food carefully tested. Delicate children 
have, in many instances, improved under its 
use; infants who have thriven under its use 
fell off when it was discontinued : and it was 
generally liked by the children to whom it 
was given. Dr. Donkin was able to report 
very favourably of its influence upon the 
health, nutrition and digestion of the children 


to whom it was administered in his hospital 
practice. In two large creches the Food has 
been found very successful : in more than 
one instance the children who had been 
subject to sickness being freed from it by the 
use of Messrs. Allen & Hanburys' Food. 
We have no doubt whatever that this Malted 
Farinaceous Food will be found very effec¬ 
tive, digestible, nutritious, and palatable, 
wherever it be tried.” 


Allen & Hanburys Ltd •9 Lombard Street, London. 

Infants' Food Manufactory : Ware Mills, HERTFORDSHIRE. 


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“SALUS POPULI SUPREMA LEX.” 


Vol. CXVIII. WEDNESDAY, FEBRUARY 8, 1899. No. 6. 


Jaris Clinical lectures. 


THE TREATMENT OF ACUTE 
INTESTINAL OBSTRUCTION. 

Delivered at the Hdpital de la PitiS, Paris, 

By Professor P. BERGER, 

Professor of Clinical Surgery. 

( Concluded .) 

It is evident that the mode of intervention in 
cases of intestinal obstruction must entirely depend 
upon the nature of the obstacle. Here, as elsewhere, 
a correct diagnosis leads naturally to correct treat¬ 
ment ; but, vou may ask, is a correct diagnosis of the 
cause and the nature of the malady possible P 

Some of my colleagues display in this regard a want 
of confidence which I do not altogether share. There 
occur, certainly, cases in which we are left in the most 
complete obscuritv; others there are which falsify 
every prediction; but often, also, a careful scrutiny of i 
all actual phenomena, a close investigation of all 
the circumstances preceding or accompanying their 
appearance, enable the observer to arrive at a trust¬ 
worthy conclusion, or at least to presumptions upon 
which he may base his decision, and make choice of 
one or other operative alternative, in accordance with 
fixed rales. The following is my advice for carrying 
out the examination, and deciding according to the 
result upon this or that surgical intervention. 

In presence of symptoms of acute obstruction super¬ 
vening in a patient previously in good health, our first 
consideration must be the possibility of the symptoms 
being due to conditions more or less analogous but 
quite different in their nature, particularly subacute 
peritonitis due to perforation or appendicitis. The 
amount of fever in some cases, the pulse and 
temperature in others, the rapid change in the 
appearance of the face, the loss of heat in the 
extremities and extreme anxiety, the sensibility of 
the belly to pressure and even to the slightest con¬ 
tact, the different character of the pain due to 
spasmodic contraction of the bowels, ana in strangu¬ 
lation, suffice very often to establish a diagnosis. In 
the rare cases, in which doubt may exist, laparotomy 
will enable us to clear it up with the least possible 
delay. But let us suppose the diagnosis of acute 
obstruction to have been established with certainty, 
in every patient, whatever hiB age and general con¬ 
dition, the first care should be the search for local 
signs. These may be revealed by careful examina¬ 
tion of the abdomen. This sign may be pain fixed 
always in the same spot; a sensation of more marked 
resistance in one spot; a local distension, or, on the 
contrary, a vague or more pronounced sensation of a 
deep tumefaction; or periodical attacks of pain and 
constriction of the intestine making themselves felt 
always in the same spot. Whatever sign be found, 
the most careful note shoald be made of it. In 
examination the greatest care should be particularly 
directed to the regions where the more deeply Beated 
hernias occur ; not only the deeper regions of the 
groin, but the semi-lunar line of Spigel; the 
para-umbilical region, that of the adductors, even 


the sciatic notch itself should be examined by 
palpation. Examination per rectum and per vaginam 
should be earned out with the utmost care, and 
it should be borne in mind that by this method, 
and especially per vaginam, the greatest number of 
obturator hernias have been recognised. With this 
method of examination we must combine also deep 
palpation of the hypogastric and inguinal regions. 
During the vaginal examination the exact condition 
of the organs of generation and their appendages 
must not be overlooked, and this remark applies 
equally to Douglas's pouch, where elytroceles may be 
strangulated. 

If a local sign be found showing certainly or pro¬ 
bably that a lesion exists in a determined spot in th« 
abdomen, no hesitation is allowable. If the general 
condition of the patient permit, it is imperative to 
go straight to the spot where the pain has been 
localised or the deep swelling discovered, either by 
direct incision over the spot or by median lapa¬ 
rotomy to proceed to the sensitive spot or towards 
the deep swelling which has been discovered. The 
incision will be above or below the umbilicus, accord¬ 
ing to the position of the local sign, and tne hand 
introduced should be directed towards the suspected 
locality. The lesion having been discovered—tumour, 
invagination, torsion, mass of intestine fixed by adhe¬ 
sions, or caught in an orifice or nipped by a band, or 
other morbid condition—must be dealt with accord¬ 
ing to rule. All necessary space must be given by 
enlargement of the first incision, so as to avoid un¬ 
necessarily complicating the operation. Extremely 
careful examination will often reveal a sign to guide 
exploration. Of six cases of volvulus of the iliac 
flexure Heidenhain was able to diagnose four, in four 
out of six cases of internal strangulation, and in three 
out of Beven cases of twisting of the small intestine 
which called for laparotomy. 

But failure is possible. If the examination reveal 
nothing which sheds light on the nature of the real 
cause of symptoms, it is only the eye, the general state 
of the patient, and the length of time that has elapsed 
since the beginning of the symptoms, which can 
guide us to a decision. 

In a young and healthy subject who has been sud¬ 
denly Beized, without warning, with symptoms of acute 
obstruction, the probabilities point to an internal 
strangulation of one kind or another, or to torsion, 
unless the case be one of pseudo-paralytic strangula¬ 
tion, impossible to diagnose except by treatment. 
If the patient’s strength permit, and if the symptoms 
are not of too long duration, after having tried an 
electrical injection on the method laid down by 
Boudet, recourse should be had without delay to 
laparotomy. 

If the patient be advanced in years we must first 
eliminate cancer of the bowel, unless it be merely a 
case of obstruction due to fawal accumulation. Tor¬ 
sion, invagination, and compression by tumour, may 
equally be met with. In a certain number of these 
cases, examination of the Bhape of the belly and of its 
sonority as showing that the large intestine is 
involved partly or totally in the distension of the 
digestive tube will suggest the choice of operation. 
It is to an artificial anus in the left iliac regioD that 
we must have resourse if we are sure that the 

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132 The Mxdical Prsbs. ORIGINAL COMMUNICATIONS. 


obstacle is seated at the termination of the iliac 
flexure. If doubt exist, the operation must be done 
on the right side, since it is important to reach the 
large intestine at a point above the obstacle, or failing 
that, at the last folds of the small intestine. An 
electrical injection will have been first administered 
if the condition of the patient allow of it. 

1 In intermediate cases, in patients of middle age, 
where no local symptom and no history throws light 
on the probable seat and character of the obstruction, 
it is the general condition of the patient, and the time 
during which symptoms have existed which must 
govern intervention. The facial expression, the 
pulse, the body heat, and the greater or less disten¬ 
sion of the belly will be noted. The presence of 
bacterium coli in the urine, in the blood, may 
furnish a contraindication, but time for such 
investigation may not be available. Albumen in 
the mine may be more easily recognised. Pul¬ 
monary complications and congestions depending 
u p on intestinal septicaemia must not be overlooked. 
When the result of the examination is favourable and 
shows the patient’s condition to be fairly good, it is to 
laparotomy that recourse should be had. And here 
two modes of operating, two opposed practices, have 
to be considered. 

A long incision of the abdominal wall may be prac¬ 
tised so as to expose the whole of the viscera and to 
facilitate discovery of the obstacle; but when the 
bowels are much distended, such an incision at once 
exposes the whole mass of intestiries, and although 
these may be surrounded by sterilised compresses, 
prolonged exposure of a large portion of bowel 
constitutes a danger in itself. Moreover, great 
difficulties and complications arise when the pro¬ 
truding mass of bowel has to be returned and the 
abdominal incision closed by suture. In order to 
accomplish this it is often necessary to evacuate the 
contents of the intestine through a small incision 
into one of the folds of bowel—an incision afterwards 
closed by suture. But evacuation of the distended 
intestines in this way gives rise to danger of infection 
through the bowel as well as by the abdominal cavity. 
Although many surgeons adopt this practice, and 
although Helferedi claims nine successes out of 
thirteen cases by it, we should not adopt it as a 
general rule. 

In ordinary cases I think it is better to make an 
incision permitting direct inspection in a certain 
locality and introduction of the hand. The cascum 
can thus be examined, and if distended can be 
followed from end to end seeking for an obstacle in 
the transverse colon and the iliac flexure. Failing to 
discover rapidly the cause of obstruction it is better at 
once to perform artificial anus under conditions 
which are very favourable to a cure. 

If the caecum be empty there ought to be no difficulty 
in discovering close at hand the lower end of the small 
intestine, and this can be followed to the obstacle. 
Or the following method, Heidenhain’s, may be 
employed:—The incision being made, the first coil 
of intestine which presents itself is allowed to escape, 
and this usually proves to be one of the folds close 
to the obstacle. This is traced back towards the end 
fixed by the obstacle. 

In whatever way the examination is earned out it 
ought to be done as rapidly as possible: and it is 
always better to make an artificial anus than to ex¬ 
pose the endurance of the patient to too prolonged 
a strain. But if it is perceived that the mass of 
the small intestine twisted upon itself constitutes the 
greater portion of it; if it is evident that the obstacle 
is in the higher parts of the digestive tract, k is 
justifiable to enlarge the original incision in order to 
allow the necessary length of bowel to be drawn out 
and to permit of an opening being made in the proper 
situation to void their contents and diminish their 


Fkb. 8, 1899. 

volume. It is here that the procedure recommended 
by Helferich and Kiimmell becomes applicable. 

As just laid down, except in cases where exceptional 
indications present themselves, complicated opera¬ 
tions ought to be avoided—entero-anastomoses as 
well as intestinal resections and enterorrhaphies with 
Murphy’s button. To prove successful, laparotomy 
requires to be done in the shortest possiblg time. 

Whatever the age of the patient, if the case present 
symptoms of advanoed strangulation, reliance must 
mostly be placed on Nelaton's enterotomy practised 
in the iliac fossa or in the right flank, or m the first 
fold of intestine which presents itself through the 
incision. 

Except in extreme cases it must be borne in mind 
that laparotomy may end in artificial anus, and it 
must not be forgotten that during the former opera¬ 
tion something may occur to make evident the nature 
of the obstacle and permit of its removal. It there¬ 
fore seems desirable always to make an incision large 
enough to permit the entry of several fingers, if not 
of the whole hand, for the purpose of exploring the 
whole abdominal region. 

Examination of the patient, diagnosis and inter¬ 
ference may be summed up thus: — Laparotomy, 
exploration and removal of obstacle constitute the 
rational and truly surgical method. Preference should 
be given to this method according to the girth of 
patient, recent strangulation and good general con¬ 
dition and guidance of local signs. In aged patients, 
and especially when the large intestine participates 
in the distension, cancer must always be suspected, 
and it is to artificial anus that recourse must often 
he had in such cases. 

It must never be forgotten that pseudo-paralytic 
strangulations and spasmodic strangulations, cases in 
which there exists a, functional obstacle, are common, 
and that they can often not be distinguished by clini¬ 
cal examination from cases of mechanical obstruction. 
When the patient’s strength permits, therefore, we 
ought always to practise electrisation of the bowels 
very carefully and methodically before surgical inter¬ 
ference is attempted. 

The cause of failure in the treatment of intestinal 
occlusion is due mainly to faulty diagnosis. Onoe 
thoroughly convinced of this fact the necessity for 
the most careful and exhaustive examination in the 
cases needs no resistance. Interference must be always 
directed by the special circumstances of individual 
cases. It is to clinical observation that we must 
look to remove the obscurity which now surrounds the 
diagnosis in many cases of acute intestinal obstruc¬ 
tion, and to establish on a more secure foundation 
the rules of treatment by operation, the results of 
which, so far, show very little improvement, in spite 
of the progress effected in operative technique. 


NOTES ON THE 

OXYGEN TREATMENT OF WOUNDS. 

By GEORGE STOKER, M.R.O.P.I., M.R.C.S.Eng., 

Physician to the London Throat Hospital. 

It has always been believed that the oxygen treat¬ 
ment brought about healing as the result of some 
process of oxidation affecting either the food on which 
the micro-organisms live or their excretions or toxins. 
This being so it is necessary that the oxygen used 
should be of the highest standard and free from all 
impurities. 

Oxygen from various sources has been tried, and 
undoubtedly the purest and of the highest standard 
is that prepared by Brin’B Oxygen Company, con¬ 
taining, as it does, not less than 96 per cent, of pure 
oxygen. 

Attention has been directed to the effect of this 

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ii. 8, 1899. ORIGINAL COMMU NICATIONS. _ Th» Medical Press. 133 

1. It at once turns a vivid green colour, which 
deepens and intensifies as the process of oxidation is 
continued, and (2) from being liquid, the fluid 
becomes thick and glutinous, or almost semi-gela¬ 
tinous. These results indicate (1) that the bacillus 
pyocyaneus has profoundly altered the character of 
the broth, and (2) that the oxygen has further pro- 


Case I. Photo No. 1. 

to be the most persisting and most inimical to healing 
of any of the micro-organisms usually found in 
■wounds. 


Cask II. Photo No. 1. 

foundly modifiedlthe character of the broth so altered. 
This product of oxidation is volatile; fori if the 
stream of oxygen',is discontinued after a few minutes, 


Case 1 Photo No. 2. 

If a sterile broth be prepared, and a s'ream of 
oxygen passed through it, no result is apparent. If 
this Bame broth be inoculated with the bacillus 
pyocyaneus and incubated for 14 days, in an air-tight 
flask, and then oxidised as above indicated, two 
immediate results are observed. 


Case II. Photo No. 2. 

the broth will, in the course of an hour or two. resume 
its original colour. But if the oxidation is kept up 
for several hours the deep green colour becomes per¬ 
manent. This last observation, confirms the necessity 
for the continuous exposure of the parts affected to 


Digitized by 


Google 















134 Thk Medical Press. 


ORIGINAL COMMUNICATIONS. 



Feb. 8, 1899. 


Case III .—Lupus of Face and Ear. —H. T.—, 
wfc. 29. This gill had been afflicted with true lupus 
of her face and ear for 14 years. The disease first 
showed itself on the side of the nose and gradually 
spread till it engaged all those parts shown in Photo 
1, Case III. 

A great variety of t- eatments had been tried. Her 
face had been scraped (under an anaesthetic) four or 
five times before she came into the Oxygen Home. 
Various lotions, ointments, and caustics had been 
tried but to no purpose, and in the two years previous 
the disease had spread rapidly. 

The treatment began on November 9th, the diseased 
surface being carefully scraped and filed, and oxygen 
applied, as soon as the bleeding ceased, by means of 
a gutta-percha mask. 

As the diseased surface was so • xtensive, it was 
found impossible to enclose it all in one apparatus, 
and so several scrapings were*necessary. An oxidised 
toxin was prepared from cultivations taken from the 
wound, and when used produced several reactions, and 
indicated several outlying areas of infection. 


Cask III. Photo No. 2. 

The patient was under treatmentfor twelve months, 
this lengthened period being necessitated by the fact 
that one part had to be completely healed before the 
adjoining portions could be scraped. 

The points suggested in using this treatment in 
such cases as this are:— 

1. To remove the diseased surface by scraping. 

2. The skin grown under oxygen being almost 
physiologica ly perfect is more capable of resisting 
further pathological attacks than an ordinary 
cicatrix. 

3. The formation of oxidised toxins on the wound 
itself, and the use of those artificially prepared, not 
only assist the healing, but also attack outlying 
lupoid areas, causing them first to break down, after¬ 
wards to heal, and in this way tend to prevent a later 
extension of the disease. It is gratifying to note 
that these results were attained, not only in this case, 
but also in others of a similar nature. 


PROFESSOR Osler has been elected Dean of the 
Johns Hopkins University in succession to Dr. W. H. 
Welch, resigned. 


oxygen gas, in order that this treatment may be 
effectually carried out. 

It is believed by many that the oxygen treatment 
is only useful in cases of chronic ulcers and si res, 
this is a grave misapprehension, the most brilliant 
results are seen when the treatment is used in cases 
of recent wounds, burns, &c., both in reference to the 
rapidity of healing as well as to the nature of the new 
skin formed ; for it is not any ordinary cicatrix that 
is produced, but a skin almost physiologically perfect. 

The following are quoted as showing the results 
produced in several kinds of cases :— 

Case I .—Chronic Senile Gangrenous Ulcer .— 
Mrs. T., art. 83, about three weeks previous to 
entering the Oxyuen Home, the patient got a bruise 
on the shin, and an ulcer formed which extended 
very rapidly, became very offensive, and was ex¬ 
quisitely tender and painful. On admission the ulcer 
was covered with a hard, dry, darkish green scab, 
almost exactly like what one sees in senile gangrene 
of the toes A few days after the oxygen treatment 
was begun a healthy action was set up. and the ulcer 


Case III. Photo No. 1. 

was completely healed in eight weeks. This was by 
no means a rapid case of healing as compared with 
others, but considering the serious nature of the 
complaint and the great age of the patient (83 years) 
I regard it as one of the most remarkable cures we 

Vi q vp pfrp r*fpH 

Case II .—Recent Wound.- J. M„ set. 47. Three 
weeks before admission the patient was knocked 
down by a heavy van, the wheel passing over the outer 
side of the left ankle, which was badly bruised, the 
bruise eventually sloughed off leaving a large open 
wound (vide Photo 1., Case II.) both extensive and 
deep. The patient was under ti-eatment for twelve 
weeKS. For the first four or five weeks the wound 
healed rapidly and then remained stationaiy for two 
or three weeks. On July 12th, he got a reaction, the 
tempera ure rising to 103 degs F., with quick pulse, 
but very little general malaise. The wound remamed 
moist, and healthy, and painless. There was, how¬ 
ever, some pain and swelling in the lymphatics ex¬ 
tending up to the groin. The reaction lasted three 
days during which time and after the wound healed 
rapidly and the patient was discharged cured on 
August 12th (vide photo No: 2, Case II). 




ORIGINAL COMMUNICATIONS. 


The Medical Press. 135 


"Feb. S, 1899. 


ADIPOSA DOLOROSA: 

A MYXCEDEMATOID DYSTROPHY 

[By a Correspondent.] 

The investigation of the disease now universally 
known under the name of myxoedema, though con¬ 
siderably advanced by the attention of which it has 
"been the object during the last few years, still pre¬ 
sents many points calling for elucidation. Apart 
from the group of morbid phenomena which constitute 
a typical case of myxoedema, it has been shown that 
there are many other conditions of which a 
myxcedematous tendency is a more or less prominent 
factor. There are many varieties of myxoedema 
which have not yet been thoroughly investigated, 
■although they present considerable interest in that 
they throw light on the pathological physiology of 
the thyroid gland as well as from a clinical point of 
-view. 

Among the abortive forms of myxoedema, there is 
one which has already been sufficiently described by 
Dr. Dercum, of Philadelphia, to enable us at once to 
outline its general features, and to which this 
observer has given the name of adiposa dolorosa. 
This name has the advantage of directing 
attention to the two principal symptoms of the affec¬ 
tion, viz., the appearance in different parts of the 
body of subcutaneous masses of fat associated with 
painful manifestations localised at these points. As 
far back as September, 1888, at the meeting of the 
Association of American Neurologists, Dr. Dercum 
brought forward his first example of this affection. 
The patient was a woman, set. 51, who presented 
what was then described as “ dystrophy of the sub¬ 
cutaneous tissues of the upper extremities and of 
the back with symptoms suggesting myxcedema.’' Two 
years later Dr. F. B. Henry communicated to the 
Neurological Society of Philadelphia a very similar 
observation, and during the following year Dr. 
Dercum, having met with a third case of the same 
kind, undertook the investigation of the pathology 
f the so-called painful adiposis, emphasising on one 
band the myxcedematous character of the syndrome, 
and, on the other, the points of distinction which 
differentiate it from the classical idiopathic 
myxoedema. More recently still two further con¬ 
tributions devoted to this subject have made their 
appearance, one by Dr. Spiller and the other bv 
Dr. Eshner. The former describes three fresh 
examples of painful adiposis, two of which he 
had bad an opportunity of studying in Dr. 
Dercum’s wards, together with one which had been 
eommunicated to nim by Dr. Hay. Dr. Eshner 
relates a case of the kind, also from the clinic of Dr. 
Dercum. adding a previously unpublished observa¬ 
tion by the latter. In looking through the medical 
literature of the last few years one meets here and 
there with a number of observations on myxoedema 
which present a certain, and in some cases a striking, 
.analogy with the condition under consideration. 
Nevertheless, as it is only in America that these 
cases appear to have been observed and described in 
a thorough and complete manner, it is to American 
authors that we must look in order to obtain a com¬ 
prehensive idea of the pathological state low known 
as “ painful adiposis.” 

Judging from these observations the malady in 
-question appears to affect exclusively persons of the 
female sex. It is generally met with in middle-aged 
or elderly people though it baa occasionally been 
observed comparatively early in life — in one case at 
the age of 29. 

The pathogenesis of the affection is obscure. In 
some cases there has been a history of alcoholism, 
syphilis, or rheumatism, but in other cases these etio¬ 
logical features have been absent. In one instance 


traumatism appeared to have had a share in its 
production, the onset of the malady dating from a 
carriage accident, as the result of which the patient 
was pitched out on to the road, and remained for a 
time unconscious. 

In its fully developed condition the disease is 
characterised, to begin with, by the presence of dis¬ 
seminated subcutaneous masses of fat. The distri¬ 
bution of these masses is usually very irregular, 
though occasionally there is a semblance of symmetry 
These masses, which vary considerably in size, may 
attain considerable dimensions. They first appear 
in the form of small nodules which grow slowly, 
while other tumours of the same nature continue to 
make their appearance in other regions of the body. 
These local deposits of adipose tissue occur on the 
legs, thighs, arms back, and abdomen, and they never 
invade the face, hands, or feet, or the body as a 
whole, and never culminate in a general uniform 
obesity, always remaining separate and distinct, with 
a well-defined outline. 

More or less soft to the touch at the beginnin /, 
these fatty deposits ultimately acquire a firm con¬ 
sistency. They are often tabulated to an extreme 
degree, and on palpation give the sensation of a 
bundle of worms or rolls of cord, resembling in this 
respect the sensation given on palpating a varicocele. 
Microscopical examination of portions of these 
tumours showed simple hyperplasia of the adipose 
and connective tissues. 

Another salient feature of these localised collections 
of fat is that they are associated with pain. This 
sometimes occurs spontaneously, at others only on 
pressure or on movement. In certain cases the sym¬ 
ptom pain has preceded the appearance of the fatty 
overgrowths, being felt at the spots where the latter 
make their appearance later on. There is no 
uniformity in this relationship for in some patients 
the painful manifestations did not supervene until 
the tumours had attained a certain size. 

Lastly, paroxysms of acute pain have been noted as 
occurring coincidentally with a sudden and rapid 
increase in size of the fatty masses. The thyroid 
gland in these patients often presents a marked degree 
of atrophy. Several other symptoms are occasionally 
observed, though less constant and of secondary im¬ 
portance, such as pain on pressure over nerve trunks at 
the root of the affected limbs, areas of hyperesthesia 
and anaesthesia, muscular and general enfeeblement, 
diminution, and even suppression of sweat secretion, 
headache, a tendency fr* haemorrhage from the mucous 
surraces, and bronchitis. The affection is essentially 
of a chronic nature. Its onset is insidious, and the 
disease runs a slow and uncertain course, culminating, 
it may be, sooner or later in marasmus and dementia. 
Except at the terminal stage, in which the influence 
of senility must be allowed for, there is not, as a rule, 
any mental disturbance. At the post-mortem 
examination of two women suffering from painful 
adiposis the thyroid gland was hard, and infiltrated 
with calcareous deposit. 

It is obvious from the description which precedes that 
painful adiposis differs from ordinary obesity in that it 
is associated with a whole series of symptoms which 
are not met with in the latter. It, on the other hand, 
presents mani est points of resemblance with ordinary 
myxcedema from which it differs however in the fact 
that the face, hands, and feet are not invaded, by the 
absence of mental disturbance and slowness of 
speech, as well as by the pain which is never absent 
in adiposa doloro.-a. The myxcedematous nature of 
the condition is, however, h«rdly open to doubt if we 
consider its symptomatology and the beneficial action 
on this affection of the thyroid treatment. Under 
its influence the fatty growths retrogress, the pain 
subsides and all the other symptoms undergo parallel 
improvement. Methodical massage, it is worth 


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noting, has been found a very useful adjuvant of 
the thyroid treatment. 


WOMEN QUACKS 

IN THE 

SEVENTEENTH CENTURY, j 

By JABEZ HOGG, M.R C.S.Eng., 

Consulting Purgeonto theBoyal Westminster Ophthalmic Hospital, j 

and to the Hospital for Women and Children. 

It is very well known thatstrange notions prevailed 
on the art of healing in the days of Charles II., even 
among the higher classes of society, but it is not so 
generally known that the women quacks of the period 
were very numerous, and most pertinaciously press¬ 
ing in their attentions upon the sick and in the 
administration of ” their infallible cures ” than the 
regularly recognised physicians of the period. Many 
curious instances of this are given in the “Verney 
Memoirs.” Ab an instance, the wife of one of the 
son's is stated to have gone “ hopelessly mad,” when 
more than one woman quack presented herself and 
offered “ a certain curefor the malady. One Mrs. 
Clark, promises an infallible cure for the sum of 
£20. Her mode of cure is not given. A certain 
widow, Scott, residing at Lawn Farm, presses her 
services upon the family. Her nostrum, as all nos¬ 
trums usually are, was a secret one. A marvellous 
powder that sends the patient to sleep for three 
or four days and nights, and he or she wakes up 
perfectly cured. Ultimately, old Judith is permitted 
to try her skill, after giving “ her devout assurance 
that she will not use any manner of sorceries, charms, 
or magic.” Her “ perfect cure! ” consisted in taking 
the head of “ a Jact-hare, wrapping it up in a new 
piece of cloth, and binding it tightly round the head 
of the patient, there to remain for three or four days, 
taken off and put in the centre of a pillow made of 
feathers, which must be slept upon until the cure is 
completed.” This not being attended with any im¬ 
provement, the husband was “ bidden to have his 
wife prayed for during six successive Sundays,” but 
“ the melancholy distemper remained uncured.” 

It was, however, during the return of the terrible 
years 1665-66, when a hecatomb of victims (over 
/0.000) were carried off by the Plague, that quacks, 
male and female, had a high time of it: when, indeed, 
the women quacks were no less to the fore than those 
hailing from the Royal College of Physi- ians. Then 
it came about that every atrocious nostrum of this 
besotted period was brought forward and prescribed. 
One Cary Gardiner boldly proclaimed that she 
had a cure “ warranted to put an end to the 
plague, “ if she could only get enough of it.” Mean¬ 
while, the official remedy for the poorer folk was 
garlic and butter, with a clove or two added.” For 
the richer patients, able to call in a phyrician (notone 
of whom seem to have been a whit wiser than their 
old women rivals), costly powders were prescribed, 
consisting of “ hartshorn, pearls, corals, tormentil, 
liyacynth-stone, onyx, and east hunicornhorn.” Aunt 
Johan exhorts Sir Ralph “ to wear a quill filled with 
quicksilver, sealed over with wax, and sewed up in 
silk with a string to wear about his neck.” This she 
offers “ as sartine as anything to keep one from taking 
the plage.” Moreover, “ if you let your horse weir it 
it will never have the disease.” Sir Nathaniel Hobart, 
who while residing in town, “ hopes God will preserve 
him, particularlv as my doctor has purged and 
blooded me.” “ Lent figs were largely prescribed. 
The Eton boys were ordered to smoke in school daily 
as a disinfectant, which they doubtless much enjoyed. 
No physician was wise enough to devise the cause, 
much less treat the dire disease. No one was able to 


oonvinoe the City authorities that plague is a dirt 
disease, for the most part due to overcrowding in 
neglected insanitary dwellings. This will be seenjto 
hold true with regard to the Indian outbreak, so the 
never-to-be-forgotten plague of 1665 was fortunately 
followed the next year by the Great Fire of London, 
which at length swept it away; thus proving a real 
blessing in disguise, a perfect God-send at the time, 
and a useful lesson to succeeding generations.” 


Clinical ^ecorbs. 

TWO CASES OF LATERAL SINUS PYAEMIA. (a) 
By James Kkbr, M.A., M.D., 

Purge >n to the Bradford Bye and Ea p Hospital. 

The first patient was a boy, set. 15, who had suffered from 
ear discharge for several years. On admission there was 
paresis of the right side of the face and loss of taste of the- 
right side of the tongue. The right mastoid was opened 
and a cavity filled with stinking cholesteatomatous 
material was emptied. Two days later a superficial 
abscess formed over the temporal bone, and was opened. 
The temperature, however, still rose to 104 in the even¬ 
ing and fell to normal in the morning. The sigmoid 
sinus was then explored, and thick green pus found about 
it. ThiB was cleared away, the opening packed with 
gauze and the jugular vein ligatured. 

No improvement occurred—facial paralysis was now 
marked. A week after admission pneumonic symptoms 
began, together with constant diarrhoea, and the child 
died a fortnight after admission. 

Anti-streptococcic serum was administered but pro¬ 
duced no good effect. 

At the autopsy there was found extension of the 
thrombus back in the lateral sinus and up the petrosal 
sinuses. 

There wa3 discoloration of the bone, and erosion and 
pus about the jugular foramen. 

Several perforations of the walls of the jugular vein 
were found and the infection appeared to have reached 
the sinuses by extension from the floor of the middle ear 
through the vault of the jugular dome. 

Cask 2.—A boy of five years who had suffered f»om ear 
discharge for a considerable time ; shortly before admis¬ 
sion an abscess had been opened behind the ear. 

When seen on November 12th the temperature was 
97'2, pulse 104. Next morning the pulse was 140 and 
temperature 103 - 6; he was mentally clear; no headache 
or pain ; the tongue was dry and furred, and discharge 
was free. There was no thickening about the jugular 
vein, and no rigois or retraction of neck. 

Oprration , November 13th.—An incision was made over 
the left mastoid bone, and a considerable area of bone was 
found to be bare. Pus was found deep in mastoid on 
chiselling, but no discharging track was noticed. The 
lateral sinus was then exposed freely backwards, and 
seemed to be greenish-blue in colour and thrombosed. The 
jugular vein was ligatured in two places and divided, 
and the septic clot scraped away. There was free bleed 
ing, which was controlled by plugging. The whole 
wound was rubbed thoroughly with iodoform and boracic 
acid. The patient was collapsed, as the operation had 
lasted 100 minutes. The after progress of the case wa3 
at first unsatisfactory, and injections of antistreptococcic 
serum were given, but the fever still cjntinued, and 
there was pain in the chest. On May 20th, a week after 
the previous operation, the wound was reopened and the 
sinus traced back till healthy vessel was reached, it was 
thoroughly scraped out and plugged with gauze. 

The middle ear was curetted, and together with the 
mastoid antrum made aseptic as far as possible. Serum 
injections were given again at intervals of thirty hours. 
The cough continued for a few diys, but apart from 
this the case progressed satisfactorily, and the boy was 
able to return home on December 20th. 


(<i) Read before the Bradford Medico-Chirurgical Society, Jan. 
17th, 1899. 


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TRANSACTIONS OF SOCIETIES. 


The Medical Press. 137 


It is worthy of note that recovery in these cases is 
unusual after chest symptoms have appeared. The use 
-of the serum appeared to have produced no beneficial 
•effect, and seemed on the other hand to temporarily 
derange the appetite for food. Early operation was 
advocated in cases of otitis media where there is a 
fluctuating temperature. 


transactions of Societies. 

OBSTETRICAL SOCIETY OP LONDON. 
Meeting held Wednesday, February 1st, 1899. 

Dr Culling worth, President, in the Chair. 


The Annual Address. 

The President, after some introductory remarks, 
•commented on the fact that there was a further slight 
falling off in their numbers. In January of last year the i 
number of Fellows was 711, comprising eleven honorary I 
and corresponding Fellows, and 700 ordinary Fellows. 
During the past year the Society had lost twelve Fallows 
lay death, and thirty by resignation. The number of 
new Fellows elected was twenty-two, so that there was a 
deficit of nineteen, and he urged them to be-tir them¬ 
selves to keep up the supply of new Fellows. Referring 
to the issue by the Council during the past year of a well 
considered code of “ Rules and Regulations to be 
Observed by Midwives holding the Certificate,” he 
observed that it had long been felt to be an a-iomaly that 
there were no such rules, especially as a phrase iu the 
declaration which every midwife who had passed the 
examination was called upon to sign before receiving the 
certificate, seemed to take their existence for granted. 
He regarded their preparation and publication as the 
most important event that had occurred in the history 
of the Society during his term of office as President. He 
did not suppose that these “rules and regulations” 
would meet with universal approval, but he thought it 
would generally be conceded that they go a very 
long way towards meeting the requirements of 
the case. The work of drawing up these rules was 
undertaken by the Council and the Board for the 
Examination of Midwives jointly. In the matter of the 
examination for midwives, he admitted that the Society 
still continued to suffer from a certain amount of pro¬ 
fessional opprobrium, which, though entirely unde 
served, was probably in some degree responsible for the 
decrease in their numbers. He declined to argue 
the point on that occasion, but he would remind 
them that the Society had undertaken the work from a 
sense of duty and merely as a temporary expedient, 
after having tried in vain to induce the Government to 
move in the matter. He added that they would be only 
too glad to relinquish the task whenever the State could 
be prevailed upon to take upon itself functions which 
properly belonged to it, and which it alone could 
adequately fulfil. 

Passing on to the scientific work of the past sesr.ion he 
congratulated the Fellows upon an excellent record, 
papers having been unusually numerous Ten of them 
dealt with obstetrical, and five with gynaecological sub¬ 
jects. He passed the various papers briefly in review, 
and then proceeded to the lugubrious task of giving a 
short biography of the deceased Fellows. In conclusion, 
he took leave of the Fellows on the termination of his term 
of office as president, thanking them all, and especially 
the secretaries, for the assistance they had rendered to 
him in his task. In resigning the chair, he had, at any 
rate, the satisfaction of knowing that the next occupant 
would be one, whose contributioos to scientific gynae¬ 
cology, they must all be proud. 

After the usual vote of thanks had been agreed to Dr. 
Griffith suggested that the new rules bearing on mid¬ 
wives should be freely circulated among the Fellows, 
most of whom were in a state of profound ignorance of 
their purport. Although himself in cordial accord with 
the Council in the work in which they were engaged he 
could not disguise from himself that the action of the 1 


8ociety in regard to the examination of midwives was 
extremely unpopular with the profession at large. He 
defended his predecessor in the Presidency of the Medical 
Defence Union (Mr. Victor Horsley) from certain asper¬ 
sions cast upon him in respect of his action in regard to 
the examination of midwives and urged that greater 
publicity should be given to the subject. 

The President pointed out that the new rules were 
bound up with the volume of Transactions shortly to be 
issued so that they would be accessible to the Fellows at 
large. He deprecated any proposal to take the sense of 
the society viewed as individuals on the question as not 
conducive to peace. The new rules had already been 
forwarded to all midwives on their register. 


EDINBURGH MEDICO-CHIRURGICAL SOCIETY. 
Mbeting Held February 1st, 1899. 

Sir John Batty Tuke, President, in the Chair. 


addison’s disease. 

Dr. R. A. Fleming showed a mother and four children 
apparently suffering from Addison’s disease. In the 
case of the first-named the pigmentation had begun 
seven years ago, and had grown deeper with each suc¬ 
cessive pregnancy. Recently numerous small pigmented 
moles had appeared. There was no discolouration of the 
mucous membranes. In addition the constitutional 
symptoms—ceaseless vomiting and diarrhoea, palpita¬ 
tion and faintness, and excessive languor—were well 
marked. The eldest child, ret. 7. had shown signs of 
pigmentation four years ago, and in her case, too, moles 
had developed. The remaining children, aged four, 
three, and two years, had become pigmented and the 
subjects of moles three years ago, six months ago, and 
seven weeks ago respectively. 1'he three eldest also 
suffered from vomiting, diarrhoea, and languor. There 
was no tuberculous family history, »nd the pigmentation 
and constitutional symptoms had somewhat diminished 
uuder the administration of arsenic. If these were really 
examples of Addison's disease the cases were probably 
unique. 

Mr. Cotterill and Dr. Russell showed a patient 
after mastoid disease and empyema. The former had 
been secondary to the latter condition—an unusual 
sequence of events Speaking of the operation, Mr. 
Cotterill deprecated the puncture of an exposed lateral 
sinus in order to solve an existing doubt as to the pre¬ 
sence of thrombosis. It was quite easy to discover the 
state of the vessel by gentle palpation, and puncture 
from a septic wound was very liable to introduce germs 
into the general circulation 

Dr. Shennan showed (1) vessels from a case of tuber¬ 
culous meningitis, demonstrating the enlargement of the 
endothelial cells lining the peri-vascular lymph spaces ; 
(2) early tubercle of the urethra from a case of general 
tuberculosis; (3) organism in cancrum oris. In addition 
to the special germ, pneumococci, staphylococci, and 
streptococci were present, but the chief organism found 
was one resembling the Loffler bacillus. It was almost 
identical with the clubbed form described by Kanthack 
as an involution stage of the diphtheria organism. 1'r. 
Shennan had found a quite similar organism in a case of 
acute spreading gangrene, and in one of phagtedenatous 
chancre. In the former case culture through two gene¬ 
rations had resulted in a growth identical with that of 
diphtheria. 

Dr. R. A. Fleming showed (1) two stomachs showing 
mammillation, and (2) a heart with aneurysm of one of 
the sinuses of Valsalva. 

Drs. VV. Stewart and John Thomson showed a speci¬ 
men of congenital malformation of the oesophagus. 
Immediately after birth it was noticsd that the infant 
was unable to swallow, and on passing a gum elastic 
catheter it was found to be checked five inches from the 
mouth. On the third day of life a Witzel’s gastrostomy 
was performed and the child fed. It progressed well for 
nearly a day, and then died suddenly. On post-mortem 
the oesophagus was found to be completely occluded, and 
there was a communication between its lower part and 

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TRANSACTIONS OF SOCIETIES. 


Fbb. 8, 189ft 


the trachea; after being fed the child had vomited the 
food into its trachea and had been suff 'cated. A similar 
complication had existed in other recorded cases. 

Dr. P. McBride read a paper on 

THE TREATMENT OF OZ2ENA, WITH SPECIAL REFERENCE 
TO CUPRIC ELECTROL Y8I8. 

After alluding to the local atrophic condition in ozeena, 
the speaker said that the methods of treatment in vogue 
might be considered under the following heads(1) 
Destruction of the secreting area by curetting, &c. This 
was now recognised as useless. (2) Stimulating and 
irritating applications, such as iodine, and nitrate of 
silver sprays. Plugs probably acted in a similar way, 
and mechanical stimulation by the use of vibrating 
pledgets of cotton wool had also been tried. (3) As an 
organism resembling that of diphtheria had been found 
in some cases of ozena, the injection of antitoxin had 
been employed, but though some benefit had undoubtedly 
resulted, the effect had only been temporary. (4) More 
recently cupric electrolysis had been recommended. He 
had tried this in a great number of cases, and recounted 
ten of these. In almost all great benefit, and in some a 
complete cure, had accrued. The advantage of this over 
all other methods of treatment was that subsequent 
douching was not required, and that even in the morn¬ 
ing the smell was completely absent. The operation 
was very simple, cocaine being used as an ancesthetic. 
The copper (positive) electrode was thrust into the sep¬ 
tum, and the steel (negative) electrode, into the inferior 
turbinate. A current of from 3 to 10 milliamperes was 
required, and each sitting lasted ten minutes. Three or 
more sittings might be needed. Local discomfort rarely 
followed the electrolysis. It was of interest to note that 
though only one nostril was treated, both participated 
equally in the benefit. The rationale of the method was 
unknown. 

Drs. Logan Turner, Shennan, and Hunter spoke. 

Mr. Wallace read a paper on 

MOVABLE KIDNEY. 

After reviewing the literature of the condition, Mr. 
Wallace went on to discuss its pathology. He could not 
agree with the ordinarily accepted view that movable 
kidney was brought about by undue laxness of the 
abdominal parietes the result of repeated pregnancy; 
almost all his cases had been in nullipara. Attention 
had recently been called to the fact that floating kidney 
was more common in childhood than was generally sup¬ 
posed ; this, too, went against the above theory, and in 
favour of some congenital defect. In examining for a 
movable kidney, it was necessary to palpate all over the 
abdomen. He had seen the condition missed because 
the organ was lying low in the right iliac fossa. He had 
now performed the operation of nephropexy on fourteen 
occasions, and in all the patients save one, the symptoms 
had been completely removed In slighter cases a pad 
should be worn, and he showed a small inflatable rubber 
cushion which was intended to be sewn to the inner 
surface of the corset This was perfectly effective, cheap, 
and could often be worn when the ordinary belt was in¬ 
supportable. The point to be attended to in the use of 
these pads, was that the kidney must be in the proper 
position before they were applied. 

Mr. Cottbrill said that those cases which showed 
symptoms of renal calculus, and which were cured by 
operation, though no stone was found, were in all proba¬ 
bility cases of movable kidney, and the operation was 
beneficial by fixing the organ. 

Dr. Russell stated that in a series of post-mortems on 
old women, it had been almost the rule to find the right 
kidney very freely movable under the peritoneum. He 
had never been able to find a satisfactory explanation 
of the condition. 

Mr. Stiles and Dr. Church also spoke. 


A special general meeting of the Irish Medical 
Schools’ and Graduates’ Association will he held at 
5-30 p.m., on February 22nd. at 11 Chandos Street, 
Cavendish Square, the President (Dr. Mapother) in 
the chair, to consider certain proposed alterations of 
rules. 


LIVERPOOL MEDICAL SOCIETY. 

Meeting Held January 26th, 1899. 

R. S. Archer, M.D., Vice-President, in the Chair. 

THE VACCINATION ACT, 1898. 

Dr. Permewan proposed the following resolution:— 
“ That the members of the Liverpool Medical Institution, 
are of opinion that the Vaccination Act, 1898, waa- 
enacted in direct opposition to the findings of the Royal 
Commission; that the operation of the Act will be 
prejudicial to the public safety, and that its amendment 
is urgently required." 

Dr. Hope, in seconding the resolution, said he thought 
that the ter ms of the resolution were in no sense too 
strong, and quoted extracts from the Report of the Royal 
Commission, showing that the Act is in direct opposition, 
to the views which the Commission expressed. He also 
alluded to the mischief already resulting from the closing 
of the vaccination stations, which he considered most 
unfortunate and ill-judged. 

The resolution was carried nernine contradicente. 

Mr. C. Thurstan Holland showed radiographs of the- 
normal chest of a boy, and also of the chest of a boy in. 
whom the left apex was in a state of tuberculous consoli¬ 
dation. The difference was most marked, as also was the 
difference between the two sides of the affected child. 
This difference could also be plainly seen with the 
fluorescent screen. The exposure with a 10 in. coil waa 
60 seconds. This boy was set. 6fc. 

THE REMOVAL OF TUMOURS BEHIND THE TONSIL. 

Mr. Mitchell Banks described three cases of re¬ 
moval of tumours lying external to and behind the tonsil, 
with lantern slide illustrations. The first case was that 
of a young man in whom the tumour had been growing 
for many years, and had attained such a size as tc cause 
a marked projection behind the vertical ramus of the 
jaw. It was removed by the mouth. A vertical incision, 
being made over it, it easily shelled out without haemor¬ 
rhage, and was found to be an adeno-fibroma. as had 
been diagnosed. The second was a precisely similar case 
in a woman of forty, with a history of ten years’ growth, 
of the tumour. As she was very stout and full-blooded 
a preliminary laryngotomy was done, and the pharynx 
packed with sponge, but the bleeding was only trifling, 
and the tumour was easily shelled out with the finger. 
The third case was different, the patient being a small, 
thin, pale woman, about twenty years of age. A swell¬ 
ing had appeared behind the right tonsil about eight or 
ten weeks before her admission, and had been steadily- 
and rather rap dly increasing. There was a great deal 
of pain in it, and the swallowing was Beriously inter¬ 
fered with. The swelling was very elastic and ill-de¬ 
fined, insomuch that there was a question as to whether 
it might not be inflammatory, having as a L*cus some 
small, very deep collection of pus. Under chloroform, 
an excision of an exploratory nature was made through 
the thinned and flattened out tonsil, the finger came upon 
a distinct tumour, which felt as if it could be shelled 
out, although clearly very adherent at the upper and 
back part. In about a fortnight the patient’s suffering 
became extreme, and she was in danger of choking, so a 
preliminary laryngotomy was done and the pharynx 
plugged. Then a free incision was made over th& 
tumour and enucleation effected. This gave a remark¬ 
able view of the deep parts, and when the growth waa 
finally torn away it was found to be adherent to the side 
of the body of the third cervical veitebra. and to the base 
of the skull. Owing to very little use of cutting instru¬ 
ments the bleeding was slight. The jaw waa drilled 
and wired, and the cheek ana jaw soon united, but there 
is undoubted evidence that the tumour is beginning to 
grow from its deepest parts. Naked eye inspection and 
the microscope showed it to be sarcomatous. 

Mr. Paul referred to six cases of adenomatous tumour 
which he had met with on the palate and fauces. Three 
ulcerating and three encapsuled. The latter were per¬ 
fectly innocent, but the former class sometimes showed a 
malignant tendency. 

REMOVAL OF TUMOURS OF THE (ESOPHAGU8 BY 
PHARYNGOTOMY. 

Dr. Permewan described two cases of tumours of 

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Fbb 1 8, 1899. 

the CBsophagus which he had removed by sub-hyoid 
pharyngotomy. The first case, in which the growth was 
benign, died from the immediate effects of the operation; 
the second recovered without a rise of temperature. 
After describing the method adopted in each case, Dr. 
Permewan stated the conclusions he had arrived at in 
this operation, these were: (1) that sub-hyoid pharyn¬ 
gotomy is justifiable in spite of the large percentage of 
fatalities after it. (2) That it is admirably adapted for 
removal of growths from the lower pharynx, upper part 
of the oesophagus, and also from the upper aperture of 
the larynx. As a preliminary to resection it is valuable 
a3 giving a more complete view than that obtained by 
thyrotomy. (3) That to insure a safe operai ion a pre¬ 
liminary tracheotomy is necessary. (4) That no attempt 
should be made to close the wound after operation, but 
that it should be plugged by gauze and allowed to heal 
by granulation. (5) That feeding should be by the 
oesophageal tube exclusively. 

Mr. Robert Jones read a paper on 

SOME POINTS IN THE SURGERY OF THE PAHALYBI8 OF 
CHILDREN. 

He deplored the lack of interest displayed by the profes¬ 
sion in the treatment of these affections. This was due 
to the pessimism derived from the pathology. It was 
essential that there should be surgical supervision almost 
from the onset, as without mechanical and operative 
help the physician was powerless. The pathology re¬ 
quired working up and further experiments made. This 
should consist of inoculations at an early stage, and of a 
search for the microbe. In view of recent experi¬ 
ences of his own, of outbreaks of an epidemic 
character at Stockholm, in America, and in Aus¬ 
tralia, there was strong evidence of the influence 
of infection. With care, most of the deformities of 
polio-myelitis, might be avoided, more especially those 
due to contractures, and by mechanism so applied as to 
equalise groups of antagonistic muscles, apparently very 
old paralyses, could be remedied. A diagnosis, often 
difficult, should be made between a paralysed group of 
muscles and a group merely rendered useless by the un¬ 
controlled action of opponents. Mr. Jones discussed the 
question of tendon-grafting and the conditions suitable 
to it. He thought the operation likely to prove very 
valuable in a number of cases. He had operated upon 
five cases. In two he had inserted the sartorious into 
the tendon of the paralysed quadriceps. In two cases he 
had inserted the peronei into the paralysed tendo- 
achilles, for talipes-calc meous. In one case he reinfoiced 
the tibialis-anticus by means of the peroneus-longus. In 
a case of talipes equino-valgus, the peroneus longus may 
be inserted into the tibialis posticus, or instead of the 
peroneus longus, a strip of the tendo-Achillis. Mr. 
Jones had operated upon over 66 flail joints in accordance 
with the rules he laid down in 1894, suppuration only 
occurred in one case. No matter what the trophic changes, 
healing seemed to occur without hindrance. He often 
anohylosed both knee and ankle at the same operation. 
In talipes-calcaneus a good view of the joint might be got 
from behind, the cartilage freshened, and the tendo-Achil¬ 
lis could be at the same time shortened. This operation 
he substituted for Nillet’s. After obtaining either short 
fibroas or bony anchylosis in knee or ankle, the psoas and 
iliacus muscles moved the limb in one piece, and so ex¬ 
pensive and troublesome appliances could be dispensed 
with. In dealing with spastic paraplegia, Mr. Jones 
combated the dicta of neurologists in regard to 
tenotomies. He divided the tendo-Achillis, and any other 
tendons which were tense, and in obstinate oases, ex¬ 
sec ted portions of the adductors. Both limbs were then 
kept in extreme abduction for several weeks; very fair 
walking results were obtained. In very spasmodic cases 
he strongly urged arthrodesis. 

Mr. Paul quoted, in support of Mr. Jones's advocacy 
of tendon grafting, the result obtained in a case of which 
the distal end of the long flexor of the thumb was 
grafted on to that of the index finger. The boy ulti¬ 
mately became a fair pianist, and could flex either digit 
independently, presumably by automatic action of oppos¬ 
ing muscles. The paper was further discussed by Dre. 
Murray, Warrington, Paul, and Barr. 


The Medical Press. 139 

BRADFORD MEDICO-CHIRURGICAL SOCIETY. 
Meeting held on January 17th, 1899. 

The Vice-President, Mr. Horrocks, in the Chair. 


Dr. Enrich gave a microscopical demonstration. 

Dr. Rabagliati showed a tumour of the uterus weigh¬ 
ing 11 lbs., which had been successfully removed. The 
tumour was found to be a fibro-myoma. The case was 
complicated by the presence of a malignant tumour in 
the left breast. 

Cases Shown. 

Subconjunctival dislocation lens—Dr. A. Bronner. 

Luxation of lens into anterioi chamber—Dr. Kerr. 

Child recovered from lateral sinus pyaemia—Dr. Kerr. 

Lupus of face and neck—Mr. Althorp. 

Dr. Kerr read notes on “ two cases of lateral sinus 
pyaemia,’ which will be found under the head of ‘ Clinical 
Records.” 

Mr. Althorp read notes on 

a case of lympho-sarcoma, 

involving the stomach, colon and rectum. The patient 
was an unmarried woman, rot. 29, a cook. The first 
symptoms of illness were in June, 1898, and consisted of 
diarrhoea and vomiting, with fever The fever persisted, 
but the other symptoms subsided with rest in bed. On 
Sept. 10th she was admitted to hospital with symptoms 
of chronic intestinal obstruction, and on examination a 
growth of the rectum was found. It infiltrated the 
surrounding tissues, and almost blocked the lumen 
of the gut, not allowing the passage of the finger 
past the obstruction. Left inguinal colotomy was 
performed on September 21st, the fingers introduced into 
the abdominal cavity felt the pelvic contents matted 
together. The patient progressed satisfactorily, and 
the bowel was opened on the fifth day. For about six 
weeks the patient did well an! was able to be up and 
about the ward, but at the end of that time began to 
complain of abdominal pain until her death on November 
16th. There had been free discharge of faeces all this 
time. A fortnight before death a swelling was noticed in 
the position of the transverse colon, and during the last 
week of life she vomited freely. At the autopsy there 
was found a growth involving (1) the stomach in its 
pyloric half, the small curvature, and spreading up to 
the oesophagus; (2) the caecum, ascending and trans¬ 
verse colon ; (3) the rectum matting together the pelvio 
contents. There was only one secondary growth, which 
was in the bronchial glands. Mr. Althorp remarked on 
the extensive nature of the growth, which had caused no 
obstruction, except in the rectum The treatment of 
rectal growths was also discussed. 

Dr. Enrich gave a description of the microscopic 
appearances of the growth, pronouncing it to be a 
lymphosarcoma. He discussed the nature of lympho¬ 
sarcomata, and suggested a parasitic origin in the case 
under consideration, although there was no direct evi¬ 
dence in the shape of organisms. He remarked that 
there was a pigment in some of the cells of a faint, 
greenish colour. He did not consider the deposit in the 
bronchial glands a secondary growth, but a primary 
manifestation. 

Die. Horrocks, Goyder, Hall, and Metcalfe, discussed 
the case. 


NORTH OF ENGLAND GYNAECOLOGICAL 
SOCIETY. 

Meeting held at Manchester, January 20th. 1899. 
The President, Dr. Donald, in the Chair. 
Specimens. 

1. Dr. Briggs (Liverpool) showed a Soft Fibroid 
Tumour removed from the Uterus by Enucleation 
through the Abdomen. 

2. Dr. Nathan Raw showed a Ruptured Uterus, 
with an Ovarian Cyst, removed by Abdominal Section, 
after delivery of a child at full term. The patient, a 
multipara, had been in labour for three days, under 
the care of a midwife. She was then seized with intense 

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140 The Medical Press. 


FRANCE. 


Feb. 8, 1899. 


E ain in the abdomen and haemorrhage, with great col- 
ipse. On admission to the hospital she was pulse¬ 
less, and four pints of saline fluid were transfused 
into the median basilic vein with very beneficial 
results. On examination, the vaginal vault was pashed 
down by a large Arm swelling behind the uterus, 
suggesting an ovarian tumour. The cervix was high up 
under the pubes. The umbilical cord was prolapsed, and 
the placenta lay in the lower uterine segment. This he 
rapidly detached and a foot was brought down. A loop of 
intestine was then found lying in the uterine cavity 
showing that the uterus was ruptured. The child was 
quickly extracted, and a large tear in the posterior wall 
was then discovered. Saline fluid was again transfused, 
and abdominal section at once performed. The peritoneal 
cavity contained a large quantity of blood and clots, and 
the contents of the ovarian cyst which had undergone 
tension had ruptured. The uterus was rapidly 
amputated, and removed together with the cyst. The 
patient rallied well, but gradually sank, and died from 
exhaustion on the third day. 

Bemarks were mode by Drs. Lloyd Roberts, Sinclair, 
Wright, Walter, and the President. 

Dr. T. Arthur Helme read the notes of a 

CASE OF DEGENERATING FIBROID REMOVED ALONG WITH 
THE UTERU8 BY ABDOMINAL HYSTERECTOMY. 

The patient, tet. 29, had suffered for ten months from 
haemorrhage and severe pain, and on one occasion had 
retention of urine. The pain came on after the use of 
ergot. Previously she had not felt any pelvic pain. 
As the haemorrhage was only controlled by plugging the 
uterus, it was thought advisable to operate The uterus 
was therefore completely removed through the abdomen. 
The vaginal roof was covered with a layer of peritoneum 
detached from the anterior surface of the uterus and 
carefully sutured. No drainage of any kind was employed. 
The patient made an uneventful recovery. The tumour 
was found to occupy the posterior wall of the uterus, 
and had become partially extruded into the cavity oc¬ 
cupying also the upper part of the cervical canal. 
A point of interest was the effect of the administration 
of ergot in setting up violent uterine contractions, re¬ 
sulting in severe pain, and also causing partial extrusion 
of the tumour and leading to increase of the haemorrhage. 
The degeneration appeared to be the result of partial 
cutting off of the blood supply to the tumour. 

Remarks were made by Drs. Walter, Davies, Lloyd 
Roberts, Briggs, and the President. 

Dr. W. E. Fothergill read a paper on some 
AUTO-INTOXICATIONS OF PREGNANCY. 

Tne presence of albumen in the urine of eclamptic 
women, and the occurrence of various lesions in the 
kidneys, the author remarked, had led to the view that 
eclampsia was of renal origin. This theory, however, 
has of late years been questioned by many. Albumen 
may be absent from the urine. Again, the urine, though 
small in quantity, is low in toxicity, whilst the blood 
serum is much more poisonous than in health. The con¬ 
stant presence of necrotic and hsemorrhagic lesions in 
the liver has led to the view that in these cases this 
organ is really at fault. Jaundice is sometimes associated 
with eclampsia, and in acute yellow atrophy of the 
liver, which is peculiarly liable to occur during 
gestation, the lesions in the liver are an ex¬ 
aggeration of the changes met with in eclampsia. 
It is probable then that eclampsia should be regarded 
as an auto-intoxication of hepatic origin. The various 
affections of the nervous system during pregnancy, such 
as polyneuritis, myelitis, Ac., are clearly toxic in orgin. 
Melancholia and mania of pregnancy have probably a 
similar origin. A number of the slighter ailments 
of gestation such as vomiting, salivation, pruritus, 
neuralgia, and the changes of temperament, are regarded 
by many writers as manifestations of minor degrees of 
auto-intoxication. When the extra strain thrown upon 
the various organs during pregnancy is considered, it is 
easy to understand that a disturbance of the equilibrium 
between poison production and poison destruction may 
readily occur, and it is found by observation that the 
blood serum is more toxic during gestation than in health. 
The subject is by no means fully worked out, but the 


auto-intoxication theory forms a useful working hypo¬ 
thesis, and may help, by associating a number of diverse 
conditions together, to afford a new grouping of these 
troubles. It is probable in the future that a number of 
these morbid conditions will be united under the term 
hepatic toxaemia, as suggested recently by Pinard. 

Dr. Gemmell said that in the puerperium many cases 
with pyrexia, which were classed as septicaemia, were 
really examples of toxaemia, arising from the liver, 
kidneys, or alimentary tract. He related a case in which 
the patient after natural labour had pyrexia and quick 
pulse, with an absence of any local signs. The blood 
and lochia were examined bacteriologically, but no strep¬ 
tococci were found. At the end o* four days suppression 
of urine came on, and the patient died of uraemia. At 
the autopsy no evidence of disease of the kidneys could 
he discovered. 

Dr. Wright and Dr. Walter also discussed the 
paper. 

The following were elected Office Bearers for the year 
1899 :—President, Dr. Donald; Vice-Presidents, Drs. J. 
Benson, J. Braithwaite, J. Cregeen, W. E. Fothergill, J. 
E. Gemmell, C. Richardson, J. Sinclair, and G. Thorpe ; 
Hon. Treasurer, Dr. Richard Farrell; Hon. Gen. Secre¬ 
tary, Dr. Arnold W. W. Lea; Council, Drs. R. A. Bran- 
nigan, E. Buxton, C. t_«wynne, D. L. Hamilton, T. A. 
Helme, J. B. Hellier, T. D. Leigh, J. Matthews, E. H. 
Monks, S. Nesfield, W. Smith, Lloyd Roberts, J. E. 
Scowcroft, J. P. Stallard, J. D. Martin, D. Smart, C. 
Breker, W. Walter, A. E. Wear, a"d R. E. Williamson; 
Honorary Local Secretaries, Dr. John Scott (Manches¬ 
ter), Dr. W. Fingland (Liverpool), Dr. E. O. Croft 
(Leeds), H. Rhodes (Sheffield). 


Jrancc. 

[from our own correspondent.] 

Paris, February 5th, 1899. 

Hernia and the Bicycle. 

M. Lucas-Championniere read a paper on the cure 
of an inguinal hernia by the use of the bicycle, and 
declared that for a long time he had considered that rest 
generally advised to persons with rupture was much less 
beneficial than muscular exercise. It was easy, he said, 
to observe that working men tolerated much better their 
hernias than habitually inactive persons. All kind of 
sports could be recommended to ruptured individuals, 
but that of the bicycle was the best of all. In a person 
seated on the machine the hernia had no tendency to 
come out, it remained in the abdominal cavity and dis¬ 
appeared in time. The bicycle exercise improves besides 
the general health, and produced a decrease in the 
embonpoint, which was greatly to be desired in such 
cases. To obtain this result, the bicycle should be used 
according to method ; the person should be seated on a 
low saddle, and as much behind the axis of the pedals as 
possible ; uphill or rapid riding should be forbidden. 

M. Robin related seven cases of acute articular rheu¬ 
matism, and one case of acute blenorrhagic rheu¬ 
matism treated by methylene blue. In all the cases, 
save one, this drug proved equal to salicylate of soda. 
Never was any unfavourable symptom observed through 
its employment on the condition however, that the 
methylene used was chemically pure. 

Tuberculous Abscesses. 

M. Lannelongue spoke, at the Academy of Sciences, on 
the treatment of tuberculous abscess, and said that it was 
rare that such abscesses got well spontaneously, and 
generally they required early intervention, consisting in 
extirpation of the tumour or in successive modificating 
injections. 


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GERMANY. 


The Medical Press. 141 


Fib. 8, 18 99 

The ablation by the bistoury of all the purulent collec- 
-tion was naturally the ideal method, if the tumour could 
be removed without opening it; but each time that the 
■cyst was more or less voluminous or deep-seated there 
was risk in opening it in dissection. Consequently it 
was preferable to empty the cyst first, and then use the 
■curette on the walls. But this method was attended with 
some danger, as it exposed to general infection, by the 
introduction of the bacilli into the open vessels, and one 
was never sure that a portion of the virulent disease had 
not been left behind. Injections, on the other hand, gave 
excellent results when properly practised, 

The trocar should be of a certain size, and passed 
through a portion of the healthy skin. Once the pus was 
■evacuated, the cyst should be washed out with a one per 
cent, solution of phenic acid until the returned liquid 
was seen to be perfectly pure. Then an ounce of the 
following solution should be injected:— 

Iodoform, ) 

Sulph. ether, ( ^* 188 ' • 

Creosote, 5sa.; 

Sweet almond oil, Jiij. 

Out of 17 patients thus treated, 4 got well after one 
injection, 3 after two, 3 others after four, and 1 after five 
injections, while the remaining 6 had fistula and go^ 
well in from ten months to two years. 

Post-partum Hemorrhage. 

Prof. Baatian, of Geneva, recommends in the treatment 
■of post-partum hemorrhage the following simple opera¬ 
tion :—A bivalve speculum is introduced and opened as 
largely as possible, and after cleaning out the clots, 
iodoform-gauze is packed in until the whole cavity is 
filled. But the point in the method is that the speculum 
is left tn $itu. At the end of twelve hours it is with¬ 
drawn with a portion of the plugging, and twenty-four 
hours later the remainder is removed. 


<§ermanp. 

[from our own correspondent.] 

Berlin, February 4th, 18W). 

Curative Institutions for Phthisis. 

At the meeting of the Society for Innere Medizin of 
the 0th inst., Hr. von Leyden reported on the action of 
the Central Committee formed for the furtherance of the 
echeme for the erection of Institutions for the treatment 
■of phthisis. The committee had decided to summon a 
•Congress in Berlin in May for the consideration of steps 
for the campaign against tuberculosis. For the various 
divisions of the subject, aetiology, prophylaxis, and treat¬ 
ment, distinguished physicians would be selected to 
introduce the subjects. As regarded the Berlin-Bran- 
denburg Branch Society there was a steady development 
that had overcome various difficulties, such as ways and 
jneans and the site of the proposed buildings, and the 
•results, so far, had been satisfactory. Their means 
would suffice for the erection of an Institution in Belzig. 
To this would be associated Bleichroder’s endowment. 
The Institution would afford accommodation for 100 
beds, and for the success of the undertaking the speaker 
■called npon all medical men to try to obtain the active 
interest of their clients. 

Hr. Milchner then followed with a note on 

The Cbll8 in the Ascitic Fluid of Lkucemia. 

Ehrlich and Lazarus had proposed the question 


whether it was possible to distinguish between the active 
and the passive forms in leucocytosis, i.e., whether 
leucocytes found their way into the blood by their own 
movements (active form), or whether they were swept 
there mechanically (passive form). In the first group 
the cells must move towards an inflamed part, and be 
met with in the exudation. This was so in the poly¬ 
nuclear form in eosinophilia (such as pemphigus and 
bronchial asthma), in which the eosinophile cells are 
found in the inflammatory products. In the second 
form no wandering of the leucocytes took place, and 
accordingly they were absent in the inflammatory pro¬ 
ducts. Whilst in lymphocytosis there was proof that the 
form was active, in myelogenous leucaemia there was no 
certain proof of it, although Ehrlich believed it, and in 
a pleuritic effusion had seen “ Mast’’ cells. The speaker 
had now made dry preparations, from the ascitic fluid 
from a case of leucaemia (myelogenous form), stained 
with eosin, methylene blue, which showed all three forms 
of cells, so that the myelogenous form might also be 
considered active. 

Hr. L. Jacobson then read a paper on 
Changes in the Spinal Column after Peripheral 
Paraltsis. 

He showed preparation from a case of recurrent cancer 
of the left breast that had implicated the nerves in the 
clavicular fossa. Pain came on in the left arm ; it began 
to swell; motor weakness showed itself that soon 
developed into complete paralysis. There was also great 
disturbance of sensibility, first on the inner, then on the 
outer side of the arm Muscular atrophy of the deltoid 
and of the supra and infra spinatus, faradic and galvanic 
excitability completely extinguished. The diagnosis 
could not be doubtful; paralysis of the left brachiaj 
( plexus from pressure. The diagnosis was confirmed after 
death. The brachial plexus, along with the vessels, was 
removed. The nerves were grey-coloured ; they had under¬ 
gone gelatinous degeneration ; the axillary vein was com¬ 
pletely blocked by thrombosis, hence the osdema. A 
transverse section was made through the plexus and 
stained. No nerves contained medullary tissue, as only 
a comparatively short time elapsed between the com¬ 
mencement of the symptoms and death, the case was suit 
able for determining what change had been set up 
in the spinal cord. The cord was therefore removed 
without any trace of cancerous disease being discoverable 
in it. The changes found must, therefore, have been 
purely secondary. The cord was treated in various ways 
for the purpose of microscopic examination. The cells 
of the lateral column of the anterior horn were rounded 
off, without processes, pale, the nucleus was absent or 
eccentric, the median cells unchanged. In the lateral 
horn also the cells were smaller and thickly pressed to¬ 
gether—on the left, full numbered but highly coloured; 
on the right, deficient in number and atrophied. The 
anterior roots on the left were slightly atrophied. 
Sensory parts: the posterior roots distinctly degenerated. 
Atrophy of the cells in the lateral columns and in the 
posterior horn ; some descending roots were also changed. 
The condition found was of pathological interest. Von 
Leyden first gave expression to the opinion that degener¬ 
ation of the posterior column ia tabes dorsalis was 
secondary to lesion of the posterior roots. This view was 
now generally accepted. A controversy had now begun 
as to where the tabetic process commenced. Von Leyden 
assumed that it begun in the periphery, and the secondary 


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142 The Medical Press. A U S T RIA , ___ Feb. 8, 1899. 

retrograde lesion was in favour of this. Against this it perfect relief. Similar success attended a case of phthisis'- 
had been objected that the tabetic lesion was consider- treated with codeia, ext. of opium, hyoscyamus and 


ably greater than that of the simple secondary lesion. 
This case, which comprises both recent and older 
degenerations, which showed a degeneration gradually 
increasing with length of time was in favour of the 
correctness of von Leyden’s views. 

The Prevention of Childbed Fever. 

This much discussed subject has again recently had 
attention drawn to it by an article in the Berl. Med. 
Wochetuch, 46 98, by Prof. Hofmeier, of Wurzburg. In 
a recent work he sought to show that obstetric wards 
could be made full use of for teaching purposes with 
perfect safety, so long as proper measures for disinfection 
of hands and genital passages were adopted and rigidly 
enforced. As temperature may be looked upon as a 
reliable test, the “ surest touchstone ” in fact of normal 
childbed, the noting of the temperature should be above 
suspicion. He has therefore published a record of 
another (fourth) thousand cases of labour in which 
the temperature was taken throughout by a 
physician instead of in the usual way by a nurse. 
In the thousand cases there were seven deaths, 
but these were all due to grave obstetric complications 
or general diseases. There was no case of infective 
disease in the general Bense in the whole series. The 
cases therefore demonstrate the correctness of the posi¬ 
tion he has taken up, that obstetric teaching is no bar 
to successful management of the puerperal state. He 
attributes the excellent results obtained, not to any 
superior sanitary arrangements, as the clinic stands far 
behind some modern institutions in this respect, not to 
any complicated methods of disinfection and sterilisation, 
such as are carried o ut in many places, but simply and alone 
to the method of treating lying-in cases always followed 
in the Wiirzburg Klinik, viz, that of thorough 
disinfection by means of 1 in 2,000 solution of subli 
mate. 

JUiBtria. 

[from our own correspondent.] 

Vienna, February 4th. 1899. 

The New Drug Heroin. 

Tau8yk has been experimenting with thi6 new sedative 
for some time past, and has now ventured on a report of 
sixteen cases. Among these are eight suffering from 
phthisis pulmonalis, one of croupous pneumonia, one of 
pleuritis, and four of bronchitis. In all these cases 
treated with heroin the cough wa9 immediately checked, 
or greatly modified, as the action of the drug is rapid 
and potent in its effects. The subjective symptoms are 
speedy relief and perfect comfort. In one caad of bron- 
ohial asthma 0 003 of heroin relieved great dyspnceal 
distress, which has not since returned. 

In other experiments he tabulates the comparative 
values of heroin and morphia. 

In cases of chronic cough which have lasted for w eeks 
he has repeatedly given 0 003 gramme (0 046 of a grain) 
of morphia without the slightest amelioration, while the 
same quantity of heroin checked it instantly, and left 


morphia. 

Heroin is also potent as an anodyne in cases of neu¬ 
ralgia in the trigemini, enteralgia, and hemicrania, while 
its efficacy in diabetes is undoubted. 

After long use the dose requires to be increased to 
0 005 gramme, owing to the peculiarity of babit. Ther® 
is only one case where stupor or giddiness was observed 
from the long and repeated use of the drug. 

Tausyk prefers giving it in powder foim with sod® 
bicarb , &c., one hour and a half before food. Here com¬ 
mends that the quantity taken daily should not exceed 
•01 gramme or 15,432 of a grain, which might be in¬ 
creased in extreme cases to 003 grammes or O'4,629 
grains. Its greatest virtue, however, is in the relief of 
cough, which renders it invaluable in phthisical coughs. 

Tannopin. 

Tannopin, according to Fuchs, is a combination of 
tannin and urotropin, possessing the astringency of the 
former and the anti-bacterial action of the latter. It is,, 
therefore, useful as a styptic and disinfectant in the 
alimentary canal. It contains 87 per cent of tannin and 
13 per cent, of urotropin. It is of a yellow colour, 
hygroscopic, soluble in water, alcohol, and ether, but 
slowly dissolved by weak alkalies. In an alkaline canal 
the tannopin is split up into its component parts. This 
new drug has been used with benefit in cystitis, ente¬ 
ritis, &c., but requires to be given in good large doses of 
4 grammes. In chronic conditions it is not so effectual, 
unless in cases of diarrhoea, when both forms are bene¬ 
fited by its use. 

Tabes Dorsalis and Nerve Stretching. 

At the “ Gesellschaft der Aerzte,” Benedikt showed a 
man on whom he had successfully operated by stretching 
the nervus ischiadicus. which quite relieved the pain, 
removed the parassthesia, and restored the functional 
activity. 

This operation is contra-indicated where the respira¬ 
tion is impaired or interfered with, in consequence of 
laryngeal irritation. In suitable cases, however, he is 
convinced that nerve stretching is an excellent 
expedient. 

Clinical Extension. 

Another era has been opened this week in the Aural 
department of the Allgemeinen Krankenhaus. Hitherto, 
Prof. Politzer’s beds have been, since Billroth’s time, 
indiscriminately scattered among the surgical patients, 
which are forthwith to be isolated and kept quite apart 
from other surgical cases. 

Boycotting the Chemists. 

A feud has broken out between the chemists and the 
charitable societies of Vienna that has led to the applica¬ 
tion of “ Boycotting ” of 105 of the “ Wiener Apotheken."’ 
Every country has its own peculiar party of pseudo¬ 
philanthropists who preach and practice chanty at 
another’s expense with tyrannical vehemence, and whose 
contributions to such objects are never discovered. A 
large charity of this kind, under the name of the “ Wiener 
Genessenschafts-Krankencassen,” exists in Vienna for 
i the supply of medical attendance and medicines to the 


the patient in a vastly improved btate of health after its poor, which is none other than the middle-class, at a 


effects had passed off. In other cases 0'06 to 0T0 (0 9259 greatly reduced rate. Before the “ Chamber of Medi- 
to 1543 grains) of codeia was given with little or no i cine ” was formed this class was a source of trouble to the 
effect, while 0 003 gramme (0'046. gr. of heroin gav® medical profession, as many would not listen to their 


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Fsb. 8, 1899. 


THE OPERATING THEATRES. 


ThB MEDICAL PRE8S. 143 


terms. Since then a tariff has been fixed. Somehow the 
apothecaries have not yet got a proper fixed understand¬ 
ing about the price of the medicine to be paid by those 
so-called charitable institutions, which the chemists 
think are able to pay a better price. On this account 
the charity has issued a ban under the heading of •* Boy- 
cot ” against 108 of these uncharitable unbending 
chemists. 


‘Ihe ©perating Uhcatrce. 

GUY’S HOSPITAL. 

Introduction of Bonk fob the Restoration of an 
Old Comminuted Fbacture of the Tibia.— Mr. 
Abbuthnot Lank operated on a girl, set. 14, who, when 
18 months old, sustained a fracture of the tibia, which 
did not unite. On subsequent occasions the intervening 
fibrous tissue and the adjacent ends of the tibia had been 
removed, with the idea of establishing union between tho 
raw surfaces of bone. At the present time, however, the 
foot was almost useless, being displaced inwards, owing 
to the upward and outward inclination of the lower frag¬ 
ment of the tibia. Both ends of the tibia were separated 
from one another by a considerable interval, with no 
connection between them. Mr. Lane cut down on 
the fragments and cleared them from the adjacent 
soft structures, and was then able to restore 
the lower fragment of the tibia to its normal 
relationship with the fibula, and to render its axis con¬ 
tinuous with that of the upper fragment. While they 
were retained in this position to one another a rabbit 
was killed, its femurs removed, and their ends trimmed; 
they were then laced by means of silver wire to the tibial 
fragments so as to keep them apart and continuous with 
on? another. On relaxing traction on the foot and lower 
fragment, the interpossd bones were found to serve this 
purpose in a perfect manner. The external wound was 
then closed and the leg immobilised in a suitable appa¬ 
ratus. Mr. Lane said he did not think it would be 
advisable for the patient to transmit his weight through 
the part for at least a year. He considered the 
important points in the introduction of & consider¬ 
able quantity of bone were: the absolute immo¬ 
bilisation of the graft, and that a sufficient 
interval of time should elapse between the opera¬ 
tion and any attempt to make use of the part; the 
length of this interval would vary with the age of the 
patient, the quantity of bone introduced, the security of 
its attachment, and the amount of force it would be 
required to transmit. 

Operation in a Case of so-called Pott’s Fracture.— 
The same surgeon operated on a nurse, set. 42, who 
exhibited the fracture of the fibula and displacement of 
the foot that results from forcible abduction, which is 
called, as Mr. Lane remarked, by the very unscientific 
a nd unmeaning term, "Pott's fracture.” Being em¬ 
ployed in a large general hospital, the patient 
had had the advantages of the best surgical treatment 
of the present day; in spite of this, however, the lower 
fragment of the fibula was ankylosed to the upper so 
as to form a considerable angle with it; the foot 
was displaced outwards and a little backwards so 
that an interval existed between the inner malleolus and 
the astragalus, and the patient was unable to walk. As 
she could no longer follow the occupation for which she 


had been trained for many years, and upon which sher 
was dependent, it was clear, as Mr. Lane pointed out, that 
the financial depreciation consequent upon her injury 
was complete, or, in other words, amounted to 100 per 
cent. He cut down on the fibular junction and freed the 
lower fragment from the surrounding soft parts; the 
junction was cut through obliquely in such a plane as to 
enable the upper end of the lower fragment to be brought 
backwards and outwards, while the outer malleolus was' 
made to move forwards and inwards, this fragment being 
rotated round a fulcrum formed by tho inferior tibio¬ 
fibular ligaments; in this manner the astragalus was 
brought into its normal relationship with the inner 
malleolus, and the foot with that of the leg; the 
fragments were wired securely together in this position. 
Mr. Lane said this formed one of the innumerable 
instances showing the impossibility of replacing the 
fragments of the fibula in accurate apposition by any 
form of manipulation when they had been displaced by 
excessive and forcible abduction, even when the tibia was 
uninjured Ho hoped that the time would soon come 
when surgeons would display a little more intelligence in 
the treatment of these conditions, and a little more 
scientific accuracy in their statements. They seemed at 
the present time, he said, distressingly anxious to bolster 
up the absurd idea that it is possible by abduction of the - 
foot to so exert force upon the lower malleolus as to 
bring the upper end of the lower fragment into 
apposition with the lower end of the upper 
when there existed no such mechanism by means- 
of which this could be effected. They could 
hardly realise, he thought, that the treatment 
they had adopted all their lives was an absurdity, and 
they would conceive any statement to the contrary a 
reflection on their intelligence. He showed another case 
of so-called Pott's fracture in a young artilleryman, set. 
24, in whom the fibula had been fractured about an inch 
and a half above the tibio-fibular articulation, and the 
inner malleolus had been broken transversely midway 
between its base and summit. It occurred through his 
having been thrown off the limber of a gun in June, 

1898. He was invalided out of the service in January, 

1899, as being physica'ly unfit to follow his duty. At the 
present moment he was unable to follow any employment 
because of the pain he suffers in his foot and ankle 
when he walks. The foot is displaced outwards. The 
fragment of the inner malleolus has followed the astra¬ 
galus, and has united to the tibia in this abnormal 
relationship. The fibular fragments formed the 
usual angle with one another. Here, Mr. Lane said, 
was a man who was obliged to give up the employment 
by which he earned his living, and eight months after 
he had sustained his injury he was so much incapacitated 
as to be unable to follow any employment other than 
sedentary, and for this kind of work he was quite un¬ 
prepared by any previous training. His financial depre¬ 
ciation then was obviously complete, and he was pre¬ 
pared to submit to any operation which would afford 
him some chance of obtaining a livelihood by relieving 
some of his present physical disability. Mr. Lane pur¬ 
posed cutting away the malleolar fragment from the 
tibia, dividing the fibular junction in a suitable plane, 
and restoring as far as possible the astragalus to ite 
normal relationship with these bones. How different, he 
remarked, would have been the condition of these two 
patients if the fragments had been exposed and fitted 

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Feb. 8, 1899. 


: accurately together at the time of the injury. Their 
mechanics would have been as perfect after the injury 
as they were before. 


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•‘SALIS POPCLI SUPREMA LEX.” 


WEDNESDAY, FEBRUARY 8, 1899. 


THE INEBRIATES' ACT. 

There can be no doubt that by the Inebriates’ Act 
passed last year, and coming into force within a few 
weeks, a great advance has been inaugurated 
in the attitude of the Legislature towards the 
alcoholic habit. In other words, the Government 
has formally recognised and acted upon the principle 
that chronic alcoholism is the symptom of some 
deep underlying condition of the individual, and is 
not a mere criminal lapse from moral standards, as 
laid down by the wisdom of Parliament. For our 
own part, we consider that a fraudulent company 
promoter is infinitely more deserving of punishment 
than the habitual drunkard who simply soaks gin 
until reason is in abeyance and then commits a 
technical breach of the law. Yet the one lives in 
secure millionaire affluence while the other registers 
by the hundreds his appearances in the police court 
and his sojournings in prison. But while recognis¬ 
ing as a profession that a vast concession has been 
made to medical science in thus treating chronic 
inebriety as a disease, it is nevertheless important to 
keep in mind other issues that are involved in the 
administration of the Act. The Departmental Com¬ 
mittee appointed to advise on the subject of the 
Act has issued a blue book, in which they deal 
among other matters, with three classes of institu¬ 
tions, namely, (1), State inebriate reformatories; (2), 
certified inebriate reformatories; (3), private retreats 
for inebriates. As regards maintenance, they remark it 
mustbe borne in mind that inmates of inebriate refor¬ 


matories will require efficient medical supervision, and 
for an institution of any size it is of the greatest 
importance that the Superintendent should be a 
thoroughly competent medical man. That is a point 
which will be emphatically endorsed by all who have 
had any acquaintance—and what medical practitioner 
has not?—with the complex is-ues involved in the 
practical treatment of alcoholism. It may almost 
be said, indeed, that the medical man who has 
acquired proficiency in that particular point has 
approached the acme of professional skill, and we 
trust that many of these important posts under 
the Act, so fraught with potential benefits to 
the community, may be placed in the hands of 
the profession that by training and temperament is 
best fitted to discharge them to advantage. Then 
the Committee make the obvious remark that the 
whole scheme of the treatment of inmates should be 
based on the principle that they are detained for 
reformation, and not for punishment. Towards that 
principle alike should be directed the dieting, the 
discipline, the religious and moral training, and even 
the forced labour. The improvement of the impaired 
physical condition, the inculcation of regular and 
industrious habits, the occupation of the mind by a 
constant round of duties, and reasonable recreation 
carried on in intercourse with their fellows, which 
should be as unrestricted, and, therefore, as cheerful 
as discipline allows, and would be the chief factors in 
rousing the lost self-respect and sharpening the 
blunted conscience of the inmates. Every inmate 
should be encouraged to exercise his faculties and 
employ his time as remuneratively as possible. He 
should therefore be employed m that kind of work for 
which his training and capacity suited him, no 
matter what that work might be, provided it could 
be exercised and supervised in the reformatory 
without serious inconvenience. All that commentary 
reads admirably and speaks well for the rational and 
thorough administration of the new Act from the 
curative standpoint. There are other important 
elements involved, as already hinted, and these it will 
be well to consider briefly, or else it seems not alto¬ 
gether improbable that for the short punitive sentence 
of imprisonment hitherto passed on the drunkard we 
may find suddenly substituted long terms of what prac¬ 
tically amounts to imprisonment under another name- 
With regard to chronic inebriates there appears to 
be little objection to bringing them under such a 
provision, for as the Home Secretary has pointed out 
in a circular letter to the judges : “ You will observe 
that under the Act you have power to order an 
inebriate qualified thereunder to be detained for as 
long a period as three years. There would appear to 
be a consensus of opinion among medical men and 
others experienced in the treatment of inebriates that 
in order to give a chance of effectual operation to 
even the best-designed method of reformatory treat¬ 
ment a considerable period of detention, amounting 
in most cases to nearly a year, is essential. 
It is found that detentions for short periods, 
such as three, six, or nine months almost 


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LEADING ARTICLES. 


The Medical Press. 145 


invariably prove ineffectual in securing the 
desired reformation.” Agreeing with those pro¬ 
positions one can hardly avoid Sir Matthew Ridley’s 
conclusion that the chronic inebriate should be 
detained for three years, and we have no more sym¬ 
pathy with him than with any other person of un¬ 
sound mental calibre. It is quite another thing, 
however, when we find the power to detain for a 
similar period any person convicted of drunkenness, 
for that is how we read the Act. That is to say, 
an enormous discretionary power has been placed in 
the hands of magistrates whereby they may arbi¬ 
trarily shut up citizens for several years in a 
virtual prison for simple drunkenness, which is 
in itself not a crime. It is to be hoped 
that this aspect of the subject, which nearly 
approaches the liberty of the subject, will be carefully 
watched by Members of Parliament. There are 
other details of administration in which the Act may 
give rise to future difficulty. However, such as it is, 
we accept it with gratitude as an earnest of the more 
perfectly humane and rational treatment of mental 
and moral lapses that awaits coming generations. 
The removal of the present savage and unjust punish¬ 
ment of minor offences that still blots the national 
record must inevitably be suggested to the thinking 
man who realises the vast social revolution that is 
now being effected in regard to the victim of the 
alcoholic habit. 


HISTORY BASED UPON DIET.—I. 

Study directed towards the connection between the 
habits of nations as regards the form in which the 
food required for their bodily needs was obtained, and 
the course of the history of the world's peoples, would 
assuredly bring forth interesting and valuable results 
if undertaken by a competent authority. The ad¬ 
vance along the path of civilisation has apparently 
been effected by nation after nation in a haphazard 
manner. Why were the Chaldeans, the Assyrians 
the Egyptians, the Persians, in turn the progressive 
and dominant race ? How could Greece subdue Persia, 
Rome, Europe, as then known, and, to come to our own 
day, how has Great Britain (withtheUnited States) been 
fitted to found so large an empire, and to spread so large 
a number of Anglo-Saxons over the globe ? Chiefly, 
we should say, as the result of climatic and dietetic 
peculiarities. The conquering peoples throughout 
history have always commenced their successful 
careers at periods when they were accustomed to 
simpler food and subjected to greater hardships than 
the people conquered by them. In turn they, too, 
having become unable to carry the full cup, have 
overstepped the limits of simplicity and sapped their 
powers of endurance, sooner or later falling victims 
to some nation still in the vigour engendered by 
natural habits. When the history of man was com¬ 
paratively short, the predominant races naturally 
were those inhabiting the warmer climates, the 
struggle for simple existence and sustenance pre¬ 
venting the tribes in unkindlier regions from 
becoming their rivals. As, however, the civilisation 


of the peoples in the more advanced and warmer" 
countries penetrated even if only slightly into the 
lands further north, the superior stamina begotten of 
endurance of hardships and by lees artificial foods- 
soon demonstrated its superiority, a sequence of 
events which history has time after time recorded for 
our instruction and edification. It may be affirmed 
that exactly in proportion to the amount of meat 
eaten by civilised nations on the average so the power 
of the nation grows, not necessarily physically 
but mentally, and in the nervous control of their 
physical power. A Chinese coolie fed on rice can 
undertake a day’s work which would appal a British 
trade’s unionist fed on beef and suet pudding. But 
pit the coolie against the unionist in the power of 
applying their individual physical powers and the 
coolie is nowhere, even if the other use his superior 
mental capacity in various unprofessional directions. 
How can the predominance of the southern races in- 
earlier times and the equal predominance of the 
northern nations now-a-days be explained on this- 
theory ? Easily enough ! It is well known that in 
warm climates, even what we should regard as a 
moderate comsumption of meat is deleterious in the 
long run. Britons in India are advised to abstain 
from eating much flesh while in that torrid country. 
We believe that advice to be founded on error, unless 
they intend to settle down and bring up their 
family there. The meat-eating Briton in India is 
usually the healthiest and the most capable of the 
sustained exertion. If, however, he live and die 
and his family are brought up there, continued free 
indulgence in meat foods is apt to be followed by 
untoward effects, The people of India and similar 
countries are dominated by the meat-loving 
Feringhee, largely by reason of that same love of 
flesh, largely because the continual influx of the 
healthy beef-eater, and the efflux of those who have 
indulged in meat quite long enough in a hot climate 
for their own good, allow of a regular supply of 
vigorous dominant minds. The citizens of ancient 
Rome, in the days of her greatest success and might, 
do not appear to have abstained from flesh, but to 
have practised moderation. Later on success and 
luxury led to the consumption of such foods in 
greater quantities than permissible in such a climate, 
leading no doubt to increased brilliance intellectu¬ 
ally, but also to national decay. The successive rise 
and fall of the various peoples of Southern Europe^ 
and the gradual superiority over them attained by 
the northern races, point to much the same con¬ 
clusion. The neceBBaiy stamina, imparted to those 
who are continually called upon to experience rapid 
alterations in weather conditions, the possibility of 
their consuming a greater proportion of meat-foods, 
have all told in the course of Nature. It seems 
probable that a native of any country with a moder¬ 
ately cold climate, and who continues his dietetic 
habits, will, as a rule, exhibit dominant powers 
over the natives of warm oountries in his person, 
so perhaps his children if they remain resident, 
but not necessarily in them or their offspring. What 


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LEADING ARTICLES. 


Fbb. 8, 1890. 


4he ultimate result of the peopling of the Southern 
States of North America with the descendants of 
Northern as well as of Southern Europe will be is 
doub'ful. But there is no doubt about the change 
already apparent in the characters and habits of those 
inhabitants sprung from Northern European stock. 
If we were inclined to generalise we should hazard the 
statement that climate per se has little to do with 
the moulding of the characteristics of a people, save 
in so far as it accustoms them to endure heat, cold, 
-or rapid changes; but that indirectly the foods 
found to be most suitable for the maintenance of 
health under the different climatic conditions exer¬ 
cises all-important influences. The various bodily attri¬ 
butes arenotall affected. The moregeneral and simple 
are usually uninfluenced, the highest and latest 
acquired profoundly acted upon. Any form of diet 
found to be most suitable by the natives of a 
•country for their environment, an instinctive 
selection founded upon personal experiment, will 
suffice to develope the muscular organs and 
the power of work to a high degree, will afford 
valuable information as to the form of diet 
best suited for work done under the conditions 
present, and will give an example of what man as an 
animal requires under these circumstances. But the 
limitations imposed by natural environment cramp 
the free development of the higher mental faculties- 
Whatever the food be, the lower mental properties’ 
such as those of courage, fear, cruelty, love, endurance 
•of pain, Ac., may be equally developed ; but the 
higher mental powers, inventiveness, imagination* 
power of continued organisation, of logic, are deeply 
influenced. 

RELATIYE IMMUNITY AGAINST SMALL¬ 
POX. 

The immunity which may be possessed or acquired 
by individuals against small-pox and other infectious 
diseases, is of course only a relative expression, i he 
degree of either natural or artificial immunity must 
vary according to circumstances, that is to say, accord¬ 
ing to the intensity of the infection to which they 
are exposed and to their actual state of health. We 
know that the virulence of pathogenic organisms 
varies within very wide limits, and it is obvious that a 
degree of protection which may suffice to safeguard a 
given subject against the attack of a moderately 
virulent organism may prove inadequate when he is 
called upon to withstand the onslaught of one 
possessed of a much higher degree of disease- 
producing activity. Moreover the fact of residence 
in a hot climate, or under hygienic or other conditions 
which favour the evolution of the more virulent 
.organism has been shown of itself to dispose human 
beings to the particular disease. It follows that the 
measure of protection which experience has 
shown to be sufficient in temperate zones may 
prove less effectual in the tropics for instance. 
These remarks are suggested by the use which is 
being made by anti-va-.cinatore of a comparison be¬ 
tween the mortality from small-pox among soldiers 


in India during the year 1896 and the freedom in this 
rfespect of the inhabitants of East London in the 
latter half of 1898. Special emphasis is not un¬ 
naturally laid by the critics on the assertion that 
soldiers have all been re-vaccinated, while a very large 
number of persons in East London have probably not. 
even been vaccinated. In making comparisons of 
this sort the first condition is to establish a paral¬ 
lelism between circumstances as regards time, place, 
and susceptibility. It is plain that this condition is 
not fulfilled when a comparison is instituted between 
England and India, for it is expressly stated in the 
Army Medical Reports that in each case small-pox 
was raging in an exceptionally severe form among 
the civil population, and only those regiments suf¬ 
fered which were in proximity to native bazaars and 
in more or less intimate relationship with the native 
population. The fact that there was no small-pox 
mortality in the East End during the last 
six months of 1898 merely shows that, in 
the absence of contagion, bad sanitation will 
not of itself determine its appearance and spread, 
and vice versa, that as small-pox is not a “ filth ’ 
disease, sanitation alone cannot be expected to keep 
it out. It is also worth noting in regard to the 
assertion that “ all the men bore marks of previous 
vaccination,’’ that the report contains no assurance 
that they had been re-vaccinated. In one case, indeed, 
ic is mentioned that re-vaccination was carried out 
two days before admission to hospital, but we are told 
nothing as to the result of the operation, except that 
the man died of confluent small-pox. As showing 
the kind of work done in respect of re-vaccination, it 
is stated that one man had been twice unsuccessfully 
re-vaccinated, aud died of a malignant form of the 
disease. Looked at from another point of view, it 
may reasonably be supposed that the large amount 
of venereal and other disease in the Indian 
Army must, in the long run, have a prejudicial 
effect on the physique of the men who are 
certainly not all “picked men,' as is stated; indeed, 
the difficulty of finding recruits has of late years led 
to a marked lowering of the standard all round 
We may point out that in Germany, where efficient re- 
vaccinatiou Of soldiers has given such brilliant results* 
in 1897 only twelve men died of small-pox, and these 
deaths all occurred in proximity to frontiers of coun¬ 
tries where vaccination is not compulsory or is not 
rigidly enforced, and where, in consequence, small¬ 
pox exists endemically. This fact bears out the 
point already mentioned, that ihe protection afforded 
by vaccination, though indisputably very great, may 
not prove equal to all conceivable emergencies, espe¬ 
cially if we allow for the difficulty of ensuring that 
the operation of re-vaccination is always efficiently 
carried out. Even in the hands of Army Medical 
officers, something must be allowed for the “ personal 
equation,” and this, along with the specially virulent 
nature of the infection to which the victims were 
exposed, affords an explanation of the apparent 
failure in this instance of vaccination to afford the pro¬ 
tection which universal experience shows it to confer 
under what we may call European circumstances. 


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Peb. 8, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Peeks. 147 


4 tote 0 on (Eurrent topics. 

The Regulation of Street Advertisements. 

It is not long since that Parliament found it neces¬ 
sary to interfere to prevent the disfigurement of 
London by sky-signs, but the perverse ingenuity of 
the advertising fraternity renders further legislation 
desirable. The newest phase of obtrusive street 
advertisement is the intermittent or flash light 
method of calling attention to this or that whiskey 
or soap, and the rapid extension of this unsightly 
and dangerous method of forced publicity empha¬ 
sises the urgent necessity for more stringent and 
more comprehensive regulations in respect of such 
attempts. We have already called attention to the 
danger to vehicular and pedestrian traffic of these 
flash-light advertisements which, moreover, threaten 
to convert London streets into a m< re background 
for ungainly announcements. The alternating glare 
and comparative obscurity upon which the success of 
these devices depends creates a state of things which 
is rapidly becoming absolutely intolerable. In the 
only too successful endeavour to “ catch the eye," the 
attention of the pedestrian is involuntarily diverted 
from the manifold dangers of London traffic, and 
■constitutes a wanton disfigurement of our principal 
squares and edifices. The grievance has given birth 
to a “Society for Checking the Abuses of Public 
Advertising,” and the movement has received the 
general approbation of the Press. Various restric¬ 
tions are proposed in the direction of establishing a 
certain correspondence between the size of the letters 
and the height of the buildings on which they are 
affixed, with a maximum applicable to all circum¬ 
stances and conditions. It is, moreover, proposed 
to prohibit advertisements above a certain level, 
which would have the advantage of leaving a certain 
space upon which the eye of the passer-by may repose 
without being fatigued by the sight of glarish signs. 
It cannot be objected that the proposed regulations 
err on the side in the direction of severity, indeed 
they constitute but a minimum of what is demanded 
by public opinion. 

The Question of Private Slaughter-Houses. 

The question of the abolition of private slaughter¬ 
houses in London is at present engaging the attention 
of the London County Council. The position taken 
up by the Public Health Committee is, that in the 
interests of the pu olic only public abattoirs should be 
allowed, and in support of this view stress is laid upon 
the law which prevails in this regard on the Continent. 
The matter, of course, is one which very largely affects 
the trade of butchers, and great opposition has been 
shown by the trade to the proposal to deprive them of 
the right of having private slaughter-houses. But in 
these days of scientific precision private interests 
count for nothing when questions of public health 
are concerned, and in this regard nothing is more 
certain than that strict supervision is absolutely 
essential in order to ensure that animals infected 
with communicable disease are not allowed to be 


killed for human food. Undeniably, therefore, it 
must be obvious that the strict supervision necessary 
could ouly be properly exercised under a system of 
public abattoirs, where every perfect appliance would 
be at hand to prove the suitability or otherwise of 
meat for human consumption. In the past it has 
oftentimes been proved, as the reports of the police 
courts show, that butchers have wilfully offended in 
attempting to distribute unwholesome meat among 
their customers, and probably many cases have 
occurred of this offence which have escaped the arm 
of the law. The mere knowledge of this fact alone 
is a strong point in the advocacy of the abolition of 
private slaughter houses, and thus, the trade not¬ 
withstanding, in time we believe the system of public 
abattoirs must become general in all the large centres 
of population. 

A Modern Greek’s Version of Gratitude. 

The Greek Government have issued an official recent 
report on their war with Turkey, and in the course of 
the r remarks, they dismiss the subject of the medical 
relief sent out to them by Great Britain with a curt 
general reference to red cross work by foreign 
countries. Now, considering the splendid service 
that was done there by this country, this t-avours in nj 
distant degree of rank ingra'itude. The Daily 
Chronicle alone raised a magnificent fund, and des¬ 
patched to the seat of war an equipment that has 
probably never been equalled in the annals of red 
cross history. Amongst other things its X-ray 
equipment constituted a pioneer essay in modern 
military surgery, and then, again, its hospitals, 
with their perfect nursing and aseptic surgery, 
did yeoman’s service at a time of dire national con¬ 
fusion and disorder. However, as the great and good 
work of the Samaritan is done for its own sake, and 
not with a view of gaining human applause, it may be 
surmised that were the Greeks in similar straits 
to-morrow the sympathies of Great Britain would be 
just as easily aroused in spite of their present appa¬ 
rent lack of gratitude. One would certainly have 
looked for a frank and warm-hearted acknowledg¬ 
ment of favours so ungrudgingly bestowed from a 
nation that undertook one of the most chivalrous 
ware ever known in the history of the world. But 
bravery does not spell organisation any more than it 
connotes gratitude. 

Libel Against a Medical Man. 

A somewhat interesting action was won last week 
by a medical man under the following circumstances : 
The plaintiff, Dr. T. J. Vallance, who held a number 
of Poor-law appointments in West Ham, said to bring 
in £1,200 per annum, sought to recover damages from 
a meat salesman, named Terrett, for libel. In March 
last a visiting committee addressed to him certain 
inquiries as to seven children under his charge. One 
asked whether a boy of twelve, who had injured his 
head, should not have a protective pad. To this plain¬ 
tiff replied, “ Yes, send him to Down's. No use to a 
boy like him ; he will want a new one eveiy week.” 
As to whether another child would not be bene- 


Digitized by v^ooQle 


148 The Medical Press. 


NOTES ON CURRENT TOPICS. 


fited by being sent to the Ophthalmic Hos¬ 
pital as an in patient, he answered, “ He 
might go. Nothing to be done but to take 
his eye out, or I will do it when I have time.” 
All seven replies were published by defendant as an 
election placard, and posted throughout the neigh¬ 
bourhood on flaring bills some three feet in length. 
The defence admitted that the comments complained 
of exceeded the bounds of fairness, and paid £20 into 
Court. The jury, however, gave judgment for £150 
and costs. This triumphant issue was in no small 
measure due to the able way in which the Medical 
Defence Union engineered the case, and adds another 
to the now familiar illustrations of the absolute de¬ 
sirability of every medical man belonging to that 
highly organised and capable body. The knowledge 
of the legal aspects of medical defence is, in itself, a 
special science, in which Mr. Hempson, the Solicitor 
of the Union, has become a past master. The case 
illustrates also the harm that may arise from a too 
matter of fact way of treating medical matters when 
dealing with persons outside the profession. 

The Surgery of the Kidney. 

In discussing the advances that have been effected 
in the domain of abdominal surgery, we are apt to 
dwell too exclusively upon the mere gynaecological 
aspect of the matter. This is unjust to surgeons who 
have devoted themselves more particularly to the 
surgery of the kidney, which has already reached 
a high level of excellence. The formerly painfully 
hopeless cases of renal lithiasis, followed it may be 
by impaction of a stone in the urether with conse¬ 
quent hydror ephrosis, are now summarily dealt with, 
the obstruction removed and the organ restored to 
its function, if still capable thereof, and if beyond 
the stage of restoration its removal enables the patient, 
relieved from actual suffering, to live on with such 
measure of health and strength as his one remaining 
kidney will suffice to maintain. That much more 
obscure affection known to the vulgar as “ floating 
kidney” is also dealt with by an operation entailing a 
minimum of danger, and if the results are not as 
uniformly successful as in renal lithiasis this must 
be attributed to the fact that laxity of attachment of 
the kidney is often only part of a widespread condi¬ 
tion of tissue weakness. 

X-Rays in War. 

The X-rays have established their place in almost 
every branch of practical surgery, but nowhere more 
conspicuously than in the rough and tumble of war¬ 
fare. Henceforth the probe is almost, if not quite, 
needless on the battle-field, to the vast benefit of the 
patient, who is thus spared the additional risk of the 
introduction of septic matter and of painful manipu¬ 
lations that were often worse than useless. The 
method has now been used in at least four campaigns, 
and a special literature has sprang up round this 
part of the subject. One interesting case was re¬ 
ported by Major Beevor, R.A.M.C., from the 
Indian frontier—namely, that of a man shot 
in the right side of the chest. Tte bullet 


Pkb. 8, 1899 . 

passed through the substance of the liver 
in which an open channel was visible, bub 
it ooula not be detected by probing. As the patient- 
was not doing well, Major Beevor was asked to apply 
the Rontgen method, which he did, and was rewarded 
by finding a round Afridi bullet in the left loin in 
the region of the spleen. The missile entered near the 
lower end of the armpit, whence it went through the- 
liver and across the body to the place where it was 
subsequently found. How it could have taken a track 
so closely packed with vital organs and not have 
caused instant death must remain a mystery. The 
shape of the bullet and the fact that it was driven by 
poor native powder, doubtless had something to do 
with the result. At present an unusual amount of 
activity is being shown by the many makers of Ront¬ 
gen apparatus, and before the next great fight takes 
place it is tolerably certain that great strides will have 
been made in the direction of portability and stability 
in field melical outfits. 


A Point in the Physiology of Vision. 

The paper read before the United Servic i Insti¬ 
tute last week upon “ The Relation of Persistence of 
Vision to Modern Rapid Visual Signalling” is 
doubtless interesting and important from the author's 
—Mr. E. S. Bruce—point of view, but unfortunately 
he is quite wrong in his deductions. He has invented 
an apparatus which he calls the aerial graphoecope, 
the chief principle of which is a narrow lath of wood 
painted white in front with a grey centre gradually 
diminishing in shade to white. The lath having been 
made to revolve rapidly, a small portion of a magic- 
lantern picture is thrown upon it, with the result 
that the spectator is expected to see the whole- 
picture before him apparently in space, the explana¬ 
tion given of this being that the retina retains for a 
short time any impression presented to it; thus the 
various portions of the picture have not time to fade 
before the whole has been successively projected on to 
the lath. The author also stated that from experiments 
with the graphoecope he had found that the same 
person could have a very different capacity of persist¬ 
ence of vision at different times of the day accor din g 
to the circumstances under which he was placed, such 
as, for example, after violent physical exertion. Fur¬ 
thermore, he proceeds to argue that a good army sig¬ 
naller would be one in whom persistence of vision 
was abnormally low, and he asserted that bodily 
fatigue tended to prolong persistence which, he be¬ 
lieved, also was the tendency in illness. It is, how¬ 
ever, obvious that generalisations upon such a com¬ 
plex subject are impossible. In the first place, it would' 
have to be shown that a signaller's vision was perfect 
and that he had no error of refraction. Next, it is 
almost certain that the maintenance or otherwise of 
a retinal image is merely the result of the retinal 
circulation. The lower persistence of vision must 
depend upon the circulation of the blood in the retina 
for the time being, and according as this is from some 
cause or other defective, so will the persistence of a 
retinal image become less and less appreciable, We 


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Fkb. 8, 1899._NOTES ON CUBKENT TOPICS. The Medical Press. 149 


-cannot see, therefore, that there is anything in what 
Mr. Bruce has shown, although, no doubt, he has 
•drawn attention to a subject which hitherto has 
attracted but little attention. 


An Enlightened Board of Guardians. 

The ways of guardians are so often branded by 
ignorance and arrant selfishness, that it is a pleasure 
to note a Board rising to a higher recognition of their 
duties and responsibilities. The Kingston parochial 
•authorities last week decided that “ in future noappli- 
•cation would be received from any candidate seeking 
appointment in the workhouse, or to the workhouse 
staff, unless proof were forthcoming that he had been 
previously vaccinated.” We have often pointed out 
that by indirect official pressure an immense deal 
might be done to ensure the efficient vaccination of a 
large part of the community. If the Local Govern¬ 
ment Board, for instance, were to render universal 
a rule like that passed at Kingston, there 
would result a standing object-lesson, as well as a 
practical enforcement of the value of vaccination. 
Indeed, it seems almost incredible that the central 
authority have not adopted some such step generally; 
but, if that were the case, we should hardly find the 
Kingston Guardians passing a resolution of the kind 
referred to. The last-mentioned folk were not con¬ 
tent with this practical resolution, but they added 
another praying the Government to repeal their 
recent Vaccination Act. Her Majesty’s Government 
enforce vaccination in the Army and Navy, and it 
may well be asked, Why should they not take a 
si milar precaution with regard to Poor-law officials P 
Their position, however, now that they have admitted 
the principle of conscientious objection to the multi¬ 
tude, must be somewhat embarrassing. Tommy 
Atkins and his naval cousins must be vaccinated, but 
the workhouse porters and other officials may do as 
they like in the matter of self-protection against the 
unost loathsome of diseases. 


Sanitation and Salvation Shelters. 

The proverbially slow-going British ways of dealing 
with fresh social problems have an admirable exempli¬ 
fication in the Salvation shelters. These institutions, 
founded on a basis partly philanthropic and partly 
commercial, fall within the category of ordinary 
dwellings so far as the control of the local sanitary 
authority is concerned. In other words, the Medical 
■Officer of Health has no right of entry during the 
night, the time when the shelter is full, but only in the 
daytime when its inmates are away. It is true that 
this difficulty can be got over if a nuisance be 
suspected, but in that case the necessary legal pro¬ 
cesses demand the expenditure of much time 
and money, to say nothing of the delay. When 
one considers the nature of the population of these 
night resorts, the danger of spreading infectious 
disease, the verminous environment, and the eye to 
profits which invites overcrowding and uncleanliness j 
it is simply amazing that no measures have been 
-taken to bring the shelters under control. The 
parallel case of the common lodging-houses, which 


are commercial ventures of private persons catering 
for the casual poor, presents a very different picture, 
namely, that of stringent, almost harassing, regula¬ 
tion. The whole question of the shelters has been 
fought out in the South London parish of St. George 
the Martyr, which seems to be a chosen spot for the 
solving of difficult but absolutely necessary sanitary 
problems. In the course of certain legal proceedings 
undertaken by the authorities of that district, the 
dictum of the High Courts of Justice was obtained 
that the Salvation shelters ought clearly to be in¬ 
cluded within the operation of the Common Lodging 
Houses Acts. 

The New London Polyclinic. 

So far as numbers are concerned, the new Poly¬ 
clinic in London has made an auspicious commence¬ 
ment. Time only can show, however, whether the 
working of the scheme will prove successful or not* 
Judging from the proceedings which took place at 
the first meeting of the Governors of the College, 
held last week, some of the details of organisation 
have still to be determined. The meeting, neverthe¬ 
less, elected the first officers, and the Council trans¬ 
acted other business of importance, among which 
may be mentioned the acceptance of the proposal 
that the West London Post-graduate College should 
be represented by two of its members on the Council, 
also that two members of the latter should con¬ 
sist of representatives of general practitioners. The 
Council will, therefore, be twenty in number, with Sir 
William Broadbent as President, six Vice-Presidents, 
Dr. W. A. Ord as Treasurer, and Dr. Fletcher Little 
as Honorary Secretary. It is evident from the high 
position of those who have identified themselves 
with this movement that a vigorous effort is about to 
be made to establish a post-graduate centre somewhat 
in keeping with the needs of the metropolis. Hence, 
upon these grounds everyone will be wishful to see the 
new venture prove a success. But everything will 
depend upon the method of its organisation. If this 
be faulty nothing but failure will be the result, and 
as the defunct London Post Graduate course proved 
a failure, so will the present newly-founded Poly¬ 
clinic, unless special care be taken to meet the needs 
of those whose support it seeks to secure. 

The Bath Fever Hospital. 

The Bath newspapers have taken our last week’s 
criticisms upon their fever hospital in good part, and 
wo trust that they will now follow up the matter to 
the end in an impartial spirit worthy of the reputa- 
of their fine old town. There is one point on which 
the Bath Chronicle , in our opinion, still takes a mis¬ 
taken attitude—namely, that of the exact relationship 
of the Medical Officer of Health to the institution. 
In its issue of February 2nd an editorial para¬ 
graph says :—“ Dr. Field is the responsible medical 
man at the Statutory Hospital, not Dr. Symon’s 
deputy! ” It then goes on to say that we have been 
“ led to believe ” that the latter was the case. With¬ 
out further parley, we may at once say that state¬ 
ments of that kind made in the columns of the 


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150 Thb Mbdical Prbss 


NOTES ON CURRENT TOPICS. 


Medical Press and Circular are not, as a rule, 
founded on fancy, but on fact. In support of th e 
particular point in question the editor of the Chronicle 
may be referred to the official application and order 
for the admission of the patient to the hospital. The 
application is a request that the patient be admitted 
and kept “ during such time as the Medical Officer 
of Health shall deem necessary.” This is to be signed 
by the last-named officer and sent to the matron. 
We should like a clear and substantiated account of 
the staff, buildings, organisation, and work of the 
hospital, say, during the past five years. 

A Mere Act of Justice. 

Our readers may recollect the regrettable case of 
Dr. Campbell, the late medical superintendent of the 
Cumberland County Asylum, whose health broke 
down shortly before his resignation of the post, and 
caused him to commit an act which led to police- 
court proceedings. Previously to this untoward 
incident the Cumberland County Council had in¬ 
timated their intention to confer a superannuation 
grant of £700 per annum upon their officer, whose 
long service of thirty-three years in the asylum 
had throughout given satisfaction to the Lunacy 
Commissioners. But in view of what afterwards 
transpired it would seem that some pressure 
was brought to bear upon the Council, urging them 
to rescind their former decision. We aie glad tonote> 
however, that this unjust course has not been adopted, 
although the Council have modified their original 
intention. Dr. Campbell has now been granted a 
pension of £350 per annum, instead of £700, and thus ) 
by refusing to be coerced into perpetrating an act of 
injustice, the Cumberland County Council have 
shown a further proof of their regard for an offioer 
who, till his health failed in their service, had always 
ably discharged his duties. 

International Congress on Tuberculosis. 

The subject of tuberculosis is “ booming,” and the 
crusade against the dissemination of the disease is 
making progress daily. There is, therefore, nothing 
surprising in the announcement that an International 
Congress is being organised to meet in Berlin next 
May, for the purpose of discussing tuberculosis and 
the best methods for arresting its ravages. In order 
also to make the meeting as representative as possible, 
foreign Governments will be invited to send delegates. 
Apparently, however, there is no intention of con¬ 
fining the Congress to members of the medical pro¬ 
fession, inasmuch as delegates will be present from 
trade organisations, insurance institutions, hospitals, 
and other corporations concerned in the prevention of 
tuberculosis. Dr. von Leyden is the chief official on 
the Committee of Organisation, and anyone desirous 
of being present at the Congress should communicate 
with him direct. 

An Irregular Death Certificate. 

At an inquest held a few days since at Kingston- 
on-Thames, Mr. Merrick, a local practitioner, was 
taken to task by the coroner for having certified 


Fbb. 8, 1H99. 

as due to convulsions the death of a ohild whom 
he had not seen for four days previously. Ag the 
ohild was found dead in its mother’s arms, the 
appearances not being incompatible with suffoca¬ 
tion, it was thought desirable to hold an inquest 
but the post-mortem examination showed that 
death was really due to double pneumonia. One 
cannot be too careful in these matters, but on 
the other hand Mr. Merrick would certainly have 
exposed himself to muoh odium had he refused to 
certify, and we admit that he found himself in a deli¬ 
cate situation. The best course would obviously have 
been to communicate with the coroner before issuing 
the certificate, leaving it to that official to determine 
whether or not an inquest was indicated. 


The Jubilee Hospital Again. 

This institution, which has behind it such a 
lamentable history, is again to the fore with yet 
another tale of malorganisation and mismanagement. 
At an inquest held last week by the West London 
coroner on the body of a man who had fractured his- 
skull in a street accident it transpired that there was 
no resident medical officer to attend to patients, the 
house surgeon living at a quarter-of-an-hour’s cab 
drive from the hospital. The matron is apparently 
left in charge, and has to decide whether the case is one- 
requiring immediate medical treatment, but she is not 
even in telephonic communication with the medica 
officers. Slight cases are attended to by the matron 
and sent away, and she is expected, in the event of an 
emergency such as sudden haemorrhage, to apply a 
tourniquet and send for the doctor who may or may 
not put in an appearance in about half an hour. 
Here is a hospital with eight beds left to the mercy 
of a matron who, whatever her experience and good 
sense, cannot be expected to fulfil the functions of 
matron and medical officer rolled into one. Such a 
truly scandalous condition of things makes one regret 
that there is not some check upon these private-venture 
concerns which are labelled hospital, and thereupon 
tout for the support of the charitable. In any event 
the police ought to receive instructions not to take 
the viotims of accidents to such an institution, seeing 
that others, not far distant and admirably equipped, 
are available. 

Boards of Guardians and the Appointment 
of Vaccination Officers. 

The Local Government Board are having some 
trouble with certain Boards of Guardians in respect 
to the appointment of vaccination officers. As is 
well known, some of these Boards are predominated 
by anti-vaccinationist faddists, to whom the mere 
mention of vaccination is as a red rag to a bull. 
Consequently when the question of appointing 
a vaccination officer for their respective districts 
comes up for discussion they are able to carry 
a resolution refusing to make any such appoint¬ 
ment. The Local Government Board, however, have 
very plainly shown that they will not sanction 
this nonsensical course of action, and they have 
insisted upon a vaccination offioer being duly 


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Feb. 8, 1899. 


SCOTLAND. 


The Medical Press 151 


appointed. The Eastbourne Board of Guardians are 
at present endeavouring to shirk their duty in this 
respect. But they might as well submit with a good 
grace without further ado to the inevitable. Per¬ 
haps these recalcitrant Boards have overlooked the 
fact that the central authority can compel them to 
make the appointments. 

The “Grammar School” Science of the 
London Colleges. 

It will be recollected that the Irish College of 
Surgeons addressed to the last meeting of the General 
Medical Council a very emphatic remonstrance 
against the recent action of the London Conjoint 
Examination Board, which—in defiance of the resolu' 
tion of the Council—had intimated that it would 
accept the Grammar School courses in chemistry, 
practical chemistry, physics, and biology as part of 
the requisite five years’ course. The Irish College 
regards such courses, pursued by schoolboys of un¬ 
known age, in the int rvals of their Latin grammar 
and arithmetic, as a transparent sham, and a palpable 
evasion of the regulations for the medical curriculum* 
and that College has quite recently refused to recog¬ 
nise such studies in a technical school because it had 
no assurance of their bona fides. When the protest 
of the Irish College came before the Council, the 
representatives of the two London Colleges, seeing 
that it was backed by the Education Committee, 
thought it wise to cry peccavi, and the subject was 
remitted back to that Committee to see what would 
be done. We observe with satisfaction that the 
Conjoint Committee has recommended the Colleges 
to rescind the objectionable announcement, and that 
the London College of Physicians has assented, 
though not without opposition f-om the Grammar 
School party. The question, however, still remains 
whether studies supposed to be so pursued in such 
Institutes can be recognised in any way as part of 
the medical curriculum. 

Doctors’ Unqualified Dispensers. 

The question of the employment of unqualified 
dispensers by medical men has been formally brought 
before the Pharmaceutical Society by the indefatig¬ 
able Mr. Glyn Jones, and, on the motion of the Pre¬ 
sident, was referred to the Law and Parliamentary 
Committee of that body for consideration and report. 
Threatened people proverbially live long, and in spite 
of the sensation created by the unfortunate incident, 
to which we recently called attention, it is quite 
possible that the humble and unqualified dispenser 
may outlive his present critics. 

The Royal College of Surgeons, Ireland. 

The President and Council of the College have 
re-elected Sir Philip Smyly as its representative in 
the General Medical Council for a year from this 
date. The position was contested, as it was last year, 
by Dr. Archibald H. Jacob, and, as last year, Sir 
Philip Smyly was successful by a majority of one. 
The Council contains twenty members besides the 
President. 


An Australian Abortion Tragedy. 

Another of these too frequent and lamentable 
abortion tragedies is reported from Melbourne, where 
Dr. Gaze is reported to have been arrested in con¬ 
nection with the death of a young woman whose body 
was found floating in a box in the river Yarra, the 
receptacle having being insufficiently weighted with 
stones. An examination of the body revealed the 
existence of pregnancy, together with the presence in 
the stomach of a large quantity of arsenic. 

PERSONAL. 

Her Majesty the Queen has consented to open the- 
Diamond Jubilee wing of the Royal Isle of Wight Infir¬ 
mary to-day (Wednesday). 

The Duke and Duchess of York will open, on March? 
1st, the new wing of the Royal Portsmouth Hospital. 

Dr. Roux, chief of the Pasteur Institute at Paris, has 
been elected a member of the Acaddmie des Sciences, 
vice M. A im tS Girard, deceased. 

We learn with regret that Dr. William Frazer, of 
Dublin, F.R.C.S.I., M.R.I.A., is still suffering from 
the very serious illness which he has had for many 
weeks. Dr. Frazer is well know n as a high authority on 
antiquarian subjects, and a valued member of the Royal 
Irish Academy. 

Surgeon W. J. Maillard, R.N., M.D., V C., having 
been awarded the Victoria Cross for bravery during the 
recent disturbances in Crete, the medical officers of the 
Mediterranean Fleet entertained him to dinner at the 
Malta Union Club on bestowal of the honour. 

A memorial to the late Dr. Henry Marshall, of Clifton, 
consisting of a side altar, which has been erected by sub¬ 
scription in the Lady Chapel of St. Raphael's Church, 
Bristol, was dedicated a few days since by the Bishop j 
who spoke of the life and work of Dr. Marshall as a 
brilliant example to be followed. 

Professor WioGiN, of the College of Physicians, 
Chicago, has, according to a telegram in the Morning 
Lender, been suspended because, in one of his lectures on 
pathology, he described woman aB " a two-legged dys¬ 
peptic owl,” and said that the “ female form divine ” 
was the climax of Nature’s irony. Of course, the 
women’s clubs are up in arms at such an insult. 


gartlmtb. 

[from our own correspondent.] 

Thb Late Professor Coats, of Glasgow —Professor 
Joseph Coats, whose death was recorded in the last issue 
of this journal, was in many ways a remarkable man. 
He first distinguished himself as a Glasgow student 
under the late Professor Allen Thomson, whose method 
he closely followed and imitated. After graduating in 
1867 with “ honours,” he proceeded to the Continent, 
studying both in Leipzig and Wurzburg under Virchow. 
On his return to Glasgow he became house surgeon to 
Lord Lister (then Mr. Lister), and succeeded the 
late Dr. Samuel Moore as pathologist to the 
Royal Infirmary, and from the Royal went over 
to Hie Western Infirmary, also as pathologist. Even from 
his early days as pathologist in the Royal Infirmary he 
frequently suffered from boils on his hands, after a post¬ 
mortem examination, which often necessitated the aaais- 


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152 The Medical Press. 


CORRESPONDENCE. 


"tance of a substitute. He, however, seemed to get over 
these attacks rapidly until while in the Western he had 
really a severe attack, after which he seemed to age 
-greatly. About eighteen months ago he was seriously 
ill, and after his partial recovery took a trip to Australia 
and New Zealand for the benefit of his health, and on 
his return seemed greatly benefited by it. Resuming 
his lectures in due course with great spirit, the students 
gave him quite an ovation, and it was hoped that he 
would long be spared to carry on and teach in his 
lucid and concise manner the subject he loved so 
well. His health, however, gradually gave way, 
and, matters becoming serious, it was deemed advisable 
that an operation should be performed, which was 
accordingly done on January 21st, when it was discovered 
that there was a malignant tumour in the splenic arch, 
which was accordingly removed. All appeared to be 
going on well when however, he gradually became weaker 
and died on Jan. 24th. His death is a very heavy blow 
to the university. After seeing his hopes realized in the 
establishment of a chair of pathology, chiefly through 
his own exertion, and occupying the chair as the first 
professor for the brief period of five years, his untimely 
death is the more to be deplored. On the day of his 
funeral the students turned out in large number* 
to do honour to his memory. Few men, especially in the 
medical profession, who have lived, worked, suffered and 
died, have been more beloved than Joseph Coats 

The Vacant Chair op Pathology. —We understand 
that Dr. Lewis R. Sutherland, M.B.C.M., assistant to the 
late Prof. Coats, is an applicant for the Chair of Patho¬ 
logy now vacant. The patronage is vested in seven 
.curators, of whom four are nominated by the University 
■Council, and three by the directors of the Western 
Infirmary. The Professor is the pb’hologist to the 
Western Infirmary, and the salary attached to the Chair 
is something like £1,100, and no doubt there will be 
many applicants for the post, but when it is coosidered 
that Dr Sutherland carried on the class for a consider¬ 
able time, and during all the period when Dr. Coats was 
on his Australian trip, it is hoped that he will be elected. 
Certainly he is well qualified; he is painstakin j, obliging, 
and amiable, a good lecturer, and a general favourite with 
the students, so much so in fact that if the students had 
the appointment to confer no other would stand a chance, j 
Unfortunately Dr. Sutherland ha* been laid aside for 
some time past, having been suffering from pleurisy. 
During ais temporary absence the lectures have been 
ably carried on by Dr. Ferguson, another assistant of 
Professor ' oats. This gentleman up till Christmas had 
to do all the work of the Pathology Department single- 
handed, besides giving the ectures and demonstrations 
We have no hesitation in saying that Drs Sutherland 
Both are good lecturers and teachers, qualifications 
which are not always found together We understand 
that the patronage of this cha : r, now vacant, is in the 
hands of a Board of Curators, four of whom are appointed 
by the University Court, and three by the managers of 
the Western Infirmary. The curators met on Thursday 
afternoon. Present: The Principal (in the chair), Dr. 
Hector Cameron, Dr. McVail, Mr. J. H. Dickson. Mr. 
James Boyd, and Mr. William Ker. Instructions were 
given to advertise the vacancy. Applications to be sent 
in by March 24th. The new Professor will ba required 
to begin his duties on April 25th. 

Glasgow Royal Infirmary.— 'Hie annual meeting of 
the Qualified Contributors to the Glasgow Royal In¬ 
firmary was held on the 30th ult., the Lord Provost, Sir 
David Richmond, presiding. We must congratulate 
those who are iminedittely concerned in the management 
-of the institution that instead of a few thousands the 
deficiency for the past year amounts to the small sum of 
£742 5s. lid. After compliments were paid all round to 
everyone in connection with the ins’itution the proposal 
of females to act on the directorate was brought before 
the meeting. Mr. Hugh Brown stated that as two of the 
old directors’ term of office had expired it was necessary 
that two new ones should be elected, and he proposed the 
names of Mr. Neilson and Mr. Warren. Two ladies were 
proposed in opposition by Col. Denny, viz, Mrs. Mather 
and Mrs. Napier. A', the end of the voting, which; by 
the way, was sealed by envelopes, it was found that the 


Feb. 8, 1899. 


gentlemee candidates were returned by large majorities, 
vlr. Neilson polling 85 votes and Mr. Warren 83, the 
ladies polling but 26 votes each. 

How is it Done ? We are informed by newspaper 
paragraph, tic—“ Forensic Medicine.—Professor Glaister, 
M.D., F.R.8.E., Regius Professor of Forensic Medicine in 
Glasgow University, has been appointed one of the 
Medico-legal Examiners of the City of Glasgow, in place 
of the late Professor Coats." Is this an advertisement ? 
We hope not! But, how is it that the appointment has 
been made almost instantly on the demise of the late 
professor ? An instance of a similar nature recurs to our 
mind where, while attending a professional brother a 
message was sent to the seat of Government soliciting 
the dying man's appointment. He obtained the appoint¬ 
ment, but latterly died in a lunatic asylum. “ Allah is just.” 
How is it that, as we have already spoken, de mortuis 
nil nisi bonum, yet why so much haste in putting on the 
dead one s shoes P The late Professor A. S. Simpson was 
able to prevent an appointment, but in course of time 
Professor Simpson was gathered unto his fathers, and 
now his little jokes are retold to a body of students who 
laugh at them, and without poor" Friday ” being present 
to lead off the laugh. Why are these appointments 
given to those who already hold either university or hos¬ 
pital appointments ? Are there no equally capable men 
outside the walls ? Is influence the only “ sesame ” ? 
Yet there are two men in Glasgow who rise above the 
ordinary; they depend upon their own merits, they are 
now to the front, and long may they remain there, even 
although the loaves and fishes do not fall to their lot. 
Brain comes out first. Sutim cuiqut. 


(Eomspmttance 

We do not hold ourselves responsible for the opinions of oar 
correspondents. 


DETERMINATION OF SEX IN ECTOPIC 
GESTATION. 

To the Editor of The Medical Press and Circular. 

8ir, - Now that a very considerable number of cases of 
extra-uterine gestation have been operated on, would it 
not be interesting if the sex of the foetus could be ascer¬ 
tained in such cases ? 

The pregnancy taking place in Dr. Strauch’s seventy- 
nine cases (as notified in your last issue) in the pro¬ 
portion of right tube, 31; left tube, 39. 

I think the noting of the sex. if only in a proportion of 
the cases (some, of course, being too young), might help 
to prove or disprove the old theory of a different sex 
from each ovary. 

I am, Sir, yours truly, 

Cheltenham. Alexander Duke. 


MEDICAL AID ASSOCIATIONS. 

To the Editor of The Medical Press and Circular. 

Sir, —Of the harm done to the medical profession by 
these associations there can be no possible difference of 
opinion. 1 he-question is. What measures should be 
taken to endeavour to prevent men from becoming allied 
to them y With the competition that now exists in the 
profession, it is useless to point out to the junior mem¬ 
bers how undignified it is to ally themselves to a trading 
concern. Neither will they listen to the counsels of 
their seniors when it is pointed out to them that the 
way 8 of these aid associations are such as respectable 
friendly societies would not think of adopting. What 
requires to be done is to prove to them that they will 
suffer themselves if they become medical officers of them. 
Once let it be known that medical men holding office 
under these trading associations are ineligible to become 
members of the various medical associations and local 
medical societies, then—and then only—will be there a 
reasonable prospect of preventing men from becoming 
allied to these “touting” companies. 

I am, Sir, yours truly, 


oogle 


G-. P. 



Fra. 8. 1899.' 


MEDICAL NEWS. 


Xaboratorg Jlotes. 

OXYDOL. 

Ws have received from Messrs. Maiche, Ltd., of 4, 
St. Mary Axe, London, E.C., samples of “Oxydol,” an 
extremely powerful antiseptic. Oxydol is essentially a 
solution of hydrogen peroxide of great purity, a quality 
which renders it equally suitable for internal as for 
external use. When examined in an intrometer hy the 
B J?. test it yielded seven times its volume of gas, and 
on evaporation it leaves practically no residue (6 grains 
per gallon). The amount of free acid is very small, 
being only 012 per cent, calculated as hydrochloric 
acid. 

Oxydol is absolutely unirritating, and may be applied 
without hesitation to freshly wounded surfaces, which it 
promptly renders aseptic. It inhibits all fermentation, 
and for this reason is especially recommended for internal 
administration in gastric disorders, associated with the 
presence of putrefaction or pathogenic organisms in the 
alimentary canals. In typhoid fever it deodorises the 
motions, and notably modifies the painful intestinal sym¬ 
ptoms of that disease. It is valuable as a mouth wash 
and gargle, in that it renders these cavities aseptic, thus 
averting a fertile source of contagion. It is an excellent 
gargle, for use in infective sore throat, whether scarla¬ 
tinal or diphtheritic, as well as in those forms due to 
other organisms. The importance of local treatment in 
such a disease as diphtheria is generally recognised, and 
it must be an advantage to make use of an antiseptic 
which is non-toxic or non-irritating. 

VIBRONA. 

Vibrona is a tonic wine with a basis of red cinchona 
bark, duly standardised in respect of its alkaloidal con¬ 
tents. The cinchona constituents are in the form of 
neutral hydrobromates, a form which is reputed to lie free 
from the inconvenient effects which even small doses of 
cinchona and its alkaloids produce in certain persons, 
however administered. Vibrona, with its cinchona 
basis, is distinctly tonic and recuperative in its action, and 
must not be classed with wines, of which coca active is the 
constituent, the effects of the latter drug being of quite 
a different nature and, if injudiciously or indiscriminately 
used, very apt to prove detrimental. 

In Vibrona we have what Americans call an “ele 
gant” and highly palatable vinous preparation of 
cinchona, the value of which is proved by the rapid 
strides it has made in professional favour. 


Jfabtcal JletoB. 


Royal College of Physicians of London. 

The second award of the Weber-Parkes prize and 
medals (to be awarded triennially to the writer of the 
best essay upon some subject connected with the aetiology, 
prevention, pathology, or treatment of tuberculosis, 
especially with reference to pulmonary consumption in 
man) will be made in made in 1900. The adjudicators 
have selected as the subject of the essay for that occasion 
—“ The aetiology of human tuberculosis and the assist¬ 
ance which a knowledge of the ffitiology may render to 
the task of prevention.” The essay must be based on 
original work and observations (experimental or other) of 
the author, and must include a detailed exposition of the 
methods employed and their mode of application. The 
value of the prize is 150 guineas and a silver medal. A 
similar medal, distinguished as the second medal, will be 
awarded to the essayist who comes next in order of merit. 
The award will be made on some day previous to October 
18th (8t. Luke’s Day), 1900. 

The Medical Sickness and Accident Society. 

Thx usual monthly meeting of the Medical Sickness, 
Annuity and Life Assurance 8ociety, was held on 27th 
••It., at 429, Strand, London, W.C. There were present 
Dr. de Havilland Hall in the chair, Dr. J. B. Ball, Mr. J. 
Brindley James, Mr. F. Swinford Edwards, Dr. Walter 
Smith, Dr. Alfred S. Gubb, Dr. W. Knowsley Sibley, Mr. 
Edward Bartlett, and Dr. Francis J. Allan. The 
accounts presented showed that, as is usual at this time 


The Medical Press. 153 

of the year, the Society was receiving a considerable- 
number of claims for sickness benefit, but they were for 
the m<*t part of short duration, and the total amount of 
sickness experienced is well under what is expected and 
provided for in the contributions. The committee 
specially examined into the claims arising from per¬ 
manent incapacity. In the>*e ca«es a provision, usually 
of one hundred guineas a year, is granted to the members, 
and they are entitled to receive this without deduction 
until they reach the age of sixty-five, should they live so 
long. The accounts for 1898 which will be presented to 
the members in May next, show that the financial posi¬ 
tion of the Society is very strong. Prospectuses and all 
particulars from Mr. F. Addiscott, Secretary, Medical 
Sickness and Accident Society, 33 Chancery Lane, 
London, W.C. 


Royal College of Physicians, Edinburgh, Royal College of 
burgeons, Edinburgh, and F&cul'y of Physicians and 
Surgeons, Glasgow. 

The Quarterly Evaminations of the above board were 
held in Edinburgh in January, with the following 
results:— 

First Examination, Four Years’ Course.—Of 17 can¬ 
didates the following 6 passed the examination :r— 

John Lang Niven, Shanghai; Robert Shenton, Derby ; Thomas 
Lynaa, Belfast; Rooert Elliott, Manchester, and Samuel Robinson, 
Ireland. 

First Examination, Five Years’ Course,—Of 20 can¬ 
didates the following 12 passed the eiamination :— 

T J. McKaigney, London -erry ; James H. Sutherland, Stirling¬ 
shire ; M. V. Shanahan, Cork ; John H. O’Sullivan, Galway ; Richard 
Lewis, Portmadoc ; William S. B. Dick, Ballynaflc . John W. Cross, 
Houghton-le-Spring (with distinction); Roger L. Williams, Moun¬ 
tain Ash, South Wales ; James A. Whitla, Monaghan ; Herbert 
McMaater, Donaghadee ; Henry Doig, Glasgow (with distinction), 
and Peter Watt. Tinwald, Dumfries. 

Second Examination, Four Years’ Course.—Of 24 can¬ 
didates, the following 10 passed the examination :— 

John Wilson Dickson, Tyrone; Alfred J. W. Noble, Aberdeen; 
Robert Paterson, Ayrshire; James Ebenezer Boon, Kirkcaldy; 
William D. Dickson, Co. Tyrone; Barclay B. Head, Kent; Kenneth 
R. D. Shaw; Edwin Robert Thomas, Dowlaia; William Boyd, 
Kilrea; and Henry JobnClague. 

Second Examination, Five Years’ Course.—Of 30 can¬ 
didates. the following 16 passed the examination :— 

Patrick Carroll, Kildowery, Ireland; W. Brown Heagerty, Cork: 
Ethelbert Hearn, Kent; Angus Mclnues, Old Kilpatrick ; Haroid 
W. Young, London; Prederick A. Georgeeon, Wick; Frederick C. 
Willmot, South Africa; John M. Morton, Glasgow (with distinc¬ 
tion); James Colquhoun, Durham; William C. M. Burnside,. 
Belfast; Daniel McIntyre, Littleborough ; John P. Cameron, Banga¬ 
lore, India ; KallyaniPado Chatterjee, Calcutta; W. James Healy, 
New South Wales (with distinction); Anthony Hag&rty Corley,. 
Dublin, and John Kean, Newry. 

Third Examination, Five Years’ Course.—Of 25 
candidates, the following 15 passed the examination:— 

John B. Swinden, India; Henry F. Stilwell, England; John 
Thomson K. Thomson, Glasgow ; Frederick W. Tough, Aberdeen ; 
Albert E. Ward, Glasgow; William Airlie Qgilvy, Cambuslang; 
Philip H. Parsons, Essex ; William Donovan, Blarney, Cork ; Wil¬ 
liam A Benson, Durham; Edith Anna Wynne-Edwards, Mont¬ 
gomery ; Charles R. Sutherland, Durham; William J. Morgan, 
WaleB; Mary Birrell Davies, Liverpool; William A. Dawson, Ban- 
don; and George Evans, County Derry. 

Final Examination.—Of 101 candidates the following 
53 passed the examination, and were admitted L.R.C.P.E., 
L.R.C.S.E., L.F.P. and S.G. : — 

Joseph P. Woodhouse, Stockport; Arthur Clarence Turner, 
Copake; Francis C. Gould, Hales Owen; John Hilton Howlett, 
Norwich ; James V. Watson, Darlaston, Staffs; James Rase, Bally¬ 
mena, Co. Antrim ; Thomas L. Wyndham, Surrey ; William Lloyd, 
Carmarthen; Thomas A. Chalmers, Ayrshire; Ellis Owen Jones, 
Bethesda; Frank Rowland, Birmingham; W.C. E. O’Donoghue, 
Dublin. Charles Abbott, Leeds; James Fleming, Avondale : John 
Fruncis Dwyer, Co. Cork ; Jacob M. Wood, York ; Ernest Alexander 
Campbell, Aldershot : Herbert M. Cockcroft, Mashuni, Yorks: 
George Yeoman, Osmotherley, Yorks: John Herbert Gibbs. 
London; Charles F. Gmves, London; Edward Lewis Nathanial 
Hopkins, Carmarthen; Alfred Myles Staunton, Ireland; Mary 
Ariel Stewart, Portislieod ; John C. Dnnaher, Limerick ; 
Michael Halpeuny, Ardee; Herbert John Beven, Ceylon ; 
Henry Fowler, London ; William Roper, Bridport ; W. Marley Cass, 
Durham ; Samuel Rees, Trefriu ; Elsie Rosa C Taylor, Tunbridge 
Wells; F. Morton Black, Broughty Ferry ; Thomas Webster Atkins, 
Cork; John Kerr, Inverness; Frederick P. Walsh, County Cork; 
P ml J. Van-Coller, Cape Colony; Kristualal Datta, Calcutta; 
Gervus Parnell, London; Francis Pius Lauder, Bombay; James 
Barkley, Maghera ; Francis Ed. Dowling, Cork ; Donald F, Schok- 
umn, ColomlKJ, Ceylon ; Reginald C. M. Hoare, Birmingham ; Caris 
W. Iliffe, Derby; Andrew F. C. Gilmour, Linlithgow; Edmond 
Wnlsh, Limerick; John Timothy Buckley, Ireland; Cyril H. 
Burger, Jamaciu; Lydia Prio Datt, Nepaul; Timothy J. O’Dono- 
vun, County Cork; John Patrick Corcoran, County Mayo ; and 
John G. Blantyre, Gowllnnd, Sydney. 



le 


154 The Medical Press. 


NOTICES TO CORRESPONDENTS. 


Feb. 8, 1899. 


Notices to 

(Sorresponbotto, Short fetters, ■&£. 

%&- Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive signature or 
initials, and avoid the practice of signing themselves " Reader,” 
'Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
•pared by attention to this rule. 

FOR THE AMU8EMENT OF PATIENTS- 

A correspondent sends us the following effusion:—During the 
period of convalescence it is sometimes a difficult matter for the 
practitioner to propose a form of amusement suitable to the 
patient> ’ class of illness. I venture to suggest the following as a 
help In the complaints indicated :— 

Nap. 

Hide and-Seek. 

Billiards (spot barred). 
Leap-frog. 

The Race Game. 

Draughts. 

Rubber of Whist. 

Cricket. 

Fuss (pus) in the Corner. 

A. D. 

Statistician.— We have succeeded in finding the formula you 
require, though not without difficulty. M. de Movlne, in 1685, 
described his method as follows-.—When it is desired to estimate 
the “ expectation of life ” for a person at a given age. he directs 
us to subtract the actual age from the number 86. halve the 
remainder, and the result is the “ expectation of the individual.” 
Thus with a man, set. 42, 86 minus 42 equals 44 divided by 2 
equals 22. 

A WONDERFUL OPERATION. 

“Yes, sir.” said the American surgeon, " I have performed 
some wonderful operations. Perhaps the most surprising and 
most successful was after a railway accident. One of our promi¬ 
nent citizens was absolutely disembowelled by a fragment of the 
car I was on the spot. There were some sheep grazing near by, 
and in a moment’s time I had transferred the Inside of one of 
those sheep to the palpitating form of the man and sewed him up.” 
“That m n recovered, sir?” “Yes, sir; and he had iambs In 
-the ►pring.”—Exchange. 

Prop. Comby, Trousseau Hospital (Paris) .—Clinical Lecture on 

Infantile Pneumonia,” received with thanks. 


"Insomnia” . 

“ Phlebites " . 

“Measles" . 

“8r. Vitus's Dance ” ... 

" Galloping Consumption ”. 

M ipsomania ”. 

“Pruriius” . 

'’Torticollis”. 

>' Abscess of Lachrymal Sac ’ 


JfUetings of the §otieties attb lectures. 

Wednesday. February 8th. 

Hunterian 8ociety. — 8 p.m. Annual General Meeting. 
8.30 p.m. Sir H Beevor, Bart.: The Declension of Phthisis 
(Annual Oration). . , 

Royal College of Surgeons of England.— 5 p.m. Prof. L. 
Hill. ” Researches on the Influence of Gravity on the Circulation.” 
THCB8DAY, FEBRUARY 9TH. 

Bbitibh Gynecological 8ociety (20 Hanover Square. W— 
8.30 p.m. Specimens will be exhibited by Dr. Bantock, Dr. H. 
Jellett, Dr. H. Snow, Mr. J. F. Jordan, and Mr. Charles kyall. 
Papers wi'l be read i y Prof. Mayo Robson, " Complete removal of 
the Sac in a Case of Extra-Uterine Gestation and Dr. J. 
Ma<-phereon Lawrie, ‘ Notes on a Case of Extra-Uierine Preg- 
nancy.** 

Hospital fob 8ick Children (Great Ormond 8treet). - 4 p.m. 
Demonstration of Selected Cases by Dr. Barlow (Free to Practi¬ 
tioners). 

Friday, February 10th. 

Clinical Society of London (20 Hanover Square, W.).-8.30 

? ,.m. Papers:—Mr. W. G. Spencer, “Tuberculous Cavities in the 
,ungs giving rise to Gaseous Metastatic Abscesses.” Dr. Barlow 
an-> Dr. Batten “ACase of Myopathy, with Aut-.psy, in a Boy, 
®t. 5 year- ” illustrated by microscopical specimens and lantern 
slides). Mr. J. R. Luun, Some Results of Operation for Enla-ged 
Pr-state.” Mr. H. Botham Robinson, “ Hydatid Cy-ts of the 
Upper i obe of the Right Lung and Liver Successfully Removed." 

*oyalAc*demy of MrdicinhinIreland. —Obstetrical Sec- 
TI0!f .—sp-cim ns: Dr. F.Winifrid nicks »u. ‘SmallOvarian Oi stre¬ 
amed by Laparotomy ”; Dr. W. J. Kmyly, (a) “ Ectopic Gestation 
removed by Grliotnmy ”; b) “ Four Cases of Myomatous Uterus 
removed b j Cu-liotomy”; Dr. Kidd. " Three Cases of Ovarian 
Multilocular Cycts removed by Cceliotomy”; Dr. Glenn (a) 
“Cae of Dermoia Tumour of both ovaries removed by Ccelt- 
otoiny”-. (b) “ Epithelioma of the left Labium M-*jus removed 
by kxciaion Dr. Alfred Smith, (a) “ Fibro Myoma of the Fallo¬ 
pian Tube (b) "Case of Ovary and Tube adherent to Vermi¬ 
form Appendix removed by Cceliotomy”; (c) “Two Ovarian 
Cystx”; nr. Purejoy, (a) “Large Quantity of Hair from a Der¬ 
moid Tumour" ; (b) “Case of Pyosalpinx removed by Celi¬ 
otomy ” Papers: Adjourned discussion on the Report of the 
Rotunda Lying-in Hospital for 1898; Report of ihe Rotunda 
Gynmcoloiica. Hospital for 1898, by Dre. Puiejoy, Lyle, and 
LI -yd: “ Treatment f Uterine Carcinoma.” by Dr. More Madden; 
” Two Years Work at t»e samari'an Hospital for Women, Bel¬ 
fast,” by Dr. J hn Campbell; “Notes on a Case of Ciesarian 
Section, hy Dr F. W. K dd. 

Royal College f Surgeons of England.— 5 p.m. Pror. 
Hill, “ Researches on the Infiuen- e of Gravity on the Circulation.” 
Tuesday, February 14tu. 

Hospital for Diseases op the s-kin (Blackfriare Road).— 
4 p.m. Demonstration of Cases by Dr. Phineas Abraham. 


Vacancies. 

Colonial Office, London.—Medical Officers for temporary service 
on the Gold Coast, for one year. Unmarried. Salary at the 
rate of ESSO a year, with quarters, or an allowance in lieu 
thereof. Al*o Medical Officers for the West African Frontier 
Force on the Niger. Apply personally to the Assistant 
Private Secretary at the Colonial Office. 

Coventry and Warwickshire Hospital. Coventry.—Senior House 
Surgeon for nor less than two years. Salary £100 per annum, 
with rooms in the hospital, board, washing, and attendance. 

Hereford General Infirmary.—Assistant House Surgeon and Dis¬ 
penser for two years; unmarried. Salary £75 per annum, 
with board, residence, and washing. 

Kent County Lunatic Asylum. Barming Heath, near Maidstone.— 
Fourth Assistant Medical Officer and Pathologist; unmarried. 
Salary commencing at £175 per annum, with residence, atten¬ 
dance, coal, gas, and washing. Applications to the 8nperin- 
teudant. Barming Heath Asylum, Maidstone. 

Morpeth Dispensary, Beechfleld, Morpe'h.—House 8urgeon, 
unmarried. Salary £120 per annum, with furnished rooms, 
coal and gas. 

Rathdowa Union.—Superintendent Nurse in the Workhouse 
Infirmary. Salary £40 with board and residence. Also a 
trained Nurse at a salary of £25 with board and residence. 
(See advertisement.) 

Sheffield Union.—Assistant Medical Officer for Fir Vale, Pitsmoor. 
Workhouse Infirmary. Salary £100 per annum, with ap&rt- 
ments, rations, and other usnal allowances. Also Junior 
Assistant Medical Officer. Furnished apartments, board, 
and washing provided. Honorarium of £12 will be granted. 
Applications to the Clerk to the Guardians, Union Offices, 
West Bar. Sheffield. 


appointments. 

Bailey, John George, M.B., C.M.Ediu., Senior House Surgeon 
to the Bury Hospital, Lancashire. 

Barnabd, Harold L., M.S Load., M.B., B.S., F.B.C.S.Eng., 
L.R.C.P. Loud., M.R.C.S., Assistant Surgeon to the Metropoli¬ 
tan Hospital and Surgical Tutor to the Loadon Hospital. 

Batten, Frederick E., M.A.. M.D.Cautab., M.R.(!.P.Lond., 
Pathologist to the National Hospital for the Paralysed, 
Bloomsbury. 

Rbamwbll, Edwin, M.B., C.M., Junior House Physician to the 
National Hospital for the Paralysed. 

Dibbs, W. S., L.B.O.P.i.ond., M.R.C.8.. Medical Officer to the 
Farnham Royal Sanitary District of the Kton Union. 

Gaman, F. R. B„ L.R.C.P. Lond., M.R.C.8.. Medical Officer for 
the No. 1 Banitary District and the Workhouse of the Caistor 
Union. 

Hopkins, H. C. L.R-C.P.Edin., M.R.C.8., Medical Officer to the 
No 2 Sanitary District of the Bath Union. 

Ingram, A. M„ M.B^ C.M.Ed., L.R.C.P., M.R.C.8., Resident 
Assistant Medical Offleer to the Workhouse of the Birkenhead 
Union. 

Mobgan. D. N., L R.C.P.Lond., M.R.C.6., Medical Officer for the 
Tonyrefail and (iilfach Ooch Sanitary District of the Ponty¬ 
pridd Union. 

O’Dowd, J. A., L.R.C.P.Lond., M.R.C.S.. Assistant Medical 
Officer to the Workhouse of the Parish of Birmingham. 

Procdfoot, Frank G., M.A.St.And. M.B. and C.M.Edin., 
Examiner in Materia Medica University of St. Andrew a. 

Raper. M. H.. M.D.Lond., L.R.C.P., M.R.C.8., Medical Offleer 
to the Wakering 8anltary District of the Roehford Union. 

Walter, E. W. L.R.O.P.Ediu., M.R.C.S., Medical Offleer to the 
South Shoebury Sanitary District of the Roehford Union.; 


girths. 

Brack bnbury.— On Jan. 27th, at Strand Green, the wife of 
Henry B. Brackenbnry, M.R.0.8.Eug., L.R.C.P.Lond., of a 
sou. 

Clark.- On Feb. 1st, at 59, Norton Road, Hove, the wife of Arthur 
D. Clark, L.R.C.P. and 8., of a daughter. 

Newton —On Feb. 1st, at Genoa Villa. Tonbridge, the wife of 
Isaac Newton, M.R.C.8.Bng., L.R.C.P.Lond., of a son. 


Jtariages. 

Walker -Moorhousb.— On Feb. 2nd, at 8t. Mary’s Church, 
Crumpsall, Manchester, Edward J. Walker, B.A., M.D.. Man¬ 
chester, youngest son of the late Rev. John Walker, Dublin, 
to Emily Henrietta, second daughter of Christopher Moor- 
house, Fieldhead, Crumpsall, Manchester, 


garths. 

Carlb88. —On Jan. 25th, at Devizes, suddenly, Edward Nicholls 
Carless, aged 50 years. 

Crane.-O n Jan. 25 th, at Kensington Court Gardens, Samuel 
Leonard Crane, C.M.G., M.D. 

Fisher— On Jan. 30th. at hts residence, Lowlher Terrace, 
Lytham, Luke Fisher, M.D., aged 59 years. 

Iles.- On Jan. 31st., at his residence. The Retreat, Falrford, after 
a brief illness, Daniel Iles, M.R.C.S.,agei 67. 

Paul.— On Jan. 29ih, at The Terrace, Camberwell, John Hayball 
Paul, aged 83 years 

Turner.— On Feb 2nd, at 24, South 6treet. Greenwich, Reuben 
Turner, L.R.C.P.I.. L.R.O.S.I., son of the late 8. J. Turner, 
J.P., Dundalk, aged 44. 


Digiti: 



°gle 


¥W>. 15, 1899 


The Medical Press and C«rcnlar Advertiser. 


1 


jj^j 

1 


Allen & Hanburys’ 


Perfected i 


Cod 


tv&r 


TS> at tHyeiir ©w n factor!©* Sir? IL®f®4@in> S@n?<ta@irp in? 

W®rw&yp fr®n? absolutely fm&lfo anydl selected liver* ©f tbe 
u Cod-fish only, all *tal© Overs feeing rejected. Buy st@m?y 
weatSyer t3y© fishing boat* are ©fteny delayed p the fish beiiyg landed 
ini) a state ©f partial decomposition. TSyi* 9 together with the fact 
that manufacturer* are frequently not careful t© use oiyly C®d 

liver*? result* is? the Oil being of varying 

J C@s?f@iBE@Jj and contaminated with hye- 
m-pj product* nauseou* t© the taste? indigestible? 

and irritating t© the stonyady. 

| By the special processes employed the elirpination 

of all nauseous oxidation products is effected without 
jirnpairing in the smallest degree the invaluable nutritive 
and medicinal properties* By a very recent nyodifi- 
cation of our methods the 44 PERFECTED ” Oil is now 
rendered freer from taste than at any period since its 
introduction to the Profession in 1879, when the British 
A\edical Journal described it as having 44 almost the 
delicacy of Salad Oil/' and the Lancet as being 44 as 
..r- nearly free from taste as Cod-liver Oil can be.” 




&®in<e east! 


IborHj® and assimilated where 
sr 011 if refu*ed? it i* P fortSyes© 
sasoir?*, th© most ©fficaeiou? 


iffiSpSiQ, 

«»«!< ! 


Hind in ui®o 

44 It is a great boon to get such an Oil.” 1 44 No nauseous eructations follow after 

—The Practitioner. | it is swallowed.” — Med. Press &• Circular. 

In the “PERFECTED ” Oil we have a food which can he easily digested, even in cases of 
Phthisical Dyspepsia, where Cod-liver Oil is specially indicated, yet cannot he borne. 

ALLEN & HANBURYS desire to state, as emphatically as possible, that their “PERFECTED n 
“ " Cod-liver Oil is NEVER supplied in bulk to be bottled by retail dealers, trade marc. 

and that no Cod-liver Oil represented as being their “ Perfected ” is genuine unless 
sold in their original capsuled bottles and bearing their Signature in white across " T 

the label, and their Trade Mark—a Plough. Frequent misrepresentations have «o. ms. 
nvolved disappointment both to doctor and patient, and necessitated legal proceedings against 

the vendor. 


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Th« Pr»RR and Circular Advertiser. 


On an Exact Bacteriological Investigation made to ascertain the'Value of 

“Sanitas” Fluid, “Sanitas” Oil, & “Sanitas” Emulsion 

As DISINFECTANTS for GENERAL USE, 

By o. O-. MOOR, M.A.. (Cantab.), F.I.O., F.O.S., 

Member of the 8oclety of Public Analyst*, Joint Author of “Applied Bacteriology," Ac., Ac. 


4 Danes Inn, W.C„ London, July 2nd, 1898. 
C. T. Kinqzett, Esq., F.I.C., F.C.S., 

The “Sanitas" Company, Limited, 

Bethnal Grkxn, London, e. 

Dear Sir, 

I beg to present you my report on the experimental investiga¬ 
tions I have conducted on the preparations manufactured by your firm, 
named “Sanitas" Oil, "Sanitas" Emulsion, and “Sanitas’’ Fluid. 

The experiments were made to ascertain and establish, if possible, 
on a scientific basis, the efficiency of these preparations, and their 
auitabllity for the purposes for which they are designed as indicated 
by your publications and labels giving directions for use. 

Ihe experiments instituted for this purpose were as follows :— 

(а) In the case of the preparations above mentioned, various 
disease organisms-namely, those of Anthrax. Cholera, Diph¬ 
theria, Staphylococcus Pyogenes Aureus and Typhoid were 
brought into contact with the disinfectant for a given time and 
in a manner detailed below, and means were taken to ascertain 
whether the disinfectant employed was sufficiently powerful to 
determine the death of the organism in a given time. 

(б) A second series of experiments was undertaken to ascertain 
the effect when similar cultures were exposed to different 
strengths of these disinfectants for a standard time. 

(c) Expert menu were also made to ascertain the effect on 
ordinary air, as regards the removal or extermination of 
organisms suspended in it, by spraying with "Sanitas" Oil and 
•‘Sanitas" Fluid. 

(6) In the case of “Sanitas“ Oil, I have experimented as to the 
action of the vapour given off at a temperature not exceeding 
that of the human body. 

(e) Finally, I have tried some experiments to ascertain the 
action of “Sanitas ” Oil and "Sanitas" Fluid on the Bacillus of 
Plague 

Table 1. 

EXPERIMENTS WITH “SANITAS” OIL. 

Silk threads infected with cultures of the following organisms were 
exposed in "SANITAS’ OIL for the times shown below and then 
incubated in broth. Growth is shown by a + sign, no growth by a 
— sign. 


Anthrax and S. P. Aureus were also killed in 30" exposure. 
Controls all grew well. 

Table 2. 

A sim ilar experiment was carried out in the case of “ SANITAS ' 
FLUID. (Threads.) 


Obganibms. 


Times of Exposure. 



Anthrax 
Cholera 
Diphtheria 
B. P. Aureus 
Typhoid 

Controls all grew well. 

I next proceeded to ascertain the strengths of these dUlnfectanU 
required to ensure the death of the above-named liacteria in a given 
tinie—and in the following experimenU the time of exposure of the 
bacteria to the action of the disinfectant was In all cases ten minutes. 

In these experiments I used the method of shaking together an 
ie Ively growing broth culture of the organism U> be tested, with such 
A ,|ii n.ity of disinfectant that the resulting mixture contained the 
ftnngth of disinfectant specified in the tables below ; the exact details 
of 'be method of experiment are described in Peamiain A Moor’s 
A p- lit d Bacteriology, 2nd Edition, pages 377-382. (Balligre, Tindall, 
OH Cox). 


Table 3. 

“8ANITAS ’ OIL.—As the Oil is not readily miscible with water 
the “Sanitas” Emulsion, which contains 46 per cent, of “ Sanitas” 
Oil, was employed. 

Ten minutes' exposure. 


Organisms. 

Strength employed in Terms 
of “Sanitas” Oil. 

26 % j 10 % 6 % 

Anthrax . 

_ 


+ 

Cholera. 

— 


— 

Diphtheria. 

— 

— | 

— 

S. P. An reus. 

— 

+ ' 

+ 

Typhoid. ' 

- 

— | 

— 


Controls all grew well. 

Table 4. 

‘ SANITAS ” FLUID tested against Broth Cultures, as above. 
Ten minutes' exposure. 


Strength Employed. 


Organisms. 

60 °/ 0 

-6 % 

10% 

Cholera. 

_ 

_ 

_ 

Diphtheria. 


— 

— 

Typhoid. 


- 

- 


Organism. 

Times of Exposure. 

1" 

10" 

80" 

Cholera. 

_ 

_ 


Diphtheria. 

- 


— 

Typhoid . 

— 


— 


Anthrax and S. P. Aureus were also both destroyed by the 60 °/o 
mixture in ten minutes' exposure. 

Controls all grew well 

(>). I have made several experiments as to the destruction of 
bacteria floating in the air of a room by spraying the air with 
“ Sanitas ” Oil, and with “Sanitas ’’ Fluid—testing the air by means of 
He888 1 tube. 

The removal of bacteria from air by spraying will, doubtless, depend 
very greatly on the mechanical action of the particles of spray, because, 
as is well known, bacteria are very largely removed from air by a 
shower of rain, therefore, too much importance must not be attached 
to such experiments. 

Taking, however, the mean of several experiments, whereas the air 
of the room contained a considerable number of bacteria before spray¬ 
ing, the numbers were reduced, after spraying, to under five per cent, 
of those previously found. 

(6) . “Sanitas” Fluid floes not give off much vapour at ordinary 
temperatures; but, Sanitas ” Oil, on the other hand, is sensibly 
volatile at room temperature, and I have tested the action of the 
vapour given off by “ Sanitas ” Oil, at blood-heat on bacteria similar to 
those used in the broth and thread experiments. 

Some of the growth from agar tubes was smeared on filter-paper and 
suspended in a wide-mouthed Jar containing a little “ Sanitas ” Oil. 
The whole was placed in the Incubator (37° C.), and, after an hour, 
cultures were made on to nutrient media. The result was that only 
the two moat resistant organisms-namely, Anthrax and Staphylo- 
loccus Pyogenes aureus - had survived, while Cholera, Diphtheria, and 
Typhoid failed to grow. 

(7) . Having a culture of Bubonic Plague brought by a student from 
Hong-Kong I tried the effect of “ Sanitas" Fluid and "Sanitas " Oil 
on it. The bacillus was killed in each case by a ten minutes’ exposure 
to a strength of 33 per cent, of each disinfectant—the only strength 
tested. 

In conclusion, I regard the results of my investigation as affording 
ample evidence that the “Sanitas" preparations are thoroughly 
re table, when employed in the strengths and for the purposes 
spe-tfled in the directions issued by the proprietors, while their non- 
poisonous nature and pleasant cbaracter render them applicable in 
many Inst races where such substances as carbolic acid or mercurial 
ohioride would be inadmissible or dangerous. 

C G. MOOR.M.A., (Cantab.X F.I.C., F.C.S., 
Member of the Society of Public Analyitt, 

Joint Author of—“ Applied Bacteriology,” 

„ „ “ The Analysis of Food and Druos” 

„ „ " The Chemical and Biological Examination 

Water." 


THE 


14 


SANITAS” CO., Lim., Bethnal Green, E., 

Disinfectant and Embrocation Manufacturers. 


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o 



rcss and Circular. 


“SALUS POPULI SUPREMA LEX.” 


Vol. CXVIII. WEDNESDAY, FEBRUARY 15, 1899. No. 7. 


fkria Clinical lectures. 
INFANTILE PNEUMONIA. 

By Professor COMBY, 

Troufeeau Hcapital. 

TFrom our Own Correspondent.] 

Fibrinous or lobar pneumonia is very common in 
childhood, especially after the second year, and it 
would be well to decide on the treatment to be pre¬ 
scribed. For that, however, it is absolutely ne essary 
to understand the natural evolution of the malady. 

Since the researches of Talamon, Fraenkel.Weich- 
selbaum, &c., it is generally admitted that idiopathic 
pneumonia is an infection due to the presence of an 
encapsuled diplococcus called pneumococcus. This 
microbe is, indeed, common enough, as it is frequently 
found in the mouths of healthy persons, though it 
usually confines its attacks to the lungs. But its field 
of action is not necessarily confined to the pulmonary 
parenchyma ; it can invade the pleura, the meninges, 
the peritoneum, &c. These abnormal localisations, 
with their multiplied and extended points of 
infection, materially influence tbe prognosis, ren¬ 
dering it peculiarly grave in almost every case. 
Apart from these complications recovery is the 
rule. Of 150 cases of lobar pneumonia treated in my 
wards during the last eighteen months, I only lost 
one patient and here the pneumonia was double, com¬ 
plicated with empyema and suppuration of the mas¬ 
toid. Out of 20*2 cases. Rilliet and Barthez reported 
but two deaths ; and Cadet de Gassicourt, one out of 
seventy patients. From the statistics published by 
both home and foreign physicians, it clearly results 
that idiopathic pneumonia is absolutely benign in 
children, and this benignity contrasts with the gravity 
of broncho-pneumonia which has nothing in common 
however with the naineof the malady we are treating. 
The evolution of pneumonia is absolutely cyclic; it 
commences suddenly, runs its course rapidly, and 
terminates suddenly; the defervescence sets in as 
quickly as the invasion, and in a few days the most 
alarming symptoms give place to all the attributes of 
health. The cycle generally lasts one week, but it may 
be shorter (abortive) or longer (prolonged pneumonia). 
Sometimes the symptoms are well marked, at others 
insidious and attenuated in their expression; as in 
the rudimentary pneumonia of d'Espine. 

It must be borne in mind that no matter what kind 
of pneumonia you are called on to treat, the thermic 
cycle is inflexible, no therapeutic agent can cut it 
short. It is possible that the natural course of the 
disease could be interrupted by a specific remedy, an 
anti-pneumococcic serum for instance, but this specific 
we do not possess yet, and we must be modest as to 
our role in the treatment of pneumonia, and spare 1 
the patient that injurious medication so justly criti- | 
cisea by Talamon. 

In the review of remedies appropriate in pneu- | 
monia, I will dwell as much on those to be avoided j 
as on those to be prescribed. Where the malady runs 
its course without any alarming symptoms, the treat- : 
inent must be of the simplest, viguant observation 
being all that will be required. 


The little patient should be kept in a large well- 
lighted and well-aired room, and the windows opened 
now and again to change the air. Where the room, 
on the contrary, is small and dark, inhalations of 
oxygen may be ordered, with benefit. The temperature 
of the apartment should be moderate (68 degs. F.); 
cleanliness of the body is not less necessary, and can 
be secured by a bath which may be renewed once or 
twice during the malady, antiseptic sponging (boric 
acid) of the mouth, the nostrils and the throat should 
be done systematically, so as to ward off as much as 
possible secondary infection. The diet should be 
liquid, and the child will be pressed to drink plenty 
of bland infusions, so as to provoke renal activity, by 
which the organic waste and the toxins which 
threaten to poison the patient are removed; the intes¬ 
tines, moreover, should be attended to, as constipation 
is very general in pneumonia. 

Up to the present I havenot spoken of therapeutical 
agents ; they might, indeed, often be dispensed with 
altogether. In what cases then may they be 
prescribed ? 

Formerly, no case of pneumonia was treated 
without energetic revulsives and the youngest 
children did not escape the blister. This revulsive 
may in some cases be prescribed with benefit as a local 
derivative, but in the child it is never indicated and 
may do a great deal of harm. I never prescribe it in 
pneumonia; it is inefficacious and dangerous, and 
that is enough to exclude it from our treatment. 
But if we abstain from the blister, we may with 
much advantage employ other agents, such bb the 
mustard pouli ice, dry cupping, local applications of 
cold water or even ice. I have already said that 
liquids should be given freely to the patient so as to 
provoke an abundant flow of urine. It is necessary 
also to purge once or twice during the disease with 
castor oil or scainmony. If the tongue be loaded and 
the case complicated with intense dyspncea and 
bronchial catarrh, I always order an emetic con¬ 
sisting of a tenth of a grain of tartar emetic and 
twenty grains of sulphate of soda for each year of 
the patient; for instance, for a child of ten I give :— 

Tartar emetic, 1 grain; 

Sulphate of soda, 3>ij ; 

Syrup of gum, Jj ; 

Water, Jiij. 

a third part to be taken every half-hour in the morn¬ 
ing fasting. The patient will thus vomit and be 
purged three or four times, and a considerable im¬ 
provement is always the result ot this treatment. 

The fever runs very high in wises of pneumonia, 
but it is well known that children bear a high tempera¬ 
ture very well. The antithermics, quinine, anti¬ 
pyrin, &c., ere of no use unless given in large, that 
is to say, toxic doses. <old water acts better and 
costs less. I have noticed that the cold bath (75 degs. 
to 65 degs.) was well Supported by children, and when 
resorted to every three or four hours, it lowered the 
temperature, attenuated the dyspnoea, improved the 
pulse, and calmed any agitation, delirium or sleep¬ 
lessness, that might exist. In cases where the malaay 
is complicated with nervous manifestations, Buch as 
convulsions, I have found trional to be of great 
service in five or ten grain doses according to the 


Digitized by VJ oogle 







156 The Medical Press. 


ORIGINAL, COMMUNICATIONS. 


Feb. 15, 1899. 


age, repeated two or three times a day; where the 
heart showed signs of weakness moderate doses of 
digitalis might be useful, say, from one to four grains 
of the powdered leaves infused in a glass of water and 
drank in divided doses during the day. 

You will see by this rapid resume what a small 
place is occupied by drugs in the treatment of infan¬ 
tile pneumonia. In every case therapeutical hygiene 
is absolutely necessary; in some cases only, and 
according to the symptoms, light revulsives, laxatives, 
cold baths, tonics, and sedatives may be prescribed. 


(Original (Eomnumications. 

SOME RESULTS OF. OPERATIONS 
FOR ENLARGED PROSTATE, (a) 

By JOHN R. LUNN, 

Medical Superintendent, Marylebone Infirmary. 

In the Lancet of October 3rd, 1896, a most suc¬ 
cessful case was reported by Mr. Arthur Hunt, in 
which double castration was performed on a man, 
set. 73, for severe cystitis and enlarged prostate with 
recovery, after which the patient was able to go 
shooting and fishing in Scotland. After reading Mr. 
Hunt's article I determined to do something for my 
distressing cases of enlarged prostate. This is my 
reason for bringing a few of my notes before this 
Society on some of the results of operations for en¬ 
larged proBtate. 

Case I.—Edward H—, set. 72, was admitted 
into St. Marylebone Infirmary, May 5tli, 1896. 
with an old irreducible hernia on the right 
side, and retention of urine, for which he i 
had been admitted into the infirmary several times 
and treated. He stated he was in the habit of pass¬ 
ing his water 20 or more times in the twenty-four 
hours. It was found the retention of his urine was 
clearly due to an enlarged prostate, the urine was 
acid 1025 and contained blood. On May 14th, 1896, 
the left vasdeferens and nerves were divided and tied. 
As no apparent diminution of prostate, and no 
alteration of micturition had taken place, the right 
testicle was removed and a radical cure for the right 
inguinal hernia performed. The operation was 
rfectly satisfactory, the patient's general health 
gan to improve, though he got retention, but no 
cystitis, which he had when admitted into the 
infirmary on other occasions. Taking into consider¬ 
ation the patient’s good health and the fact that but 
for the frequency of micturition, he might be up and 
a oout, and able to do some light work, he was advised 
to have the left testicle removed, to which he readily 
consented. On August 7th, 1897, the left testicle 
was removed, which did not appear much atrophied. 
Whilst the patient was under chloroform a careful 
examination of the prostate per rectum was made, 
and there was no doubt that though still large 
the right lobe was less prominent than the left, and a 
large size No. 10 catheter could be passed easily. 
On March 20th, 1898, the patient said he had kept a 
record of the number of times he had passed urine 
in the twenty-four hours, and he said that there was 
a considerable improvement, since the last operation, 
he only passed urine ten times instead of sixteen to 
twenty in the twenty-four hours. He never had now 
to pass a catheter, and did not get retention and 
enjoyed life more than he did before the operation. 
Towards November 29th he developed dropsy, and 
died December 21st, &c. 

Case H.—Edwin H—, set. 63, a hawker bv trade, 
and a married man, was admitted March 4th, 1897. 

(a) Abstract of popjr read at the meeting of the Clinical Society 
Of London, February 10th, 1809, 


He was admitted the first time in February 1896, when 
he had retention, and the first thing he noticed 
wrong was an increased frequency of micturition, 
and ne passed water as many as six times every 
three hours both during the day and night. He 
stated he used to get very ill with shivering fits, 
and was obliged to run to the nearest hospital and 
have his urine drawn off. When he was 
first admitted it was noticed he had a large 
prostate, and No. 6 gum elastic catheter was 
passed with difficulty, the urine then was offensive, 
and contained albumen, specific gravity 1020,{alkaline. 
Section of the right vas deferens was performed 
February, 1897, and had a marvellous effect on 
reducing the number of times of micturition per day. 
After he had left the infirmary several months, the 
shivers, aB he described it, came on again, though he 
kept at his work. He frequently got retention, and 
had to visit the hospital again when this occurred. 
On May 4th, 1897, he was readmitted to St. Maryle¬ 
bone Infirmary, and with rest in lied, hot baths, &c., 
he improved in health, his temperature became 
normal, but still he had to pass liis urine several 
times during the night. He wished for another 
operation on the other side, so on June 17th, 
1897, the left vas def-rens and nerves . were 
tied under chloroform. The prostate had not appa¬ 
rently altered mach in size, though it felt soft to 
touch. The patient’s wound healed by primary union. 
A month after the operation the patient said he was 
much better with his urine, and only made water four 
to six times in the twenty-four hours, and went the 
whole night without passing his urine. He dis¬ 
charged himself six weeks after the operation in per¬ 
fect health, and the urine was quite normal, and he 
expressed himself much pleased with the results of 
the operation. 

Case III.—Henry C —,fet. 63, a painter, was admit¬ 
ted into St. Marylebone Infirmary, Dec. 9th, 1896, for 
double tuberculous disease of his testicles, the right 
epididymus was enlarged and indurated, and the 
thickening of the vas extended up the cord on both 
Bides as far as the external rings. On Jan. 4th, 1897, the 
left testicle was removed. An examination was made 
of the prostate, which was much enlarged and easily 
felt. Two weeks after the first castration, the right 
testicle was removed, after which his general condi¬ 
tion began to improve, his appetite increased, his 
temperature went down, aud he expressed himself 
feeling much better since the operations. The interest¬ 
ing point was the remarkable condition of the man’s 
prostate when examined per rectum, with a No. 10 
catheter in the bladder (on June 5th, 1897), one was at 
once Btruck with the small size of the gland; in fact, it 
seemed as though there was a depression at the point 
where the prostate should have been. The patient 
got quite well, and discharged himself. I have seen 
him Bince, and the urine is normal, and he has no 
frequency of micturition and otherwise is in good 
health. 

Case IV.—Samuel G—.set. 66, was admitted March 
10th, 1897, with retention of urine. No catheter could 
be passed, even under anaesthetics, and as the patient 
appeared very ill—temperature, 102'4—the bladder 
was drained supra-pubically. After a few days 
the stricture was divided, and a large catheter 
(No. 10) was passed. The prostate was found to be 
much enlarged on digital examination, nnd the catheter 
was not fastened into the bladder as the urine was 
very alkaline sp. g. 1020 and offensive, and contained 
blood, pus, and albumen. The bladder was washed 
out once or twice daily with lotio boracis, but 
he did not improve. The operation for castration 
was suggested, which he refused. His general con¬ 
dition and health began to fail and the man became 
very ill indeed, and he could only pass a very smal 
quantity of urine at a time, which was very onensive 

i 


oogle 


Diqi 


Fib. 15, 1899. _ORIGINAL COMMUNICATIONS. The Medical Press. 157 


lie became hectic and his temperature rose to 103, 
and he had rigors with a furred tongue. On May 
■6th he had begged for something to be done (after 
being told his case was hopeless). Double castration 
was performed by the median incision as rapidly as 
possible whilst the patient was under the influence of 
A.C.E. mixture. He had a good deal of shock after 
the operation. The next day the patient expressed 
himself feeling very much better. He had some in¬ 
continence of urine, the temperature became normal 
in a remarkable way, and the condition of his urine 
improved, the pus became less, his appetite became 
ravenous. He then passed 30 ozs. to 40 ozs. of urine 
in the twenty-four hours without difficulty, and the 
catheter was only passed twice a week. He began 
to take Didymin tablets once a day for some weeks, 
and they were increased to twice a day. The patient 
began to improve in a miraculous way until August 
12th, when he had gained a stone in weight, and was 
getting up all day and thinking about going out to 
his work. The urine then only contained a trace of 
albumin, and was neutral to test paper. He was 
,suddenly seized with vomiting and diarrhoea, and 
obliged to take to his bed again. The tablets of 
Didymin were stopped, and he began to improve until 
November, 1897, when he became ill again with 
vomiting and uncontrollable diarrhoea, the pus in 
the urine increased again, he became semi- 
comatose, and died November 6th, 1897, six and a 
half months after the double castration. 

P.M.—Most of the viscera wei*e in good condition, 
the bladder was hypertrophied, and contained about 
one ounce of clear fluid, and tone muco-pus. The 
orifice of the urethra) was quite freely open. The 
ureters were both dilated and pouched, and contained 
all the pus. The prostate was not apparently 
enlarged, but had a very prominent hard middle lobe. 

Case V.—Edwin S—, tet. 76, a joiner, was admitted 
Jan. 20 oh, 1898, with retention of urine for which he 
had been admitted before and was obliged to pass a 
catheter very .often for himself, and complained also 
of frequent micturition day and night (sometimes 
getting up at nights 6 or 7 times). The patient’s 
general health was good. On examination of the 
prostate by the rectum and catheter in the bladder, 
a large projection could be felt in the rectum the Bize 
of a small tangerine orange which impeded the passing 
of the catheter. He had no luematuria or offensive 
cystitis, the urine was acid and contained albumin. 
'The man stated he passed urine about 16 to 20 times 
in the 24 hours. On April 29th the left vas and 
nerves were tied and cut under the influence of 10 p c. 
•cocaine which was injected into the tissues 
where the vas was resected. The wound healed 
well and was dressed on the sixth day when 
the stitches were all removed. No improvement 
of micturition took place, so on June 18th 
the right vas was tied under the influence of 
•5 p. c. cocaine, which was injected as before, there 
was little or no pain from the skin incision, but on 
separating and tying the cord and nerves with silk 
gut ligatures, the patient complain-d of a little 
smarting pain. On June 30th it was noted the 
patient got up and expressed himself much pleased 
with the results of the operation, as he passed good 
nights and never got retention, and only passed urine 
half the number of times he did before the operation, 
and was able to get about as well as ever he did. In the 
middle of November he began to vomit and become 
jaundiced and developed cancer of the liver, from 
which he died on December 18th, 1898. Both testicles 
were found atrophied, and he had developed a double 
hydrocele of his tunica vaginalis. His other viscera 
were normal. 

Case VI.—Thomas P—, set. 64, a coachman, with 
■a. very good history, was admitted in Oct., 1898, with 
retention of urine, and though a No. 10 catheter could 


be passed fairly easily, there was a distinct obstruction 
about the prostatic part of the urethra, which could 
easily be felt with the finger in the rectum, the urine 
was 1*005 alkaline and contained albumin, and he had 
several severe attacks of hsematuria after admission. 
On November 28th double vasectomy was performed 
under the influence of chloroform. The next day the 
urine contained more albumin and some blood. He 
was able to pass his urine normally, and he did not 
seem any the worse for the operation, and was about 
the ward as usual. December 30th, 1898.—He tells 
me he Bleeps all night without passing urine, and 
expresses himself quite well, and was discharged quite 
well January 6th, 1899. 


^hc Xcttsomian Xctture 

ON 

SOME OF THE CLINICAL ASPECTS 
OF GRANULAR KIDNEY, (a) 

Bt SAMUEL WEST, M.D., F.R.C.P., 

Assistant Physician, St. Bartholomew’s Hospital; Senior Physician* 
Royal Free Hospital, &c. 

Granular kidney is a disease of great importance on 
account of its frequency, a frequency which is by no 
means adequately recognised. Post-mortem it is often 
discovered when not suspected. It is often in itself the 
cause of death, even of sudden death, and it often 
explains why death has happened in other diseases 
which otherwise might not have proved fatal. During 
life it is often discovered unexpectedly if looked for; it 
is often overlooked if not suspected, and 't often explains 
a case which has been a puzzle until granular kidney 
gave the key. For all these reasons, granular kidney is 
not only one of the most interesting of diseases but also 
one of the most important. The general frequency of 
granular kidney post-mortem ranges from 11 8 to 18 per 
cent., so that it is a very common condition. 

Nothing will better prove the importance of granular 
kidney than the fol owing statistics obtained for 
me by Dr. Horder, the result of an investiga¬ 
tion made into the causes of death in persons 
brought into St. Bartholomew’s, dead or dying. 
The total number of such cases (excluding children 
under five) was 79, in all of which a post-mortem 
examination was made. Of these, sixty-four were dead 
on reaching the hospital, and fifteen died in the surgery. 
In 48 per cent of these cases chronic interstitial nephri¬ 
tis was present; in 16’8 per cent, it was the only cause 
of death, and in 21’6 per cent, more it played its part 
either in producing death or in causing the lesion which 
led to death, i.e., it was the sole or part cause of death 
in 38’4 per cent. Of the remaining cases, three had 
phthisis and one pneumonia. 

The influence of granular kidney upon the prognosis 
of other diseases may be well illustrated by the case of 
acute pneumonia. In 100 fatal cases which I investigated, 
23 showed some pre-existent chronic disease of the 
lungs or pleura, eight of the heart and ten of the 
kidneys. Granular kidney is a bilateral, and to a great 
extent, symmetrical affection, that is to say, both kidneys 
are affected, though not necessarily to the same extent. 
The difference between them, however, if there be any, 
is slight and rarely exceeds an ounce. The kidneys may 
be much contracted and greatly reduced in size, so that 
they may not weigh more than It or 2 ozs. each. Ex¬ 
treme contraction such as this is really rare. The 
kidneys are, it is true, usually reduced in size and weight, 
but by no means to the extent that seems generally 
believed, while in some instances so far from being 
smaller than normal they may be much above the 
average size and weight. In other words, there are large 
as well as small granular kidneys, just as there are large 
and small cirrhotic livers. The kidneys, moreover, are 

(a) Abstract of lecture delivered at the Medical 8odety of London 
on Monday, February 6th, 1899. 


Digitized 



LV^ 


168 The Medical Pbess. 


ORIGINAL COMMUNICATIONS. 


not alwayB granular on the surface, though microscopic¬ 
ally the interstitial change may be marked enough. 

The typical granular kidney is small, contracted, 
hard, cirrhotic or granular, has a nodular surface, often 
studded with numerous cysts. On section the whole 
kidney is found to be cirrhotic and wasted, but the 
wasting affects chiefly the cortical region. The changes 
consist in fibroid induration and cellular degeneration. 
Though granular kidney is described as chronic inter¬ 
stitial nephritis, it is an open question how far these 
changes are in reality of inflammatory origin. Certainly 
in most cases we have no more evidence of inflammatory 
processes in the cirrhotic kidney than we have in the 
cirrhotic liver. 

Granular kidneys are sometimes described as of two 
kinds, the white and the red, and the difference in colour 
is held by many to denote difference in origin, and they 
are accordingly called the contracted white and the 
contracted red. The small white is stated to be gener¬ 
ally somewhat larger than the red, to be less granular 
on the surface, and to have more cellB left, these cells 
being in a condition of fatty change, to which the colour 
is referred. These statements are not, in my experience, 
correct; for small white kidneys are often quite as small 
and as granular on the surface as the small red, and 
may have quite as few, or even fewer, cells left, and 
these cells are often not fatty. The two forms certainly 
exist. 

The term “ contracted white ” introduces confusion, 
and seems to assume what ought to be proved, viz., the 
different origin of the two forms. It suggests that the 
small white is but the later stage of the large white 
kidney. It assumes that every stage can be d-monstrated 
between the large white kidney of chronic parenchy¬ 
matous nephritis, through the contracting white to the 
contracted white. If this was the usual sequence of 
events, it ought to be capable of easy clinical proof. 
Pathologicall. it is easy to show that chronic parenchy¬ 
matous, or the large white kidney, presents interstitial 
changes of a contracting kind, but the weak link in the 
chain is between the so-called contracting form and the 
contracted form. 

Jf the distinction between the two forms is to be made, 
it would be very much better to speak of them as small 
white and small red, or as white cirrhotic and red cir¬ 
rhotic, rather than white and red contracted kidney s. 
For myself I consider the difference is really one of 
colour chiefly. Microscopically I do not see that any 
clear distinction can be drawn. 

If, pathologically, the distinction between the two 
forms is open to question, clinically, so far as I can see, 
no distinction at all can be drawn between them ; that 
is to say, with exactly the same clinical symptoms we 
may find the kidneys in the one case white, and in the 
other case red. Granular kidney is often described as 
chronic interstitial nephritis, but all forms of chronic 
interstitial nephritis are not necessarily granular kidney 

First of All must be cut out of the category of granular 
kidney all those cases in which the lesion is unilateral; 
for example, that which results from obstruction to the 
ureters. 

Again, all cases of fatty patchy fibrosis, e.g., the results 
infarcts or gummata, even if both kidneys are 
involved, must be excluded, for they do not produce the 
clinical symptoms of granular kidney. 

Even when the lesions are bilateral and both kidneys 
are affected, I should still exclude from the category of 
granular kidney certain forms of chronio interstitial 
nephritis which are often included pathologically, 
though clinically they are distinct. I refer to the 
degenerate kidneys met with in connection with 
advanced atheromatous disease or with the chronic 
gout of elderly persons, in fact, the kidneys, which are 
commonly called senile or gouty. 

These kidneys are often markedly interstitial, and 
there is a good deal of fatty and cellular degeneration, 
giving the surface a mottled appearance, but they need 
not necessarily be granular, and are usually large. 
Moreover, the cases need not run the clinical course of 
granular kidney. 

Eliminating these various forms, we are left with a 
pathological group of cases of interstitial nephritis 


Feb. 15, 18W. 

kidneys of a definite character, which we commonly 
recognise by the term granular or cirrhotic kidneys. 

In most recent writings, granular kidney is divided - 
into two forms, the arterio-scierotic and the renal, and 
these are often dealt with in different places, the one 
form under diseases of the vessels, and the other under 
diseases of the kidney, so that in order to gain a complete 
view of granular kidney as a disease, it has to be read in 
different chapters. This is very inconvenient and con¬ 
fusing, and suggests a marked difference between the 
two forms which, clinically, does not exist. It has, how¬ 
ever, one advantage in that it fixes attention upon the 
question which is still at issue, viz., whether it is in the 
vessels or in the kidney itself that the primary causes of 
the disease are to be sought. 

Acute nephritis attacks the cells primarily and chiefly, 
but the interstitial tissues are always involved to some 
extent, and the more so the longer the disease has existed. 
This small-celled infiltration may in time end in the 
production of connective tissue at first in part only, in 
other cases more widely distributed, and there will be 
the more of it the longer the disease has lasted. The 
large, red kidney of acute nephritis passes, as the disease 
lasts, gradually into the large white. In the large 
white kidney some interstitial change is often fouDd, 
sometimes local, at other times more diffuse ; and admit¬ 
ting that pathological connective tissue contracts in the 
kidney as elsewhere, wo should expect the large white 
kidney in time to become smaller, to undergo a certain 
degree of contraction in parts if not as a whole, and of 
this we have frequent pathological proof. The kidney is 
then described as contracting white. It is even conceiv¬ 
able theoretically that the contraction might go much 
further, so that in time we might have the large 
white kidney passing into what may be described as a 
small white kidney, or even possibly ending in a small 
red kidney. 

Now, admitting the pathological possibility that acute 
parenchymatous nephritis might end in a granular 
kidney, if this actually occurred frequently it ought to 
be capable of easy clinical proof ; for the symptoms of 
acute nephritis are not such as are likely to be often 
overlooked by the patient or by tho friends. Such cases 
are recorded, but they are certainly rare, and many of them 
prove on careful critical investigation not to be so con¬ 
clusive as they at first sight appear. I have been on the 
watch for them for years, and although I have seen 
many in which the lesion has gone so far as to produce a 
somewhat diminished white kidney, the majority of such 
kidneys are still much above normal size. I have never 
traced a single case beyond this, i.e., as far as a small 
white kidney. I do not say that it does not occur ; on 
the contrary, I believe it may. I merely say that so far 
I have failed to observo it. It might be urged that 
marked contraction in granular kidney would be more 
frequent if the patients lived long enough. But it does 
not necessarily follow, even when the symptoms of 
chronic parenchymatous nephritis have lasted for many 
years that a contracted kidney will result. I know of a 
woman who has had several attacks of parenchymatous 
nephritis in the course of thirteen years, and who has 
never at any time lost the albumen from the urine; yet 
now, at the end of thirteen years, her arteries are thin 
and her heart not hypertrophied, she appears in fair 
health, and her retinae are normal. There are, in fact, in 
spite of the long duration of the case, no clinical signs 
whatever which would justify the diagnosis of granular 
kidney. 

Nor can any closer relation be proved by the clinical 
history to exist between granular kidney and antecedent 
acute nephritis. It is quite unusual in cases of granular 
kidney to obtain any history of symptoms which would 
in any way justifiy the diagnosis of acute nephritis. 
This fact has been always insisted on as long as granular 
kidnev is recognised ae a disease, and is generally 
accepted. 

Even when the history of antecedent acute nephritis 
is obtained it doep not necessarily follow that the 
granular kidney has been the result of it. 

The occurrence of acute nephritis is no proof in itself 
that prior to the acute nephritis the kidney was sound, op 
in other words, that if after an attack of acute nephritis 



Feb. 16, 1899. 


ORIGINAL COMMUNICATIONS 


The Medical Press. 159 


"the kidneys are found granular they became granular as 
the result of the acute attack. 

For, on the one hand, it is not uncommon in the course 
■of a case already recognised as one of granular kidney 
to see acute parenchymatous nephritis develop; and, on 
the other, to see a patient hitherto believed to be healthy 
■with the symptoms of acute parenchymatous nephritis, 
and yet for that patient to present thickened arteries, 
and even eye changes, which show that the disease really 
<lated long before the commencement of the so-called 
acute attack; in other words, that the patient has got 
acute nephritis in both cases alike because the kidneys 
were already diseased. Indeed, I think we may almost 
-go so far as to say that as in children acute parenchyma¬ 
tous nephritis raises a strong presumption in favour of 
a recent attack of scarlet fever, so in the adult it ought 
to suggest the suspicions that the kidneys were pre¬ 
viously unsound, in other words, granular. Of this I am 
•quite sure, that if in cases of acute nephritis in the 
adult the signs of granular kidney be looked for they will 
very frequently be found. If then, in spite of the fact 
in the majority of cases of granular kidney, the history 
and symptoms of nephritis are lacking, granular kidney 
is still to be referred to some antecedent nephritis, it 
follows that the initial attack must either have been 
slight, and therefore overlooked, or else that it was of 
some peculiar and specially latent kind. 

It is evident from what hasjbeen said that it is only in a 
very small number of cases that a history of antecedent 
acute nephritis can be obtained; that in still fewer 
instances can a case be traced from an initial acute 
nephritis to granular kidney. It follows, therefore, that 
most cases of granular kidney must be referred to some 
other origiu. 

The changes in the arteries with granular kidney are 
general, widespread in fact, universal throughout the 
whole body. They are found in all parts alike, in the 
kidney for instance, as well as the brain, eye, spinal cord, 
or even skin. 

Now, there are only two forms in general arterial 
-change recognised in pathology ; viz., atheroma, and that 
•connected with granular kidney. 

Atheroma is a well-marked disease of the vessels. It 
is the degeneration which is usual as age advances, and 
though sometimes met with in earlier life, and even 
sometimes in quite young people, it is certainly a com¬ 
paratively rare affection at the time when the changes 
of granular kidney are most common. 

Atheroma being a general disease will, of course, affect 
the renal arteries like any other, and will produce in the 
'kidneys similar changes to those to which it leads in 
-other cellular organs, e.g., in the brain. 

Thus it is not at all uncommon in the later periods of 
life to find the kidneys large and mottled, showing a 
good deal of interstitial tissue and of cellular change; yet 
the atheromatous or senile changes do not as a rule, 
though they may sometimes, lead to the well-known 
granular contracted kidney. Of course, old persons may 
Buffer from granular kidney, and the two conditions may 
be associated. But, for all that, if the question be re¬ 
garded without bias and in a general, comprehensive 
way, it must be acknowledged that atheromatous diseases 
of the arteries, and the changes of granular kidney, are 
different in kind as well as in history. In granular 
kidney the thickening of the vessels is fairly uniform. 
At any rate, it does not occur in the irregular patches if 
.atheroma is universal. 

As to the exact nature of the change in the vessels, 
opinions 6till differ, as they have done from the first 
There can be no doubt that there is a considerable 
amount of muscular hypertrophy in the vessels, or that 
it is associated in many cases with changes in the intima 
as well as in the adventitia, which are not atheromatous, 
And yet are of a marked character. 

The relatioa between the cardio-vascular and the renal 
lesions is very difficult to determine. So far as the 
cardio-vascular symptoms go, I think we may say this, 
that the cardiac lesions being of the nature of hyper¬ 
trophy, must, as in other cases, be the response of the 
heart to some extra work thrown upon it of a permanent 
kind; it must therefore be secondary. It certainly 
<seems more probable that both the heart and the vessels 


hypertrophy together, for the purpose of assisting the 
circulation to overcome some obstruction. If this be so 
the obstruction must be peripherally seated, and must 
be sought therefore in the small peripheral arteries or 
capillaries. 

In these peripheral vessels, the possible causes of 
obstruction are two: either there must be a structural 
change, that is to say, an anatomical lesion, or some 
functional disturbance, which interferes with the passage 
of the circulation through the vessels. 

If the change be structural and the lesions of the peri¬ 
pheral vessels are of a degenerative character, bein^r 
general throughout the whole of the body, they would 
involve the kidneys as well as other parts, and in this 
way it is conceivable that the kidney disease might be 
a co-ordinate or subordinate part of the general vascular 
disease. This is a theory which is now indicated by the 
term arterial-sclerosis, and such kidneys are described 
as arterio-sclerotic kidneys. 

If, on the other hand, the change here be not of a struc¬ 
tural kind, but a functional one, any structural change that 
is found being of a secondary and subsequent order, the 
obstruction must depend upon Borne impurity in the blood. 
But this impurity of the blood, which renders it more or 
less obnoxious to the tissues, may be either of a renal 
or extra-renal origin. If of extra-renal origin then the 
result may be the same as in the former case, viz., a 
general vascular disease which affects the kidney as well 
as other parts But it may also be of a renal origin, in 
which case there must have been some renal mischief 
antecedent. Thus even from the point of view of the 
vessels we are brought back again to the two original 
views about which so much discussion has raged, viz., 
whether the disease is primarily arterial or primarily 
renal. 

If the changes in the vessels be regarded as primary, 
as they certainly aie in atheroma and may be also in 
granular kidney, then it might be possible to find cases 
of marked changes in the vessels with little or no changes 
in the kidney. And the same would be true if the changes 
in the vessels and in the kidnev both stood in relation to 
common cause. It is only by studying the beginnings of 
the disease, that is to say granular kidney in its earlv 
stages, that we can hope to arrive at a solution of these 
difficulties ; for in the later stages all these changes are 
present together, and it is difficult, if not impossible, to 
form any opinion as to precedence of the one or the 
other. 

From whatever point of view, then, we regard granular 
kidney, whether pathological or clinical, we come to the 
same conclusion, viz., that whether primarily arterial or 
primarily renal, granular kidney is a disease sui generis 
and ought on that account to be treated, in writing on 
the subject, under a separate heading, and not split up, 
as it generally is, between diseases of the arteries on the 
one hand and diseases of the kidney on the other. 

Granular kidney is a very insidious disease. For a long 
time it presents no symptoms at all, and can be recog¬ 
nised then by ph>sical signs alone. The only definite 
symptom, perhaps, in the early stage (and even this is 
not constant), is an increased frequency of micturition. 
eapaciaUy at night; but as this has been of such gradual 
i ons t that the patient has become quite accustomed to it, 
i and does not regard it as peculiar, no complaint is made 
of it unless it be extreme, and the history of it is often 
; only to be elicited on pointet questioning. When 
symptoms arise the disease is already far advanced. In 
oth-r words, the symptoms do n t occur until late in the 
disease. 

The symptoms fall like the lesions, into two groups, 
viz., cardio-vascular and renal. Speaking generally, the 
cardio-vascular are earlier than the renal. The cardiac 
symptoms are those of heart-failure, more or less pro¬ 
nounced. The vascular symptoms are the more or less 
mechanical effects of the vascular lesion, and consist 
chiefly of haemorrhage and its results. The renal 
symptoms are the latest to develop and fall into two 
groups according as they are of gradual development or 
of sudden onset, and they are frequently described as 
chronic and acute uraemia respectively. 

1 should prefer to call them acute and chronic renal 

I) 

Digitized by GoOgle 



160 Thb Mbpioal Pbbss. _ORIGINAL COMMUNICATIONS.__ Fbb. 15, 1899. 


toxEemia. Both alike are to be connected with the 
wasting in the kidneys and it3 consequent defective 
action. The gradual »nd progressive wasting is attended 
with the gradual and progressive development of the 
chronic form of uremia. 

Renal cachexia is the name that I should prefer to 
give to chronic uremia. It strongly resembles, both in 
character and course, the cachexia that is seen in a 
variety of other diseases, eg., in Addison’s disease, in 
the later stages of cirrhosis hepatis, in diabetes, and 
malignant disease. It consists in a gradually increasing 
anemia and asthenia, associated with various miscel¬ 
laneous symptoms. The symptoms are similar in kind, 
and differ from them only in the rate of development, to 
those that are seen after complete obstruction of the 
ureters or removal of the kidneys, which has been 
experiments ly produced in animals or observed in man 
as the result of pathologic il causes or surgical opera¬ 
tion. 

The symptoms in all these cases are similar, but differ 
from those which are usually described as acute uraemia, 
andthe difference is probably not one of degree only but 
of kind, so that I think they ought to be distinguished by 
different names; for the first I should reserve the term 
renal cachexia, for the second I should use that term 
which is generally accepted, viz., uraemia, and both alike, 
both the cachexia and the uraemia, may be of slow or 
sudden development. 

I propose to deal with the signs and symptoms of the 
disease in this order. 

(1) The physical signs; (2) the cardio-vascular sym¬ 
ptoms ; (3) the renal symptoms. It is the early signs of 
the disease rather than the late symptoms that are of 
importance. What is required is an early diagnosis 
before the disease is far advanced, and this is essential 
if light is to be thrown upon the causes and course of the 
disease, or if influence upon it is to be successfully exerted 
by treatment. In the early stage the diagnosis 
is to be made by physical signs and not by symptoms. 
The physical signs are high tension and thickened 
arteries, hypertrophy of the heart and albuminuria. 
When these are all present together the diagnosis is 
easy, even in the young, and the diagnosis thus made 
during life is verified post-mortem. But if one or other 
of these physical signs is absent the question arises, of 
what value are those remaining? For instance, if 
albumin is absent, what do high tension and thickened 
arteries mean, in the young ? Or if the arteries are not 
thick or the tension high, but albumin be present, what 
is the significance of the albuminuria ? 

Each of these questions is of great clinical importance. 
We know that the vascular changes, viz., thickened 
arteries and high pulse-tension develop so early in the 
course of granular kidney that they seem to be rather 
coincident or, as some maintain, even antecedent, 
phenomena than effects consequent upon and produced 
by the kidney lesion. If this were so, vascular changes 
might be found without the kidney lesion, and such cases 
are described. Post-mortem evidence would point to 
hypertrophy of the heart as a most important sign of 
granular kidney, and so it is in the later stages, where 
the cardiac enlargement is such as to be easily made out 
by percussion. In the early stages it is of very little 
assistance because of the difficulty in diagnosing it then. 

The hypertrophy of the heart is probably secondary 
to the vascular changes and the result of them, and 
therefore not of the prime importance they are or so 
likely to be met with early. 

Thickening of the arteries is one of the cardinal signs 
of the disease, and is never absent in advanced cases. I 
have already referred to the fact that thickening of the 
arteries is by no means uncommon in young people, and 
the question as to what its significance is becomes im¬ 
portant in relation to the early signs of granular kidney. 
At this stage the thickening cannot often be of an 
atheromatous nature, for although atheroma does ocour 
in early life it is very much rarer than the thickening I 
am Rpeaking of. The change is in great part muscular, 
no doubt, as it is in granular kidney, and the effect of 
nitrate of amyl upon it is the same. Arterial thicken¬ 
ing always rouses my suspicion in young people, and 
leads me to make a careful examination for other 


symptoms; sometimes they are found, and the diagnosis 
is clear; but not unfrequently nothing else is found, and 
the doubt remains as to the meaning of this thickening 
in relation to granular kidney, but that it is pathological 
there can be no question. 

In well marked (i.e,, advanced) granular kidney the 
high-tension pulse, as well as the thickened arteries, are 
well recognised. The tension is measured between the 
pulse waves ; the arteries therefore feel abnormally full 
as well as abnormally tense. When the heart begins to 
fail, the diminished force does not necessarily alter the 
character wave When the tension falls, the fall is due 
to a failure of the artery and not necessarily of the heart 
at all, though both may fail together. The low tension 
then observed is a neuro-paralytic phenomenon and a 
bad sign. It occurs only in the later stages of the dis¬ 
ease, but may then continue f^r some time. Though the 
tension be low, the thickening of the arteries can still 
be easily made out and is as characteristic as ever. 

A persistently high tension, to whatever cause due, is 
of itself pernicious, but not so with granular kidney, 
paradoxical as this may seem. The patient is best with¬ 
out granular kidneys, but if the kidneys be granular it 
is better that the tension should be high rather than 
low; i:> other words, the patient is worse with a low ten¬ 
sion, and this explains the benefit of digitalis in such 
cases; it does so much good by raising the arterial 
tension. 

This low arterial tension, or rather the fall in tension, 
in the later stages of granular kidney is of great clinical 
importance, the value of which Sir William Broadbent 
has lately emphasised. 

I may refer to one other phenomenon which, though 
implied by what has just been said, is not generally re¬ 
cognised, although easy to be observed if looked for. I 
refer to the irregular fluctations in tension which take 
place in the later stages of the disease, before the tension 
becomes persistently low. Thus, it may be felt to vary 
considerably, even in very short spaces of time ; for in¬ 
stance, while the finger is placed upon the pulse. In the 
early stages of granular kidney, go back as far as we may, 
as soon as the disease is diagnosable, the pulse tens : on is 
high and the artery thickened. The question arises, 
what is the value of a high pulse tension in a person in 
whom there is not yet other evidence enough to diagnose 
granular kidney by ? Temporary or transient increase 
of tension may occur in a variety of affections, but it 
is not to these that I refer. I am dealing with those 
cases in which the tension is pers stently raised. 

Sir William Broadbent, differing as he does from 
Mahomed in theory, yet attaches quite as great signifi¬ 
cance to this increase of pulse tension. He describes as 
the ultimate results of this increased tension a variety of 
symptoms, cardiac failure, general disturbances of health, 
a sort of cachexia, and even hajmorrhage, which, as he 
stated, could be truly piedicted long before it occurred. 
There are, of course, the same symptoms as those pro¬ 
duced by advanced vranular kidney. If the kidneys are 
not granular in these cases, of which no proof is given, 
the arteries must, at any rate, become diseased if hajmor¬ 
rhage is to occur; for I can suppose it will hardly be 
asserted that mere iocrease of tension can lead to the 
rupture of healthy vessels In respect of the results, 
therefore, Sir Wm. Broadbent’s views and Mahomed’s 
views agree exactly, the difference cnly is that whereas 
Mahomed referred the results to granular kidney, Sir 
Wm. Broadbent seems not to do so. I cannot help 
adopting the views that Mahomed urged. 

These differences in theory would remain a matter of 
opinion still, if there were not some fresh facts by which 
to elucidate them, and these have been obtained by the 
moi-e exact and careful study of the early eye changes 
met with in granular kidne* .. As I shall show shortly, 
our knowledge of the early stages of albuminuric retinitis 
has been great!v extended of recent \ears. If, in maty 
of these doubtful cases of high pulse tension, and 
thickened artery albuminuric retinitis or the early 
changes which lead to it are found, even in the cases in 
which albumin may not be present in the urine, the 
diagnosis of granular kidney will be surely justified. Con¬ 
sidering that albuminuric retinitis is not of course 
invariably found even in advanced granular kidney, that 


itized by GoOgle 




Fkb. 1 5, 1899. _TRANSACTIONS OF SOCIETIES. The Medical Press. 161 


it ean be discovered in these earlier doubtful cases is a 
significant fact, which throws a startling light upon many 
of those other cases which must still remain more or less 
doubtful. Some of these doubtful oases, therefore, at any 
rate, must be referred to the group of granular kidnev, 
and the possibility that a much larger number of them 
can be fairly so referred is therefore increased. It appears 
to me, therefore, that the presumption is very strong 
indeed in favour of these cases of high pulse tension as 
well as those of thickened arteries in the young being the 
initial stages of granular kidney which it is so important 
to recognise. 


Clinical ^iecortie. 

MONKSTOWN HOSPITAL. 

Trephining for Cerebral Abtcess. 

Under the care of Mr. Hr. Gray Croly, F.R.C.S. 

On Saturday last, February Ilth. Mr Henry Croly, 
trephined over the right temporo sphenoidal lobe in a 
young woman, set. 24, who had for some time past suffered 
from chronic otitis media. After admission to hospital 
she developed serious brain symptoms and temperature. 
A consultation was held between Dr. Hawtrey Benson, 
consulting physician, and Dr. Beatty, physician to the 
hospital. Mr. H. Gray Croly, consulting surgeon, and Mr. 
H. Croly attended. It was decided to operate, and a por¬ 
tion of bone was accordingly removed, pus escaped with 
flakes. 

The patient bore the operation well, and got immediate 
relief. We hope to publish a full report of this inter¬ 
esting and important case later on. 


transactions of §octettcs. 

CLINICAL SOCIETY OF LONDON. 
Mkbting hkld Friday, February 10th, 1899. 

The President, Mr. Langton, F.RC.S., in the Chair. 


TUBERCULOUS CAVITIE8 IN THE LUNGS GIVING RISE TO 
GA8EOU8 METASTATIC AB8CE8SE8. 

Mr. W. G. Spencer described an exceptional case in 
which abscesses formed in the back, in the right 
pleura, and in the upper part of the left thigh, 
the latter bursting into the rectum through the 
great sciatic notch. Meanwhile the disease of the 
lungs gave rise to practically neither symptoms 
nor signs. The patient was a West African negro, 
let. 22, who was attended by Dr. Denue for pain in the 
left knee, frequent headaches and vomiting, which he 
had had for eight months.. A large superficial abscess 
extending from the left scapula to the lowest rib was 
opened, but no communication with the chest found. As 
the patient still had fever he was admitted to the West¬ 
minster Hospital, where a tympanitic swelling was found 
occupj ing the upper portion of the left thigh and buttock. 
On opening this multiloculated abscess, gas and pus with 
a faecal odour escaped, and it was found to communicate 
with the rectum through the great sciatic notch. There 
was no ulceration of the rectum nor infiltration of the 
ischio-rectal fossse. Later on the patient suddenlv 
developed an acute effusion into the right pleura. The 
fluid aspirated having a fee cal odour and containing pus 
cells, the right pleura was consequently drained. Then 
followed a period in which the patient declared himself 
better, the abscesses in the back and the pleura wound 
nearly closed, the man insisted upon getting up and 
asked repeatedly to be discharged, The septic fever, 
however, continued, and foul 3 ellow pus was discharged 
from the thigh in spite of frequent irrigation. All the 
evidence of chest disease was an occasional cough and a 
few rales. Yet malaria, dysentery, typhoid fever, and 
ffflcal fistula from intestinal ulceration, appeared to be 
clearly negatived. One dav, after being five months under 
observation, the patient suddenly collapsed and died in 
four hours. Post-mortem showed a tuberculous cavity 


in the upper part of the right lung, the size of an 
orange, filled with a gummy purulent fluid, whilst the 
rest of the right and the left lung contained numerous 
caseous tubercles; extensive tuberculous caries of the sixth, 
seventh, and eighth ribs on the left side, and of the 
eighth and ninth ribs on the right side; the right pleura 
thickened and adherent; the upper part of the left thigh 
and buttock completely occupied by multilocular abscess 
cavities. There was no tuberculous ulceration of the 
intestines. 

Dr Kingston Fowler asked whether tubercle bacilli 
had been found in the lungs. He was not aware of any 
cases in which gas and fcetid effusion had occurred in the 
pleura apart from gangrene or perforation of the 
lung. 

Mr. Makins said it was probably a mixed infection, 
and suggested that possibly th- foetid abscesses were not 
directly traceable to the pulmonary lesions. 

Dr. J. H. Bryant asked if any anaerobio cultures had 
been made, and recalled the fact that the bacillus 
aerogenes capsulatus had been demonstrated in connec¬ 
tion with gaseous abscess of the liver and in a case of 
pneumothorax without perforation. He himself had 
found the bacillus coli communis in such a case, and he 
handed round photographs of the liver from that case. 

Mr. Spencer, in reply, said the bacillus coli was found 
in the pus of the abscesses. Tubercle bacilli had been 
found in the lungs after death. The abscess in the back 
might have spread from the lung by way of the rib, but 
the abscess in the thigh must have been metastatic. 

Dr. Thomas Barlow and Dr. F. E Batten read a 
paper on a case of 

MYOPATHY WITH AUTOPSY IN A BOY, AGED FIVE YEAR8. 

The case was shown at the Clinical Society in Novem¬ 
ber, 1894. »nd the following account of the case was 
given: —The boy had suffered from weakness of the back 
and legs since birth, he has never talked clear'y, but is 
considered fairly intelligent, he has never had any severe 
illness. He was a healthy baby, and nothing was noted 
to be amiss till the time when he should have begun to 
walk. No similar affection occurred in any member of 
the family, except possibly his sister (seen by one of us, 
T. B.), in whom it is noted that the pectorals and del¬ 
toids were small. Cn admission (o the hospital the follow¬ 
ing note was taken .-—He is an intelligent-looking boy, 
his face, eyes, mouth, and tongue present nothing 
abnormal. His speech is of the type known as “ idio- 
glossia.” He sits up in bed and holds the back very 
straight, if placed on his back he is unable to raise him¬ 
self into the sitting position without turning on to his 
face. The child is unable to stand, and the legs 
are flexei at the hip and knee. The muscles 
are everywhere very weak and thin and have a 
tough feeling. In the upper limbs all movements 
seem capable of being performed. The latissimus dorsi 
and pectoral muscles are very wasted, the infraspinatus 
is comparatively good. In the lower limb both limbs are 
equally wasted, no hypertrophy, all movements capable 
of being performed but the legs cannot be fully extended. 
The knee-jerks are present, equal and active. Sensation 
is normal to all forms of stimulation, and the electrical 
examination show only a diminution to both faradic and 
galvanic elements. The boy developed an attack of 
gastro-enteritis and died. At the autopsy was found 
some defect in the arches of the lower lumbar vertebra, 
the spinal cord and brain appeared normal. The pectoral 
muscles were very poorly developed, the serratus was 
small, the biceps was fairly developed but was pale, the 
rectus abdt minis muscle appeared normal. The glu ei 
were converted into masses of fat, and the rectus 
femoris was poor and thin. Microscopically no lesion 
could be found in the brain, medulla, and spinal cord. 
The anterior horn cells appeared quite normal except for 
the deposit of some pigment which does not usually occur 
in young subjects. The medullated sheath of the root fibres 
appeared thinned out and not possessed of the regular 
contour of the normal fibres. In the muscles the follow¬ 
ing changes were found Extreme variation in the size 
of the muscle fibres, some being considerably larger than 
normal, increase in the interstitial tissue between the 
fibres. Vaouolation in some fibres and a very consider- 


-oogle 


Digit 



162 The Medical Prims. _TRANSACTIONS OF SOCIETIES._ Fib. 15 , 1809 . 


able deposit of fat between the fibres, a fine granular 
(? fatty) change was found within certain muscle fibres, 
rendered apparent by staining in Marchi's fluid. The 
muscle spindles form a striking feature in sections of the 
muscles and are apparently normal. The sensory nature 
of these organs is no longer doubted, and it is argued that 
if it can be proved that these organs remain normal while 
the rest of the muscles undergoes atrophy, then it is 
]>robable that the primary lesion in this disease lies in 
that part of the nervous system where the motor and 
sensory paths lie separate. The authors assign the case 
to the group known as the Leyden-Mobius, although 
hereditary history was wanting in the present case. The 
muscular atrophy corresponds to the late pseudo-hyper¬ 
trophic type. 

Dr. Bablow called attention to certain clinical 
features which were at the time as puzzling as they 
were remarkable. When the case was shown before the 
Society he took the view that it was of a type inter¬ 
mediate between the cases of myopathy described by 
Erb and the pseudo-hypertrophic paralysis described by 
Duchenne, approximating rather to the latter. Even the 
most atrophied muscles still presented the very note¬ 
worthy toughening and fibroid-feel, especially marked in 
the muscles of the lower limb. None of the muscles of 
the tipper limb presented the absolute atrophy met with 
in the more advanced cases of Erb s type. He admitted 
that the absence of the hereditary element in this 
case was remarkablo, but .suggested that possibly, 
if they could keep the other memberd of the family 
under observation, this might develop later on. He 
thought the pathological appearances supported the view 
as to the nature of these cases, viz., that they were deve¬ 
lopmental, and that though there might not be a definite 
congenital defect at birth, there was a pronounced ten¬ 
dency to degeneration which came out at an early period. 
The noteworthy fact that the laminae of the lower verte¬ 
brae were wanting lent support to the supposition that 
there the case must be classed with those in which there 
was a potential congenital defect. He remarked on the 
slight tenacity of life which these subjects exhibited, as 
illustrated by the rapidity witb which this patient suc¬ 
cumbed to an inexplicable attack of gastro-enteritis. 

Dr. Beevor thought too much stress was generally 
laid on the matter of hypertrophy, fur before Duchenne 
had described his cases of pseudo-hypertrophic paralysis, 
cases had been recorded in which there was no hyper¬ 
trophy. The microscopical examination allowed that 
some of the muscular fibres were definitely hypertrophied. 
This actual hypertrophy had, in some cases, been the 
cause of the visible hypertrophy, but in this particular 
case there was no visible hypertrophy, so that tois actual 
hypertrophy might exist without any outward and visible 
increase in size. 

Dr. Abrahams thought the case certainly supported 
the view held by Erb that all th*-Be myopathies had a 
c mmon origin. With regard to the hypertrophy of the 
individual fibres one was struck with the great similarity 
between these specimeus and those of disseminated 
sclerosis in the nerve fibres. There one saw some fibres 
hypertrophied and others wasted, and in both cases the 
hypertrophy was of the degenerative kind. He recalled 
that in 1894 Babes had described certain changes in the 
motor ends of nerves in cases of peeudo-hypertrophic 
paralysis, something like these of peripheral neuritis 
which were figured in his atlas. These had not been 
generally accepted, and he asked the authors whether 
they were in a position to confirm these changes. 

Dr. Savill said the question was after all whether 
ic was not really a nerve change, and asked whether 
auy changes in the nerves were seen. Two 
things had struck him in studying these cases, 
first the small differences there were between the 
different kinds of myopathiee described by various 
observers. As a matter of fact he thought Duchenne 
hud described them all, and he oould not understand 
why Erb’s type and Leyden’s type were regarded as 
different or why Duchenne's pseudo-hypertrophic para¬ 
lysis should be regarded as different from primitive 
myopathy. He thought they were really the same. In 
the first place cases with hypertrophy and others with, 
atrophy had been observed in members of-the same' 
family. He agreed with Dr. Barlow that it was de¬ 


cidedly an hereditary disease. Secondly, the electrical 
changes had not been sufficiently studied. It had been 
said that there were no electrical changes in primitive 
myopathy, but in this case there was a decided diminu¬ 
tion to Faradism and a modified form of reaction of 
degeneration to galvanism. His own idea was that it 
was the lower motor neuron that was affected, and that 
it was primarily a nerve disease. If the same changes 
were observed in the myeline sheath or other part of 
the nerve that would go far to elucidate the pathology 
of these interesting if rare cases. 

Dr. Batten, in reply, said he had not examined the 
motor ends in the muscles, pathologically, nor did he 
know how to proceed to do so. With regard to the 
changes in the nerves he thought they had taken place in 
the medullary sheath in the nerve root fibres and not in 
the nerves in the muscles. 

Rr6CLTB OF OPERATIONS FOR ENLABQED PR 08 TATE. 

Mr John R. Lunn read a paper on this subject, which 
will be found on page 156. 

The President recalled a case of his own before the 
introduction of this operation. The patient was a man. 
rot. 68, with tuberculous disease of the right testicle and 
a considerably enlarged prostate, which made his life a 
misery, as he had to get up twenty times a night to pass 
water. He removed the testicle and then lost sight of 
the patient for three or four years W hen he next saw 
him he had a similai condition of the left testicle, but 
he noticed then that the corresponding right half of the 
prostate had undergone marked diminution. He removed 
the other testicle, and a further diminution of tho size of 
the prostate as a whole ensued, and the patient was still 
alive at the age of 87, and was ooly obliged to get up 
twice or three times during the n'ght. He referred to 
the mental disturbances which sometimes followed cas¬ 
tration and a-ked if the author had observed anything 
of the kind in his cases. He himself had met with this 
acute senility two or three times. He objected to the 
use of the term surgical kidneys, they being rather asur 
gical kidneys. 

Mr. W. G. Spbncer observed that some of the patients 
had died of surgical kidney due to the resistance of an 
enlarged prostate which the operation had not averted. 
This reminded them of the fact that the operation did 
not enable them to dispense with the necessity of adopt¬ 
ing the usual treatment such as washing out the bladder, 
drainage, &c. He agreed that the senile degeneration 
that followed was sometimes of an acute character, and 
in other cases there had been described an eunuchoid 
condition, and these facts made one rather reluctant to 
advise the operation. 


HARVEIAN SOCIETY OF LONDON. 
Clinical Meeting held on February 2nd, 1899. 

The President, Mr. Henry Juler, F.R.C.S., 
in the Chair. 

Mr. Ratmond Johnson showed a girl, set. 8, who was 
the subject of a large congenital oystic hygroma of the 
neck, bhe had been under obs rvation since the age of 
sixteen months, and the tumour had progres-ively but 
slowly diminished in size. On three occasions the tumour 
had been the seat of attacks of violent acute inflamma¬ 
tion, during which the swelling became enormously 
increased in size, and there was rather severe constitu¬ 
tional disturbance. On each occasion the inflammation 
had subsided spontaneously, and was followed by a more 
rapid shrinking of the tumour. One of the largest cysts 
had been treated by drainage, but, in view of the very 
marked tendency of tumour to shrink, and its extent and 
diffuse character, it was not proposed to make any 
attempt to remove it by operation. 

Mr D'Arcy Power remarked that such growths, in the 
neck, usually involved the lobule of the ear, as had evi¬ 
dently been the case in. this child, though the lobule of 
the ear was actually .separated from the growth by a con¬ 
siderable distacoe. . Mr.. Power alluded to four other 
oases, of a similar kind jn the jfttpp .situation upon which 
he had lately operated. He had been able to remove 



Feb. 15, 1899. _TRANSACTIONS OF SOCIETIES. Thb Medical Pemp. 163 


the bulk of the growth in three of the cases, but in the 
fourth it was so extensive, and involved such important 
structures, that much had to be left behind. Yet, in 
this case, the remainder of the growth absolutely 
vanished in the course of a few months, and after attacks 
of lymphangitis like those described by Mr. Johnson. 

In reply to Mr. E. L. Hunt, Mr. Johnson said that the 
tumour in his case could be distinguished from a deeply- 
seated dermoid chiefly by its diffuse character and the 
fact that it was multilocular. 

Mr. Jackson Clarke showed a little girl, set. 3, who 
had several congenital deformities. The deformities of 
the hands and feet had been cured by gradual methods, 
and he expressed his preference for such methods over 
procedures such as Phelp’s operation which, in his 
opinion was undesirable as applied to club foot in 
children. 

Mr. D’Arct Power asked Mr. Jackson Clarke whether 
he had been able to elicit any history of syphilis in this 
case, or whether there was any evidence of placental 
inflammation. He thought that the dimpling had been 
caused by the presence of allantoic bands, for it was so 
exactly symmetrical. The imitation of these bands had 
led to the slight hypertrophy of the bone underlying 
each dimple. 

Mr. Clarke replied in the negative. 

A CASE OF MUMPS, WITH MASKED BNLAHiiEU NT 
OF THB SPLEEN. 

The patient, exhibited by Dr. Ewart, a healthy boy, 
set. 13, was admitted into hospital on the third day of 
the attack, with the characteristic swelling of the left 
parotid. The affection remained limited to the left side, 
and ran a mild course without pyrexia. The only com¬ 
plication was an enlargement of the spleen, which per¬ 
sisted for several days, and gradually subsided as the 
parotid gland returned to its normal sizo Tracings of 
the splenic dulness taken durincr the period of enlarge¬ 
ment and after recovery were shown. Dr. Ewart had 
not found in text-books any reference to this complication, 
which may perhaps sometimes occur unnoticed. In this 
case it gave rise to no symptoms. The dulness measured 
61 inches in the horizontal and 5 inches in the vertical 
direction. The enlargement took place upwards, the 
spleen projecting half an inch only below the costal 
arch. The spleen when percussed at the meeting was of 
normal size, and yielded the “ boxy ” percussion note 
which, as recently pointed out, sometimes replces the 
splenic dulness. A specimen of the blood had been 
stained for micro-organisms by Mr. Hunt with negative 
results. 

Dr. Maguire remarked that this was a case in which 
his method of palpation was particularly valuable for de¬ 
fining the outline of the spleen and avoided the errors 
which beset the employment of percussion in such cases. 

At the invitation of the President, 

Dr. "William Hill showed a young woman who had 
been the subject of chronic suppuration in the middle 
ear, and who for two years had suffered from facial 
paralysis, associated with paralysis of the corresponding 
half of the soft palate. No evidence of diphtheria was 
obtainable. The interest of the case consisted chiefly in 
its bearing upon the question as to whether or not the 
muscles of the palate received any part of their nervous 
supply from the facial nerve. 

Ur. Herbert Tilley said the occurrence, if real, of 
combined facial and unilateral palatal paralysis, pointed 
to the palate having a double nerve supply—the facial 
through the vidian, and the spinal accessory by the 
pharyngeal branches of the vagus, the latter being the 
most constant, and probably the sole one. He referred 
to three cases of the kind which had recently come under 
his notice: - (1) A man, tet. 55, who complained of “ con¬ 
stant accumulation or phlegm in the throat.” and on 
examination showed paralysis of soft palate (left side), 
left side of pharynx, left vocal cord, left sterno-mastoid, 
and upper part of left trapezius. (2) Case of syringo¬ 
myelia in girl, set. 15, with paralysis of right palate, 
right side of pharynx, right vocal oord, together with 
other lesions characteristic of the disease. (3) A case 
the speaker had that day seen at Golden Square, in 
which a woman, rot. 38, after Buffering for a few days 
from violent pain in the back of the head, had “afit,”. 


and on recovering from it was “ paralysed in the left arm 
and leg ” for three weeks, and also “ in the throat.” 
Examination rf the lat er shows paralysis of the left sido 
of the palate, pharynx, and left vocal cord, but not of the 
sterno-mastoid or trapezius. Such cases proved indis¬ 
putably that the spinal accessory supplies the palate and 
pharynx and larynx (motor fibres), and bore out the ex¬ 
perimental evidence. 

Dr. Guthrie only accepted the diagnosis of paralysis 
of the palate on the strength of the reaction of degenera¬ 
tion. 

Diphtheritic Tracheitis io-th Temporary Obstruction of 
the hight Bronchus in the Adult. —Dr. Ewart and Mr. 
E. L. Hunt exhibited a series of tubular casts of the 
trachea expectorated on the third, fourth, and fifth days 
of the attach, by a maid servant, i»t. 32, who was now 
recovering, after a pyrexial period of nineteen days, from 
a severe pulmonary catarrh, due. as shown by repeated 
cultivation, to diphtheria. She had been injected on the 
third and the fifth day with 4,000 units of antitoxin. 
On the third day the laryngoscope had shown the pre¬ 
sence of membrane immediately above the glottis, but 
the vocal cords were free. There was considerable 
dyspnoaea on exertion, but no apparent distress of breath¬ 
ing in recumbency, though the rate of pulse and respira¬ 
tion remained rapid, with some cyanosis of the face and 
lips throughout the attack. For s veral days there was 
loss of respiratory sounds and great diminution of 
respiratory movement over the right side of the chest, 
which were attributed to impaction of membrane : n the 
right bronchus, as there was no evidence of any inhala¬ 
tion of food having occurred. With the return of the 
respiratory function abundant rales gradually developed. 
The patient was completely aphonic for fifteen days, but 
in contrast with the familiar s\mptoms of membranous 
croup in children the cough was not ‘croupy,” and there 
was no stridor i or spasm of the glottis. < n alarming 
attack of heart failure had occurred on the tenth day, 
but neither albuminuria nor paralytic symptoms of any 
kind had hitherto made their appearance. 

In answer to a question by the President, Mr. E. L. 
Hunt remarked that the antitoxin with which the patient 
was injected was obtained from the Royal College of 
Physicians. Two injections were given, of 4,000 units 
each, into the subcutaneous tissue of tho abdomen. The 
injections were given on the third and fifth days of the 
disease, and were followed by rashes, erythemitous, and 
transient on the arms and legs on the eleventh and 
fourteenth days of the disease, and about the same time 
the patient suffered from swelling and redness of tho 
hands and pain on movement in the wrist and finger 
joints ; there were also pain and tenderness in the muscles 
of the legs and thighs. 


WEST LONDON MEDICO CHIRURGICAL 
SOCIETY. 

A meeting of this Society was held in the Society’s 
Rooms at Jthe West London Hospital, on February 3rd. 

Dr. S. D. Clippingdale, President, in the Chair. 

A discussion on the “ Treatment of Appendicitis ” 
was introduced by Dr. Seymour Taylor, and Mr. 
McAdam Eccles. and continued by Dr. Donald Hood, 
Mr. Keetley, Mr. Bidwell, Dr. Caley, Mr. E. T. A. Boyton, 
Dr. George Eccles. Mr. Lunn, and Dr Dobson. 

Dr. Seymour Taylor in opening the discussion re¬ 
marked: That so long as physicians reergnised the 
appendix as the cause, in perhaps 90 per cent, of cases, 
of those groups of symptoms which have been called 
typhlitis and perityphlitis, a long stride forwards has 
been made. One further step should be made, vit., to 
recognise that sepsis by micro-organisms or by their pro¬ 
ducts is the chief or only cause of that fear of peritonitis, 
whether local or general which is the sequel to appendi¬ 
citis. He would not say that appendicitis itself is not 
set up by the influence of fruit stones, grit or other 
foreign bodies, nor would he deny that the condition 
is preceded by catarrhal enteritis of the appendix, or by 
tuberculous deposit therein; but these alone are not suffi¬ 
cient to complete the clinical picture. So far as treat- 


j 



164 Th* Medical PkS88. 


FRANCE. 


Feb. 15, 1899. 


ment i8 concerned, the physician’s advice may be of the 
utmost weight and importance in two periods, viz., from 
the preventive period, when by ordering a patient’s diet 
and mode of life he may postpone or even prevent an 
attack of appendicitis; and, secondly, when a local tumour 
having formed he may arrest the progress of the disease 
at a point Bhort of the formation of pus; for suppuration 
having once occurred all further treatment must then 
be at the hands of the surgeon. In the first stage the 
diet should be largely of a liquid character, but consist 
also of vegetabl s and some beef extract. Milk should 
be rigidly excluded, as it tends to constipation, 
with bulky or scybalous stoo'B. In the second 
stage his experience was strongly in favour of 
treatment by perfect rest, small doses of opium frequently 
repeated, and the administration of copious enemata of 
soap water and olive oil. On the other hand, if compe¬ 
tent surgeons by early laparotomy and removal of the 
appendix could show a death rate which was more 
favourable than the physician’s palliative and expectant 
treatment, then there could be no two opinions that 
from the first all cases of appendicitis should be handed 
over to their care. Should the case, however, have 
passed on to suppuration, surgical help is needed at 
once. The delay of an hour even may cause the loss of 
a life. Then comes a time in many cases, which no one 
can foretell, when the patient who was apparently in no 
great danger, is suddenly, as it were, precipitated over 
the abyss and is beyond all surgical skill. The thermo¬ 
meter will not necessarily be a guide to the existence 
either of pus or of perforation, but it should be used 
intelligently in combination with a clinical eye on the 
tongue and pulse. Finally, he would with all respect 
impress on their surgical friends to so incise the abdomen 
in all cases of doubtful obstruction as to readily command 
the appendix. The site of pain and tenderness is by no 
means a guide to the seat of disease. 

Ii reviewing the surgical treatment of acute 
inflammation of the vermiform appendix, Mr. McAdam 
Ecclkb said that he considered that surgical inter¬ 
ference was called for in all cases where there 
was no suppuration, whether local or remote; in 
instances where there was general septic peritonitis; 
and in many instances between attacks, so that the 
offending organ might be removed. When an abscess 
In the right iliac fossa had to be dealt with, he 
thought that two points needed emphasis, one that a 
very free exit for the pus should be secured, and the 
other that nothing more than free drainage, as a rule, 
should be attempted. His belief was that most cases 
thus treated do well, and have but little tendency to 
further trouble from the appendix. He laid stress upon 
his view that it was not advisable to explore the area of 
suppuration until time had elapsed, so that peritoneal 
adhesions, shutting off the general peritoneal cavity, 
might have formed. The pus did not tend usually to 
pass into the serous cavity, and therefore too early 
operation was a mistake. 


efrance. 

[from oub own correspondent.] 

Paris, February 12th, 1899. 

Appendicitis. 

M. Eeclds, in referring to the treatment of appen¬ 
dicitis at the last meeting of the Academy of Medicine, 
said that if one was to consider exclusively medical sta¬ 
tistics it would seem paradoxical to advise an operation 
jn every case, it should not be forgotten that persons 
cured medically remained exposed to new attacks of 
appendicitis; he knew a patient who had been cured of 
sixteen attacks, and would have died of the seventeenth, 
which occurred a month afterwards, if an operation had 
not been quickly performed. It was tiue that there were 
caaee which could get well without interference, but 
there was no means of distinguishing them from those 


requiring an operation. Consequently he was of the 
opinion of M. Dieulafoy that an operation was alvayt 
necessary. But the question, Should it be done in the 
acute stage, or would it be better to wait until the aoute 
symptoms had subsided (operation a froid) ? The 
majority of surgeons preferred to wait, insisting on the 
difficulty of recognising the appendix in the inflammatory 
stage and the possibility of wounding the caecum, and of 
infecting the peritoneum. Those fears he considered as 
a good deal exaggerated, for an experienced surgeon 
oould always avoid such dangers. In any case 
it was impossible to predict the course the affec¬ 
tion might take, and, while waiting, the patient 
might be carried off by acute peritonitis. . The 
wisest plan was to operate as early as possible. 

M. Dieulafoy s iid that he was the much more partisan 
of an early operation, as the acute symptoms of appen¬ 
dicitis, fever, vomiting, abdominal pain, Ac., were fre¬ 
quently followed by a brusque arrest, which did not how¬ 
ever presage a favourable turn. On the contrary, the 
deceptive improvement coincided often with the forma¬ 
tion of the gravest lesions, gangrene of the appendicitis« 
septiceemia, or diffuse peritonitis. 

M. Walthier gave statistics of 27 operations done by 
him last year, all of which, except four, were performed 
after the acute symptoms had subsided, and all got well; 
while of the remaining four, one died. If he preferred 
applying the medical treatment first, it was because he 
considered the ablation of the appendix more important 
than was generally believed, and that in the acute stage 
it was not always possible to remove it. 

M. Kirmisson said that he operated twenty-five times 
in 1898, and twelve of the patients died from diffused 
peritonitis. If they had been operated on earlier some of 
them would have been saved. 

M. Jalaquier was of the opinion that the present dis¬ 
cussion demonstrated clearly that it was impossible to 
lay down a hard and fast rule as to the treatment of. 
peritonitis. It was certain that the principle of operating 
as soon as the case was properly diagnosed was very 
seductive, but unfortunately the surgeon was never called 
quickly enough in private practice to a patient suffering 
from appendicitis. He was consequently a partisan of 
abstention in cases where the symptoms remained 
localised, applying medical treatment only ; within the 
past year he injected subcutaneously artificial serum. 

Pleurisy. 

Pleurisy constitutes, as everyone knows, a malady 
difficult to diagnose as regards the abundance, the seat, 
the distribution of the liquid in the pleural cavity. The 
case is specially difficult where adhesions exist dividing 
the cavity into several compartments. Frequently this 
complication is only discovered after several times 
practising thoracentesis. Professor Chauffard reports 
such a case treated by him in the hospital. The patient 
was 55 years of age and of a sound constitution. At the 
end of January he was seized with all the symptoms of 
pleurisy and decided on entering the hospital. Examina¬ 
tion showed an increase in volume of the thoracio wall 
of the left side. Dulness was present over the whole 
Tegion and the vibrations abolished up to the middle of 
the scapula ; the dyspncea was considerable. The same 
day six ounces of fluid were drawn off by the trocar, the 
instrument being placed in the eighth interoostal space. 
The following day no improvement had taken place, on 
the contrary matters seemed to have grown worse. This 

oogle 


Digitize 


g”: 15 > 189 9 _ GERMANY. The Medical Press. 165 


time the trocar was passed in the sixth space giving exit 
to a large quantity of liquid (a quart) to the great relief 
of the patient. A few days afterwards the needle was 
passed through the third intercostal space, and a 
small quantity of liquid removed. Finally, after a 
fourth operation, by which four ounces were withdrawn, 
the cavity was considered empty, and the man made a 
slow recovery. 

The Academy of Medicine. 

The demolition of the old Mont de Pi6t4 in the rue 
Bonaparte, to make room for the palatial building which 
is to be constructed on this central site for the Academy 
of Medicine, has been completed. The building, higher 
up in the same street actually inhabited by this body, is 
-R mediaeval structure of small dimensions and singularly 
unprepossessing appearance, and it has for years been 
scandalously unsuited for the purpose. It is estimated 
that the new buildings will take about two years to put 
up, and the cost is put at 832,000 francs, that is to say, 
between £32,000 and £33,000. This sum will be contri¬ 
buted partly by the State and partly from the funds of 
the Academy, and we are promised that, from an archi¬ 
tectural point of view, the new building will be a master¬ 
piece in this city of masterpieces. 

d&erntanp. 

[from OUR OWN CORBESPOIfflENT.] 

Berlin, February 11th, 1899. 

Dietetic Treatment. 

In the Munch. Med. Wochensch., 30/98, Hr. G. Treupel 
Baa an article on the subject with special reference to 
the form of treatment in certain classes of cases. The 
advances in the domain during the last twenty years 
have been considerable, and bid fair to go still further in 
the near future. The first subject discussed is the 
treatment of diabetic mellitus. The aim of treatment 
in this disease is, first, to diminish the formation of sugar 
within the system, and, secondly, to use up the sugar 
existing in the body fluids. Both aims are best reached 
by limiting the quantity of carbohydrates in the food. 
The restriction should be absolute during the first four 
weeks of treatment. During this period the patient’s 
diet should consist of albumen and fats, and limited 
quantities of certain vegetables, tea, coffee, and certain 
drinks free from carbohydrates. After this period is 
over, starchy foods may be given, but in certain limited 
quantities, strict regard being paid to the body-weight 
and the character of the urine. • Beer should be avoided. 

Subcutaneous feeding is the next point discussed, the 
author confining himself to a report on the present stage 
of the question rather than to conjectuie as to the future. 
Pat lends itself more readily to the purpose of sub¬ 
cutaneous feeding. It iB not irritating to the tissues, is 
heat-giving, and it can be readily stored up in the 
system in large quantities. Sugar has the advantage of 
being readily sterilised, it can be stored up in the form 
of glycogen, and it is easily and well used up in the 
ordinary tissue change. But against anything like a 
general use of these substances subcutaneously there are 
many objections, and, most of all, the painful swelling 
that takes place in the muscular tissue after theiv 
administration. Albumen does n^t lend itself to sub¬ 
cutaneous injection, it is sterilised with difficulty, is often 
not assimilated, and does not form a reserve material. 


and in addition to this the albuminous bodies, to some 
extent, are poisonous when in the blood. 

Artificial foods are next touched upon, and regarding 
these, he opposed the opinion of Klemperer that the 
natural products were more suitable. In many cases, for 
example, in blood diseases, with their accompanying 
emaciation and exhaustion, in the numerous cases of 
tuberculosis, admitting of recovery, it is not possible to 
give such a quantity of the natural foods as will answer 
the purpose. In such cases the artificial foods find their 
proper place, and of these the albuminous preparations are 
the most important. It is important not only that ex¬ 
cellent preparations are before the profession (somatose, 
nutrose, eucasein, sanatogen, sanose), but that such can 
be procured at a not too exorbitant cost, although the 
ideal in this respect has not yet been reached. He ex¬ 
pressed the hope that when the subject of tissue 
changes and nutrition are better known that good foods 
will be forthcoming, not only for the sick, but for the 
people at large, and at a low cost. 

At the Society for Innere Medizin (December 12th) 
Hr. P. Ehrlich gave an address on 

The Relation between the Constitution and 
Action of Medicines. 

The dependance of a knowledge of drugs on chemistry 
becomes the greater the more one recognises that the 
action of chemical combination on the organism depends 
on the presence of certain sharply definable “ atomen- 
complexe ” in moleculi, for example, the action of curare 
on the quaternary ammonium group, the anaesthetising 
action of cocaine on the presence of the benzoyl group 
the action of the phenacebineoid antipyretics on the 
formation of paramidophenol in the system, the affinity 
of nerves for a'l the ethyl combination. 

The results of this research within this region had not 
hitherto been of very great importance. Chemical constitu¬ 
tion alone does not suffice to explain action. The relation¬ 
ships here were more complicated than in the case of the 
dyes, in the case of which important conclusion* could be 
drawn from the constitution alone. He had determined 
that the introduction of the sulphoacid groups would 
convert poisonous bodies into non-poisonous ones 
(aniline), the nerve staining properties of certain 
species could be entirely abolished by the introduction 
of the same groups. By the introduction of such different 
groups the diffusion of the body within the system was 
changed. 

The peculiar dissemination of each chemical body 
within the system was a result of election by the organs. 
There was no foundation for the view that the vessels 
in various organs showed different degrees of permea¬ 
bility. 

Venilamine, foi example, caused an isolated necrosis 
of the kidney papillae, acetylparaphenylendiamine a 
peculiar brown colouration of certain muscular parts of 
tbe diaphragm which did not depend on the presence of 
a derivative of haemoglobin, but probably on an oxidising 
combination of acetylparaphenylendiamine with the mole 
cule of the muscle albumen. Except the diaphragm, only 
muscles of the eyes and the external muscles of the 
larynx were occasionally affected. 

The election of the tissues could only be attributed in 
part to the combination of the body introduced with the 
protoplasm. Of most of the foreign bodies introduced 
there could be no question of chemical combination 
within the system, as the carbo-hj drates, ether, chloro- 

Digitized by Google 



166 Th* Medical Press. 


THE OPERATING THEATRES. 


Fib. 15, 1899. 


form, sulphonal. For these bodies the explanation of 
the attraction was that lecitine had a great power of 
solution for them and attracted them. In the case of 
other bodies the explanation was more difficult, for very 
different bodies such as aniline and salicylic acid were 
not chemically combined in the protoplasm, as they could 
be extracted from the s\ stem by indifferent solvents. 

W itt believed that the dyes were not chemically united 
in the fibres, but were like dissolving bodies in their 
solvent material. In this hypothesis he has brought 
forward a number of facts in confirmation. 

Dyes again gave us an idea of what tissue elements 
took in the material. It had never yet been observed 
that in cases of vital staining, the living protoplasm had 
been coloured, but only certain paraplasmatic granules in 
the cells. In nerve staining, also, it must not be assumed 
that the nerve substance itself was coloured, but certain 
paraplasmatic bodies present in the nerves took on the 
colour. These facts made it probable that poisons also, 
such as the alkaloids, were not taken up directly into the 
protoplasm, but into paraplasmatic elements. 

From these considerations the following conclusions 
could be drawn. In the synthetic preparation of a 
chemical material from which a definite physiological 
action is desired, two conditions have to be fulfilled. 
First, the configuration of the molecule must be such 
that it could enter into rigid (“ starre ”) solution with 
the tissue elements in question. Secondly, the molecule 
must contain an atomcomplex, which exercises a specific 
action on the protoplasm. Thus, in cocaine, for example, 
the bearer of the antesthetising properties is always the 
benzoyl remnant, whilst the whole remaining molecule is 
fitted by its configuration to enter into “ rigid ” solution 
with the protoplasm, and in this way carries the benzoyl 
groups into the protoplasm. 


Austria. 

[from ODE OWN CORRESPONDENT.] 

ViBWNA. February 11th. 1899. 

Editorial Changes. 

It is interesting to note how easily a medical journal 
in Vienna changes hands. Without any preliminary 
announcement or apparent difficulty the new editor of 
the Wiener Klinitche Rundschau briefly states in a few 
words that “ we—Drs. Obermayer and Kunn - hope to 
merit the good esteem of our readers in the future with 
the assistance of our co-labourers, &c., Ac.” It is not 
long since Dr. Paschkis made his dihut in a similar 
fashion in the pages of the same journal on the retirement 
of Prof. Schnitzler. This is the fourth time in twelve 
years which proves that the life of a Vienna editor must 
be a hazardous one when we find his ardour spent in an 
average of three years. It is not, however, so strange 
when the circumstances are examined of the editors’ 
daily performances. They are all busy practitioners who 
take to this literary work as a sort of “ extra ” which ere 
long beoomes tedious to themselves. 

Epi-deshitis Pekforans Sanata. 

For some years past we have been flooded with terms 
“ more appropriate ” for “ perfect division and definition ’» 
in our classification of disease that renders it difficult for 
the casual reader to recognise what he is perfectly 
familiar with. Epidesmitis (r« im&tofia appendix) is no 
exception to the ru’e as Eiselt is persuaded that this 


ia the more correct term for the disease we have lately 
defined as appendicitis, processitis vermisculitis, cceculitis, 
Ac. 

He records a case of this kind, which came under his 
notice in November last, and recovered without any 
surgical interference. 

A scholar, cet. 14, became ill on November 7th ; on the 
11th pain in abdomen, diarrhoea, vomiting, and sore 
throat commenced; on 15th he was brought to hospital. 

On examining the patient, follicular angina was dis¬ 
covered, the abdomen regularly distended, with ampho¬ 
ric percussion, the diaphragm was raised to the fifth 
rib, the lung percussion normal, while liver and spleen 
could not be defined, except posteriorly, where the liver 
was percussed under the right shoulder blade. Fever, 
vomiting of a bitter, greenish fluid, with great pain in the 
abdomen, aggravated by movement were the dominant 
symptoms. Owing to the great abdominal distension, no 
further palpation could be made in the lower part of the 
body, but it was assumed that the peritoneal cavity was 
filled with gas or pneumo-peritoneum. 

The history of this case was at first somewhat ob¬ 
scured, as nothing could be elicited in the way of 
typhoid ulceration or other causes which might lead to 
perforation, and are often due to peptic, tuberculous car¬ 
cinomatous, and other forms of ulcers, as direct erosion of 
the bowel is rare. None of these causes being probable, 
the origin was supposed to have proceeded from the 
appendix. 

As no typhoid symptoms had preceded the illness, 
there was constipation prior to the attack, with slight 
pain, which we may assume to have been typhlitis. There 
are cases on record, however, where ambulant typhoid 
has proved fatal in the ball room, but these usually 
occur in the third week of the attack, when an apyretic 
condition of the temperature is observed. In the case 
of this scholar the tympanitis, vomiting and collapse con¬ 
tinued up to November 21st, when the vomiting ceased, 
and the distension of the abdomen suddenly disappeared. 

On November 25th distension and pain in the abdomen 
reappeared, with an elongated tumour in the cffical 
region. On November 27th the diaphragm was raised to 
the level of the sixth rib. Clysma were occasionally 
given with sedatives for the pain up to the 28th, when 
the fever subsided, though it slightly recurred on 
December 5th. The cffical tumour gradually disappeared 
after this till it reached the dimension of 6 ctm. long 
without pain, and was immovably fixed at Poupart’s 
ligament, when the patient again recovered his usual 
health. . 

It is fair to assume from these symptoms that the 
perforation took place in the vermiform process and that 
gas, probably coprophytic, escaped into the peritoneal 
cavity without producing exudative diffuse peritonitis, 
which finally became absorbed after the perforation had 
closed. 


^he (Operating theatres. 


ST. THOMAS’S HOSPITAL. 

Removal of Cabcinomatoub Qlandb from the 
Axilla. • No Apparent Primary Disease.—Mb. An¬ 
derson operated for the removal of a mass of carcino-; 
matous glands from the right axilla. The patient, a • 
healthy-looking woman, set. 46, had noticed a growth in 


Digitized by 


Google 


THE OPERATING THEATRES. The Medical Pees, 167 


F»b. 15, 1899. 

the right armpit six months before; this continued to 
enlarge, and other growths made their appearance in the 
same region. There was no marked impairment of general 
health, and no sign of other disease in the body. The 
family history was negative. On examination a number 
of hard tumours, evidently glandular in origin were 
found filling the whole of the right axilla as high as the 
first rib. They were not adherenteither to the skin or to the 
axillary walls and were but. moderately tender on pres¬ 
sure. The supra-clavicular region was normal. A close 
examination was made of the mammae and of the whole 
trunk, but no abnormality of any kind could be detected. 
The axilla was freely opened up, and the tumours, 
together with the axillary fat, were completely removed 
leaving the vessels and nerves cleanly dissected, and clear¬ 
ing the whole of the connective tissue from the axillary 
portion of the pectorals and subscapularis. On section 
of the structures removed the glands were found to have 
undergone scirrhous transformation, but the disease had 
not eitended beyond the capsule of the gland in any 
case. The operation was attended with little bleeding, 
and no apparent shock. Subsequent microscopic exami¬ 
nation confirmed the diagnosis of carcinoma. Mr. Ander¬ 
son remarked that the case was one of great pathological 
interest; there could be no doubt as to the malignant 
nature of the tumours, and that the growth was carcino¬ 
matous and not sarcomatous, but no primary disease could 
be discovered in any of the parts drained by the affected 
glands. Suspicion pointed towards the right breast as 
the most probable seat of primary disease, it even became 
a question whether it was not desirable to remive the 
mamma as a precautionary measure, the p 'ssibility of the 
existence of small dessiminated foci, not yet appreci. 
able to the touch, haying to be considered; it was 
decided, however, not to take this step. A close 
watch would be kept on the patient, all the regions 
drained by the axillary glands would be retained under 
notice, and a further operation would be performed 
should any justifying lesions reveal themselves. He was 
not aware that any similar case had been recorded. 
Theoretically, he said, it appears impossible that an epi¬ 
thelial growth should originate in the lymphatic glands, 
and the probabilities still were that some primary disease 
would ere long become manifest, but there was nothing 
J n the present aspect of the case that justified further 
interference. 

It is now four months since the date of the operation. 
The wound healed by first intention, the patient’s health 
remains good, and there is no sign of d sease in the 
mammae or in any other part; the axilla shows no re¬ 
current growths, and the supra-clavicular region remains 
free from disease. It is still early, Mr. Anderson thinks, 
to pronounce a dictum upon the case. The patient will 
be watched closely, and should she remain free from 
malignant growths for a twelvemonth there will, he con¬ 
siders, be an interesting field for pathological speculation. 

Removal of a Tumour of the Ascending Ramus 
of the Lower Jaw.— The same surgeon operated on a 
boy, set. 14, a fairly healthy-looking lad, who had noticed 
Bix months before a swelling of the left side of the lower 
jaw. This gradually increased, but without causing 
much pain or inconvenience. The tumour involved the 
whole of the asoending ramus up to the sigmoid notch. 
It was fusiform in shape, about two inches in thickness 
from without inwards, the inner surface was hard as 
though covered with a shell of bone, the outer surface 


was soft, no glandular enlargement was found, and there' 
were no indications of secondary deposits. Mr. Ander¬ 
son commenced the operation by making an incision from 
the angle of the mouth downwards to the angle of the 
jaw, then curving upwards in the direction of the 
mastoid process; the flap so formed was reflected with 
the parotid and the superficial fibres of the masseter, 
which, apparently uninfiltrated were stretched over 
the tumour; the bone was sawn across from 
behind the second molar tooth downwards in front of the 
insertion of the masseter, this was then seized, turned up¬ 
wards, the fibres of the internal pterygoid being cut across ; 
the coroncid process was divided with bone forceps, and 
the bone was disarticulated from the inner side; the 
diseased portion of bone could now be detached by a few 
touches of the knife, leaving the parotid intact. The 
bleeding vessels were secured as soon a3 divided, the loss 
of blood being on'y mo lerate. On examination of the 
tumour it appeared to be an endosteal sarcoma, which 
had distended the bone on the inner side, but had escaped 
from it on the outer side; it presented the characters of 
a myeloid, and was afterwards found to be of this 
nature. Mr. Anderson said that in the absence of infil¬ 
tration of the tissues the operation was not one of great 
difficulty, and the prognosis, on the diagnosis of endosteal 
sarcoma, wa3 decidedly favourable. The chief difficulty 
would be, he considered, in relieving the deformity 
which would arise as a result of the unbalanced action 
of the masticatory muscles of the opposite side ; it was 
a problem that at present remained unsolved to keep the 
teeth of the lower jaw in their correct position with re¬ 
gard to tho-e of the upper, although Mr. Birnie and 
others had devised various ingenious appliances, and 
this would be a matter for consideration during the 
following weeks in the present case. 


Vital Statistics. 

The deaths registered last week in thirty-three great 
towns of England and Wales corresponded to an annual 
rate of 19'5 per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of the year 1899. 

Birkenhead 22, Birmingham 22, Blackburn 15, Bolton 
19, Bradford 16, Brighton 13, Bristol 15, Burnley 18, 
Cardiff 15, Croydon 11, Derby 18, Dublin 31, Edin¬ 
burgh 26, Glasgow 33, Gateshead 24, Halifax 22, Hud¬ 
dersfield 13, Hull 14, Leeds 18, Leicester 15, Liverpool 25, 
London 19, Manchester 23, Newcastle-on-Tyne 23, Nor¬ 
wich 14, Nottingham 17, Oldham 22, Plymouth 15, 
Portsmouth 19, Preston 22, Salford 19, Sheffield 20, 
Sunderland 27, Swansea 21, West Ham 15, Wolver¬ 
hampton 22. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were :—From measles, 12 in Manchester, 1’4 in Oldham, 
and 19 in Bolton • and from whooping-cough, 10 in 
Gateshead, 1-1 in Nottingham and in Halifax, 1-3 in 
Bristol, 1*5 in Swansea, and 2 2 in Preston. In none of 
the large towns did the death-rate from scarlet fever, 
from “fever," or from diarrhcea reach 1*0 per 1,000. 
The 90 deaths from diphtheria included 32 in London, 
9 in Leeds, 8 in Sheffield, 6 in West Ham, 5 in Birming¬ 
ham, 5 in Leicester, 5 in Liverpool, 3 in Glasgow, and 3 
in Portsmouth. No death from small-pox was regis¬ 
tered in any part of the United Kingdom. 

A Very Small Baby. 

The Boston Medical Surgical Journal says there is at 
present at Gouvemeur Hospital a female infant reported 
to be perfect in its development in every respect exoept 
as regards size; at the age of two months she weighed 
but 32J ounces. When bom her weight was only 16- 
ounces. 

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LEADING ARTICLES. 


Feb. 15, 1899. 


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Letters in this Department should be addressed to the Publishers, 


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“ SAL US POPULI SUPREMA LEX.” 


WEDNESDAY, FEBRUARY 15, 1899. 


DIRECT REPRESENTATION AND THE 
GENERAL MEDICAL COUNCIL. 

There can be no question that the recent dramatic 
case of the General Medical Council versus Hunter, 
■with its tragedy of main motive, of climax, and of 
sequel, has sunk deep into the minds of the profes¬ 
sion. When the time comes for the Council to meet 
once again we must look to the Direct Representa¬ 
tives to insist upon threshing the matter out, as far 
as it may be possible, in the teeth of an obstruc¬ 
tionist majority. There are points involved in this 
case that must he publicly investigated, or a great 
number of medical practitioners will lye for ever 
exposed to a ruinous prosecution similar to that 
which their elected representatives on the Council 
have been ind uced to sanction in absolute ignorance 
of the essential facts of the case. To prosecute a 
licentiate of the Society of Apothecaries because he 
chooses to style himself a physician is to beat the 
air and to harass the loyal soldier within the camp 
while treacherous hordes of outlaws are allowed to 
plunder both public and profession at their own sweet 
will. We ask, as many have asked before, why 
it all this ? What condition of government 
permits such a gross travesty of the ordinary 
rules of common sense to sway the destinies of a 
oody of educated men, from whom Government has 
exacted the most stringent proofs of special technical 
knowledge ? The only answer we have ever seen 
advanced that deserves serious consideration is that 
by constitution the Counjil is.an autocratic bureau, 
a body nominated mainly by Government and by the 
medical corporations, to the exclusion of the elective 
principle. Could we imagine a popularly elected 
governing body neglecting the quacks and turning 


their attention to the discomfiture of their own duly 
qualified and registered members P The decision of 
the Court of Appeal in the Hunter case has added to 
the absurdities of the position, for so far qb we can 
grasp the situation Her Majesty’s judges have 
declared that no one b ut a doctor of medicine may 
call himself physician; at any rate, a man holding 
the diploma of the Royal College of Surgeons and of 
the Apothecaries alone is not entitled to the titles of 
either “ Doctor ” or “ Physician.” If the Council be 
logical it will go the round and spend the funds pro¬ 
vided by the medical profession in a prolonged series 
of domestic prosecutions founded oa this or that 
similar fa’ uous hair-splitting, which puts money in the 
pockets of the lawyers, but confers not one morsel of 
good upon any other person iu the realm. On 
reviewing the past history of the General Medical 
Council it is impossible to escape from the con* 
elusion that the policy of that august body is out 
of touch with the sympathies and the interests of 
the profession they are supposed to govern. A 
simple remedy for the present state of affairs, which 
the Hunter incident has rendered well-nigh intoler¬ 
able, may be sought in an in mediate increase of the 
Direct Representatives a reasonable demand that has 
now been urged upon the Council for years past 
But it is always better, where feasible, to make the 
most of existing machi nery, audit is quite likely that 
the University representatives should legally be 
elected by graduates, and not nominated by each 
individual Senator. If this point were established, a 
great step would thereby be accomplished towards a 
broader electo ral basis for the Council. We fear 
such a que stion lies somewhat outside the field of the 
Medical Defence Union, the quarter to which we 
are beginning to lurn for help in every strait. The 
want of organisation among the ranks of medical 
practitioners renders it well nigh hopeless to look to 
them for any initiative. For all that, the question 
of choosing their own Council repres entatives might 
be usefully discussed by some of the graduates’ 
clubs that exist in various parts of the United King¬ 
dom. Will some Scotch or Irish university lead the 
way P 


HISTORY BASED UPON DIET.—II. 

At the present time Americans eat more meat 
per head per diem than any other civilised people, 
closely followed by the people of our islands. 
Then come the Germans, followed by Austrians, 
French, Russians, &c. In almost the same order the 
brain power, as shown by inventive genius and 
mental acuity, may be arranged. The genius of the 
German people, so fruitful in output of material, 
tends rather to the laborious expansion of ideas and 
discoveries initially conceived by the more active 
cerebral centres of the Anglo-Saxon than to initial 
invention. The German brain consolidates and per¬ 
fects what the Anglo-Saxon suggests. The brain 
of the greater flesh-eater conceives what the other 
is better able to examine and prove after suggestion. 
It is easy, of course, to instance numberless oontra- 


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The Medical Press. 169 


Fbb. 15, 1899. 

-dictory examples of individuals personally endowed 
with unusual talent, either through heredity, owing 
to environment, or even to what must be regarded as 
pathological development. But if the achievements 
of nations be taken en masse the characters of their 
work represent the results of diet. It is almost the 
fashion to sneer at food as a factor in human acquire¬ 
ments. Many instances of great men who have 
showed an utter disregard for the pleasures of the 
table and the manner of their nourishment can be 
mentioned Still brain tissue is the outcome of 
food; its quality the outcome of the food’s 
quality. The nature of the food eaten influences 
the meal-timeThe Briton and American enjoy a 
• good breakfast, they deposit cash in their bodily 
bank on which to draw for the purpose of paying 
ready money for the energy made use of in the course 
of the forenoon’s mental and physical work. They 
supplement the withdrawal after midday, and again 
at night. The amount deposited overnight is added 
to next morning, and the day’s work can be paid for 
without stress. The common custom of many nations 
to delay their first solid meal until near mid-day 
involves overdrawing their balance in the fore¬ 
noon, replacing the deficiency at mid-day, but only to 
overdraw it again later, unless, as often is done, another 
large deposit is made before the first has been pro¬ 
perly dealt with and distributed; while, after this, a 
long period elapses before any further addition is made, 
-during which time their outlay again depletes their 
intake. One result of this method of paying at the 
end, rather than drawing upon cash already pro¬ 
vided, is the common auto-intoxication from over¬ 
absorption of digestive products after the midday 
meal. The interval from the last intake of food has 
been so long, the debit balance so great, that rap id 1 
absorption leads practically to proteose intoxication. 
.Somnolence oomes, and very frequently a universal sus¬ 
pension of work for one or two hours is necessary. 
The interval, or even siesta, after the midday meal, 
■common even in parts of Germany, results from this. 
The natural result is apparent in the greater 
power for rapidity in work done, should the 
worker be untrammelled by restrictions as to 
meal-times put on him by others. To our per¬ 
sonal knowledge some of the best medical autho¬ 
rities upon dietetics in Germany follow our example, 
and partake of a much more generous break¬ 
fast than the roll and coffee usual there, and 
for much the same reasons as are put forth above. 
As the body is nourished by the food taken in; and, 
as the nature of the food, while exercising no influ¬ 
ence upon primitive and generic characteristics, and 
but little upon the lower nervous attributes of early 
acquisition, appears to affect very markedly the range 
and activity of mental processes; so dietetical 
economy must influence the story of a nation’s 
history in the World, must mould the predominant 
characters of the race, and shape its destiny more 
intimately than our public politicians might care to 
aBow. Climate governs diet; diet governs human 
minds; progress and predominance musi rest with 


those races who dwell where they can consume 
the results of “ breeding-in ” among animals. But the 
more brain-helping food than their neighbours, 
provided they fall not into ways of luxury and 
foreign habits as to food, inapplicable to the 
degree of latitude near which they dwell* 
But it is not the trivial forms in which the necessary 
food stuffs are consumed and appreciated which 
affect nations, but the much wider question of their 
actual source. Animal proteids and extractives in 
any form, compatible at least with the process of 
healthy digestion, serve no more useful purpose in 
rendering perfect the physical development of man, 
than those substances obtained from the vegetable 
world. The lower cerebral faculties, touch, sight, 
hearing, the reflex and trophic powers, are probably 
as highly organised, though they may be, when cir¬ 
cumstanced differently, educated to a keener or duller 
pitch. The more mechanical mental processes, the con¬ 
descension to present and petty details, the qualities 
of fear, love, and endurance of pain, these may not 
differ markedly; but the greater powers of governing 
and swaying others and looking beyond the actual 
surroundings or the details of the present, to the 
possibilities of the future or to the discovery of new 
laws and facts; such powers are dependent, we 
believe, upon the actual soui ce of the body’s nutri¬ 
ment. Beef-eating Britons invented the loom and 
steam-engines, discovered the practical powers of 
electricity, introdueed vaccination, antiseptics, pro¬ 
duced a Shakespeare, founded the Mistress of all 
Parliaments, and have succeeded marvellously in 
the art of governing other peoples. Their greater 
brain power has conduced to the strengthening of their 
bodies by various games and athletic exercises; the 
excess of nervous activity seeking such outlets. 

■ ■ •»- 

THE PROVINCES AND MEDICAL PROGRESS. 

London possesses no monopoly in human intellect, 
nevertheless it deservedly enjoys the reputation of 
possessing most that is best in this regard. No one 
can dispute that the environments of a Londoner are 
precisely those which compel the development of the 
intellectual, as opposed to other.faculties. The speed 
of life, both mental and physical, is for this reason 
much greater in the metropolis than elsewhere. The 
proof that this is so is furnished by the necessity 
which exists for annually recruiting the popula¬ 
tion from country-bom persons. The inter¬ 
marriage of Londoners does not result, as a 
rule, in offspring whose physique even under the 
best circumstances can generally be said to attain 
to a normal standard. Indeed, there are some autho¬ 
rities who go further and state that the intermarriage 
of Londoners could not be continued beyond the 
third generation, inasmuch as by that time most of 
the persons concerned would be dead, or those that 
were living would be mostly imbeciles. To a large 
extent, however, tbis must be a matter of specula¬ 
tion. Nothing absolutely certain is known upon the 
subject, nevertheless the statement receives some 
support from the facts which we possess concerning 


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170 The Medical Press 


NOTES ON CURRENT TOPICS. 


Feb. 15, 1 » 9 9. 


discussion of these interesting questions need not detain 
us now; the point to which we desire to draw attention 
is the comparison which has recently been made 
between the provinces and London in relation to the 
progress of medicine and surgery. In such a matter, 
of course, there cannot be any cause or room for 
rivalry. Clearly, it is immaterial in what part of the 
kingdom a great discovery in medical science is made. 
And yet Dr. Priestley Leech, in a recent presi¬ 
dential address delivered before the Halifax and 
District Medical Society, would seem to imply that 
some competition in this connection exists. He even 
definitely claims that the provinces have earned a 
position equal if not superior to that of the metro¬ 
polis in the advancement of medical science, 
and he further avows that “ What the pro¬ 
vinces think to-day London thinks to-morrow,” 
paraphrasing a well known political saying, is by 
no means imaginative so far as the matters medical 
and surgical of the past are concerned. Illustrative 
instances are thus given of the discovery of chloroform 
ansesthesia by Simpson in Edinburgh, of the birth of 
Listerism in Glasgow, of the provincial origin of the 
operation of ovariotomy, and of the work of McEwen. 
of Glasgow, Ogston of Aberdeen, and many others. 
Furthermore it is pointed out that to the provinces 
belong the work of Graves, of Dublin ; Sir Dominic 
Corrigan, Sir William Roberts, late of Manchester, 
Christison and Hughes Bennett, of Edinburgh; 
also Syme, Liston, Sir James Clark, and the 
immortal Jenner, the discoverer of vaccination. 
Again, as if to further clinch the argument, it is 
shown that many successful and renowned metro¬ 
politan physicians and surgeons are provincial men, 
the explanation given of this being that “ London is 
the Mecca of the medical and surgical pilgrim, just 
as it is of the literary pilgrim.” All that the writer 
says, of course, is perfectly true. Outside the metro¬ 
politan area the members of the profession who have 
contributed to the advancement of medical science 
have been many and their work lias been great. 
But because this has been the case in the 
past, it does not constitute, in our opinion 
a reason for drawing an invidious comparison 
between the original work of London and provincial 
physicians and surgeons. To attempt to establish a 
rivalry in this matter, and attach importance to the 
locality in which the work of scientific men is first 
made known, is not suggestive of the spirit of high 
ideals which should animate those who work at 
science for its own sake. What can it matter whether 
a valuable discovery in medical science is made in 
London, Dublin, Edinburgh, or some other town in the 
Kingdom, beyond the fact that mankind benefits by 
its application ? It is not the man, but his circum¬ 
stances, which usually determine the locality in which 
his life work Bhall be carried out. 


A BAD fatality occurred last week near Richmond, 
where Dr. Hudson Hairsine, of Sungate, Hook, was 
killed by being thrown out of his trap, a friend, Mr. 
Scott, being at the same time severely injured. 


4totes on Current topics. 

• Influenza Again. 

Thk recent warm, damp weather appears to have- 
paved the way to an epidemic of influenza of the 
classic type, though fortunately of a rather mild 
character. It is more especially in the metropolis 
that the outbreak has made itself felt, and the cases- 
have been very numerous, far more so indeed than 
for two or three years past. Unlp86 more seasonable 
weather characterises wlat remains of an exception" 
ally mild winter the epidemic may run on into the 
spring, a prospect which, if not altogethcr disconcert¬ 
ing to medical practitioners, cannot fail to entail 
grave inconvenience on the public. The prevalence 
of a disease such as influenza, even of a mild type, is 
attended by very disastrous results to friendly socie¬ 
ties and similar provident associations, the average 
weekly sick list being hugely exceeded in the aggie- 
gate without warnin'.', and to the detriment i f their 
finances. We shall no doubt witness a correspond¬ 
ing increase in the death-rate, for although the dis¬ 
ease may only temporarily disable persons of average 
vitality, the debility which it engenders is quite 
sufficient to turn the scale in the case of thoBe 
whose hold on life is enfeebled by age, pre-existing 
weakness or disease. Attention has been called to the 
prevalence of a disease resembling influenza among 
cats, and though it must be difficult to identify it 
with that from which so many human beings are just 
now suffering there is enough to justify the warning 
to discourage intimacy on the part of children with 
animals r< cognised to be suffering from what is- 
vujgarly described as ‘’cold.’’ 


Women Dipsomaniacs. 

Of all the problems before the busy practitioner, it 
may safely lie asserted that none presents more 
knotty and complicated issues than that of secret 
drinking among women. For reasons that are more 
or less apparent, the disastrous habit of intemperance 
assumes peculiar characters in the sex mentioned. 
The element of secrecy is exaggerated, the moral con¬ 
trol of the victim more surely sapped, and the hope 
of future amendment more forlorn. For the medical 
man, therefore, when called in to such a o»se, 
to decide upon what is the best course to 
pursue, with a due regard to the interests 
of his client, is always a momentous one. If he 
assume an attitude of honesty and tell the patient 
outright that her symptoms are due to alcohol, which 
must be no longer consumed in any shape or form, it 
is always certain that he will thereby lose a patient. 
If, on the other hand, be temporises, and allows her 
to feed the flame of her craving with small doses of 
stimulants, he knows that the last lingering chance 
of reform is thereby destroyed. To disclose the state 
of affairs to the patient's friends, and to ask their 
help in cutting off supplies, is rarely of the least use. 
Supposing the patient to be mother of a family, how- 
can one send her away to a private “ home " for in¬ 
ebriates P A clear and concise guide to the medical 


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Fib. 15, 1899. 


1'hb Medical Puns. 171 


NOTES ON CURRENT TOPICS. 


man, as to the best course to pursue with female 
alcoholics, would be of the greatest practical value. 


Tonsillitis and Rheumatism. 

Thebe is an evident relationship between the 
rheumatic diathesis and a tendency to tonsillitis, at 
any rate to the extent of coincidence. It cannot> 
however, as yet be affirmed that there is any closer 
association, because both rheumatism and tonsillitis 
are such common ailments that mere coincidence does 
not per »e go far to establish anything in the nature 
of a direct pathological association. It is asserted 
that faucial erythema is an initial manifestation of 
rheumatism, and may, indeed, be the actual primary 
lesion. Many cases are recorded in which endocai" 
ditis has followed a non-scarlatinal tonsillitis unac 
companied by joint pains, and in many other in_ 
stances the tonsillitis has been followed by an attack 
of arthritis or chorea. All these cases go to prove 
that rheumatic subjects are specially prone to faucial 
and tonsillar inflammations, just as they are known to 
be prone to certain forms of cardiac disease, chorea, 
<fec. If we ask patients suffering from follicular 
tonsillitis or quinsy, whether they, or other 
members of their family, have suffered from 
articular rheumatism we shall find that in a 
very large proportion of cases the answer will be in 
the affirmative. It would be odd if it ultimately 
turned out that rheumatism is a microbial affection 
whereof the point of entry was, in many cases, if not 
in all, the pharyngeal mucous membrane and its 
glands. So strongly is the interdependence of the 
two conditions believed in by some authorities that we 
are invited to institute the salicylic treatment in 
■ every case cf sore throat of the types known to occur 
in association with rheumatism with the object of 
.averting subsequent arthritic manifestations, but we 
are not pi-epared to say that the suggestion receives 
much support from clinical experience. It is 
generally conceded that this treatment produces no 
very tangible effect on the course of the tonsillar 
nffeotion and attacks of articular rheumatism have 
l>een known to supervene in spite of it. How often 
the treatment is the means of averting a rheumatic 
explosion must remain matter for surmise, but the 
subject is one which merits careful consideration and 
further clinical observation. 


Purulent Ophthalmia and Gonorrhceal 
Rheumatism. 

Pubulent ophthalmia in the new-born is almost 
always of gonorrhceal origin, and there is no obvious 
reason why a gonococcic inflammation of the con¬ 
junctiva should not occasionally be followed by the 
articular manifestations which are, in rare instances, 
associated with gonorrhoea involving the urethra. 
In a paper recently brought before the Royal Medical 
and Chirurgical Society by Mr. Clement Lucas, a 
n .mber of cases were related in which arthritic 
•manifestations had supervened in the subjects of 
-ophthalmia neonatorum. The ophthalmia usually 
made its appearance on the third day after birth, and 


the joint disease towards the end of the second or 
during the third week of the ophthalmia. The 
knees were the joints most frequently affected, espe¬ 
cially the left, but the mischief was not limited 
to the knee, for the wrists sometimes suffered. 
It is noteworthy that complete resolution was the 
rule in these cases within from three to five weeks, 
contrasting strangely with the course of the disease 
in typical gonorrhceal rheumatism. Bacteriologies 
examination showed that the gonococcus of Neisser was 
the cause of the ophthalmia and of the joint disease, 
but in the rare cases of suppuration of the jointB 
other pyogenic organisms were also present. It is 
not denied that this complication is rare in associa¬ 
tion with purulent ophthalmia, but this may possibly 
be explained .by the greater ease with which the 
secretion escapes from the conjunctival surface as 
compared with its tendency to accumulate in the 
male urethra, and this explanation may also throw 
some light on the infrequency with which women 
, suffer from this arthritic sequel of gonorrhoea. Sup¬ 
puration in any part of the body may be followed by 
inflammation of a joint, and this is not in¬ 
variably the result merely of the passage 
into the circulation of the products of in¬ 
flammation, seeing that the pathogenic organism 
itself has been isolated from the fluid in the joint. 
The fact that the relationship between the conjunc¬ 
tival affection and the joint trouble bas been but 
rarely noted does not, of itself, militate very strongly 
against its existence, for until we have been taught to 
look out for them, such associations usually escape 
notice, especially as the treatment of the eye affec¬ 
tion falls into the hands of the specialist, while the 
joint trouble comes under the cognisance of the phy¬ 
sician. Now that attention has been directed to the 
possible existence of an inter-dependence of the two 
affections, clinical observers will be enabled to scruti¬ 
nise their cases more closely, ai d thus establish the 
validity of the view put forward by Mr. Lucas. 


A Simple Method of Curing Aphonia. 

A beady means of curing functional aphonia is 
suggested by Dr. Abrams ia the Therapeutic Gazette 
He marks with a pencil on the side of the neck cor¬ 
responding to the paralytic vocal cord the point 
where the puperior laryngeal nerve sends its internal 
branch to the larynx. This, it will be remembered, 
is the sensory nerve lor that organ, and he applies at 
the spot indicated a spray of chloride of methyl or 
other local refrigerant until the freezing process is 
complete. The relief is in most cases immediate and 
phonation, which was before difficult or impossible, 
can be performed with perfect freedom and painless¬ 
ness. The relief is in some cases only of short dura 
tion, and in these the process of freezing must be 
repeated one or several times. This method, he 
adds, is also of value in neuroses of the 
larynx, such as laryngismus stridulus, spastic 
aphonia, and in the laryngeal crises of tabes. 
He explains the action of the refrigerant on 
the assumption that the cold acts as a shock inhibit' 


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172 The Medical Press. 

ing nerve action for a time. The sedative action of 
refrigerant sprays is well known in other neuroses, 
as for example in neuralgia, for which sty page, the 
name given in France to the linear application of 
extreme cold, renders signal service. The treatment 
is equally applicab'e to the painful manifestations of 
peripheral neuritis, sciatica, and the like, and it 
merits more attention than it has hitherto received 
in this country. It is at once cheap, prompt, and 
effectual. All that is necessary is a cylinder of 
anestile provided with a fine jet, and this is drawn 
along the line of the irritated nerve until relief is 
obtained, a process which usually does not take more 
than a few seconds. 

The New Consumption Cure. 

A paragraph has been going the round of the 
Press announcing that the managers of the Brompton 
Hospital for Consumption have decided io inaugu¬ 
rate the “ new ” cure for consumption, viz., the open- 
air treatment. Now this is probably the oldest treat¬ 
ment devised for the disease, and after many vicissi¬ 
tudes it has once again come to the fore, but to call 
it a new treatment is, of course, a flagrant absurdity. 
Its usefulness in suitable—that is to say, not too 
advanced—cases cannot be questioned, and there 
could hardly be a better place in this country to 
carry it out than on the vevy eligible property be¬ 
longing to this wealthy institution in the Isle of 
Wight. As might have been anticipated, the an¬ 
nouncement of the new departure is coupled with a 
statement that the managers are obliged to sell stock 
to provide the money, pending public contributions 
to the extent of six or seven thousand pounds. One 
advantage of this treatment is that it need not entail 
any great expense. The accommodation required is 
of the slightest, and there are no heavy items on 
account of extensive buildings, such as have largely 
contributed to absorb the more than liberal dona¬ 
tions of which the Brompton institution has from 
time to time been the recipient. It looks as if “ con¬ 
sumption camps" were about to become a national 
institution, but there is no manifest advantage in 
making them large; on the contrary, the moment 
they exceed the number of patients who can be effi¬ 
ciently looked after by a single medical superinten¬ 
dent the tendency is all the other way. 


M. Haffkine and the Plague Commission. 

After the virulent attack by Colonel Lawrie upon 
M. Haffkine's inoculation treatment of the plague, it 
is pleasant to refer to the evidence of the latter, given 
before the Plague Commission, and learn the truth 
about his serum. In the first place, M. Haffhine 
admits that his serum is not a cure for the plague. 
He even candidly asserts that, “ on comparing the 
mortality among those who passed through his hands 
with those who were treated in the ordinary manner 
it was found that the mortality was greater among 
the pa'ients who passed through his treatment.” 
Candour on the part of a scientist could scarcely go 
further than this. On the other hand, he claims 


Feb. 15, 186ft. 

with a confidence bred from Experience, that hiff 
serum is a prophylactic, and that, giveh a healthy 
person inoculated according to his method, it will 
prevent him contracting the disease. He lays 
great stress upon the fact of the previous healthi¬ 
ness of the inoculated person ; so much so 
that he states that his serum cannot prevent 
or modify the disease if the latter develop® 
within a few hours of inoculation. It is reported that 
M. Haffkine will come to England in May next with 
a view of laying his results before the Royal Society. 

A Wily Testator. 

Considerable interest has been manifested in 
France in respect of the testamentary disposition of 
a well-known theatrical author called d’Ennery. Not 
long before his death he made a fresh will disinheriting 
his immediate relatives, and constituting as universal 
legatee his adopted daughter. As thp wily old gentle¬ 
man foresaw litigation by his disappointed family he 
actually took the precaution to nominate a commission 
of medical experts to inquire into his mental con¬ 
dition, and when they had signed a certificate of 
compos mentis he put his intentions into words. It is 
difficult to see what loophole he has left for under¬ 
mining his testamentary dispositions, and he has set 
an example which eccentric and aggravating testators 
may perhaps find it well to follow in the interests of 
their estates. 

A Sanitary Oath. 

A New York police magistrate has set a good 
example in the matter of oath-taking by ordering the 
Bibles then in use to be discarded, denouncing the cus¬ 
tom of kissing them as “ dangerous to health and un¬ 
speakably filthy,” and, as a result of this magistrate's 
protest, the New York courts are being supplied with 
“ hygienic Bibles,” the covers whereof are made of 
celluloid, which is kept clean and free from infection 
in accordance with antiseptic principles. Following 
on the same line the Board of Health has ordered 
persons in charge of public telephones to wash the 
ear and mouth pieces daily with a disinfectant, a pre¬ 
caution which ought to be made compulsory here as 
soon as the use of this instrument becomes as general 
as it ought to be. 


Another Death Sentence Farce. 

Jane White, the nurse who was convicted last 
week of causing the death of a woman in London by 
the performance of an illegal operation, was sub¬ 
jected to the repulsive form of being sentenced to 
death by the judge, in spite of the fact that in the 
present state of public opinion there is no possibility 
of its being carried out. We have no sympathy 
needless to say, with delinquents of this type, but it 
is urgent that this melancholy judicial farce, conse¬ 
quent upon the i ^defensible doctrine of constructive 
murder, should be abolished. Every case that 
occurs of this kind renders its absurdity more 
glaring, and we trust that the present session of 
Parliament will put an end to what is universally 
recognised'and described as a judicial scandal. 


NOTES ON CURRENT TOPICS. 


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New Poison Regulations for England. 

The Privy Council, on the requisition of the 
English Pharmaceutical Society, has adopted the 
following regulation for the guidance of chemists :— 

“ 1. That in the keeping of poisons, each bottle, 
vessel, box, or package containing a poison be 
labelled with the name of the article, and also with 
some distinctive mark indicating that it contains 
poison. 

“2. Also that in the keeping of poisons, each 
poison be kept on one or other of the following 
systems, viz.: — 

(a) In a bottle or vessel tied over, capped, 
locked, or otherwise secured in a manner differ¬ 
ent from that in which bottles or vessels con¬ 
taining ordinary articles are secured in the 
same warehouse, shop, or dispensary ; or 

“ {!>) In a bottle or vessel rendered dis¬ 
tinguishable by touch from the bottles or 
vessels in which ordinary articles are kept in 
the same warehouse, shop, or dispensary; or 
(c) In a bottle, vessel, box or package 
kep - in a room or cupboard set apart for 
dangerous articles. 

“ 3. That in the dispensing and selling of poisons, 
all liniments, embrocations, and lotions containing 
poison be sent out in bottles rendered distinguishable 
by touch from o din.ry medicine bottles, and that 
there also be affixed to each such bottle (in addition 
to the name of the article, and to any particular 
instructions for its use) a label giving notice t‘at the 
contents of the bottle are not to be taken internally.” 


The Conecientious Objector. 

It is comforting to be assured, as we are by 
a contemporary, that the state of affairs as regards 
exemptions from vaccination is not so bad as 
might have been feared. It would appear that a good 
many of those who obtained exemption did so to be 
in the prevailing fashion, and to save themselves 
trouble. Having appeared in Court and been granted 
the exemption, numbers of them did not take the 
trouble to call for the official certificate which is now 
invalid by lapse of time. The vaccinations also have 
shown a remarkable increase in number in some of 
the worst districts. 

Beautiful for Ever. 

There is probably no branch of quack practice 
that brings in a greater amount of solid pelf than 
that which deals with personal appearance. To pre¬ 
serve, to magnify, and even to create beauty is the 
ba^t that attracts clients above all others. The 
cure and care of the skin, hair, teeth, nails, and the 
removal of blemishes fall within the scope of these 
cosmetic operations albeit nowadays a good many of 
them are pex-formed by qualified medical men. 
Within recent years the prevention and the treat¬ 
ment of baldness and prematurely grey hair, so long 
the harvest field of the charlatan, have come within 
the range of scientific medicine. To a certain extent 
a similar observation applies to the complexion, 
which may be benefited by many direct and indirect 
procedures. As a broad general rule, however, it 
may be said that more skins are ruined by interfer¬ 
ence than by neglect. The constant use of certain 
irritating soaps, toilet vinegars, and powders to be found 
in nine out of ten genuine toilet outfits would, in 


the course of time, prove fatal to the well-beingof any 
complexion. So long as human nature runs on its- 
present lines it seems likely that the tradesman who 
panders to vanity by professing to help people -t > 
keep level with Father Time will be usually foremost 
in the road to fortune. 


CoDgresa Against the Abuse of Alcoholic 
Liquors. 

The Seventh International Congress against the 
abuse of Alcoholic Liquors will be held in Paris in 
April, and a very extensive programme of matters 
for discussion has been arranged. Among the sub¬ 
jects to which special attention will be devoted will 
be : the temperance cause in the primary schools, alco¬ 
holism among workmen in urban and country districts, 
the prevalenceof alcoholism among native races and its 
prevention. The drink problem is one eminently 
suitable for international di-icussion, inasmuch as in 
every part of the world it demands attention. 
Althou gh intemperance cannot be abolished by law, 
there is yet much which can be done by voluntary 
effort to counteract its evils, and no nation can afford 
to lose sight of the fact that the education of the 
community in the principles of temperance is a wise 
policy to encourage and endorse. 

Royal Munificence. 

A noble act in connect on with the movement for 
the prevention of tuberculosis has been pointed out 
by the Local Government Journal. The sum of 
£25,000 was raised as a national tribute to the 
Queen Regent of Holland, when Her Majesty relin 
quished the position at the recent coronation of her 
daughter. With womanly generosity and pity, bow- 
ever, Her Majesty directed the sum to he employed 
in the building of a sanatorium for phthisical 
patients, and not content with this act of munifi¬ 
cence, she has also given a splendid site on her own 
property for the proposed institution. Such open- 
hearted generosity as this on the part of the Queen 
Regent of Holland forms an object lesson which 
might well be taken to heart by wealthy persons 
generally. Moreover, apart from the munificence of 
the gift, no one can fail to be stiuck with the admir¬ 
able object of its disposal. 

A New Medico-Ethical Society. 

The practitioners of the East-End are to be con¬ 
gratulated upon the success of the East London 
Medical Protection and Medico-Ethical Society which 
they founded a year ago. One of its objects is to 
compile black lists of patients who fail to discharge 
their debts; another is to deal with cases of 
unprofessional conduct, and during the past 
year, despite opposition, the society has succeeded 
in obtaining adequate representation (25 per cent.) of 
the medical profession upon the committee of the 
proposed East Ham Hospital. Thus the society may 
be held to have well established its raison d’etre, and 
there is no doubt that it is eminently worthy of the 
support of all East-End practitioners. Up to the 
present, we believe, it consists of nmrlya hundred 


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174 Thb Medical Press. NOTES ON CURRENT TOPICS. 


-members. So far as it goes this is a satisfactory 
.commencement, but there must be Btill a large con¬ 
tingent of practitioners in the district, whose interests 
.it would be to join the Society. 

The Taking of Snuff. 

It is likely that a few people are aware of the 
-extent to which snuff is still consumed in Great 
Britain. Many large and flourishing manufacturers 
of that article are in full swing in various parts of 
the United Kingdom. The habit of “snuffing ” is 
usually regarded as a characteristic of byegone gene¬ 
rations, but a little inquiry will show that the custom 
not only survives among the derelicts but is also con¬ 
tinually finding recruits among the young men of the 
present day. Judging from report snuff seems to be 
enormously adulterated. Some years ago a defendant, 
charged with an offence of that kind, explained that 
taere was really not a particle of tobacco in his 
precious commercial compound, which consisted 
simply of tan and powdered roasted apples, with an 
added aroma skilfully derived from ammonia and 
essence of geranium. Before that brilliant essay the 
average fraudulent tradesman may well pale with 
envy and hide his diminished head. When our local 
boards bring their energies to bear upon the really 
useful and necessary duty of a proper control of the 
purity of food and drugs it would be well for some of 
the inspectors to overhaul the snuff stores of their 
districts. From a health point of view lead and 
many other harmful adulterants are often added, and 
,in the form of snuff run every chance of absorption 
. into the system. 

A Bacteriological Squabbie. 

The popular lecture which Mr. Bousfield, the 
bacteriologist for the district of Camberwell, recently 
delivered at the invitation of the vestry, has since 
proved the occasion of scenes of the most indecorous 
kind in the bosom of that body. They had voted £10 
for the expenses of the lecture, which appears to have 
.degenerated into a sort of soiree whereat refresh¬ 
ments to the tune of £20 or so were consumed, which 
the vestry was asked to make good. As is not in¬ 
frequent in discussions about trivial subjects in 
these local parliaments, the proposal proved the 
starting point of an exchange of personalities which 
culminated in the expulsion manu militari of one of 
the membere, after which the deficiency was voted, 
though not without a protest against the extrava¬ 
gance of the committee responsible therefor. 

The Colour of Negro Babies 

This much controverted question has—let us hope 
—been settled by the statement of a well-known 
authority, who affirms, apparently on the strength of 
experience, that “pure negroes when born are pink 
like young rats, and at the end of three or four 
months they gradually become black.” We trust 
this may settle the question, which, after all, possesses 
but a mediocre interest for the inhabitant of these 
.blest isles where coloured people are so rare that, if 
possessed of means, they are positively lionised. So 


Feb. 15, 1899. 

long as these babes ultimately become black, so 
that they cannot pass themselves off as British bora, 
we have no right to complain. 


Public Analysts. 

A serious, though probably unwarranted, charge 
against the integrity of public analysts was made last 
week in the Barnsley Police Court by a shopkeeper 
who was prosecuted, on the certificate of the public 
analyst, for selling fraudulent ginger. He alleged 
that he had tried in vain to obtain an independent 
opinion from another public analyst, but that he 
found th.it there is an understanding among the 
analysts that no one was to give evidence against a 
public analyst’s certificate. He therefore, asked the 
magistrate to send a sample to Somerset House, 
which was done. 

The Professorship of Pathology at 
Cambridge. 

On Saturday last Dr. G. Sims Woodhead was 
elected to the post of Professor of Pathology at the 
University of Cambridge, in succession to the late 
Dr. Kanthack. Dr. Woodhead has for the 
past few years held the appointment of Direc¬ 
tor of the Pathological Laboratories of the 
Royal Colleges of Physicians and Surgeons, at the 
Examination Hall building on the Embankment. He 
is well known as an original worker, and has fully 
proved himself competent to undertake the responsible 
duties of the Professorship to which he has just been 
elected. We cop jratu late him upon his appointment 
and the University of Cambridge upon securing the 
services of so able a pathologist. 

Medical Officers for West Africa. 

The Colonial Office has advertised for medical 
officers for temporary service on the Gold Coast and 
also with the Niger force. The salary offered is £350 
with quarters, or an equivalent allowance, and free 
passage out and home. The officer will also receive 
£100 at the end of his first year of service, if he be 
approved of, and will have six months leave for every 
twelve months served on the coast. 


Gastric Origin of Rickets. 

A French observer claims that rickets in children 
is due to abnormal conditions of digestion ; that the 
secreting function is extremely defective, as well as 
the quality of the secretions ; and that there is espe¬ 
cially a lack of free hydrochloric acid. The organism 
suffers from the want of properly digested nourish¬ 
ment, and the stomach is the seat of abnormal 
organic ferments generating acids, principally lactic 
acid, which affect the bony tissues unfavourably, 
especially as respect the phosphates. 

A suspicious death has occurred i*t Middleburgh 
in the Transvaal, the victim being an Indian who 
presented symptoms suggestive of plague, and a 
movement is on foot to restrict _ the immigration of 
Asiatics. 


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SCOTLAND. 


Fxb. 15, 1899. 

Re-Definition of Dispensary Districts in 
Ireland. 

A good deal of local excitement has been produced 
in various parts of Ireland by the distribution of the 
Dispensary districts which the new sub division of 
the country into counties, districts, and unions has 
rendered necessaiy. Medical officers find that slices 
are taken from neighbouring districts and added to 
theirs, or vice versa, and the balance of power greatly 
disturbed, additional work being added on or rivals 
introduced into what they have, heretofore, regarded 
as their preserves. Moreover, the poor find them¬ 
selves precipitately handed over to new doctors, with 
perhaps the necessity of travelling longer distances 
to consult them. We cannot see how these troubles 
could have been avoided, and it seems obvious that 
the only means to a settlement of disputes will be 
by conference between the local guardians and com¬ 
mitteemen and the Local Government Board which, 
we are convinced, are anxious to meet local opinion 
as far as possible. At all events it is clear that The 
Medical Press and Circular is not competent to 
express opinions upon these purely local questions, as 
it has been asked to do in several instances. 

The Parliamentary Outlook. 

The Government programme contains, practically, 
but one Bill, the Adulteration Bill, of special interest 
to the profession. No mention is made of any 
attempt to remedy the vaccination muddle of last 
year, nor is there any hint of the Re-Vaccination 
Bill which Lord Harris, on behalf of the Government, 
almost promised to Lord Lister last session. Private 
Bill legislation on medical or any other subject is in 
a worse pickle than ever. No more than six or eight 
Bills have a chance of being heard of in the House 
before Government seizes the private Members’ days. 
Of course there will be opportunity, when the House 
is moved into Committee of Supply, to debate a 
variety of questions, and. thereby, educate the 
Government and the public, but no more can be 
expected than this. 

- # 

The last public function performed by the Countess 
of Elgin before leaving India for England was the 
opening of the Lady Dufferin Victoria Hospital for 
Women in Calcutta. The building is a very beauti¬ 
ful one, and with its modern arrangements, marble 
floors, white tiled walls, &c., bids fair to rank as the 
finest hospital for women in India. Miss Church, 
M.D., is the doctor appointed to this hospital. 


PERSONAL. 

Me. C. B. Lockwood, F.R.C.8., has resigoed his 
appointment as surgeon to the Great Northern Central 
Hospital. 

A telegram from Constantinople announces the death 
of Mavroyein Pacha, private physician to the Sultan of 
Turkey. 

The Grand Duchess of Saxe-Meiningen has intimated 
her intention to attend the Tuberculosis Congress to be 
held in Berlin in May next. 


The Medical Press 175 

The Senate of the Royal University of Ireland have 1 
appointed Professor Byers, of Belfast, as Examiner in 
Midwifery in the University. 

Db. Farquharson, M.P. for Aberdeen, has been 
selected to act as chairman of the Scotch Liberal mem¬ 
bers in room of 8ir Henry Campbell-Bannerman. 

Dr. Clifford Allbutt, F.R.S., Regius Professor of 
Physic in the University, of Cambridge, has been elected 
an Honorary Fellow of the Rdyal ^College of Physicians 
in Ireland. 1 ' li; 

•- : !• I 

A Distinguished Service Pfension of £100 a year has 
been conferred on Sir Robert Jackson, F.R.C.S.I., 
Governor of the Apothecareis’ Hall of Ireland, in con¬ 
sideration of his long and brilliant services in the Army. 

Dr. W. J. Collins, ex-President of the London 
County Council, has been appointed by the President of 
the Board of Agriculture to represent the Council on a 
Departmental Committee to inquire into the Diseases of 
Animals' Act. 


A half- length portrait of the late Mr. Henry Lee, 
F.R C S , by Mr. James Sant, R. A., has been presented by 
his widow to the Royal College of Surgeons. Mr. Lee 
was formerly Member of Council, and Lecturer in Patho¬ 
logy and Surgery of the College. 

Dr. A. C. Duffey, late House Surgeon to the City of 
Dublin Hospital, was the recipient last week on leaving 
of a very fine antiseptic operation case and an exqui¬ 
sitely appointed smoker’s cabinet, presented as an ex¬ 
pression of the esteem in which he was held during the 
whole time he held the office by the medical and surgical 
staff, resident students, ex students, and nursing staff. 


£fcotlanb. 

[from our own correspondent.] 

Proposed Memorial to the Late Professor Coats.— 
A meeting of the friends, former colleagues, and assis¬ 
tants of the late Professor Coats was held last week in 
the Faculty Hall, for the purpose of considering a scheme 
for erecting a memorial to the memory of the deceased 
professor of pathology. Principal Story presided and 
having briefly stated the object of the meeting, Sir 
William Gairdner moved a resolution, seconded by Dr. 
H. C. Cameron, which was carried unanimously, that a 
memorial be raised to the Late Professor Coats. Dr. J. 
Lindsay Steven moved “That the memorial take the 
form of a prize or scholarship to be called the Joseph 
Coats Memorial Prize in Pathology.” Dr. David Newman, 
in seconding, said that £1,000 would be required for the 
foundation of a prize or scholarship. This having been 
adopted, the following were appointed a committee to 
ctrry out the scheme : The Principal (convener), Dr. 
H. C. Cameron (president of the faculty) ; Sir William 
Gairdner; the Professor of Pathology (if agreeable upon 
appointment); Dr. James Finlayson, Dr. J. Linds«y 
Steven, Dr. Donald Fraser (Paisley), and Dr. David 
Newman, secretary. 

Independently of the above subscriptions will be taken 
very soon among the students of the university for the 
purpose of erecting a “students’ memorial” to the late 
professor. The form proposed is to be either a tablet 
in the pathology class-room or a bust on the grand stair¬ 
case. Subscriptions will be limited to one shilling, and 
it is expected that the sum required will be raised inde¬ 
pendent of outside aid. 

Will it come to anything? We ask the question 


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176 The Medical Press. MEDIC A.L SOCIETY OP LONDON. Feb. 15, 1899. 


advisedly in reference to the proposed memorial to the 
late Dr. Coate. Of course we do not in this question in¬ 
clude the scheme of the students, for if unanimous, they 
will fulfil their intentions. Although we do not for a 
•moment wish to put a wet blanket on the larger scheme, 
which we should like to see carried out, yet, when it is con¬ 
sidered how many memorial schemes are at present before 
the Glasgow public, not one of which is as yet completed, 
we donot feel at all sanguine. Briefly, there is the Diamond 
Jubilee Memorial, for the purpose of raising funds for the 
rebuilding of the Glasgow Royal Infirmary. Certainly a 
large sum has been raised, but which is insufficient for the 
purpose. Then we bar e the private memorial for the late 
Principal Caird, and also the more public scheme for the 
.erection of a Btained-glass window in the Bute Hall. 
3. The Lewis Carroll Memorial Cot Fund is not yet com¬ 
pleted. 4. The memorial to the Brothers John and 
William Hunter. 6. Last week it was announced that a 
great many citizens in Glasgow felt a great desire that 
they ought to hononr the late Mr. Gladstone with a 
statue, and to-day (February 15th) a meeting is to be 
.held in the City Chambers for this purpose. Now we 
have the Joseph Coa’s’ Memorial Fund in hand. There 
.can be no second opinion that the memoriaists are 
animated with the best intentions, but the public 
purse has limitations, and we have, nowadays, no 
ram’s horns for the purpose of bringing down the walls, 
or of opening the pockets of the would-be benevolent; 
consequently these memorials have before now collapsed 
on account of their very frequency, and have been care¬ 
fully put away until the next occasion for another 
memorial blast. 

Glasgow Royal Infirmary Re-Construction.— It 
js Baid that the plans for the reconstruction of the Royal 
Infirmary have now been revised and adjusted on the 
lines of the most recent suggestions of the staff, and it is 
expected that the Lord Provost’s Committee will be able 
to announce without delay that the plans for the main 
or Cathedral Square elevation have been finally approved, 
so that no time may be lost in beginning the actual work 
of reconstruction. We hope when this takes place the 
public will come forward and subscribe the remaining 
£20,000, required for the completion of the object in 
■view. 

Extension of Leith Hospital. —In 1897 it was re¬ 
solved to devote the local Jubilee Fund to increasing the 
number of the beds in Leith Hospital. Plans have now 
been drawn up and approved by the directors, acting in 
concert with the medical staff, which will increase the 
present hospital accommodation from 76 beds to 100. 
The previous enlargements of the hospital have always 
been of a more or less makeshift character, with the 
result that the administrative buildings, designed for a 
hospital of some fifty beds, have had undue stress 
thrown upon them. By the present scheme, however, a 
radical change will be be effected. What amounts to a 
practically new pavilion is to be erected, together with 
an entirely new administrative department. The total 
cost of the buildings, exclusive of furnishings and the 
value of the ground, works out at about £18,000. The 
sum contributed toward this by the Diamond Jubilee 
Fund is about £5,000, leaving the balance to be provided 
from the capital fund of the institution. It is hoped that 
-the annual loss of income from the diminution of the 
capital fund will be more than compensated for by an 
increase in the ordinary income derived from subscrip¬ 
tions. That the hospital is economically managed is 
shown by the fact that the annual cost per bed is 
barely £60. 


ittimrh ester. 


[From Our Own Correspondent ] 


Royal Infirmary. —The annual meeting of trustees 
-bas just been held. Negotiations with the City Cor¬ 
porations respecting the future of the Institution are 
still proceeding. A clinical laboratory has been erected 
at a cost of over £400, and a curator is about to be 
appointed. During the year, 4,533 in-patients and 
'38,443 ont and horrib patients received treatment. At 


the Convalescent Home 1,717 cases had been dealt with. 
In connection with the Asylum at Cheadle, further 
accommodation is to be provided for epileptio cases. 
Two new posts are to be created, an aural surgeon and 
an additional assistant surgeon. Other changes in con¬ 
nection with the staff are expected during the coming 
year. 

Tuberculosis. —Much local interest is being taken in 
the measures for preventing tuberculosis. The north¬ 
western branch of the Incorporated Society of Medical 
Officers of Health has adopted a resolution approving 
of the compulsory notification of phthisis. The Con¬ 
sumption Hospital is making arrangements for carrying 
on the out-door treatment now so enthusiastically advo¬ 
cated. 

Inebriety. —The new Act is being ardently discussed, 
and a conference of representatives of local municipal 
corporations has just been held in Msncheater. Statistics 
and estimates are to be immediately prepared in order to 
ascertain if the number of cases would justify the estab¬ 
lishment of a reformatory on a sufficiently large scale. 

Examination of Morbid Products. —The Pathologi¬ 
cal and Medical Societies of Manchester have made 
arrangements with the authorities of Owen’s CoUege 
whereby their members may obtain investigation of 
preparations relating to tuberculosis, tumour formations, 
and blood diseases. The scheme has been in actual 
work for about six weeks, and promises to be of mu ch 
value. 


MEDICAL SOCIETY OF LONDON. 

Last Monday’s meeting was devoted to the exhibition 
of living specimens. 

Mr. Watson Cheynb led the way with two cases of 
coxa vara after operation. His plan is to saw through 
the femur below the trochanters, and to invert the lower 
segment of bone maintaining the inversion by tacking a 
perforated plate of aluminium to the two ends of bone in 
the new position. The results in both instances were 
excellent, though in one an abscess had formed over the 
seat of the operation three years later, which when 
opened gave exit to the plate and tintacks. While he 
preferred this operation for young subjects, he thought 
that the alternative plan of sawing a wedge-shaped pieoe 
of bone from the neck of the femur might be preferable 
in adults. 

Mr. Jackson Clarke referred to cases of his own in 
younger subjects in whom rickets was still active, which 
he had treated by the use of instruments designed to keep 
the foot looking forward, and to take the weight off the 
hip. The results had been very satisfactory. 

Dr. Maguire showed an interesting case of recovery 
after operation for cerebellar abscess in a young man ; 
and Dr. St. .Clair Thomson showed a case of what is 
usually described as Pharyngo-mycosis leptothrica, an 
affection of the tonsils which superficially resembles 
follicular tonsillitis, from which, however, it differs in 
every essential particular. In respect of the latter Eh-. 
Hall pointed out that good results had followed the 
application of a 15 per cent, alcoholic solution of sali¬ 
cylic acid. 

Dr. Hector Mackenzie showed a man with an enor¬ 
mous thoracic aneurism, which extended from the 
clavicle above to the fifth rib below. In spite of its 
size the aneurism had given rise to very little inconve¬ 
nience, and even now the man did not feel ill enough 
to go into hospital. 

Dr. Mackenzie also showed a man who presented the 
characterises symptoms and signs of Graves’ disease, of 
interest partly on account of his sex, and also by reason 
of the prominence of cutaneous itching, a symptom, he 
added, which was often complained of by patients suffer¬ 
ing from myxeedema while undergoing the thyroid 
treatment. 

Mr. Cheynb discussed the results of operation in these 
cases which, in his experience, had been uncertain. Dr. 
Maguire recognised cactus grandifolia in the treat¬ 
ment of the palpitation. Dr. Moribon pointed out that 
these cases often improved of themselves by the efflux of 
time, and suggested that thyroid hypersecretion, if pre¬ 
sent, was probably only one manifestation of an esaen 


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P*B. 15, 1890. 


OBITUARY. Thb Medical Press. 177 


tially nervous disturbance. Dr. HadlSy observed that 
these cases often underwent spontaneous improvement. 
Tout some went into asylums, and others died either of the 
disease or of some intercurrent disorder. 

In conclusion, Mr. Warren Low showed a man who, 
as the result of a fall, had sustained subcoracoid dis¬ 
location of the head of the humerus, with detachment 
and comminution of the great tuberosity and fracture of 
the glenoid fossa. They cut down and removed the head 
■of the bone, as it could not, even when eiposed, be re¬ 
turned to its normal position, and the man made a good 
recovery with some movement of the joint. 

Mr. Jackson Clarke related a similar case except 
that the tuberosity was not comminuted. He did not 
first open the capsule, and so did not know that the 
tuberosity was fractured, and it ultimately became neces¬ 
sary to remove first the head of the bone and then the 
limb, on account of the persistence of cedema. 


THE PLAGUE IN INDIA. 

Thb latest news from Bombay as to the spread of the 
plague are to the effect that many fresh cases have 
Appeared among the miners of the Kolar gold mining 
■district. This outbreak has been followed by seven 
deaths. It iB also reported that the disease shows a 
disposition to spread ; if so, there will certainly be a 
stampede among the coolies, large numbers of whom are 
-employed in the mines. Accordingly precautions have 
Toeen taken to meet the danger, and the medical staff has 
been increased, while every effort is being made to induce 
■fche workpeople to submit to inoculation. From the 
perusal of carefully compiled statistics we gather that 
greater immunity from attack ha3 been observed since 
Haffkine’s newly-introduced serum has come int> general 
use. The time required for securing immunity is much 
shorter in plague tha i in that of other infectious diseases. 
'This averages from twelve to twenty-four hcuis, while in 
-cholera it is four days ; in vaccination against small-pox, 
seven days ; in anthrax, twelve days; and in rabies, fif¬ 
teen days. 

In Dharwar town, the plague is rapidly on the decline, 
only one or two cases occurring daily, and consequently 
the alarm is gradually subsiding, and the inhabitants 
returning to their homes, which, during their absence, 
have been thoroughly disinfected, and made habitable. 
Dharwar is the central headquarters of the collector and 
magistrate, as well as that of the Southern Mahratta 
Railway Company. Here, then, the plague inspectors 
-took up their quart? rs, and established a hospital for the 
reception of the plague-stricken, with a fully equipped staff 
-of medical officers, empowered to keep a close watch upon 
»11 travellers arriving and departing, all arrivals from in¬ 
fected districts, as Bangalore, Gadag, &c., being detained 
for twelve or twenty-four hours. These precautions have 
been found highly necessary ; withal a lady from Banga¬ 
lore was allowed to proceed direct to her residence in the 
Fort. On the second day after her arrival she was stricken 
■with plague. She was without delay inoculated, and 
After the second injection the symptoms improved, and 
.she made a good recovery. The inoculation results in 
Dharwar in the last week of December were as fol¬ 
lows:— 


Present Total attacks Total deaths 
papula- from com- from com- 
tion. mencement. mencement. 


•Once inoculated 

. 2,610 

115 

42 

'Twice inoculated 

. 6,906 

29 

7 

TJninoculated 

. 1866 

1,172 

916 

Total 

- 11,382 

1,316 

965 

From this it will 

be seen 

that the twice 

inoculated 


secured almost perfect immunity from plague. The total 
number of persons inoculated up to date in the town of 
Dharwas was 17,076. Of these 8,844 were twice inoculated. 
In Bel gaum, Hubli, and Madras the plague may be said 
-to have quite disappeared. This result has been chiefly 
Attained by the incessant and untiring care and atten¬ 
tion bestowed on all classes alike by the medical and 
aanitary officers appointed to the several plague stricken 
-districts. 

By a later mail we find that some considerable in¬ 
crease has taken place in the number of deaths from 


plague in the city of Bombay. There were in the last week 
of January no less than 538 deaths reported, an increase 
of 80 over that of the previous week. In Mysore the 
disease is still following a fatal course, in spite of well 
considered precautionary measures in force with regard 
to the placing in quarantine all suspected persons 
travelling by railway. An infective native will contrive 
to’slip through the meshes of the inspecting officer. A 
case in point is reported from Pretoria. The ‘ Indiana ’ 
steamship from Bombay landed a passenger suffering 
from suspected bubonic plague, and the infected person 
died next day at Middelbing. Plague is also spreading 
in Madagascar. In the tow.i of Tamatava 285 cases have 
been reported with 195 deaths. Of the five Europeans 
infected one only died. The outbreak is chiefly confined 
to the more populated towns, the whole of which are 
known to be in a sadly neglected filthy condition, sanita¬ 
tion in fact is almost unknown to the Malagasy, and its 
French occupation has tended to increase rather than 
diminish its malodours. 


(Dbituanj. 

THOMAS COOKE, M.D. (PARIS), F.R.C.8., &c. 

Many generations of medical students will learn with 
pain and regret of the sudden death of Mr. Thomas 
Cooke, the well-known anatomist and teacher of anatomy, 
of Brunswick Square, W., which took place without a 
moment’s warning, while actually engaged in demonstrat¬ 
ing to his class on Wednesday of last week. Mr. Cooke 
had been indisposed for some time previously, and had 
only returned from a rest at the seaside on the previous 
day, still unwell, but intent on resuming his work. 

Mr. Cooke was the only son of Mr. John Hawley Cooke, 
and was born in America in 1841. He was brought up 
and educated in Paris where he graduated M.D. in 1870. 
He was interne at vaiious Paris hospitals, and was also 
demonstrator of anatomy at the Ecole Pratique. He 
shared in the hardships of the siege of Paris, and this 
bitter experience was possibly not altogether foreign to 
his leaving that city and coming to London in 1870. In 
1871 he married Comtesse Aglae de Hamel, a lady of dis¬ 
tinguished parentage, who, with several children, is left 
to mourn his loss. 

Mr. Cooke took his M.RC.8. in January, and hip 
F.R C.S. in June, 1871, and was forthwith appointed 
demonstrator of anatomy and physiology at the West¬ 
minster Hospital Medical School, where he v as sub¬ 
sequently appointed assistant surgeon, a post which he 
held for many years 

In 1870, he founded the institution with which his 
name will remain associated, viz., the London School of 
Anatomy, Physiology, and Operative Surgery. Starting 
in a very small way, by his perseverance, energy, and 
untiring application to work, he ultimitely built up a 
sort of extra-mural college which occupied an altogether 
unique position in the world of medical teaching. The 
thoroughness of hiB methods and his conscientiousness 
in the training of his pupils gained the confidence of the 
authorities, and to this doubtless was due the fact that 
his was the only private medical school recognised by the 
London Colleges, the University of London, the Society 
of Apothecaries, &c. 

Mr. Cooke was a teacher in the truest sense of the 
term. Teaching was, indeed, the aim and object of his 
existence. It was to him no mere livelihood : it was a 
sacrament. He toiled by voice and pen in furtherance of 
his object, which was to impress upon students and upon 
those who controlled their destinies the far reaching im¬ 
portance of practical work in the dissecting-room and in 
the laboratory. His indefatigable labours in this direc¬ 
tion occupied most of his time, for he was little prone to 
amusements, and his great distraction was writing ap¬ 
peals against the decay of practical anatomical study. 
He was the author of various works on anatomy, most of 
which are household words with students, especially 
those who had been unfortunate as candidates, and the 
names whereof it is therefore unnecessary to recapitulate 
here. The production of the final (eleventh) edition of 
his well-known " Tablets of Anatomy ” occupied the last 
years of his life, and they were published but a few 


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178 Thi Medical Psbss. PARLIAMENTARY NEWS. __Fra. is, 1880. 


months since. He adhered to the original plan, but intro¬ 
duced copious illustrations, so that they constitute a 
compendium of anatomy complete in themselves. 

During the last year or two Mr. Cooke undertook an 
active campaign against the existing tendency to drop 
dissections! anatomy in favour of what he contemptuously 
termed “ scientific ” anatomy, and there is no doubt that 
his protests were justified by recent tendencies. He 
published a number of appeals on this subject which are 
remarkable for their earnestness and evident fixity of 
purpose, and no one who has read these will deny that 
Mr. Cooke did good work in calling the attention of the 
profession to this very important subject. 

In his private life Mr Cooke was a man of sterling 
principle and earnest conviction, and if somewhat austere 
in demeanour there was an undercurrentof geniality which 
came to the surface on slight provocation. He was very 
popular with his pupils, who learned to respect in him the 
uncompromising disciplinarian associated with the ardent 
teacher. He possessed in a noteworthy degree the faculty 
of securing the attention of his classes, and this, in the 
absence of the moans at the disposal of most lecturers, 
seeing that his pupils were all voluntary. Mr. Cooke 
represented, in his person, probably the last of a long and 
distinguished series of teachers of anatomy working out¬ 
side academical lines, and his success as a teacher made 
his school the foremost of its kind in this country. He 
died on his field of battle—the dissecting- room — and it 
would be difficult to imagine a more appropriate ending 
for a life largely spent therein either as student or 
teacher. 


CtarteponiJmce, 


We do not hold onrrelves responsible for the opinions of our 
correspondents. 


AN EXPLANATION. 

To the Editor of The Medical Press and Circular. 

8ir,- In your report of the proceedings at the Edin¬ 
burgh Medico-Chirurgical Society’s meeting last week, 
your reporter appears to have quite misunderstood my 
remarks. What I did say was that Kanthack, from con¬ 
sideration of the organisms from the case of Ozama, had 
surmised that in cases of Cancrum Oris there would be 
probably found, as cause, the diphtheria bacillus, or at 
all events, a debased form of it, and that had prepared 
me for what I did find. Both in the case of Cancrum 
Oris and in the case of slow (not acute) spreading gan¬ 
grene, with slough formation, I found a similar bacillus, 
resembling in 24 hours culture, the diphtheria bacillus 
of 48 hours, and longer, cultures, when it shows involu¬ 
tion foims. In several ways it, however, differed from 
the diphtheria bacillus. The other case was not a case of 
phagsedenatous chancre; in fact, I stated that venereal 
possibilities had been absolutely excluded. Moreover, it 
was Dr. Muir who separated a somewhat similar organism 
in that case, not myself. 

Finally, subcultures only approximated slightly to the 
form of the diphtheria bacillus. There was still clubbing 
of the ends of the organism which remains even after six 
subcultures. 

I am, Sir, yours truly, 

Edinburgh, February 10th, 1899. T. Shennan. 


EXPECTATION OF LIFE. 

To the Editor of The Medical Press and Circular. 

Sir,— There is another method of calculation in use, I 
believe, among actuaries which varies somewhat from 
that you mention, and gives a little longer expectancy. It 
is to add to the actual age of the individual two-thirds 
of the difference between it and 80, a limit of life which 
is certainly more reasonable than that of 86. 

Thus: deduct present age, 42 from 80, result 38; 
add two -thirds of this number, 25; the net result 
is the probable duration of life—67 years. By your 
method it is 64 years. 

I am. Sir, yours truly, 

L. B. 


NEW SELF-RETAINING DRAINAGE TUBING. 

To the Editor of The Medical Press and Circular. 

8ir, —I defire to bring to the notice of the profession a 
new form of drainage-tubing—practically self-retaining, 
and which I have found to answer admirably. 

It consists of ordinary drainage tubing of various sizes 
perforated along its entire length at intervals of about 
three-quarters of an inch, and between each perforation. 


on either side of the tube, are studs, or wings, which* 
being of the same elastic material as the tube and cast 
together in one mould, offer no resistance during the 
process of introduction, and, as the drainage tissues dose 
around the tube, these studs offer points of resistance and 
effectually prevent its slipping out. My suggestion has 
been very well carried out by Messrs. Arnold and Sons, 
of West Smithfield, with their usual care. 

I am, Sir, yours truly, 

T. Carter Wiqo, M.D., M.R.C.S., «tc. 


literature. 


THE SYDENHAM SOCIETY’S LEXICON, (a) 

We learn from the Report of the Society that “ It is 
confidently hoped that the ‘ Lexicon of Medical Terms 
may be completed within twelve months. Considerable 
progress has been made in the preparation of a Supple¬ 
ment, which will follow the completion of the main work." 
We congratulate the editor on the industry that made 
the notice in the Report possible ; and we congratulate 
the profession on the possession of the best technical 
lexicon ever produced. Every page bears e\idence of 
ripe scholarship and increasing vigilance. 

In 1878 the first number of the Lexicon was issued, 
and year after year with unfailing regularity number 
followed number. Few subscribers think of the great 
( labour entailed in producing a number, and some time 
Bince we took the trouble to find the average number of 
pages and words in each. We find the pages number 
160, double columned, containing in all, 9,600 words. 

If any reader cares to trace the origin of a word, to 
give a definition of it, to find the effect cf time on its 
meaning, and to mark its increased or lessened use, ha 
may form some idea of so treating 9,600 words a year. 
Then, and then only, can a true value be placed on this 
magnificent work which the New Sydenham Society has 
given to its subscribers. 


J3avlwmentarg ilctos. 


VACCINATION: CERTIFICATES OF EXEMPTION. 

In reply to Mr. Johnson-Ferouson, the Home Secre¬ 
tary said he had no power to enforce uniformity in 
respect of the fees charged for certificates of exemption 
from vaccination, though in the model table of fees 
drawn up in his office for the guidance of local authori¬ 
ties he had inserted a small inclusive charge for these 
certificates. In respect of the requirement by some 
magistrates of the production of the birth certificates of 
the children for whom exemption was demanded, he &aid 
he was advised that this was within their discretion. 


UNVACCINATED CHILDREN. 

In answer to a question put by Mr. Bartley, the Pre¬ 
sident of the Local Government Board observed that 
there were no returns or other source of information to 
justify the assumption that the number of children not 
protected by vaccination was largely increasing. He- 
pointed out that since 1885 the total number of children 

(o) “ The New Sydenham Society’s Lexicon of Medicine and the- 
Allied Soiencee." (Based on Mayne’s Lexicon.) Twenty femrtlx 
Part. Scap.-Tape. London : The New Sydenham Society. 1806. 


Digitized by CjjOCK^Ic 


IftW IS, 1899. 


MEDICAL NEWS. 


The Medical Phkss. 179 


-remaining unvaccinated had steadily increased year by 
_year, from 130,000 in 1885 to 370,000 in 1898, the total 
number for the whole period being 8,235,000. Of these, 
■certificates of exemption were given in respect of only 
239,000. Since the new Act came into full operation the 
■demand for glycerinated lymph had been so great as to 
render neoessary a large increase in the staff engaged in 
its production and distribution, a fact from which he 
drew a favourable inference. On the whole, as the Act 
Mad only come into full operation six weeks ago, he was 
not in possession of sufficient information as to its work¬ 
ing to justify his making any proposal fora modification 
of the Vaccination Law. 


THE PURITY OF MILK. 

In answer to a question put by Mr. Channino, the 
the President of the Local Government Board, stated 
that the Government had arrived at a decision as to the 
portions of the recommendations of the Royal Com¬ 
mission on Tuberculosis, to which effect ought and would 
Me given, but he questioned the necessity for a General 
Bill having for object to secure better protection to con¬ 
sumers from tuberculous infection of milk. He announced 
-the forthcoming issue of an Order extending the defini¬ 
tion of “ disease ” in the Dairies, Cowsheds, and Milk- 
tfchops Order of 1885, so as to include in the case of a cow 
.such disease of the udder as shall be certified by a veteri¬ 
nary surgeoa to be tuberculous. He also announced that 
Me was about to issue a circular to local authorities 
dealing with various other matters comprised in the 
.report of the Commission. In answer to a further ques¬ 
tion, Mr. Chaplin added that he had .considered the 
possibility of tuberculosis being introduced by foreign 
milk. - 

COMPULSORY VACCINATION IN THE SERVICES. 

In reply to a question put by Mr. Babtlbt, Sir J. 
Gorst stated that Art. 35 of the Education Code, re¬ 
quiring candidates for pupil-teacherships to be vac¬ 
cinated, was still being acted upon. 

In reply to further questions by this gentleman, it was 
.stated that no man is enlisted unless he consents to be 
vaccinated, and that vaccination is enforced on all men 
And boys entering the Navy. 

.DEPRIVATION OF MEDICAL DIPLOMAS FOR 
CRIMINAL CONDUCT. 

Tex attempt of the Parliamentary Bills Committee of the 
British Medical Association to obtain an amendment of 
-the Medical Act which would deprive any practitioner 
convicted of criminal conduct of his diploma and degrees, 
and of his qualification to practise, has met with an un¬ 
expected opposition. The Counoil of the Royal College 
of Physicians of London declares that the particular 
clause of the amending Bill would infringe its privileges. 
Great efforts are being made to induce the College to 
-withdraw its opposition, and the contention is made that 
the proposal is in harmony with the general views of 
the profession. At the present time a criminal practi¬ 
tioner may be struck off the register, but still retain his 
■diploma and qualification. A conciliatory conference, 
to be attended by members of the Bills Committee and 
■of the Council of the College, has been suggested. 


^ebical ^etos. 


The City of London Lunatic Asylum 
The Corporation of London have decided to make 
improvements at the City of London Lunatic Asylum, at 
Stone, near Dartford, at a cost of .£85,850. The original 
estimate—£70,000—which the Common Council accepted 
in October, 1897, included £12,095 for the warming, 
heating, lighting, and engineering works in connection 
with the new building, but further inquiry has led to 
the condemnation of existing boilers, which have been in 
use since 1865, and to the introduction of an entirely 
new system. This, together with the installation of the 
-electric light in the asylum, has necessitated an increase 
in the expenses of £15,850, bringing the total to £86,850. 
A Report sanctioning that enhancement passed the 
Corporation last week. 


Medical Aid Assoclat on and the M.D.U. 

The following motion will be discussed at the meeting 
of the Medical Defence Union, which takes place to¬ 
morrow (Thursday) :—“ Inasmuch as medical aid asso¬ 
ciations adopt measures which are highly objectionable 
in character, and are subversive of the best interest! of 
the profession, the council of the Medical Defence Union 
strongly recommend the members of the Union at the 
next annual meeting to pass a resolution authorising the 
council to decline to accept as members gentlemen hold¬ 
ing office in such associations.” 

The Eubl n Hospl'al Sunday. 

The Council of the Fund will meet at the Shelbourne 
Hotel, Dublin, on the 10th inst., to receive the reports of 
the executive committee with regard to collections, visi¬ 
tation of hospitals, and other matters. 

Coming Congresses. 

The following Congresses are announced .-— 

1. German Surgical Society, Berlin, April 5th. Pre¬ 
sident, Professor Hahn. 

2. Portuguese Congress of Medicine, in Oporto, in 
1900. 

3. On Prophylaxis of Syphilis and other Venereal 
Diseases, at Brussels, September 1899. 

4. Balneological Congress, at Berlin, March 3rd, 1899. 

The Weber-Parkei Prizes. 

The Royal College of Physicians of London has 
announced that, in 1900. it will award the prize of £150 
and two silver medals for the best essay on the Etiology 
of Human Tuberculosis. 

The Irish Union Drug Contract System. 

It having been reported to the Guardians of the South 
Dublin Union by Sir Charles Cameron that the linseed 
meal supplied by Leslie and Company, the contractors, 
was nothing but ground cake, a prosecution of the firm 
was ordered. They wriggled out of the difficulty by 
pleading that the contract was taken before the issue of 
the new Pharmacopoeia, and that they were not bound 
to the standard of that book. 

Epidemic at Peterborough. 

An epidemic of a rather obscure disease is prevalent 
among the young in one of the suburbs of Peterborough. 
It presents some resemblance to scarlet fever, and is 
very infectious. Several deaths have occurred, and the 
schools have been closed for the present. 

Mortality among American Troops in the Philippines. 

The death roll among the American soldiers at the 
Philippines amounts to 220, including 40 from wounds 
and accidents, 65 from typhoid fever, 43 from small-pox, 
and 22 from dysentery. Vigorous measures have been 
taken to prevent the further spread of small-pox, and 
twelve medical officers have been told off for the express 
purpose of vaccinating the natives. 

A New Hospital Gaze .te. 

Not to be behind the times the Westminster Hospital 
Medical School is to the fore with a gazette of its own, 
of which the first number is now before us. The page 
facing the first page of text is graced with a very smart 
sketch which we take to represent Mr. Stonham whose good 
natured, though somewhat cynical, physiognomy is very 
cleverly delineated by the hand of an anonymous artist. 
This first number does credit to its editors, and if they 
can maintain the standard of witful waggishnsss no old 
student of the school will willingly deprive himself of the 
pleasure of revisiting mentally the scenes of his early 
years. There is nothing like a gazette to maintain intact 
the bonds which should unite all students of a medical 
school. But too often they lose touch of each other and 
of the school, and forfeit that etpril de corps which is in¬ 
dispensable to continuity of tradition. 

Salary of Irish Poor-law Dispensers. 

The Irish Local Government Board has refused to 
sanction a salary of more than £15 a year for the dis¬ 
penser of the Skibbereen Union. 

Psittacosis, the infectious pneumonia Rpread by par¬ 
rots, has broken out again in a number of Italian towns. 
Some years ago it prevailed extensively in Genoa and 
Florence, but a municipal decree forbidding the keeping 
of parrots in private houses put an end to the epidemic. 


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180 The Medical Press. NOTICES ^6 CORRESPONDENTS. Fsb. 16. 1899T 


^rtrccs to 

Corrcoponbcitts, Short JCcttcro, &c. 

**T Corrbbpondents requiring a reply In this column are par 
tlcnlarly requested to make use of a distinctive signature or 
initiate, and avoid the practice of signing themselves “ Reader,” 
“Subscriber,” "Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

CANDOUR. 

The Yorkshire Post publishes the following advertisement:— 
" Wanted.—Young man a< Dispenser, knowledge of dispeising 
not necessary, address, stating salary expected. Ac., Ac.” 

Milo—L ondon can no longer lay claim to being the healthiest 
of Eunpeau cities. Ten yea s ago the death rate whs li» - 9. and in 
1898 it was 17-2. During this period the death rsteof Rome, which 
ten years ago stood at 220. has been reduced to lti'9, and that of 
Berlin has fallen from 20 4 to 17 7. Amsterdam has the lowest 
record of any. having in ten yea's fallen from 20 - 2 to 15 8. Ten 

f ’ears ago Stockholm had the same death rate as London, but 
□stead of a reduct ion of 1 per 1 000 . there is an improvement to the 
extent of 3 per l.oort, and to-day the figures stand nt 16 7. B'usseN 
has fallen from 20 2 to lii’6, and Copenhagen from 20 5 to!7’5in 
the same period. 

Dr. Gborge Flbming.-O ur best thanks are tendered to our 
correspondent for the very valuable information vouchsafed, on 
the u. e of tuberculin as a means of discovering th9 existence of 
tuberculosis in su pected cattle. 

PHY8IOGENIC CATHARSIS. 

(✓I reply on the moat recent model.) 

Ignoramus.- \ our letter received. We consulted our dis¬ 
tinguished friend, Professor Dry-as-Dust Vole, on the question. 
He considers that the brisk cathartic street was probably due to 
the medicine yru prescribed, viz , A bolus often grains of calomel, 
with sixty grains of the compound powder of jalap, taken at bed¬ 
time, and followed by twoounces of black draught the following 
morning. The learned l’rofeesor writes that after much research, 
he concludes that the b->ius and draught were sufficient to account 
for the symptoms described. 

Mr S. P.—MS. received, and will be utilised in an early 
number. 

B. L.—Should have sent hi* communication to the offlc9 In the 
division in which he resides. It would have saved time. 

Surgeon-General Francis' paper is marked for insertion in 
cur next. 

P. D. (South Coa*t).—In view of the fact that a new water supply 
is being sought by your district, the question you ask is to the 
point The answer has of'en been insisted upon in the columns of 
the Medical Press and Circular, namely, that no water that 
has once been polluted by sewage can be regarded as a satisfactory 
source of public supply. That view has been abundantly sup¬ 
ported by recent bacteriological advances, and by the experiences 
Doth of our own and of foreign countries. In any case our corres¬ 
pondent may protect himself by boiling the water before using it 
for drinking purposes, or hnmay sterilise it by passing it through a 
Pas'eur filter, or the Berkfeld filter, both of which act on the 
principle of #■ rdng the fluid through glazed porcelain. The ele¬ 
mentary facts about wholesome and unwholesome water might 
well enter into a Hoard school education, and would replace with 
advantage some of the fanciful mbjecta now tvught. 

Dr. Hbbrivs.-W e mnch question whether the scheme wlli ever 
prove successful, and before becoming a subscribing member we 
think that our correspondent had better wait a little. 


Meetings of the §orieties anb lectures. 

Wednesday. February 15th. 

Royal Microscopical Society (20. Hanover 8quare, W.)— 
7.30 p.m. Mr. J Rheinberg: Exhibition of Objects shown by 
Multiple Colour Illumination. 8 p.m. Meeting. 

North-West London Clinical Society (North-West London 
Hospital).—8.30 p.m. Dis nssion on th- Relation of Gout to 
Rheumatoid Arthritis. (Opened by l)r. W. Ewart, i 
Thursday, February 16th. 

Hartkian Society of London (Stafford Rooms. Titchbonie 
Street. Edgware Road).—9 30 p.m. Dr. A. Whitfield: Varieties of 
Eczema »nd their Treatment. 

The Hospital for Sick Children (Gt. Ormond 8treet, W.C.) 
— 4 p.m. Dr. Vo-leker: Demonstration of Se'ected Cases. 

Royal institution of Great Britain.— 0 p.m. Dr. A. 
Macfadyen: Toxins and Antitoxins. 

Friday, Fbbruary 17tii. 

Epidemiological Focirty op London (11 Chandos Street- 
Cavendish square. W.)—8.30 p.m. Meeting. 

Society of Anesthetists (20 Hanover “quare, W.).— 8.30 p.m. 
Papers and Communications by Dr. Fluv, Mr. B. Gardner, M'. T. 
G. A. Burns, Mr. McCardie, Mr. H. Hilliard, Mr. A. Granville. 
SAtuRDAY, February 18th. 

Royal Institution of Great Britain.—3 p.m. Right Hon. 
Lord Rayleigh: The Mechanical Properties of Bodies. 

Vacancies. 

Colouial Office. London.—Medical Officers for temporary service 
on the Gold Coast, for one year. Unmarried. Salary at the 


rate of £350 a year, with quarters, or an allowance in Ue» 
thereof. Al«o Medical Officers for the West African Frontier' 
Force on the Mger. Apply personally to the Assistant 
Private Secretary at the Colonial Office, Westminster. 

County of Lanark.—Assistant Medical Officer of Health. Salary, 
commencing at £130 per ennom. Applications to Dr. Wilson. 
County Medical Office, Hamilton, nTr. 

Dairymple Home for Inebriates, Rickmansworth.— Resident 
Medical Superintendent, married. Salary £200 per annum, 
unfurnished house, food, coals, gas, Ac., provided. 

Hereford General Infirmary.-Assistant House Surgeon and Dis¬ 
penser for two years; unmarried. Salary £75 per annum, 
with board, residence, and washing. 

Hertfordshire l>unty Asylum, Hill End, 8t Albans—Assistant 
Medical Officer, unmarried. Salary commencing at £130 per 
annum, with furnished quaiters, boaid, washing, and 
attendance. 

Kent C< unty Luna'ic Asylum Banning Heath, near Maidstone.— 
Fourth As»i:tant Medical Officer and 1Ethologist. Salary 
commencing at £175 per annum, with residence, attendance, 
coal, gas, and washing. Applications to the Snperintendant, 
Banning Heath Asylum, Maid-tone. 

Liverpool School of Tropic.1 Dlseas s.—Lecturer in Tropical 
Dl> eases. Salary £250 a y. ar and proportion of students’ fees, 
with the rtght of private practice. Applications to Professor 
Boyce, University College, I iverpool. 

Norfolk and Norwich Hospital, Norwich.—Hou c e Surgeon for 
two yeats. Salary £80 per annum, with board, lodging, and 
washing. 

University College. Sheffield.- Demonstrator In the Bacteriological 
Laboratory. Salary flS 11 . 

University of Glasgow —Chair of Pathology. The normal salary 
of the Chair is fixed by Ordinance at £1,100 For particulars 
as to applications, see advertisement in another column. 


^ppoittfntentB. 

Annett, H. E., M.B., Ch.B.Vict., D.P.H., has been appointed 
Demonstrator of Tropical Pathology in the newly-founded 
School of Tropical Diseases Id Liverpool. 

Bter8, Prop , J W., M.A., M.D.. M.A.O. (Hon. Causa), Examiner 
in Midwiferz to the Royal University of Ireland.! 

Kevin, Byrne p., M.D., B.8., K.A , Medical Officer to the Christ 
Church District of the Parish ot St. Marylebone, London. 

Lby, J. W., F.R.C.S.Eug., Medical Officer for the Newton Abbot 
Cottage Hospital, District and Workhome. 

Matston, R. W., M.B.Loq'., M.R.C.K. Bug. L R.C.P.Lond., House 
Physician to the Seamen's Hospital, Greenwich. 


#irths. 

Osborn.— On Feb. 7th, at the Chalet, Dover, the wife of Arthur 
Osborn. M.R.C.8 ..and L.R.C.P.,of a dsughter. 

Sayers.— On Feb 12th, at Woodford, Essex, the wife of A. W. 
F. Sayers, M.D., of a son. 


Carriages. 

Bowb8—Lrb.- On. Jan. 9th, at Christ Church, Herne Bay, Ton* 
Armstrong Bowes, M.D.. third son of John Bowes, M.R.C.8.. 
of Herne Bay. to Geittude Anne, youngest daughter of 
George Lee, Victoria Park Road, Herne Kay. 

Cocking—Bikks.—O n Feb. »th, at the Pari-h Church, 
Sheffield, Wm. Tusting Cocking, M.D.Lond., to Alice Mary, 
yonng<st daughter of Edward Blrks. Birchcllffe, Broom hall 
Park, Sheffield. 

Dahling—Smaill.— On Feb. 8th. at Ft. John’s Free Church, 
Edinburgh, Thomas Brown Darling, M.D., of Merchiston 
Place, Edinburgh, to Elizabeth bitnlop, second surviving 
daughter of the late George Barclay, and widow of W. R. 
Smaill. Edinburgh. 

Hudson— Kkmpthornb Bbnnbtt.— Feb. 8th, at Wynberg, Cape¬ 
town, Ainslie Hudson, M-D., F.R.C.S.Edin., of East London, 
Cape Colony, only tou of the late Rev Charles Hudson, vicar 
of skillington. Lines., to Kertha. only child of Mr. G. C. 
Kempthorae-Bennett, of Maldeira. Wjnberg. 

Woodyatt—Bowcboft.— On Feb. 9th, at 8t. John’s Church, 
Ca'erham Va ley, John F Woodyatt. M.R.C.S., L.R.C.P.. of 
Halifax. Yorkshire, to Violet Isab 1 youogest daughter of 
Major-General G. C. Itowcroft, J.S.C., of Hampden Mount, 
Caterham Valley, 


§eaths, 

Cookb.—O n Feb. 8th. at his residence. 40, Brunswick Square, 
London,suddenly, Thomas Cooke,M.D., F. M.R.C.8. (Kng.), 
aged 57. 

Hail.— On Feb. 4th. at Albion Slrett, Lewes, Frank Algernon 
Hall, M.R.C.S.. in his 52ud year. 

Macaui.at.—O n Feb 4th »t Asbfleld, Halifax, Madge, the dearly 
beloved wife of D. J. Macaulay,M D.Brux., L.R.O.P., L.R.C.S. 
Edin., L.F.P.S.Glasg. 

MacUougall.- On Ftb. 9th, at Dnnollie, Oban, Henry R. L. 
Macl'ougaJl, of MacD.mgall, Deputy Surgeon General, late 
Bombay Army, aged 03. 

Morrison.— On Feb. 1st. at St. Mary’s Hospital, London, Henry 
Morrison, Surgeon, of Hounslow. Middlesex, aged 76. 

Walker.— On Feb. 1-t. at h'ewttn Heath, Manchester, Alexander 
Walker, M.D., sged 40 j ears. 


Digitized by GoOglC 




Feb. 22, 1899 


The Medical Press and Circular Advertiser. 


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XIV 


The Medloal Press and Circular Advertiser. 


Feb. 22, 1899 


LISTERINE. 

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Digitized by booQ le 





®Iw IgWiral I’rcss and Circular. 

“SALUS POPULI SUPREMA LEX.”_ 

Vol. CXYIII. WEDNESDAY, FEBRUARY 22, 189 9. No. 


<£hc Davbcn Xccturcs. 

THE ADMINISTRATIVE CONTROL 
OF TUBERCULOSIS, (a) 

By Sir RICHARD THORNE THORNE, 
K.C.B., M.B., F.R.S., 

Medical Officer of the Local Government Board. 

Lecture I. 

I desire in the course of these lectures to consider how 
far it is practicable to control and prevent tuberculosis 
in the human subject by means of administrative 
measures. With that which merely happens to fall 
within the range of possibility, but which is obviously 
not within the range of practice, I do not intend to con¬ 
cern myself at any length. I may, however, at times find 
it necessary incidentally to refer to measures which, 
though excellent in theory, must, in my opinion, be set 
aside as incapable of application. 

As a preliminary to the discussion of this subject, it 
becomes necessary to ascertain, as far as we can, what is 
the extent and character of the evil that has to be con¬ 
tended with; and this inquiry leads us, in the first 
instance, to consider how far this point may be elucidated 
by the aid of vital statistics. Hitherto, the statistical 
aspect of the question has been very involved and 
obscure, but the data supplied by Dr. Tatham to the 
Royal Commission on Tuberculosis, 1896, have made this 
part of my task distinctly easier, and I do not hesitate to 
make considerable use both of his evidence and of the 
tables which he submitted to that Commission. 

It is well known that before 1874 the medical certifica¬ 
tion of causes of death was optional, and that for a long 
period antecedent to and for some time subsequent to 
that date, even those deaths which were classed as certi¬ 
fied can by no means be so regarded from the medical 
point of view. It is also matter of notoriety that a 
number of deaths now referred to tuberculosis were 
formerly not so referred; whereas, on the other hand, 
many deaths formerly certified as due to one or other 
form of tuberculosis are now differently classified. 
Owing to these causes it is not possible to make any 
exact comparison between the rates of death from tuber¬ 
culosis as a whole, and from the different forms of tuber¬ 
culosis, at different periods of time sines the passing 
of the Act for the Civil Registration of Deaths in 1837, 
or even since 1847, when, for the first time, the causes of 
death in combination with ages were abstracted in the 
General Register Office of England and Wales. But it 
is a matter of satisfaction to have the official assurance 
of Dr. Tatham to the effect that even for this purpose 
the available statistics are not without value. 

Taking deaths registered from “ All Forms of Tuber¬ 
culous Disease,” first in the three decennial periods 1851 
—1860, 1861—1870, and 1871—1880, and then in the 
quinquennial periods 1881—1885, 1886—1890, and 1891 
—1895 in both sexes and at all ages, it appears that the 
rate of death per million living has undergone continuous 
diminution, and that whereas the rate for 1851—1860 was 
3,483, it was only 2,122, which exhibits a diminution of 
39T per cent, in 1891—1895. And further, when these 
two groups of years are compared for each separate age- 
period for which the material is available, it is found 

(a) Abstract of Lecture I, on “ The Administrative Control of 
Tuberculosis.” 


that the rate for 1891—1895 invariably exhibits a marked 
reduction as contrasted with that for 1851 1860. 

Indeed, with but few exceptions, the reduction shows 
itself to have been continuous for each period referred to 
throughout the term of forty-five years in question. 

This cannot but be matter of satisfaction; and that 
satisfaction is enhanced, in so far as purposes of .,tate are 
concerned, when it is noted that by far the greatest 
amount of reduction in death from tuberculous disease 
sets in during the period of incipient youth, reaches its 
maximum in the period of full adolescence when human 
life is commonly at its highest value to the nation, and 
that it still obtains throughout the period of adult man¬ 
hood and womanhood. Although, therefore, it remains 
true that we are dealing with a group of diseases which 
is still so fatal as to cause some 60,000 deaths annually in 
England and Wales, yet it ought not to be forgotten 
that for a long series of years we have been steadily 
advancing in the adoption of measures tending to 
diminish preventable disease, and that, speaking of death 
from tuberculous diseases as a whole, we have no cause 
to be ashamed of the result achieved. But when we 
come to examine all the available statistical records in 
detail we find that this reduction has not been uniform, 
either as regards the different forms of tuberculous 
disease or as regards persons living at different age- 
periods. 

Thus, when we look at the rates of mortality from 
“ Phthisis,” we find that in each of the fivp-year periods 
up to 25 years of age there have been reductions which 
are distinctly in excess of those affecting the same age- 
periods from “All Forms of Tuberculous Disease : 
indeed, it seems clear that much of the reduction referred 
to under the latter heading has been due to a fall in the 
phthisis rate. The reductions in the rates of death from 
phthisis at the earlier age-periods are doubtless vitiated 
by reason of improved diagnosis and improved certifica¬ 
tion in the later as contrasted with the earlier periods ; 
but there remains the fact that there has been reduction 
at every age-period, and also that in the several age- 
groups included in the age-period 15—15 J ears, when the 
mortality from phthisis is still very heavy, the contrast 
between the rates in 1891—1895 as compared with 
1851—1860 shows for the later of the two periods reduc¬ 
tions ranging from no less than 32 to 68 per cent. 

So, also, there are phases in the statistical history of 
fatal tuberculosis in England and Wales which, instead 
of affording ground for satisfaction, lead us to inquire 
how it is that amidst the general saving of life from 
tuberculous disease which has been at work, we have so 
signally failed to secure its benefits to a large class of the 
most helpless of the population, namely, infants and 
young children who are still claimed in almost undi¬ 
minished and even increasing numbers as victims of 
“ Tabes Mesenterica,” a term the use of which is mainly 
limited to disease and death occurring in infancy and 
childhood. Taking the rate of mortality under this 
heading per million living at all ages, there has been 
a diminution from 260 in 1851—1860 to 238 in 1891 1895, 

namely, one of 8-5 per cent. But under one year of age 
the corresponding rates were 3,169 for 1851—1860 and 
4,046 for 1891—1895, mamely, an increase of no less than 
27*7 per cent.; and during the period under 5 years 
there was only a trivial decrease at the rate of 3 0 per 
cent. These rates stand in striking contrast with those 
for “ All Forms of Tuberculous Disease,” and still more 
so with those from “ Phthisis.” 

Thus, when we compare the vital statistics as to tuber¬ 
culosis in this country during the early and the later 


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182 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


Feb. 22, 1899. 


years of a period which well-nigh covers the last half- 
century, we find as follows: — 

(1) There has taken place a remarkable reduction in 
therateof death from “All Forms of Tuberculous Disease,” 
this reduction being most marked during the age-period 
10-35 years. 

(2) There has been a still more remarkable reduction 
in the rat9 of death from “ Phthisis,” this reduction 
having been greatest at the several age-periods ranging 
from infancy up to 35 years. 

(3) Notwithstanding the fact that at the earlier 
periods of life there have been reductions in the rate of 
mortality from the two groups of tuberculous disease 
referred to, there has, on the contrary, been a large 
increase in the rate of death from “ Tabes Mesenterica ” 
under one year of age, and such reduction in the rate of 
death from this cause, as has taken place during the first 
five years of life, has been altogether insignificant. 

When, therefore, we come to discuss the question of 
the administrative measures which may tend to the 
prevention of tuberculous disease in this country, it 
behoves us to seek some explanation of these conflicting 
results, which are the outcome of the past, and to ask 
ourselves the question Can a reason be assigned for the 
fact that whilst signal success has been obtained as 
regards reduction in the death-rate from the two groups 
of tuberculous disease first named, there has been almost 
entire failure, and at one age-period worse than failure, 
as regards the third form referred to ? No sufficient 
answer can be given to this question until we have 
sought to learn, in the first instance, what have been the 
influences—administrative and other—which have been 
at work in our midst during the period governed by the 
statistics quoted, and which at one and another period 
of life have gone to modify, for better or for worse, the 
death-rate from one or another form of tuberculosis. 

Among the influences that have been at work in the 
past I have no hesitation in assigning a foremost place 
to those administrative measures which have gone so far 
to secure for men, women, and children the benefits of 
free movement of air and free access of sunlight as 
regards both their dwellings and their places of labour. 
When we recall the descriptions given between twenty- 
five and fifty years ago as to the overcrowding of houses 
on space, and of people within the houses in some of our 
large towns and cities, and as to the incidental evils, 
both physical and moral, which always go hand in hand 
with that obvious breach of Nature’s simplest law, by 
which our fellow subjects are deprived of air and light, 
and then compare the existing state of affairs in those 
same cities, we may be proud of the achievements of the 
past half-century, even though we may deplore that the 
change has not been so complete as we could have 
wished. 

There is abundant evidence of the advantages brought 
about by metropolitan improvements; ana the well- 
known investigations of Dr. Tatham in Salford have 
afForded definite proof of the value of this open space in 
the redaction of that form of tuberculosis in which the 
infection is mainly conveyed through the air. Thus, in 
districts where ali the houses were built on the vicious 
system known as “ back-to-back,” the phthisis death-rate 
was 6'2 per 1,000 living; where 56 percent, of the houses 
were so built the rate was 3’6 ; where 23 per cent, only 
were so constructed it was further reduced to 3 3 per 
cent.; and, lastly, where there were no “ back-to-back ” 
houses, that is to say where all houses were provided 
with some means of light and air both in front and to 
the rear, the rate was only 2 8. The result is also the 
more remarkable because, as Dr Tatham puts it, “ with 
the exception of the means for through ventilation, the 
back-to-back houses as a whole are in a better sanitary 
state than the through-houses.” 

Modem research has supplied the explanation of this, 
for we now know that there are few things more destruc¬ 
tive to the bacillus of tuberculosis than exposure to the 
combined influence of sunlight, or even ordinary day¬ 
light, and of movement of air. Such research affords 
also an incentive to further progress in this matter, but 
I cannot help calling attention to the fact that the great 
progress in this country in the reduction of the phthisis 
death-rate was in full operation before the discovery of 


the tubercle bacillus, and before any action could be- 
based on the knowledge since acquired, to the effect that 
we had to deal with a living infective organism. 

Administrative measures, including the adoption of 
bye-laws as to new dwellings, have also gone to secure 
much greater dryness of the sites of dwellings than 
formerly obtained. I refer to the draining of the sub¬ 
soil, to the concreting of the ground surface of dwellings, 
to the provision of damp courses in walls, to the proper 
collection and disposal of rain falling upon roofs, and to 
the paving of yards. It is certain that the reduction 
in the rate of death from phthisis has gone hand in hand 
with a reduction in soil wetness; and here again we have 
an indication as to one of the lines of further adminis¬ 
trative action in so far as the surroundings of our towns, 
villages, and dwellings are concerned. 

The influences I refer to, and many others due to ad¬ 
ministrative action of one and another sort, must, how¬ 
ever have operated on persons at all ages; indeed, this is 
shown in the table dealing with “All Forms of Tubercu¬ 
losis ” and in that relating to “ Phthisis,' where it will 
be seen that the important reductions effected apply to 
infancy and childhood as well as to adolescence and 
mature age. Hence I am unable to find in these 
influences any sufficient answer to the question, Why 
has there been failure, and even worse than failure, to 
diminish the toll of death paid by our infant population 
from that form of tuberculosis which is registered 
under the name of tabes mesenterica ? When, however,, 
we remember that in the case of phthisis or pulmonary 
tuberculosis the tuberculous infection is mainly received 
aerially, whereas in the case of tabes mesenterica it is 
mainly received by the digestive tract, we get an indi¬ 
cation which tends to solve the difficulty. The various 
administrative measures to which I have thus far 
adverted have, in so far as tuberculosis is concerned, 
tended in the main to diminish the chances of the 
aerial diffusion of the tuberculous infection. They have 
also tended to prevent those forms of pulmonary mischief 
which must necessarily facilitate the retention in the 
tubercle bacillus of its vitality and its power of repro¬ 
duction when once this pathogenic organism is received 
into the lungs. Is it possible that during the period in 
which there has been so vast a saving of human life 
from that form of tuberculous disease, namely, phthisis, 
in which the infection is conveyed aerially, there have 
been in operation one or more influences under which the 
tuberculous infection has had such increasing facilities 
for reaching the digestive tract as to have altogether 
outweighed, at least among our infant population, the 
benefits which would otherwise have followed a control¬ 
ling action of the sort to which I have referred ? I 
believe there have; end this leads me to consider how 
that infection may reach the digestive tract. 

Two of the conclusions of the Royal Commission of 
1890, will suffice to justify the prominence which is here 
given to the question of food supplies in relation to 
human tuberculosis. One runs as follows:—“ Any per¬ 
son who takes tuberculous matter into the body as food 
incurs risk of acquiring tuberculous disease.” The other 
is:—“No doubt the largest part of the tuberculosis 
which man obtains through his food is by the means of 
milk containing tuberculous matter.” Taking these 
conclusions as a sort of text, I am driven at once to divide 
my subject into two parts. One deals with the influence 
of meat, the other with that of milk, in the production 
of human tuberculosis. 

Meat. The demands for the adoption of administrative 
measures in order to control the risk to man of acquiring 
tuberculosis through the agency of meat have mainly 
come from certain medical officers of health having 
experience of public slaughter-houses and from those 
who are engaged in the meat trade. The former have 
largely based their demands on physiological considera¬ 
tions ; the latter, who naturally view the matter from a 
commercial point of view, have in the main enforced 
their requests by referring to seizures of carcases and by 
quotations from the report of the Royal Commissson 
appointed in 1890. 

In considering these demands I would note that they 
have, in the main, had concern with the meat derived 
from bovine animals. This has distinct interest for us. 



Feb. 22, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 183 


because whatever the influence of race may be on the 
occurrence of tuberculosis in the lower animals, it is cer¬ 
tain that animals of the bovine race lead a much more 
unnatural life in this country than do sheep, for example, 
among which latter animals tuberculosis is compara¬ 
tively rare. Indeed, next to the milch cow, and perhaps 
the pig, there is probably no animal, the flesh of which 
is used as a food for man, so liable to tuberculosis as the 
well-stalled bullock. In support of the contention that 
this contrast between bovine and ovine animals is not 
exclusively an affair of race, I would recall a piece of 
personal experience. When visiting the public slaughter¬ 
houses of one of our large cities I was shown, as a 
curiosity, a group of cows. To me each cow seemed to 
consist of little more than a skeleton framework covered 
tightly with a hide, and in my ignorance I asked if the 
lot had been condemned, even before slaughter, as unfit 
for human f<x>d. To my astonishment I was informed 
not only that this was not so, but that cows of the same 
class were often received from the same locality, and that 
they were peculiar inasmuch as tuberculosis was very 
rare among them. They were disused milch cows from 
some of the poorest of small tenant farmers in the United 
Kingdom. Although they had been milked as long as it 
was practicable to milk them, they had mainly subsisted 
on such grass as they could pick up, and their former 
owners had been unable to provide for their protection 
in stalls against inclement weather. In short, though in 
one sense their life had been a hard one, they had 
enjoyed the benefit—inestimable from the point of view 
of tuberculosis—of having lived in the open air. 

But tuberculosis in animals, the flesh of which is used 
for human food, notably in those of the bovine race and 
in the pig, is a reality; and in considering how far it 
may be controlled by administrative measures, it will be 
well to ascertain, as far as this is practicable, what 
evidence is available as to the extent of the mischief 
induced by the use, as food, of the meat of tuberculous 
animals. 

With such evidence before me I fully admit that 
there are conditions under which tuberculous disease can 
be and is communicated to man as the result of the use, 
as a food, of the meat of tuberculous animals, but I fail 
to find any evidence justifying the view that the disease 
is so communicated to any wide extent. To the limited 
extent to which vital statistics enable us to form a judg¬ 
ment, the conclusion would be in the opposite direction 

Such positive results as were obtained by certain 
experiments carried out by the Royal Commission of 
1890 were achieved under altogether exceptional circum¬ 
stances. They serve indeed to represent a risk, and even 
an occasional danger; but it is not one. in my opinion, 
that justifies some of the claims that have been based 
upon it. It should also be remembered that the Royal 
Commission of 189U, having these facts before them, re¬ 
ported that “ tuberculous matter is but seldom found in 
the meat substance of the carcass,’ ’ and referring to Dr. 
Sidney Martin, who gave much attention to the question 
of “ smearing” meat, they add that he “sees no objec¬ 
tion to the sale of meat substance from carcases which 
have shown only localised tuberculosis and from which 
every particle of tubercle has been skilfully removed.” 

It is quite unnecessary to discuss with you the ques¬ 
tion of the urgent need for preventing, by administra¬ 
tive control, the sale of many tuberculous carcases that are 
now used for the purpose of meat supply, and especially 
of portions of carcases exhibiting general tuberculosis 
or tuberculosis of the internal organs. 

I only know of one means, namely, by the abolition, as 
far as this is practicable, of private slaughter-houses ; by 
the provision in all large centres of population, whether 
technically styled urban or rural, of public slaughter¬ 
houses under the direct control of the sanitary 
authorities and their officers; and by the adoption of 
measures which will as soon a3 practicable, provide a 
class of skilled meat inspectors. 

Another point that has been strongly pressed in recent 
years, as an administrative measure that is called for in 
the interests both of justice and of public health, is that 
of compensation out of public funds to the butcher 
wherever a carcass is seized on account of tuberculosis, 
such compensation only to be given in the case of cattle 


which have cost a certain minimum sum—say £8—and 
in no case to go beyond a maximum sum of £30. 

My main objections to compensation for carcases or 
portions of carcases seized on account of tuberculosis 
may be summarised as follows:— 

(1) That it is wrong in principle to call upon the 
public to give compensation to a man who, having made 
a purchase involving some risk, and having placed the 
purchased article on sale for his sole profit, subsequently 
finds that the article in question is not one that, in the 
interests of the public, he can be allowed to dispose of. 

(2) That the risk involved in the purchase of animals 
of the bovine race, by reason of tuberculosis, is one that 
is well known and perfectly recognised. 

(3) That, notwithstanding repeated applications on 
behalf of the Commission to be supplied with evidence 
showing that real hardship and substantial loss are in¬ 
curred by butchers by reason of the seizure of tubercu¬ 
lous carcases, the general tenour of nearly all the 
evidence submitted was in precisely the opposite direc¬ 
tion. 

(4) That the representatives of the various societies 
and bodies who urged that compensation Jfrom public 
funds should be accorded to the butchers were almost 
unanimous in admitting that in businesses extending 
over a long series of years and often involving tens of 
thousands of carcases, they had either incurred no 1 iss 
at all owing to seizures for tuberculosis, or any such loss 
had been altogether trivial. 

(5) That such freedom from risk of financial loss in a 
commercial transaction is hardly to be met with in any 
other trade. 

(6) That the few exceptions which came before the 
Commission were almost exclusively limited to a few 
towns where a standard of excessive stringency had been 
maintained as to the amount and extent of tuberculosis 
which called for seizure of a carcass. 

(7) That in all these exceptional instances those 
responsible for this stringency expressed their willingness 
to abide by any standard which might be authoritatively 
laid down by a Government department or other authori¬ 
tative body concerned with the matter of food supplies. 
Such a standard code of rules has now been laid down by 

i the Royal Commission of 1896. 

(8) That even in these exceptional cases by far the 
majority of seizures had to do with the carcases of cows 
that had served as milch cows involving special risk. 

(9) That in view of the fact that milch cows have 
already been a source of profit as milk suppliers, and 
in order to ensure that profit they have generally been 
kept under sanitary conditions calculated to lead to 
tuberculosis, the grant of compensation would tend to 
encourage the very disease which should, as far as 
practicable, be prevented. 

(10) That the danger to man of contracting tubercu¬ 
losis as the result of eating meat from a carcass which, 
though tuberculous, is otherwise of such wholesome 
appearance as to justify its being used for a meat supply, 
is both rare and trivial. 

(11) That the amount of risk really incurred in the 
slaughter of apparently healthy animals may best be 
estimated by the fact that some butchers do not think it 
worth while to pay an insurance fee in order to cover 
it, which fee would, at the end of the year’s transactions, 
cost them no more than 3d. or 4d per beast slaughtered. 

(12) That, in so far as vital statistics can be relied on 
to afford any indication of this risk, they go to show 
that at the ages when meat is most used as a diet, there 
has not only been no increase of death from tuberculous 
disease, but that persons living at these ages have been 
those which have signally profited by the general dimi¬ 
nution in death from tuberculous disease which has 
taken place in this country. 

(13) That the large saving of life from tuberculosis at 
the ages in question has corresponded with a period 
during which there has been a large increase in the 
amount of meat consumed. 

(14) That any use of Imperial funds for compensation 
in this matter, on the ground that the protection of the 
public health is involved, would be contrary to the 
action hitherto adopted in this oountry, and under which 




184 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


Feb. 22, 1899 


measures of public health carried out l.ically are paid 
for by the community carrying them out. 

(15) That the use of Imperial funds for such a pur¬ 
pose would be liable to open the door to grave abuse. 

Public slaughter-houses, officered by skilled inspectors 
and supervised by medical officers of health, are 
urgently required, among other reasons, for the preven¬ 
tion of tuberculosis in man. When these have been 
provided, and rules such as those laid down by the 
Royal Commission of 1896 as to action with regard to 
tuberculous cases are uniformly acted on, then this ques¬ 
tion of the seizure, on account of tuberculosis, of car¬ 
cases which, apart from that disease, are deemed fit for 
human food, should, and I believe will, practically cease 
to exist. The remedy lies, not in resort to public funds 
for the purposes of compensating a particular trade, but 
in the adoption of administrative measures of control 
such as I have indicated. 

But if efficient control is to be exercised over the car¬ 
cases of beasts slaughtered in this country, a control 
corresponding as nearly as is practicable to that applied 
at home should be exercised over imported carcasses ; 
otherwise the contrast between laxity in the case of 
home carcases would be not only unfair, but it might 
act as an incentive to the transmission to this country 
of meat which would be condemned abroad. 

I would therefore submit for consideration, whether it 
is not equitable as well as in the interests of public 
health that skilled inspectors should be appointed at all 
ports where foreign carcases arrive, and that these 
officers should be required to select from each ship's 
cargo a number of carcases for such examination as 
may be necessary to the protection of the interests of 
the pub'ic. The cost ot the necessary staff and accomo 
dation should in my opinion be paid by means of some 
trival tax per carcass to be levied on the importers. 


Original dTommmmations. 

SYPHILIS IN THE ARMY, 1812-189G. 

BEING A REPLY TO ' 

MITIGATION AND AGGRAVATION OF 
SYPHILIS. 

By JOHN A. SHAW-MACKENZIE, M.D.Lond. 

The variable intensity of syphilis and its explana¬ 
tion has been the subject of controversy ever since 
the reputed introduction of syphilis into Europe or 
its de novo origin at the end of the fifteenth century. 
Without attempting to go into the disputed origin of 
syphilis at the present time, it is right to mention 
that syphilis is said to have existed from the first, 
and the intensity of disease at the end of the 
fifteenth century regarded as an aggravated form. 

Not only has the pathology and treatment of 
syphilis commanded at all times universal attention, 
but its prevalence and intensify in the Services has 
been the subject of many reports and especial in¬ 
quiry. The Report of the Select Committee, appointed 
in 1879 for the purpose of inquiring into the adminis¬ 
tration, operation, and effect of the Contagious 
Diseases Acts, 1866-1869, is well known. 

One effect of the repeal of those Acts has been 
undoubtedly, the discouragement of the teaching and 
study of the pathology and treatment of syphilis, 
even sometimes to the mention of or diagnosis of the 
disease. The whole subject, however, has again 
assumed, or is assuming, importance in view of the 
aggravated form of disease in British troops invalided 
home from India, which formed the subject of a 
report by a Committee cf the Royal College of Phy¬ 
sicians in 1897. 

The etiology of “ Malignant Syphilis ” had already 
formed one of the subjects of debate at the Third I 
International Congress of Dermatology (London) in | 
1896. Both here and in a subsequent publication (1) 


Prof. Neisser, admitting the great diminution of 
malignancy during the last four centuries, withdraws 
hiB previous vigorous adhesion to “ congenital immu¬ 
nity conferred by hereditary transmission.” He con¬ 
sidered there was no substantial proof of this, and 
attributes the diminution to “increased resistance 
inseparably associated with decreasing virus activity” 
accruing from adoption of improved methods of 
treatment, the use oi antiseptics, greater care in the 
treatment of local and general manifestations, and 
improved general, sanitary measures. Nevertheless 
he is willing to admit some degree of inherited immu¬ 
nity, notes the attenuation of measles in communities 
and countries, and states the following “ Nor have 
I noted during the recent extension of syphilis in 
Russia that an unusual proportion of cases of malig¬ 
nant syphilis has-been noted. . . It is interesting in this 
reference to draw attention to the fact that Epstein 
has recently recorded a remarkable number of cases 
of malignant syphilis among the Jews. He is 
inclined to account for his observations on the hypo¬ 
thesis that the individuals of a community which has 
been free from syphilis tend to show the malignant 
type more frequently when at length attacked than 
the members of a population which has experienced 
the disease for generations." 

In the same year Dr. G. Ogilvie (2), founding his 
opinion to some extent on the testimony of Professor 
Neumann, considered that “ attractive as this theory 
is by its simplicity and plausibility.” both it 
and the late Mr. Henry Lee’s theory of individual 
hereditary immunity seem “ to stand upon a 
weak foundation.” “Ferguson’s (sic) statement.” 
says he, that “syphilis has become so much 
mitigated in Portugal by reason of general diffu¬ 
sion or other causes, that after running a mild 
course it exhausted itself and ceased spontaneously, 
has been generally accepted as trustworthy, and been 
taken over from one text-book to another without 
further confirmation. It is, therefore, interesting to 
compare it with the results recently come to by Pro¬ 
fessor Neumann, of Vienna. Hesajs. . . . lam 
by no means in a position to corroborate Ferguson’s 
t-tat°ments about the particularly beni.n cases of 
syphilis in Por uea', still less that the cases there 
take a milder course without the us“ of mercury. 
On the contrary, in the hospitals of Lisbon I have 
fully convinced myself that tie symptoms are 
practically identical there as elsewhere. Tertiary 
affections are m t rare either. . . . “Unless one 
resorts.” says Dr. Ogilvie, “to the improbable 
supposition that the relative immunity which Portugal 
once enjoyed has bee une exhausted, and that thereby 
a revival of syphilis has taken place, such an experi¬ 
ence made by so competent an observer goes far to 
discr- dit Ferguson's earlier statements. . . . The 

reporis from different Russian, German, and 
English regiments adduced by Ferguson and Lee 
have, if possible, still less claim to trustworthiness 
. . . . These o> servations, as well as the German 
and Englis’i ones, were made at a time when no dis¬ 
tir ction was drawn between syphilitic and other sores. 
This circumstance Blone deprives them of all scientific, 
demonstrative value. The sad state of the British 
Army in India i-< sufficient to shake any theory of 
general immunity,” and, acknowledging the views of 
Neisser, “it seems explainable by lack of hygiene, 
preventive, and therapeutic measures.” 

This paper, containing conclusions obviously 
founded upon imperfect knowledge of Fergusson s 
original paper (3) andbeingprominently noticed (4), led 
me to draw attention to the original work of Fergus¬ 
son and work of Rose (5), in support of the former’s 
views respecting mitigation and aggravation of 
syphilis. 

The subsequent discovery by Dr. Ogilvie (6) of a 
later paper (7) by Fergusson, in which the latter 

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Feb. 22, 18»9. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 185 


admitted aggravation of syphilis by the abuse of mer¬ 
cury among the British troops in Portugal, and 
does not refer to attenuation, seemed to Dr. Ogilvie 
to prove beyond doubt the correctness of his inter- 
1 'rotation. Shortly afterwards Dr. Ogilvie’B paper 
upon Syphilis among British Troops in Portugal, 
1812, and in India, 1896,” appeared (8), in which his 
original views are for the most part maintained. 

Considerable support was subsequently given to 
these views in the editorial columns of the British 
Medical Journal, November 5th, and, notwithstanding 
the subsequent and for the most part adverse corre¬ 
spondence which followed, the same paper is 
prominently noticed in the editorial columns of the 
Medicax Press and Circular of January 25tb, 
1899. In this a direct appeal is made for recognition 
of this paper, it is further stated that “ it has evi¬ 
dently already borne fruit, judging from the fact 
that the subject for the next Parkes’ Memorial Prize 
will be the “ Prevalence of Venereal Diseases in the 
British and Indian armies ” ; an unqualified verdict 
is delivered against Fergusson's statement of the 
“ gradual self-extinction of syphilis in the Peninsula,” 
and support is given mainly to the mercurial abuse 
theory in explanation of the present aggravated form 
of syphilis, qualified by the bread theory of improved 
hygienic conditions and treatment in explanation of 
mitigation. 

It seems necessary, therefore, that I should again 
endeavour to represent the work of Fergusson in its 
proper light, review the grounds upon which Dr. 
Ogilvie arrives at his conclusions, and Bubmit afresh 
the factors or combination of factors which have been 
adduced in explanation of mitigation and aggrava¬ 
tion of syphilis. 

Dr. Ogilvie’s contentions in this paper are, that the 
form of disease amopg the Portuguese manifesting 
itself as primary ulceration, either local or followed 
by insignificant throat ulceration, and by affection of 
the bones often so slight that, but for the previous 
history, it might be mistaken for simple rheumatism, 
each and all being curable by antisyphilit'C woods 
and sudorifics, the quantity of mercury being always 
insignificant and often altogether omitted is (1) not 
a mitigated form of syphilis due to self-exhaus¬ 
tion, but the natural type of disease; relying largely 
upon Fergusson’s later paper, that (2) the aggravated 
form of disease seen among the British troops in 
Portugal was mainly due to the abuse of mercury; 
and that (3) the present aggravated form seen among 
British troops invalided Dome from India may be 
mainly due to the abuse as opposed to the use of 
mercury. 

(la) The difficulty of establishing a standard of 
syphilis is great. It admittedly varies under different 
conditions of time, place, and other circumstances, 
irrespective of treatment. Starting from the admitted 
intensity of syphilis at the end of the fifteenth cen¬ 
tury or perhaps before this, under the covering term 
“ lepra,” its su' sequent lesser intensity has been 
regarded as modification, and the disease in Portugal 
among the bulk of the inhabitants depicted by Fer¬ 
gusson must be regarded as a modified form. As, 
for instance, Wallace, of Dublin, in 1836-8, regarded 
primary and secondary pustular as the normal type 
and the exanthematous as the modified. On the 
other hand, at the present d*y, the exanthematous 
eruptions are approximately regarded as the normal, 
and the pustular as the “ malignant.” If, however, 
any importance is to be attached to the descriptions 
of antiquity, constitutional symptoms are, according 
to referees, conspicuous by their absence, or nearly 
so. The local venereal ulcerations alone may thus be 
regarded as the typical, and anything over t^ese, 
in the way of consecutive symptoms, as aggravation. 
The Portuguese local ulcerations, therefore, on such 
speculative grounds might be regarded as typical 


and the disease among the bulk of the inhabitants as 
depicted by Fergusson, in respect of secondary and 
tertiary symptoms, as aggravation, and not normal. 

Dr. Ogilvie contends that Fergusson made no differ¬ 
entiation between “ hard and soft, between infecting 
and non-infecting sores, between syphilitic and non¬ 
syphilitic cases.” Dr. Ogilvie omits to say that this 
kind of argument was dealt with by Rose as well as 
by the late Mr. Henry Lee. 

‘ It is reasonable,” says Rose (9), ‘’to think that a 
considerable part of the cases of which Mr. Fergusson 
epeaks could not be regarded by cautious practitioners 
as venereal, ’ but while admitting some of the cases 
he himself brought forward were not venereal in the 
Guards he concludes that “ among a number of 
cases of such a description taken indiscriminately the 
probability of some being venereal is materially in¬ 
creased and must at last approach nearly to a cer¬ 
tainty ”; while “ It is true,” says Mr. Lee, “ that at 
the time Mr. Rose conducted his experiments no clear 
distinction was drawn between those syphilitic 
affections which if left to themselves would infect the 
constitutions of the patients and those which would 
not, and therefore a great many sores were no doubt 
said to be cured withoat mercury which under no 
circumstances would have been followed by secondary 
symptoms. It is exceedingly probable, however, that 
a certain proportion of the cases treated by Mr. Rose 
really depended upon the infecting variety of the 
disease, and as Mr. Rose found that he could deal 
with these cases without administering mercury we 
can only conclude that the disease he was treating 
had appeared in some modified form such as Dr. 
Ferguson had noticed in Portugal and such as he 
states to have existed alsj in Germany and in 
Russia.” 

The syphilitic nature of phagedsena and the chan¬ 
croid are admittedly controversial points. Fergusson, 
however, distinctly noted a difference between the 
Portuguese ulcerations and the “trifling cases of 
chancre as we have seen at home which can often be 
dried up with a piece of lint ’ and the venereal 
ulcerations in the British which were “ more intract¬ 
able to the operation of mercury than under similar 
circumstances at home.” He, moreover, noted a 
difference between the non-infe' ting character of 
phagedsena in certain cases, under certain circum¬ 
stances, as opposed t> those cases “ in which the con¬ 
stitution has become affected with the secondary 
symptoms in a proportion that could not have been 
expected." The Portuguese, according to Fergusson s 
later paper, had no phagedsena, at least, he could only 
recall one case. They were “ syphilitic ulcerations.” 
That the British phagedsena was syphilitic is sup¬ 
ported by Mr. Hutchinson s statement that ‘ phage- 
dsena is very much more common in the hard than in 
the soft sores,” as well as by the late Mr. Henry Lee's 
statement that in acute forms of destructive and 
phagedsenic inflammation “ the action which is taking 
place may save the patient's system from syphilitic 
infection.” As to the non-differentiation betwe n 
“ hard and soft ’* sores, it is difficult to follow Dr. 
Ogilvie. “ The question still remains,” says he, 
“ whether syphilis at the beginning of this century 
existed in Poitugal in a milder form than in other 
countries. There is nothing in Fergusson s somewhat 
fragmentary description to foster such a belief. With 
regard to the primary lesion (including the non¬ 
syphilitic sores), it appears that it was by no means 
uncommonly mild. Among the forty cases which 
were at the hospital none of the ulcers were such 
trifling cases of chancre as we have seen at home. . . . 
but they were large extensive ulcerations . . . which 
may prove their apathy, but it does not prove the 
disease to be a particularly mild one.” 

Such an admission appears to establish the suppu 
rative character of these syphilitic sores in contra-' 

D 


186 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


Feb. 22, 1899. 


diction to this dualistic argument of Dr Ogilvie and 
the views of many. Moreover, the diagnosis between 
“ syphilitic and non-Byphilitic ” cases in these days 
is no more certain than in Fergusson's. 

(b) “ Fergusson, however, inferred us much from 
its easy cure as from its analogy of the natural 
small pox. . . . To prove mitigation or attenua¬ 
tion of a disease in one population as compared to 
another it is not sufficient to prove that the disease 
runs a milder c mree, but it has to be shown that it 
does so under identical conditions. In this particular 
case the circumstances under which the respective 
observations were mide were so widely different as 
to make the observations incomparable.” He refers, 
of course, to the abuse of mercury under which the 
British partly laboured, as compared with the treat 
ment of the Portuguese by their faculty. This argu¬ 
ment is of little importance. Leaving the British 
out of the question, Fergusson, corroborated by 
Guthrie, notes that “ dreadful exfoliations and loss 
of parts (nose bones) no doubt sometimes occur, but 
these by no means constitute a large proportion of 
the affected,” and were for the most part noticed in 
Lisbon. Dr. Ogilvie, it r-eems to me, would have us 
be'ieve that these also were due to mercury, espe¬ 
cially drawing attention to Fergusson’s first estima¬ 
tion of an “ adequate ’ dose of mercury compared 
with his later view of “a tithe of a tithe, or a cen¬ 
time.” There is nothing to justify such an inference. 
Dr. Ogilvie admits that ” its (mercry) in¬ 
ternal use was reserved till the disease shows 
itself in the last order of parts, its last citadel, the 
bone6.” And,notwithstanding the fact, which has been 
authoritatively testified to. that the most serious 
destruction of parts has followed the non-mercurial 
treatment Fergusson himself qualifies the term 
“ adequate,” as it referred to dosage by the Portu¬ 
guese faculty, by the statement that such adminis¬ 
tration was “ in an alterative form ” and a “ ridicu¬ 
lously insignificant quantity of xr ercury generally of 
calomel along with Dover's powder, guaiacum, &c.,” 
was given, as opposed to inunction, which Fergusson 
leads us to suppose in his later paper was practised 
and abused by nimBelf. The comparison also of the 
Portuguese disease and treatment with the same type 
under similar treatment at home, so far from proving 
the fallacy of attenuation there, begs the whole 
question as to under what conditions the simple i 
treatment proved efficacious in certain cases. 

Far also from the non-differentiation of sores 
rendering all comparison “ vague and worthless,” the 
fact remains that there was a difference in the 
intensity of syphilis among the Portuguese; a 
comparison sufficiently obvious to Guthrie (10), and 
which led him, notwithstanding his admitted pre¬ 
vious and subsequent practice of, and belief in, the 
non, or modified mercurial treatment, to state “ the 
secondary symptoms of the most serious nature will 
occasionally follow in particular constitutions.” Dr. 
Ogilvie does not state that. 

With regard to the anal )gy of the small-pox, Dr. 
Ogilvie considers such very remote or artificial, 
and while admitting that little is known of its “ self¬ 
exhaustion by acquired immunity hereditarily trans¬ 
mit' ed,” is inclined to think that facts and theory are 
against such transmission, and that vaccination, 
inoculation, and isolation are the true explanation. 
He omits to give us Fergusson’s facts in refutation of 
the same, and which showed that though inoculation 
and vaccination were well known in Portugal, they 
were never p-actised as far as he could ascertain. 
Nor were there any isolation means adopted, the 
affected lying apparently unconcerned in the hospitals 
among ihe unaffected, &c., nevertheless small-pox 
was prevalent and a mild disease, and he could not 
recollect it even terminating fa-ally. I believe the 
same obtains now to a great extent, and that the 


popular idea is that the mitigation is due to the 
climate. . . . “ Yet he (Fergusson) had no doubt 

if this mild disease was transp'anted i- toap-ople who 
hid never known it,” and I might add into th • unpro¬ 
tected among us at the present time in consequ-nce 
of th • abolition of compulsory vaccination, “ it would 
(and will) desolate with all the fury of pestilence.” 

Nor do- s Dr. Ogilvie mention Fergusson's analogy 
to *• all adventitious diseases. . . . that are not 

connate, endemic, and sporadic, which appear more 
or less to ran this course of exhausting themselves 
while retained upon the same ground.’’ 

(c) Rose, it is true, regarded attenuation as “ as 
et me ely hypothesis,” and Guthrie, notwithstanding 
is opinion already stated in respect of constitution, 
i-» opposed to it. After quoting va ions testimonies, 
•‘of course n .t all of the same value,” including the 
impression among Portuguese medical men that 
syphilis has becom- milder during the last thirty 
years, thanks to hygiene and improved treatment, 
such information being vouchsafed by a “highly 
intelligent patient” who writes from Lisbon, Dr. 
Ogilvie attaches “ the greatest importance to that of 
Guthrie. “ We cannot shut our eyes to the fact that 
not one of these witnesses reports attenuation. This, 
taken together with Fergussoa’s later viewy. . . 

will, I think, be ample justification to relegate the 
allegations w th regard to self-extinction of syphilis in 
Portugal to the sphere of lege idary histories. ’ 

Obviously, none of these report attenuation in 
favour of the “ special pleading ” of Dr. Ogilvie, but 
he does not mention Hennen (11), an equally pro¬ 
minent Peninsular surgeon, who, while subscribing 
to the non-mercurial treatment, thinks it “ proper to 
direct att ntion to the opinion of those who held,” 
like Fergusson and others previously, that syphilis 
has “ undergone great changes in its nature since the 
end of the fifteenth century.’’ Moreover, he con¬ 
sidered the analogy of leprosy and scurvy was 
“ strongly in favour of such a supposition. ’ 

“ We have,” says he, “ also direct testimony which 
shows that its symptoms have become milder and 
more tractable. No author is better entitled to speak 
on the disease than the well-known German, Ulrich 
de Hutten, if personal suffering can confer such a 
melancholy distinction. After having suffered for 
nine years under it (many times salivated and after¬ 
wards cured by guaiacum), and we may naturally sup¬ 
pose studied its history minutely, he tells us, in his 
work published in 1519, that for the first seven years 
af. er its appearance in Germany.it raged with the 
utmost violence, but that when he wrote its virulence 
had considerably abated. In 1563, upwards of forty 
years afterwards, Bernardinus Tomitanus, of Padua, 
after noting some changes of symptoms which had 
taken place in the disease since its first appearance in 
Europe, bears strong testimony to its increasing 
mildness at the time ne wrote. . . . The learned 
and indefatigable Astruc has collected the authorities 
of various physicians and historians to the same 
effect, including a period from 1546 to 1711, to 
which he adds his own testimony, dated 1735. In it 
he savs, ‘ I have, by careful and repeated observation, 
found the venereal disease daily to grow milder; it 
may, perhaps, be more frequently contracted than 
formerly, yet its rage is less violent, its symptoms are 
not so many, so painful, nor so difficult to be cured, it 
yields more readily to remedies properly applied, and 
in a word seems little and little to approach towards 
its close.’ ” 

1) Tlie “ British Journal of Dermatology,” January, 1897. 

2) I bid, November. 

(3) “Observations on the Venereal Disease in Portugal,’’Ac. ( 1812 ). 

(4) The “Lancet," January 15th, 1898. 

(5) Ibid. Januarv29th,April23rd,andJune4tb. (6) Ibid. June4th. 
<7) “Notes and Recollections of a Professional Life.” (1846). 

(8) The “ British Journal of Dermatology,” July, 1898. 

(9) “Med. Chirurg. Trans.” Vol. VIII. (1817). (10) Ibid. 

(11) “ Principles of Military Surgery." (1829). 

(To be concluded in our next.) 

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The Medical Press. 187 


Feb. 22, 1899. 

A FURTHER CONTRIBUTION TO 
THE PRACTICAL ASPECT OF 
INFLUENZA. 

By Sur.-Gen. CHAS. R. FRANCIS. M B., M.R.C.P., 

II.M. Indiau Army (retired). 

The retired Indian officer, whose lepeated 
attacks of influenza during the past few years I 
reported in your journal in 1895, and of whom T pre¬ 
dicted that, if he remained where he was—in a house 
with damp surroundings—other attacks would pro¬ 
bably follow, has been twice attacked since l wrote. 
About the middle of October, 1896, he was taken ill, 
for the fifth time, with a very severe form of the dis¬ 
order, confining him to his room for five months. 
The heart and stomach were involved—the former 
especially; but the effect upon the nervous system 
with the weakening, even almost crippling, of some 
of the limbs, was exceptionally striking. The most 
remarkable feature in this attack—followed by 
one very similar the next year—has been the 
gradual though steady deterioration of the nei-ves 
shown by slowness both in walking, and writing, 
accompanied, when so occupied, by an occa¬ 
sional spasm of the hand. He still works at 
literary pursuits, which give a certain amount 
of pleasure, but there is now no enjoyment in them 
Until quite lately, he has remained comparatively 
well, the several functions being correctly performed : 
and he has been free from pain. But on the 9th of 
last month he was attacked with what was, appa¬ 
rently, rheumatism, the limbs being affected alter¬ 
nately with but little power to move them, but with 
pain when doing so. There was no fever, the urine 
only being somewhat high-coloured; and the tongue 
was clean. Influenza was prevalent in the station, 
assuming, generally, a rheumatic form; so that I 
am inclined to look upon this attack as a form of 
this disorder. Althaus, probably our best English 
authority on the subject, does not indeed give rheu¬ 
matism as a phase of the disorder, but he describes 
cases of rachialgia and neuritis as complications or 
as post grippal; but a case of rheumatism, pure and 
simple, turning out to be influenza is probably without 
the pale of medical experience. " hat favours the 
theory is the extreme characteristic nerve debility 
which has accompanied and followed the attack. The 
patient was well in a fortnight, but the weakness and 
crippling remain in an increased degree. 

The case of this officer seems to afford a good 
object lesson in teaching, as before observed, that 
change of air is the best remedy; which is the more 
especially called for where the original locality is 
damp. C:ises will, of course, occur where this is im¬ 
practicable; though, whenever possible, it should be 
adopted. Influenza is usually connected in the 
public mind with some affection of the respiratory 
organs. Indeed, till very lately, this was the pro¬ 
fessional view. The idea of its being essentially a 
nervous affection is gradually gaining ground with 
the public, though it i6 very difficult to convince 
people of its truth. It was discredited in this case by 
members of the patient’s family, who held to the 
belief that, being old, he was bound to have some¬ 
thing the matter! They told him that, at any rate, 
he had influenza on the brain ! I firmly believe that 
had the change to a more suitable climate been re¬ 
sorted to when I last wrote four years ago, there 
would have been no more attacks to chronicle, neither 
« f influenza nor of so-called rheumatism. Granted 
that it was a genuine attack of rheumatism, previous 
visitations of influenza doubtless increased the sus¬ 
ceptibility of the patient. It may be mentioned that 
never before, in a long life of seventy-eight yeurs, 
had there been a suspicion of a rheumatic tendency. 


VAGINAL CLESAREAN SECTION, (a) 

By A. DUHRSSEN, 

rrofttsjr of GyntecoloKy, Unlv.r*ity of Berlin. 

("from our own correspondent.] 

Thanks to asepsis and Sanger’s method of vaginal 
suture, the old Caesarean section has lost much of its 
terrors, so that the indications for it are not confined 
to absolute obstacles to delivery, but are extended to 
cases of moderate obstruction. A substitute has 
been proposed for the operation in perforation 
and symphyseotomy. I have substituted vaginal 
Ciesarean section in one oase, and I repeated the 
operation last year. The description and the results 
of the operation have already been published in a 
monograph. It consists essentially in a sagittal 
splitting of the anterior and posterior vaginal culs-de- 
sac and separation of the bladder from the uterus und 
splitting of the uterine wall as far as the lower uterine 
segment, is required. In this way in the first case 
I was able to extract at term a child weigh¬ 
ing 4,700 grin. Puerperium normal. I i the mono¬ 
graph I have formulated the three following 
indications for the operation (1) Abnormalities 
of the cervix and lower uteri e segment, which 
render dilatation impossible or difficult. (Carci¬ 
noma, rigidity, stenosis, sacculation.) (2) A danger¬ 
ous condition of the mother, that rendering 
speedy delivery necessary. (3) Dangerous condi¬ 
tions that will lead to t-peedy death. It was on this 
account that I operated last year in a case of mitral 
insufficiency ana dilatation of the right ventricle ; in 
which the patient had passed several days and nights 
sitting upright in a chair. There was still some hope if 
the uterus could be promptly emptied, otherwise it was 
evident Blie would die during the course of the labour. 
The operation was performed as described. The blood 
was almost black. Easy turning and extraction of 
an asphyxiated female child; but immediately after¬ 
wards the pulse stopped, and finally, whilst attempts 
at resuscitation were being performed, sutures were 
inserted, the placenta was removed and the uterus 
plugged. The operation lasted at most five 
minutes before the child was visible. The autopsy 
showed that the operation had been entirely extra- 
peritoneal. In cas-i of carcinoma, extirpation of the 
uterus should follow extraction of the child. That 
this would be successful was shown by a case of 
rupture of the uterus, which was followed by success¬ 
ful extirpation. The results of other operators who 
have adopted this method have been even more favour¬ 
able than my own, when, as I recommended, the pos¬ 
terior vaginal wall was split up. The mortality 
was 27 per cent., a favourable result when one 
remembered that in eight out the eleven cases carci¬ 
noma was the complication that called for the opera¬ 
tion. Some, such as Olshausen, have a horror o the 
operation because they believe that speedy delivery 
at term is incompatible with gentle handling, and 
that gentleman recommended the classical Caesarean 
section with subsequent removal of the organ. But 
Olshausen’s operation is a much longer one, there 
is more danger of shock and infection, and more 
manipulation of intestines. As regards haemorrhage 
it is free in both forms of operation, but in the 
vaginal it ceases as soon as the hand is introduced. 
Drawing down of the uterus and plugging are 
effective means of arresting haemorrhage. The 
operation is also indicated when there is premature 
separation of the placenta with absence of pains, and 
when the cervix is not dilatable. 


(a) Abstract of an address delivered before the Berlin Medical 
Sect tty, January 4th, 1899. 


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Diqitizec 



188 Thk Medical Phess. TRANSACTIONS OF SOCIETIES. Feb. 22, 1899. 


(Clinical ^Rctorbs. 


CASE OF ECTOPIC GESTATION, (a) 

By Dr. Macpherhon Laubie, 

Vice-Pre»ident of the British Gynaecological Society. 

Mbs. W., set. 35, consulted me on September 16th, 
1898, on account of pain in the right ovarian region 
associated with a swelling which she had recognised 
hereelf. , 

She had been married for nine years and had three 
children, the youngest 4J years old. 

The periods had been regular since the birth of the 
last child until six weeks before she came to see me; 
since then she had suffered from a constant haemorrhagic 
discharge. This was moderate in amount, and latterly 
partly purulent. 

On one occasion something came away having the 
appearance of a large clot of blood, rather dark in 
colour, and presumably composed of decidual membrane. 

On examination the uterus was found somewhat 
enlarged and pushed over to the left by an irregular 
swelling of firm consistency, and rather bigger than an 
orange. 

On September 25th, the abdomen was opened. The 
right side of the pelvis was occupied by a swelling which 
was intimately adherent to the intestines. In the pro¬ 
cess of separation the mass ruptured, discharging a 
great deal of black clot into the peritoneal cavity. 

The abdominal viscera were protected with sponges, 
the patient raised into the Trendelenburg position, 
and the clot removed. Separation was cautiously 
carried out, and completed by passing chain sutures 
through the broad ligament and cutting through the 
tissues on the distal side. On further examination, a 
cavity as large as a hen's egg, and containing blood clot 
was demonstrated in the ovarian portion of the swelling, 
and the walls of this space were completed by the expanded 
end of the Fallopian tube and some portions of adjacent 
bowel. 

Patient made a good recovery. 

A report from the Clinical Research Association con¬ 
firmed the diagnosis. 

The case seems worthy of record as a possible example 
of ovarian pregnancy, and I thought it sufficiently 
interesting to bring before the Society. 


transactions of Societies. 

ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Pathology. 

Meeting held Fbidat, Januaby 13th, 1899. 

The President, Dr. J. M. Purser, in the Chair. 


PATHOLOGICAL FEMORA AND TIBIJE. 

Dr. Knott exhibited a series of nineteen femora pre 
senting various anatomical, anthropological, and patho¬ 
logical peculiarity s of interest, and Dr. Knott then 
exhibited a series of nineteen tibiae, also presenting 
points of interest. 

Specimens Exhibited. 

Mr. H. Croly : (a) Tumour of the Left Ovary; (6) 
Specific Fungus of the Testis; (c) Carious Os Calcis; 
(d) Scirrhus of Breast of eighteen years’ standing. 
note on the agolutinability of different races 

OF THE TYPHOID BACILLUS. 

The Secretary (Dr. McWeeney) read a note on 
this subject. He described how he had been obliged 
1o suspend temporarily the sero-diagnostic work 
at the Mater Misericordiaee Hospital, owing to 
the peculiar liehaviour of a strain of typhoid bacilli, 
called, for brevity's sake, T. A, which he had 
isolated by the usual methods from the bile of a 
fatal case of typhoid. Death had occurred in this case 


(a) Bead before the British Gyntecolog-ical Society at meeting 
held February 9th, 1899. 


from cardiac failure nine days after defervescence, and 
at the autopsy the ulcers in the small intestioe were 
healed, but there were many open follicular ulcers in the 
colon. The bacillus T. A. was present in the bile in 
great numbers and pure culture. It presented the cul¬ 
tural characters of genuine Eberth’s bacillus. Distinc¬ 
tive peculiarities were the extreme slowness of its growth 
on gelatine plates, the fewness, delicacy, and shortness 
of the flagella, and the fact that although the mobility 
was extremely active during the first twelve hours of 
culture, it had died down by the end of twenty-four 
hours to a waggling movement hardly distinguishable 
from that of B. coli. Tested against the serum of several 
typical cases of typhoid side by side with a typical 
race obtained from Professor Lorrain Smith, of Belfas*, 
it proved markedly resistant against agglutinating 
influences. The dilutions generally practised were 10 
per cent., 1 per cent., ‘2 per cent., and 1 per cent. Sera 
of cases in the third week, which clumped the Belfast 
bacillus (“L.S.”) instantaneously in 10 per cent, dilution, 
and left the field quite clear of isolated organisms, took 
an appreciable time to clump T. A., and after the lapse of 
half an hour the field was not quite free from scattered 
bacilli. In the 1 in 100 dilution, where L. 8. was well 
clumped at the end of the observation period (two to- 
five hours), T. A. was so imperfectly agglutinated that 
diagnostic inferences could not be drawn—in fact, with 
the higher dilutions these two races of undoubted 
typhoid bacilli gave directly opposite sero-diagnostic 
results. The speaker referred to the view that the 
phenomenon was the result of the interaction of two- 
substances, one contained in the serum, the other in (and 
subsequently outside of) the bacterial bodies, which 
played a purely passive role ; that the serum need not 
necessarily bo immune, nor was the phenomenon essen¬ 
tially specific ; and finally, the interesting work of Bordet 
was described as showing how, quite apart from bacterial 
action, the serum of the rabbit agglutinated guinea pig's 
serum containing red corpuscles, causing these latter to- 
form “ clumps; ’ and how, if the serum of the guinea* 
pig, which exercises but a slight agglutinative action on 
the corpuscles in rabbit serum, be taken from a guinea 
pig which has previously had rabbit’s blood injected a 
few times, the agglutinative action of the guinea pig 
serum is greatly increased. The bearing of these- 
researches on sero-diagnostic work was pointed out. 
The paper was illustrated with slides showing the 
relative size, length, and number of the flagella of T. A. 
and L. S. 

Mr. O'Sullivan said that in a case of Dr. Finny’s, in 
Dun’s Hospital, of typhoid fever, accompanied by effusion 
into the knee-joint, he had isolated bacilli from the 
effusion which gave the culture reactions, as then prac¬ 
tised, of typhoid bacilli, and showed stronger agglutina¬ 
tion with the serum of typhoid patients than the stock 
bacilli which he had at the time. He thought then that 
this might be due to the fact that the bacilli were more 
virulent, but it appeared tha+ virulence and the faculty 
of being agglutinated had no relation to one another. He 
would like to ask Dr. McWeeney whether, in Krau’a 
experiment, the behaviour of the talc had been examined 
under the microscope and proved to be a true agglutina¬ 
tion and what was known as to the nature of the coagula¬ 
tion of which he had spoken ? 

Dr. E. J. McWeeney, replying, said that the pheno¬ 
menon which occurred was one of agglutination and not 
precipitation. 

A CA8E OF PERITONEAL TUMOUR. 

Dr. Conolly Norman described and exhibited a case of 
peritoneal tumour. The growth occurred about the junc¬ 
tion of the jejunum and ileum, and appeared to spring 
from the peritoneum covering the anterior wall of the 
intestine; it was of oval shape, about the size of a goose 
egg, and in colour and consistence, both externally and 
on section, strongly resembling an uterine fibroid. The 
growth had penetrated the intestine, an irregular 
ulcerated surface, not fungating, and about the size of a 
sixpence, ehowing in the gut. The patient died from 
repeated haemorrhages from this point. No other new 
growths were discovered, and the uterus and ovaries 
appeared perfectly normal. 1 he tumour was described 
as consisting of an aggregation of ovoid and ppindle- 


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Feb 22. 1899. 


FRANCE. 


The Medical Press. 189 


shaped cells, the former having large granular bluntly 
ovate nuclei, the latter passing into fibrous tissue in 
parts. The vessels were very numerous, so that here 
and there the structure resembled that of an angioma. 
The tumour could not be made out to be continuous 
with the muscular wall of the intestine, which it seemed to 
have des'royed by mere pressure, and, in the opinion of 
the exhibitor, was to be regarded as a sarcoma, arising 
probably from the peritoneal blood-vessels. 

Dr. McWeene? suggested the possibility of the tumour 
being myomatous. 

Dr. E. Travers Smith thought the specimen was a 
spindle-celled sarcoma, th-ugh possibly it might be a 
myoma, and have originally grown in the uterus, and 
become separated, and become secondarily adherent to 
the intestine. 

Dr. E. J. McWeeney pointed to certain appearances 
suggesting that the growth was a fibro-myoma. 

Dr. A. K Parsons agreed that the tumour might be a 
myoma. 

Dr. Conolly Norman, in reply to the President, said 
that the tumour was not adherent to the mu-cular coat 
of the intestine. In the central portion of the tumour 
there was a large number of bluntly-pointed ovoid cells 
such as one sees in an ordinary quick growing sarcoma. 

Dr. Coleman showed aspecimen of (a) Glioma of Cere¬ 
bral Hemisphere; (b) Tuberculous Tumour of Cerebellum ; 
{c) Abscess of Cerebellum. 


Jnutcc. 


[from oor own correspondent.] 

Paeis, February 19th, 1899. 

The Treatment of Ubjemia by Injections of 8bbcm 
in the Renal Vein. 

At the last meeting of the Lyons Medical Society M. 
de Lignerolles gave an interesting account of his treat¬ 
ment of uraemia by injections of serum int> the renal 
veins. The kidney, he said, possesses an inter nal secre¬ 
tion which it pours into the organism bv means of its 
efferent vessel. The importance of the antitoxic role of 
that secretion against hurtful substances that the kidney 
could not eliminate had been demonstrated by numerous 
experiments and by clinical facts. To remedy that renal 
insufficiency Brown-S^quard, Meyer, Ajello, and Paras- 
candalo injected in animals deprived of their renal organs 
the diluted juice of kidney extract; they obtained in 
uraemic troubles very favourable results, which confirmed 
the clinical observations of Dieulafoy, Teissier, Donovan, 
and others. But“ would it not be better,” asked Brown- 
Sequard, “ to employ the venous blood of different parts 
of the organism than the extracted juice of these parts. 
The venous blood coming from an organ contains, in 
fact, the principles of the internal secretion special to 
that organ.” 

This conception, which had already guided Meyer in 
his experiments on the .periodic respiration of Cheyne- 
Stokes, had been realised by Prof. Vitzou, of Bucharest. 
The remarkable cases of prolonging life which he 
obtained in animals, from which the kidneys had been 
removed by injections of defibrinated renal venous 
blood, encouraged Dr. Turbure to treat in the same way 
patients suffering from uraemia. Under the inspiration 
of Prof. Teissier, the speaker made a special experimental 
study of the treatment at the hospital. 

The blood of the renal vein of a young and healthy 
goat was drawn under perfectly aseptic conditions, and i 
its serum decanted into small six drachms bottles. The 
toxic properties of the serum were insignificant, espe¬ 
cially when the liquid was injected into the subcutaneous 
cellular tissue. 


The cases he presented to the Society were not 
numerous on account of want of time, but such as they 
were they merited attention, not only on account of the 
nove ty of the method but also, and what was more 
important, by the constancy of the results obtained* 
The first case was that of acute nephritis complicated 
with uraemia. The patient, a boy of 15, entered the 
hospital suffering from anasarca, the result of scarlatina* 
The urine contained a large quantity of albumine, 
leucocytes, and cylinders. Vomiting was persistent. 
The symptoms became so grave that an injection of six 
drachms of the serum was made in the right flank. The 
following morning the improvement was considerable * 
the violent headache had subsided as well as the vomit¬ 
ing, and four days afterwards the oedema had disap¬ 
peared, while the urine, rare before the injection, returned 
with great abundance. All trace of the albumen had 
disappeared at the end of a fortnight, and the patient 
rapidly gained strength. Another case was that of a 
woman, set. 69, who entered the hospital with signs of 
chronic nephritis (bruit de galop (heart), a large quan¬ 
tity of albumen in the urine, diminished renal perme¬ 
ability). An injection of the serum of the renal vein 
produced a very notable improvement in all the sym¬ 
ptoms, and in the general condition of the patient. Here 
also the albumen disappeared. 

The details of the following case were furnished to the 
speaker by Prof. Turbure, of Bucharest. 

Nicholas V., tet. 27, entered the hospital with gene 
ralised anasarca; the legs were swollen to the abdomer 
and the patient complained of frequent micturition* 
thirst, headache, pains in the back, and tingling sensa¬ 
tion in the fingers. The lungs, heart, and liver appeared 
sound. The urine contained albumen, and was very 
abundant (5 litres). In a few days these symptoms grew 
much woree, the headache became excessively violent, 
dyspncea set in, and finally he was s ized with tonic con¬ 
vulsions, in spite of the application of repeated wet cup¬ 
ping. The quantity nor the quality of the urine could 
not explain these phenomena, what was wanting was the 
internal secretion of the kidneys, whose office was to 
neutralise the toxins accumulated in the organism 
This point was remedied by injecting under the skin of 
the patient three drachms of defibrinated renal venous 
blood drawn from a strong and healthy dog. A few hours 
later the patient became calm, and asserted that he felt 
much better. Four days afterwards the headache re¬ 
turned, but yielded to another injection, and the 
urine diminished by a third. A few days after¬ 
wards the patient insisted on having another injection, 
and in all six were given with constantly improving 
results, so that at the end of six weeks he left the hospital 
cured. 

In summarising the effects of the treatment, M. Lig¬ 
nerolles said that the effects of injections of six drachms 
showed themselves in general a few hours after the 
injection. The violent headache was the first to dis' 
appear, while the nervous troubles, prostration, weakness, 
melancholy, delirium, gave place rapidly to gaiety some¬ 
times exuberant the vomiting ceased after one injec¬ 
tion, and the oppression or dyspncea was eased in a very 
short time while the urine, rare before the injection, became 
very abundant under its influence, with consequent 
removal of the oedema. 

From all these facts he would conclude that injections 
of the serum of the renal vein could be employed with 


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190 The Medical Press. 


GERMANY. 


Feb. 22, 1899. 


success against the uremic oomplications of nephritis, and 
could contribute to the improvement of these maladies, 
as he had several times observed. They furnished to the 
organism the internal socretion wanting, and allowed- 
the kidney to recommence its normal function of excre 
tion and its anti-toxic role. 


(Herman!?. 

[from our own correspondent.] 

Berlin, February 18th, 18W. 

At the Society for Innere Medizin Hr. Bendix showed 
a case of 

Recurring Ertbipelas. 

Two months before, the patient had been admitted 
into v. Leyden’s klinik for erysipelas of the face, hairy 
scalp, neck, and upper part of the trunk. This was the 
tenth attack of erysipelas that the patient had suffered 
from. After the fifth attack the face, but especially the 
upper lip and the chin remained swollen. The skin was 
not affected by inflammatory changes, its colour was 
normal, was firm to the touch, and left no pitting on 
pressure. As a result of the erysipelas a pachydermatic 
process had taken place in the shape of a chronic lym¬ 
phatic oedema that had become organised. Therapeuti¬ 
cally, it was probable that systematic massage would 
be tried. 

Hr. Jastrowitz said it was a curious fact that some 
people had a tendency to erysipelas, as all recurring 
cases showed. In earlier cases it was believed that there 
was a connection between the erysipelas and li\er 
affections. 

Hr. Ohrtmann some years ago had seen two cases that 
were treated with Fowler's solution, and after this they 
had no return of the disease. 

Hr. A. Fraenkel believed that individuals specially 
disposed to erysipelas harboured virulent streptococci in 
their nasal cavities for a long time, just as individuals 
with a tendency to pneumonia harboured virulent pneu¬ 
mococci in the cavity of the mouth. 

Hr. Bernhardt had some time before published the 
history of a similar case. With this lady after any 
great excitement erysipelss of the face came on, although 
without any new infection. Thus on one occasion when 
some curtains took fire at home she was frightened, and 
in an hour the erysipelas was there Her case was often 
demonstrated, and every time she became excited and got 
erysipelas. In such cases there were exaggerated ex¬ 
citability from vasomotor system without infection. 

Hr. Ohrtmann had frequently had to treat a well- 
known deputy for erysipelas that affected the whole of 
the head and always lasted tome weeks. The attacks 
always came on when in the course of his public life he 
underwent any great excitement. 

Hr. Gluck believed that in cases of recurring erysi¬ 
pelas depots of streptococci remained in the lymph track. 
In cases in which streptococcic collection had been 
removed after suppuration there had been no recurrence 

At the Society for Psychiatry and Nervous Diseases, 
Hr. Valentin related a case of 

Pachymeningitis with Tabes on a Syphilitic Base. 

The patient was a merchant, set. 46, who in 1870 had a 
hard chancre, and was only treated locally. In 1889 he 
had gastric crises and lost flesh. He underwent various 
courses of treatment without effect. In 1892 Remak 


diagnosed incipient tabes ; in 1894 the patient got worse. 
Along with other symptoms there was giddiness and 
diplopia. In 1897 there was paralysis of all four extremi¬ 
ties. There was violent pain in the neck. The patient 
was admitted into the Nerve Klinik of the Charite. He 
was a big, strong man. There was pressure pain over 
the whole length of the 6pine. The movements in the 
knees, feet, and toes were only very slight. With the 
eyes closed there was ataxia. Patellar reflex on one side 
present, on the other exaggerated. The head only 
slightly movable. He could swallow, Bpeak, and move 
the tongue, the sensorium was free. The pupils were 
unequal, not acting to light; but reacted to 
accommodation. There were disturbance of feeling 
and sensibility. Strong Faradic currents were not per¬ 
ceived in the arms. With inunction of potassie iodide 
the movements improved. Later the patellar reflexes 
disappeared, and the patient died of decubitus, cystitis* 
&c. On section macroscopic syphilitic changes were 
found in the liver and heart. In the upper part of the 
cord the meninges were adherent, and there was sclerosis 
of the lateral columns. Below this the changes were not 
so marked. Both grey and white substance was diseased 
in the dorsal spine. The syphilitic disease was very 
evident in the arteries. 

At the Medical Society Hr. Plonski showed 
A Case of Change in the Skin Produced by 
Rontgen Rays. 

The case differed from those previously shown by him, 
inasmuch as the time that had elapsed was longer, Two 
and a half years ago the patient was a stenographer in 
a large electro-technical institution, and volunteered to 
submit to experiment with the radiograph. At first no 
harm was done, but at last inflammation of the skin 
took place, partly of a malignant character. After the 
parts had healed further changes took place in the cica¬ 
trices. Innumerable new growths of vessels were seen 
around the white cicatrices, so that the whole back, for a 
Bpace of two hand-breadths in width looked like a large 
red patch not unlike teleangiectasis. There was a 
similar appearance on the hands. Associated with this 
were subjective disturbances, intense itching from 1896 
increased from year to year, on the hands a feeling of 
coldness, and they became more easily tired than before. 
Sensibility was slightly diminished. Therapeutically 
the speaker would probably reduce the vascularity by 
electrolysis, and recommend massage and hot bathing. 
To avoid such changes, the tension of the current should 
not be too high, the time exposure should not be too 
great, and the parts should not be brought too close to 
the Crooke's tubes. 

At the Dermatological Society Hr. Joseph read a note 
on 

Cheloid 

Whilst Kaposi made a distinction between true and false 
cheloid Unna saw in every one a cicatrical cheloid, and 
in the absence of visible injury, assumed an unimportant 
one (scratch wound). The speaker extirpated one that 
had arisen in a cicatrix where union had taken place 
by first intention. There was no recurrence. On 
section of the tumour in series there were no foreign 
bodies. It showed peculiar septs. It appeared as if 
the cells of the tumour lay around lymph vessels, 
and the sept formation was caused by their crowd¬ 
ing around the lymph tracts. The lymph vessels 
themselves were often destroyed. It was possible that & 


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Ffb. 22, 1899. _ A DST 

portion of the cells had wandered out of the smallest 
blood-vessels, and by their growth had given origin to 
the tumours. Plasma cells, and elastic fibreB were pre¬ 
sent in true cheloid, but not in cicatricial cheloid. The 
elastic fibres of the tissues pressed npon by the cheloid 
were destroyed, either by pressure or by a chemical pro¬ 
cess. Elacine was not present; but it appeared as if the 
collageni basic substance underwent hyaline degenera¬ 
tion. In a case of cicatricial cheloid there were no 
tumour cells two years after removal. Papillary bodies 
were absent in all cicatricial cheloids and hyperplastic 
cicatrices. True cheloid, on the other hand (Joseph’s 
case sprang from the skin over the breastbone), showed 
a well-developed papillary body. The tumour consisted 
of spindle-celled fibres. There was no recurrence. 

A large number of preparations were shown. 

Hr. Lesser had met with a similar condition of things 
in a case of acne cheloid in a negro. In spite of extirpa¬ 
tion through healthy tissues, and covering the defect by 
a flap, the disease had returned. 


Austria. 

[from our own correspondent.] 

Vienna. February 18th. 1899. 

Htdrocele and Eversion of the Tunica Vaginalis. 

In November of 1895 Prof. Doyen published a paper on 
the Radical Cure of Hydrocele by Everting the Tunica 
Vaginalis. This operation, he tells us in that paper, had 
engaged his close attention since 1890, when he firet per¬ 
formed it in a case of obstinate, constantly recurring hydro¬ 
cele, which proved a success, and induced him to practise 
it in other cases, which he did for five years. The radical 
principle of the operation is to destroy the cavity of the 
tunica vaginalis by removing the posterior sheath of the 
vaginal covering instead of the outer fold. In order to 
do this the operation is performed by entering the tunica 
along the seminal ducts posteriorly, as described by 
Doyen, as follows : — 

First Stage.— An incision about an inch long 
(3 cm.) in the upper and anterior half of the 
scrotum. With a blunt sound the edges of the wound 
are separated, allowing the tunica vaginalis to protrude 
in the form of a hernia from the wound. 

Second Stage.—Puncture and eversion of the tunica 
vaginalis : With a bistoury the tunica is punctured and 
the fluid drained off. The puncture is next enlarged 
with a pair of scissois towards the duct to the extent of 
an inch, through which opening ihe testicle is pressed 
out and with the point of the finger passed along the 
seminal duct. He separates the tunica and returns the 
testicle. In some cases Juvara, who has recently per¬ 
formed many of these operations, tells us that the wound 
of the tunica vaginalis can be too large to allow of return, 
in which case he applies a stitch. 

Third Stage —The wound is now closed with catgut 
suture and compressirn applied, or dressed with iodo- 
foim and collodion and enveloped tightly in a cotton 
wool suspensor. In two or three days the patient may 
leave bed and in seven or eight the wouLd is quite 
healed. 

Juvara performs the operation sometimes under general 
anaesthetic and sometimes with only local antesthesia. 

In cases of very large hydroceles simple eversion and j 
twisting is not enough, as the large tunica is cumbrous 


^ 1 A ■ _ The Medical Press . 191 

and must be resected, leaving the portion around the 
cord. 

This operation has many advantages over the older 
forms of treatment, and can be easily performed by any 
surgeon, and may be accomplished in three or five 
minutes. The simple operation of injecting iodine tinc¬ 
ture takes longer time without the security of success. 

In the eversion method all those grave complications are 
avoided which attend the tincture injection, as complica¬ 
tions in the former seldom ever arise, even in total 
resection; in the latter a hsematoma may take place, 
but in simple eversion, without resection, no hsematoma 
can occur as no vessels are cut. 

Hyddrops Genus Intermittens. 

At the Medical Club, Bum showed a patient, a mer¬ 
chant, set. 37, who, seven j ears ago. suffered from neu¬ 
rasthenia, pains in back, &c. A few months ago a 
cyclical form of dropsy commenced in the right knee. 
The swelling has no pain ; increases for three days, and 
then gradually declines in the same time. No other 
morbid condition can be discovered. No medicaments 
for neurasthenia have any effect in checking or modifying 
the repetition. He collated similar cases from the lite¬ 
rature of Seeligmuller, who is inclined to classify such 
cases under the head of Vasomotor Neurosis, although 
the astiology of the disease must yet be acknowledged 
as obscure. Heredity, according to some French authors, 
is not without its influence. 

Schliesinger told the meeting that he had another 
similar case under observation, who for the last six years 
has had periods of suffering regularly every two years 
Attacks of three days’ duration with remissions of ten 
days occurred during the months of November and March. 
At the onset of the disease strangury is persistent, causing 
the patient to urinate every few minutes. The quantity of 
urine passed in twenty-four hours is great, although 
very little is passed at a time. During the attacking 
months, November to March, the upper extremities 
become astonishingly emaciated, but rapidly recover 
after the attacks have ceased to recur. This patient is 
not neurasthenic. He says he has been able to keep 
the attacks off since he has become a vegetarian ! 


Continental gcalth Resorts. 


[From Our Special Correspondent ] 


MONT-DORE. — (Pu y-de-Dome). 

The number of British invalids seeking the health 
resorts of Central France has for several years been 
gradually decreasing; but for Mont-Dore at least (judging 
from the past autumn) the tide is apparently turning, and 
this station of ancient celebrity promises to be more than 
ever popular with our countrymen. 

It is easy of access from Paris (by either the Paris, 
Lyon-Mediteranean, or the Orleans railroads) and now 
the branch railway from Laqueuille to La Bourboule and 
Mont-Dore dispenses with the one and a half hours' 
carriage-drive, often objected to as a tedious termination 
of a long journey from Calais or Boulogne. Some, how¬ 
ever, may be old-fashioned enough to regret the 
“ improvement.” For that drive was one of beauty ; 
winding up and down along wooded slopes with glimpses 
of lovely landscapes, and occasionally, bits of grander 
scenery. 


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192 The Medical Press. 


THE OPERATING THEATRES. 


Ffb. 22, 1899. 


Nowadays we talk much of altitudes when comparing 
health stations. Mont-Dore is the most elevated thermal 
resort in central France, being 3,418 feet above sea level, 
almost approaching the Alpine zones. Around the 
narrow valley in which the town lies rise the highest 
summits of Auvergne—the Puys Gro3 and Angle, and 
the Pico Sancy, and Capucin. The Sancy peak has an 
altitude of 6,190 feet. 

A multitude of picturesque spots are in the immediate 
neighbourhood. The readily accessible Capucin heights, 
the Gorges d’Enfer, Lake Guery, Chambon, and Pavia, 
the cascades of the Dore, and the Dogne streams at the 
foot of Mount Sancy, and those of Queureilh, Eossignolet, 
Saut-du-Loup, Plat-a-Barbe, Verniere, Serpent, &c 
There need be no idle days at Mont-Dore for visitors 
who love Nature in any - of “ her * arious moods ”; for 
those who like leaf, flower, or insect-gathering, geo¬ 
logical iaunts, archaeological trips, sketching, or photo 
graphing. And for the less active and more lazy during 
the months of t-.e “high season” (July to September), 
are the Casino, theatres, caf^s, ball-rooms, reading-rooms, 
and other town amusements, with abundance of 
fashionable attire, promenading, seeing and being seen. 
Pleasure-taking, hobby-riding, and health-seeking can 
go all summer and autumn hand-in hand continually in 
“ old Auvergne! 

Mont-Dore, said one American physician, ‘ is popular 
with priests, clergymen, actors, and artists.” To pass 
part of an August afternoon in the really artistic halls 
galleries, and salons of its Thermal Establishment is to 
recognise fully that Mont-Dore is then equally thronged 
with all other “ sorts and conditions of men, ’ and more 
than equally thronged with the priestesses and devotees 
of fashion and elegance “ flitting gaily around, drioking 
gargling, or sipping the waters” in the intervals of 
healthful strolls and lively gossipings. Those who prefer 
the greater quietude should come before July 14th, or 
after August. 

The mean average temperature of summer does not 
exceed 54° Fahr. The average of the barometer (during 
the Thermal season) is only 26^j ins.; on the coast it is 
29-fc ; thus showing considerably less weight of 
atmosphere at Mont-Dore than at the sea-side. 

The averag- temperature in June, July, and August is 
61 Fahr. Evenings ani mornings the air is usually 
f re3h; only becoming heated about mid-day, when 
generally are breeze* from the hills and valley* prevent¬ 
ing disagreeableness. Occasional storms are of short 
duration, and cause no inconvenience, simply lowering 
the temperature for a time. The pointed mountain 
peaks guard the valley from electrical disturbances. 

The winter climate of Mont-Dore is cold; the summer 
climate temperate and strengthening; the Bath esta¬ 
blishment is one of the finest in France; and is com¬ 
pletely equipped with a'l modern appliances foi the most 
efficient uses and applications of the mineral wat-rs. It 
consists of t wo separate bui dings, connected by a covered 
bridge. One building is for vapour treatment, with 
rooms for inhalations and pulverisation for men. The 
other building (recently rebuilt at a cost of .£120,000) 
contains the baths. It is erected over the springs, and 
has many galleries for baths, douches, inhalations, pul¬ 
verisations, nasal-douches, foot-baths, and two hydro¬ 
pathic apartments. Two staircases, on the right and 
left, ascend to the first storey, leading into a very large 
hall, with a roof supported by eight great columns of 


polished Vosges granite; each column, cut from a single 
block, being 27 feet in height. A main gallery leads 
from this grand central hall to the various baths and to 
the celebrated “ Cesar Spring.” Built into the walls and 
foundations of the establishment are numerous remains 
of ant que baths, temples, mansions, sepulchral-stones* 
parts of statues cut from porphyritic lava, and other 
vestiges provine the great use of these springs in Roman 
and even pre-historic ages. The primitive piscines of 
the Gauls are yet visible, and tide by side with them 
portions of the extensive Roman Baths. During the 
Middle Age* the springs were apparently neglected; to 
be brought again into popular use in 1605. The pros¬ 
perity of the present station dates from the days of Dr. 
Michel Bertrand (1810). 


^hc ©pcrating theatres. 

ST. THOMAS'S HOSPITAL 
Operation for Elfphantiasis of Scrotvm and Penis 
—Mr Battle operated on a man, tet. about 45, a seaman, 
who had been sent to the hospital from the South Coast 
suffering from swelling of the penis and scrotum. 
Although he had b en abroad he had never been in the 
tropics, his longest voyage having been only to Ham¬ 
burg. He had noticed gradual swelling of the penis and 
scrotum, which had been coming on painlessly for a 
period of some months ; it had become so large that it 
interfered considerably with his getting about, and the 
scrotum and skin of the penis were much enlarged, the skin 
of the scrotum being such as described in accounts of 
elephantiasis met with in foreign parts; it was very 
heavy, and easily indented with the fingers The penis 
resembled more the condition of the penis as seen in 
chronic dropsy, the skin being but little affected. There 
were, however, no signs of dropsy in other parts of the 
body, nor of any disease to account for it. At the opera¬ 
tion a greatly elongated prepuce was slit up along the 
upper surface and the glans exposed. The skin, which 
was diseased, and the subcutaneous tissue were then re¬ 
moved. There w?s not much bleeding An elastic band 
was then passed round the base of the scrotum. Two 
flaps were then fashioned, one from each side of 
the scrotum, from the tissues which had been 
dragged down by the weight of the part and which 
as yet presented no change. Numerous vessels required 
ligature when these incisions were made. The testes 
were tlaen sought for and isolated from the other tissues 
after which th? remainder of the scrotum was cut off well 
above the diseased portion. During the operation there 
was a great escape from the cut tissues of watery fluid* 
so that the weight of the tumour was much reduced 
before it was finally removed. The t wo flaps were then 
united in the middle line forming abundant covering 
for the teste* ; no attempt was made to bring 
a covering over the denuded penis. The usunl 
dressings were applied. Mr. Battle said that during 
the patient’s stay in the hospital before opera¬ 
tion the blood had been frequently examined 
for the filaria sanguinis, but none were found, and, 
although the case was evidently one of elephantiasis, 
there wa3 no excessive enlargement such a9 might be 
seen in several recorded cases. The case was interesting 
from the absence of anything like a chance of catching 


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LEADING ARTICLES 


The Medical Press. 193 


the filariaby visit to the regions where it is known. The 
hemorrhage would have been very severe had it not 
been for the use of the Esmarch's band. 

The patient made a satisfactory recovery, the penis 
granulating over and becomiog covered with soft 
cicatrix. 


Vital Statistics. 

The deaths registered last week in thirty-three great 
towns of England and Wales corresponded to an annual 
rate of 219 per 1,000 of their aggregate population, 
which is estimated at 11,404,418 persons in the middle 
of the year 1899. 

Birkenhead 21, Birmingham 22, Blackburn 16, Bolton 
24, Bradford 17, Brighton 14, Bristol 21, Burnley 11, 
Cardiff 16, Croydon 15, Derby 20, Dublin 31, Edin¬ 
burgh 27, Glasgow 35, Gateshead 18, Halifax 20, Hud¬ 
dersfield 16, Hull 16, Leeds 20, Leicester 16, Liverpool 30, 
London 22, Manchester 25, Newcastle-on-Tyne 19, Nor¬ 
wich 15, Nottingham 24, Oldham 25, Plymouth 20, 
Portsmouth 20, Preston 32, Salford 22, Sheffield 19, 
Sunderland 27, Swansea 22, West Ham 16, Wolver¬ 
hampton 20. The highest annual death-rates per 
l,00j living, as measured by last week’s mortality, 
were .- —From measles, 10 in West Ham, P6 in Manches¬ 
ter, and 19 in Bolton; from scarlet fevei l’l in Sun¬ 
derland; from whooping-cough, P5 in Bristol, l - 8 in 
Sundrland, and 2 5 in Cardiff; and from “fever,” 27 in 
Preston. In none of the large towns did the death- 
rate from diarrhoea reach PO per 1,000. The 118 
deaths from diphtheria included 49 in London, 10 in 
Leeds, 8 in West Ham, 7 in Sheffield, 6 in Birmingham, 
6 in Liverpool, 4 in Edinburgh, 4 in Leicester, and 3 
each in Glasgow, Cardiff, Swansea, and Manchester. 
No death from small-pox was registered in any part of 
the United Kingdom. 


extol the virtues and maintain the verdure of the 
memory of John Hunter. Possibly, therefore, no 
pioneer of medical science, not excepting the 
immortal Harvey, has been made the object of so 
much adoration on the part of a grateful posterity. 
As a matter of fact, an oration upon John Hunter 
has been delivered upon fifty-nine occasions, and 
among the orators are included m st of those whose 
names are indissolubly associated with the progress 
of surgery in this country. But no one can dispute 
the worthiness of the panegyrics which have been 
bestowed upon Hunter—for anything Hunterian is 
naturally endowed with an interest which time can 
never diminish. Reflect, for a moment, upon his 
remarkable personality. There was nothing common¬ 
place about him ; his habits, modes of thought, enter¬ 
prises, indomitable energy—everything was original. 
His life was one unresting, ceaseless exercise of mind 
and body. The few hours which he is Baid to 
have allowed himself for sleep at nights seemed to 
have been begrudged by him, and at the zenith of his 
work were probably often interrupted by sudden 
flashes of thought bringing in their train suggestive 
and attractive problems. In these days it is almost 
impossible to conceive of a man of Hunter’s energy 
and indomitablcne8s. The conditions, indeed, of 
present day life are probably entirely unsuited to 
the existence which he adopted; moreover, Hunter 
lived at a time when the field of human knowledge 
was vastly limited in comparison with that which is 
now the case. He appeared on the Beene when, so to 
speak, an unexplored country of virgin land lay open 
before him, and, as a pioneer, imbued with confidence 
in his own capacity, he set himself the task of tilling 
it, and o r proving the value of the crops which it 
could produce. It is doubtful whether any man, in 
the world’s history, has, in his lifetime, added so 
much to the sum of human knowledge as did 
John Hunter. There is, then, nothing surprising in 
the fact that successive Hunterian orators should 
find that the record of his wonderful life will bear 
the retelling without losing in interest or attractive¬ 
ness. The oration delivered before the Prince of 
Wales at the College last week by Sir William 
MacCormac is an instance in point. A tone of 
sympathetic admiration pervades it throughout, and 
mingled with the many instances of stupendous 
investigations which Hunter undertook are subtle 
reflections upon his many sided character which 
throw further light upon the genius which Hunter 
was. In alluding to the portrait of the great surgeon 
by Sir JoBhua Reynolds, which adorns the theatre of 
the College, the orator said as follows:—“As we look 
at the picture, painted in 1785, when Hunter was 
fifty-seven years old, we perceive him in deep 
reverie in one of those waking dreams to 
which he refers in his lectures. He has paused 
from writing in order to think out some problem, 
and as he often said, it was a delight to him 
to think. As we dwell upon his features, we 
cannot doubt that a sudden inspiration has flushed 
upon and gradually pervaded his mind, some great 


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‘Che Jftebtcal gress anb Circular. 


“ 8ALD8 POPDLI SUPREMA LEX.” 


WEDNESDAY, FEBRUARY 22, 1899. 


THE HUNTERIAN ORATION. 

From the year 1814, almost annually till 1855, and 
since then biennially, an orator has been appointed 
by the Council of the Boyal College of Surgeons to 


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194 Twn Medical Press. _ LEADING ARTICLES. _ Fkb. 22, 1899. 

scientific truth or generalisation which he has grasped not, they drift to a certain death, at the same time 
and is pondering with intense satisfaction. Those distributing out the germs of infection to all around 
eyes, full of the keenest intelligence, seem in eager who are susceptible to the disease. We are glad to know 
quest of something far beyond the visible tokens of that the guardians of the poor of Liverpool are to 
his work. We may imagine Hunter trying, per- hold a conference with the view to providing such a 
chance, to solve 6ome hidden mystery of life or seek" sanatorium for the tuberculous poor, and this is a 
ing to pierce the veil which hides from us the great decidedly progressive step, and one that can be 
unknown beyond.” This fine tribute to the great emulated by every Poor-law authority in the country, 
surgeon, as well as to the great painter who repro- The Committee also recommend that wards should be 
duced his features, will alone make the Hunterian set apart in every hospital for tuberculous cases, 
oration of Sir William MacCormac memorable. Last thus reducing the risk of infection to other patients 
Tuesday week was by no means the first time to a minimum. With regard to the notification 
that the Prince of Wales listened to an Hunterian of phthisis, the Committee do not recommend 
oration, but we can conceive that His Royal Highness such a step at present, although there are many 
could not fail to have been interested in the record o^ reasons in favour of such a proceeding. Consump- 
Hunter’s life which Sir William placed before him. tion being an infective disease, clearly ought to be 
. 9 treated as other such diseases, and we have no doubt 

when the mind of the public is thoroughly educated 
THE TUBERCULOSIS CRUSADE ^ ^he su bject notification will follow as a natural 

The public interest in the subject of tuberculosis Beq uence. Another important point is the disinfec- 
has at last, we are thankful to say, been fully roused, tion of bouses in which tuberculous patients have 
with the gratifying result that endeavours are being n ye( } an d died. This is most essential and we are 
made in every quarter to do something to abate this g i a d to see that the Medical Officer of Health has 
terrible scourge. A few weeks ago the Medical consented to carry out all such disinfection of cloth- 
institution, which fully represents the medical pro- { ng and houses free of cost. Altogether the report 
fession in Liverpool, had an interesting discussion on j 8 carefully drawn and reflects credit on the Medical 
the subject, the result of which was the appointment institution, who are thoroughly alive to the import- 
of a special sub-committee to draw up a report and ance G f t he subject, and are making an honest 
present it to the Institution. The Committee dealt en deavour to grapple with a problem which will we 
with the subject in a most exhaustive manner, and La ve no doubt be satisfactorily solved in due time, 
the report they have issued is full of useful sugges¬ 
tions for the prevention and treatment of the disease 

in all its stages. The text of the report consists of HISTORY BASED UPON DIET.—III. 
four subdivisions, and refers in the first place to the Further consideration of this subject may be 
diffusion of information for the general public- directed towards the apparent relationship between 
There can be little doubt that before much the form of food and the disposition of the eaters, 
can be expected in a progressive direction the regarded in mass, not in particular. All statements 
co-operation of the public must be obtained, on a subject so wide as this is, cribbed and confined 
and as the disease i3 more prevalent in the poorer within the space available here, must be understood 
quarters of a city, this information must be dis- to be only applied in the most general sense. The 
tributed by handbills or leaflets, in which are set forth various and complex circumstances which influence 
the main points regarding the precautions to be more or less strongly the applicability of general laws 
taken. The handbill drawn up by this Committee is to individual cases, though individual here may 
excellent, containing a lot of useful information in a represent considerable numbers, assuredly merit much 
few well-chosen and easily intelligible sentences, and additional argument. The disturbing factors are 
the Health Committee propose to issue several innumerable, but taken all over, they neutralise the 
thousands among the poorer classes of the community, deductions derivable from their action in one instance. 
They are printed on stiff cardboard, so that they will by altered effect in another. The spirit of cruelty^ 
not be destroyed readily. The sec ion which deals the love of torture, these are surely not qualities high 
with the sources of infection lays special stress on up among the lungs of the neurotic ladder. The meat- 
the good work which has been done hitherto by the i loving nations, however, are no more cruel than the 
Corporation of Liverpool in destroying and demolish- vegetarian peoples. The lack of appreciation of cruelty 
ing insanitary property. Perhaps the day may come was no more deeply conspicuous in the brains of the 
when it will be found practicable to provide tlie Red Indians of North America than in the ascetic, 
working classes with houses in the suburbs of large supposedly half-starved cerebral tissues of the 
cities, but the problem is a most difficult one, and is Roman Catholic monk or inquisitor ; while the 
not favoured by the industrial < lasses themselves. American Indian could give the natives of 
The most important part of the report, however, modern southern Europe points in affection for and 
deals with the treatment of tuberculosis iu its early kindness for their domestic animals. The Mahome- 
Btages, and recommends the prevision of sanatoria in dan, the Chinese, even the mild Hindu are surely not 
some healthy and suitable localities. There can be any less callous of causing suffering than the in- 
no possible doubt that if early cases of phthisis are habitants of this country; they are probably more 
placed under proper conditions they will recover, if cruel, even though the first-named is supposed to 

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Fkb. 22, 1899. 


NOTES ON CURRENT TOPICS, 


The Medical Pkess. 195 


abhor the juice of the vine and its protean poisons. 
The tribes in many parts of Africa and the Esqui 
maux in Greenland live principally upon flesh, but 
the first may prove truculent and cruel, the second are 
mild-mannered men. In neither instance have the 
higher qualities of the brain benefited from the 
animal food, in both its procural takes up too much 
time, while, in the one a more vegetable diet would 
suit the climatic environment better; in the other the 
difficulty of obtaining the food is of an extraordinary 
kind. To take a more modem instance. The statem* nt 
may be hazarded that the nature of the diet has to do 
with religion. The more absolute the religious power 
exercised by the clerical officials over a race or nation, 
who have themselves appointed their clerics, the less 
is their food adapted for the higher development of 
their mental centres, dependent, of course, upon their 
environment. In Europe and America the Roman 
Catholic nations are chiefly those which eschew or 
have to be sparing with flesh. In the United King¬ 
dom the same tendency is apparent. The humbler 
Irish, fed so largely upon vegetable food. con. 
trast with the Scotch, even if the latter be 
allowed only porridge. Oatmeal is above potatoes. 
“ Sandy ’’ is no doubt deeply religious, but his religion 
is personal, independent; “Paddy’ trusts and is 
swayed by one of his fellows initiated into religious 
mysteries which are withheld from him, and is 
religious by proxy. “ John Bull ” follows also an 
independent line for the greater part. To conclude 
this series of articles, bearing in mind that every sug¬ 
gestion is only to be regarded as based upon the 
broadest lines, a study of the history of the nations 
apparently justifies the dictum that diet rules the 
world. During mankind's nursery days his greatest 
advance and power naturally accompanied his oppor¬ 
tunities of getting food, of living most easily, and of 
lack of struggles with the elements. Later on 
the fact that the food which is most suited 
to a temperate climate, along, no doubt, with 
several additional aids, is most fitted to de¬ 
velop the higher cerebral faculties, irresistibly 
influenced national history, influencing it gradually 
through many stages, each stage, however, a link in 
the chain leading to the present balance of racial 
power. It is never safe to prophesy, but we would 
venture to doubt the occurrence in the future of any 
prolonged predominance of a race living in the 
warmer climates, even after the natural decadence of 
the present northern Powers, induced by over indul¬ 
gence or by Malthusianism. Given equal opportunities 
for the obtaining of food and for the education of her 
people, a nation living in a temperate climate, and 
consuming flesh in the proportion permissible while 
living in it, will infallibly advance beyond nations of 
warmer countries and sparer flesh-eaters. 


Wi regret to hear that Professor William Ruther¬ 
ford, of Edinburgh, is seriously ill, but we are pleased 
to be able to add, that the latest reports are more re¬ 
assuring. 


^otcB on torrent ‘topics. 

Death in a Padded Room. 

Last week an inquiry was held concerning the 
death of a patient at the London Hospital under 
somewhat unusual circumstances. From the evidence 
of various witnesses it appeared that deceased broke 
his ankle as the result of an accident, and after ad¬ 
mission to the ward he developed delirium tremens. 
He was then transferred to a padded room, and 
restrained by means of straps or shackles,” and was 
kept under those conditions until his death, on the 
third day after admission. An occurrence of this 
kind in one of our great hospitals is no more credit¬ 
able to the management than it is in touch with 
modern scientific principles of medical treatment 1 
First and foremost, the act of transferring a 
delirium tremens patient to a padded room will be 
regarded by many medic d men as well nigh indefen¬ 
sible. Desirable as it undoubtedly is to keep sick 
wards free of delirious patients, yet it by no means 
follows that they should be removed to a padded 
room. The use of such a place for such a patient 
sounds like an echo of the bad, old hospital days. 
Surely in a place with the resources of the London 
Hospital it would be possible to have an isolation 
ward with an ample staff of nurses for emergencies 
of the kind, a certain percentage of which must arise 
from time to time. The house surgeon is reported 
to have said that he could give the deceased no 
medical aid in his condition, and that the only thing 
to do was to keep him quiet. A statement of that 
sort could hardly come from a medical man about 
a condition in which active medical treatment is con¬ 
spicuously successful in saving life. 


Foreign Bodies in the Stomach- 
The newspapers report a curious case in the Peter, 
borough Infirmary. An itinerant juggler is said to 
have presented himself with the statement that he had 
swallowed a number of pebbles in the course of his 
conjuring entertainments. This statement was con¬ 
firmed by the recovery of some sixty stones, some as 
large as a pigeon’s egg, weighing altogether about a 
pound and a half. ^ he conjurer is to be congratula ed 
on his escape, f< r recovery under such circumstances 
is often doubtful. Not many months ago a famous 
American juggler found himself unable to empty 
his stomach of its w< nted lead of nails, coins, 
pieces of chain, and other metallic articles, 
which he had swallowed by way of public entertain¬ 
ment. An X-ray photograph revealed the foi-eign 
bodies as a large diffuse mass in the abdomen. The 
weight of this indigestible load stretched the stomach 
and pulled it out of position to such an extent that 
one day he was unable to expel its contents, as he 
had previously been in the habit of doing. Gastros¬ 
tomy was promptly performed, but the patient died 
shortly afterwards, a monument of human folly. The 
folk who flock to a repulsive exhibition of this kind 
are to t e condemned more severely than the UDfor* 
i innate victim who has sacrificed his life in pandering 


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196 x'he Medical Puses. 


NOTES ON CURRENT TOPICS. 


Feb 22, 1899. 


-to the heedless and morbid curiosity of mankind. 
Why does not the State control public performances 
in fact as well as in theory ? 

Tuberculous Infection and Second-Hand 
Clothing. 

The bye-ways by which tuberculous infection may 
b« conveyed are being investigated with a keenness in 
the present day which leaves nothing to be desired 
And, after all, the value of the crusade against 
tuberculosis will almost entirely depend upon the 
peifection of the methods of prevention which it may 
bring into vogue. With a perfected, regular, and 
universal system of prevention, tuberculosis as an 
infective disease may, in time, be relegated to an 
obscure position in the list of ills to which human 
flesh is heir. As showing, however, the activity now 
prevailing among bacteriologists and others in 
investigating all possible channelsof tuberculous infec¬ 
tion, reference may here be made to some interesting 
observations upon second-hand clothing recently re¬ 
corded by Dr. W. G. Bissell, Buffalo (U.S.A.). In the 
health department of the town with which he is con¬ 
nected he noticed that several of the officials had to cease 
work in consequence of tuberculosis. At that time 
the uniforms and overcoats, when discarded by an out¬ 
going official, were assigned to the next new candi¬ 
date. The suggestion, therefore, presented itself that 
were these uniforms formerly worn by tuberculous men 
capable of transmitting the disease to the next 
wearer. The author then: with a view to investigating 
the possibility of this theory, conducted a series of 
experiments. Uniforms were secured, their pockets 
removed and labelled; they were then washed, and 
the resulting washings were placed in a centrifugal 
machine until a sediment was obtained; this sediment 
was diluted and injected into sixteen guinea pigs; 
seven of these died from acute septic symptoms; 
while of the remainder, five recovered, but two of 
•these subsequently died of tuberculosis. These facts 
are decidedly of importance, and the moral to which 
they point is self-evident. They clearly show that 
not only the personal clothing, but the bed-clothing 
of all pei'sons dying of tuberculosis should be either 
effectually sterilised and washed or destroyed. 

H.R.H. The Prince of Walec. 

The Prince of Wales in again honouring a Hun¬ 
terian Orator by being present at the oration at the 
Royal College of Surgeons (England) last week, paid a 
gracious tribute to the surgical profession in this 
country, which was inspired no doubt by the desire to 
show some appreciation for the success with which 
the treatment of his fractured patella was carried out. 
It is, perhaps, quite true that His Royal Highness 
owes a good deal to the profession of medicine, but it 
is also equally true that the Prince, with his unfailing 
tactfulness, is never backward in making use of a 
favourable opportunity of showing his indebtedness. 
In view, however, of the repeated honours which he 
has conferred upon the Royal College of Surgeons by 
attending to listen to the Hunterian Orations the 
idea suggests itself that the College might f jllow the 


lead of the Royal College of Physicians and offer for 
His Royal Highness's acceptance an Honorary Fellow¬ 
ship of the College. The Prince would then possess* 
in keeping with the present requirements of the pro¬ 
fession, a double qualification—conferred by the 
conjoint Colleges. At present he is only qualified to 
practise medicine as a Fellow of the Royal College of 
Physicians; surely, therefore, the least that the 
College of Surgeons can do is to offer to make him 
anHonorary F.R.C.S.,andperhaps,entitle him,should 
he so wish it, to be placed upon the Medical Register. 
We trust that for the honour of the College of 
Surgeons, the Council of the College will lose no time 
in taking the necessary steps to enable them to offer 
an Honorary Fellowship of the College to His Royal 
Highness. 

President Kruger as a Patient. 

The presence of skilled, accomplished English 
practitioners in Johannesburg, some of whom are 
well known in the profession, does not seem to have 
had much civilising influence upon the President of 
the South African Republic. This worthy official, it 
is stated, lias a rcoted antipathy to medical men, 
which he is not slow to manifest. He has for some 
time been suffering from marked evereion of the lower 
lids and chronic conjunctivitis, but nothing will in¬ 
duce him to submit to the surgical measures neces¬ 
sary for the relief of the defect. Whenever he is 
prevailed upon to see a surgeon as to his condition, 
and the latter points out the relief which an operation 
would afford him, he at once directs the surgeon to 
leave his presence. The last medical man to give 
him this advice was a' German, so it cannot be 
said that his refusal to be operated upon is deter¬ 
mined by any political sympathies. After all Presi¬ 
dent Kruger is setting a bad example to his own 
countiymen in the Republic. Moreovei - , he is pro¬ 
bably losing a golden opportunity of acquiring a large 
measure of popularity and sympathy which the brave 
submission to a small operation would be likely to 
achieve for him. Upon the whole, then, on poli¬ 
tical, social, and personal grounds the President 
should accept the advice of his purgeens, and be 
cured of his distressing malady. 

Prison Diet. 

At last the powers that be have decided upon the 
revision of prison dietaries, and we may hope that in 
future prisoners will be fed on a scale more worthy of 
a humane and scientific age. Hitherto prisoners 
have been underfed and overworked in a manner that 
turns them out after their term of imprisonment, be 
that short or long, so half-starved and weak that 
their chance of doing any honest work is reduced to 
a vanishing point. In this treatment the prison 
administration of this country is consistent, for the 
reform or rescue of the criminal appears not to 
enter into their calculations. Their main object 
seems to be to render the penal side of incar¬ 
ceration terrible by goading with an iron disci¬ 
pline the prisoner whose moral faculties have shared 
the degeneration of tissue entailed by what is 


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Tax Medical Pbxbe. 197 


virtually chronic starvation. We do not advocate 
rose-water and eider-down for hardened offenders, but 
for many years we have protested against a system 
that imposes savage and unmeaning punishments for 
trifling offences against dis ipline, and which 
punishes a man by depriving him of food. The 
latter proceeding is illogical in the extreme, seeing 
that the brain is one of the first organs to suffer 
from damage to general nutrition. We hope to deal 
at length with this most important matter in an 
early issue. 

Scarcity of Glycerinated Lymph. 

Mr. Chaplin has intimated that the demand for 
glycerinated calf lymph for vaccination, as supplied 
by the Local Government Board, is exceeding the 
supply, and steps have had to be taken in order to 
increase considerably the facilities for its preparation. 
It is also stated that, in addition to the public vacci¬ 
nators, private practitioners are applying to the 
Board for the lymph, but in the latter case 
it has not been found possible to satisfy their 
requirements. Sir William Priestly has since pointed 
out to Mr. Chaplin that medical men would be 
glad to pay for the Board’s lymph if it cou’d be 
supplied to them. Hithei’to the lymph has been given 
without any payment being required. But it is clear 
chat it would be an advantage to the Board to accept 
payment for their commodity, for in such a case they 
would be enabled to increase the means of its pro¬ 
duction. Mr. Chaplin has the matter under his con¬ 
sideration. 


The Chloroform Bogey. 

Popular ideas concerning the ease and rapidity 
with which unconsciousness can be induced by means 
of chloroform are curiously wide of the mark, hence 
the ludicrous statements that find their way into the 
press and into novels written by persons who have 
not taken the trouble to “ verify their references.” 
Last week the daily press related in all seriousness 
the story of an attempt to narcotise a traveller on a 
French railway by means of chloroform projected 
into the compartment through an aperture drilled for 
the purpose. If the anecdote lie authentic the 
attempt merely proves profound ignorance on the 
part of the would-be miscreant of this particular 
method of ansesthetisation. Apart from the fact 
that it would take a prodigious quantity of chloro¬ 
form to produce any appreciable effect unless held 
in close proximity to the mouth and nose, it is 
highly improbable that a sleeping person could be 
amesthetised without being awakened, the olfactory 
nerve remaining active even during sleep. In the 
drama and in novels the rapidity with which chloro¬ 
form narcosis is induced is a very conspicuous 
feature. Authors appear to be under the impres¬ 
sion that it is sufficient to wave a handkerchief 
sprinkled with the drug in front of the victim’s 
face during a brief space of time for the latter 
to sink, without resistance, into a limp, un¬ 
conscious mass Considering that in the hands 
of an expert anaesthetist, justified by the patient's 


consent, it takes from five to ten minutes to- 
determine loss of consciousness, and that even then 
there is usually a stage of more or less violent excite¬ 
ment, it is obvious that, short of an overwhelming 
display of physical force, it would be next to impos¬ 
sible to narcotise an unwilling victim. The odour of 
chloroform is so pronounced and unusual, and the 
first effects on the organism are so singular, that its 
unsuspected inhalation is altogether incredible. In 
view of the fact that in spite of the precautions with 
which the law hedges in the sale of this drug, it can 
be obtained with tolerable facility by the exercise of 
a little patience and ingenuity, it will comfort the 
public to learn that its effects are not characterised 
by the fulminating rapidity with which they are 

popularly credited. - 

Alcohol in the Profession. 

It must ever be a matter for painful surprise that 
medical men, who cannot but be cognisant of the 
terrible and inevitable effects of excessive indulgence 
in alcohol, should themselves so often fall victims to 
this degrading habit. In some, no doubt, the- 
habit is the legacy of irregular student life, 
but in the majority of cases drink seems to 
be resoited to for the purpose of combating the 
monotony and fatigue of daily practice. When 
to these factors is added the depressing sensa¬ 
tion of failure, the temptation to see ephemeral 
comfort in alcoholic stimulation is too strong to be 
withstood by men of weak moral fibre. As one might 
expect it is especially in the lower walks of the pro¬ 
fession that this form of indulgence is most preva¬ 
lent. The habit is sometimes, no doubt, the cause of 
failure in practice, in others, the result of it. but 
however this may be, the lamentable fact remains 
that there is ample scope for medical temperance 
associations. The evil is unfortunately not confined 
to the victims whose influence on their patients in 
regard to the use of alcohol can hardly be other than 
disastrous. The time may come when notorious 
addiction to alcohol will be regarded as a sufficient 
reason for inhibiting the peccant member from the 
practice of his profession, and no one can deny the 
grave risks to the public which such a habit must 
entail. Medical menand ministers of religion occupy 
positions of great moral responsibility, and they owe 
it to their patients and flocks to set a good example- 
in this, a3 in sundry other, respects. 

A Niggardly Board of Guardians. 

A point of some importance was recently elicited 
at the Crediton County Court under rather peculiar 
circumstances. Dr. Haycroft, a Poor-law medical 
officer, attended a woman during labour in confor¬ 
mity with an order to that effect served upon him by 
one of the overseers. The guardians, however,. 
declined to pay his fee of a paltry half-guinea on the 
ground that, as the woman’s husband was not 
destitute, he, and not they, was liable for the amount. 
Judge Woodfall appraised the behaviour of these 
niggardly guardians at its proper estimate, observing 
that it would be an intolerable burden on the medical 
officer if he had to ascertain the circumstances of the • 


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193 The Medical Press. NOTES ON CURRENT TOPICS. 


people he was called upon to attend, adding that the 
Poor-law did not contemplate the administration of 
medical relief “ in any 6uch grinding spirit.” As 
leave to appeal was asked for and granted, it looks as 
if these mean-spirited officials intended to challenge 
his niling. but if so, we trust that the general body 
of Poor-law medical officers will rally round Dr. 
Haycroft, who is fighting their battle. 


The Irish Collegiate Preliminary Examina¬ 
tion. 

Foe some years past the General Medical Council 
has sought to crash out of existence the preliminary 
examination held conjointly by the Royal Colleges 
of Physicians and Surgeons, Ireland, ihe obvious 
pm-pose being to clear the ground of all competition 
with the Universities, no reason being assigned for 
the wished-for extinction. These colleges, while 
both expressing and demonstrating their willingness 
to raise the standard as high as the General Medical 
Council might desire, resisted annihilation on the 
grounds that no other examination is open, in Ire¬ 
land, to the average medical student. Inasmuch as 
(a) The recognisable examinations of Dublin Uni¬ 
versity involve a payment of £15 and are, in some 
cases, inferior in standard, (b) Those of the Royal 
University are two in number, and with an interval 
of a year. Under these circumstances, it was sug¬ 
gested by the Irish Colleges that the examina¬ 
tions of the Intermediate Education Board, now in 
course of reorganisation by a Commission, might 
supply the want if three objections to these examina¬ 
tions could be overcome. The objections are these : — 
1. That they are held in June, which does not suit 
the students annus medicus. 2. That the age for 
the Junior Grade examination is too early for such 
student. 3. That the extreme age limit for any of 
the Grades is only eighteen years, and that a student 
who had not passed by that time would be excluded 
for ever. 4. That, in any case, a student would have 
to lose an entire year if he failed to pass at the first 
attempt. It was suggested that the Intel-mediate 
Board might make special arrangement to overcome 
these difficulties, and, to that end, the colleges, 
represented by Dr. Atthill, for the College of 
Physicians, and Sir William Thomson, for the 
College of Surgeons, testified before the Commission 
last week. They placed these points very clearly and, 
apparently, with considerable effect, and we should 
hope that a modus vivendi may be arrived a?. 

The Livingstone College. 

The fifth annual report of this useful Institution 
was read at a meeting of the subscribers and 
supporters last week. It appears to be doing an 
excellent work, and is worthily deserving of the 
cordial assistance of all the missionary societies. By 
means of the education supplied by the college, not 
only are missionaries the better able to look after their 
own health, but many opportunities are afforded 
them to using their knowledge to advantage upon 
others. 


Ffb 22. 1899. 

Ancient Burial Vaults. 

In most of our great towns there exist vast collec¬ 
tions of coffins piled up in the crypts of churches, a 
ghastly bequeathal from the times when our forefathers 
had not realised the elements of wholesome environ¬ 
ment. Such burial vaults still abound in the metro¬ 
polis, where the size of the population and the lack of 
proper cemeteries made them in former days especially 
convenient and lucrative. Last week no lesB than 
200 coffins were discovered stowed away beneath a 
Friends’ mission house at Limehouse, the date of the 
latest burial being 1856. The Home Office has taken 
the matter in hand, and it is to lie hoped that their 
efforts will be more speedily successful than in 
a very similar case of the Parish of St. George the 
Martyr, Southwark. Last summer (as readers may re¬ 
member) London was startled with the news that some 
1,500 to 2,000 coffins were lying in the vaults beneath 
the church of that ancient parish. After sundry 
official proceedings an order for removal was sent to 
the vestry by the Home Office. Six months later no 
action has been taken by the local authorities, and, 
if we are to believe the assertion of the newspapers 
of the district, the official notice actually lay unopened 
for four out of the six months. There can be little 
doubt that a systematic search would reveal not a few 
such undesirable burial places, and we must thank 
the Church of England Burial Reform Society for 
persistently having, for years past, drawn attention 
to this danger to health. In these cases we think 
the Home Office would do well to cremate the whole 
of the remains, or if their powers do not extend so 
far, to apply to Parliament for the necessary 
authority. 

A Classical Suicide. 

A somewhat curious case of suicide has been 
recently investigated at Croydon. The man seems 
from the evidence to have gathered hemlock, 
wherefrom he distilled the poison that formed h : s 
lethal draught. This proceeding was possibly 
suggested to him by a perusal of ancient history, 
when poisoning by conium was a recognised means 
of inflicting death, whether penal or suicidal. The 
paralytic properties of the plant conium appear to 
have been recognised at the dawn of civilisation 
and probably a long time before that epoch, as 
we find some of the most degraded aboriginal tribes 
possessed of considerable toxicological lore. The 
personal account of the symptoms of conium 
bequeathed to posterity by the dying Socrates stamps 
him as a master of accurate observation. The 
“ death-cup ” of the ancient Greeks, among whom 
suicide was common, consisted mainly of the juices 
of a species of hemlock. A similar remark is true of 
the ancient Romans, with whom, indeed, some 
authorities maintain the morbid and degenerate 
fashion originated. It is somewhat noteworthy, by 
the way, that, notwithstanding the advances of 
modern chemistry and pharmacy, scientists have 
not yet discovered a physiological antidote to the 
poison of hemlock. 


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NOTH* ON CURRENT TOPICS. 


Thb Mrdical Press 199 


The Spread of Venereal Diseases. 

There ia no greater anomaly in the whole of our 
curiously mixed social administration than the way in 
which venereal diseases are allowed to flourish un¬ 
checked. From a logical point of view ike exact 
position of that class of maladies is clear enough. 
They form a well-defined and deadly group of the 
great family of communicable diseases. As regards 
many of the specific infectious diseases, as a com¬ 
munity we have taken up a stong attitude, and have 
assumed the right of control over the individual in 
the interests of the many. The results of that action 
are recorded in the brilliant annals of preventive 
medicine. Nevertheless, at the end of the 19th 
century we leave reverely alone the most loath¬ 
some and insidious of communh a l >le diseases. Some 
thirty years ago an attempt was mide to deal 
with the question by the passing of the Contagious 
Diseases Act. That measure, however, was so imper¬ 
fect that the repeal that overtook it in 1836 might 
almost have been foretold. It applied, for instance, 
to certain towns only, it controlled one sex alone, and 
it placed the possibility of terrible abuses in the 
hands of the police. Yet Great Britain enforces a 
modified Act in India, and it may well be asked in 
the name of reason and common sense why the same 
thing should not be done at home. The sooner the 
whole question of venereal disease is treated purely 
and simply as a health matter, and quite apart from 
its moral aspects, the better for the national welfare. 


The Forthcoming International Gynaeco¬ 
logical Congress. 

We are asked by the Honorary Secretary of the 
International Congress of Gynaecology and Obste¬ 
trics, which is to be held at Amsterdam from the 8th 
to the 12th August, to publish the following latest 
arrangements:— 

The questions for discussion are as follows: — 

1. The surgical treatment of fibro myoma. 

2. The relative value of antisepsis and improved 
technique for the actual results in Gynaecological Sur¬ 
gery. 

3. The influence of posture on the form and dimen¬ 
sions of the pelvis. 

4. The indication for Caesarian section compared 
to that for symphyseotomy, craniotomy and prema¬ 
ture induction of labour. 

Among those who have consented to take part in 
these discussions are, Messrs. Doyen, Howard, Kelly, 
and Schauta, who will treat the first question; 
Messrs. Bumm, Ricbelot, and Lawson Tait, the 
second ; Messrs. Bonnaire, Pinzani, and Walcher, the 
third ; and Messrs. Leopold, Pinard, and Pestalozza, 
the fourth. The reports with their translations in 
the official languages will be sent to all the members 
a month before the opening of the Congress. As 
regards private communications, preference will be 
given to those bearing upon the above-mentioned 
leading questions. Sufficient time will also be 
allowed for any demonstrations kindly afforded by 
the members. The official languages are, English, 


French, German, and Italian. The subscription for 
membership is one guinea. Subscription forms and 
further particulars may be obtained from the Hon- 
Secretary for Grei-t Britain and Ireland, Dr. Arthur 
Giles, 37 Queen Anne Street, London. 

Earth-Eating. 

The Society Anthropolog’.que of Vienna reports to 
us curious information of the geophagic or earth¬ 
eating habit. This custom exists in many tropical 
countries. It is especially practised by negroes and 
Indians, but exceptionally in Europe. Lasch quotes 
the case of workmen employed on an English race¬ 
course, who at all times spread clay on their bread 
and eat it with a relish. In Persia certain earths are 
considered by gourmets a great dainty. In the 
Archipelago the people buy “ ampho” earth in pro¬ 
vision shops. In China, New Caledonia, and New 
Guinea geophagy is much practised. Humboldt 
observed it in America and Lasch remarked that 
among savages (especially pregnant women) earth was 
much.used, the latter considered it assisted them in 
their confinements. In Guatemala it is used in con¬ 
nection with superstition, and in the course of religious 
ceremonies the faithful may be observed devouring 
statuettes of clay, with an air of profound devotion. 
From this barbarous practice results consumption, 
anaemia, and inflammation of the liver. 

The Epidemic of Influenza. 

The epidemic of influenza is not confined to the 
metropolis. From various parts of the country we 
receive reports of its prevalence. Among the men 
employed at the railway works at Crewe, for example, 
hundreds are reported to be incapacitated for work, 
and some difficulty in the traffic department has been 
experienced from the same cause. A similar state of 
things prevails in Glasgow, where business is dislo¬ 
cated by the large number of absentees. As we pre¬ 
dicted a few days Bince, the resources of the various 
provident funds and slate clubs have a heavy strain 
put upon them by the unforeseen prevalence of 
sickness. 

A Midwife Censured. 

Mrs. Avenell, set. 71, a Walthamstow midwife > 
who claimed to possess a “ diploma ” from the 
Obstetrical Society, and to have successfully passed 
the curriculum of the “Ladies’ Medical College,’' 
whatever that may be, with honours, has been 
severely censured by a coroner’s jury for her 
conduct in connection with a labour which she 
had attended, the patient having succumbed to 
septic complications, the result of want of cleanliness 
and neglect. The censure will doubtless have the 
desired effect, in that it will deprive this careless 
nurse of further opportunities of doing mischief. 

Surgeon A. R. Bankart, H.M.S. ‘ Surprise,’ who 
was in attendance upon his Royal Highness the late 
Hereditary Prince of Saxe-Co ourg and Gotha during 
his last illness, had the honour of being received hy 
' Her Majesty at Windsor last week. 


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LITERATURE. 


Feb. 22 , 1899. 


The Royal Army Medical 8ervice. 

It must be a source of unmitigated satisfaction to 
the military authorities to find that the measures of 
reform so reluctantly conceded by them have had for 
effect to restore the Army Medical Service to its 
erstwhile popularity. At the recent examinations 
there were upwards of seventy candidates for twenty- 
four vacancies, so that, for the first time for some 
years they were competitive in fact as well as in 
name. Unfortunately the evil effects of the last few 
years will not at once disappear, and it will take a con¬ 
siderable time for this department of the Service to 
“level up.” None the less we congratulate “my 
military advisers ” on having restored order out of 
chaos, and on having averted what at one time threat¬ 
ened to be a deadlock. 

Food Adulteration in America. 

It has been estimated that food adulteration takes 
place in America to the extent of £140,000,000 per 
annum. In other words, the people of the United 
States are swindled out of this amount by dishonest 
tradesmen. The sum seems an enormous one, and 
it is remarkable that such a practical people as the 
Americans are should allow themselves to be so vic¬ 
timised. The necessity, however, for dealing with 
the evil has, it appears, at last become palpable, so 
much so that two Bills for the prevention of the adul¬ 
teration of food and drugs have just been introduced 
into Congress. Perhaps Congress might learn some¬ 
thing from the laws in force in this country upon the 
subject of food adulteration. But there is no saying. 

The author so widely known as “ Cavendish,” in 
private life Mr. Henry Jones, whose death took place 
a few days since, was himself a medical man, and the 
son of Mr. Henry W. Jones, also a medical prac¬ 
titioner, of Soho Square. Mr. Henry Jones took his 
M.R.C.S. in 1852, and subsequently became a member 
of the Society of Apothecaries. He ceased to prac¬ 
tise in 1869, but had long before achieved the position 
of an unquestionable authority in all matters apper¬ 
taining to card-playing. His numerous works, all 
written under the nom de plume “Cavendish,” still 
hold their own in all English-speaking countries. It 

a curious fact that his father, who was veiy fond of 
a rubber at whist, acquired the habit of settling dis 
putes by referring to “Cavendish,” years before he 
became aware that the author was his own son. 


An Order in Council will shortly be issued for the 
increase of a number of medical officers for the Royal 
Navy. The establishment is up to its limits at the 
present moment, but it is determined that these shall 
be still further increased in order to provide for 
eventualities. 


Colonel J. A. Clery, R.A.M.C., has been 
se'ected for the appointment of Principal Medical 
Officer to the Woolwich and Thames district, in suc¬ 
cession to Colonel Ferguson, who retires from the 
service next month. 


gtortlani. 


[from our own correspondent.] 

Influenza in Edinburgh. —The citizens of Edin¬ 
burgh are suffering at present from a wide-spread 
epidemic of influenza, luckily, as yet, in a not very dan¬ 
gerous form. As far as can be ascertained, both from 
the cases seen in hospital and outside, no specially 
marked type, such as that which was characteristic of 
the much milder epidemic of last spring, viz, the gastro¬ 
intestinal type, can be said to be shown in its victims •, 
it chiefly appears in a simple pyrexia, more or less pro¬ 
nounced, with or without arthritic pains, and culmina¬ 
ting in exceedingly profuse pfrspiration. Moderately 
acute nervous sequela;, however, are apparently more 
common than in several of the epidemics of recent years. 

Edinburgh Hospital Reports. —The members of the 
medical staffs of the various infirmaries and hospitals in 
Edinburgh have at length decided to prooeed with the 
publication of the Edinburgh Hospital Reports. Five 
volumes have been published Bince 1891, but the existing 
arrangement having expired at the end of five years, and 
difficulties having arisen in re their continuance, the whole 
question has been submitted d*. novo to the medical staffs, 
and reorganised upon a wider basis. The Royal In¬ 
firmary, Royal Hospital for Sick Children, the City Fever 
Hospital, Leith Hospital, Edinburgh Ro^al Asylum, and 
the Deaconess, Victoria,and Chalmers Hospitals have 
all been invited to collaborate, and all of them, we believe, 
have promised to do so. 

Glasgow Fog and the Death-rate. —On account of 
the dense fog in Glasgow a few days ago the death rate 
made a leap upwards to 35 per 1,000 of the population, 
thus placing Glasgow in the unenviable position of 
having the largest death-rate of any town or city in the 
United Kingdom. This high mortality has not been 
reached since the winter of five years ago, when the frost 
and fog were intense. Even then the same suffocating 
and throttling effect was not experienced sb on the pre¬ 
sent occasion, when several instances of giddiness and 
vomiting in the street came under our immediate notice. 
Whether the smoke and soot-laden atmosphere was 
charged with a larger quantity of poisonous gases, or 
that the influenza bacilli were more numerous as well as 
ponderous, is, perhaps, difficult to decide, yet it is a fact 
that since the fog passed off influenza has been increas¬ 
ingly prevalent in the city, so much so that in the police 
force alone there are at least 100 men off duty. 

Principal Story “Means Business ’’—The late Pro¬ 
fessor Coats remarked in a letter which, strange to say, 
was publicly read on the evening preceding his death 
“ Principal Story means business.” It is noticed that the 
Principal is taking the very sensible step of familiarising 
himself with all the details of university affairs. More 
tlian one classroom having been lately visited by him and, 
as graphically put, heroically sitting out the lecture; 
and now, by means of an “ At Home,” he is about to form 
the personal acquaintance of the lecturers, assistants, 
examiners, office staff, and librarians. This evidence of 
interest displayed by the Principal or Academio head is 
greatly appreciated by the officials generally. 


literature. 


LENNOX BROWNE ON THE THROAT AND 
NOSE, (a) 

Mr. Lennox Browne deserves the thanks of the pro¬ 
fession for this new edition of his book. It is practi¬ 
cally a new work, and some of the very best parts of the 
book are those that he has now added to it. Both the 
text and the illustrations are full of interest, and it would 
be hard to find a more thorough or more instructive 
account of all the facts of laryngeal surgery. The 
arrangement of the whole subject is well thought out, and 

(a) “ The Throat and No-e, and their Diseases.” By Lennox 
Browne, F.R.C.8.K. Fifth Edition. Bailliere, Tindall and Cox. 
London. 1899. 1’p. 967. With 650 Illustrations In Colour. 
Fries Sis. 6d. 


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F»b. 22,1899. 


LITERATURE. 


The Medical Press 201 


from beginning to end the book is clear, practical, and full 
of experience. The numerous cases that he quotes are 
well selected and well described, and the book is enriched 
with an immense number of admirable coloured 
plates. His illustrations of the diseases of the 
larynx are to good that thev stand the severe test that 
should be applied to all such pictures—that one should 
hold them upside down, and look at them with a 
laryngeal mirror, and see whether i hey stand out like 
the living structures. Altogether, the book is excellent, 
and forms a most notable addition to the literature of 
surgery. 

There is first a very careful and comprehensive account 
of the anatomy and physiology of the upper air passages, 
including the microscopic structure of the different 
tissues. Then comes a well-written set of rules how to 
use the laryngoscope and examine the nasal passages In 
all this part of the book, there is hardly a word that can 
be criticised ; unless it be the statement (p. 119) that a 
wide naso-pharynx is more likely to be diseased than a 
narrow one: “the wider the distance between soft palate 
and pharynx, the mure surely one may expect, on 
examination, to find post-nasal trouble.” The chapters 
that come n-xt, on the general signs, treatment and 
pathology of the diseases of the throat, are very good ; 
and in all of them we find only two points for criticism. 
One is that Mr. Lennox Browne seems to us to over-rate 
the importance of the lingual tonsil and its veins; the 
other is his statement that spasm of the pharyngeil 
muscles “ is liable, if neglected, to lead to true stricture 
of a practically, if not actually, malignant nature.” 

His account of the diseases of the tonsils is excellent, 
especially the rules of treatment. For simple acute 
ton-illitis, he recommends that the inflamed surface 
should bo painted with equal parts of guaiacol and 
almond oil He does not, we think, take such a hopeful 
view as he might of operative interference in cases of 
malignant disease of the tonsil. The chapter on adenoids 
is one of the best parts of the book, and we note with 
approval that he has given up the use of the artificial 
nail in favour of the forceps or the curette. We doubt 
whether he is justified in putting stammering among 
the defects that may be cured by the removal of adenoids : 
it does not seem likely that the operation could put an 
end to any real impediment of speech. 

The chapters on laryngitis (pp. 434-609) are of great 
value, especially for all that he says about the singing 
voice. Tbe other chapters on the laryngeal diseases 
raise two questions which Mr. Lennox Browne has 
already raised in debate—the exact measure of the 
advantages given by the antitoxin treatment of diph¬ 
theria, and his belief that a benign growth in the larynx 
may be irritated into malignancy by surgical treatment. 
On the first of these questions he writes with great care 
and moderation; on the second, we think ho ought to 
give up his position altogether, and certainly he yields 
most of the ground. 

His account of nasal diseases evinces a perfect grasp 
of the subject, and is by no means the least valuable part 
of the book. Finally, there is a very good short chapter 
on those aural troubles that are most associated with 
naso-pharyngeal disease ; and a good list of formula;. 

The whole book is worthy of praise, both the text and 
the plates, the printers' and publishers' work keeping 
pace with the author’s in point of excellence. The 
special chapters contributed by Mr. Mayo Collier, Dr. 
Cagney, and Mr. Wingrave add much to its thorough¬ 
ness. Here and there a captious critic may find a fault 
of style—some unnecessary claim of priority in work, or 
some horrible half-creek. half-Latin word. But it is, on 
the whole, a very fine piece of work, careful, complete, 
and thoroughly practical, and we doubt whether its equal 
is to be found in the English or any other language. 

SQUIRE’S COMPANION TO THE BRITISH 
PHA KMACOPCEIA (a). 

It is but four short years since the sixteenth edition of 
this indispensable work of reference was published, but 
many and important changes have taken place since 

(a) “ Companion to the British Pharmacopaia.” (i ast Edition.) 
By Peter Pqnire. 17th Edition. Revised by Peter Wyatt 8quire, 
P.L.8., F.C.8. London: J. and A. Churchill. 1899. Price 12s. 6d.j 


then. Not only is additional information available 
respecting drugs with which use has already made us 
familiar, but various new drugs and compounds have 
been introduced into therapeutics on approval, and 
claim our attention. The present edition has been 
brought well up to date, containing, as it does, references 
as recent as January of this year. Among the more 
recent additions to the unofficial repertory of contem¬ 
poraneous therapeutics, are the following: Heroin, 
peronine, ephedrines, hydrochloride, mydrin, tartrate of 
piperidine, Ac. How many of these will be retained after 
being rubbed through the sieve of experience, time alone 
will show. There are quite a number of products intro¬ 
duced as substitutes for cocaine, and some of them may 
possibly secure a share of popularity, notably eucaine, 
the chemical name whereof takes a whole line all to 
itself. Under the head of silver also we are treated to a 
large number of new compounds, most of them 
intended for the treatment of urethral troubles, 
special advantages being claimed for each. Considerable 
space i3 devoted to the pharmaceutical peculiarities 
of creosote and guaiacol, which, with their compounds, 
appear to belong to the select group of remedial agents 
capable of really rendering service in the treatment of 
tuberculosis. 

In order to facilitate reference, the paragraphs dealing 
with solubility, therapeutical properties, prescribing 
notes, and list of official preparations have been arranged 
on a novel plan, so that all the information required 
under t re respective headings can be seen at a glance. In 
the task of embodying the results of the most recent 
researches, certain art icles have had to be virtually re¬ 
written, as, for example, those on atropine and its salts, 
digitalis, ipecacuanha, jaborandi, opium, nitrate and 
hydrochloride of pilocarpine, sulphate of quinine, and 
last, but not least, the thyroid gland. 

Tbe notes, interspersed here and there, on the defini¬ 
tions contained in the new Pharmacopoeia afford proof of 
original observation, and we commend them to the 
editors of the official compilation. In respect of benzoic 
acid, for instance, the Pharmacopoeia defines the acid as 
obtained from benzoin by sublimation, which strictly 
speaking is the “ Resin-Sublimed Acid ; ’ it possesses a 
strong empyreumatic odour. It is stated, moreover, that 
“ benzoic acid is odourless when quite pure, but when 
obtained from benzoin possesses an aromatic odour,” 
thereby inferring that the acid generally used would not 
be obtained from benzoin. It would have been more 
correct to have stated that the acid is obtained from 
benzoin by precipitation and subsequent sublimation, 
such an acid although obtained from benzoin does not 
possess the odour of the drug. Then, again, in regard to 
bismuth carbonate, this, says the editor of the “Com¬ 
panion ” is an instance of the disadvantage attaching to 
the new method introduced into the B.P. of grouping 
the characteristic reactions. It has been very per¬ 
tinently asked whether iron, arsenic, lead, tellurium, 
selenium, and magnesium are all equally objectionable ? 
Under bismuthi salicylas the editor states “ we have not 
yet seen a sample which would pass the ferric chloride 
test, also there is a slight discrepancy between the 
figures given for bismuth sulphide and bismuth oxide. 
Although Mr. David Howard called attention to the 
inaccuracy of the formula given for bismuthi subnitras 
in B.P. 1-85, the error is repeated in B.P. 1898. It is 
also at variance with the official test which requires that 
it should yield 84 p.c. of bismuth sulphide.” Avis a qui 
de droit! 

It is comforting to be assured that chloroform sp. gr. 
1*497 is not as liable to change on keeping as is gener¬ 
ally supposed. We may particularly call the attention 
of our readers to the radical changes in the formula for 
the preparation of tinctura chloroformi et morphinaa 
composita, which is now official in place of the tinctura 
chloroformi et morphina; of B.P. 1885. 

Another note of special interest bears on the great 
change with regard to eucalyptus oil. Eucalypti oleum 
as defined officially is the oil distilled from the fresh 
leaves of eucalyptus globulus, and other species of 
eucalyptus, and there is nothing to call attention to the 
fact that the oil from a particular species (eucalyptus 
amygdalina), which has been official Bince 1885, is now 
excluded by the official tests. This, after all, is of more 



202 Thb Medical Pbess. 


LITERARY NOTES AND GOSSIP. 


Feb. 22, 1899. 


interest to chemists than to medical men. Respecting 
hyoscinae hydrobromidum the editor asks whether the 
compilers of the test given for this salt have ever met 
with a salt in commerce of the melting point given 
(193 to 194 degs.). 

It is pointed out that the hydrochloride of pilocarpine 
is official in most other pharmacopoeias, probably because 
it more readily admits of purification than the nitrate, 
commercial samples of which vary in their melting point. 

The Pepsin test, remarks the editor, is a half-hearted 
copy of the U.S.P., but omits important particulars 
relating to the stirring, and B.P. directs the almost 
microscopic quantity, -^th of a grain, to be weighed out 
for the test, instead of employing a measured quantity of 
a solution of definite strength. Under lithium carbonate, 
lysidine, piperazine, and piperadine tartrate, references are 
given to the latest work (by Luff) as to the action of 
these substances on sodium biurate. Large numbers of 
notes occur under menthte piperita; oleum, and medicinal 
properties of menthol enlarged. 

In conclusion we may congratulate the editor upon 
having achieved the task of revision of this impatiently 
awaited work with so little delay. It is a “ Companion ” 
in the best literary sense of the term, and generations of 
practitioners and pharmacists have learned to appreciate 
its accuracy, its comprehensiveness, and the admirable 
arrangement of its heterogeneous contents whereby 
reference is made easy. The work has now reached a 
degree of perfection which defies constructive criticism, 
aud the welcome which has been extended to its pre¬ 
decessors will certainly be accorded to the seventeenth of 
this ilk. 


'ptcvari) 4;lotcs anb (Sossip. 

Dr. F. J. Webb, a Manchester practitioner, has just 
published a work which graphically portra\8 many 
features of medical student life, and particularly illus¬ 
trates the trials and disappointments of practice. The 
novel has been well received. “ Harry Ingelby, Surgeon,” 
is the title of the work. 

• • 

# 

Ruskin at eighty has been photographed in his study 
by the well-known photographer, Frederick Hollyer. A 
reproduction of this photo is given, by permission, in the 
“ Leisure Hour ” for February. Old Alleynians will be 
pleased to see in the same magazine their popular Latin 
school.song, written by Dr. Welldon when headmaster of 
Dulwich College. 

# • 

• 

Messrs. Longmans inform us that a considerable 
portion of the work of revisal necessary in the prepara¬ 
tion of a fourth edition of “ Coats’ Manual of Pathology ” 
had been already accomplished by Professor Coats imme¬ 
diately preceding his death ; and in response to the 
author’s expressed wish the editorial duties have now 
been assumed by Dr. Lewis R. Sutherland, Senior Assis 
tant to the late Professor of Pathology, University of 
Glasgow. It is expected that the work will be ready for 
publication in the early autumn. 

V 

The “ Text-Book of Zoology, ‘ by Messrs. M ells and 
Davies forms part of “ The University Tutorial Series,” 
and it is in reality a revised and enlarged edition of a 
work published five years ago, now before us. What 
with alterations in the schedules of requirements of 
examining boards, and with the progress of knowledge, 
this new edition does not come any too soon. The 
authors’ experience of actual teaching has been turned 
to good account, and all trace of ambiguity has been 
eliminated from the text, which is copiously illustrated 
by diagrams specially drawn for the book by Mr*. Davies. 
What is known as the “ type system ” of imparting an 
introductory knowledge of natural history sciences has 
been adopted, but every endeavour has been made to 
obviate the drawbacks associated with the too exclusive 
restriction of the attention to isolated species. Though 
compact, this work deals very comprehensively with the 
subject; the text is lucid and is clearly printed, whi e 
the diagrams reflect great credit on their delineator. 


The “ Handbook of Obstetric Nursing,” by Dr. F. W, 
N. Haultain and D;. J. Haig-Ferguson (Edinburgh : J. 
Pentland), primarily destined for the instruction of 
obstetric nurses, is an admirable compilation. It errs, if 
anything, in the direction of over-comprehensiveness, for 
a medical student who had, even approximately, mastered 
its contents, would probably pass any examination on the 
subject with flying colours. It is liberally illustrated, 
and the title page is faced with a full-page coloured 
diagrammatic drawing of a woman at full-time preg¬ 
nancy. Apart from the usual chapters on anatomy, 
pregnancy, and labour, there is an excellent expose of 
antiseptic principles, and much space is also devoted to 
eclampsia, and other complications of labour and the 
puerperium. The chapter on the management of the 
child is worthy of praise, and the volume closes with an 
appendix setting forth the duties and responsibilities of 
the midwife, followed by a glossary of medical terms. 

• * 

• 

Dr. Porter Mathew’s “Clinical Observations on 
2,000 Obstetric Cases” abstracted from his thesis foe 
M.D. (Cantab.), is a well-digested synopsis of the results 
of the careful scrutiny of a large number of obstetrical 
records justified by an unusually large personal experi¬ 
ence The author’s remarks are characterised by much 
sound common sense, and command respect even when 
they do not conform to accepted views. He points out, 
for example, that the presenting part is usually much 
lower in primiparte than in multiparse before the onset 
of labour, owing to the greater abdominal tension in the 
former. He reminds us too, that the ear is a valuable 
guide to diagnosis in doubtful vertex presentations, a 
fact not alluded to in most text-books. We learn that 
in 1,200 cases, albuminuria was present in 20 per cent., 
the amount exceeding 1-20 in over 4 per cent., and primi- 
parse are five times as liable to this complication as 
multiparse. There are many other valuable hints which 
will repay perusal by those interested in obstetric prac¬ 
tice, and the work, brief though it may be, stamps the 
author as an original and painstaking observer “ dig mis 
intrare.” 

« • 

• 

The “ Strange Stories of the Hospitals,” by Frank 
Aubrey, is a book with a purpose. Its kindly object is 
sufficient to render it worth of consideration. It is dedi¬ 
cated to the Council of the Hospital Saturday Fund, and 
all profits arising from the sale of it are to be placed at 
the disposal of the managers. The author’s intention is 
to bring before the public what he terms " The Pic¬ 
turesque and Romantic Side of Hospital Work ” in the 
hope that the interest excited by this novel point of view 
may be the means of increasing subscriptions to medical 
charities. Of the stories themselves there is little to say. 
They are short and simple, and some of them are cer¬ 
tainly strange enough to warrant the old proverb with 
regard to truth and fiction. Such, for instance, is the 
tale of the “ Gold Idol,” in which we read of the terrible 
misfortunes that befell the successive owners of a little 
golden figure stolen by some South American explorers. 
If these tales excite an interest in hospitals and their 
motley inhabitants, the labour of writing them will not 
have been thrown away. 

• « 

* 

The book by Wirtzung, respecting which a correspon¬ 
dent asks our opinion, is probably the English translation 
of Jacob Mason, published in London by E. Ballifant, in 
1598, of Wirtzung s Praxis Medicime Universalis. “A 
generall practise of physicke; wherein are contained all 
inward and outward parts of the body, with all the 
accidents and infirmaties that are incident unto them, 
even from the crowne of the head to the sole of the 
foote ; also by what meanes (with the helpe of God) they 
may be remedied; very meete and profitable, not only 
for all phisitions, chirurgeons, apothecaries, and mid¬ 
wives, but for all other es'ato* whatsoever, the like 
whereof as yet in English hath not been published. 
Compiled and written in the German tongue, and now 
transl. into English, in divers places corrected, and with 
many additions illustrated and augmented, by Jacob 
Mason ” Wirtzung was born in 1600, and died in 1671. 

• His book went through seven German editions. To the 


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Fbb. 22, 1899. THE DEA.TH OF PRESI DEN T FAURE. The Medical Press. 203 


medical archaeologist it is interesting as showing the 
accepted theories of medical practice in the sixteenth 
century. Its market va'ue would be about IDs. t$d. 

NEW BOOKS AND NEW EDITIONS. 

The following have been received for review since the 
publication of our last monthly list: — 

Cassell and Co. (London). 

Year-Book of Treatment for 1899. By Various Contributors. Pp. 
473. Price 7s. tid. 

J. and A. Churchill (London). 

A Manual of Diseases of the Nervous System. Vol. I. The Nerves 
and Spinal Cord. By Sir W. B. Gowers. M.D., F.E.S., and 
James Taylor, M.D., F.K.C.P. Third Edition. Pp. 692. Price 
15e. 

H. K. Lewis (London). 

The Liverpool Medico-Chirurgical Journal. Vol. XXXVI. Pp. 
194. Price 38. 6d. 

Longmans, Greek, and Co. (London). 

Elementary Physiology. By Benjamin Moore, M.A. Pp. 295. 
Price 3s. fid. 

Oliver and Botd (Edinburgh). 

Notes on Surgery for Nurses. By Joseph Bell, M.D., F.R.C.S.Ed. 
Pp. 194. Price 2s. 6d. 

Patter and Clarke (London). 

King's American Dispensatory. New Edition. Rewritten and en¬ 
larged by Drs. Harvey W. Felter nud John Uri Lloyd. Two 
vole., 95(i pp. Price 4.50 dole, per vol. 

Young J. Pextlaxd (Edinburgh). * 

The Edinburgh Medical Journal. New Series. Vol. IV. Edited 
by G. A. Gibson, M.D., F.R.C.P.Ed. Pp. COO. 

The Scientific Press, Limited (London). 

The Nursing Profession : Howan 1 Where to Train. By Sir Henry 
Burdett, K.C.B. Pp. 241. Price 2s. 

Smith, Elder and Co. (London). 

St. Bartholomew's Hospital Reports. Vol. XXXIV. Edited by 
Norman Moore, M.D., and D'Arcy Power, F.K.C.S. 

The Union Steamship Compant (Londou). 

South Africa as n Health Resort, especially for Consumptive 
Invalids. By Arthur Fuller, M.B.,Ed., M.R.C.S. 

J. Whitaker and Sons (London). 

The Naval and Military Directory and Indian Army List for 1899. 
Pp. 656. Price 5s. 


THE DEATH OF PRESIDENT FAURE. 

From information which we have been enabled to glean 
from authoris: d sources, it appears that the sudden death 
of M. Felix Faure did not come upon his medical advisers I 
altogether as a surprise. Only last year, in the course 
of an examination for the purpose of ascertaining the 
exact nature of a painful affection of the left knee, it was 
discovered that the heart was nolably enlarged, and on 
consultation, unquivocal evidence was obtained of an 
atheromatous condition of the aorta, a form of degenera¬ 
tion the importance whereof is too well known to 
physicians to call for explanation. Some wasting of the 
muscles of the leg was noticed, but this promptly yielded 
to a course of massage and electricity and the limb ceased 
tocause any trouble. The existence of high arterial ten¬ 
sion inspired feelings of apprehension in the minds of 
those upon whom devolved the responsibility of advising 
the distinguished patient, and these found official utter¬ 
ance on more than one occasion though, for good and 
obvious reasons, it was not thought desirable or neces¬ 
sary to take the public into their confidence. 
The first symptoms of the attack which ultimately 
proved fatal were suggestive rather of an impend¬ 
ing attack of angina pectoris, great praecordial 
distress being complained of, with intense pallor and a 
tendency to syncope. Drs. Lannelongue and BergeroD, 
summoned in hot haste, almost at once remarked the 
gradual supervention of right facial paralysis, leading to 
distorsion of the features which was painfully evident 1 


even when lying in state and this placed the diagnosis 
on a 8ure footing. The pulse was 74 per minute and 
regular, though with occasional in ter mitten ces. Respi¬ 
ration was normal and consciousness was retained. Soon, 
however, the tongue became paralysed in its turn, and 
after a brief period the paralysis extended down the left 
side of the body. It was evident in short that a vessel 
had ruptured in the neighbourhood of the upper part of 
the medulla, and it was not less evident that a fatal issue 
was virtually inevitable. This gloomy prognosis was 
rapidly confirmed by loss of consciousness, which gradu¬ 
ally merged into coma, in which condition death super¬ 
vened, only three hours and a half after the first 
malaise. No autopsy appears to have been made, or if so 
the details have not been made public. 


THE LONDON UNIVERSITY. 

A conference between representatives of the Govern¬ 
ment, the University, and the Imperial Institute will 
shortly be held to consider the proposal for a migration 
of the University to the latter Institute under authority 
of the Act of last session. 

IDEAL SANITATION. 

The aspirations of theoretic sanitarians (at least, 
tho>e ideas which they are content to put for¬ 
ward for the present) have been formulated in a 
Bill introduced to the Commons by Sir Alfred Hickman 
and Sir Walter Foster. It provides that washerwomen 
shall furnish to the Medical Officer of Health lists 
of the owners of clothes which may be suspected 
of infection—that all infected persons shall cease busi¬ 
ness—and that books in public libraries shall be periodi¬ 
cally disinfected. Also that cow-keepers shall notify the 
sources of supply of their milk, the persons to whom it 
may have been distributed, and all cases of infective 
disease in their servants, and, also, of tuberculosis any¬ 
where. 


PROFESSIONAL EXPURGATION OBSTRUCTED. 

We learn with regret that, probably, both the London 
and the Dublin Colleges of Physicians will decide to 
oppose the very necessary and reasonable proposal of the 
Medical Council that a misdoer who has been struck off the 
Register for “infamous conduct” shall not be allowed 
to persist in the use of his diplomas for illicit practice, 
as mar>y such do. The Medical Council desires that it shall 
be declared that such use is illegal, and that the pub.ic 
shall be thus protected, but the oppressive dignity of 
these Colleges will not, it is feared, allow the pro¬ 
posal to be carried out lest some scintilla of their rights 
might be sacrificed. It would be a great pity that the 
Pontifical robe should be sullied for the good of the 
profession or the public. 

Mr. William Joseph Myles Starkib, who succeeded 
SirThos. Moffett as President of the Queen’s College, 
Galway, has been appointed Chief Commissioner of 
Education, and has thus opened the former office to 
competition. 

In response to the Right Hon. Mr. Balfour’s appeal for 
the endowment of Medical Research, Sir Frederick Wills 
has forwarded a cheque for £5 ,COO to the Treasurer of 
Guy*6 Hospital for work in this direction in the medica* 
school. 


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204 The Medical Press 


MEDICAL NEWS. 


Feb. 22, 1899. 


$arlmmentitrB ^ctos. 

Foreign Milk.— In reply to Mr. Warner, Mr. Chaplin, 
President of the Local Government Board, stated that 
foreign milk as soon as imported is subject to the same 
treatment as English milk, but obviously the regulations 
which apply to dairies and cowsheds in this country, 
cannot, of course, apply to dairies and cowsheds abroad. 
The matter is, however, of comparatively small import¬ 
ance, because while the consumption of milk is estimated 
at 600,000.000 gallons a year, 60,000 gallons only were 
imported during the ten months ending in January last; 
and, according to the latest returns, the quantity is de¬ 
creasing as compared with last year. 

The Metropolitan Asylums Boards.—M r. Chaplin, 
in reply to Mr. H. E. Kearley, said the Metropolitan 
Asylums Board were taking active steps to find suitable 
premises for invalid children. For children afflicted 
with ophthalmia two sites had been purchased, one on 
either side of the Thames, for buildings intended to ac¬ 
commodate 360 children. For children suffering from 
ringworm, negotiations were being made for the acquisi¬ 
tion of the Sutton Schools For children of defective 
intellect, managers had provided a home fortwenty girls 
sent by the Guardians. Homes had been provided for 
co ivalescents, one at Herne Bay for 134 children, and 
the ether at Margate for 41. 289 children had been ad¬ 

mitted to these homes. Another site had been purchased 
on the south coast on which to erect three houses to I 
accommodate twenty-five children each. These arrange¬ 
ments would provide for all the children requiring sea¬ 
side air. 

The Plague.— In reply to Dr. Tanner, who asked the 
Secretary of State for India if there was any foundation 
for the report from Bombay of a plague panic from the 
southern Kolar goldfields, and what steps were being 
taken to prevent further loss of life, Lord G. Hamilton 
stated that the latest information received was that 
during tho week ending Monday, February 13th, there 
were 12 plague seizures and 9 plague deaths in the Kolar 
district of Mysore. Nothing was said in that report as 
to any plague panic among the gold miners. The 
Mysore State, supported by the British Resident, and 
aided by the Government of India, he added, was 
sparing neither expense nor effort to combat the plague 
wherever it appears in Mysore territory. 

Tuberculous Cattle.— Mr. Warner asked the First 
Lord of the Treasury whether he proposed to introduce 
any Bill for appointing Government inspectors to inspect 
and condemn cattle afflicted with tuberculosis, as uniform 
action all over the country was most desirable on this 
subject, and as one private Bill had been introduced by a 
corporation to give its own inspectors these powers out¬ 
side the municipal boundaries. Mr. Long, who answered 
the question, said it was not the intention of the Govern¬ 
ment to appoint inspectors for the purpose suggested, 
and, as far as the legislation to which he referred was 
concerned, it was impossible to say what powers in this 
direction Parliament would grant to local authorities. 

Company Pharmacy in Ireland.— A somewhat sym¬ 
pathetic reply was elicited fr^m the Chief Secretary to 
the qu3stion, by Dr. Tanner, respecting unqualified 
traders who had been prosecuted for offences under the 
Irish Pharmacy Act, and, though convicted, were enabled 
immediately to extricate themselves from the penalties 
out of the Act, and pursue their illicit trade by turning 
themselves into a limited company. The Chief Secretary 
said that “ the subject had been brought before him by 
the society, and would call for consideration whenever a 
general amendment Act for the whole kingdom is pro¬ 
posed,” but he did not say when there was any chance of 
this. 


Zaboratort} Jlotcs. 


“ HIPI ” MUTTON ESSENCE. 

We have received from Messrs. George Nelson Dale 
and Co., of 14 Dowgate Hill, E.C., samples of “ Pure 
Mutton Essence (Hipi Brand). The preparation is one 
which fulfils a distinct want, and as it compares very 


favourably with similar preparations of beef, it will be 
the means of introducing a welcome relief to the 
monotonous dietary of the febrile patient. Our analysis 


gives the following results:— 

Moisture . ... 42’0 

Nitrogenous matter, including gelatine ... 43 0 

Mineral matters . 8”4 

Non-nitrogenou8 extractives . 6 6 


1000 

The mineral matter consists merely of phosphates. 
The fatty constituents of mutton are eliminated during 
the process of manufacture, and the composition of the 
extract justifies its claim to be considered as an article 
possessing a high dietetic value, especially as the pro¬ 
portion of merely stimulating principles is small com¬ 
pared with that of the really nutritive substances. The 
flavour is satisfactory, and the product is certainly one 
which merits a prominant place in invalid dietetics. 


PHENALGIN. 

Phenalgin is an ammoniated, synthetic, coal-tar pro¬ 
duct, manufactured by the Etna Chemical Company 
of New York. Technically described as belonging to 
the amido-benzine series, it presents itself in the form of 
a fine white powder, with a characteristic ammoniacal 
odour. Being practically insoluble, it has but a faint 
ta«te, and is consequently not disagreeable to take. It 
differs from most of the analgesics in that it exerts a 
stimulating effect on the heart. In doses of ten grains 
and upwards a sedative effect is produced, in addition to 
its unquestionable analgesic action on the sensoiy 
apparatus of the nervous system. These various actions 
are precisely those which a consideration of the chemical 
constitution of Phenalgin would lead one’ to expect, and 
this is a striking confirmation of the truth of the thesis 
promulgated some years since by Dr. Lauder Brunton in 
respect of the inter-dependence of chemical constitution 
and physiological action. The stimulating effect of the 
ammonia constituent is first perceived, and this is soon 
followed by a soothing sensation due to the gradual sub¬ 
sidence of the painful manifestations. Phenalgin appears 
to be an ideal agent for the relief of insomnia 
associated with neuralgic or rheumatic distress. Simi¬ 
larly, in dysmenorrhooa, not dependent upon obvious 
organic lesions, Phenalgin procures prompt disappear¬ 
ance of the pelvic misery. Like most drugs belonging to 
this series it is possessed of anti-pyretic properties and, 
as already stated, it has hypnotic as well as anodyne 
properties which enable it, in certain cases, to take the 
place of opiates, the use of which is attended by such 
marked gastro-intestinal disturbance. Its value in the 
treatment of acute rheumatism has not as yet been esta¬ 
blished on as firm a clinical basis as in the case of 
neuralgic and so-called functional affections accompanied 
by pain, but there is no obvious reason why it should 
not prove of service in combination with other anti¬ 
rheumatic remedies 

Phenalgin is sold in powder, and in 2\ grain tablets 
for convenience of administration. As it is insoluble, 
the drug is best given in the form of tablets, or, if it 
be desired to associate it with other remedies, in the 
form of cachet3. 

The sole agent for the sale of Phenalgin in Eng¬ 
land is Mr. E. J. Reid, 11, Dunedin House, Basinghall Street, 
London, who we understand, will send free samples to 
any medical practitioner, on application. 

-♦- 

^ebtotl ^Ictos. 

Milk In Relation to Tuberculosis. 

The Aylesbury Dairy Company, which is one of the 
largest purveyors of milk in the country, has adopted a 
very wise attitude in the now popular crusade against 
tuberculosis, and its action should remove any anxiety in 
the public mind regaiding the purity of the milk supplied 
from its farms. We have previously referred to tho pre¬ 
cautions originated by the directors in 1868, but these 
have been developed from time to time as science and 


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Feb. 22, 1899. 


MEDICAL NEWS. 


The Medical Pbbss. 205 


experience have suggested, and the farms and distri¬ 
buting branches are now under the inspection of no lesB 
than fifteen medical officers, six veterinary surgeons, and 
four public an.Vysts. Each farm from which the com¬ 
pany draws ito nyplies is visited frequently and regu¬ 
larly by the Me-Dal Officer of Health for the District; 
the sanitation, health of the farm labourers and their 
families, &c., all being carefully investigated by him, and 
the water used periodically analysed, both chemically 
and bacteriologicaJly, in the company’s laboratory. In 
case of anything being found unsatisfactory, the milk is 
at once stopped, but the farmer is paid for it in full; 
this guarantees him against loss, and makes it his 
interest to give immediate information. Further, a 
sample from every churn of milk received is taken and 
tested before the milk is sent .out to the consumer, 
further samples are taken from the carriers in the 
streets and on their return to the depots. In addition to 
the foregoing very stringent measures, the directors 
have, in view of the question of tuberculosis now so 
prominently before the public, taken the further precau¬ 
tion of ! having the whole of the cows from which their 
supply is derived individually examined by the Principal 
of the Royal Veterinary College. These precautions go 
even beyond the action recommended by the Royal Com¬ 
mission on Tuberculosis, and it affords us much pleasure 
to chronicle these important precautions, pour encourager 
les autres. 

nlversity College Hospital. 

Sib John Stirling Maxwell, Bart., M.P., has con¬ 
sented to preside at a Festival Dinner in aid of the funds 
of University College Hospital, at the Whitehall Rooms, 
Hotel Metropole, on Thursdav, June 15th, next. 

Dublin Hospital Sunday. 

The meeting of the Council of the Fund, preparatory 
for the annual public meeting, was held last Thursday, 
the meeting not being open to the Press. The total 
amount received (£4,285) was £71 worse than la-t year, 
and would have been worse still but for a donation of 
£100 by a baronet in the noith of County Dublin. The 
distributable amount is £4,020. 

A Viet m of Alcohol. 

An inquest was held at Liverpool last week on the 
body of Mr. Albert Ryan, a medical practitioner in 
charge of a dispensary. The evidence showed that death 
was attributable to an epileptic seizure, the result of 
chronic alcoholism, and a verdict to that effect was 
returned. 

Congress of Medical Life Examiners. 

The first international congress of medical examiners 
for life assurance is announced to take place at Brussels 
on September 25th. In view of the interest of many of 
the problems to be discussed, the meeting is likely to be 
largely attended, and it cannot be gainsaid that there is 
ample material for very useful discussions 
Diphtheria at Aldershot 

An inspector has been dispatched by the Local Govern¬ 
ment Board to Aldershot to inquire into the causes of 
the prevalence of diphtheria in that district. For some 
time past the comparatively large number of deaths from 
this disease in both the camp and the town has given 
rise to anxiety. 

Poisoning by Atropine. 

A strange case of poisoning, placing the lives of a 
whole family in jeopardy, is reported from Watford. 
The symptoms were those of belladonna poisoning, and 
the servant has since been charged with maliciously 
mixing with the pudding the contents of a bottle of 
“eye water” belonging to her master. Thanks to 
prompt antidotal measures four of the six victims are out 
of danger, but two still remain in a precarious condition. 

The Scientific Value of Alcohol. 

A meeting of the British Medical Temperance Asso¬ 
ciation was held on the 17th inst. at the Conjoint 
Examination Hall, Victoria Embankment, London, when 
Capt. P.W. O’Gorman, D.P.H. .Indian Medical Service.read 
a paper on “ The Scientific Valuation of Alcohol in Health.” 
Dr. Morton presided in the absence of the president, Pro¬ 
fessor Sims Woodhead, through illness. The paper gave 
an excellent summary of facts and experiments with 


respect to alcohol. The conclusions of the lecturer were 
that alcohol did not act as a food, that it did not retard 
waste but was a protoplasmic or tissue poison, that it 
did not impart energy, but was essentially a nerve 
paralyser, that it was dangerous both in hot and cold 
climates, and that it did not conduce to longevity. He 
pointed out that it reduced vascular tension, and that 
Prof. Martin had shown that the strength of the heart 
contraction is diminished by alcohol. Dr. Ridge, in 
moving a vote of thanks to the lecturer, said he hoped 
the paper would be published, as he had found many 
medical men entirely ignorant of the immense number of 
facts which had accumulated proving the harm done by 
alcohol even in moderate doses, and the advantages of 
total abstinence; these things were not taught in the 
usual way, but there was some hope for the future, as 
there were between 300 and 400 medical students who 
were abstainers and belonged to the Association. The 
vote was seconded by Dr. Claude Taylor, and carried 
unanimously. 

The field Trust for the Education of Women. 

The Trustees of this Fund have decided to offer a 
Scholarship at the London (Royal Free Hospital) School 
of Medicine for Women in memory of their valued co¬ 
trustee, Miss Bostock, of Penmaen, Glamorganshire, 
lately deceased. The value of the Scholarship will be 
£60 a year, tenable for two or four years, and awarded on 
the result of the Preliminary Scientific Examination of 
the University of London. The Bostock Scholar must 
re id for the London Medical Degree. Further particulars 
may be obtained from the Hon. Secretary of the Reid 
Trust, Bedford College, York Place, London, W. 

An Unqualified Apothecary. 

Thomas Allen, of Commercial Road, E., an unquali¬ 
fied practitioner, whose name cropped up a year or two 
since in connection with a charge of covering againr.t 
one Costelloe, has been fined £20 and costs for having 
acted as an apothecary without authority. The defend¬ 
ant had previously been cautioned by the coroner in 
respect of his conduct. 

The Mortality of Foreign Cities. 

The following are the latent offic.al returns, and repre¬ 
sent the last, weekly death-rate per 1,000 of the several 
populations :—Bombay 89, Madras 44, Paris 20, Brussels 
20, Amsterdam 14, Rotterdam 15, The Hague 14, Copen¬ 
hagen 17, Stockholm 27, Christiania 34, St. Petersburg 
28, Moscow' 25, Berlin 17, Hamburg 14, Dresden 16, 
Breslau 21, Munich,—, Vienna 21. Prague 26, Buda 
Pesth 22, Trieste 33, Rome 18, Venice 24, New York 
(including Brooklyn), —, Philadelphia —. 

PASS LISTS. 

Army Medical Service. 

The following is an official list of successful candidates 
for Commissions in the Royal Army Medical Corps, at 
the recent examination in London, arranged in order of 
merit:— 


Delay, G. G . 

Marks. 

... 2.393 

Munson, 0. C. 

Marks. 

... 2,1)52 

Wurren, F . 

... 2,388 

Onruel, H. B. 

... 2,i47 

Cunningham, E. A. 

... 2,385 

Fnlkner, F. H. 

... 2,143 

Crawford, V. J. 

... 2,3*4 

Hart, H. F. 

... 2.025 

Palmer, F. J. 

... 2,375 

Winslow, L. F. F... 

... 2.016 

Challis, 0. . . 

... 2,: WO 

Norman. H. H. 

... 1,1*71 

Siuison, H . 

... 2,316 

Chopping, A. 

... 1,935 

Stokes, T. G. N. ... 

... 2,282 

Prescott J. J. W. ... 

... 1.930 

Butler, S. G. 

... 2,151 

Eisner, 0. W. A. ... 

... 1.1*25 

Irvine, G. H. 

. . 2,140 

Webb, A. L. A. ... 

... 1.914 

Woodside, W. A. ... 

... 2,133 

Ellery, E. E. 

... 1.899 

Blackwell, W. R. ... 

2,109 

Nicholls, H. M. ... 

... 1,846 


Indian Medical Service. 


The following is an official list of candidates for her 
Majesty’s Indial Medical Service who were successful at 
the competitive examination held in London during the 
present month, arranged in order of merit 



Marks. 


Marks- 

C. Dykes . 

... 3,457 

A. B. Fry . 

... 2,708 

W. E. Mckechnie ... 

... 3,276 

E. C. G. Maddock... 

... 2,685 

E. D. W.Greig ... 

... 3.275 

A.W. Tuke. 

... 2,682 

D. McCny . 

... 3.119 

F. C. Lewis 

... 2,574 

J. J. Urwin. 

... 3,069 

M. W. Manuk 

... 2.552 

W. F. Harvey 

... 3,037 

W. H. Tucker 

... 2.432 

H. D. Peile. 

... 2,990 

C. S. Lowson 

2,390 

W. C. H. Forster ... 

... 2,949 

J. H. L. Beaman 

... 2,369 

D. H. F. Cowin 

... 2,927 

W. H. Dickinson ... 

... 2.295 


Digitized by Vj 









206 Thb Medical Pbess. NOTICES TO CORRESPONDENTS. Feb. 22, 1899. 


Notice* to 

(Eorrespottbents, Short 5f*tter*, &c. 


wr Correspondents requiring a reply in this column are par¬ 
ticularly requested to make nse of a distinctive signature or 
initial», and avoid the practice of signing themselves “ Reader,” 
"Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
■pared by attention to this rule. 

Local Reports and News.— Correspondents desirous of draw¬ 
ing attention to these are requested kindly to mark the newspapers 
when sending them to the Editor. 

Mr. Albert E. Morison (Hartlepool).—Your paper on “Four 
Cases of Intussusception.” is marked for early insertion A note 
has been made of the other request. 

The Medical Directory for 1891* gives the number of t racti- 
tionere of all categories as dose upon 35,u00. This represents 
an increase of ninety-over over the figures of the previous j ear— 
an extremely small excess. London alone accounts forti.117 medical 
men of this total, the rest of Englaod absorbing between fifteen 
andsix een thousand practitioners. In the naval, military, and 
Indian services there are 2,52* doctors. 

Professor Gaillard’s Clinical Lecture on “ Pyo-pnenmothorax 
from Necessity,’’ received from our Paris correspoudeu' with 
thanks. 

D. H. G.-Great improvement has already been effected in the 
direction you advocate, only twenty-eight out of 7,428 inquests 
having been held in public-nouses. 

THERMOMETRIC CALCULATIONS. 

From Centigrade to Fahrenheit, 

’Tiseasy to divine— 

You first must use arithmetic 
And multiply by nine. 

The answer now divide by five. 

And then you have in view 
The very number that you seek 
By adding thirty-two. 

Prom Fahrenheit to Centigrade, 

However, it is plain— 

You first must take the thirty-two 
And multiply again; 

But this time only by the five 
And then you draw a line 
Straight up and down, in order that 
You may divide by nine. 

(The Corpuscle.) 

Dr. Wsi, Ewart’s paper on “ The Relation of Gout to Rheuma¬ 
toid Arthrlti* ’ ’ received. 

Dr. J. R. Wolfe (Melbourne). - Paper on “Serum Inoculation ” 
received. 


^Ratings of the §ocictics anb 'Jecturcs. 

Wbdnesdat, February 22nd. 

Rotal College of Surgeons of Bngland.— 5 p.m. Dr. T. G. 
Brodie: Erasmus Wilson Lecture on " The Chemical Pathology of 
Some Infective Diseases.” 

Dermatological Society op Grbat Britain and Ireland 
(20, Hanover Square, W.)—4.30 p.m. Informal Exhibition of 
Cases. 5 p.m. Ordinary Meeting. 

Hunterian Society.— 8.30 p.m. Mr. C. J. Symonds: The Value 
of Individual Symptoms in Perforative Peritonitis, more especially 
in regard to operation. 

Thursday, February 23rd. 

Royal Institution of Great Britain.— 3 p.m. Professor 
McFadyen on Toxins and Antitoxins. 

Friday, February 24th. 

Royal Collbob of Surgeons of England— 5 p.m. Dr. T. G. 
Brodie: Erasmus Wilson Lecture on “The Chemical Pathology of 
Some Infective Diseases.” 

WEsr Kent Mbdico-Chirurgical Society (Royal Kent Dis- 

K iusary, Greenwich Boad, S.E.).-8 43 p.m. Special General 
eeting. 

Clinical Society of London (20 Hanover Square, W.).-8.30 
p.m. Clinical Evening. The following cases will be shown:—Dr. 
Rolleston: Multiple Periarticular Bursa-.—Dr. F. P. Weber: Re¬ 
commencement or Muscular Atrophy long after Infantile Paralysis. 
— Dr. Cahill: Unilateral Hyper'rophy of the Female Breast re¬ 
sulting from Pressure.—Or. Caley: A Case of Tabes Dorsalis with 
Arthropathy and Pnlmouary Fibrosis.—Mr. G. B. Hunt: Rheu¬ 
matoid Arthritis with enlarged 8pleen and Glands in an Infant.— 
Dr. Wasbboum and Mr. W. Arouthnot Lane: A Patient from 
whom a Cerebral Tumour was removed seventeen months ago.— 
Dr. Mooat-Biggs: Bxt-eme Case of Factitious Urticaria.—Dr. R. 
Crawfurd: Myositis Ossificans Progressiva.—Dr. L. Guthrie: A 
Case of Congenital Paralysis.—Dr. StClair Thomson: A Man aged 
Sfl years complaining of Dysphagia found to be affected with Uni¬ 
lateral Paralysis of the Eighth and Bulbar Nerves.—or. L. Gnth- j 
rie: Acute Atrophic Paralysis affecting both Upper Extremities. 
—Mr. E. W. Roughton: Tumour of Maxilla of Doubtful Nature. I 
Patients will be In attendance at 8 p.m. , 


Royal Academy op Medicine in Ireland.— Pathological Sec¬ 
tion.—The Sec. (Dr. E. J McWeeney): Case of Septico-Pyeemia, 
with Ulcerative Endocarditis, secondary to Croupous Pneumonia 
and due to the Diplococcm of Fraenkel.—Dr. J. B. Coleman: Case 
of H-.dgkln’s Disease.—Mr. G. Jameson Johnston: (1) Epithelioma 
of lip, removed from youth. 18 years old; (2) Tumour of Breast 
(? 8cirrhosis). from youth, aged 17 years.—Dr--. J Magee Finny 
and A. C. O Sullivan: Sarcoma of the 8uprare-.uls and secondarily 
of the Lung—The Secre ary (for Dr Cole t:.-er): Melanotic 8ai- 
coma of the Onoroid. — Dr. Knott: Pathological Fibulte and 
Patella-.—Mr. W. I. Wheeler: Specimen showing situation of 
Retro-Uterine Abscess.—Mr. Henry Gray Croly: Brodle’s Abscess. 


laomcuB. 

Dalrymple Home for Inebriates, Rickmansworth.—Resident 
Medical Superintendent, married. Salary £200 per annum, 
unfurnished house, food, coals gas. &c.. provided. (Seeadvt.) 

Essex County Asylum, ’B.entwood.—Juuior Medical Assistant 
Officer, unmarried Salary, £120 per aunum, with board, resi¬ 
dence, and washing. Applications to the Medical Superin¬ 
tendent. 

Halifax Union Workhouse.—3t. Luke's Hospital.-Assistant Medi¬ 
cal Officer, unmarried. Salary. £100 per annum. Applications 
to tlie Clerk to the Guardians. Union Offices, Halifax. 

Hereford Central infirmary.—Senior House Surgeon; unmarried. 
Salary £:»0 per aunum, with furnished rooms, board, washing 
gas. coals, aud atteudance. 

Hertfordshire County Asylum, Hill End, St. Albans.—Assistant 
Medical Officer, unmarried. Salary commencing at £130 per 
anuum, with fu nislied quarters, board, washing, and 
attenoance. 

Leeds Union.—Assistant Medical Officer for the Workhouse, 
Schools, and Infirmary; unmarried. Salary. £100 per annum, 
with board, washing, apartments, and atteudance. Applica¬ 
tions to the Clerk. Poor-law Offices, East Parade, Leeds. 

Manchester Royal Infirmary and Dispensary.—Au Aural Surgeon 
aud an Assistant Surgeon on the honorary staff. The former 
must be a graduate of a University of the British Isles; the 
hitter must be a F.R.O.S. (See advt.) 

Norfolk aud Norwich Hospital, Norwich.—House Surgeon for 
two years: unmarried, salary £80 per annum, with board, 
lodgiug. and washing. 

University of Glasgow.—Chair of Pathology. The normal salary 
of the Chair is fixed by Ordinance at £1,101 For particulars 
as to applications, see advertisement in another column. 

Windsor Royal Infirmary.—House Surgeon; unmarried. Balary 
commencing at £100 per annum, with residence, board, and 
attendance. 


appointment*. 

Arnold, E. G. E„ M.B., B S.Dnrh., M.R.C.P.Lond., M.R.C.8.. 
Senior Medical Officer to the Toxteth Workhouse. 

Booth, J., M.B., B.Ch.Irel., House Surgeon to the South Charit¬ 
able Infirmary and County Hospital, Cork. 

Cowell, A. R., M.B.Camb., L.R.C.P.Lond.. M.R.C.8., Medical 
Officer pro tern, to the Eastern portion of the Parish of Hamp¬ 
stead. 

GLA8SON, C. J., M.D.Brux., L.R.C.P.Lond., M.R.C.S., Medical 
Officer to the Third 8auitary District of the Romford Union. 

Knox, J. E.. M.B. C.M.Edin., Medical Officer of Health to the 
Hast and West Molesey Urban District. 

Marshall, C. Divbrecx, F.R.C.8.Bng., Ophthalmic Surgeon to 
the Victoria Hospital for Sick Children, Chelsea. 

Murray, John, M.B., F.H.C 8., Surgeon to Out patients to the 
Paddington Green Children's Hospital, London. 

Nariman, B. K., M.B., B.Sc. (Public Health), E.M.Edin., Assis¬ 
tant Surgeon to the South Dispensary, Liverpool. 

Ogilvt, Alec. M.D., F.R.C.8.I., Surgeon to the Bristol Bye Dis¬ 
pensary. 

8tonb, Frederick W. 8., L.R.C.P. & S.Irel., Public Vaccinator 
to the Bitton District. Warmley. 

Taylor. Jambs. M.A., M.D.. F.R.C.P., Physician to the Royal 
London Ophthalmic Hospital, Moorfields. 

Turner. C. E., L.R.O.P.'xjud., M.R.C.8., House Surgeon to the 
Royal Bucks Hospital, Aylesbury. 


#irth*. 

Haldane.— On Feb. 13th at Viewforth. Bridge of Allan, N.B, 
the wife of William Haldane, M.D., F.R.C.P., of a son. 


Carriage*. 

Woods—Chalonbr-Smith.— On Feb. llth. at St. Bartholomew’s 
Church, Dublin, Hugh Woods, M.D., of Hlghgate, to Tempe, 
elder surviving daughter of the late John Chaloner-Smith, 
C.E., of St. Helen’s, Bray, co. Wicklow. 


geaths. 

Monckton.— On Feb. 16th, at Wimbledon, Mina, widow of the 
late Stephen Monckton, M.D., F.R.C.P., of Maidstone. 
Ransford. — On Feb. 12th, Gifford Ransford, M.D.Durh., of Sussex 
Square, London, W., aged 5*!. 

Rob.—O n Feb. 10th, in London, Edward Roe, M.ACantib., 
L.R.C.P., M.RX.S.Eng., of Lyndhuret, Hants, aged 53. 


Digitized by booQ le 




March 1, 1890 


Tha Medical Press and CT^ar Advertiser. 


xm 


“Allenburys” Foods 


FOR 

= ^r i .... infant Feeding 1 

A PROGRESSIVE SERBEf OF FOODS. 


The Foods constituting the series described below are not interchangeable, but should 
be used in succession as indicated. Perfectly sterile in themselves, they are best given 
with the “Allenburys” Feeder, which is capable of easy and complete sterilization* thus 


presenting a physiologically accurate diet, 
products of decomposition. 

THE 

“Allenburys” Milk Food No. 1 

Affords, when prepared lor use, a correct substitute 
for human milk. It is manufactured from fresh 
cow’s milk, so modified as to present all the 
constituents of human milk in their true relative 
proportions. Being in a desiccated and sterilized 
form, it requires only the addition of boiled water to 
obtain a pure and sterile food suitable for infants 
during the first three months of life. 


THE 

“Allenburys” Milk Food No. 2 

Is identical with No. i, with the addition of 
small quantities of maltose, dextrine, and soluble 
phosphates derived from the digestion of whole 
meal with Malt Extract. These ingredients are 
a valuable adjunct to the increasing needs of 
digestion, yet the Food is readily and easily 
assimilated, there being no unconverted starch 
present. The No. 2 Food is designed for children 
between three and six months of age. 


free from all fear of contamination by the 

THE 

“Allenburys’’Malted Food, No.3, 

USUALLY KNOWN AS 

Allen & Hanburys’ Malted Infanta’ Food, 

Is not a milk, but a purely farinaceous Food, 
prepared by improved methods after Baron von 
Liebig’s formula. The basis is fine wheaten flour, 
which has been thoroughly cooked and partially 
digested by an active Malt Extract, so that a 
large proportion, but not all of the starch has been 
converted. It is particularly rich in soluble 
phosphates and albumenoids. 

This Food should be given from six months 
and upwards. For the first month or so after the 
change of diet it is generally advisable, instead of 
using cow’s milk, to employ the “ Allenburys ’’ 
Milk Food No. i or No. 2 in preparing it. The 
demand on the child's digestive organs is less 
abrupt, and a humanized milk is used in place of 
the more indigestible cow's milk. This precaution 
is specially recommended in the case of delicate 
children. 


The “Allenburys” Feeder. 

This bottle has the nipple at one end and a valve-stopper at the other, so that, both 
removed, it can readily be cleansed under the tap. The valve admits 
air behind the column of milk, thus avoiding the swallowing of air 
and the resulting wind-colic ; while the rubber nipple is easily 
detached, and can be turned inside out. The bottle is graduated 
approximately in ounces » 

\ The “Allenburys” Thermometer, in nickel 
v case, as figured, is provided for determining the 

B right temperature at which the Foods should be 
given, and for general Nursery use. 

Allen & Hanburys Ltd • y Lombard Street, London. 

Infanta* Food Manuf actory: WARE MILLS, HERTFORDSHIRE. 

W For farther detail* concerning these Foods, tee succeeding numbers of the British Medical Journal and Lanai 

D 

C 




Digitized by 


Google 



xiv 


The Medical Press and Circular Advertiser. _ March 1, i89t» 


Why is 


Because 


VIBRONA contains all the tonic and aromatic principles 
of Cinchona and is therefore superior to Quinine alone. 


Becaus e VIBRONA is pleasant to take, and does not p roduce the 
headache, deafness, or other d isagreeable se nsations caused 
by Quinine. 


Because 



VIBRONA is entirely free from Coca, “ the third scourge of 

humanity.” (vide British Medical Journal.) 


Because 


Because 


Because 


VIBRONA has proved invaluable in the treatment of 
Anaemia, Neuralgia, Insomnia and Nervous Exhaustion. 

VIBRONA is found to accelerate in a remarkable degree 
recovery from Diphtheria, Influenza, Pneumonia, Typhoid, 
and other wasting diseases. 

VIBRONA, not being a secret remedy , has gained the 
confidence of the highest medical authorities. 


VIBRONA . 

VIBRONA -SHERR V 
VIBRONA ■ CHAMPA ONE 
VIBRONA-MALT 


Supplied by all leading 
CHEMISTS, WINE MERCHANTS 
AND STORES 


per bottle 4/-., per dozen 45/- 
per bottle 2/9 , per dozen 30/- 
per doz. pints, 38 /-, per case 72/- 
per bottle 2/6, double size 4/6 . 


Or carriage paid froa 
FLETCHER, FLETCHER ft Ca., 
HOLLOWAY, LONDON, N. 


Digitized by v^.ooQle 




She IgWieal |#tess and ®itettlat. 


“ SALUS POPULI SUPREMA LEX.” 


Vol. CXVIII. WEDNESDAY, MARCH 1, 1899. No. 9. 


(Original Communications. 


ON THE RELATION OF GOUT 

TO 

RHEUMATOID ARTHRITIS. 

Opening Remarks to a Discussion before the 
North-West London Clinical Society, 
February 15th, 1899. 

By WM. EWART, M.D., F.R.C.P, 

Senior Physician to St. George’s Hospital and to the Belgravt 
Hospital for Children; Joint Lecturer on Medicine in 
the Medical School of St. George’s Hospital. 

In opening a discussion in which so many are invited 
and ready to take part my most important duty is to be 
brief ; and a further duty is to submit for your considera¬ 
tion some of those points which seem to be most in need 
of elucidation. 

The leading note in my few remarks will be that the 
relation between gout snd rheumatoid arthritis is rather 
accidental than essential, and that when the two affec¬ 
tions happen to combine, this conjunction is but one of 
many varieties included under the broad heading to 
rheumatoid arthritis. 

The relationship between gout and rheumatoid arthri¬ 
tis may be profitably considered from two points of view 
—the purely theoretical or pathological aspect, including 
their aetiology and their morbid anatomy, and the prac¬ 
tical or clinical aspect, which is concerned with the 
natural history of the diseases, with their diagnosis and 
with the results of their treatment; and it is only from 
a joint study of all those aspects that we can hope to 
derive any true insight into the relation which may exist 
between them. 

Within this hour it would be impossible to deal sys¬ 
tematically with so large a subject, but out of it arise a 
few definite questions, to which I may at once call your 
attention. I venture to submit to you the following: — 

1. Are gout and rheumatoid arthritis directly anta¬ 
gonistic, so as to exclude each other; or are they capable 
of affecting the same subject ? 

2. If not mutually exclusive, are they capable of 
actually coexisting, or can they only occur at an interval 
of time in the same individual ? 

3. If the relation is one of sequence rather than of 
coexistence, does rheumatoid arthritis pass into gout, or 
is it gout which may lapse into rheumatoid arthritis ? 

4. The remaining questions are those of diagnosis and 
of treatment, a discussion of which cannot fail to be of 
practical use. 

The Pathological Uncertainty as to Rheumatoid 
Arthritis. 

At the outset I encounter a difficulty which others 
may also realise. Whilst gout, in spite of the obscurity 
of its aetiology, is probably, for all of ub, a sufficiently 
definite clinical unit, and whilst we are all probably 
agreed as to its material basis, I am not confident that 
under the name of rheumatoid arthritis we all recognize 
a thoroughly well defined and uniform disease. Yet some 
general agreement as to the meaning of the term is 
essential to the success of the discussion. 

Most of us have probably been struck with the variety 
of conditions included under that name, and with the 
number of theories which have been put forward, and 
this must incline us to suspect that we may have to deal 
not so much with different phases and with different 
presentments of a single disease, as with different affec¬ 


tions among which at least two and probably three or 
more separate diseases will ultimately be isolated. 

Looking specially at the clinical aspects, I have long 
been impressed with an apparent distinction between two 
*ets of cases, the group of “ gouty ” rheumatoid arthritis 
uid that of “ rheumatic ” rheumatoid arthritis; but I 
im willing to admit that this is too superficial and per¬ 
haps too exclusively clinical a division which, moreover, 
ieals only with a limited section. There is a larger sec¬ 
tion comprising various types which are neither gouty 
aor rheumatic. 

The futility of former endeavours to explain all cases 
by any one theory has led to an attempt to split up the 
group, and to contract the boundaries of rheumatoid 
arthritis by excluding the chronic senile monarthritic 
variety. And recently part of the group has been re¬ 
constructed on a bacteriological basis. You are pro¬ 
bably all acquainted with the bacteriological work of 
Bannatyne, Wohlmann, and Blaxall. Max Schuller, (a) 
to whom we owe the earliest bacteriological observations, 
now goes so far as to separate as the strictly infec¬ 
tious form of rheumatoid arthritis, the villous affec¬ 
tion of the synovial membrane, Arthritis chronica villosa, 
which he has been able to produce experimentally in 
animals, and which he has treated successfully in man, 
both surgically and by intra articular medication. 

I need not point out that the infectious group can 
present but little affinity with gout, and that further 
evidence must be forthcoming before we can admit that 
a bacterial origin has been proved in all the varieties. 
This would still leave upon our hands the monarthritic 
varieties which are not senile, and two or three different 
types of the polyarthritic affection, besides the affections 
following upon traumatism, and upon septic, gonorrhoeal, 
tuberculous, and syphilitic lesions. And we may, there¬ 
fore, still ask. What is Rheumaotid Arthritis P 

The Characteristics of Rheumatoid Arthritis. 

The definition of rheumatoid arthritis would have to 
be reduced to a very simple expression to fit all cases— 
that of the pale child with symmetrically swollen and 
shapeless joints, and, perhaps, as in the cases recently 
described by Dr. G. F. Still, with swollen glands; of the 
young adult with stiffened articulations and unbending 
spine, of the woman of mature years with Heberden’s 
nodules and easily excited articular pains, and of the 
veteran whose longevity declares his original soundness, 
but who has long been crippled with a wasted and ebur- 
nated hip-joint. 

In this long gallery of deformities, of which I have 
only mentioned a few, the chief common features are 
constitutional and local. Constitutionally the affection 
is chronic and progressive when left to itself; it is a 
disease of depressed nutrition and of debility. Locally 
it is also chronic and progressive if allowed to advance. 
Its lesions are not metastatic but permanently localised. 
They are essentially degenerative, with marked ten¬ 
dency to overgrowth In varying degrees according to 
cases, it affects each of the constituents of the joint, but 
more markedly perhaps the cartilage. But the cause of 
the degeneracy is not obvious, though its results are 
considerable. In this it differs from gout. And from 
the common form of rheumatism it differs in all cases by 
the extent of the destruction and by the permanence of 
the lesions; in the monarthritic varieties by the striet 
limitation, and in the polyarthritic varieties, by the 
symmetry as well as by the number of the joints affected, 
and there is also a greater tendency to an implication 


(a) Cf. Verlihnndl. des xv. Congress for Inn. Medicin. 


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208 Th* Mkdical Prkbs. 

of the small joints as well as of the larger ones; whilst 
in acute oasee the acuteness is less than in rheumatism, 
and there is less profuseness and acridity of perspira¬ 
tion. The constitutional influence of the disease is not 
marked by visceral degeneracies ns that of the kidney in 
gout, nor so frequently by complications such as those 
of the serous membranes and of the heart, as in rheu¬ 
matism. 

Thus, with the exception of the marked peculiarity of 
the degeneration, those pathological features which 
are common to all cases are to a great extent negative, 
and consist of nothing more definite than the permanent 
localisation and the dystrophic character of the lesions. 
They point in other words to perverted local nutrition 
combined with constitutional debility and mal-nutrition 
as to the essentially rheumatoid characteristics. 

The Theories. 

Owing to this comprehensive broadness of type, con¬ 
siderable scope is given to our speculations as to the 
latent cause, and theories have been freely supplied. To 
call the affection gout is, pathologically speaking, out of 
date, though not always out of fashion. To regard it as 
rheumatism is a large postulate in face of many patho¬ 
logical and clinical discrepancies; and we cannot forget 
that the aetiology of rheumatism itself is a mystery. 
Some regard rheumatoid arthritis as a form of senile 
decay, and others as the outcome of some traumatic 
lesion which has failed to recover, an explanation which 
is plausible only in the monarthritic cases. But these 
views hardly explain the early adult and especially the 
juvenile cases, and those case3 in which no lesion can be 
found. Lastly, we have the more ambitious theories 
which seek an adequate explanation in some disordered 
state of the great agents of nutrition, the blood on the 
one hand, and the nerveB on the other; these are the 
neural and the humoral or toxic theories. 

It is obvious that these theories cannot all be right— 
yet they represent the conclusions of thoughtful 
observers, and. perhaps, none of them may be absolutely 
wrong, but they may be partially, if not absolutely 
applicable in different cases. The fact of the discrep¬ 
ancies between them is a strong argument as to the want 
of unity in the group of rheumatoid arthritis, and also as 
to a possible co-operation of many factors in individual 
cases. 

Rheumatoid Arthritis viewed as a Morbid Result 
rather than as a Disease.— The variety almost amounting 
to opposition in the theories as to the nature of rheu¬ 
matoid arthritis suggests strongly that an attempt may 
have been made to describe as a disease that which may 
be essentially a result. If the familiar changes might be 
regarded as the progressive stages, varying freely in 
their individual developments, but agreeing in their 
terminal condition, of the non-suppurative variety of 
degeneration of joints it would be conceivable that 
various diseases, gout, rheumatism, tabes, gonorrheal 
infection, as well as simple injury, might lay the founda¬ 
tion of the mal-nutrition in question. 

There might still be room for the recognition of 
hitherto imperfectly proved agencies, for instance, for 
the subtle influences of bacillary infection, or of peri¬ 
pheral nerve affections whether of a structural or of a 
functional kind, as direct causes foi those varieties which 
are not manifestly connected with any constitutional 
disease or local factor, and are therefore classed as 
“ spontaneous ” or “ pure ” cases of rheumatoid 
arthritis. We might then more easily reconcile diver¬ 
gent theories, because no longer claiming a pathological 
unity for the clinical types. It might be possible to 
regard the trouble sometimes as essentially a tissue 
degeneration, and to this view correspond the sugges¬ 
tions of traumatism, senility, and disease is possible 
causes, and sometimes as a definite disease. 

In dealing with rheumatoid arthritis as a disease we 
should have to leave aside as incapable of any general 
application the theories of traumatism, of senile decay, 
and o* pure gout, and to choose between three hypotheses: 
(1) the neural theory, (2) the infective theory, and (3) 
the rheumatic theory with its two chief modifications— 
the one being (a) that rheumatoid arthritis is a hybrid 
between g >ut and rheumatism, the other (b) that it is a 
systemic disease distinct from gout and from rheumatism, 


Mah. 1, 1899. 

yet possessing analogies with both. Or, if it had to be 
viewed as a specific disease entirely distinct from gout 
and trom rheumatism, then only two adequate theories 
as to its production would remain—the neural and the 
toxic. In favour of both, weighty arguments have been 
brought forward. On the oni hand, a strong point has 
been made by Dr. Ord of the frequent coincidence of the 
affection with uterine and ovarian troubles, and with 
catamenial irregularity, amenorrhoea, and the menopause. 
This, he believes, indicates a reflex nervous mechanism of 
production. Arguments are also derived from the consider¬ 
able wasting of the muscles, from the occurrence of 
peripheral neuritis, from the alterations in the myotatic 
reflexes, and from the close analogy of the articular 
lesions of tabes with the rheumatoid lesions On the other 
hand, a bacillus has been described by Schuller, Banna- 
tyne, and others, by which a destructive toxin might be 
elaborated. 

Considerable importance also attaches to the view put 
forward prominently by Mr. Macnamara (a) and accord¬ 
ing to him originally suggested by Todd, who ascribed 
certain joint affections to putrid discharges from the 
vagina, that the intoxication may be of a non-specific 
nature, viz., such as may arise from disordered metabolism 
or impeded excretion, or be due to poisons manufactured 
within the organism (such as ptomaines produced by 
suppuration), rather than to germs imported from with¬ 
out. Arthritis may be caused by “ the passage into the 
blood of the chemical products of inflammation rather 
than to the direct entrance of the microbes into the 
affected joints.” Mr. Macnamara has made the further 
suggestion that decayed teeth may be in many cases the 
source of an infection to which the joints may react in a 
manner analogous to that which we observe in arthritis 
due to gonorrhoea, pyaemia, scarlet fever, and various 
other infections. These suggestions possess much weight 
and deserve our close attention. 

It is noteworthy that one of the affections so well 
described by Dr. Still (cf Clifford Allbutt’s System of 
Medicine, vol. III.) as apt to occur in a somewhat acute 
form in children, is stated by him not to develop usually 
before the period of the second dentition. This would 
coincide with the time of decay and absorption of the 
temporary teeth. 

The Clinical Basis of the Theories.—The neural theory 
and the h umoral or tourir theory have both appealed to 
the same clinical facts. 

Thus the high tension and increased pulse rate, in¬ 
sisted upon by Kent Spender, and the liability to palpita¬ 
tion noted by Duckworth might equally be regarded as 
vasomotor agencies, or as Jue to the action of irritating 
principles in the blood. 

Catamenial irregularities, amenorrhoea, and the meno¬ 
pause, ovarian ind uterine affections, mental shock, have 
all their neural and their humoral aspect. 

The pigmentary changes pointed out by Kent Spender 
and the increased myotatic irritability, are not constant 
phenomena, but they belong decidedly to the province 
of the nervous system. 

General Mtiology. —In dealing with the general 
Aetiology, ‘predisposition cannot bo entirely disregarded. 
Rheumatoid arthritis does not present that directness of 
transmission which is a feature of gout. Indeed, we look 
in vain for that something which coaid be transmitted, 
unless it be a general liability to articular disease. A n 
element of truth is probably contained in the popular 
view which credits oertain individuals with a definite 
structural weakness of some one or other of their organs, 
be it weak lungs or weak kidoeys, or a weak heart. Mor¬ 
bid functional peculiarities may run along given lines 
of structural weakness, and whether we shift this 
supposed imperfection from the joints to a cerebro¬ 
spinal joint-centre, or localise it in the articulations 
themselves, there is some reason for admitting that 
a delicacy of the joints may be inherited. Gout and 
its associate diabetes, rheumatism, and phthisis are 
among the most prevalent of our diseases, and we 
must be prepared to find them largely represented 
in the family histories of the rheumatoids; but there 
is significance in the fact made out by Sir A. Garrod 

(a) Proceedings of the Royal Medieo-Cluniixicsl Society. Thinl 
Series. Vol. XI, i>. 48. 1K*0. 


ORIGINAL COMMUNICATIONS. 


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ORIGINAL COMMUNICATIONS. The Medical Pbess. 209 


Mar. 1, 189 9. 

that of these three influences that of gout is the pro¬ 
genitor is by far the most frequent. 

Vulnerability .—Without attempting to discuss the 
well-known but unexplained susceptibility of joints to the 
action of various morbific agencies, as, for instance, of 
gonorrhoea and other infective poisons, we are almost led 
to assume a relatively increased vulnerability of the 
joints in the subjects of rheumatoid arthritis as an ex¬ 
planation for their unhappy reaction to influences of 
climate, soil, atmosphere, and occupation which leave 
stronger subjects unaffected. Other causes sometimes 
alleged, traumatism, disturbed internal mechanism of 
the joint or dislocation, paralysis or prolonged disuse 
will not of themselves produce the disease. Undue vul¬ 
nerability must be called to aid before we can account 
for these alleged causations. 

The vulnerability referred to is closely connected with 
the question under discussion, inasmuch as it might ex¬ 
plain the late development of rheumatoid changes in 
joints as a result of previous gouty lesions, without the 
intervention of any fresh and additional disease. 

THE RELATION BETWEEN GOUT AND RHEU¬ 
MATOID ARTHRITIS VIEWED FROM A 
BROAD STANDPOINT. 

Enough has been said to justify a suspicion that the 
rheumatoid conditions do not form a homogeneous unit 
but they may result from various influences and assume 
different types of development. Since they have always 
been described under one heading the assumption is that 
they are kept together by a central well-defined type 
which has served as the backbone of the entire group, 
and that it is to that type that the term rheumatoid 
arthritis properly belongs. This is the type more speci¬ 
ally considered in my present remarks. 

Cout and Hheumatoid Arthritis contrasted .—Had we 
beenasked to discuss the relationship between rheumatoid 
arthritis and rheumatism, there would have been no 
difficulty in tracing many points of contact between them, 
and no lack of variety in the opinions which would have 
been elicited, for the question which this relationship 
involves remains to the present day one of the funda¬ 
mental and most debatable questions in the pathology of 
arthritis deformans. 

Between it and gout there is much less obvious affinity 
and at first sight little to debate upon. Yet we are 
invited to take the matter under consideration; and 
since we must discuss it, we shall probably discover 
sufficient material. If I were asked to broadly define the 
relationship botween gout and rheumatoid arthritis I 
would state it to be one of contrast, not of resemblance. 
There is no relation between them. They differ from 
each other all along the line of clinical symptoms and of 
pathological changes, with the exception that they are 
both in their later developments deforming and crippling 
affections, and that some minor characteristics are 
common to both. 

Constitutionally they are most unlike. Rheumatoid 
arthritis, as its name implies, is nothing if it is not a 
local joint affection. It is apt to shorten life, but thiB is 
chiefly due to the deleterious results upon the general 
health of the antecedent crippling. Gout is not confined 
to the joints. Its most fatal results are largely inde¬ 
pendent of the local articular trouble and are exerted 
directly upon the kidney, the heart, and the blood vessels, 
and sometimes also upon the visceral functions, indepen¬ 
dently of any coarse structural changes. 

It would be rash to assert that there is not a constitu¬ 
tional ens morbi in rheumatoid arthritis ; some peculiari¬ 
ties rather suggest that there is. But we are agreed that 
this ens morbi, if it exist*, is much less prominent. And 
although future investigations may perhaps reveal its 
power of damaging the vital organs and functions, this 
power has hitherto been much less obvious, nay, even 
latent, and the field of its workings totally different from 
that occupied by gout. For instance granular kidney 
and albuminuria, and atheroma of the blood-vessels, 
which are the chief dangers of gout, do not form an essen¬ 
tial part of the natural history of rheumatoid arthritis. 

Moreover, we notice at first sight that the constitu¬ 
tional types attacked by the two diseases are in obvious 
contrast. The gouty, in general, are apt to be full- 


blooded ; those who develop rheumatoid arthritis weakly 
and ansemic. 

Clinically the line of distinction is no less sharply 
drawn. Rheumatoid arthritis selects some of its victims 
at a relatively early age; with gout, pre-eminently a 
disease of middle age, this is exceptional. The female 
sex, which suffers much less often and much less severely 
from gout, contributes a large majority of the cases of 
rheumatoid arthritis. 

The march of the two diseases is also singularly 
different The onset of gout is commonly much more 
abrupt and acute, and confined to a single joint. That 
of rheumatoid arthritis, in perhaps its most common 
form, is relatively gradual and often insidious, and in the 
typical cases many jo : nts suffer and symmetrical joints 
are affected. 

Pathologically, what do we find? In gout sodium 
biurate is traceable in the joints and in their coverings, 
as well as in the tophi. Nothing of that kind is to be 
discovered in the straightforward cases of rheumatoid 
arthritis, and an excess of uric acid in the blood has also 
been looked for in vain. Locally the pitting and super¬ 
ficial ulceration of cartilages may be a relatively early 
event in gout. In rheumatoid arthritis the early event 
is swelling and overgrowth of cartilage, destined in 
typical cases to be a permanent feature, but accompanied 
later by an extensive destruction of the hypertrophied 
cartilage and by a varying amount of ossification. 

In the later stages some of the local results are analo¬ 
gous. Lipping of the cartilage is seen in some of the 
chronic cases of gout, and it is the rule in arthritis. Dis¬ 
tortions occur in both which, though essentially different, 
may sometimes present a rough resemblance. In gout 
they are due most often to the peri-articular thickenings 
which are apt to supervene. 

Looking at the therapeutical side of the question, we 
discover no less marked a contrast. To climate, atmos¬ 
phere, and soil the reaction is almost identical, but in 
every other respect there is an opposition in the effects 
produced by medicines and other measures of treatment, 
and by diet. 

(To be concluded in our next.) 


COMPLETE REMOVAL OF FCETUS 
AND SAC IN A CASE OF 
ADVANCED EXTRA-UTERINE 
PREGNANCY. 

By MAYO ROBSON, F.R.C.S., 

Professor of Surgery in the Victoria University: Senior Surgeon, 
General Infirmary of Leeds ; Honorary President 
International Gynaecological Congress. 

It is not mv intention to invite a discussion on the 
pathology ana classification of extra-uterine gestation, 
as the subject has been recently considered by a 
Fellow of the Society, Mr. Taylor, in his very instruc¬ 
tive Ingleby Lectures for 1898, and by myself in my 
Valedictory Presidential Address before this Society ; 
nor do I propose to consider the treatment of the 
early stages of the disease, but to limit my remarks, 
first, to the report of a case in which I removed the 
entire fcetal sac, together with the foetus, two months 
after the full term of pregnancy, and, secondly, to 
the treatment of advanced extra-uterine gestation 
generally. 

Mre. R —, a;t. 29, was seen by me with her own 
medical attendant, Dr. W—, on September 29th, 
1898, when she gave the following history :—She had 
had two children, the last five years ago. Since the 
birth of the last child she had been quite well, and 
had menstruated regularly until September 20th, 
1897, when she was unwell for three days, the loss 
being somewhat excessive. The next period was due 
on October 18th, but nothing showed until three days 
later, after which metrorrhagia continued to January 
loth. On November 29th she received a terrible 


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210 Thb Medical Press. 


ORIGINAL COMMUNICATIONS. 


mental shock from suddenly finding her father dead. 
Almost immediately the metrorrhagia changed into 
profuse bleeding, and several clots were passed. As 
the bleeding continued Dr. W — was asked to see 
her for the first time on December 6th, and it was 
then thought that she had had a miscarriage. No 
tumour could be detected on palpation of the abdo¬ 
men, and the sound passed 2$ inches. On 
December 13th there was still no evidence 
of tumour, though the bleeding was continuing. At 
Christmas a tumour could be detected bi-manually, 
and this had increased so rapidly that, when on 
January 15th she was seen by a specialist in con¬ 
sultation with Dr. W-, the tumour was palpable 

above the pubes on the left of the middle line. The 
sound then passed to the right of the tumour, and 

Dr.-thought it a case of myoma ; but when he 

saw the patient again on February 7th, the tumour 
reached to the umbilicus, and the sound still passed 
to the right; the diagnosis being then altered to one 
of pregnancy in the left horn of a bicornuate uterus, 
as the fcetal heart sounds could be distinctly heard. 

After January, there was no uterine discharge 
until June, when there was a slight “ show," which 
soon ceased. In July, just a month later, a coloured 
uterine discharge again appeared, and from that time 
up to being seen by me in September there had been 
more or less metrorrhagia, and during the past four 
weeks this had been excessive and bright in colour. In 
January, the tumour steadily increased in size, and at 

the end of July she was again seen by Dr.-, the 

specialist, who then thought her seven months ad¬ 
vanced in pregnancy, but on the same evening the 
fcetal movements, which had at first been observed in 
February, became more excessive and energetic, and 
labour-like pains came on so severely that morphia 
had to be given hypodermically. 

From that time all foetal movements ceased. There 
were then milk in the breasts, and all the other signs 
of pregnancy. When seen by me on September 29th 
I found the abdomen occupied by a large tumour (as 
shown in the diagram), and a bi-manual examination 
revealed the uterus pushed to the right, the fundus 
being easily made out separate and distinct from 
the tumour itself, and the uterine sound could be 
passed for a little over the normal distance. The 
roof of the vagina on the left was somewhat pushed 
down by the tumour so that the cervix was placed 
more to the right than to the left. Ballotteinent 
could not be obtained either from side to side or per 
vaginam. Auscultation failed to reveal either the 
sound of the foetal heart or the placental bruit. A 
diagnosis of extra-uterine gestation was made, and 
early operation was advised, since the foetus was mani¬ 
festly dead, and the patient’s health was becoming 
seriously deteriorated as the pulse was persistently 
rapid, from 110 to 120, and there were considerable 
loss of flesh, a hectic flush on the cheeks, and a tem¬ 
perature each evening. 

On October 4th, Dr. W-giving the anaesthetic, 

and Dr. Macrae assisting at the operation, I opened 
the abdomen in the middle line and found the foetal 
sac on the left of the uterus, from which it was 
separate and distinct. The sigmoid flexure of the 
colon was crossing its upper part, and the omentum 
was adherent to the front of tne sac. After packing 
sponges around, I opened the thin part of the sac in 
front and removed a quantity of dark, inodorous, 
grumous fluid, afterwards extracting the child. After 
a careful examination I found it would be possible to 
completely remove the sac. I therefore ligatured off 
the ovarian vessels externally, and made a pedicle 
between the uterus and the sac internally. I then 
detached the omentum ligaturing several adherent 
portions, and dividing between ligatures. 1 then 
separated the anterior layer of the meso-sigmoid 
which was expanded over the sac and found that I 


Mab^I, 1899. 

could easily shell the tumour from its bed, the only 
difficulty occurring in one or two places where the 
posterior layer of the meso-sigmoid carried the large 
intestinal vessels and was rather adherent to the sac. 
After the separation of these adhesions I had a few 
vessels to ligature. The detached part of the sac 
enucleated withoutdifficulty. Although the peritoneum 
appeared to be perfectly dry I thought it wise to 
nsert a glass drainage tube for 24 hours. The next 
morning there was so little discharge that it was felt 
safe to remove the drainage tube. 

The wound healed by first intention and the sutures 
were removed on the seventh day. After the first 
day the temperature and pulse were perfectly normal, 
and recovery was uninterrupted. Tne patient is now 
in good health. Specimen shown. 

A quotation. Sir, from your own text-book 
(Macnaughton Jones' “Diseases of Women,” p.595), 
would seem to show that removal of the eitire sac is 
not worth considering after the fourth month. 

“ When the gestation has not advanced beyond the 
fourth month, it is sometimes possible to remove 
embryo, tube, ovary, and sac by transfixing the broad 
ligament as in a simple ovariotomy. When the 
pregnancy has advanced beyond the fourth month, 
the placenta has become too large to be thus dealt 
with. The sac is then exposed, through an abdominal 
incision, the foetus, placenta, and clot evacuated, the 
bleeding checked with sponges, the edges of the sac 
are then stitched to the abdominal incision and its 
cavity drained After the fifth month operation must 
be considered under two headings : — 

“ 1. The Treatment of the Sac. 

“2. The Treatment of the Placenta.” 

Mr. Taylor, in his Ingleby Lectures, recommends 
removal of the placenta in tubo-abdominal preg¬ 
nancy, and drainage of the sac in tubo-ligamentary 
pregnancy, but does not advocate removal of the 
sac, which be describes as unnecessary and dangerous. 

In Dr. Kelly’s work, “ Operative Gynaecology.” 
vol. 2, p. 457, complete removal of the sac is advo¬ 
cated wherever it is practicable on account of the 
danger to life from the possible infection of the large 
lacental mass, and from the danger of secondary 
semorrhage due to the breaking down of recent 
thrombi when the placenta is separating piecemeal 
at a later date. 

From the description I have £iven of the removal 
of the specimen on the table it will be recognised 
that the operation presented no extraordinary diffi¬ 
culty beyond what would have occurred in removing 
a large multilocular or dermoid ovarian cyst that 
had invaded the meso-sigmoid; in fact, I have per¬ 
formed many ovariotomies that have presented much 
greater difficulties and which have recovered without 
unusual complications as in the case under discus¬ 
sion. 

I would offer for discussion the following points in 
the treatment of advanced extra-uterine pregnancy. 

On opening the abdomen, if the foetus be found 
among the intestines, the cord should be divided and 
the foetus removed; if the placenta be attached to 
the expanded tube it can probably be removed, as 
suggested by Mr. Taylor, but if spread over the intes¬ 
tines or large pelvic vessels its removal will be unsafe, 
and gauze packing of the placental area and drainage 
will be the safer method, the placenta having been 
cleared of blood and cleansed as much as possible. 

If the fcrtus is enclosed in a sac this should be 
opened at its thinnest part and the foetus extracted; 
the sac should then be carefully examined to ascer¬ 
tain if its removal is feasible. If thought practicable, 
the preliminary ligature or clamping of the uterine 
and ovarian arteries will simplify the subsequent pro- 
cedure-*. All intestinal and omental adhesions must 
be dealt with by peeling them off where feasible and 
ligaturing where necessarv. The deeper parts of the 


Google 


Mar. 1, 1899. 


ORIGINAL COMMUNICATIONS*. 


The Medical Press. 211 


sac will be easily dealt witb, if, as is usual, the attach¬ 
ment of the placenta is at the upper part. It will do 
no harm if very adherent portions of the sac be left, 
should their detachment present unusual difficulties. 
Subsequent drainage tor twenty-four hours with a 
glass tube is, to my mind, both safe and useful in 
these and similar cases, and with proper antiseptic 
precautions is not, in my experience, attended with 
risk of infection. 


SYPHILIS IN THE ARMY, 1812-1896. 

BEING A REPLY TO 

MITIGATION AND AGGRAVATION OP 
SYPHILIS. 

By JOHN A. SHAW-MACKENZIE, M.D.Lond. 

(Concluded from page 186.) 

(d) “ Mitigation,” “ Self-exhaustion,” “ Self-ex¬ 
tinction.” 

These terms are by no means synonymous, as 
possibly might, at first sight, be inferred. Very 
numerous are the adduced causes of mitigation or 
modification in syphilis, and Fergusson himself when 
he adduced the attenuation theory directed atten¬ 
tion to the mitigating effect of climate, which has 
received the support of numerous observers in various 
places other than Portugal. 

For instance, Acton, in 1860 refers to Wilde’s 
observations on mitigation of syphilis in Austria 
assisted by temperance, hygiene, and non-mercurial 
treatment. The hard sore was practically unknown, 
but various intensities of syphilis were noted in 
different countries, Lisbon being mentioned. Acton, 
in referring to the later work of Fergusson, and sup¬ 
porting the aggravating effect of climate, campaign¬ 
ing, and abuse of mercury, enjoys with Dr. Ogilvie 
the melancholy distinction, in my opinion, of regard¬ 
ing Fergusson’s admissions in respect of the abuse of 
mercury in the light of “ confessions.” 

Dr. Ogilvie explains attentuation by self-exhaus¬ 
tion in reference to the analogy of the natural small¬ 
pox by “acquired immunity hereditarily transmitted.” 
Ferausson's original conclusion was “ that the viru¬ 
lence of the disease has become so much mitigated 
by reason of general and inadequately resisted diffu¬ 
sion or other causes that, after running a certain 
{oommonly a mild) course according to the known 
laws of itR progress, it exhausts itself and ceases 
spontaneously.” 

Obviously Fergusson applies the term “ self-exhaus¬ 
tion ” to cases among the bulk of the Portuguese 
which got well without mercurial or very little mer¬ 
cury, irrespective ot cause. “ Diffusion r ’ in syphilis 
is not restricted to “ acquired immunity hereditarily 
transmitted,” either generally or by Fergusson. He 
mentions hereditary syphilis it is true, but was 
unable to follow the cases up on account of the 
jealousies of the native faculty. He thinks such may 
continue from infancy to puberty, but was not yet 
disposed to believe that it could appear at puberty 
for the first time. Struma was, he thought, explain¬ 
able by other causes than the venereal, but he in no 
way mentions immunity conferred by hereditary 
transmission. 

Indeed, among “other causes,” he thinks 
mitigation was occasioned by diffusion unresisted by 
mercurial treatment. The term “ self-extinction ” 
can only be employed in the same sense as “ self- 
exhaustion,” that is, to the spontaneous cure of a 
mild disease in the individual. Fergusson does, how¬ 
ever, state that “ by the resistance we have opposed 
to syphilis and variola (by mercury, vaccination, and 
inoculation), we have retarded their natural decay 
among us. That we have made both more rare I 


believe, and that we may finally sucoeed in extinguish¬ 
ing both I devoutly hope, but whenever we are 
revisited by either the one or the other, I fear they 
will not come to us disarmed of their terrors. The 
Portuguese, through apathy, and at a dreadful price 
levied on the generations that are passed and never 
in all probability to be redeemed by their descendants, 
appear to have gained a great exemption from their 
immediate effects.” It is only these hitter paragraphs 
which can justify any idea of complete immunity in 
the individual or extinction in the nation. The latter 
is opposed to his portrayal of revisitation, as also to 
bis view of the de novo origin of syphilis, which his 
“ friend Guthrie ” also believed to be the case, “ when¬ 
ever prostitution is foul and unclean, restricted to 
few women amidst crowds of men, which afterwards 
spreads through society at large.” 

(e) Much importance is attached by Dr. Ogilvie to 
Fergusson’s later paper which I have readily admitted 
in the first instant I was not aware of. “ Writenin 
the year 1843,” says Dr Ogilvie, “ it bears witness 
to a total change of his (Fergusson’s) views regarding 
it (mitigation by self-exhaustion), and which seems to 
have escaped the notice of nearly all those who have 
written on the subject. My attention has been drawn 
to it by the first edition of Drysdale’s work (12). The 
only other author who refers to it as far as I have 
been able to ascertain, is the learned historiographer 
of venereal disease, T. K. Proksch.” 

In this paper Fergusson fully testifies to the aggra¬ 
vation of syphilis among the British troops in 
Portugal by the abuse of mercury, and makes no 
mention of attenuation. 

This paper, Fergusson tells us, was “ but a frag¬ 
ment intended to fill up a gap in the systematic treat¬ 
ment and history of syphilitic diseases. Letit betaken 
for what it is worth, a military sketch of a period 
when a discovery of njuch importance in regard to the 
treatment was made, and a mighty error was exposed 
and corrected.” 

In his introductory remarks he states: “ I have 
now arrived at that period of life when its game 
has been nearly played out. ... I shall there¬ 
fore, using another privilege of my age, venture upon 
the task without fear or favour to any authority, or 
school or party, but taking what I behove to be the 
spirit of truth for my guide, fearlessly tell it in every 
part of my subject, always, however, eschewing per¬ 
sonal offence and needless injury to the feelings of the 
living or memory of the dead. For nearly fifty years 
T have been an indefatigable scribbler. . . . but 
the health of armies was, above all, the shrine at 
which I worshipped. ... I have not unfrequently 
found parts and parcels in the pages of my con¬ 
temporaries without at all recognising them as my 
own. . . . For candid criticism I shall ever feel 

moet grateful, but I shall not reply to it otherwise 
than by correcting the errors and mistakes I may have 
fallen into in a second edition should this work ever 
be permitted to arrive at that distinction. I feel that 
I am past the age of controversy. Its triumphs would 
bring me little satisfaction, because I know they would 
stain my pages if achieved even temporarily at the 
expense of truth. I write not for the drawing-room, 
or the schools, or the circulating libraries, or lor any 
time-serving purpose, but I write more especially and 
in the first instance to illustrate if I better can the 
British military character.” 

Fergusson never lived to complete his work 
Shortly after the completion of the chapter on 
syphilis he was attacked by his last illness (hemi¬ 
plegia), and from that time till his death in 1846, 
his editor—son—tells us “ it remained sealed up in 
my hands. I am perfectly aware of many defects the 
work unfortunately possesses and .... in the first 
place it is manifestly imperfect, ending abruptly 
with the article on syphilis without any peroration 

Digitized by GoOgle 


212 Thx Mxdical PrKSS. 


ORIGINAL COMMUNICATIONS. 


Mar. 1. 1899. 


or retumi, and I know it was my father's intention to 
have added considerably to it, besides correcting 
many minor defeots in its passage through the press. 
But even had this been completed, it then would 
have been only half the intended work which was to 
have had a second volume comprehending his opinions 
and experience of the civil branch of his profession.” 
Would further opinions have shed any light on the 
question of mitigation ? I think not. He had sub¬ 
stituted “ idiosyncrasy ” for attenuation in explana¬ 
tion of “ the incontrovertible fact that the British 
Army at this moment contains thousands in perfect 
health, and has contained many thousands more who 
have been perfectly cured of every stage and state of 
syphilitic diseases without ever having taken a 
particle of mereu 17 , although amidst the infinite 
variety of idiosyncrasies which the human race 

S resents there can be no doubt that particular cases 
ave occurred, and always will occur, in which the 
use of that remedy has been and will be found abso¬ 
lutely necessary.’ It is the explanation of “idio¬ 
syncrasy ” whicn is now the point at issue. With 
the greatest admiration and respect ” for Fergusson 
it seem 8 to me in this paper he was overwhelmed 
with the “mighty error’’ of the abuse of mercury 
(which he had done so much to expose) at the expense 
of explanation of those facte, Dr. Ogilvie omits to 
credit him with. And he was unmindful of Colies’ 
(and Wallace’s views) that “this disease appears 
to become less virulent as it becomes fur¬ 
ther removed from the fountain head.” (13) 

Six years later, even had he lived, Fergusson again 
might have had reason to revert to his original 
opinion. “ We can scarcely understand how an 
impartial inquirer not led away by the necessity of 
upholding a theory, or not puffed up by an inordinate 
estimate of the transcendental value of everything 
modern, and a thorough contempt of everything old, 
can doubt that syphilis has undergone many and 
important changes in its external manifestations— 
now presenting itself in the most inveterate and 
intractable forms—then again within a single genera¬ 
tion, and under the observations of men with as much 
brains in their head and as good eyes in their orbits 
as any modem syphilographer (to use the cant 
phrase) appearing in a milder and more manageable 
shape, so much as to induoe more than once an almost 
universal hope in physicians throughout Europe that 
the malady might possibly wear itself out. When a 
malady then can alter its aspect, we cannot venture 
to dogmatically deny that it may manifest itself in 
forms which we never expected it could assume ” 
(14). 

In 1854, not in 1863, nor “resuscitated from 
oblivion,” as Dr. Ogilvie states, the Late Mr. Henry 
Lee first fully testified to Fergusson’s theory of 
attenuation (15). He at the same time pointed out 
that “ the modification of the action of the syphilitic 
poison inconsequence of repeated inoculation, although 
it has of late years assumed a new name, is not, as we 
have seen, a new subject,'’ and that Fergusson 
pointed 1 -ut, “ the disease had become so much miti¬ 
gated in Portugal by reason of general diffusion that 
after running a mild course it exhausted itself, and 
ceased spontaneously ” in the bulk of cases. “ It must 
be remembered,” says Mr. Lee, in referring to the 
non-mercurial successful method of treatment adopted 
by Mr. “ Rose and many other Army surgeons, that 
the cases which they have to do with occur in those 
who are often in some measure syphilised . . . 
their systems have in some measure become accus 
tomed to the influence of the poison, and the 
forms both of primary and secondary disease in them 
are most materially modified thereby ... It is well- 
known that individuals exposing themselves to the 
same source of disease will often be very differently 
affected.” 


He clearly pointed out three types of sores: — 
(a) The primary indurated and limited ulcer, followed 
by chronic enlargement of the inguinal glands and 
constitutional manifestations, (b) The sore present¬ 
ing the characters of acute ulceration, the glands in 
the groin becoming inflamed and suppurating with 
no constitutional symptoms; and (c) the sloughing 
sore, with neither inflamed inguinal glands or con¬ 
stitutional symptoms. With respect to the first two, 
says he, “ Anyone carefully considering these differ¬ 
ences for the first time might surely say, Why! these 
are two different diseases. They cannot depend 
upon the same morbid poison. And this view has 
actually been entertained by surgeons of very great 
eminence, and is regarded by some surgeons even of 
the present day as the only way of accounting for the 
difference observable in different cases of syphilitic 
infection. The difference, however, consists not in 
the kind of poison, but in the kind of morbid pro¬ 
cesses to which that poison gives rise in different 
instances. . . . One of the causes which determines an 
inoculated part at once to pass into suppuration 
appears to be the fact of the system being already 
under the influence of the syphilitic poison." 

Not long before the lamented decease of Mr. Lee, 
I drew his attention to the apparent discrepancy 
between his earlier demonstration of the unity of the 
syphilitic virus, and his later dualistic theories. He 
gave me permission to make use of, or even alter, 
any of his writings, and I think it is of interest at 
the present time, when constitutional symptoms are 
reported as following suppurative primary disease, 
to remind observers there are two forms of primary sup¬ 
purative venereal disease, one of syphilitic inoculation 
upon infection previously acquired, or inherited which 
may, or m ay not be followed by constitutional sympt oma 
andtheotherhavingnothingto do with syphilis,and not 
usually followed by constitutional disease. Recently, 
however, even this form of sore has been credited 
with toxic consecutive manifestations, and the initial 
differentiation of primary lesions becomes, even more 
complicated, in the absence of precise bacteriological 
demonstration, and history in patient or parents. 

In 1862 Mr. Hutchinson adduced three oases of 
acquired venereal disease in patients the subjects of 
heredito-syphilis. “ In none of these cases did the 
patients suffer from constitutional symptoms. In 
none is there any proof that the sores were of the 
indurated type, ana in the first two it is certain they 
were not. As far as they go they favour the belief 
that hereditary syphilis, if severe, is protective against 
subsequent contagion, and that its subjects are not 
liable to contract the indurated form of chancre.” 
(abstr.) Subsequently, in his work on Syphilis, he 
reports a case under similar circumstances which de¬ 
veloped severe consecutive symptoms, and concludes 
that more well observed facts are requisite for deter¬ 
mination. In 1863 Mr. Lee testified to the same 
immunity hereditarily acquired, which he had in 1854* 
alluded to as “ natural immunity ’’ in individuals or 
in nations (16). 

In 1864 Drysdale's work, in support of the non¬ 
mercurial treatment, was the subject of review, 
debate, and correspondence (17), and in many places 
Fergusson's later publication of 1846 is mentioned. 
In face of Drysdale's quotations from both works, 
the authoritative opinions expressed in that year re¬ 
garding mitigation of syphilis (per soil or virus) 
were, modification by previous infection, liereditaiy 
influence, by the length of time it has existed in a 
people, transmission from one patient to another, re¬ 
pressive and preventive regulations in the Services, 
climate, treatment, age, sex, coexistence of other 
diseases, temperament, hygiene, and moral influence, 
both of which latter value Fergusson himself was 
alive to, as evident in his chapter on “ Fever as an 
Army Disease.” 


Mar. 1, 1899. ORIGINAL COMMUNICATIONS. Tm Medical Press 213 


Among '* the well-known facts of Fergusson,” bis 
notice of the “ very severe ” disease in Lisbon among 
the Portuguese is referred to. Professor Neumann’s 
later opposition to the “ malignancy (?) of syphilis in 
Portugal ” is, probably, not “ evidently a slip of the 
memory excusable in so bulky a work, as Dr. Ogilvie 
thinks, but founded on the statements of Fergusson, 
■corroborated by Guthrie. 

“ One side of the case only is argued. And how¬ 
ever this may be calculated to influence those who, 
with Dr. Drysdale, see only a part of the question, 
we cannot think that he has advanced any evidence 
upon which he can claim a verdict from those mem¬ 
bers of the profession who have studied the whole 
subject, or from those who have read the book of 
Nature as it lies open for their inspection. . . . 

Now, in many parts of the world it has long been 
ascertained that these men (rank and file) get well of 
their venereal complaints without mercury, and the 
reason is probably the same in all countries. . . 
He is one who has not improbably been subject to 
syphilis before joining the Army, or who is not un¬ 
likely to have inherited the disease from his parents. 
Such persons are very much in the same condition as 
the Portuguese to whom Dr. Fergusson so pointedly 
refers.” 

It should be noted, however, that the long-service 
system in those days permitted such observations and 
explanations. At the present day it is the youth 
who acquires syphilis probably for the first time, and 
though the Bame condition of hereditary influence 
may obtain, the difference between his acquired 
disease in India and at home must be noted, and 
aggravation accounted for. 

In the recently published “ Transactions ” of the 
Third International Congress of Dermatology held 
in London, 1896, the theory of immunity heredi¬ 
tarily conferred, receives considerable support from 
Prof. Haslund, confirming Lesser and Kopp (as we 
have seen only qualified support from Prof. Neisser), 
and from Prof. Tarnowsky, of St. Petersburg, whose 
views form the subject of Prof. Neumann’s paper in 
The Medical Press and Circular of January 4th 
last on the “ Etiology of Syphilis Maligna.” Tar¬ 
nowsky states that “ in syphilis which never enters 
the gummatous period, and which is even exclusively 
limited to the initial symptoms, abortive syphilis so 
to say," parental syphilis has “ transmitted a lesser 
receptivity to the syphilitic diathesis.” He refers to 
thirty observed cases, in the.majority of which one 
of the parents had suffered. 

(2) With regard to aggravation of syphilis among 
the British troops in Portugal Fergusson did not 
admit mercury was the only cause in either paper. He 
advanced the hot climate and intemperance and trans¬ 
plantation of virus from the mitigated disease of the 
native to the foreigner. Dr. Ogilvie mentions these, 
but he does not mention the “febrile affections” in¬ 
cidental to the climate, nor does he mention that 
Guthrie fully agrees with Fergusson in respect of the 
aggiavating effect of “the change from the climate 
of Great Britain to that of Portugal in the summer 
with the different mode of life” which “ does act most 
powerfully on our northern constitutions and dis¬ 
poses strongly to inflammatory affections.” 

In proof of the truth of FergusBon’s views the 
similarity of the aggravated form of disease among 
British troops invalided home from India was origin¬ 
ally adduced by myself. 

(3) In Professor Neumann’s paper above men¬ 
tioned, malaria is stated among other co-existing 
diseases as an aggravating factor. It is also adduced 
and confirmed in the recent correspondence (18), and 
long previously was noted by Mr. Lee. 

J. Marston (Royal Artillery) especially noted in 
1863 the aggravation of syphilis in the Mediterranean, 


especially at Malta and Gibraltar, in the summer 
months (19). 

It has also been authoritatively noted that syphilis 
does exist on the Continent in certain places, for in¬ 
stance, cold regions and seaport towns, in fifteenth 
century intensity. With regard to seaport towns in 
general, e.g., Lisbon, so often quoted, hygienic 
defects—overcrowding, have been given as expla¬ 
nation, while another, confirming therefore Fer- 
gusson’s earlier view, has been the importation or 
exportation of syphilis into or from different races at 
such places. 

Another factor in aggravation, confirmed in the 
recent correspondence, is “ youth.” Also the absence 
of repressive and preventive or sanitary regulations, 
not only with regard to prevalence but virulence (20). 

Epidemic intensity is another noteworthy expla¬ 
nation. The prevalence and virulence of syphilis in 
1860 in the Services was noted over the type of disease 
in the preceding year, as well as over that twenty years 
previously, in the Pacific station, The authoritative 
opinions in favour of this and other factors as opposed 
to mercury expressed then are confirmatory of the 
independent views recently expressed, that the in¬ 
fluence of mercury cannot be mainly responsible for 
the present aggravated form of disease among 
British troops invalided home from India. 

No one, I suppose, at the present day doubts the 
mitigating effects of improved treatment in its broad 
application, but other factors converting mitigation 
into aggravation, or aggravation into mitigation, 
must receive due consideration in explanation of the 
various degrees of intensity met with in individuals, 
in the Services, and in a people. Nor should it be 
forgotten that in the past it is to the “ meritorious 
labours of the Army Surgeons ” that the most im¬ 
portant advance in the therapeutic treatment of 
syphilis is mainly due, and that their “ opportunities 
of investigation were ” and are “ better on several 
accounts than those of private practitioners, who 
generally soon lose sight of their patients, and never 
have them sufficiently under their control and obser¬ 
vation to render a full perseverance in any method, 
a matter of certainty." 

Bibuoobapbt. 

(13) “ On the Treatment of Syphilis without Mercury.” (1863). 

(13) The Works of Abraham Colles. (R. McDonnell.) “ A 

Treatise on the Venereal Disease and its Varieties ”; 

Lectures. The “Lancet," 1836 7. By W. Wallace. 

(14) The " Brit, and For. Med. Chir. Review." (Abstract) 1852. 

(15) Lectures. (Lock Hospital). 

(16) On “Syphilis.” 

(17) The “Lancet,” “British Medical Journal,” The "Medical 

Press, ' The “ Medical Circular," The " Medical Times and 

Gazette,” The Hsrveian Society, &c. 

(18) The "British Medical Journal," November 26th, et teq. 

Capt. E. Freeman. December 10th, 1888. 

(19) Rond Med. Chir 8oc. 

(20) "Madras Quarterly Med. Journal." (1840). Major W. G. 

Macpherson (R.A.M.C.) “Brit. Med. Journ.,” November 

12th, 1898. Surfr.-Col. F. H. Welch. Ibid. June 4tli, 

December 3rd, 1898. 


^hc JCcttsomian ^Ccrturc 

ON 

SOME OF THE CLINICAL ASPECTS 
OF GRANULAR KIDNEY, (a) 

By 8AMUEL WEST. M.D., F.R.C.P., 

Assistant Physician, St. Bartholomew's Hospital; Senior Physician 
Royal free Hospital, Ac. 

Albuminuria in granular kidney is an inconstant 
symptom, but possesses special interest in its bear¬ 
ings on so-called physiological or functional 
albuminuria. 

After eliminating the various recognised causes of 

(") Abstractor lecture rfe.ivered at the Medical Society of London 
on Monday, February 2<»tU 1819, 


D 




214 The Medical Pees?. 


ORIGINAL COMMUNICATIONS. 


Mae. 1, 1899. 


the presence of albumen in the urine there remains a 
group of cases in which albuminuria is present with 
apparently nothing whatever in the previous history 
or the actual condition of the patient to explain it. 
It would perhaps be better to describe this as latent, 
other than physiological, albuminuria, though it is 
often not so much latent as overlooked. On the whole, 
I prefer to speak of “ albuminuria in the apparently 
healthy.” 

In respect of the frequency of this condition the 
figures given by the different authors vary in their 
wide limits, but one notes 1. That the majority of 
observations upon which the statements are based 
have been made upon children and adolescents. 2. 
And those almost entirely of the male sex. 3. That 
the higher percentages have been obtained by includ¬ 
ing cases in which very minute traces of albumen 
were found by the most delicate tests. To com¬ 
mence we may group the cases into two periods, 
according as they occur before or after 25. We need 
only consider two forms—(1) serum albumen, which 
for our purposp, will also include serum globulin; 
and (2) nucleo-albumen, a mucin-like body which has 
been till lately confused with mucin. It is by 
reckoning nucleo-albumen in with serum-albumen 
that the high percentages of albuminuria have been 
obtained. There is no single test upon which reliance 
can be placed to distinguish absolutely between 
nucleo-albumen and serum-albumen, but the series of 
tests systematically used in order will suffice to make 
the distinction quite clearly in most cases. 

Mr. LevisOn undertook some observations for me 
on 336 healthy persons, of whom 108 were young 
soldiers; the rest were hospital convalescents. A 
proteid reaction of some kind was obtained in 136, 
or 40'47 per cent., and of thiB serum-albumen occurred 
in 22’02 per cent., and nucleo-albumen in 18 - 05 per 
cent. The amount of albumen in all cases was 
extremely small, and probably in half the cases 
would have been overlooked in the ordinary methods 
of examination. The largest amount in these series 
was not more than would give a ring of one to two 
millimetres in thickness with nitric acid. Nucleo- 
albumen was found alone in nearly one-half of the 
cases, 18'44 per cent., and this was the same in both 
the groups, i.e., before twenty-five as well as after 
twenty-five. No clinical difference could be detected 
between the cases with serum-albumen and those with 
nucleo-albumen. 

Speaking generally, the significance of this form 
of albuminuria is entirely different before twenty- 
five and after twenty-five. What is required is a 
systematic series of observations in which the same 
carefully selected tests have been employed, and a 
sufficient number of cases of the one sex and of the 
other examined at the different age-periods, because 
we have not much information of albuminuria in 
infancy aud early childhood. 

Statistics show the extraordinary frequency of 
albuminuria between 10 and 18 years, usually small, 
but sometimes considerable. There is no proof that 
masturbation is a predisposing cause; indeed, what 
evidence there is, is against it. 

It is upon cases of adolescents between 18 to 25 
that most of the statements as to physiological 
albuminuria in adults are based, and most of the ob¬ 
servations have been made upon young soldiers. The 
108 young soldiers whom Levison examined ranged 
from 17 to 27 years of age, but of these only eight 
were above 25. A proteid reaction of some kind was 
found in 51 cases—47 25 per cent. This was due to 
serum-albumen in 30 cases—27'75 per cent; to nucleo- 
albumen in 21 cases—19 - 50 per cent. The effect of 
exercise is well shown. Thus, morning drill con¬ 
siderably increased the total frequency of albuminuria, 
but made no difference in the relative frequency of 
the two kinds of albumen 


If we take young adults between 25 to 30, we find 
that at the Provident Clerks’ Life Assurance Associa¬ 
tion, in the course of the five years 1893 to 1898, 
25 cases out of 7,950 were found to have albumen in 
the urine. This was a percentage well under 1, 
actually of 0 - 55. At another office, for a period of 
ten years, the number of applicants below 30 years of 
age was, roughly speaking, about 750, and out of these 
seven only were deferred or rejected on the ground 
of albuminuria. This gives a percentage of nearly 1. 
These facts are sufficient to show that at this age- 
period albuminuria is very unfrequent, and probably 
stands at its lowest point in life. 

After 30, Levison’s figures yield an average per¬ 
centage of 40, and the difference in results is evidently 
due to the different tests employed. It would greatly 
simplify matters if we could agree upon a standard 
test, and the best in my opinion would be Helleoe. 
An amount of albumen, which cannot be shown by 
Helleos test may, qua albumen, be diagnosed clinically. 

In considering the significance of albuminuria it 
will be well to retain the division into two groups, 
before and after twenty-five, as we have hitherto- 
done. 

Albuminuria is common during the period of 
growth and immaturity, and becomes less frequent 
when development is approaching completion. 
Assuming that during the period of growth all tho 
tissues of the body are in a condition of instability 
and immaturity, it is easy to suppose that very slight 
causes might disturb their balance, and thus, in the 
case of the kidneys, albumen might appear in the 
urine, as the result of causes which would have no¬ 
effect upon the fully developed or adult organism, or 
organ. 

Now, as regards the boys in whom albuminuria is- 
found, they appear to fall into at least two groups. 
In one the child appears to be robust and healthy, 
has a rigid artery, and a high tension; these are the 
cases which Clement Dukes has recorded as met with 
so frequently in schoolboys. In the other the children 
are not robust and healthy, but feeble and pale, and 
in them the tension is low and the artery nob 
thickened. These two groups probably indicate not 
only different conditions but different prognosis. In 
no case is the albuminuria, strictly speaking, physio¬ 
logical ; it is always pathological, though not neces¬ 
sarily renal. What we require to know is the course 
which these cases run in after life. Granting that 
many, perhaps the majority, ultimately recover, there 
remains another group to which the patients continue 
to pass albumen for many years and yet remain in 
good health, and a third in which signs of renal dis¬ 
ease ultima'ely develop. Making all allowance for 
exceptional cases such as there, the significance of 
albuminuria in early life must for the present still 
remain doubtful. 

Before 25 many cases may be curable; after 25 the 
chances of renal disease increase rapidly. Conclu¬ 
sions drawn from cases under 25 cannot be applied 
without consideration to cases over 25. 

If we follow out the history of these cases we find, 
for example, that in Washboum’s series, out of 1,070 
cases 38 had albuminuria, that is to say 3 55 per cent. 
Of these 38 cases 18 were traced. Thus, out of 18 
cases 6 had renal disease for certain and 5 more pro¬ 
bably, giving a percentage of not less than 33 and 
possibly of 60. Waslibourn calculated that the mor¬ 
tality-rate among these cares for the age was 17‘54 
per cent., that is to say was nearly double the normal 
average. 

Munn found that out of 25 cases 1 died within the 
year following the examination, and 4 more died dur¬ 
ing the subsequent 3 years, while in all the rest the 
health had obviously deteriorated. In another series 
of 6,400 adults examined between the years 1877 and 
1893, 454 cares of albuminuria were round. Of 13T 


Mas I, 1899. 


ORIGINAL COMMUNICATIONS. 


oases among these in which the urine was examined 
microscopically casts were found in 31, i.e., in about 
23 per cent. Thus in round numbers albumen 
occurred in about 7 per cent, of all apparently 
healthy adults, the probability of finding casts in the 
urine associated with albumen was about 1 in 4. For 
the first 8 years or so nearly all the cases were traced 
and the record is remarkably complete; after this 
many apparently were lost sigut of. Dur.ng those 8 
years the total mortality in cases under 40, was 17 
per cent., and in cases above 40 30 per cent, a very 
considerable death-rate for presumably healthy lives. 
Evidently therefore the albuminuria largely increased 
the risk 

In this class, taking 8 years also, the mortality 
was higher—viz., 20 per cent, and 50 per cent, respec¬ 
tively. 

The following table has been calculated out for me 
by an actuary friend, to show approximately, as far 
as the figures permit, the difference in mortality 
compared with healthy male3. and to make the results 
more obvious they have been taken for difference of 
two years in age : — 

Ages Rate of Ages Rate of 

at- following at- following 

talned. ' a ) year. tained. year. 

30 — ... — ... 50^ ... 370 ... 197 

32 156 ... 106 ... 524 ... 264 ... 220 

34 3 27 ... I ll ... 541 ... 3 74 ... 2 43 

36 3 33 ... 116 ... 264 ... 713 ... 269 

Without laying any stress upon the actual figures 
these calculations show how largely the presence of 
albuminuria raises the mortality as well in those 
below forty as in those above. We must conclude 
therefore that for the ages at which Life Insurances 
are generally effected, i.e., from twenty-five years 
upwards, the presence of even a trace of albumen in 
the urine is of considerable significance. 

Rabagliati concludes:— 

(1) Over 40 reject; (2) under 40 load heavily; (3) 
in young adults rate up moderately. With the first 
recommendation I entirely concur. The second is 
necessary, but the loading might be prohibitive and 
tantamount to rejection for any age over 30. In 
respect of the third between 25 and 30 there would 
have to be a fairly heavy loading, but between 18 and 
25 many cases could be safely accepted without any 
great risk. Each case of this kind, however, must be 
considered on its merits 

The general conclusions to which these considera¬ 
tion lead are these; that the so-called physiological 
albuminuria is always pathological even if not always 
renal when the amount of albumen is more than the 
merest trace, and probably pathological even in these 
cases when there is but a trace and no good cause 
obvious. 

If renal derivatives are found as well as albu¬ 
men it must be almost necessarily due to renal 
disease, and this is in all probability also the case 
even if no renal derivatives are found in patients in 
whom the arteries are thickened and the pulse tension 
high. 

Albuminuric Retinitis. 

In its early stage and typical form albuminuric 
retinitis is characteristic and pathognomonic. 

The question arises whether albuminuric retinitis 
occurs in any other form of chronic renal disease than 
granular kidney. In acute parenchymatous nephritis 
and amyloid diseases it is never seen, but it is stated 
to occur occasionally in chronic parenchymatous 
nephritis. The changes are usually found in both 
eyes and are remarkably symmetrical in position. 

Hemorrhages. 

These generally occur at a later period. There is 
nothing characteristic about them, for similar b senior- 

(a) Starting with average of those given and scanning uniform 
increase for eight years. 


The Medical Pr ess. 215 

rages may be seen in grave anaemia and in optic 
neuritis of other origin. When exudations occur the 
appearances present a close resemblance to other 
forms of optic neuritis, thus the vessels may be 
covered with effusion and the discs be swollen, the 
edges indistinct and frayed out; yet even in the most 
extreme cases there is generally something in the 
appearance of the fundus to suggest the cause of the 
trouble. 

Early as the white patches are, they are preceded 
and result from still earlier changes in the vessels. 
The lesions in the vessels have been carefully studied 
by Brailey and Edmunds, and are briefly described by 
them as obliterative arteritis leading to inflammatory 
degeneration of the structures supplied. These 
changes, Gunn states, begin to be seen usually, 
between the ages of 40 and 50, but they are not due to 
old age, i.e., to atheroma, for this does not produce 
them, but they may occur much earlier in life than 
this. These changes are really the early changes of 
granular kidney. 

The vascular changes of granular kidney are of 
great importance in relation to various hasmorrhagic 
affections of the eye, e.g., haemorrhagic retinitis and 
haemorrhagic glaucoma. Haemorrhage occasionally 
occurs behind the eyeball in the orbital chamber. 
Spontaneous haemorrhage under the conjunctiva, just 
as occurs in aged people as the result of atheroma, is 
not at all uncommon. 

Detached retina is an interesting, but not alto¬ 
gether rare phenomenon in granular kidney. It is 
in most cases due to an effusion of serum beneath the 
retina, and not, as might be expected, of blood. 
Haemorrhagic detachment of the retina indeed is a 
rare affection. The early lesions of albuminuric 
retinitis produce no defect of vision, and even in the 
later stages it is very remarkable how extreme the 
eye changes may be without a complaint being made 
of impairment of sight. Routine examination with 
the ophthalmoscope will often discover albuminuric 
retinitis when it is not expected, and will make a. 
diagnosis clear which may till then have been 
obscure. 

When the vision once begins to fail it fails rapidly. 

Amblyopia is often said to be a common symptom 
of uraemia. Of toxic retinal amblyopia we know 
little or nothing, for most of the cases are associated 
with definite lesions in the retina visible with the 
ophthalmoscope. Amblyopia of central origin— i.e., 
non-retinal, is often associated with other symptoms, 
e.g , hemiplegia. In such cases the amblyopia is also 
due to lesions of an organic kind. It is not rare 
when a patient dies of uraemia to find the symptoms 
which appeared to be merely toxic or functional 
explained by an organic lesion in the brain, viz., 
small haemorrhages. In cases of amblyopia in which 
the defect of sight persists after the uraemic attack 
is past we must presume there has been an organic 
lesion. In cases of toxic amblyopia recovery 
ought to take place in the course of a few hours or 
less, though instances are recorded in which recovery 
has been sudden and complete even after four days. 

Some clue as to place of origin of the amblyopia, 
may be given by the condition of the pupil. It 
would be an interesting question to ascertain in what 
proportion of grandular kidney cases albuminuric 
retinitis occurs, but that is impossible, for we have 
not yet the figures upon which a conclusion could be 
based. I Bbould say that in most cases of granular 
kidney, if they live long enough, albuminuric retinitis 
does ultimately develop, but a large number of 
patients with granular kidney die from other causes, 
e.g. from htemorrhage in the brain, and so d) not 
reach the state in which albuminuric retinitis de¬ 
velops. 

Albuminuric retinitis is said sometimes to recover. 
On this point, I think, some caution must be exer- 


Digitized by VJ 


Mas. 1, 1890. 


216 The Medical Pbbm. TRANSACTIONS OF SOCIETIES. 


cised. Haemorrhage of course may be absorbed and 
disappear, whether due to granular kidney or not, 
but I have never seen the glistening white patches of 
granular kidney disappear, though instances are 
recorded by good observers. It is of course possible 
where eye changes occur in the course of chronic 
parenchymatous nephritis that if the primary 
disease gets well the eye changes also may disappear, 
but this is not so in granular kidney. 

The significance of albuminuric retinitis is always 
ra ve, not only in respect of sight but also of life. The 
uration of albuminuric retinitis, or of life after its 
appearance, it is not possible to determine accurately. 
Speaking generally, the duration of life after albu¬ 
minuric retinitis has been discovered is short. 

Where the patients are in a condition to take the 
best care of themselves life may be prolonged for 
some time, but such cases as these are quite excep¬ 
tional, and speaking generally when albuminuno 
retinitis is found the patients have not many months 
to live. 


CASE OP CHRONIC INTESTINAL OBSTRUCTION, 
RESULTING FROM STRICTURE, (a) 

Operative Removal of Csecum and Portion of Ileum. 

By John Lentaigne, B.A , T.C.D., F.R.C 8.1, 

Surgeon to the Mater Misericordite Hospital, and to the Children’s 
Hospital. 

The patient, a girl, set. 12, came under my care on 
April 16th, 1898. She was then in a very miserable con- , 
dition. vomiting frequently and rejecting almost all food, 
and complaining of constantly recurring attacks of 
severe pain in the abdomen; the abdomen was greatly 
distended, and the attacks of pain were usually accom¬ 
panied by visible peristaltic movements of the intestines, 
which formed large tumours under the parietes moving 
slowly in various directions. These attacks would last 
for one or two minutes after which the patient would be 
free from pain. The bowels were very constipated, no 
motion ever coming except after the administration of 
purgatives followed by enemata. The illness had com¬ 
menced two years before, and from then the girl had 
been steadily getting worse up to the date of the first 
operation. 

On April 22nd I opened the abdomen in the median 
line. Huge coils of intestine, which proved to be the 
ileum enormously distended and with greatly thickened 
wall, came out at once. On passing the hand along this 
enlarged intestine it was found to end in a large mass 
firmly bound down by adhesions in the right iliac foBsa. 
O wing to the adhesions it was impossible to bring this mass 
into view, and as the patient was almost moribund be¬ 
fore the operation, I decided to give temporary relief by 
forming an intestinal fistula in two stages, after first 
emptying the distended bowel by enterotomy. On in¬ 
cising the gut two large basinsful of pea-soup like faeces 
flowed out, and the intestinal cavity was irrigated and 
washed out with a stream of warm water; the opening 
was then closed by silk sutures, and the gut was returned 
to the abdominal cavity. When emptied and flattened 
out the intestine seemed to be about four inches across 
from lower margin to mesentery. My left hand was 
introduced into the cavity and directed well over to left 
side; it was then cut down upon and the bowel securely 
fastened to the opening by a few sutures passing through 
the parietal peritoneum, muscle and skin. The incision 
in the median line was closed with three layers of sutures, 
the two deeper of silk for peritoneum and muscle, and the 
superficial of catgnt for the skin, covered by a layer of 
celloidin. The small opening on the left side of the abdo¬ 
men was kept open by a plug of iodoform gauze, and on the 
third day after operation the fistula was made complete 
by an incision into the bowel. There was an immediate 

(a) Patient shown at the meetinK of the Boyal Academy of I 
Medicine, January 20th, 1809. See page 220. 


improvement in the patient’s condition. The bowels 
emptied themselves continuously through the fistula, 
and the vomiting and attacks of pain ceased almost at 
once. On June 27th, as the patient had got into a gcod 
condition, and was naturally anxious to be relieved of 
the annoyance of the fistulous opening, excision of the 
c®cum was performed, with end to end suture of intes¬ 
tine by Kocher's method. The bowels acted naturally 
four times on June 29th, and almost every day after. 
There was considerable delay in the healing of this 
wound, as infection of the silk used in Buturing the 
parieties seemed to have occurred, the silk slowly coming 
away through a small sinus at the upper end of the 
wound, and it was not completely healed until October, 
1898. The intestinal fistula closed of itself as soon as 
the bowels acted normally, and on July 12th it had 
practically closed, neither faeces nor flatus coming 
through it. It was now represented by a firm, cleau 
scar, no trace of the opening existing. The patient was 
shown to be in excellent health and condition, the bowels 
acting regularly every day. 


^ransactiung of gocktics. 

CLINICAL SOCIETY OF LONDON. 
Meeting held Friday, February 24th, 1899. 

The President, Mr. Langton, in the Chair. 


Exhibition of Cases. 

Dr. Parkb8 Weber showed a case of recent muscular 
atrophy supervening long after infantile paralysis. The 
patient was a boy, set. 17, who suffered from severe 
infantile palsy at the age of two. About four or five 
months ago he noticed loss of power in the right hand 
and wasting in the right thenar .muscles. The original 
disease in infancy affected both right limbs, the right 
side of the face, and probably also the left lower limb. 
As a result the whole right lower extremity is wasted 
and almost completely useless. It was possible that the 
paralysis of the right arm and right half of the face, 
from which the patient recovered, were due to a tem¬ 
porary affection of the cerebral cortex (polioencephalitis 
of Striimpell) occurring simultaneously with the acute 
anterior poliomyelitis. 

Dr. Cahill showed a woman, set. 27, with hypertrophy 
of the right breast due to pressure of a paralysed and 
contracted right arm. At the age of nine she had right 
hemiplegia after diphtheria, and the right arm became 
spastic and contracted, being firmly flexed and adducted 
so that the band pressed on the thorax just above the 
mamma, and this breast had always been larger than the 
other. That this was due to the pressure was confirmed 
by the fact that diminution had taken place since the 
arm had been kept extended at night by a splint. 

The President thought that the breast was not so 
much hypertrophied as displaced downwards by the arm. 

Dr. Caley showed a woman, eet. about 40, suffering from 
pulmonary fibrosis associated with tabes dorsalis and 
arthropathy. The patient first came to St. Mary’s Hos¬ 
pital in October, 1896, with characteristic symptoms of 
tabes. As there was some cyanosis of her lips he ex¬ 
amined her chest and found Bigns of pulmonary fibrosis, 
most marked on the right side, a cavity at the right 
posterior apex, and bronchiectasis at the right base. 
She had no cough or other pulmonary symptoms. There 
was a history of her having attended a hospital for chest 
trouble at the age of thirteen, and Dr. Caley thought that 
the chest trouble dated from then. In 1897 she developed 
painless effusion in both knees of the type described by 
Charcot in tabes Dr. Caley regarded the association of 
the pulmonary and nervous diseases as purely accidental. 

Mr. Bf.rtram Hunt showed a boy, set. 6, suffering 
from rheumatoid arthritis, with enlargement of the 
spleen and lymphatic glands. While in hospital suffer¬ 
ing from tonsillitis and broncho pneumonia, the knees 
and elbows became painful and then swelled. The 
effusion was not great, and skiagrams showed that the 
bones were normal. There had been irregular pyrexia. 


google 


Diai 



Mar. 1, 1899. _TRANSACTIONS OF SOCIETIES. The Medical Peers. 217 


the temperature sometimes reaching 104° F, progressive 
ansemia, enlargement of the lymphatio glands in the 
axilla and groins, and considerable enlargement of the 
spleen. Bacteriological examination of the synovial 
fluid gave negative results. Mr. Hunt thought that the 
joint disease had been secondary to tonsillitis. 

Dr. Wabhbourn and Mr. Arbuthnot Lane showed a 
woman from whom Mr. Lane removed a tumour growing 
from the pia mater over the arm area two years ago. 
The case was recorded in the Clin. Soc. “ Trans.,” Vol. 
XXX., p. 154. Permanent paralysis of the right arm had 
followed the operation, but she was otherwise in good 
health, and there had been no recurrence of the fits from 
which she previously suffered. 

Dr. Mow at Bigos showed a young man suffering from 
factitious urticaria. The patient was a healthy athlete, 
who had never suffered from urticaria from any of the 
usual causes, but remarkable uiticarial wheals could be 
induced anywhere on his skin by drawing lines on it 
with any blunt instrument A white wheal rose on a 
scarlet back ground, forming an elevation of quite an 
eighth of an inch. This reached its maximum in five 
minutes, and faded in the course of an hour. There was 
not the least itching or discomfort. Pressure alone 
brought them about. Some cases had been described in 
which similar wheals were produced by local cold such 
as that by ether spray, several of them having also 
paroxysmal hemoglobinuria, but these were not present 
in this case. 

MYO8ITI8 OB8IFICAN8 PROGRESSIVA. 

Dr. Raymond Crawfcrd (with Mr. Lockwood, of 
Sheffield) showed a well-marked example of this condi¬ 
tion in a boy, a?t. 61. There were no traceable evi¬ 
dences of rheumatism in the family, though the 
child himself had disease of the mitral valve, 
which presumably was rheumatic. Injury, as in 
so many cases, appeared to have been the direct 
exciting cause at 21 years old. The bony growths 
for the most part seemed to have originated from the 
spinous processes of the vertebrae, and to have spread 
into the retro-vertebral muscles, more particularly the 
latissimus dorsi and trapezius; the child’s back was 
traversed in several directions by elevated ridges of bone. 
The fixed curvature of the spine and the rigidity of the 
cervical muscles gave the child a very characteristic 
attitude. The upper arms were glued to the sides by 
ossification of the humeral attachments of the latisBimus 
dorsi on either side. 8kiagrams were handed round to 
show the actual condition of the thumbs and great toes. 
The shortness of the thumbs was chiefly due to short¬ 
ness of the metacarpal bones, and their rigidity to syno¬ 
stosis of the first and second phalanges. In the great 
toes the metacarpal bone was completely united by bone 
to the first phalanx, and the effort of nature to compen¬ 
sate this condition had resulted in a throwing outward 
of the ungual phalanx beneath the second toes. 

Dr. Leonard Guthrie showed a case of myopathy in 
a child of 4. The disease appeared to have been con¬ 
genital. The child had never been able to walk or stand. 
He could sit up, but easily fell backwards and was 
unable to rise. All the muscles were extremely weak, 
but in the arms he could perform most movements, 
although feebly. In the legs there was almost complete 
loes of power. There was diminution of both faradic 
and galvanic irritability, but no definite reaction of 
degeneration. 

Dr. Guthrie also showed a boy of 6 with infantile 
paralysis affecting both arms, and also the intercostal 
muscles, so that the breathing was purely diaphragmatic. 
The legs were unaffected. 

Dr. St. Clair Thomson showed a man, set. 36, com¬ 
plaining of dysphagia, and found to be affected with 
unilateral paralysis of the eighth and bulbar nerves. He 
had complained of giddiness and deafness for three 
years, ana a year ago he became hoarse and had diffi¬ 
culty in swallowing. On examination his left vocal 
oord was found to be paralysed. There was no oeso¬ 
phageal obstruction. Six months ago his palate became 
paralysed on the left side, and taste is lost on the back of 
the tongue on that side. The pulse has been rapid 
throughout. There was no specific history, but Con¬ 


siderable improvement followed a course of mercury 
iodide of potassium. 

Sir Hugh Beevor showed a case of chronic rheumatic 
arthritis in a man, set. 60. It was almost co nfine d to 
the metacarpo-phalangeal joints in either hand. The 
fingers were flexed to the ulnar side. This was attributed 
to the use of his hands in working the large “ sweeps ” 
of a barge. 

Dr. Harry Campbell showed a case of asthenic bulbar 
paralysis in a woman, set. 29, which he believed to be 
the fourth reported in this country. The paralysis was 
incomplete, but became much aggravated if the muscles 
were used. Symptoms showed themselves fifteen months 
ago when she noticed that she had difficulty of utterance 
if Bhe sang for a short time. At the present time all 
the muscles ordinarily concerned in bulbar paralysis 
were affected by this curious weakness and also the 
anterior part of the occipito-frontslis, and occasionally 
there had been loss of power in the arms when they had 
been raised for a time. The symptoms were always 
better in the morning after a night’s rest. No lesion had 
been found in the brain in any of the recorded cases. 
There was no sensory change and the electrical reactions 
were normal. 

Dr. Ormerod said that he had seen an exactly similar 
condition affecting the upper muscles of the thigh in a 
man. 

Mr. A. H. Tubby showed a man, set. 65, suffering from 
multiple sarcomatous tumours of the skin. The primary 
tumour was in the upper part of the right side of the 
scrotum, and was noticed six months before. A second 
tumour appeared on the left side, and then one under 
the jaw. Now there were hundreds, some of them of 
considerable size, all over the surface of the body. The 
liver was enlarged, and there was some jaundice. 

The President referred to a similar case, and com¬ 
mented on the small disturbance of the general health 
which they presented. 

Mr. Tubby also showed a child with anterior con¬ 
genital dislocation of the hip. He remarked that this 
form was more common than usually described, being 
present in one third of the cases. It was uncertain 
whether they were intra-uterine dislocations or birth 
dislocations. In this case he had tried to replace the 
bone, but had failed, as there was no definite acetabulum. 


BRITISH GYNECOLOGICAL SOCIETY. 
Meeting held Thursday, February 9th, 1899. 

The President, Dr. Macnaughton Jones, in the Chair. 


Specimens. 

Dr. Bantock exhibited two specimens of fibroid 
tumour, weighing respectively 6J lbs. and 8 lbs. The 
first was obtained from a married lady, rot. 49, sterile. 
The case had been under his observation for four years. 
When first seen, the tumour was about the size of a 
small foetal head, on the left side of the uterus, with a 
good cervix slightly to right of middle line. There were 
no symptoms demanding interference, and the tumour 
had been known for eight years. Two years later there 
were still no symptoms, but about the beginning of 1898 it 
began to grow, and the menses became more abundant, 
and irregularly protracted to as much as two to three 
weeks. The tumour had increased very much, and while 
it had descended into the left side of the pelvis the 
cervix had risen until the os could only be reached by 
the tip of the finger. After securing the ovaries on 
each side, the broad ligaments were divided and 
an elastic ligature put round the tumour as low 
as possible. The peritoneum was then divided all 
round, and as the tumour was shelled out and 
raised out of the pelvis, the ligature slipped below 
the tumour and the slack was taken up. The posterior 
cul de sac was now opened, the uterine arteries were 
secured and the whole of the uterus removed. After 
turning the ligatures into the vagina the peritoneum 
was closed over, and the abdominal wound cloeed in two 
stages. There was very little blood lost, towards which 
the elastic ligature helped materially. In spite of the 



Mar. 1.1899 


218 The Mbdical Press. TRANSACTIONS 

great amount of fat in the parietes, and a very troublesome 
cough the wound healed well, except just at the umbilicus 
where it was difficult to keep the edges of the skin 
together 

No. 2 This was a rapidly-growing pedunculated fibroid 
springing from the fundus of the uterus by a pedicle 
from three and a half to four inches in circumference 
removed from a single lady, set. 49. There was an 
enormous plexus of veins in the left side. Having failed 
to secure the pedicle by ligatures after forcible compres¬ 
sion, he was obliged to use the serrenoeud after removal 
of the appendages. The patient was doing well. 

Dr. Herbert Snow. 

Case I. Vaginal Hysterectomy for Epithelioma of 
Cervix. —A single woman, rot. 28. Five months previously 
fell over edge of bath with legs separated. Hfemor- 
rhage three weeks afterwards, followed by the usual 
symptoms. “ Scraping ” in a provincial hospital a 
month before admission. A soft, flattened, pulpy, broad 
mushroom-like mass of cervix; bled profusely when 
touched; marked anEemia, 

At the operation most of this had to be tom off with 
fingers before any hold for the volsella could be gained. 
This on November 25th last. Entirely cicatrised on 
December 19th. Remains well up to date. By the 
microscope, epithelioma 

Case II. Abdominal Hysterectomy for Myoma. —Tumour 
noticed three months in a rather spare married woman, 
set. 37. Growing rapidly and causing frequent and 
scanty micturition. 

At the operation a departure was made from usua 
methods, by dissecting off a thin layer of the uterine 
tissue, as well as peritoneum The advantages claimed 
for this are smaller risk of wounding ureters. Also 
preferable when many pelvic adhesions. The plan has 
the disadvantage of greater liability to hsemorrhage from 
the uterine veins. This readily controlled, however, by 
dragging well on the tumour with the volsella. Martin's 
catgut used for the lower ligatures. Abdominal wall 
sutured in two layers, catgut and silk. The process ; 
of recovery shown by temperature chart. 

Cabe III. Small Myoma removed from Portio-vaginalis, \ 
Posterior Lip, of Woman, ret. 47.—Formed a most pedun¬ 
culated mass, causing much lumbar pain, and profuse 
vaginal discharge; so simulating malignancy. Only 
myoma detected. The operation in November, 1897. 
Now exhibited as showing the fresh appearance of the 
tissues, as preserved by the formaline process, after tho 
lapse of time. 

REMARKS ON DR8. BANTOCK AND 8NOw’s SPECIMENS. 

Mr. F. Bowreman Jessett said he was pleased to find 
that Dr. Bantock was becoming a convert to the sub- 
peritoneal method of dealing with these myomatous 
growths. He could not quite understand why heuBed the 
elastic ligature, as, even in the very largest cases of 
myoma, he had never seen any haemorrhage which could 
not be controlled by pressure process. Moreover, in his 
opinion, the very presence of the elastic ligature must 
interfere materially with the later steps of the operation, 
whether for complete removal of the uterus or the sub- 

J eritoneal method of dealing with the stump. Mr. 

essett always found it easy to ligature the uterine 
artery after the broad ligament had been secured and 
divided. Mr. Jessett regretted that Dr. Bantock had in 
his second case resorted to the serrenoeud, as on examining 
the specimen he could not see that there would be any 
difficulty in ligaturing the uterine arteries and treating 
the stump subperitoneally. 

Referring to Dr. Snow’s case. Mr. Jessett had always 
been able to peel off the peritoneum from the growth and 
uterus in the front very easily ; posteriorly occasionally 
there was greater difficulty. He could notagree with Dr. 
Snow that securing some of the uterine tissue was good 
ractice, and he feared the patient would be much more 
able to sepsis from the possible sloughing of the tissues. 
Moreover there must be much more bleeding from the 
cut surface than would arise from peeling off the peri¬ 
toneum. 

Dr. F. Edge agreed with the views and remarks of 
Mr. Jessett. His experience, although short, had proved 
t q him the inadvisability of leaving the cervix or any 
uterine tissue, as was the case with the extra-peritoneal 


OF SOCIETIES. 


clamp operation, and as Dr. Snow had advised in his case 
since it was at present not in their power to decide with 
certainty whether the growth was malignant or benign. 
He had had two cases of malignant growth, whether re¬ 
current or arising de novo was not known, in portions of 
uterus left wi'.hin twelve months. 

Dr. Walter (Manchester) referred to some of the in¬ 
conveniences and dangers of using the clamp; since he 
had discarded it he found the mortality of abdominal 
hysterectomy was greatly reduced. He did not see any 
necessity for including muscular tissue in the flaps as 
advocated by Dr. Snow, unless in those cases where the 
myoma was intra-ligamentous, and in direct contact with 
the ureter. 

The President asked Dr. Snow if he understood him 
to say that the operation he referred to was myo- 
hysterectomy, If so, he demurred altogether to the 
leaving of any muscular tissue to cover the stump, and 
he could see no possible object with regard to the ureters. 
Often as Howard Kelly’s operation had been performed, 
it was shill on its trial as a perfect method as compared 
with complete removal of the uterus, or pan-hysterec¬ 
tomy. The leaving of the cervical stump was a most 
important consideration. It involved the possibility of 
infection from the cervical canal and sloughing of the 
stump, as well as return or recurrence of disease in the 
latter. If myo-hysterectomy be performed, he preferred 
to leave as little muscular tissue as possible, covering the 
stump carefully with peritoneum alone, and hollowing 
out as far as possible the subjacent tissue of the cervix. 
He quite agreed with all that had been said of the now 
discarded elastic ligature, and believed that Dr. Ban¬ 
tock would before long, with his usual operative Bkill, 
bring as large tumours for exhibition removed by the 
subperitoneal method without ligature. 

Dr. Bantock, in his reply, expressed his astonishment 
that he could have been so misunderstood as he had 
been by Mr. Jessett, Mr. Edge, and Dr. Walter. The 
greater part of their criticism was absolutely irrelevant 
to his remarks. With regard to Mr. Jessett’s objection 
to the elastic ligature he had to say that in the first case 
it was of the greatest service to him and would always 
prove to be so when properly used. As to that barbarous 
instrument—the serrenoeud—which was objected to, on 
the groimd—among others—that it caused so much pain, 
his answer was the words of his patient that very morn- 
ning - viz . that she had no idea that the operation could 
be attended with so little pain. He could not accept the 
opinion that the sub-peritoneal or intra-peritoneal method 
was likely to yield the best results as experience bad 
proved the contrary, and it lay between the clamp or 
elastic ligature with the stump fixed in the parietal 
wound and total hysterectomy, both of which were extra- 
peritoneal methods. 

Dr. Snow, in reply, had omitted to mention a third 
advantage, which had originally suggested the pro¬ 
cedure : he had seen the peritoneum torn so that the flaps 
could hardly be brought together. This could not happen 
when muscle was included. He could not possibly see 
how Mr. Jessett could fear subsequent sepsis, if sufficient 
precaution were taken to aseptic ise tho cervical canal; 
nor what objection there was to leaving behind a small 
portion of uterine tissue, as stated by Mr. Edge. 
Pan hysterectomy should he thought, be reserved for 
malignant cases, on account of the much greater risks. 
The case had done so w ell, that he should certainly be 
disposed to repeat the method. 

COMPLETE REMOVAL OF F<ETU8 AND SAC IN A CASK OF 
ADVANCED EXTRA-UTERINE PREGNANCY. 

Mr. Mayo Robson, of Leeds, gave an account of an 
interesting case of advanced extra-uterine pregnancy, in 
which he had successfully removed the foetus and sac 
complete. It iB published in full on page 209. 

In the discussion that followed:— 

The President said that the two important pointa 
dealt with in Mr. Mayo Robson’s paper were those of the 
propriety or feasibility of the removal of the sac, and the 
management of the placenta. With regard to the 
opinion quoted by Mr. Mayo Robson out of his—the 
President's—work, the view there expressed was not his 
own, but that of Mr. Bland Sutton, whom he was happy 
to see present. On both points, as regards plaoenta and- 


Mae. l, 1899. TRANSACTIONS OF SOCIETIES. -The Medical “Press. 219 


•sac, in these advanced stages of the pregnancy, authori¬ 
ties were divided, and such a case as Mr. Mayo Robson's 
was valuable, as showing the advantage of removal of the 
sac. 

Mr. T Bland Sutton asked Mr. Mayo Robson how 
many cases of advanced extra-uterine pregnancy he bad 
seen. [Mr. Mayo Robson : About three.] He thought 
that three were too small a number to generalise upon. 
There were two quite distinct kinds of sac to be con¬ 
sidered ; firstly, the sac formed in part out of the broad 
ligament when the pregnancy was intra-ligamentous; 
secondly, that formed by the fcetal membranes when the 
tube had ruptured in such a fashion that the fcetus 
passed into the general peritoneal cavity. The latter 
kind of sac could be removed as a rule, but these cases 
were very rare ; he had seen only one out of sixteen cases 
-of advanced extra-uterine gestation. The foetus might 
pass out of this sac also; not very long ago he had 
operated on such a case. Dr. Giles, who assisted him. 
could corroborate his statement. The fcetus was lying 
-quite free among the mother’s viscera, and clutched at 
Its mother*8 omentum during extraction. But when a 
sac was formed by broad ligament and the child was 
alive the removal of sac and placenta was one of the 
most formidable operations in surgery. 

Dr Bantock expressed his concurrence with Mr. 
Bland Sutton’s views. The first case he saw was at St. 
Thomas's Hospital, in which it appeared that the fcetus 
oscaped with its amniotic sac into the general peritoneal 
cavity, and then went on to full time, being alive at the 
time of operation. The placenta covered in the pelvis 
on the left side, attached to the left side of uterus, broad 
ligament and intestines, and any attempt to remove it 
must have proved disastrous, as an accidental disturb¬ 
ance of a very small portion of its edge caused very 
troublesome bleeding. He had seen only one case of 
rupture into the broad ligament, and the case showed 
that the proper treatment was opening the sac, emptying 
it of its contents, stitching it to the parietes, and drain¬ 
ing. He had described one case before the Society, in 
which he removed the whole sac, containing a large child, 
as easily as if it had been an ovarian tumour with a 
Broad pedicle. He had brought forward this case to 
support his view that when the pregnancy occurred in 
the uterine end of the tube rupture usually took place 
about or within the thirteenth week, that when it occu¬ 
pied the outer end of the tube it escaped through the 
mouth of the tube, but that when the middle portion 
was the seat of the pregnancy it might go on to full time 
without rupture. 

Dr. Walter pointed out the great difference there 
was in operating on advanced cases of ectopic pregnancy 
after the fcetus was dead. To remove the sac under 
those circumstances was not attended by the same 
danger as when the fcetus was still living. 

Dr. F. Edge said he had had the pleasure of hearing 
Mr. Taylor deliver the Ingleby Lectures, which marked 
a step in our knowledge of the subject. In tubo-abdo- 
minal cases it was pointed out that the sac and placenta 
were almost entirely tubal, and that the blood-vessels 
were ovarian and uterine, and if these supplies were con¬ 
trolled the case was in the Burgeon’s command. 

Dr. Arthur Giles thought the discussion would be of 
permanent value, and it would impress od all present 
the distinction, hinted at by Mr. Mayo Robson, and un¬ 
folded with singular clearness by Mr. Bland Sutton, 
Between the different kinds of sac met with in ectopic 
pregnancy at term, namely, the fcetal sac in the rare 
cases of abdominal pregnancy, and the sac formed by 
•expanded broad ligament occurring in intra-ligamentous 
pregnancy. He had a vivid recollection cf the case men¬ 
tioned by Mr. Sutton. He had himself operated in a 
case of intra-ligamentous pregnancy at the fifth month, 
and had removed the entire sac. In that case the fcetus 
Bad evidently been dead about a fortnight; but even 
with this favourable circumstance, the removal of the 
-sac was not an easy matter, and left a bare space, which 
could not be covered by peritoneum, on the side and 
floor of the pelvis. He would ask Mr. Sutton whether 
euQh cases, when the foetus was dead, formed a general 
-exception to his rule that no attempt should be made to 
[remove the sac in cases 


of intra-ligamentous pregnancy . 


The President asked Mr. Bland Sutton what, in his 
experience, was the relative frequency with which intra¬ 
ligamentary ectopic gestation occurred as compared with 
the other forms, tubal, ovarian, or interstitial. He 
believed that true intra ligamentary gestation was very 
rare. He took it that Mr. Bland Sutton referred in his 
remarks to such intra-ligaiuentary gestation, and of the 
sixteen cases he had seen did he mean that twelve (?) 
of these had begun as intra-ligamentary, and was he 
perfectly satisfied of this fact when he operated ? The 
President cordially thanked Mr. Mayo Robson for his 
paper, and conveyed to him the indebtedness of the 
Society for the discussion it had given rise to. 

ROYAL ACADEMY OF MEDICINE IN IRELAND. 

Section of Suroert. 

Meeting held January 20th, 1899. 

The President, Mr. R. L. Swan, in the Chair. 

ON DISLOCATIONS AND FRACTURES OF THE ASTRAQALU8. 

Mr. H. Gray Croly read a paper on astragalus dis¬ 
locations and fractures, and gave a history of several 
very important cases which occurred in his hospital and 
private practice One case of fracture of the body of the 
astragalus was caused by a horse falling on the man’s 
foot, which was caught in the stirrup. Amputation was 
proposed, but refused by the patient, who subsequently 
sought admission into the City of Dublin Hospital. Mr. 
Croly excised the bone, and the man was enabled to re¬ 
sume his work as a groom. In the case of compound 
luxation of the astragalus forwards and outwards, the 
bone was completely displaced from all its attachments ; 
the head and neck of the bone protruded. Mr. Croly ex¬ 
cised the astragalus immediately. The accident was 
caused by the man jumping from a trap to save himself, 
the backhand having broken; the man landed on his 
heel; the foot was forcibly inverted; the internal mal¬ 
leolus was completely buried. The patient made an 
excellent recovery, and can walk as well as ever. The 
third case was one of complete simple luxation of the 
astragalus forwards and outwards. The gentleman, who 
is in his 69th year, was walking along the street, and 
slipped off the kerbstone into the gutter, violently twist¬ 
ing his foot inwards, from which he suffered intense pain. 
This patient was treated for eleven days before Mr. 
Croly was sent for. On examination, as shown by the 
cast, the right foot was forcibly inverted, the head and 
body of the astragalus resting on the dorsum of the 
foot externally ; the skin over the head of the astragalus 
was red and shining; the internal malleolus was com¬ 
pletely buried, a deep groove taking its place : there 
were two sloughs on the outer side of the foot (ashy 
grey) and a large deep slough on the inner side of the 
foot; there was no movement at the ankle. The patient'B 
health was much impaired, and Mr. Croly decided to 
put off operating until the health had improved and the 
sloughs separated. On March 5th, and about two months 
after the injury, as the patient’s health was much im¬ 
proved, Mr. Croly, assisted by his son, Mr. Henry Croly, 
excised the astragalus by making an incision over the 
protruded bone; the superior articulating surface was 
directed outwards and had completely left its box. The 
bone was seized in a lion forceps; it had contracted ad¬ 
hesions and required some dissection for its removal. 
Immediately on the enucleation of the bone the muscles 
drew the foot into its normal position, and a suitable 
splint, with footboard, was applied. The patient made 
an excellent but somewhat slow recovery, and he now can 
walk without the aid of a stick ; i extra thickness on 
the heel and sole of his boot makes up for the slight 
shortening; he has a movable ankle but perfectly firm. 

Professor E. H. Bennett expressed the thanks of the 
Academy to Mr. Croly for his most practical and com¬ 
plete communication on the subject. 

Mr. LeNtaigne exhibited a cast of fracture of the 
astragalus, This particular injury was exceedingly rare. 
It was a fracture of anterior portion of astragalus, with 
displacement forwards and outwards of the fractured 
head of the bone, and was caused by jumping off a car'. 

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220 The Medical Press. 


GERMANY. 


After an interval operation was allowed. The loose head 
of the astragalus was found to be completely detached 
from all structures except by a few threads of fibrous 
tissue. The head of the astragalus was reduced and the 
wound closed. The case was still in hospital, and would 
be exhibited, he hoped, later on. 

Mr. W. I Wheeler mentioned a case of dislocation of 
astragalus backwards, the result of a blow by a cricket 
ball on the front of foot when in a flexed position. 
Efforts to reduce the dislocation were unsuccessful; 
although it was never reduced the patient to this day 
has a most useful foot. The question of waiting until 
a slough occurs, or removing the bone, or touching it at 
all, was very important. It depended on the circum¬ 
stances. He had seen cases of slight partial displace¬ 
ment which were left alone and the patients had very 
useful limbs' afterwards. If the astragalus were dis¬ 
placed so much as to act as a foreign body he would 
advise immediate removal. 

The President had seen one case of dislocation which 
was remarkable inasmuch as it bore out what Mr. Croly 
had said—the apparent facility with which the astra¬ 
galus could be dislocated by accident. He had made 
several endeavours to imitate that force on the dead 
subject, because he had often had occasion to remove 
the astragulus for aggravated equino-varus in the adult. 
It is a very successful operation. In this operation he 
always had to remove the astragalus piecemeal. He 
had never succeeded in getting the hammer and anvil 
described by Dr. Hadden. The result obtained by Mr. 
Croly seemed to show that the fdot was almost as good 
without the astragalus as with it. 

Mr. Croly, in reply, expressed as his strong opinion 
that immediate removal of the bone with careful dress¬ 
ing of the wound was the proper treatment. 

CASE OE CHRONIC INTESTINAL OBSTRUCTION. 

Mr. John Lentaignb exhibited a patient from whom 
he had removed the oseoum and a small portion of the 
ileum for ohronic intestinal obstruction, resulting from 
stricture at the junction of the ileum and caecum. 

This case will be found fully reported in another 
oolnmn under the heading of “ Clinical Records." 


(Skrmanp. 


[PROM OUR OWN CORRESPONDENT.] 


Berlin. February 26 th, 1899. 

The Mechanical Treatment op (Edema op the Skin. 

Prof. Pubbrinoer has an article on this subject in the 
D. Med. Wocheruch., 1/99. The treatment mainly consists 
in subcutaneous drainage by means of soft rubber tubes. 
The trocar, 5 to 6 mm. is passed through as nearly as 
possible parallel to the skin surfaoe, and brought out 
again, so that the space is tunnelled. India rubber 
tubing about two mm. in length, but not too loosely 
fitting into the metal trooar is then passed through. In 
the middle of the tube three holes are punched a few 
oentimetres apart. The tubing iB passed until the holes 
in it are in the punctured canal, when the trocar is 
withdrawn. The ends of the tube are now placed in a 
vessel containing fluid. A lightly placed antiseptic 
bandage keeps it in position. The tubing is soon so 
firmly gripped by its vital surroundings that scarcely 
any fluid escapes from the wound opening. Even when 
in susceptible people the puncture is painful, the pain 
soon passes off. Two such tubes may, if necessary, be 
placed near each other, in order to further facilitate the 
escape of fluid, but more than these are not required. 
If the patient requires to leave the bed, for a time, the 
ends of the tube can be damped. When the time 
comes tb remove the tubing, this can easily be done by 
cutting it through close to the wound. Upon the whole 


Mae. I, 1899. 

the plan appears to be in some respects an advanoe on 
drainage by Southey’s tubes. 

At the Medical Society Hr. Benda showed prepara¬ 
tions from a case of 

Syphilis op the Liver. 

The patient had been a woman, set. 54, who had died in 
the 2nd internal klinik in the Urban Hospital. She hud 
also had nephiitis, asoitee, and general oedema. Section 
showed nephritis on an amyloid base. There was also 
general syphilis which had led to great changes in 
the liver. Numerous cicatrices gave an appearance at 
nessar lobatum thickly strewn with gummatous nodules- 
There were in addition broken down gummatous nodules 
on the skull, and several cicatrices on the bones; deep 
cicatrices at the base of the tongae, no general 
smooth atrophy, but retraction of the frinulum glottidis; 
a cicatrix on the external genitals, possibly the remains 
of the primary sore and smaller cicatrices from a pre¬ 
vious papulous syphilide. 

Hr. Hausemann showed the skeletons from two 
cases of 

Rachitic Microcephaly. 

The patients were sisters, who were admitted into 
hospital on September 22nd, 1897. Both had necrotic 
sores on the external genitals resembling noma. They 
died of sepsis after a short stay in the hospital, the 
younger, eighteen months old, on September 23rd, the 
elder, two-and-a-half years old, on September 27th. The 
father showed some possible remnants of rickets. The 
mother was quite healthy. One child, aged five, has a 
head like the father, but no rickets, and a later bom 
child was quite healthy. The intellectual development 
of the children that died was said to be normal, but the 
speech of the elder one was imperfect. There were 
abnormalities in the kidneys of both children. The 
changes in the skeleton were so evident that the children 
were looked upon as microcephalic, both before and after 
death. The development of the skull was backward, and 
showed a resemblance to the birdlike aspect of the 
Aztec’s type. Proportion of the head to the remaining 
parts as in the dwarf skeleton. The brain very back¬ 
ward in development. The signs of rachitis were very 
general in both skeletons. The disturbances in the brain 
corresponded to those of microcephaly; the cere¬ 
bellum was not covered by the cerebrum, so the 
sulci and gyri were not sufficiently developed, 
as, for instance, the frontal gyrus This was 
present, but not separated from the second suloue. 
The temporal lobes were the best developed. The 
precuneus and cuneus very defective. He could 
not determine any connection between the microcephaly 
and 83 noetosis of the cranial vault. The development 
of the microcephaly must begin in an earlier embryotde 
stage, before that of rickets comes into the question. 
Festal rickets, according to reoent investigations, were 
not properly rickets. Hypertemia and slight thickening 
of the bones were not rickets. Cystowicz had' examined 
100 foetuses and newly-born children, and had never found 
rickets; neither bad the speaker, and even if foetal 
rickets could be assumed, it could not reach a high 
development during fcetallife, and as the bmln developed 
daring that early period there could be no connectibiv 
between the two. It should rather be assumed that 
with congenital microoephaly rachitis had developed 
that had led to the syuostmta 

He then showed the skull Cf a 9-yette old'child with. 


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AUSTRIA. 


The Medical Prise. 221 


a premature synostosis that had led to idiocy; bat in 
spite of this there was no microcephaly, there was no 
limitation of the development of the gyri by compres¬ 
sion. 

At the meeting of the Society for Psychiatry, 
Prof. Westphal gave a note on 

An as yet Undbscribed Pupil Phenomenon. 

He showed in a number of patients from the Cbarite 
partly with rigid pupils, partly with slowly acting pupils, 
the following phenomena:—If the eyelids are strongly 
dosed and then opened the bulb rotates upwards and 
outwards, more rarely downwards and inwards. At the 
same moment narrowing of the pupil is distinctly seen. 
The process is best seen when the rigid pupil is widely 
dilated, when the pupil is already contracted it cannot 
be seen. In health he had only seen the phenomenon in 
once instance. The speaker described the phenomenon 
as a co-ordinate movement from the region of the facial 
upon that of the oculomotor. In a patient with trau¬ 
matic neurosis the bulbi on dosure of the eyes rotated to 
the side of the wound. 

Hr. Konig asked if the narrowing of the pupil during 
Bleep was produced in the same way ? 

Hr. Westphal said that in sleep the eyelids were very 
lightly closed, but here the contraction was only seen 
when they were energetically dosed. 

Hr. Jolly said it was a surprising phenomenon that 
could easily be verified. 

At the Society of Innere Medizin, Hr. M. W. Wasser- 
mann spoke on 

Immunity against Pneumococci. 

He said there were many questions still undedded, 
such as how the anti-bodies get into the blood, and 
whether at certain times there were more anti-bodies 
in oertain organs than in the blood. He had endea¬ 
voured to solve these questions by animal experiment. 
As a result of his researches he concluded that a special 
irritation was set up in the medulla of bones by pneu¬ 
mococcus infection, and that there the anti-bodies were 
specially to be met with. After the fifth day they 
passed into the blood, where they remained in the serum 
a long time. The medulla of bones was, therefore, to • 
be looked upon as the place of formation of the anti- j 
bodies in pneumonia. These experimental results he 
was able to verify in the case of a man who died on the 
fifth or sixth day of the disease; the anti-bodies were 
found in the medulla of the ribs. Parallel with the 
passage of the anti-bodies into the blood a leucocytosis 
developed, but he could not determine experimentally 
if the leucooytes, the place of development of which 
was also the medulla of bones, transported the anti¬ 
bodies out of the marrow into the blood, and by their 
destruction set them free in it. 


Jluetria. 


[from our own correspondent.] 


Vienna, February 9Sth, 1899. 
Chronic Bead Poisoning. 

Hlava reoordb a case of some interest from Eiselt’B clinic, 
a few specimens from whioh were exhibited at the 
last medical meeting. The patient was a house painter, at. 
08 , sfifferihg from “ chronic lead intoxication,” according 


to the clinical records, whose symptoms were described 
as severe painful attacks of colic as in nephrolithiasis ;• 
albumen and granular cylinders in urine; hypertrophy 
of the left ventricle, Ac. 

The post-mortem revealed large coagula in the- 
abdomen. Behind and below the right lobe of the liver 
the serous covering of the organ was torn, and from it 
protruded a nodulated tumour. On cutting into the 
parenchyma of the liver a large number of haemorrhagic 
centres were discovered, while the peripheral surface was 
white or anaemic; this condition was most marekd in 
the right lobe, the external surface having a compressed 
or crushed appearance. The kidneys appeared quite 
healthy. In the right ureter not far from the pelvis 
was found a longitudinal baematoma. The mucous mem¬ 
brane of the ureters was thickened, and at various spots 
raised. The left ventricle was concentrically hyper¬ 
trophied. The large vessels and vena porta were care¬ 
fully examined for the cause of this bursting of 
the smaller vessels, but nothing could be found. On 
closer examination of the parenchyma of the liver 
white fibrous bands were discovered around the smaller 
vessels of the organ itself, causing the vessels of the 
interior to bulge and become varicose. In one place this 
aneurysmal condition was beautifully demonstrated by 
a section. The disease was therefore a multiple 
aneurysm of the arteria bepatica which explains the 
serous rupture and clots found in the abdomen. 

Eppinger, in tracing this morbid condition to its 
source, attributed it to mycotic emboli; while Kussmaul 
and Mayer are inclined to believe in a periarteritis 
nodosa extending over the entire arterial system ; yet 
strange to say, after careful examination, the aneurysmal 
condition could not be found in any other vessels of the 
body outside the liver, though the walls were much 
thickened. 

Alava was inclined to believe in " lues ” localised to 
the vascular system as the remote primary cause of the- 
morbid transformation. 

This opinion is sustained by the microscopic appear¬ 
ances as endarteritis obliterans, in the centre of which 
are to be met with small miliary tubercles resembling the 
centre of a gumma. 

Acoine. 

Acoine is a substitute for cocain, and it is said to be 
safer, and to give rise to more lasting effects than the 
latter as an anesthetic. By the makers it is known as 
“ alkyloxyphenylguanidine.” A dose of 0 5 gramme can 
be borne without any apparent inconvenience, but larger 
doses are found to produce an escharotic effect on the 
stomach and bowel, resulting in death. 

When applied to the eye of a dog, anaesthesia may be 
observed for a few days after its application, theie being 
at the same time considerable irritation of the cornea 
and conjunctiva. 

Experiments have been made with another congener, 

“ Aooin C ” (or “ Diparaanissyl - mono - parapbenetye- 
guanidin-chlorhydrat ”) in different grades of dilution 
whioh will produce anssstbesia from two minutes’ dura¬ 
tion to many days. From these results it is found that 
1 in a 1,000 will last 15 minutes 
1 „ 400 „ „ 30 

1 ;. 200 „ 00 

1 „ 100 „ „ 40 to 80 „ 

1 „ 40 „ „ over a day 


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THE OPERATING THEATRES. 


Mae. 1, 1869. 


■: The latter solution irritated the eye, but did not injure 
it in any way. The other solutions were quite free from 
irritation, while the eye was perfectly anaesthetic for the 
.operator. 

In the form of subcutaneous injections, it was used in 
the following form :— t 

I£ Acoin, OT ; 

Sodi, Chloratis. 0'8; 

Aq. Distill, lOO'O. 

This solution was used without any bad effects being 
.observed, while the anaesthesia would last for forty or 
fifty minutes, after which sensation returned gradually 
from the periphery to the centre of injection. 


^he (Operating theatres. 

WEST LONDON HOSPITAL. 

Two Cases of Appendicitis. —Mr. Bidwell operated 
on a boy, aet. 18, who had been admitted with symptoms 
.of acute appendicitis. Seven days before admission he 
had an attack of pain in the right iliac fossa, which was 
accompanied by diarrhoea and some abdominal distension. 
The diarrhoea continued, and a hard swelling formed at 
the seat of pain. The temperature was 102, and the 
tongue dry and coated. As pus was evidently present it 
was decided to operate at once. An incision was’made 
along the outer edge of the right rectus muscle, the 
sheath was 6pened, and the outer fibres of the muscle 
separated with the handle of the scalpel; the posterior 
layer of the rectus sheath was then divided, and the peri¬ 
toneum opened; a few recent and very slight adhesions 
were found between the abdominal wall and the caecum. 
On passing the finger on the outer side of the caecum a 
quantity of very offensive pus welled up; this was washed 
away with a 1 in 2,000 pei chloride solution, and the 
appendix searched for; it was easily found, and brought ! 
up into the wound; it was removed after a ligature had 
been applied close to the caecum. The appendix showed 
a large perforating ulcer in one wall, and inside was a 
concretion about the size of an almond. A largest size 
rubber drainage-tube was passed to the bottom of the 
sac and a gauze drain by its side. Another strand of 
gauze was placed inside the drainage tube to act as a 
wick, and the rest of the abdominal incision was closed. 

The second case was that of a girl, at. 16, who had 
been seized with a pain in the right iliac fossa six days 
before admission. The symptoms had been similar to 
those in the former case, with the exception that she 
had suffered from retention of urine for the last four 
dayB, which had necessitated the employment of a catheter. 
In this case an incision was made with its centre two 
fingers breadth’s internal to the anterior superior spine of 
the ilium on the rightside. After dividing the aponeurosis 
of the external oblique, the fibres of the internal oblique 
were separated.without division; the transversalismuscle 
being then cut through ; adhesions were found between 
the abdominal wall and a structure which resembled the 
caecum, they were, therefore separated towards the outer 
side with the finger, and the posterior part of the 
swelling explored, but without finding pus; a needle 
was then inserted in the centre of the swelling and pus 
-escaped ; a free opening was therefore made evacuating 
about two ounces of offensive pus and two small concre¬ 
tions about the size of grape stones. The cavity was 


thoroughly flushed with 1 in 2,000 perchloride lotion. 
The appendix was found at the back of the sac, and was 
removed after ligature of its base and of its mesentery. 
It contained a concretion the size of a cherry stone, and 
its wall had perforated by ulceration. A large tube was 
placed down to the bottom of the sac, a gauze wick 
inserted and the rest of the wound closed with silk¬ 
worm gut sutures. Mr. Bidwell remarked that both of 
these cases were unusual by the fact of their haviog 
been accompanied by diarrhoea instead of constipation ; 
the presence of retention of urine, too, in the second case 
was also unusual, and might be explained by reflex irri¬ 
tation of the right ureter from its proximity to the 
inflamed appendix. With regard to the incision em¬ 
ployed in the first case he said the object of separating 
the fibres of the rectus instead of going through the 
linea semilunaris was to avoid the chance of subsequent 
hernia, and this was the incision he had always 
practised in these cases, and although answering 
admirably either in cases of large abscesses or in cases 
of removal of the appendix between the attaoks of in¬ 
flammation it does not appear, he considered, to be suit¬ 
able to a small collection of pus such as was present in 
this case because direct drainage is not afforded. The 
incision practised in the second case answers this re¬ 
quirement. He said there was considerable difficulty in 
distinguishing the sac of the abscess from the ctecum in 
the second case, because the size and appearance of the 
abscess sac was precisely similar to the viscus when dis¬ 
tended. He thought it wiser to explore the posterior 
surface of the swelling than to risk opening what might 
have been intestine; the diagnosis by inserting an 
ordinary surgical needle could have done no damage 
even to the gut, and at once demonstrated the pus. He 
said he strongly recommended the removal of the appen¬ 
dix in these cases unless it should be so placed that its 
removal might risk disturbing the adhesions shutting 
off the general peritoneal cavity. Leaving a perforated 
appendix, he thought, caused the period of convalescence 
to be much delayed as a sinus persisted for months, and, 
moreover, had in some cases been followed by second 
perityphlitic abscess. 


Vital Statistics. 

The deaths registered last week in thirty-three great 
towns of England and Wales corresponded to an annual 
rate of 19'5 per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of this year. 

Birkenhead 25, Birmingham 17, Blackburn 16, Bolton 
17, Bradford 17, Brighton 16, Bristol 17, Burnley 16, 
Cardiff 14, Croydon 15, Derby 20, Dublin 27, Edin¬ 
burgh 26, Glasgow 32, Gateshead 21, Halifax 20, Hud¬ 
dersfield 12, Hull 14, Leeds 18, Leicester 10, Liverpool 27, 
London 19, Manchester 23, Newcastle-on-Tyne 21, Nor¬ 
wich 15, Nottingham 17, Oldham 20, Plymouth 20, 
Portsmouth 14, Preston 28, Salford 27, Sheffield 20, 
Sunderland 23, Swansea 19, West Ham 16, Wolver¬ 
hampton 20. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were:—From measles, 1*3 in Manchester; from whoop¬ 
ing-cough, l - 4 in Sunderland, 16 in Halifax, and 2 3 in 
Birkenhead; from “ fever,” 10 in Gateshead; and from 
diarrhoea, l'O in Gateshead. In none of the large towns 
did the death-rate from scarlet fevei reach 1-0 per 
1,000. The 92 deaths from diphtheria included 40 in 
London, 8 in Sheffield,' 5 in West Hanl, 5 in Swansea, 4 
in Birmingham, 4 in .-Liverpool, 3 in Birkenhead, and 3 
in Leeds.. . No dealjh from small-pox was registered in 
any part of the tXnited Kingdom. 


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LEADING ARTICLES 


The Medical Press. 223 


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“ 8ALDS POPULI SDPREMA LEX.” 


WEDNESDAY, MARCH 1, 1899. 


THE ANTI-TUBERCULOSIS CRUSADE. 

We have already expressed the opinion that the 
movement which has recently been started for the 
-education of the public and the promotion of legisla¬ 
tion for the extinction of tuberculosis, may, if ener¬ 
getically worked, prove to be the central epoch in the 
history of preventive medicine. The scourge of 
oonsumption among Caucasian races transcends that of 
■even small-pox in its prevalence and its fatal results, 
and presents greater difficulties in finding and apply¬ 
ing remedies. Nevertheless, there is every encou¬ 
ragement to press forward the movement with 
enthusiasm and energy because the means suggested 
are quite within reach if the public can be once 
thoroughly aroused to the necessity for self protec¬ 
tion and persuaded that strict, but not unreasonable, 
precaution will afford that protection. The first step 
will be to clear away the ingrained belief that con¬ 
sumption is necessarily hereditary and almost neces¬ 
sarily incurable, and the second step, to establish 
the belief that it is a purely contagious disease, and 
that those who are not exposed to the contagium need 
not and will not suffer from it. The third step, to 
make it well understood that, if taken in the early 
stage, consumption is by no meany incurable under 
proper management. The next duty of the cru¬ 
saders will be to persuade the authorities, by 
persistent agitation, of the urgent necessity 
for segregation of tuberculous subjects in work- 
houses, asylums, hospitals and orphanages, on 
board the Queen’s ships, and in other places 
where people congregate under official disci¬ 
pline, and also to promote, by persistent clamour, 
legislation for this object. Next comes the peremptory 


interdiction of the sale of the milk or the meat of 
tuberculous cattle, and it may be assumed that any 
attempt to do this will be met by strenuous opposi¬ 
tion by dairymen, farmers, and meat dealers, and that 
considerable expense must be incurred for supervision 
of these trades, and for bacteriological examinations, 
reports, and prosecutions. However, the ground has 
been already prepared for this sort of legislation by 
the existing safeguards against cattle disease and 
milk adulteration, and we trust that the extension of 
the existing system would not be found very difficult- 

The crux of the whole problem iB the means to be 
taken to isolate the free population who may be 
suffering from the disease, and for this purpose the 
establishment of Consumption Homes on a lavish 
scale, and the enactment of a variety of coercive 
regulations have been already advocated. 

To every movement for the protection of the 
community, obstructions are inevitable. There 
are, first, the Christian Scientists, Peculiar People, 
Anti-Vivisectioniste, Anti-Vaccinationists, and such¬ 
like, who yearn for advertisement, and usually for 
the more material benefits which accrue there* 
from. Next, there is the enormous multitude 
who know or care nothing about anything save 
the earning and outlay of a daily maintenance 
pittance, and every one of whom will need education, 
persuasion and strong pressure before they submit to 
precautionary measures. Then there are the intelli¬ 
gent working classes who may resist because their 
breadwinning is endangered by restrictive measures— 
by the boycotting of their little shops, or their possible 
discharge from work by reason of supposed delicacy. 
These are really the only persons to be pitied 
in this connection, and to whom it is essential 
to make the burthen of sanitation as light as pos¬ 
sible. We may hope that, as regards the prophylaxis 
of consumption all these obstructions can be got 
over by patient persistance in persuasion. It is 
necessary, however, to count among the hindrances to 
reform, another class whose firm repression is essential 
at the beginning of every sanitary crusade— 
i.e., the Ultra-Sanitarians. We do not wish to 
cloud the initial difficulties of this movement by 
entering into details of these propositions. Per¬ 
haps the time may come when the nation is willing to 
pay the enormous tax required for sufficiently 
accommodative Consumption Homes, and to face 
the interference with personal liberty which has been 
suggested. Certain it is that years must elapse before 
the public mind is prepared for such a change, and 
for those who desire, as we do to stimulate imme¬ 
diate action, “the least said the sooner mended ” 
on these subjects. But it is necessary to speak 
now because in this particular instance a num¬ 
ber of these gentlemen are already on the war path, 
frightening off the public from consumption prophy¬ 
laxis. More suo they want, as soon as possible, a corps 
of Inspectors to watch every individual who coughs, 
to interview him, collect his Bputum, and submit it to 
microscopic examination. Then they want a law to 
expatriate such individual, if found infected, to a Con¬ 
sumption Home (provided by, Heaven knows whom 


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221 Thu Medical Press. 


LEADING ARTICLES. 


Mar. 1, 1899. 


at Heaven knows what cost); and a further law to 
compel each one to cany a spit-cup in his pocket and 
expectorate into it at every public place—at church, in 
the theatre, or in the omnibus. Lastly, they insist in 
the immediate provision of Homes at the public 
expense, forgetful of the fact that there are at least- 
380,000 persons in the United Kingdom now suffering 
from tuberculosis, and that each one of these, on the 
ultra-sanitarian plan, must cost someone at least £20 
per annum for maintenance, irrespective of the vast 
original outlay for the sites and buildings for these 
homes. If the taxpayer were required to pay the 
whole maintenance charge, it would cost £7,600,000 
a year, with a proportionately larger sum if it were 
found necessary to retain the patient for a longer 
period than one year. We entreat our ultra-sani¬ 
tarian friends to “ moderate their transports ” for a 
few years, and not subject this great movement to 
their freezing douche, even, as one of our correspon¬ 
dents suggests, that they may “ advocate the ideal in 
order to arrive at the practical.” 


FACTS AND FALLACIES ABOUT INSANITY. 

Thu course of Monday free lectures at Glasgow 
University this winter is being taken advantage of 
and is much appreciated. The University is, as all 
universities ought to be, model nising so as to bring 
within the limits of its use not only students within 
its walls, but the intelligent populace outside. One 
of the latest free lectures has been that of Dr. 
Yellowlees, of Gartnavel, on “ Facts and Fallacies 
about Insanity." We are not surprised that this 
lecture was attended by a great number of people, 
nor that it was received with rapt attention, for as a 
popular lecturer Dr. Yellowlees is sure to inspire and 
interest his hearers. With some of his ideas re¬ 
garded from a critical, and from a strictly 
scientific point of view, we cannot agree, but 
with the general principle of his teaching, and 
the great purpose involved, viz., the education of the 
general public on the principles which under¬ 
lie mental health and the conditions which in¬ 
volve mental disease, we have nothing but good 
to say. It is quite true that, as Dr. Yelowlees 
observed, the subject of mental disease is now 
regarded with an interest and intelligence very differ¬ 
ent from the superstition and prejudice enterta ned 
by the public twenty or thirty years ago, but to go 
further back and to study the subject as it was 
regarded in Biblical times the solution of all insanities 
was at once referred to the unseen and the infinite, 
afflicted ones were regarded as possessed by a dem n 
or spirit. Even in Palestine to-day a friend of the 
lecturer informed him that he had seen a lunatic 
oovered with bruises and wounds. When remon¬ 
strated with, his keeper said “ It is not the man we 
are punishing, it is the demon, it is that evil spirit 
that dwells in him.” The conviction that insanity is 
not a disease is a fearful fallacy. We can endorse this 
statement. The more insanity is recognised as a 
d i s ea s e by all intelligent, right-thinking men and 


women, by those who exercise ordinary common-sense- 
the more will the prejudice against its early treat¬ 
ment break down, and the sooner may we expect to see 
a serious attempt made to grapple with it in its early 
stages. On this is based our real foundation of the 
hope we entertain that by-and-bye the preventive 
treatment of insanity will take a hold of the public 
mind as a serious and immediate question of practical 
politics. The next fallacy Dr. Yellowlees pointed out 
was the fallacy that insanity was a disease of the 
mind, of the immaterial part of the man, and through 
this the natural conclusion arose that he was no longer 
a human being but was on a level with the brutes, 
and so he was treated accordingly. That this natural 
conclusion does arise from symptoms in some mental 
cases is true, but it does not follow as a necessary 
corollary that these should be deemed brutes. The 
next point to which attention was drawn in this 
lecture was that the disorder of the mind was really 
due to the disorder of the body. As a general state¬ 
ment this will pass, but undoubtedly these are cases 
of so-called mental disease which some would 
call mental idiosyncrasy, and which as age- 
advances develops and becomes more pronounced, 
individualistic and erratic. In such it may be simply 
impossible to demonstrate any disease of the body 
associated with it whatever, and up till now impos¬ 
sible even to demonstrate any mici'oscopic brain con¬ 
dition to account for it. Certain statements made by 
Dr. Yellowlees to his audience might be disputed by 
medical men, but we are by no means desirous to be 
critical, haviDg regard to the fact that in lecturing to- 
a popular audience too fine a point would preclude 
their conception of the real crux of the question, at 
the same time, we should not like it to go undisputed 
that, if the blood which the brain receives is thin and. 
poor, melancholy ensues. This, for example, as in Dr. 
Yellowlees’ illustration of brain starvation caused by 
the over-nursing of women, is not borne out by the 
actual clinical experience of mental disease. Melan¬ 
choly is certainly prevalent in these cases, but it is nofc- 
a necessary sequel to brain starvation, or thin and 
poor blood. It is a curious fact that the same indi¬ 
vidual, twice or thrice insane, will exhibit the mental 
symptoms of opposite poles in two different attacks, 
melancholia in the one case, mania in the other. A 
different physical condition may not be discovered to 
account for the contrast, for all our knowledge of the 
explanation of different mental states as re gar da- 
blood supply and the cerebral structure is still in the 
midst of futurity. With what Dr. Yellowlees has to- 
say of Bleep as a most blessed thing for brain health,, 
we cordially agree, and it is very likely, taking his 
statements not exactly in a literal sense that the man 
who lays his head on the pillow by 11 o’clock at night 
does the best brain work. Undoubtedly, late hours, 
irregular habits, excitement, irregular, deficient sleep, 
accounts for much of our indifferent brain work, and, 
in susceptible cases accounts for much of our mental 
disease, it may not be in the present generation, but. 
in generations to come. 


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Mae. l. 1899. 


NOTES ON CURRENT TOPICS. 


The Mbdicax Pbsss 225 


IS IT DESIRABLE TO BOIL MILKP 

Aw esteemed correspondent, commenting upon 
the campaign in favour of boiling all milk 
before consuming it, ventures to call in question 
41 the enormous benefits conferred on the com¬ 
munity by the invariable sterilisation of milk 
before use,” and he openly scoffs at “ the appalling 
results which accompany or follow the drinking of that 
most pernicious and wicked of fluids, raw milk,” a state, 
ment which he believes has unnecessarily created a 
widespread feeling of insecurity among members of 
the public. We must disclaim any sympathy with 
his views, but it is always well to hear the 
other side. Alluding to the fact that deaths from 
abdominal tuberculosis in children are becoming 
more numerous, he points out that the total 
mortality among children is decreasing. Scarlet 
fever, typhoid, and a host of infectious diseases 
are often ascribed to infection through milk. But 
the mortality from these diseases is less than formerly. 
Raw milk from tuberculous cows is said to induce 
tuberculosis in those partaking of it. Can it do this 
he asks, unless there is a predisposition to tuberculous 
disease P Sterilised or boiled milk, he admits, is free 
from this danger, but, he asks, can jt nourish the 
child as well as the raw milk P He goes on 
to assert that the impoverishment of the body- 
soil, induced by complete abstention from milk in a 
raw state, and by the administration of only the 
more indigestible and considerably less nutri- 
ious boiled article, increases the possible danger 
of subsequent infection with tubercle in other 
organs; that it lowers all the bodily powers and 
faculties out of proportion to the original reason 
for its boiling. Let those responsible for the 
supply, he suggests, go to the fountain - head 
of the evil, test the cows and reject the tuber¬ 
culous. But, he urges, even if the milk be 
tainted, in the long run as much harm as good is 
brought about by feeding children who are beyond the 
bottle or breast stage principally upon boiled milk. 
It not only conduces to the survival of the unfittest, 
but tends to cause serious deterioration in the persons 
of the fit. He declares that there is a very marked 
difference in looks between children given milk only 
after boiling, and those who are allowed to con¬ 
sume it raw. The first are anaemic, white-faced, 
and, although perhaps of good size, flabby ; the second 
Tosy-cheeked, full-blooded, and full of animal spirits. 
Nature, he asserts, never intended children to 
consume her ideal food solely in a cooked state. 
Its proteids are altered in character, its phos¬ 
phates are rendered less available for absorption, 
while modifications of smell and taste indicate 
the occurrence of other intimate chemical changes. 
Nature, no doubt, did not surmise that milk would 
prove an ideal medicine for the growth of 
tubercle bacilli; but she provided mankind with 
defences in the stomach, bowel, and blood, quite 
adequate in healthy children for a successful resist¬ 
ance against the assaults of the ubiquitous, obsti¬ 
nate, but fragile, bacillus, the ca-usa causans of 


tuberculous inflammation and degeneration. If the 
milk is to be boiled, so must the cream be sterilised ; 
and so should butter be only partaken of soon after melt¬ 
ing it at or near its boiling point. Hot buttered toast is 
generally regarded as heavy and indigestible, but, he 
asks, may not hot buttered toast, sterilised milk, boiled 
cream, and hot “ Welsh rabbit” represent the most 
innocuous forms in which to consume milk and its 
products for infants, youths, and adults of our very 
delicate population ? He concludes his criticism by 
calling attention to the fact (?) that all products 
made from milk are rendered more indigestible by 
heat. 

If the sole object and aim of medical humanity 
were to aid and abet the survival of the fittest no 
doubt one means at our disposal would be to abrogate 
all sanitary and prophylactic precautions, and to 
leave the human race to fight it out with the microbes 
on the principle that the weaker must go to the wall. 
Rightly or wrongly public opinion favours an exactly 
opposite course, and the aim of those who practise 
medicine is to thwart pathogenic influences by every 
means in their power, regardless of the ultimate 
effect of this system of “ bolstering up the unfit ” on 
the race at large. Unless we are to reverse the 
''humanitarian levers we must continue to advocate 
the exclusive use of boiled milk and boiled or care¬ 
fully filtered water. We may, in conclusion, express 
a doubt, baaed on extensive experience, as to the 
alleged indigestibility of boiled milk. Are roast beef 
and plum pudding rendered less digestible by the 
process of cooking P Moreover, laboratory experi¬ 
ments do not show any Buch difference in the action 
of ferments on boiled and raw milk respectively as 
our correspondent’s statement would lead us to 
believe, and we are at a loss to know on what ground, 
chemical, physiological, or clinical, such statements 
are founded. 


4tot£8 <nt Current topics. 

The Possibility of Rejuvenescence. 

The maintenance or the recovery of youth has, ever 
since the dawn of history, been the aim and object of 
countless generations of thinkers and hopers, pro¬ 
bably as a pendant to the philosopher’s stone which 
if discovered would make persistent youth worth 
having. It would have been more to the point per¬ 
haps if these dreamers had included the maintenance 
of health among the things wished because no one 
we imagine would wish to prolong indefinitely 
an, existence associated with the pangs of chronic 
dyspepsia or the depression begotten of confirmed 
melancholia. With the advance of scientific know¬ 
ledge, it is true, human hopes have taken a somewhat 
different direction, time has discredited the mysterious 
jumblings of the old alchemists, and experience hns 
discredited the efficacy of baths of blood, and the 
at-one-time common belief that sleeping with the 
young had a beneficial effect on the senile, witness 
the treatment of King David in his old age, and, 
much more recently, of Catherine II. of Russia 


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226 The Medical Press. 


NOTES ON CURRENT TOPICS. 


Even nowadays there is a general, and probably not 
altogether unfounded, belief that it is injurious for 
the young to sleep with persons much older than 
themselves, though this thesis, even if proved, would 
not, of course, prove the converse. However this may 
be, there still lurks in the recesses of the human 
mind a secret aspiration for perpetual youth of which 
no better evidence is necessary than is afforded by 
the popularity which for a brief period hallows 
every new suggestion holding out the promise in 
however small a degree, of “ repairing the irre¬ 
parable.” Mephistopheles having dishonoured the 
drafts on his bank of youth men now look to science 
for a solution of the eternal problem, resolutely re¬ 
fusing to admit that science also is bankrupt. 
Science has done, and is still doing, so much to render 
life agreeable that one is loth to believe it cannot pro¬ 
long the life thus rendered the more desirable. The 
last craze of the kind was one of which the recollec¬ 
tion will, let us hope, sooner or later sink into oblivion 
with the mortal remains of its author, the late 
Brown-S^quard, who mistook his senile dreams for 
realities and his aspirations for accomplished facts- 
His arguments were preposterous, and his methods 
revolting, but his object was one that secured for 
him and his measures an outburst of popularity 
which caused the wise to blush, and over which the 
frivolous made merry. Such popularity is of its 
nature ephemeral and the Tarpeian rock is not far 
from the Capitol. Undeterred by experience others 
will from time to time hold out mirage-promises to 
the eager crowd ever willing to acclaim without too 
closely scrutinising their credentials those who are 
clever enough to promise compliance with their 
wishes. Some are fools and some are knaves, but all 
dealers in rejuvenescence fall into one or other 
category. 

The Law aa to Quack Concoctions in 
France. 

An important principle, which may have far- 
reaching effects, was recently established in the 
law courts in France. A firm of opticians were the 
proprietors of a glass containing baryta from which 
they manufactured spectacle lenses. The latter 
were described as “ isometropic,” and were exten¬ 
sively advertised as possessing excellent qualities. 
Dr. Javal, however, of the Sorbonne, having had his 
attention directed to the claims of the advertisers, 
commissioned two of his assistants to institute a 
careful examination of the special glass and of the 
lenses made from it, with the result that they 
reported that the difference between baryta glass ani 
ordinary glass was insignificant, that they were not 
in favour of the former, and that isometropic 
“lenses” did not offer any advantages to purchasers. 
Dr. Javal accordingly brought this report under 
the notice of the French Academy of Medi¬ 
cine, whereupon the firm sued him for £800 
damages. But the Court found for Dr. Javal, main¬ 
taining that a scientific man might rightly examine 
and criticise upon public grounds any manufactured 
article for which special merits were claimed. This 


Mab. 1, 1899. 

undeniably is a most important principle to have 
established, and its legality might with advantage be 
put to the test in this country. If a board of ana¬ 
lytical and medical experts were to be formed for the 
purpose of analysing, testing, and reporting upon the 
many quack concoctions thrust under the noses of 
the British public which are guaranteed to cure all 
the ills to which human flesh is heir, a marvellous 
work might be accomplished. The public,as it has been 
proved, are unable to protect themselves in this matter;, 
and the Government have repeatedly refused to act t 
but individual enterprise has now and then been of 
service, and it is to be hoped that such enterprise will 
prove its value again. A well-known instance of this 
was the Harness case, the proprietor of the notorious 
so-called electropathic belt, had a very short innings 
as soon as an inquiry into his business was made 
public. 

“The Latest Sham Diploma.” 

Under this heading we recently discussed the 
assumption of the title of “ Doctor of Refraction ,r 
by a Yorkshire chemist, which was granted to him 
by the Philadelphia Optical College. In commenting 
upon our remarks our contemporary, the New York 
Medical News, says : “ Really we had thought that 
our neighbours of Philadelphia were more careful of 
the ethical economy of their medical educational 
household than this. We supposed the days of 
Buchanan were gone for ever. Least of all 
would we have expected a diploma-selling insti¬ 
tution to spring up in the ophthalmological 
line since our lusty young contemporary of 
Philadelphia had shown frequent signs of caring 
especially for abuses in this line of the healing art. 
This is a matter which deserves looking into. Phila¬ 
delphia's fair name in medical education has become 
of late years once more a treasure to her and her 
professional progeny. Let it not be smirched again 
by the diploma traffic.” Presumably by “ lusty 
young contemporary ” is implied the Philadelphia 
Medical Journal, which recently caused some astonish¬ 
ment among its contemporaries in the States by 
declining to continue exchanging with them. 

A New Form of Writers’ Cramp. 

Although it is not given to a very large propor¬ 
tion of medical practitioners to see, still less to study 
a case of writers’ cramp it is generally conceded to 
be a very disabling affection. According to Dr. C. D. 
Musgrove, however, this is not the only professional 
disability to which this long-suffering individual is 
prone. This gentleman, indeed, describes a form of 
angina pectoris or heart cramp observed in a patient 
who, having to get through some urgent corre¬ 
spondence in a comparatively short time, suddenly 
experienced the characteristic precordial oppression, 
followed by violent palpitation, obliging him to 
abandon his occupation for the time being. 
The symptoms subsided in the course of a 
few minutes, but recurred on his recommencing 
work. The symptoms appear to have been due 
in pr *t at any rate to the position of the body 


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Mae. 1, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Pbiss. 227 


while at work under conditions which entailed 
great nervous strain. It is obvious that the 
attitude of forward inclination which the ordinary 
use of the pen entails is unfavourable to the prope r 
play of the thoracic apparatus, respiration in a 
person writing under pressure becoming shallow 
and the movements of the diaphragm being interfered 
with by the abdominal compression. The best way 
to avoid tbe occurrence of such attacks is to modify 
the physical conditions under which they are known 
to arise. The patient, for instance, should be advised 
to write slowly and never to hurry, using a high 
table in preference to a desk, or, if sitting, to be 
careful to cross the legs. These precautions are 
specially indicated in the subjects of cardiac disease, 
and in elderly persons presenting signs of arterio¬ 
sclerosis. 

The Proposed London School for Tropical 
Diseases. 

• Although the Seamen’s Hospital Society have 
acoepted the suggestion of their committee to found 
a school for tropical diseases at the Albert Docks, it 
does not follow that the scheme, if carried out, will 
meet with the support of the profession. There can be 
nocondoning of the gratuitous insult shown the staff of 
the 1 Dreadnought ’ at the time that the scheme was 
formulated. Moreover, Mr. Chamberlain has shown 
a lamentable want of judgment in not having at¬ 
tempted to arrive at a compromise in the matter. 
It is obvioas that the success of such an undertaking 
must largely depend upon all the support that the 
profession can give it—a vital fact which its lay pro¬ 
moters seem to have entirely overlooked. Hence, if 
Mr. Chamberlain had assumed a diplomatic attitude 
and had shown that he was prepared to reopen the 
question of the organisation of the scheme, all might 
have terminated favourably. But now he has 
obviously proved himself to be a partisan, with the 
result that he has probably alienated a great deal of 
support for the proposed school which otherwise 
would have been freely bestowed. 

A Curious Charge of Malpraxis. 

Really some patients are very difficult to please. 
Last week at Bristol a dissatisfied person claimed 
damages from a dentist and from the practitioner 
who administered the anassthetic on the ground that 
they had removed more teeth than he had authorised, 
and had left him bleeding and still unconscious 
with a mouth full of holes. The defendants had an 
easy task in disproving the allegations of negligence 
and improper conduct in a professional respect and 
the jury promptly gave a verdict in their favour. 
This, however, is sorry compensation for all the 
worry and trouble of defending an action-at-law and 
the flimsy nature of the allegations can only exasperate 
tbe feeling of resentment. We have heard ovanoto- 
mists accused of removing spare ovaries, though it is 
difficult to fathom the reasons that would theoreti¬ 
cally induce them bo to do. Decayed teeth are 
about as useful after extraction as damaged ovaries, 
so that it would not be easy to suggest a plausible ' 


motive for a dentist allowing his zeal to outrun his 
discretion. The public had better take note that 
when they place themselves in the hands of a surgeon 
or a dentist the limits of the operation are left to the 
operator to fix, in the absence of an exprese stipu¬ 
lation to the contrary. On the other hand, few sur¬ 
geons of repute would consent to operate with their 
hands tied, feeling as they must that if they do not 
possess the patient’s confidence, they had better hold 
aloof. 

The Medical Profession in Germany. 

There seems to be no lack of medical men in the 
Fatherland. In Berlin and its suburbs, 2,233 practi¬ 
tioners administer to the needs of the community, or 
one medical man to eveiy 75 L of the population. In 
contrasting this reeord with the state of affairs in 
earlier times, it has been pointed out that there were 
191 practitioners in Berlin in 1825, or one to every 
1,153 inhabitants, in 1849, 515, or one to 823. More¬ 
over between 1875 and 1885, statistics show that while 
the Berlin population increased at tbe rate of 37 per 
cent., the medical practitioners increased at the rate 
of 43 per cent. The total number of medical men in 
Germany amounts to 25,957 at the present time, and 
of these 15,951 are located in Prussia. The curious 
fact also is stated that the number of medical men in 
Berlin alone exceeds the total number of practitioners 
throughout the kingdom of Bavaria. Still, despite 
these statistics, it is probably the case that in many 
parts of Germany medical men are few and far 
between, owing to the scattered population offering 
them but little opportunity of making a living. 

The Prince of Wales’s Hospital Fund. 

The Prince of Wales presided last week at the 
second annual meeting of the committee of this 
fund, when the statement of accounts for the past 
year was presented. The total receipts for the year 
ending December 31st last, amounted to £39,270, 
while the expenditure was £34,960, of which the hos¬ 
pitals received £32,500. The expenses, therefore, of 
carrying out the work were £2,460, or “ only seven 
per cent, of the total expenditure,” as the report 
states. But this item of expenditure compares very 
badly with the announcement that in the first year 
the cost of collecting the fund only reached two and 
a half per cent. A sum of nearly £2,500 seems a 
large amount to spend in, order to collect £39,270, 
taking into consideration the favourable auspices of 
the Royal patronage of the Fund. After the accounts, 
however, bad been passed, His Royal Highness said, 
in reply, “ My duties are very easy and light ones.” 
It may seem most ungracious to pass any criticism 
upon this statement, but, at the same time, with all 
loyal respect, we venture to assert that the Prince of 
Wales’s Hospital Fund would be much more 
likely to become a success if it were felt that His 
Royal Highness did take an active part in its 
management. Whatever reasons may have existed 
for doubting that this was the fact have now been set 
at rest by the Prince’s own statement. Everyone 
' knows how deeply anxious the Prince is to render all 


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NOTES ON CURRENT TOPICS. 


228 The Medical Pkxbb. 

the assistance in his power to the London hospitals, 
but it must be conceded that hie fund has not won 
the confidence and unanimous approval of the hos¬ 
pital authorities. Until, therefore, this is the case 
we fear that the fund can never be a success. Rather 
the policy seems to be of those who pull the wires of 
the fund to deliberately excite a feeling of hoetility 
in certain hospital authorities, instead of conciliating 
them by tactful management. The editor of the 
Hospital newspaper has said that the awards of the 
fund excited very little criticism last year, and 
assumes from this that they must have given general 
satisfaction. But a reference to the annual reports 
of various hospitals concerned, which are now being 
published, will show him that he is entirely mistaken. 

Cycling Incidents. 

Two cycling events of the past week have a special 
interest to the medical profession, the one from a 
a scientific, and the other from a social standpoint. 
The first is that of an Australian champion cyclist, 
who, twenty-five yards before the end of a carnival 
race, fell forward in his saddle, and, with his feet still 
moving with the pedals, reached the winning-post, 
when it was discovered he was dead. The story ap¬ 
pears to be well authenticated, and if so it records 
another striking instance of the indomitable pluck of 
athletic man. Tt shows, moreover, the unerring 
balance and precision needed in a race, and the in¬ 
stinct that caused the rider, even in the act 
of dying, to throw himself into and main¬ 
tain a proper poise. This is the only in¬ 
stance, probably, ever recorded of a race being 
won by a dead man, and it is said the doctors said he 
died during the last lap. Medical cyclists will 
naturally look forward with interest to learning 
further details of this moet tragic affair. The second 
incident was that of a country surgeon haled before 
a bench of magistrates for riding a cycle on the foot¬ 
path. He represented that, as a medical man, he was 
entitled to take the shortest route to his patient, and 
that did not happen to lie upon the roadway. His 
plea was accepted and the case dismissed. It is 
generally admitted by the legal profession that, for 
the sake of saving time, a medical man in an emer¬ 
gency has the right to pass over any private ground, 
and we believe the point has been settled by various 
legal decisions. At the same time, it would be well 
for medical men to avail themselves of such a right, 
assuming it to exist, only upon occasions of great 
emergency, on the principle that it is easier to raise 
than to subdue a storm. 

The Perfection of Sanitary Science 

Recently, in commenting upon the national 
scourge of tuberculosis, one of the speakers in a dis¬ 
cussion at a Liverpool medical society said that we 
could not hope for a progressive decrease in the 
disease equal to that of the last forty or fifty years, 
because sanitary science had become almost perfect. 
There is much virtue in a saving clause, and the 
qualifying term “ almost" secures away of retreat 
from a position it would be impossible seriously to de¬ 


Mab. 1, 1899. 

fend. In many of our towns, small and great, especially 
in these of older creation, it is hardly too much to say 
if we adopt the view of not a few practical authorities, 
that sanitary science, so far from having attained its 
prime, is in its mere infancy. It may be pretty 
safely asserted, for instance, that not a single London 
parish has an intelligible plan of its sewers, a fact 
which is incompatible with systematic administra¬ 
tion. In the matter of house sanitation and con¬ 
struction, moreover, it is certain that an enormous 
percentage of hygienic defects escape detection. The 
subject iB a large one, and is alluded to here, not in a 
spirit of pessimism, but with a full recognition of the 
good that has been brought about in the past, and a 
confident trust in a future perfection. We simply 
contend that the day of ideal sanitation is not yet at 
hand. 


The Death-Point of the Tubercle Bacillus. 

Although it is a truism in the mouth of every¬ 
one who speaks of tuberculosis to say that Koch’s 
famous discovery placed the study of the disease 
upon a scientific basis, there nevertheless remains 
much to be learned as to the habitat, the natural 
history, and the means of propagation of this most 
devastating bacillus. A most important practical 
step was registered by Woodhead when he showed 
that milk could be adequately sterilised by raising it 
over a water bath to a temperature of 198 degs. F. 
As everyone knows, the simple boiling of milk suffices 
to destroy any tubercle bacilli it may contain, but 
exposure to the degree of heat entailed by that pro¬ 
cess injures the flavour of the milk. Actual boiling, 
i however, is now proved to be unnecessary, but to 
determine the exact amount of heat required to steri¬ 
lise would demand the use of a delicate thermometer, 
a fact that alone would prevent its adoption to any 
wide extent in the ordinary household economy. The 
more logical way of preventing consumption would 
be to look after the cows that supply the milk, and 
rigidly exclude all tuberculous animals. To treat the 
victims of the pestilence in sanatoria at great cost, 
and to allow the active germs to be distributed 
broadcast by the butcher and the milkman is to pay 
an enormous tribute of money and blood to the fetish 
of vested interests. 

Tooth Extraction “ a Discretion.” 

An interesting point lately settled in the Blackpool 
County Court will probably affect the practice of 
dentistry for some time to come, if not, indeed, for 
all the ages. From the evidence it appears that a 
young lady artist went to a branch of a Dental Asso¬ 
ciation in the town mentioned, and requested a 
qualified assistant to draw three teeth. She was 
placed under the influence of gas, and when she came 
round discovered that the whole of the top row of 
teeth had been extracted. The defence urged that 
the plaintiff had left herself entirely in the assistant’s 
hands to do what he thought proper with regard to 
the teeth. The judge, however, appeared to think 
otherwise, for he promptly awarded the injured 
patient a solatium of £30 damages. From this 


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NOTES ON CURRENT TOPICS. The Medical Press. 229 


Mar. 1, 1899. 

decision few persons are likely to differ. The case is 
much on the line of the ordinary surgical operation, 
wherein the discretion as to the extent of operation 
procedures is usually left to the judgment of the 
surgeon, ^-t the same time, where there is likely to 
be any ground of future complaint, as in the removal 
of the ovaries or of a great number of teeth, it is well 
to have a written or attested assent from the patient. 
If it be clearly proved that a dentist has grossly ex¬ 
ceeded his authority, as in the Blackpool case, then 
the laws of common-sense equity demand that a 
smart penalty be inflicted upon him. Tooth extrac¬ 
tion d, discretion by a dentist while one is in a con¬ 
dition of suspended consciousness would be a situation 
too terrible to be tolerated for a moment. 

The L. a. d. of Medical Treatment. 

Thebe can be no doubt whatever that in the 
highly complex scheme of life, which it is our pride 
to speak of as “ modern civilisation,” money is 
the mainspring on which the efficient and smooth 
movements of the vital machinery depend. The rich 
are able to secure change of air, and to command all 
the costly resources of modern scientific treatment. 
The poor, on the other hand, are handicapped by 
their straitened means, and have, for the most part, 
to turn for medical succour to the charity of private 
individuals, or of the State. Fortunately, most of 
our large voluntary hospitals are well equipped with 
the most effective appliances for the relief of ailing 
humanity, but that fact simply means that so much 
money has been contributed out of the pockets of the 
wealthy. In a word, approach the matter from what¬ 
ever side we may, the conclusion is forced upon one 
that curative measures are costly. This £ s. d. aspect 
of the question is more than ever to the fore in these 
days of open-air sanatoria, local hot-air baths, 
Rontgen ray photographs, and the thousand and one 
recent additions to our therapeutic armament. 

Artificial Air. 

At a recent meeting of the French Academy of 
Medicine MM. Laborde and Jaubert contributed a 
preliminary note on a certain chemical substance- 
the nature whereof is for the present kept secret, but 
which, it is claimed, will by simple contact regenerate 
air contaminated by respiration ; in other words, it 
absorbs the excess of carbonic acid, water vapour, 
and organic impurities, at the same time liberating 
with mathematical precision the exact quantity of 
oxygen wanting. It is asserted that Beven or eight 
pounds of this substance will enable an adult man to 
live for twenty-four hours in a hermetically sealed 
space of small dimensions. It would be idle to 
speculate upon the manifold uses to which such a 
product might be put. It will solve the problem of 
ventilating submarine vessels and of aerating divers, 
and it would also place the oxygen treatment, at 
present a veiy costly fad, within the reach of the 
poorest and the most economical, seeing that with a 
drachm or two of the salt twenty or thirty quarts of 
the gas can at once be produced. Perhaps, however, 
before deciding the best ways in which we can utilise 1 


the new body it would be wise to await further 
particulars. 

Asphyxia as the Determining Cause of 
Parturition. 

Among the numerous hypotheses that have been 
put forward to account for the initiation of the 
parturient process is one which assumes an accumu¬ 
lation in the maternal blood of a surplus quantity of 
carbonic acid, the effect of which it was alleged, 
would be to determine uterine contraction. This was 
an excellent example of the pure unadulterated 
hypothesis, in that not one of the premises had been 
verified. Dr. Chambrelent, of Bordeaux, records 
certain experiments recently undertaken by him with 
the object of ascertaining whether asphyxia will 
really provoke expulsive action on the part of the 
uterus. With this object in view, he cut both the 
vagi in several pregnant rabbits producing double 
broncho-pneumonia which caused death in the course 
of two or three days without labour having set in. 
He concludes that the presence of carbonic acid in 
the blood, even in lethal amount, is not of itself the 
determining factor in the induction of labour. 


The Admiralty and the “Conscientious 
Objector.” 

The Admiralty have no sympathy with the “con¬ 
scientious objector,” and they have accordingly 
issued some stringent orders in regard to the vacci¬ 
nation of children belonging to the men of the Royal 
Marine corps. One of these orders is as follows:— 
“ Unvaccinated families are not to be allowed to live 
in barracks, nor are they to be conveyed to any 
foreign station at the public expense; nor is any 
unvaccinated child to be allowed to attend a divi¬ 
sional school.” This order, it is stated, has caused 
much dissatisfaction, owing to the heavy penalties it 
will entail upon any man who may object to having 
his children vaccinated. But no one but a “con¬ 
scientious objector" could dispute that the Admi¬ 
ralty have acted with sound judgment in the matter 
having regard to the interests of the public service, 
as well as to those under their authority. 

The English Local Government Board and 
the Anti-Vaccinationist Guardians. 

The Local Government Board is in the position 
of prosecuting certain English Boards of Guardians 
for refusing to appoint vaccination officers. Two of 
these Boards have refused because the officer, when 
appointed, would be obliged to carry the Act into 
effect without consulting them. But it will be 
obvious that this point involves the whole case be¬ 
cause, if the officer were obliged to ask leave to pro¬ 
ceed, the Board would certainly refuse it to him. 

The Naval Medical Service. 

It is announced that a considerable addition will 
shortly be made to the Service in order to meet the 
requirements of the large number of ships building. 
For the present, fifty new commissions are to be 
offered for competition. 


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230 Thb Medical Press. NOTES ON CURRENT TOPIC. M»n i. 1899. 


“Double Pneumonia.” 

The regretted illness of Mr. Rudyard Kipling, the 
inimitable tale-teller, in verse and prose, places in 
evidence the much greater prognostic significance of 
double pneumonia over the ordinary inflammatory 
attack, in which only one lung, and usually only one 
lobe of that lung, is attacked. Double pneumonia, - 
indeed, is but too often merely a manner of dying— 
an expression of heart breakdown. Although the 
lungs are the seat of the obvious manifestation of 
disease, it is really the organism as a whole that 
threatens bankruptcy. In persons living at high 
pressure it often happens that nothing occurs to 
call attention to the dangerously narrow margin 
of heart-Btrength until a trifling cold, asso¬ 
ciated with a little bronchial catarrh, adds the 
last straw to the burden which the heart 
has to bear. Unequal to the additional strain, the 
right heart yields, and the blood, no longer forced 
through the lungs, accumulates therein, creating a 
state of congestion which rapidly merges into inflam¬ 
mation. The progress is almost of necessity from 
bad to worse, because the heart, which has yielded to 
a comparatively small strain, will very improbably be 
enabled to cope with the much greater one implied 
by the modification in the pulmonary circulation. If 
there are unsuspected reserves of strength which can 
be drawn upon, the sufferer may yet emerge from the 
valley of the shadow of death, but, in general, the 
breakdown is due to irreparable physiological bank¬ 
ruptcy. 


Rip Van Winkle. 

One of our medical weekly contemporaries has 
happened across the fact that sham diplomas are 
being issued wholesale to “ Fellows ” of the Spectacle- 
makers’ Guild, and to “ Doctors of Refraction ” of some 
American quack diploma shop. The two paragraphs 
which have at length enlightened our contemporary, 
appeared in the Medical Press and Circular 
nearly six months ago. However, it is pleasing to know 
that the Sphinx has spoken, and that it “ has no 
observations to make beyond this—that the public 
should be warned that the holders (of these diplomas) 
are not qualified to practise ophthalmic surgery.” 
Now that “ a Daniel has come to judgment ” it may, 
perhaps, do no harm for us to remind the prophet that 
the sham diploma of “ Doctor in Pharmacy ” is being 
freely disposed of by certain Universities in America 
and France, and may, at any moment, be put upon 
the English market by the chemists and druggists. 
The time is, we fear, coming when genuine Doctors 
of Universities and Fellows of Colleges will decline 
to use titles and costumes which can be bought in the 
open market by druggists, spectacle traders, and 
such like. 


The Gosport magistrates last week dismissed a 
police summons against a doctor who rode a bicycle 
on the footpath, on the ground that a medical man 
called to an urgent case had a legal right to take the 
shortest wav 


From Pillar to Poet. 

Miss Beatty, of Beatty v. Cullingworth notoriety, 
is desirous of exercising her rights under Section 82 
of the Lunacy Act in the direction of obtaining 
copies of the certificates under which she was incar¬ 
cerated as a lunatic. The Act says that copies of the 
document in question can be obtained on application 
to the secretary of the Lunacy Commissioners, but 
this official declares that they are not in his posses¬ 
sion, while the clerk to the Hackney Board of Guar¬ 
dians, who admitted having the certificates, refused 
to deliver them up without an order of the Court. 
The North London police magistrate, however, did 
not see hi3 way to making the required order, as the 
Act only authorises application to the secretary of 
the Lunacy Commission. If Miss Beatty perseveres 
success will no doubt ultimately crown her efforts, 
and then p 

Antipyrin and Salicylate of Soda. 

As a combination of antipyrin and salicylate of 
soda is very much in use at the present time in the 
treatment of influenza, it is interesting to note what 
are their effects in respect of diuresis. The salicylate 
stimulates diuresis while antipyrin reduces it, even 
in doses not exceeding one grain of each. Coinci- 
dently with this effect on the urinary secretion the 
salicylate determines some vaso- dilatation in the 
kidneys with a slight rise in the general blood pres¬ 
sure. Antipyrin also tends to raise the blood pres¬ 
sure, but provokes a vaso-constriction of the renal 
blood vessels with, as already stated, diminution of 
the flow. 

Influenzal Mortality. 

As we foreshadowed last week, the weekly mor¬ 
tality returns of the Registrar-General testify to the 
prevalence of influenza, the number of deaths attri¬ 
buted to this cause having risen to 74, as compared 
with 50 during the previous week, and 22 and 21 for 
the two weeks immediately preceding. The lethal 
effects of influenza, however, are not to be measured 
by the mere number of deaths recorded under that 
head, for it will always be found that there is a simul¬ 
taneous increase in the proportion of deaths from 
respiratory diseases, the prevalence and fatality 
whereof are greatly influenced by the influenzal 
element. 

Vaocination Amendment Bill 

We think it is wise for Mr. Boulnois, Sir John 
Lubbock, and the other backers of this Bill to intro¬ 
duce it even though its chances of survival are but 
small. The absence of such a Bill this session would, 
no doubt, be made use of by the Antis as proof that 
their victory of last year is likely to be quietly 
accepted. Emphatically, it is not accepted, and we 
are convinced that the mass of public opinion is dead 
against the conscientious objector clause which this 
Bill proposes to repeal, and that, sooner or later. 
Parliament will repent of the decision which a 
timorous and trimming Government has induced it to 
arrive at. 


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Mab. 1, 1899. 


PARLIAMENTARY NEWS. 


The Medical Press. 231 


Additional Army Surgeons Wanted. 

The Secretary for War has announced, in the 
memorandum of his Arm? Estimates, that 18 addi¬ 
tional officers of the Royal Medical Corps will be 
shortly required to supply the needs of the additional 
30,000 men whom he proposes to add to the Army. 


§cotlani). 


[from our own correspondent.] 


The Late Professor Rutherford.—The Chair of 
Physiology. —The funeral of the late Professor W. 
Rutherford took place on Saturday last. A large num¬ 
ber of the medical profession in Edinburgh attended at 
his late residence as a mark of respect for his great 
attainments and self-denying life in the cause of scientific 
medicine, along with the representatives of the Senatus of 
the University and other bodies, while at least 500 
students followed the hearse to the railway station. The 
interment took place at Ancrum, his native place. A full 
obituary notice of the deceased will be found in another 
column. 

The Vacant Chair of Physiology in Edinburgh 
University.— Already various rumours as to those who 
will seek to fill the place of Professor Rutherford in the 
University of Edinburgh are flying about. As it is per¬ 
haps the greatest of physiological plums the candidates 
will form quite a host in themselves. We hope that the 
patrons will take into consideration, whoever may apply, 
the fact that as the ordinary medical student does not 
propose to become a laboratory research scholar or a 
physiological expert, but to practise medicine; and that 
as Edinburgh University turns loose over the world a 
large number of new practitioners each year, and only a 
limited number of scientific physiologists in a decade, a 
professor in this subject should be cognisant of the 
physiological requirements of the ordinary general 
physician, and be thus induced to so frame 
his course of instruction that the future at¬ 
tendants upon our sick may get the most useful 
and suitable insight into those sections of the 
science likely to help them in their practioe, not to be 
obliged to master all the abstruse niceties evolved by 
laboratory workers, many of whom have never felt a 
pulse or written a prescription since graduation, and 
most of which are of value may be to specialists, but have 
to be forgotten by busy practitioners. 

Discontent of Students.—Two assistants are now 
conducting classes in the Edinburgh University—the 
classes of Materia Medica and of Physiology. The class 
of Materia Medica has been so conducted from near the 
beginning of the session, and some signs of discontent 
from the students have become manifest. They complain 
that, having paid for a professor’s tuition, they have 
received another’s. 

Glasgow University.—The Vacant Assessorship.— 
It is expected that there will be a very large attendance, 
in fact a record one, at the statutory half yearly meeting 
of the University General Council on April 5th next, at 
which the members present will be required to fill the 
temporary vacancy of assessor to the University Court. 
The friends and supporters of Professor Herkless are 
greatly disappointed at the turn things have taken, as 
the appointment is now regarded as lying between Sir 
James Bell, Bart., and Mr. Copland. Professor Herkless 
is to address a meeting of members of Council in further¬ 
ance of his candidature. As the General Council will 
have two seats to fill in October the result of the vote in 
April will be an indication of the relative strength of the 
opposing forces. Sir James Boll has a large committee, 
over a thousand, but there are 5,541 names on the 
Council’s register. There is no doubt that a great many 
names have been sent in to swell the list of Sir James 
Bell’s committee under the impression that he is an 
almoner of the University, and from the fact that he sa 
in the Court before, but in truth Sir James Bell wa 
never a student of the University of Glasgow, and hi 


connection with the University Court was due to the 
fact of his being then Lord Provost of the city of 
Glasgow. Professor Herkless, on the other hand, is a 
graduate of the University, a teacher in St. Mungo’s 
College, and has done yeoman service for university 
improvements when things were in a state of chaos. 

Honorary Degrees of the Glasgow University. 
—The Senatus Academicus have resolved to confer the 
honorary degree of LL.D. on the following gentlemen at 
the public graduation ceremony on Tuesday, April 18th, 
next: viz., James Finlayson, M.D., Lecturer on Clinical 
Medicine, Western Infirmary ; Sir Henry B. Irving, K.B., 
Lyceum Theatre, London; William Jacks, merchant, 
Glasgow, sometime M.P. for Leith and Stirlingshire, 
author of “ Robert Burns in other Tongues,” <fcc.; 
Horace Lamb, M.A., F.R.S., Professor of Mathematics in 
Owens College, Manchester, author of works on hydro¬ 
dynamics and infinitesimal calculus; Henry Francis 
Pelham, M.A., President of Trinity College and Camden 
Professor of Ancient History, Oxford. 

Improvrd Facilities for the 8tudy of Mid¬ 
wifery.— According to I'nirersity Jottings, Professor 
Murdoch Cameron “ has set his heart and soul ” on the 
improvement of the very wretched facilities for studying 
midwifery in Glasgow, and the still more deplorable 
hospital accommodation for lying-in women. Dr. 
Cameron has our hearty sympathy in this, and we trust 
his efforts may meet with the success they deserve, and 
if accomplished, the proposed institution may not become 
entirely a family company limited. We also hope that 
this desirable improvement will not fall through as did 
those efforts on behalf of Queen Margaret College, which 
still stands greatly in need of a place for her students to 
study midwifery and gynaecology. At present they have 
to travel in all kinds of weather from the extreme west 
to east of the city in order to get the necessary teaching, 
which is particularly unpleasant for female students in 
winter. 


Jarlmmctttarg ^ctos. 


In reply to the irrepressible Mr. Bartley, Mr. Hanbury 
stated that candidate® for admission to the permanent 
Civil Servioe and all established workmen in Civil de¬ 
partments are required to have been vaccinated or revac¬ 
cinated. Customs boatmen must have been vaccinated 
within seven years. The Post Office requires its em¬ 
ployes to have been revaccinated, the latter within seven 
years, an exception being made in favour of ex-soldiers. 
The Government declines to interfere with the discretion 
of the Peabody Trustees in insisting on the children of 
their tenants being vaccinated. Mr. Hanbury added 
that persons not less than 10 years of age, who have not 
been revaccinated within ten years, as before the passage 
of this Act, be revacoinated free of charge by the Public 
Vaccinator. 

A Bill has been introduced by Mr. Boulnois of two 
clauses only—“ to repeal Section 2 of the Vaccination 
Act, 1898, such repeal to date from October 1st, 1899.” 

The Publio Health Acts Amendment Bill was down 
for Wednesday last, but failed to advance a stage, and 
therefore stands postponed until March 29th. 

We understand that the Government would be willing 
to facilitate, possibly even to introduce, legislation 
having for object the amendment of the Indecent Adver¬ 
tisement Act, and the great obstacle in the path of this 
much-needed reform appears to be the intrinsic difficulty 
of drafting such a Bill on practical lines. 

An amendment of the law as to constructive murder 
is the purport of a Bill by Mr. Ambrose. He proposes to 
give effect to the recommendation of the Criminal Code 
Bill Commissioners, and the Bill provides that upon a 
trial for murder no constructive or implied malice shall 
be imputed to the accused merely because it is shown 
that the death was caused by him or in the course of the 
commission or attempt to commit some other felony. 

In reply to Lord William Fitzmaurice, the President 
of the Local Government Board said that if he saw any 
reasonable prospect of making progress with a Bill em¬ 
bodying the clauses relating to the inspection of water 



232 The Medical Press. 


OBITUARY. 


Mar. 1, 1899. 


supplies by local authorities, he should be quite ready to 
introduce it. 

Ik reply to Mr. Daly, Mr. G. Balfour stated that it was 
not at present contemplated to suspend the Muzzling of 
Dogs Order in Ireland. The total number of cases of 
rabies throughout Ireland in the twelve months ending 
December 31st, 1898, was 132, as compared with 162 in 
the last six months of 1897, while the number of cases in 
the first six months of 1897, before the Muzzling Order 
came into operation, was 335. 

In answer to Captain Norton.it was stated that the 
average number of trained nurses in attendance on 
Br itish soldiers in hospital at Cairo and Alexandria, be¬ 
tween September 20th and October 30th, 1898, was 236, 
made up of 226 men and 10 women. 

In reply to a question by Sir W. Wedderburn, Lord G 
Hamilton stated that the mortality among coolies em¬ 
ployed on the Uganda railway works during 1898 appears 
to have been about 16 per 1,000 per annum on an average 
labour force of 12,800 hands. At the port of emigration 
the labourers are kept, as far as possible, apart from all 
infection; they are medically inspected before they go on 
board, where their food, clothing, sanitation, and medical 
attendance are provided for. There are hospitals at the 
base and at different points on the works. Medical men 
and medical subordinates. European and Indian, are 

E rovided for the service of these hospitals and of the 
kbourers. At the most unhealthy season of the year 
nearly 10 per cent, of the labourers were in hospital; at 
healthier seasons from 21 to 5 per cent, may be in hos¬ 
pital. The medical report of July last says, “ the pre¬ 
vailing diseases are malarial fever, diarrhoea, dysentery, 
liver complaint, scurvy, and ulcers. A complication of 
the last two generally neo essitates invaliding.” Those 
who are invalided are sent back to India. 


©bituarg. 

EMERITUS-PROFESSOR SIR JOHN STRUTHERS, 
M.D., LL D., Ex.-P.R.C.8.E. 

By a pathetic coincidence Professor Rutherford’s 
teacher and old chief in anatomy, Sir John Struthers, 
h as only survived his former assistant by a few days. For 
some months past his health had not been at all satis¬ 
factory, and nothwithstanding a trip to Norway last 
summer did not improve; so that when a serious attack 
of influenza supervened a few weeks ago, the physical 
weakness produced by his long-continued ill-health could 
offer little hope of a successful resistance to the malign 
effects of this modern scourge. 

Sir John Struthers was born in Dunfermline in 1823; 
graduated at Edinburgh University in 1845 ; and being 
attracted towards anatomy, soon became a successful 
extramural lecturer upon this subject. In 1853-54 he 
acted as deputy-professor in the University in place of 
Professor Goodsir during the prolonged illness of that 
well-known anatomist. Ten years later he was appointed 
the Crown Professor of Anatomy in Aberdeen University, 
a post which he held and adorned until 1889, when he 
retired, owing to a feeling that he was hardly equal, at 
his age and state of health, for the completely satisfac¬ 
tory conduct of the duties. Since that year he lived in 
Edinburgh, and occupied his leisure by taking an active 
part in the management of many of the hospitals in 
Edinburgh and Leith, and in the business of the Royal 
College of Surgeons of Edinburgh, of which he filled the 
President's chair two years ago. 

Sir John Struthers was essentially a man of ideas and 
a worker. Many of the recent reforms in the system of 
medical teaching in Scotland were adumbrated and in¬ 
sisted on by him long before they appealed to the general 
mind of the profession. In season and, as some thought, 
out of season. Struthers preached from the text that 
medical education should not consist entirely of courses 
of didactic lectures, but should be largely supplemented 
by practical classes and tuition. Long before Darwin’s 
views upon evolution were adopted by tbe teachers in 
medical schools, or regarded seriously by tbe public, 
Struthers advocated their truth with ardour, and did 
much to render them known and acceptable to the people 
of Scotland. 


A most persevering, even pertinacious, reformer. Sir 
John Struthers delighted in exercising his power in 
thiB direction upon any institution of which he 
might have been appointed a manager. He often 
used to boast of how he reformed the medical 
institutions in Aberdeen, and of several of the 
hospitals in Edinburgh and Leith after his retirement. 
His motives were always logically grounded, and con¬ 
scientiously believed in by himself, but a certain dis¬ 
inclination to modify his own views upon the advice and 
opinions of his colleagues rendered many of his efforts of 
less value, and undoubtedly caused on several occasions 
some feelings of irritation among those of his professional 
brethren affected by the proposed changes. No doubt 
his live-long purely academic associations led latterly to 
his seeming to be a little out of touch with practising 
physicians and surgeons. He did good work, however, 
and his strong advocacy of the benefits which would 
accrue from the addition of a fifth year for clinical work 
to the students’ curriculum, largely educated, we believe, 
tbe members of the profession in the decision later com© 
to that such a prolongation should be decreed. His 
published works were mainly papers upon anatomical 
subjects. 


PROFESSOR WILLIAM RUTHERFORD, M.D., 
F.R.C.P.S., M R.C.S.Eng., FR.S., F.R.S.E. 

The change for the better in the condition of Professor 
Rutherford, which we were able to chronicle in our last 
number when going to press, unfortunately was inter¬ 
rupted upon Monday, February 20th, by a serious re¬ 
lapse—so serious, indeed, that at 7 a.m. on Tuesday 
morning this brilliant exponent of physiological laws 
passed away. His illness commenced with a septic ton¬ 
sillitis, which went on to abscess formation, but, an inter¬ 
current attack of influenza supervening, his heart evinced 
grave signs of weakness, so that the appearance of pneu¬ 
monic symptoms upon the Monday night rendered his 
condition quite hopeless. 

Bora in 1839 at Anorum, in Roxburghshire, the son of 
a farmer, William Rutherford was educated first at Led- 
burgh Grammar School, then at Edinburgh University. 
A successful undergraduate, he obtained his degree in 
1863 with honours, and won a gold medal for his thesis. 
After filling residents’ posts in the infirmary, he acted as 
Professor Strother’s assistant in his anatomy room 
for a year, the pupil predeceasing the teacher by a few 
days. After a Bojoura at the chief Continental oentres 
of medical science, Rutherford, at 26, became Hughes 
Bennett's assistant in physiology in the University of 
Edinburgh, only to be selected four years after for the 
Professorship in Physiology in King’s College, London ; 
an appointment gained by reason of the high qualities 
of bis published results of original work. He held this 
post for five years, for the last three being Fullerian 
Professor to the Royal Institute of London as well. At 
the end of these five years his Alma Mater was inspired 
to send for him to fill the vacancy caused by the resigna¬ 
tion of hb former chief, Professor Hughes Bennett. 
Since that time, from 1874 to 1899, for twenty-five 
years, William Rutherford carried out the duties of the 
Chair of the Institutes of Medicine in a masterly 
manner, and devoted his whole existence to the fur¬ 
therance of the physiological education of his students. 
So engrossed was he by the constant attention, deemed 
by him to be requisite and proper for the observance of 
his academic obligations, that, though highly fitted by 
mental endowment for the successful prosecution of 
original investigation, he waived the personal advan¬ 
tages which undoubtedly would have come to him had 
he so pleased, that he might the more thoroughly and 
conscientiously fulfil his duty to his students. Notwith¬ 
standing this his famous series of experiments upon the 
action of various drugs upon the secretion of bile and 
in relation to hepatic functions will remain a physio¬ 
logical classic, though the results have, and may still 
have, to be further modified in the light of more recent 
researches and improved methods. 

William Rutherford was of marked individuality. He 
appeared to be conceited and supercilious, he was really 
somewhat sensitive, perhaps self-conscious; but absorbed 
in his life’s work. He was most genial and amusing 


CORRESPONDENCE. 


Mar. 1, 1899. 


The Medical Press. 233 


socially, in his ordinary work so wrapped up in it 
that his nervous mechanism became impatient of inter¬ 
ruptions or mishaps caused by undergraduate thought¬ 
lessness, or by failure of carefully prepared demonstra¬ 
tions. No medical teacher in Edinburgh, except Sir 
William Turner, in anatomy, could approach him in 
power of lucid exposition, nor in the succinctness with 
which his explanations were expressed. 

Apart from his professorial duties almost the only 
offices he held were those of member of the Edinburgh 
University Literary Committee, and recently of University 
Representative upon the Royal Infirmary Board of 
Management. In the latter position he proved of great 
service, and performed unostentatiously an immense 
round of useful work. Possessed of a fine musical talent, 
he not only was able to render his description of 
acoustical physiology of the greatest value and interest, 
but was led by it to found in 1889 the Edinburgh Univer¬ 
sity Musical Society, and constantly contributed songs 
at the various students gatherings or at meetings of the 
numerous medical social clubs for which Edinburgh is 
so noted. It was often said against him that os he could 
show so little evidence of original work or published writ¬ 
ings that his teaching must have fallen behind the 
times. This was not really so. The time spent by him j 
over the study of and obtaining a complete acquaint¬ 
ance with the latest physiological doctrines and results, 
prevented any great output of written work. Every 
detail and all the minutuc of the complicated and neces¬ 
sary demonstrai ions required for his lectures were per¬ 
sonally supervised and tested beforehand. He lived for 
his subject, and suffered for his devotion to it. 

The appreciation felt for him by his students was 
evidenced by their proceedings on hearing of his death. 
A meeting of senior and junior students who had 
attended his class was held on the afternoon of the day 
of his death, at which >t was unanimously resolved to 
commission Mr. Hutchinson, R.S.A., to prepare a bust of 
the late professor to be placed in his old classroom at 
their expense ; while on Saturday 500 students attended 
the funeral cortege from his house in Edinburgh to the 
railway station, whence his remains were taken to 
Ancrum for burial. 

DR. CHARLES JOSEPH ARKLE. 

W e regret to have to announce the death from pneu¬ 
monia, at the early age of thirty-seven, of Dr. Charles 
Joseph Arkle, F.R.C.P., Assistant Physician to the 
Charing Cross Hospital and to the Hospital for Con¬ 
sumption and Diseases of the Chest, Brompton. 
Educated at University College and Hospital, Dr. Arkle 
held most of the resident appointments, graduating 
M.D. London in 1887. He was elected to the Fellow¬ 
ship of the Royal College of Physicians only last year. 
At the time of his death Dr. Arkle was Physician to the 
Electrical Department and Joint Lecturer on Medicine 
and teacher of Bacteriology at Charing Cross Hospital. 


ComBpmttance 

We do not hold ourselves responsible for the opinions of our 
correspondents. 

MEDICAL RITUALISTIC MILLINERY. 

To the Editor of The Medical Press and Circular. 

Sir,—I have read with humiliation the letters of corres¬ 
pondents to your contemporaries on the great, absorbing, 
and critical gown question, from which the painful con¬ 
viction is forced upon me that a considerable number of 
my confrere-i feel that their statue as gentlemen and as 
members of an educated profession is to be evidenced by a 
public display of clothing, and that, to obtain the privi¬ 
lege of such display, they are willing to descend to the 
appropriation of costumes to which they have no earthly 
title, moral or legal, or by precedent. 

I ask, sir, are we scientists or only school girls 'i Have 
these correspondents no soul above gee-gaws, or do they 
suppose that their figuring in gowns, to which they are 
not entitled, will inspire their compeers with any senti¬ 


ment save contempt for their silliness. One writer claims 
his gown because of the “ financial support *' (i.e., his 
examination fees) which he gave to the London College 
of Surgeons, and another formulates, with great care, the 
exact material and the colour of the trimmings which he 
would like in his gown (when he gets it). Have these 
gentlemen no shame? What would they think of a 
lieutenant who masqueraded in major’s uniform, or a 
vicar who showed himself in public in lawn sleeves ? 

As they are debarred by law from these costumes. I 
venture to suggest that the dress of an alderman or of a 
parish beadle may be open to them, and would certainly 
eclipse the “royal blue with red facings,” which one 
correspondent has indicated as the toga of honour. 

I am, Sir, yours truly, 

Tartar-Emetic. 

THE TREATMENT OF INFLUENZA BY 
SALOPHEN. 

To the Editor of The Medical Pbhss and Circular. 

Sir,— As it appears that we are in the midst of another 
invasion of our old enemy, influenza, I should like to 
draw attention to its treatment by salophen, the value of 
which seems not to be generally known and appreciated 
by the profession in this country, although the success 
that has been attained with it on the Continent is re¬ 
markable. It has long been an admitted fact that sali¬ 
cylic acid and its salts are among the most reliable 
remedies in influenza; but the use of this salt and its 
compounds when long continued, or when exhibited in 
large doses, frequently produce symptoms such as vomit¬ 
ing, nausea, headache, buzzing in the ears, or even 
delirium, which often compels us to abstain from then- 
use, and this before the cure is complete. 

Salophen is, I understand, a combination of salicylic 
acid and acetylparamidophenol which is not decomposed 
by acid, and which passes through the stomach un¬ 
altered, and without disturbance. The intestinal alka¬ 
line mucus, however, splits it up into salicylic acid and 
acetylparamidophenol, but the process is so gradual and 
slow that the effect of the salicylic acid on the system is 
much more lasting, and this without any of the disturb¬ 
ances previously referred to. 

Salophen has been used largely, and with marked 
success, by many well-known medical men abroad, such 
as Drews of Hamburg, Hennig of Konigsberg, Gold- 
Bchlager, Pierre Marie, Huot, Goldmann, Block, Ac., 
added to which there is any amount of reliable literature 
to confirm its merits, especially in the work of Dr. Baque, 
and in the reports of Privy Councillors Guttmann and 
Drasche, and Professor Raimondi. This drug first came 
into note in the treatment of acute articular rheumatism, 
chronic rheumatism, and allied disorders of a rheumatic 
and gouty nature, but more recently it has been used 
with success in the treatment of idiopathic neuralgia, 
cephalalgia, sciatica, Ac., and, indeed, in all ailments 
where the use of salicylic acid is indicated. 

It is, however, as a specific for influenza that I desire 
now to call attention, and from the evidence adduced 
there can be little doubt that salophen stands pretty well 
at the top of the list of all the reputed specifics for the 
cure of that disease. 

Dr. Hennig, when speaking of influenza, says that 
“among the remedies applied by mo for neutralising 
neuralgic pain none have proved so efficacious as salo¬ 
phen,” ana he “ recommends salophen most cordially in 
the nervous forms in which influenza presents itself." 
Dr. Goldschlager, of the Wieden Infirmary, Vienna, 
reports that heobtained“someextraordinardy favourable 
results in treating influenza with salophen.” Again, 
Dr. Drews, of Hamburg, is still more emphatic. He 
states that “ the effect of salophen on the nervous forms 
of influenza is no favourable as to cause me to declare it, 
unhesitatingly, to be a specific for the nervous forms of 
influenza.” This statement with regard to its specific 
action is fully endorsed by Dr. Claus, of Ghent, and other 
physicians. In the face of this unanimous testimony as 
to the value of salophen, coming from men whose ipse 
dixit is above suspicion, and incontrovertible, it is clear 


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234 The Medical Pbws. MEDICAL SOCIETY OP LONDON. 


Mar. ], 1899. 


that we are in possession of a remedy that will help ns 
in cheoking the ravage of this recent scourge to society. 

The dose used appears to vary somewhat. Dr. Drews, 
in violent cases, gives an initial dose of 30 grains, fol¬ 
lowed by 15 grains about every three hours. In less 
severe cases 8 to 12 grains will suffice, at the same in¬ 
tervals, and in children from 4 to 8 grains, up to about 
<50 grains in twenty-four hours. The rapidity with 
which salophen relieves the pains of influenza is of great 
importance. After profuse perspiration the patient feels 
practically relieved of the symptoms but it appears to 
be generally advisable to continue the remedy for a few 
days after all the symptoms have disappeared. 

Lastly, n-t the least merit of this preparation seems 
to b6 that it is entirely innocuous, and that it greatly 
reduces the probability of complications, and of the 
supervention of the dangerous sequel# of influenza to a 
minimum. I may, therefore, be pardoned calling atten¬ 
tion to it at the present juncture, and shall be glad to 
know that other members of the profession have mot 
with the same success by its use as 

Yours truly, 

T. Poynton Wright. 

Medical Officer of Health for St. Neots, Hunts. 


HISTORY BASED UPON DIET. 

To the Editor of The Medical Press and Circular. 

Sir,— I see in your issue of the 15th inst., an account 
of how history is based upon diet. The subject is most 
interesting and is ably treated, but I doubt whether it 
is not a rather narrow view to look at the present period 
of history alone, and to deduce therefrom the theory that, 
because the foremost nations of Europe happen to be 
large consumers of flesh, flesh eating is conducive to 
progress beyond the lower stages. The writer admits, 
indeed, that the ideal, i.e., of course bloodless diet, is quite 
sufficient for the highest physical development and for 
the perfect working of our five senses, the ability to 
satisfy the needs of present circumstances, the qualities 
of fear, love and endurance of pain ; but he goes on to 
say that the power of governing, of swaying other minds, 
foresight and providence and altruistic speculation gene¬ 
rally, are only capable of their fullest development upon 
a diet containing flesh food. Let us consider a few 
nations who have governed, philosophised, and influenced 
the minds of others. Which nations are above all pre¬ 
eminent here? Without doubt the Jews, Chinese, 
Greeks, and Romans. The foundations of the creeds, 
philosophies, and modes of thought of nearly all 
the world come from the philosophies and learned 
speculations of these four. The mass of each of these 
nations was vegetarian up to their best periods. Where 
are the great animal-eating philosophers beBide the 
Jewish prophets, Buddha, Confucius, Pythagoras, 
Plutarch, Plato, Socrates and the philosophers ? These 
all either abjured the use of flesh altogether, or ate 
about a tenth part of what the average Englishman 
thinks he requires. As regards the statement that 
climate governs diet, we need only mention that can¬ 
nibals and vegetarians are found in the Tropics, and that 
in some parts of China where the climate corresponds to 
and is in some cases more rigorous than, our own, the 
people are entirely vegetarian. We believe, that, if only 
a more general view of the world be taken, the British 
nation will be seen to be in the van in spite of rather 
than because of, its flesh-eating habits. 

I am Sir, yours truly, 

Clare College, Cambridge, William Cumming. 
February 23ra, 1899. 

CHLOROFORM ADMINISTRATION IN CHINA. 

To the Editor of The Medical Press and Circular. 

Sib,—W e have just received the annexed table of 
results with our regulating inhaler, from Dr. John F. 
Wales, of Kowloon, near Hong Kong. The quantities 
of chloroform used appear to have been in excess of 
what experience has proved to be necessary in this 
country, but obviously evaporation takes place more 
freely in hot climateB apart from the fact that some 
Burgeons amesthetise more deeply than others. On the 


whole, therefore, the results obtained in Chin* compare 
favourably with those obtained in Europe. 

We are Sir, yours truly. 

Krohne and Sesemann. 
[Copy.] 

Cases with Krohne and Seeemann’s Inhaler at the 
Civil Hospital, Hong Kong :— 

Rename lor October. 

Chloroform administered 25 times. 

Average quantitv = 1 dr. 45 m. (=4*7 minims per minute, 
equal to 1*08 per cent, vapour). 

„ time to produce an£esthesia= 51 minutes. 

„ „ of operation = 16$ minutes. 

Europeans - 5 men, 1 woman = 6. Chinese -16 men, 
2 women, 2 children = 19. 

Resume for November. 

Chloroform administered 17 times. 

Average quantity = 2 dr 45 m. (= 6 minims per minute, 
equal to 1*38 per cent, vapour). 

„ time to produce anaesthesia =. 8 min. 8 sec. 

„ „ of operation = 17 min. 16 sec. 

Europeans—6 men. Chinese—9 men, 2 women. 

Resume for December. 

Chloroform administered 18 times. 

Average time to produce anaesthesia =_ 5 min. 58£ sec. 

„ „ of operation = 9 min. 21 } sec. 

„ quantity = 1 dr. 45 m. (= 6*8 minims per 
minute, equal to 1 *56 per cent, of vapour. 
Europeans—2 men. Chinese—9 men, 6 women, 1 
child. 

Detailed account of cases will be published in the 
annual report by the Colonial Surgeon, which I hope to 
forward. 


MEDICAL SOCIETY OF LONDON. 

Dr. Sidney Martin, at the meeting on Monday even¬ 
ing last, read a paper on “ Auto-intoxication and its 
Relations to the Treatment of Disease.” He contrasted 
infection with intoxication, the former being the invasion 
of the body by a living germ, while intoxication meant 
the poisoning of the body by chemical agents, usually 
the products of activity of the living germ. He 
described three kinds of auto-intoxication (1) of gastro¬ 
intestinal origin ; (2) occurring in the course of chronic 
disease ; (3) occurring in association with distuibed 
glandular function. He objected to the use of the term 
auto-intoxication to describe the results of bacterial 
processes, but admitted that it was very difficult to draw 
a strict line of demarcation between infection and 
intoxication. He agreed that some of the symptoms of 
indigestion might be due to the absorption of certain 
toxic substances formed in the intestines as the result 
thereof. He discussed the theories put forward to 
explain the phenomena of uraemia and diabetes, and 
criticised Bouchard's view, based on the lessened 
toxicity of urine in uraemia, that the symptoms were due 
to the retention of poisons in the body. At the same 
time he admitted that occurrence of peripheral neuritis 
in diabetes seemed to point to intoxication. He 
pointed out that most glands had an internal secretion 
indispensable to the integrity of certain physiological 
processes or their removal might be followed by the non¬ 
elimination of some poison inimical to life. Moreover, 
excessive activity of certain glands might of itself 
determine profound disturbances of nutrition. 

After some remarks by the President (Mr. E. Owen), 
who asked whether rickets was not a form of intoxi¬ 
cation of gastro-intestmal origin. Dr. Mott briefly 
narrated the results of certain researches he had made 
on the bio-chemical changes associated with general 
paralyBisof the insane. These changes were characterised 
by a widespread fatty degeneration of the tissues, an 
effect which he thought might be produced by the 
presence of cholin. Dr. Washbourn agreed that the 
term auto-intoxication was very misleading, in that on 
the one hand it applied to the absorption of substances 
from the intestine, and on the other it denoted certain 
changes occurring in chronic disease. 


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Mar. 1, 1899. 


MEDICAL NEWS. 


The Medical Press. 235 


The President announced that the Fothergillian 
prise and medal for 1899 had been awarded to Dr. 
Monckton Copeman for his work in connection with 
glycerinated lymph. 


The Cancer Hospital, Brompton, London. 

At the forty-eighth annual meeting of the governors 
of Ihis charity held last week the report, which was read 
by the secretary, stated that during the past year 2,477 
new patients were received, 835 bhng in and 1.642 out¬ 
patients, whilst the total number of attendances of out¬ 
patients was 13,803. The most modern advances in 
operative surgery had been noted and introduced into 
the practice of the hospital, and numerous operations of 
a serious character, which would have been utterly im¬ 
possible a few years ago, had been performed with 
remarkably successful results The valuable clinical ex¬ 
perience thus obtained was much appreciated by a large 
number of British and foreign medical visitors. Much 
regret was expressed at the untimely deaths of Mr. W. 
H. Hughes (secretary) and Mr. Edward Cotterell, 
F.R.C.S., an able and valued surgeon of the hospital for 
the past six years. The Committee had appointed, as 
secretary to fill the vacancy caused by Mr. Hughes 
death, Mr. Fred W. Howell, of the York County Hospital, 
out of about 300 applicants, and Mr C. Jarman as 
assistant-secrotary in appreciation of his services for 
twenty-six years. The report and balance-sheet were 
adopted and the usual votes of thanks accorded, after 
which the proceedings terminated. 

Gateshead Medical Association. 

(In affiliation with the Corporate and Medical 
Reform Association.) 

At a meeting of this Association, held on February 
7th, 1899, the following resolution was unanimously 
adopted :—“ That this Association strongly supports the 
memorial of November 23rd, 1898, signed by 309 practi¬ 
tioners and laymen, presented by the Corporate and 
Medical Reform Association, Limited, to, and received by 
the General Medical Council, against' Illegal Certificates 
in Departments of Medicine, Surgery, and Midwifery,’ 
now permitted by the Council in a department of 
midwifery, and followed by opticians in a department of 
surgery, and thanks the direct representatives, Mr. G. 
Brown, Mr. Victor Horsley, F.R S., Dr. Glover, Dr. W 
Bruce, and Sir W. Thomson, and also Sir C. Nixon, 
Dr. Bennett, and Dr. Tichbome, for their support of the 
following resolution moved by Mr. G. Brown and 
seconded by Mr. Horsley: - ‘ That a Special Committee 
be appointed to consider and report at the next session 
of the Council all cases of alleged infringement of the 
Medical Acts by persons who profess to examine candi¬ 
dates in medicine, surgery, or allied subjects, and to 
grant certificates or diplomas testifying as to proficiency 
in any branch of medical or surgical science.’ And that 
copies of this resolution be sent to the medical Press, and 
to the representatives above mentioned.” 

Royal Free Hospital. 

There was a large attendance last Wednesday at the 
sevent -first annual meeting of Governors and friends of 
this charity, the Hon. Mr. Justice Bruce presiding. In 
moving the adoption of the report, the chairman pointed 
out that the work of the hospital was being carried out 
in the most efficient manner in all the various depart¬ 
ments, and the committee considered that the time had 
come when a commencement should be made in carrying 
out the urgently needed building improvements referred 
to in the report, viz., (1) the alterations and additions to 
the ward lavatories, sculleries, and bathrooms; (2) 
better accommodation for the nursing staff. With 
regard to the latter, the visitors who inspected the 
hospital on behalf of the Prince of Wales’s Fund, 
strongly recommend the carrying out of these improve¬ 
ments The total cost of these works, as now estimated by 
the architect, is .£8,500, towards which the sum of £2,870 is 
available. Mr. Charles Burt, chairman of the weekly 
board, said that as one of those who had during the past 
year visited many hospitals and other institutions as a 
" epresentative of the Prince of Wales’s Hospital Fund, 


he was only too conscious of the need for the improved 
sanitary arrangements, and the additional accommoda¬ 
tion for the nursing staff referred to by the chairman. 
The Earl of Stamford was elected to fill the vacancy 
occasioned by the death of the Earl of Lathom, and the 
election of the Committee of Management and auditors, 
and votes of thanks to the various committees, medical 
and other officers, concluded the business. 

St. Thomas’s Hospital.—Housa Appointments. 

The following gentlemen have been selected as House 
Officers from Tuesday, March 7th, 1 99. 

House Physicians—G. B. Thwaites, L.R.C.P., M.R C.S. 
(Extension); E. A. Gates, L.R.C.P., M.R.C.S.; A. E. 
Stevens, M.B Durb., L.R.C.P., M.R.C.S.; and H. D. 
Singer, M.B.Lond., L.R.C.P., M.R C.S. (Extension). 

Assistant House Physicians—E. H. Ross, L.R.C.P., 
M.R.C.S., and H. C. Thorp, M.A., M.B., B.C.Camb. 

House Surgeons—S. O. Bingham, L.R.C.P., M.R C.S.; 
E. M. Corner, M.A., M.B, B.C.Camb., B.Sc.Lond., 

L. R C.P., M.R C S.; J. A. Barnes, L.R.C.P., M.R.C.S. ; 
and J. E Kilvert, L.R C.P., M R.C S. 

Assistant House Surgeons—H. J. Phillips, L R C.P., 

M. R C.S ; P. W. G. Sargent, M.A., M.B., B.C.Camb., 

L. R.CP., M.R.C.S.; S. A. Lucas, L.R.C.P., M.R.C.S.; 
and H. T. D. Acland, L.R.C.P., M.R.C.S. 

Obstetric House Physicians.—(Senior) R H. Bell, 

M. A., M.B , B.C.Camb., L.R.C.P., M.R.C.S., and (Junior) 
S. H. Belfrage, M.B.Lond., L.R.C.P., M.R.C.S. 

Ophthalmic Housh Surgeons. — (Senior) J. S. Hall, 

L. R.C.P., M.R.C.S., and (Junior) T. Hoban, L.R.C.P. 

M. R.C.S. 

Clinical Assistants in the Special Department for 
Diseases of the :—Throat—W. C. Ambrose, B.A.Camb., 
L.R.C.P., M.R.C.S. (Extension), and E. C. Bourdas, 
L.R.C.P., M.R.C.S. Skin—H. M. Scaping, B.A.Camb., 

L. R.C P., M.R.C.S. (Extension), and J. Gaff, L.R.C.P., 

M. R.C.S. Ear—A. W. Jones, L.R.C.P., M.R.C.S. 

Clinical Assistants in the Electrical Department.—H. 

N. Goode, L.R.C.P.,M.R.C.S. (Extension), and A. Bevan, 
LR.CP., M.R C.S 

The Irish Schools' and Graduates' Association. 

St. Patrick’s Day falling on Friday this year, the 
St. Patrick’s Festival Dinner of the Irish Medical 
Schools’ and Graduates’ Association will be held at the 
Cafd Monico, Piccadilly Circus, on Saturday, March 18th, 
at 7.15 p.m, the President, Sir William Thomson, of 
Dublin, in the chair. The Association will have the 
honour of entertaining as the guest of the evening a 
distinguished Irishman, General Sir George White, V.C., 
G C.B., G.C.S.I., G.C.I.E., the Quartermaster-General. 
As a very large attendance is anticipated, members 
shonld make early application for dinner tickets to the 
Hon. Secretary, P. J. Freyer, 46 Harley Street, W. 

The Middlesex Hospital 

The new laboratories in connection with the Middlesex 
Hospital Medical School, we understand, are now com¬ 
pleted, and are equipped with all the best modern appli¬ 
ances for the purpose of instruction and original research. 
A conversazione will be held on the evening of March 
15th in the new buildings, when many objects of interest 
will be exhibited. 

Mortality in Foreign Cities. 

The following are the latent official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations':—Calcutta 38, Bombay 98, Madras 42, Paris 
21, Brussels 21, Amsterdam 13. Rotterdam 18 The Hague 
19, Copenhagen 22, Stockholm 26, Christiania 25, St. 
Petersburg 27, Moscow 27, Berlin 17, Hamburg 15, 
Dresden 16, Breslau 30, Munich 22, Vienna 24, Prague 
23, Buda Pesth 25 Trieste 33, Rome 20, Venice 28. 
Apothecaries Hall of Ireland. 

The following candidates have passed the recent ex- 
aminatiens for the License in Medicine, Surgery, and 
Midwifery:— 

Phy-iology—8. Adye, Curran, and L. J. Farr-11. Anatrniy-S. 
A 1> e Curran and A. J. Barnes. Materia Medics—A. J. Barnep. 
Pathoiovy- W. P. Hardin*. Sorcery W.W. Perie. Midwifery 
W. W. Ferie. Ophl'i-lm c Surgery W. W. Feris. Completed 
Third ProfeMlonal W. P. Hardin*. 

The following have passed the L.A.H. 

F. G. Adye Curran, W. P. Delahunt, J. D. Power, M. P. 
O'Brien, and J. J. Ahern. 


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236 The Medical Press. 


NOTICES TO CORRESPONDENTS. 


Mar. 1, 1899. 


JlotiaB to 

dtorrwponbcnto, Short JLttttxs, -&c. 


iV Correspondents requiring & reply In this column are par¬ 
ticularly requested to make use of a distinctive signature or 
initials, and avoid the practice of signing themselves " Reader,” 
“Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

Comte De Mabillac.—W e are unable to comply with your 
request for publication, partly on account of the inordinate length 
of the communication and partly because, the enterprise, at this 
itage, does not present any particular Interest. 

Dr. F. Dbas (Merton).—Your cases are marked for early 
insertion. 

CnlRVROicus.—A mixture of soap and glycerine makes a very 
good lubricant for catheters and the like provided the loap does 
not comprise an excess • f nlkaii. An alternative suggestion Is to 
make use of the following:—Gum tragacanth, 26 parts; glycerine. 
10parts; solution of carbolic acid (1 in 100), 90 parts; mix and 
rub down wi'hout heating. This has the consistency of cold 
cream and is re -dily soluble in water, thereby greatly facilitating 
the subsequent cleansing of instruments. 

Db. E M. Cosgravk.—W e hope to have space for your paper 
on “ The Treatment of Tuberculosis at Falkenstein ’’ in our next. 


' “ Nbws Indeed!— We l<*arn from the Globe tha*- men who work 
in compressed air are liable to a new malady called ‘ caisson,’or 
compressed air disease, and Dr. Thomas Oliver traces it to increased 
.solution in the blood of the gases met with in compressed air, and 
the liberation of these vases after the person escapes from the 
compressed atmosphere.”—Bravo, Dr. Oliver! 

Db. S. A. T. - win receive a private note so soon as the necessary 
inquiries are complete. 

Mr. G. J. Wilson.— One cannot always form a correct opinion 
upon matteis on the surface Please supply us with fuller data 
and we will then carefully consider and report. 

Mbs. 8. F. W.—Will be able to get the surgical appliance 
needed in her case of Messrs. Pope and Plante (recently removed 
from Regent Street to 3H Old Bond Street, London), who make a 
specialty of it. 

INFLUENZA 8BT TO MUSIC. 


Our "special correspondent,” whose letters on Continental 
Health Resorts are read here with considerable interest, tells that 
among tbe musical attractions at Nice last week was a grand con¬ 
cert at which was pe>formed a spirited overture, composed by the 
Grand Duke Michael of Russia, and entitled “ Influenza.” The 
overture is said to have been written when it author was suffering 
from influenza and has considerable orchestral merit. The 
audience received the composition with enthusiasm, as it naturally 
would from a Grand Duke of Russia, but nothing is said of its 
effects on the microbe. 


Jftwttngs of the Societies attb lecture*. 

Wednesday, March 1st. 

Obstbtrical^Socirty of London.—8 p.m. Specimens will be 
shown by Mr. Bland button, Mr. Targett, and others. Mr. A 
Doran (President): Inaugural Address. Paper:-Dr. C. H. 
Roberts: A second Case of t rimary Carcinoma of the Fallopian 
Tube. 

Royal Collbge of Surgeons op England.—5 p.m. Mr. B. G. 
A. Moynihan: The Anatomy and Surgery of the Peritoneal Fossie. 
(Arris and Gale Lecture ) 

Medical and Scientific Society of thb Catholic Uni¬ 
versity.— 8 p.m. Inaugural Address by Dr. MacArdle. 

Thursday, March 2nd. 

Harvkian Socibty of London (Stafford Booms, Titchborne 
Street, Edgware Road).-8.30 p.m. Mr. D’Arcy Power: On Vanish- 
ngTumours.-Mr. B Gardner: A New Ether Inhaler. 

Nburological Society of London (11 Chandoe Street, W.).— 
-s.30p.rn. Clinical Evening. Dr. F. E. Batten: Muscular Atrophy 
iu a Child.—Dr. T. D. 8avtll: Epileptiform Seizures of probable 
Vaso-motor Origin. Dr. H. A. Caley: Syringomyelia with Sudden 
Increase of 8>mptoms.—Dr. W. Harris: Htemorrhage into the 
Spinal Cord (? Syrlngomyella).-Dr. J H. Bryant: Paralysis 
Agitans following Typhoid Fever in a Man. ait, 81.—Dr. Stansfleld: 
Epileptic Insanity associated with Mastoid Disease, Operation, 
Relief of Mental Symptoms. And other cases. 

British Balneological and Climatological Society (20 
Hanover Square, W.J.-3.30 p.m. Papere:-Dr. D. Kerr (Bath): 
Treatment of Disease by Meat.-Dr. Hedley: The Therapeutics 
of Heat. 

Royal College of Physicians of London.-6 p.m. Dr G.V. 
Poore: The Earth in Relation to the Preservation and Destruction 
of Contagia. (Miboy Lecture.) 

St. John’s Bospital for Diseases of the Skin (Leicester 
Square, W.C.).- 4.30 p.m. Mr. M.Dockrell: Cases of Telangiectasis 
and Vascular New Growths. 

Friday, March 3rd. 

West Kent Mbdico-Chirurgical Society (Royal Kent Dis- 
nensary, Greenwich. Road. S. B.J.-8.45 p.m. Clinical Cases:-Dr. 
McCann and IT. Ezard: Notes with specimens of (1) a Case of 
Dermoid Cyst of Ovary, simulating Extra-uterine Preguancy; (2) 
a Case of Parovarian Cyst of Unusual Size. - Mr. Kme3t Clark: Eye 
Cases (Living and Pathological). - Dr. Toogood: Cases from 
Lewisham Infirmary.—Dr. Scholefleld: Clinical Cases. 


West London Mbdico-Chirurgical Society (West London 
Hospital. Hammersmith, W.). — 8.15 p.m. Clinical Evening 
Cases will be shown by Dr. 8. Taylor, Mr. R. Pollock, Mr. McA. 
Ecclee, and others. 

Lahyngological Society of London (20, Hanover Square. 
W.).—6 p.m. Cases will be shown by the President, Dr. l»e H, 
Hall, Mr. Bowiby, Dr. E. Law, Dr. 8t. Clair Thomson, and others. 

Boyal College oy Surgeons op Bhqlant— 5 p.m. Mr. 
B. G. A. Moynihan: The Anatomy and 8urgery of the Peritoneal 
Posen-. (Arris and Gale Lecture.) 

Monday, MiBcn 6 th. 

Odontolcgical Pocikty op Great.Britain.—M r.iC. S. Tome’, 
F.R.8. “A Remarkable Diseased Tootn,” and Mr. F. T. Paul. 
M.D., F.W.C8, “A Contribution to the Histological Study of 
Dentine. ’ Casual Communication, by Mr. Ashley Bairett. 


Uaomtite. 

Bristol City Hospitals.—Resident Medical Officer for the Ham 
street Fever Hospital. Salary, £100 per annum, with board, 
lodging, and washing. Applications, before March 18th, to 
Dr. Davies, General Medical Superintendent, Public Health 
Offices, Bristol. (8ee advt.) 

Gorey Union.—Trained Night Norse. Salary, £30per annum, with 
£23 extra in lieu of board, applications to Clerk of Union. 
(See advt.) 

Manchester Royal Infirmary and Dispensary.—An Aural Burgeon 
and an Assistant Surgeon on the honorary staff. The former 
must be a graduate of a University of the British Isles; the 
Utter must be a F.R.O.8. (See auvt.) 

University of Glasgow.—Chair of Pathology. The normal salary 
of the Chair is fixed by Ordinance at £1,100 Por particulars 
as to applications, see advertisement in another column. 

Weston Super-Mare Hospital.—House Surgeon; unmarried. Salary, 
£60 per annum, with board and residence in the hospital- 


^ppoiittnunto. 

Blathbrwiuk, H.,L.RC.P.Lond . M.R.C.8., Medical Officer tothe 
Dulwich Sanitary District of 8t. Giles, Camberwell. 

Cameron, a. F., M.B., C.M.Edin., 8enior Assistant Medical Officer 
by the Sheffield Board of Guardians. 

Db Beauvais, R.N., L.8.A., Medical Officer, to the Milton Abbot 
Sanitary District of the Tavistock Union. 

Dickby, A. A. G., M.D.. L.R.C.8., L.M.R.C.P., Medical Officer to 
the Colne Sanitary District of the Burnley Union. 

Duke, A. W., Col.. M.D.IreL, L R.C.S.Irei., Principal Medical 
Officer to the North-Western District at Chester. 

Fryer, H. A., M.B., C.M.Edin., Medical Officer to the Hoxton 
New Town Sanitary District, Pariah of St. Leonard, Shore¬ 
ditch. 

Gabbktt, H. 8., M.D.Dubl.. M.tt.C.P.Lond., Pathologist to the 
Princess Alice Hospital, Eastbourne. 

Hanly, John Joseph, M.A., (B.U.I.), Medical Offloer to the No. 2 
Sanitary District of the Snepton Mallet Union. 

Jacob, F. h., M.B.Lond., M.R.C.8., L.R.C.F., House Physician to 
the Nottingham General Hospital. 

Kbmpb, Gilbert, M.D., B.S.Dunelm, M.R.C.8., L.R.0.P.Lond., 
Honorary Burgeon to the Salisbury Infirmary. 

Mann, F. w. S., L.R.C.i\Lond., M.R.C.8., Medical Officer to the 
Reveeby Sanitary District of the Horncastle Union. 

Mubkay, K. W„ L.B.G.P.Lond., F.R.C.S.,(Honorary Surgeon tolhe 
Northern Hospital, Liverpool. 

Rawlino 8. J. D., M.B.L md., L.R C.P., M.R C.S., Medical Officer 
to the Northern 8anitary District of the Dorking Union. 

Roche, Antony, M.R.C.P.Irel., Examiner in Medical Jurispru¬ 
dence and Public Health to the Royal University of Ireland. 

Stuart-Low, William, F.R.C.8.Bng., Assistant 8urgeon to the 
Hospital of St. Francis, New Kent Road, 8.E. 

Whittomh, H.. M.D., C.M.Edin., Assistant Physician to the Hos¬ 
pital of St. Francis, New Kent Road, B.E. 


#irths. 

CoLE.-On Feb. 23rd, at It 8urblton Road, Nottingham, the wife of 
George Cole, M.R.G.8., L.R.O.P., of a daughter. 

Griffiths.— On Feb. 23rd, at Egerton, Cheltenham, the wife of 
Hugh 8t. D. Griffiths, L.R.C.P., L.R.C.S.Edln.. of a son. 
Wyborn. - On Feb. 24th, at 204 Camden Road, London, N., the 
wife of W. E. Wyborn, M.R.O.S., L.K.C.P-, of a daughter. 


JftanriageB. 

H utton—Atthill.— On Feb. 23rd, at MonkstownChurch, Dublin, 
Hugh Hutton, of 118 Summer Hill, Dublin, to Maud, youngist 
daughter of Lombe Attain, M.D., of Dublin. 


Jwtho. 

Abkle —On Feb. 22 nd, at 66 Wimpole Btreet, London, W., from 
pneumonia, Chas. J. Arkle, Assistant Physician Charing Gross 
Hospital, M.D.. F.R.C.P.. aged 37. 

Bass —On Feb. 24th, at 9 Upper Wimpole 8tre«t. London, W., 
Frederick Bus, M D., F.R.C.8., Assistant Snrgeon to the West¬ 
minster Ophthalmic Hospital, aged 47. 

Tbrky.— On Feb. 16th, at his residence, 85, Grc&venor, Bath, John 
Terry, M.R.C.S.Eng., and L.S.A., aged 77. 


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She 3§Udiral |Ptess and ©irrular. 


“SALUS POPULI SUPREMA LEX.” 

Vol. CXVIII. WEDNESDAY, MARCH 8, 1899. No. 10. 


Original Communications. 

ON THE RELATION OF GOUT 

TO 

RHEUMATOID ARTHRITIS. 

Opening Remarks to a Discussion before the 

North-West London Clinical Society, 
February 15th, 1899. 

By WM. EWART, M.D., F.R.C.P., 

Senior Physician to 8t. Geoiye's Hospital and to the Belgrave 
Hospital for Children; Joint Lecturer on Medicine in 
the Medical School of St. George’s Hospital. 

(Concluded from page 209.) 

I have endeavoured to show that complete divergence 
exists between typical gout and typical rheumatoid 
arthritis, yet formerly they were included under one 
heading, until at the beginning of the century Heberden 
and Haygarth established the distinction. No serious 
effort has been made to revive the alleged identity between 
them. At the same time the confusion which existed 
between them until 1806, and the fact that we are now 
discnsaing a supposed relationship between them, forcibly 
su gge st s that there is, if not in the diseases at least in 
the appea r ances which oome before ns, some sufficiently 
marked outward resemblance. I believe that this resem¬ 
blance is limited to what may be termed “ borderland ” 
cases, and that it has been magnified by the diagnostic 
perplexity to which they give rise, and it is this un¬ 
certainty bearing upon treatment and prognosis which 
adds so much importance to the subject under discussion. 

Thus, whilst no confusion is possible between the two 
pure types, the practical point is that our diagnosis is apt, 
nevertheless, to be sometimes difficult, and the inference 
is that as they come before us the two diseases are not 
so purely typical as we read of them in books. We might 1 
well put down this difficulty to our want of perception, 
were it proved that the two diseases were not only dis¬ 
similar but antagonistic and mutually exclusive. But I 
venture to think that no universal antagonism exists. 
Although their general trend is in opposite directions 
there is a borderland where they meet and sometimes 
even blend. And to these associations I shall now 
briefly refer. 

The Types in which the Two Affections are Associated. 

1. The inherited gouty proclivity which has been 
traced by Sir A. Garrod in a rather large proportion of 
the sufferers from rheumatoid arthritis is doubtless one 
of the reasons which lends to the affection in some cases 
a gouty complexion—and this we expect to find in the 
female contingent. 

2. A more direct association is brought about par¬ 
ticularly in this country as a result of the circumstances 
of the disease. The inactivity which it entails is but 
tco likely to give scope to the climatic or dietetic 
agencies which tell upon those most susceptible to 
gout, and particularly upon males during middle life. 

3. But there is also a third group of those of yet 
stronger gouty tendency in whom the first event is 
asthenic gout at a relatively early period in adult life, 
and in whom a progressive failure of nutrition, or one 
induced by depressing agencies may at a later period 
bring about the rheumatoid change. 

4. Then there is an important group, which has per¬ 
haps more than any other influenced the nomenclature 
and the pathological theories of rheumatoid arthritis in 
the direction of rheumatism. Some sufferers present a 


record both of gout and of rheumatic fever. In harmony 
with the age period for the two diseases, we find almost 
invariably that rheumatic fever is the antecedent event, 
gout the late sequel. Many of these develop rheumatoid 
changes, and as applied to them, the term rheumatic gout 
is specially appropriate. But it must be borne in mind 
that this is not a constant result. 

We are thus furnished with four clinical types which 
agree in some very broad characteristics, and particularly 
in the symmetrical distribution of lesions, but which 
present so much individual variety and gradations that 
it is impossible to isolate them from each other as strictly 
separate morbid types. 

The most distinctly defined are that last mentioned 
and that in _which the production of Heberden’s 
nodules in the digits is the chief and sometimes the only 
visible change. This type is most commonly seen in 
women. Its pathology and clinical significance are alike 
obscure. 

The cases of early rheumatism with late gout usually 
present some unmistakably gouty characters by the 
side of the rheumatoid. 

The second and the third group are less easily defined, 
and it is in them that diagnosis is most commonly 
hesitating. 

They may come before us under two varieties, or stages, 
the dry nodose stage, or the stage of effusion, and these 
call for different lines of treatment. 

THE ACUTE ATTACKS OF GOUT AND OF 
RHEUMATOID ARTHRITIS COMPARED. 

In both diseases we have to deal with acute attacks 
and with chronic developments. The acute attaoks are, 
as might be expected, the most distinctive, and least 
likely to give rise to any oonfusion. The acute attack of 
articular gout is characteristic, and I need not dwell upon 
its details, but merely point out thatit is made up of an 
arthritic, of a nervous, and of a vasomotor local disturb¬ 
ance. Its most acute and painful symptoms seem to be 
due to the extra-articular changes, and particularly to 
the implication of the nerves and of the circulation. 

The acute attacks of rheumatoid arthritis are much 
less uniform. They are generally regarded as rheumatic 
and often mistaken at first for pure rheumatism. But 
closer observation will enable us, I believe, to distinguish 
among them two distinct types as well as mixed or 
transitional forms. One of them more closely resembles 
acute rheumatism in the important feature that the 
affection is mainly intra-art icvdar. These are the familiar 
cases of acute effusion occurring either at the outset—or 
as exacerbations in the course of the disease. The other 
form is svi generis, unlike rheumatism in many of its' 
features, and in the fact that there may belittle effusion, 
but that there is, as in gout, obvious extra articular dis¬ 
turbance and pain. 

From the point of view of a possible relationship to 
gout these painful attacks, of the more severe type, 
deserve our attention. In one respect they differ abso¬ 
lutely from acute gout. Instead of being sharp and 
short they are apt to last almost indefinitely. They are 
generally treated as attacks of acute or subacute rheuma¬ 
tism. But the more sedulously anti-rheumatic methods 
are applied so much the worse may the patient’s suffer¬ 
ings become, and so much the more lasting the pyrexia. 
The aching, the pain, and the fixation of the joints ate 
perpetuated instead of relieved by blankets, fomentations 
and medicines, and the case seems to be interminable. 
This peculiar behaviour is diagnostic of this type, and 
affords the clue to the only successful treatment. 

The onset of amendment dates from the moment when 

Digi 


jOOQle 





238 Thb Medical Press. 


ORIGINAL COMMUNICATIONS. 


Mar. 8, 1890. 


the treatment is reversed, the sufferer allowed to lie in a 
cooler bed, and oold spongings and rubbings, so ill-borne 
in acute rheumatism, applied to the joints and to the 
general surface. > 

It is significant that in some of these cases the joints 
present an erythematous aspect closely analogous to, yet 
not identical with that of the angry patchy flush seen in 
cases of acute rheumatic arthritis. It is never, in my ex¬ 
perience, capable of being mistaken for the shiny, puffy 
swelling of acute gout; but the question needs to be con¬ 
sidered whether it is not more closely allied to the gouty 
than to the rheumatic erythema, though there is not 
any ground for supposing that an uratic factor has any 
share in its production. 

In connection with the striking contrast between this 
form and the acute synovitic or rheumatic cases pre¬ 
viously mentioned, there arises also the question whether 
it is not more apt to attack those who may possess the 
gouty rather than the rheumatic tendency. 

Closely allied to this variety, which is sometimes 
monarthritic and more often polyarthritic, are the acutely 
painful but apyrexial premonitions or early beginnings 
of local rheumatoid arthritis, so often mistaken at first 
for neuralgia or myalgia, and not infrequently for a 
gouty myalgia or neuralgia. 

In all these varieties there are unmistakable nervine 
and vasomotor factors which should be kept in mind in 
any attempt to elucidate the pathology of rheumatoid 
arthritis. 

THE CHRONIC FORMS OF ARTICULAR GOUT 
AND RHEUMATOID ARTHRITIS. 

Great as is the variety of the chronic changes in gout, 
we find a yet greater variety in the chronic rheumatoid 
joint affections. 

Pure tophaceous gout is from the first, and always un¬ 
mistakable, and any rheumatoid changes that may 
supervene never disguise the true nature of the affection. 

On the other hand, rheumatoid arthritis in its extreme 
stage is also sufficiently distinctive. It may be said 
that the further the rheumatoid degeneration advances 
the greater is the convergence between its various types, 
until destruction of the cartilage and eburnation of the 
articular surfaces of the bone furnish us with an almost 
uniform end-product. 

But before this final stage is reached a series of phases 
are traversed, the exact nature of which may not be 
obvious. The family history, the clinical antecedents, 
and the general aspect of the patient, may be highly 
suggestive of gout, but the joints themselves may pre¬ 
sent the characters of arthritis deformans. On the other 
hand, there may have occurred undoubted rheumatoid 
changes, but with the lapse of time indications may arise 
justifying a suspicion that the patient has developed 
gout, and that gouty arthritis may be now associated 
with the rheumatoid degeneration. 

Three types of rheumatoid joints seem to afford room 
for some hesitation in diagnosis. They all occur at the 
gouty period of life. 

In one of them there is symmetrical swelling of the 
joints with effusion. I regard these cases as much more 
closely allied to rheumatism than to gout, and as belong¬ 
ing to the group which may be termed “ rheumatic ” 
arthritis deformans. 

In the seoond variety there is symmetrical enlargement 
and deformity, bnt although there may be synovial swell¬ 
ing and peri-articular thickening, there is no effusion. 
Cases of this kind are sometimes regarded and treated as 
gout, in spite of there being no tophi, because the 
patients, chiefly males, may present some gouty dyspeptic 
symptoms and an aspect analogous to that of asthenic 

S ut. They are usually rheumatoid cases, with more or 
is constitutional tendency to gout, and it is among 
them that we may look for instances of the “ gouty ” 
variety of rheumatoid arthritis. 

Lastly, there is the large group, chiefly of women of 
mature age, in whom there has been, and there is, no 
obvious gouty arthritis, and in whom the rheumatoid 
changes may be limited to the development of Heber- 
den’s nodules, and to slight and varying thickening of 
the wrists or other joints, but in whom, besides a strong 
gouty family history, there may be marked constitu- | 
tional symptoms, such as are observed in chronic gout. 


In some of them the gouty tendency becomes more and 
more developed. Others through careful living remain 
free from articular gout. But many of them present at 
the same time a peculiar susceptibility to, rheiupatic 
influences from soil and climate. This then is a mixed 
group, and one specially calling for study from the point 
of view of the relationship between gout and rheumatoid 
arthritis. 

There are other important varieties to which attention 
might have been called had time permitted: for instance, 
the painful monarticular rheumatoid affection of the hip, 
with relatively slight deformity, in which a gouty family 
history or a gouty tendency in the individual may often 
be traced; and again, the chronic rheumatoid affections 
with deformity, less frequently seen now than in the past, 
are apt to follow in the train of gonorrhoeal arthritis. 
Hutchinson has insisted that this is peculiar to those 
who inherit a gouty bias. 

DIAGNOSIS. 

The importance of a correct diagnosis will be obvidus 
when we come to the question of treatment and of diet. 

If we admit that the joints in arthritis deformans are 
liable to gouty phases—or that the patients are liable to 
gouty states, we must be prepared to find considerable 
difficulty in correctly estimating the position at any 
given period in the history of the cases. 

My previous remarks have indicated that the distinc¬ 
tion between pure gout and pure arthritis deformans is 
not difficult, and I need not enter into the familiar details 
of the diagnosis. It is in the ill-developed forms that 
the uncertainty arises; and this may be best overcome 
by carefully watching the case and noticing the result of 
the various forms of treatment. The question is gene¬ 
rally as to whether, where the rheumatoid changes are 
plainly marked, a gouty element is also present or not. 
But sometimes we may have to determine whether the 
deformity of the joints is not essentially gouty, the non- 
tophaceous variety of gout closely imitating the distri¬ 
bution and aspect of rheumatoid arthritis. For practical 
purposes the diagnosis of these cases lies on the 
surface. The symmetrical implication of many 
joints declares the rheumatoid characteristic of 
inherent delicacy and of vulnerability of articula¬ 
tions, whilst the history and the general features and 
aspect of the patient may be so strongly gouty as to make 
it evident that the exciting cause of the arthritic 
changes must have been of a truly gouty nature. 
Cases of this kind present to us that association which 
exists more frequently than is commonly supposed, and 
in which a gouty lesion may have been the starting point 
of a rheumatoid arthritic change, or in which an early 
rheumatoid arthritis may have been fed up into gout. 
Had the case been straightforward, with creaking joints 
and a velvety moist palm, as in rheumatoid arthritis, no 
doubt would exist; but the palm may be as dry as that 
of gout, and the creakings may not be obtainable. In 
such a case there is doubtless much of gout in spite of 
the evidence of arthritis deformans. It is reasonable to 
infer that the one condition has supervened upon the 
other, and, therefore, our diagnosis must take into 
account, besides the permanent changes of arthritis 
deformans, the fluctuating phases of gout. 

TREATMENT AND DIET. 

We need not enter fully into a description of the 
treatment of gout and rheumatoid arthritis, but only so 
far as it bears upon the relationship between the two 
diseases. 

In the first place, it may be stated that the treatment 
which is most beneficial in pure gout is that which is 
most detrimental for the worst cases of that form which 
we may term “pure” rheumatoid arthritis, to which 
colcbicum and alkalies would be almost poison, and low 
living the sure means of aggravation. 

The relation between the two forms of treatment is 
thus one of direct opposition as 'regards their specialisa¬ 
tions. Yet there is a considerable basis common to both. 
Hygiene is essential to all classes of sufferers, but 
specially to those afflicted with chronic ailments ; and 
internal hygiene is more particularly needed by all 
sufferers from joint trouble, whether this be gout 

Digitized by GoOgle 



Mae. 8, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 239 


rheumatism, or rheumatoid arthritis—in addition to the 
essentials of a wholesome dietary. 

Our difficulties begin with the management of the 
mixed forms. Wheie the indications are not absolutely 
clear our action is of necessity somewhat tentative. In 
most of the cases to which reference has been made there 
is, besides the rheumatoid basis, a suspicion of the gouty 
element. I believe that in many of these cases the best 
treatment is to treat the rheumatoid arthritis as 
thoroughly as this may be wisely done, and to be 
sparing with the more energetic remedies for gout. Our 
most important duty seems to be not to add in the 
slightest way to the depressing conditions under which 
the rheumatoid patient is suffering. A relatively lesser 
evil would be to temporarily increase his gout. But even 
this need not occur if our treatment be happily con¬ 
ceived. 

There is one direction in which the treatment of both 
affections can be carried out with safety and benefit 
almost irrespective of their special characters. I refer 
to the local measures of relief to the joint. We are now 
provided with additional means and most effectual ones 
of local treatment. It had long been noticed that the 
old-fashioned balnear treatment, which is often most 
serviceable in gout, led to very imperfect and often 
detrimental results in rheumatoid arthritis, I mean the 
treatment of the patient by prolonged immersion in a hot 
bath. The same debilitating effect would result in some 
of the mixed varieties of rheumatoid arthritis in spite of 
their gouty complication. The general balnear treat¬ 
ment had of late years been abandoned in all such cases 
for the more local measures of steaming, hot douching 
and massage applied more especially to the joints affected, 
and our chief success had hitherto been derived from this 
method. We are now provided with various means of 
treating the joint affected by dry heat up to very high 
temperatures. The careful application of these new 
methods graduated to each case will enable us to feel 
that a great deal is done for the joint, whilst no possible 
harm is suffered by the patient whichever be the stage of 
his articular complaint. 

Dr. Levison in a most interesting article has provided 
us with suggestions as to the diagnosis between rheuma¬ 
toid arthritis and gout by the X-Rays, and as to the 
treatment of the gouty joint by the electrolytic method. 
Thus electricity, which had long been known to be of 
considerable use, whether in the shape of the electric 
bath or of the constant current directly applied to the 
limb in cases of rheumatoid arthritis has now found a 
yet more direct application in gout since it addresses 
itself to the removal of the material which is the source 
of local irritation and pain. 

Meanwhile the internal treatment of such cases may be 
carried out on lines conformable not only to some of the 
obvious indications, but also to theories which are in 
some respects divergent The abundant use of water 
as the means of accelerating excretion of waste products 
and of all forms of toxins, and assiduous attention to the 
activity of the bowels are equally desirable in gout and 
inrheumatoid arthritis, and fulfil the indications claimed 
by the neural as well is by the humoral theory. 

In mixed cases occurring in mature age it may be 
best not to complicate the position by any vigorous 
tonic treatment, nor even by the iodide of iron which 
has found so much favour since first advocated by 
Sir A. Garrod, and which is admirably suited to 
the uncomplicated form witnessed in children and 
young adults. There may, nevertheless, be room for 
the administration of arsenic in small dose6 and of 
sulphur, in addition to the purgatives. These have also 
been largely prescribed by the same authority before the 
more recent ideas concerning the septic origin of rheu¬ 
matoid arthritis had been set forth. It may be said for 
aisenic that in addition to its antiseptic properties it 
must approve itself to those who regard arthritis 
deformans as conditioned largely by a disordered nervous 
function. 

Those are some of the general lines upon which 
doubtful cases may be treated safely, and with the 
promise of much benefit. 

Reference has been made to the acute and painful 
forms of rheumatoid arthritis, frequently monarticular, 


in which an inherited gouty proclivity or an acquired ten¬ 
dency to gout may be a factor. As previously suggested, 
treatment comes to the aid of diagnosis in these cases 
so apt to puzzle us. Anti-rheumatic remedies and 
methods of treatment are absolutely harmful and there 
is a positive intolerance—though this is not always 
thoughtof by those in charge nor even often realised by the 
patients themselves—for the ordinary heat of the rheu¬ 
matic bed. Let this influence be removed and they are 
immediately benefited. I regard this variety of com¬ 
plaint, long ago described as an affection tui generis and 
successfully treated by Dr. Fuller, as a special form of 
rheumatoid arthritis, of a vaso-motor type; and in 
treating it I am impressed with the necessity 
of addressing the treatment to the vaso-motor 
system. The best way to do this i9 the application of 
heat or of cold. Whilst we had remained restricted to 
the former methods of thermal treatment, treatment by 
heat had often failed, and the application of cold had 
been found to be the only successful method in some 
cases, after trying in vain the use of hot spongings or 
even of the hot-air bath Now that different methods 
are available it is conceivable that cases of this kind, 
although refractory to ordinary heat, may be relieved 
by the heat cure and derive great advantage from the 
high temperatures generated by electricity and by other 
means, as they certainly do from cold applied locally. 

As regards the general and medicinal treatment of this 
variety, it must vary with the individual characteristics 
of the patient, but in the average case most advantage 
would be gained by our disregarding indications derived 
from a mistaken diagnosis of rheumatism, and by our 
not being deterred by the gouty family history or per¬ 
sonal antecedents from endeavouring to raise the general 
strength of the patient. This practical view would also 
meet the indications suggested by any toxic theory which 
might be entertained by some in preference to the neural 
vasomotor theory. 

The antiseptic treatment by the internal administra¬ 
tion of creasotes, phenols, and naphthols, recommended 
by Bannatyne, and the local germicidal intra-articular 
treatment by means of iodoform, carbolic acid, and other 
germicides practised by Max Schuller are too important 
to be passed altogether unnoticed, but they are specially 
intended for the infective form of the disease, and they 
have not, so far as we know, a direct bearing upon the 
subject of our discussion to-night. 

Lastly, we come to the questions of diet and of alcohol, 
the answer to which is foreshadowed in my preceding 
remarks. The rheumatoid patient needs, above all, to be 
fed, and wine suits him well; but if be should turn gouty 
we cannot disregard his gout. It is pre-eminently in thi6 
connection that the practical purpose of this discussion 
is revealed. How to diet the patient and whether or not 
to allow him alcoholic stimulation are points not to be 
safely decided except on the strength of an accurate 
diagnosis not only of the general character of the case, 
but of its special phase. In doubtful cases there is pro¬ 
bably more rheumatoid arthritis about the patient than 
gout, and I am in favour of the policy, which I have 
indicated in my remarks on treatment, of running the 
risk of a slight gouty exacerbation rather than of incur¬ 
ring tbe reproach of intensifying the depression and 
debility inseparable from the rheumatoid state. The 
gouty element, if present, may, however, restrict the 
choice of stimulants to those more suited to gout; 
whereas in uncomplicated rheumatoid arthritis, particu¬ 
larly that of the young, the prevailing ansemia calls for 
a supply of the red wines. In both cases the delicacy 
of the digestion has always to be borne in mind, and it 
is equally essential that the diet should be easily 
digestible, and that it should be sufficiently varied and 
nutritious. 


The death occurred at Southsea, last week, after a 
long illness, of Lieutenant-Colonel P. R. Gabbett. 
Royal Army Medical Corps. He bad served in the 
Army at home and abroad for twenty-eight years, 
and was recently principal medical officer in Barbados. 

C 



240 The Medical Press. 1 ORIGINAL COMMUNICATIONS. Mar. 8. 1899 


GYNAECOLOGY IN RELATION TO 
SURGERY, (a) 

By ALBAN DORAN, F.R.C.S., 

President of the Obstetrical Society; Surgeon to the Samaritan 
Free Hospital, Ac. 

After remarking on the curious circumstance that 
although he was ti e twenty-first President of the 
Society, he was the first surgeon and the first Presi¬ 
dent holding no University degree. Mr. Doran com- 
pared the state of affairs in obstetrics and gynaecology 
in 1859, as gleaned from the Transactions of that and 
succeeding years, and contrasted them with the pre¬ 
sent position of things in these two departments. He 

E ointed out that the growth of obstetric pathology 
ad been comparatively slow, but under the stimu¬ 
lating influence of the Society had of late years made 
distinct and encouraging progress. 

He then proceeded to discuss gynaecological surgery, 
its triumphs and its abuses, pointing with pride to 
the fact that general surgery was more indebted to 
it than it was indebted to general surgery. He 
cautioned them, however, that just as law was not 
always identical with justice, so operating by no 
means necessarily meant surgery. Ovariotomy, how¬ 
ever, had undoubtedly revolutionised abdominal sur¬ 
gery, opening up, as it did, unknown fields, alike to 
the general surgeon and to the obstetrician. 

Touching on plastic surgery, he referred to the 
papers of Fleming and Marshall Hall, who, early in 
the present reign, brought forward their new method 
of performing anterior-colpotomy, and insisted on 
their indebtedness to Marion Sims, who, in 1859, was 
already famous for his skill in the repair of vesico¬ 
vaginal fistula. This operation had since been much 
simplified, and there had been great advance in sur¬ 
gical procedures of this class. The removal of the 
uterus through the vagina, he said, came under the 
head of surgical novelties. He, however, declined to 
endorse the gloomy view recently expressed by Dr. 
Halliday Cioom in respect of this operation for 
cancer. His own experience led him to believe that 
if it did not cure, it greatly relieved the patient’s 
sufferings and ameliorated the local condition. 

Passing on to the history of ovariotomy he pointed 
out that the operation had afforded surgeons in¬ 
valuable experience in the cleansing of the perito¬ 
neum, its effective drainage, and the flushing of the 
peritoneal cavity, for which they were originally 
indebted to Mr. Lawson Tait, though, since its intro¬ 
duction, its utility has been found even greater than 
he ever suspected it to be in that it acted like a 
transfusion as well as serving as a haemostatic, a 
remover of obnoxious fluids and solids, and a counter¬ 
actor of shock. He claimed in this connection that 
the Society had played a conspicuous part in solving 
the transfusion question. 

Operations for diseases of appendages due to inflam¬ 
mation, he Raid, might be decidedly bad surgery, or 
else questionable surgery, or else very good surgery. 
He pointed out that inflammation of the parame¬ 
tritic or cellulitic type usually subsided under appro¬ 
priate medication, and he condemned undue hurry 
in the matter of surgical interference in ordinary puer¬ 
peral cellulitis. Even old neglected cases with 
sinuses hardly called for special operative treatment. 
He had found that puerperal and gonorrhoeal disease 
of the appendages might disappear almost spontane¬ 
ously, and he regretted to read opinions implying 
that they could not do so. A tender movable ovary 
should never be removed forthwith, and a tender but 
recent fixed mass in the pelvis should never be opened 
or exposed by the knife until after the effects of 
medical treatment had been carefully watched. The 

(n) Abstract of the Inaugural Address delivered at the Obstetrical 
Society on March 1 st, 1899 . 


case was quite otherwise when inflammatory dis¬ 
ease was chronic, with a trustworthy history, in 
which exploratory incision was often needed. He 
pointed out that removal of the appendages was 
often unnecessary, it often sufficing to free them from 
old adhesions, and he deprecated the view that an 
operation was imperfect if nothing were taken away. 
He characterised as vicious the idea that when the 
appendages were removed on one side they must lie 
removed on the other, insisting on the propriety of 
minimising operative mutilation as much as possible 

The relative merits of vaginal and abdominal 
operation in the treatment of bad cases of bilateral 
pyosalpinx was, he observed, still being discussed. 
The great enemy of success in these cases was the 
stump which was so often unhealthy and so liable to 
serve as a source of infection. The removal of the 
uterus with the suppurating appendages was, he 
thought, a grave and not absolutely justifiable opera¬ 
tion. It was the duty of the surgeon to make 
sure that his patient did not merely recover from 
the operation. Commenting on Landau’s series of 
vaginal cceliotomies, he pointed out that this 
observer's tables contained over twenty cases in which 
the operation had been performed within eight months 
of their publication, eight within six weeks, and the 
majority of the operations were for salpingitis or 
oophoritis. Another foreign operator registered 
424 cures out of 453 extirpations of the uterus and 
appendages through the vagina, and 95 cures out of 
98 extirpations through an abdominal incision—all 
for suppuration. As the result of this large 
experience, this operator gave it as his opinion 
that the risk of operating was not greater by 
one way than the other. He would have liked 
to know this author's definition of the word 
“cure.” Out of a total of 519 recoveries what a 
valuable series of two years' histories they might one 
day hope to have ! He asked incidentally what could 
have been the cause of such widespread pelvic inflam¬ 
mation that one operator, in a comparatively small 
town, found it necessary to remove the uterus and 
appendages in over 500 cases for the cure of that 
disease, while in London, where all the immediate 
and predisposing causes of inflammatory disease of 
the tube and ovary were present, few. if any, of them 
found it often necessary to proceed to such an extreme 
measure. 

Removal of the ovaries for neurosis was, lie thought, 
unjustifiable, and he referred with satisfaction 
to the attitude of Dr. Howard Kelly, who, in 
his standard work, calls attention to the fact 
that in a recent series of 500 abdominal sections 
at the Johns Hopkins Hospital only four cases 
were operated upon for this reason, and admitted 
that in three of these the relief was not Avhat 
was looked for. Dr. Weir Mitchell also condemned 
the removal of sound appendages in the treatment of 
neuroses. The principle of hysterectomy for fibroids 
was, he said, agreed upon, though the limits of the 
operation were still matter for discussion. Admitting 
that the tumour might not destroy life which the 
operation might sacrifice, he pointed out that were 
things quite as precious to patients as life and the 
operation might involve more risk if delayed until 
the sufferer had passed through two or three more 
years of misery or constant discomfort. He suggested 
that their maxim should be, when in doubt, watch. 
That had been his practice, but he admitted that 
some of the cases had been the worse for waiting. 
He himself would operate on cases of uterine 
fibroids in patients above forty, when there was steady 
growth, with softening of the tumour. He thought 
they ought not to attach too much importance to the 
supposed risk of the malignantdegeneration of fibroids 
which, judging from statistics, was an extremely 
rare occurrence. On the other hand he did not 


jOOQle 


Digi 



Mak. 8, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical P&ssb. 241 


think a fibroid should be removed merely because 
it “ woiried ” a patient. Such a patient should be 
told that fibroid was not cancer, and that while 
ovarian tumours are always dangerous to life uterine 
fibroids seldom killed, and were rarely so bad as not 
to allow of watching. Speculative operating on 
uterine fibroids must, he thought, be condemned 
entirely. 

Mr. Doran then proceeded to discuss the surgical 
aspects of uterine displacements in respect of which 
he thought there was much operative abuse. He 
admitted, however, that the subject was very com¬ 
plicated, and one could not soundly judge operations 
without first knowing the pathology of flexions and 
versions, which was by no means settled. The multi¬ 
plicity of operative procedures signified that the 
disease was obstinate, and dependent on conditions 
not always easy to counteract. To judge of the 
value of these operations, long after-histories were 
indispensable, a point which many foreign writers 
ignored. 

In conclusion, Mr. Doran observed that gynaeco¬ 
logical surgery had undoubtedly done great service, 
though, as in every other branch of surgery, while 
much was good and well-established, much remained 
uncertain. He urged that they should not be too 
eager to blame others who appeared to do too much, or 
who left undone that which it seemed they ought to 
have done. Surgical procedures, he observed, were 
only justified when clinical research had proved that 
there was something which ought to be removed or 
rectified. Patient clinical research was, in fact, the 
sheet anchor of the gynieeological surgeon. 


A NOTE ON THE 

TREATMENT OF TUBERCULOSIS 

AT 

FALKENSTEIN. 

By E. MacDOWEL COSGRAVE, M.D.Dub., 
F.R.C.P.I., 

ProfeflEor of Biology, B.C S.I., Physician to C^rk Street Hospital, 
Dublin. 

The Prince of Wales’s mention of his visit to 
Falkenstein at the meeting held in Marlborough 
House in connection with the National Association 
for the Prevention of Consumption, and the prob¬ 
ability that the institution so well organised by Dr. 
Dettweiler will be adopted as a model for the 
Sanatoria shortly to be erected in the British Isles, 
may render of present interest a short note on the 
details of the treatment there carried out. 

Falkenstein is a comparatively new health station, 
having been founded in 1874, and has still more 
recently become known to the English. Bradshaw, 
in 1898 Ed. of “ Bathing Places and Climatic 
Health Resorts,” only devotes six lines to it, whilst 
St. Moritz gets three pages. 

The Sanatorium is worked by a company, who, 
however, cannot receive more than five per cent, 
interest, any surplus going to extend the establish¬ 
ment, or to afford si miliar advantages to poor 
patients. 

The Sanatorium is situated at a height of 1,300 ft. 
on the southern slope of the Taunus mountains, it 
faces the south east where the ground falls some 
thousand feet to the valley of the Maine, and to 
Frankfort, and is protected on the three other sides 
by the higher portions of the Taunus range. The 
climate is cold in winter, but although there are fogs 
the atmosphere is singularly free from winds and 
dust, and there is no perceptible fall of temperature 
at sunset.. 

The main building is in plan like a wide horseshoe, 


and encloses a gravel terrace, along which extend 
covered verandahs. In these cane sofas or deck-chairs 
are ranged, and on these the patients spend practic¬ 
ally the entire day. 

Additional pavilions ai - e placed in the grounds, 
some of these revolve so that they may be turned to 
avoid the wind and catch the sun; the Germans have 
with somewhat grim humour christened the pavilions 
by such names as “ The Hall of Sighs," “ The Temple 
of Bacilli.” 

For the first few days the patients only lie out 
from after the second breakfast to 5 p m., but after¬ 
wards the day's routine is as follows:—After ten 
minutes’ rubbing by an attendant the patients 
assemble at early breakfast, which in summer is from 
7 to 8. and in winter from 7.30 to 8.30; this consists 
of coffee, rolls and butter, and, in addition, hot or 
cold milk ad lib., the watchful attendant at once 
replenishing empty glasses. 

Then the balcony is sought, and the patients lie 
down, placing their feet in fur bags, and wrapping 
rugs and shawls about them. The wraps belong to 
the patients, and must be provided as part of their 
outfit. 

The expertest of packers then goes round and 
rapidly and skilfully tucks in the patients, who then 
appear like symmetrical and well-cared mummies. 

At 10 o'clock they go in for second breakfast, which 
consists of rolls and butter, and hot or cold milk <td 
Iib.; to those who, in the opinion of the medical 
attendant need it, strengthening soup is served. 

They again lie on the verandah until they go in 
for dinner at 1 p.m. This and supper are of the kind 
usually served in German hotels, but special attention 
is paid to making each course as nourishing as pos¬ 
sible, and each meal commences with one of the 
thick nourishing soups that form a Falkenstein 
specialty. 

At 4 p.m. milk is brought round the verandah, 
this, as well as the 9 p.m. milk, is not included in 
the regular tariff, but is served at a cost of one 
penny per glass. 

All the milk used at the Sanatorium comes from 
the dairy of the establishment which is situated on a 
bill-side up above, and is sterilised. For those who 
cannot digest so much milk koumiss is provided. 

The patients are encouraged to drink plenty of 
milk and generally take from six to eight tumblers 
a day, which is a large amount for people who are 
taking daily four solid meals. Occasionally the 
amount of milk has to be limited, as lately happened 
to a home-sick American who tried to expedite his 
cure by drinking fifteen glasses a day. Supper is at 
7 p.m., and after it the patients may lie out to 9 or 
9.30 p.m., at 9 p.m. milk is served round. The 
patients then retire to their bedrooms, which are 
warmed by pipes; the windows, however, are left 
open during the night. 

When the patients arrive they are thoroughly 
overhauled by the entire medical staff; this is 
repeated monthly, a daily inspection being made by 
one of the resident medical men. Their temperatures 
are taken four times daily—at rising, noon, 4 p.m , 
night—if the temperature shows fluctuation it is 
taken eight times daily. It is interesting to tee how 
when the clock strikes twelve and four all the recum¬ 
bent patients pull out their thermometers and place 
them in their mouths until they are ready to be 
entered on the charts. These hours are anxious 
ones to those with a temperature tending to run above 
normal, as the penalty for raised temperature is 
banishment to the bedroom until it again becomes 
normal. 

The sanitation of Falkenstein is excellent, there is 
an abundant water supply from pure springs situated 
higher up the mountains, and the sewage is received 
in precipitation tanks. The whole place is kept 

Google 


Digitized t 


242 The Medical Press. 


TRANSACTIONS OF SOCIETIES. 


Mae. 8, 1899. 


scrupulously clean, and constant war is waged on 
dust. 

Although the Sanatorium is surrounded by exten¬ 
sive woods with tempting walks, they are out of 
bounds for the majority of patients, who are required 
to rest as much as possible : indeed, even needlework 
is practically prohibited, and letter-writing is dis¬ 
couraged. 11 is only when patients are nearly well 
and about to leave that they are allowed to take 
walking exercise, and even then the distances allowed 
are short, and the limits fixed are strictly observed. 

It will be seen from the above that rest, air, and 
food are the three means of cure, and that these are 
administered with no stinting hand, Complete 
physical idleness, twelve hours in the open air, 
the night spent in a room with open windows, and 
frequent full meals of nutritious foods, with plenty of 
milk in between, take the place of medicines; it is 
wonderful how the treatment agrees with the patients, 
and how the long exposure to the fresh air does not 
cause cold, and how the frequent meals are awaited 
with sharp-set appetite. Of the benefit of the treat¬ 
ment in the majority of cases there can be no doubt, 
and that not only in incipient cases, but even when 
both lungs are affected. 

Falkenstein is easily reached; the Great Eastern 
Railway offers the best route by Harwich and the 
Hook of Holland, the journey can be conveniently 
broken at Cologne, which is reached in the middle of 
the day, and can be finished by another half-day's 
travelling, train being taken to Frankfort and on a 
few miles to Cronberg, where carriages meet expected 
guests. 

Whether equally good stations can be found in the 
British Isles is at present an urgent question, as 
although Falkenstein is easily reached, treatment 
abroad means greater separation and* isolation than 
treatment at home. It is probable, however, that our 
insular climate will not give as equable winter tem¬ 
perature as can be met with on the European 
continent, and that whilst Sanatoria at home may do 
for early cases, those that are more advanced will 
have to seek the Continent, so that even if English 
Sanatoria are opened Falkenstein will still draw its 
quota of English cases. 


A SERIES OF CASES 

POINTING TO THE 

IDENTITY OF THE CAUSE OF ACUTE 
RHEUMATISM—CHOREA- ENDOCAR¬ 
DITIS AND ERYTHEMA NODOSUM. 

By F. DEAS, M.R.C.S., L.R.C.P., 

Late House Surgeon, Liverpool Stanley Hospital. 
During two years’ residence in the Liverpool 
Stanley Hospital I had many opportunities of study¬ 
ing cases of acute rheumatism and kindred affec¬ 
tions, and of making exhaustive inquiries into the 
family histories of such cases. 

I think the following cases present features of 
sufficient interest or rarity to warrant their publica¬ 
tion, and point to an identity of cause in the diseases 
named above. In offering them for record I must 
express my best thanks to Dis. Whitford and Mac- 
alister for their permission to use my notes on cases 
which came under their care at the Stanley Hospital. 

Case I.—M. D-, female, set. 13. This patient 

had been quite well up to the day before admission. 
She then complained of pains all over, headache, sore 
throat, and sickness. Immediately after admission 
she had a rigor, and her temperature rose to 104 degs. 
Fahr. She then complained of acute pain in both 
elbows and wrists. These joints were swollen, hot, 
and tender. She was sweating profusely— the peculiar 
sour sweat of acute rheumatism. 


At the same time there were present the 
typical inco-ordinate voluntary movements, and irre¬ 
gular involuntary movements of chorea affecting the 
same limbs. Heart and lungs were normal. The 
patient was put on salicylate treatment, and at the 
end of the eighth day the temperature had become 
normal. The choreic movements continued, with 
gradually decreasing intensity, until the same day, 
when they entirely ceased. On the third day a small 
patch of pleurisy was found at the right apex, and a 
fortnight later a soft systolic bruit was heard at the 
cardiac apex. All the affections had disappeared by 
the eighth day. There was a history of acute rheu¬ 
matism on the mother’s side. 

Case II.—Ellen T., art. 12. This patient was 
admitted for acute chorea. The movements were so 
violent and incessant that she had to be fed under an 
anajsthetic. Two days after admission a punctiform 
erythematous rash, like scarlet fever, appeared all 
over the trunk, and on the front of both legs several 
typical patches of erythema nodosum. No drugs 
had any effect on the disease, and the patient died on 
the fourth day. No post-mortem examination was 
allowed. There was a strong rheumatic history on 
the side of the mother, and one less definite on the 
father’s side. 

Cases III., IV., and V.—These were three sisters 
attending the out-patient department. Jane M., art. 
17, Annie and Ellen M. (twins), set. 15. The eldest 
girl was under treatment for slight dyspnoea and 
oedema, due to double mitral disease. She had never 
had any other rheumatic manifestation. Of the 
twins, Annie had chorea and no heart affection. Ellen 
had had acute rheumatism a year before I saw her. 
and was attending for double mitral disease. Both 
parents had suffered from rheumatic fever before 
marriage, and both had a systolic bi-uit. 

The conclusions to be drawn from these cases. I 
think, point strongly to the presumption that the 
materies morbi was originally the same in each case. 
The simultaneous occurrence of rheumatic fever and 
chorea is, I believe, unique. In Case II. there were 
again two distinct manifestations present at the same 
time. In Cases III., IV., and V. separate and distinct 
manifestations appeared in three members of the 
same family, different tissues being selected in two 
members who were twins. 

In all the cases hereditary tendency was definite, 
and in the last three cases double inheritance was 
well marked. I think one is justified in concluding 
that in each case the primary cause was the same ; 
its different manifestations being due to different 
tissue selection, or to a modification of the same 
materies morbi. The last three cases are rendered 
more striking, and perhaps conclusive, by the fact 
that hereditary tendency was extremely well marked 
in the family. All three girls had been the subject 
of “ atresia vaginse.” The mother, her two sisters, 
and the maternal grandmother had all been affected 
in the same way, requiring a little surgical interfer¬ 
ence at puberty. 

-♦- 

^ranMritmts of gorietice. 

OBSTETRICAL SOCIETY OF LONDON. 

Meeting held Wednesday, March 2nd, 1899. 

The President, Mr. Alban Doran, in the Chair. 


Dr. W. J. Smyly (Dublin) showed three myomatous 
uteri which he had removed per vaginam by Doyen’s 
method. The indication for operation in all the cases 
had been haemorrhage The first specimen had heen 
removed from an unmarried woman, set. 42, from whom 
a pedunculated myoma had been removed six years 
previously with temporary benefit. When admitted to 


Digitized by GoOglc 


TRANSACTIONS OF SOCIETIES. 


The Medical Press. 243 


Mar. 8, 1899 . 

hospital in September, 1898, she was in a condition of 
profound anaemia. The uterus was again explored, but 
nothing removable discovered. After some weeks spent 
in endeavouring to improve her condition the uterus 
was extirpated November 14th. Convalescence satis¬ 
factory. The second case was operated upon on January 
14th, 1899. The patient was a married woman who had 
borne two children. Convalescence was delayed by 
phlebitis of the right saphenous vein. The third patient 
was also a married woman who had borne children ; the 
operation, which was a very easy one, occupying twenty- 
three minutes, was performed on February 2nd, 18519. 
She made a rapid recovery. Adding these three cases 
to seventeen which he had reported at the Edinburgh 
meeting of the British Medical Association, made twenty 
cases operated upon by this method, with one death, a 
mortality of 5 per cent. He said the shock was less, the 
mortality smaller, and convalescence more rapid after 
vaginal than after abdominal hysterectomy. There was 
no abdominal woimd which might develop a hernia, and 
he believed that intestinal adhesions and ileus were more 
rare. He did not believe that in any of his cases the 
tumours could have been removed without sacrificing the 
uterus. 

A SECOND CASE OF PRIMARY CARCINOMA OF THE 
FALLOPIAN TUBE. 

Dr. C. Hubert Roberts related the case of a woman, 
a?t. 60, married, but never pregnant, previously well, who 
in June, 1897, had a sudden discharge of cherry-coloured 
watery fluid, lasting three days. The menopause had 
supervened ten years before. In July she was examined 
by the vagina and abdomen, but nothing was discovered. 
Iron and ergot were prescribed, and the discharge 
ceased. Nothing further happened till September, 1897, 
when a fairly profuse discharge again occurred. During 
the preceding months two or three further vaginal and 
abdominal examinations were made, but nothing definite 
was discovered. In April, 185)8, examination revealed 
the presence of a swelling to the left of and behind the 
uterus, which it was thought might be an ovarian cyst. 
Later in that month Mr. Meredith saw the case and 
advised an exploratory operation, the swelling in 
the meantime having increased in size. The uterus 
was quite small and senile in character. On May 
6th, 1898, the abdomen was opened in the usual manner, 
and with considerable difficulty a large tumour was 
raised from the left of Douglas’s pouch which looked like 
a distended Fallopian tube. Beneath it a cystic ovary 
could be seen. At this stage the tube ruptured and a 
handful of putty-like material escaped. It was evidently 
a distended and diseased tube, but the uterine end 
appeared to be comparatively healthy. It was removed 
along with the ovary. The other tube and ovary being 
small and apparently healthy were left. There was no 
free fluid in the peritoneum which was flushed out, and 
the wound closed without drainage. In November, 
1898, there had been no return of the discharge and the 
discomfort. In January, 185)9, a subsequent report was 
received of a less satisfactory character and no doubt 
remained that recurrence had taken place, e.g., within 
eight months of the operation. The specimen consisted 
of a much enlarged and sacculated Fallopian tube, which 
contained only a small amount of fluid. On open¬ 
ing up the remainder it was seen to be dis¬ 
tended by a villous or papillomatous growth which 
appeared to spring from the walls of the tube. 
Sections thereof showed it to be carcinomatous. 
The author pointed out that cases of papilloma 
and carcinoma of the tube are very rare, though this 
was the second specimen of the kind which he had been 
enabled to bring before the society. It closely resembled 
his other specimen. The growth had formed in a 
normally constituted tube. He thought the growth 
might have begun as a papilloma, though it had 
undoubtedly become carcinomatous. He remarked that 
free fluid in the peritoneum was.always a suspicious 
circumstance, but in this case it was absent. He added 
that he had never heard of a case of primary carcinoma 
of the tube under the age of 36. 

Dr. Culling worth said that with regard to the com¬ 


mencement of this case, he took it that there was very 
strong reason to suspect that it was originally a 
papilloma which had undergone carcinomatous degener¬ 
ation, but he did not think the question could be 
quite settled until they met a case rather earlier 
in its course. With a case as advanced as this 
one, he did not think it would be safe to do more than 
hazard a conjecture as to the mode in which the carci¬ 
noma had originated. Although he himself had seen a 
good many cases of tubal disease, he had never come 
across an instance of this disease. He imagined conse¬ 
quently that it must be an exceedingly rare disease, only 
less rare than carcinoma of the tube itself. 

Dr. Inglis Parsons asked whether pain was a promi¬ 
nent symptom in the earlier stages ? 

Dr. Roberts said the first Bymptom was discharge, 
but in the second attack the pain preceded the discharge 
as if the tube were distended and had been relieved by 
the flow. 

Dr. A. Routh observed that one of the important points 
in this case was the difficulty of diagnosis. In the first 
case mentioned in the tables—a case brought forward 
by the President and himself, the diagnosis was made 
after dilating the uterus. The patient had at first no 
tumour on either side of the uterus, though &he had this 
watery blood-stained discharge. This was at first attri¬ 
buted to senile endometritis, and the uterus was dilated, 
but nothing was found. Within a week or two she had 
some sort of pelvic inflammatory attack, and when that 
cleared away the tube was distinctly felt and was sub¬ 
sequently removed. With regard t.o papilloma becoming 
malignant, his impression was that when it did so it 
remained a recognisable papilloma microscopically. In a 
case of papillomatous uteius after curetting several times, 
he determined to remove the uterus the next time it 
recurred. He did bo, and then it was found that the 
papilloma had penetrated the walls of the uterus to just 
beneath the peritoneum, presenting appearances not at 
all like the sections that had been shown them. 

The President said they hardly knew whether papil¬ 
loma was a neoplasm or an inflammatory product. 
Dolery had written a very good paper on the subject, 
showing that it was akin to mucous warts, t'.e., that it 
was a purely inflammatory product which might become 
malignant. He thought cancer only liegan in an 
unhealthy tube. Last Thursday he had come across a 
case in an old woman. It had gone on so quietly that 
they thought it was a case of old fibroid of the uterus 
which, after quiesence, was becoming cystic. It proved 
to be a very large and very ugly malignant papilloma of 
the tube, which was filled with the growth. After 
enucleation there remained a large mass in Douglas's 
pouch, and there was a bud of the growth in the uterus. 
She died twenty-seven hours later, and post-mortem she 
was found to be perfectly riddled with cancer. The 
papilloma did not look so very malignant in the tube, and 
he was not sure that it might not have been inflamma¬ 
tory. One thing was certain, viz., that, however caused, 
cancer of the tube was very malignant. He urged that 
the attention of smgical registrars and pathologists 
should be directed to the subject to induce them to look 
for every trace of cancerous disease commencing in the 
tubes. 

Dr. Roberts, in reply, said the chief symptom that 
might lead them to diagnose a case of this kind was, a 
number of years after the menopause, the appearance of 
this characteristic watery discharge. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Medicine. 

Mbbting held January 27 th, 1899 . 


The President, Dr. John W. Moore, in the Chair. 

A CA8E OF ERb’s JUVENILE FORM OF MUSCULAR 
ATROPHY. 

Dr. Langford Symeb exhibited a case of juvenile 
I muscular atrophy, fhe patient was a boy, let. 8 j. He 


)S/KJ 


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244 Ihb Medical Presb. TRANSACTIONS OF SOCIETIES. Mar. 8, 1899. 


was brought for advice for his “ inability to walk pro¬ 
perly,” and has been ailing since he was two years old. 
It began when he was learning to walk. If he fell he 
could not get up alone ; he is now getting more helpless, 
cannot walk upstairs, and is unable to get in or out of bed. 

Dr. J. B. Coleman.—( a) A Case of Progressive 
Muscular Atrophy ; ( b ) A Case of Anterior Cornual 
Myelitis. 

THE CLINICAL FEATURE8 OF BERI BERI. 

Dr. Conolly Norman read a paper on the clinical 
features of beri-beri. He briefly referred to the uncer¬ 
tainty which still exists with regard to the pathology of 
the disease, to the difficulties which may occur in dia¬ 
gnosis, and to the unfamiliarity with its symptoms 
existing among European practitioners until recently. 
He pointed out that tachycardia is an invariable condi¬ 
tion, with extreme irritability of the pulse. Unconform 
ability of heart and pulse is frequent and striking. 
Variable murmurs most commonly heard in the pul¬ 
monary area are not infrequent, also reduplication of 
the first or second sound. The heart is fre¬ 
quently dilated, and thiB dilatation, chiefly affecting 
the right side, often comes on with singular rapi¬ 
dity. Death from heart involvement is common, 
sometimes occurring quite suddenly, and in apparent 
convalescence, sometimes after a prolonged agony. The 
sensory symptoms, always occurring primarily in the 
lower extremities, and sometimes confined to the legs, 
consist of various degrees of superficial anaesthesia and 
hypo-ffisthesia combined usually with paresthesia and 
hyperesthesia, (painful anesthesia). Deep (muscular) 
tenderness and tenderness of the nerve trunks coexist 
with loss, diminution, or alteration of superBcial sensa- : 
tion. Spontaneous pain (aching and cramps in muscles, I 
painful formication in skin) are common. (Edema is 1 
probably always present, though sometimes very slight 
and transitory. It varies in character, being usually less 
marked than in ordinary anasarca, say from Bright’s 
disease, and sometimes approaching closely to the “Bolid 
oedema ” of the myxoedematous state. It may be slight, 
fugacious, and confined to the prretibial region or it may 
spread all over the body. Cases which are highly 
(edematous constitute the so-called “ wet form ” of beri¬ 
beri. Effusions into the joints are rare, but common in 
the serous cavities, especially in pleura and pericardium. 
In the latter situation they often accelerate death, which 
may also be brought about or hastened by oedema of the 
lungs. The motor symptoms are paralysis of various 
muscles or groups of muscles. The muscles first attacked 
are usually those supplied by the peroneal nerve. The 
gait in well-marked cases is characteristically neurotic. 
The greater engagement and less resistance of the exten¬ 
sors gives the shifting equilibrium in standing, the 
dropped and inverted foot, the high action in walking 
(demarche du strpper). The paralysis rarely involves 
the upper extremities. The muscles of respiration not 
rarely suffer, particularly the diaphragm, a fact which 
constitutes one of the dangers of the disease. The muscles 
engaged tend to waste rapidly. When this wasting occurs 
after cedema has been slight and transient, the “ dry ” or 
“ atrophic " form of the disease is produced, but the wast¬ 
ing may coincide with extensive anasarca, only becoming 
manifest when the latter has abated. He pointed out the im¬ 
portance of recognising the affection, which would appear 
to be spreading. Since 1894, when it first appeared in the 
Richmond Asylum, epidemics have been repoited from 
two asylums in the United States, a few cases strongly 
recalling beri-beri hare been reported from German 
asylums, and an epidemic has occurred in the autumn of 
1897 in an asylum in the South of France, which 
attacked 150 patients, of whom about 40 died. Dr. 
Norman exhibited a number of photographs of beri-beri 
patients from the Richmond Asylum epidemics, showing 
also the peculiar dropping and inversion of the feet, and 
demonstrating the peculiar relaxation of the joints 
which occurs in this disease. For purposes of compari¬ 
son, he exhibited some photographs of cases of alcoholic 
neuritis and tabes dorsalis. 

Dr. Smith considered that the diagnosis of beri-beri 
was easy only when it occurred in places where the dis¬ 
ease might be expected, or when one was already 
familiar with it. Quite lately two Norwegian sailors, 


who came from Florida, were admitted to Sir Patrick 
Dun’s Hospital. The main symptoms which they pre¬ 
sented were a curious combination of motor, sensory, and 
trophic conditions, which he thought would be hard to 
fit in with any other diagnosis than that of beri-beri. 
They would have been labelled probably as either cases 
of alcoholic neuritis; or perhaps some more high-sound¬ 
ing name, if the disease had not already been known in 
Dublin. It was a singular fact that on removing patients 
in the earlier stages of this disease to new surroundings 
they were likely to recover—a thing that would not hap¬ 
pen in the case of other infective diseases. There was 
no use in removing a typhus fever patient to a place 
where there were no other cases of the same disease, 
though such a procedure was of benefit to the beri-beri 
patient. On account of this fact Dr. Manson supported 
the theory that it was due to a peculiar poison which was 
distilled, so to speak, from the soil, the building, and the 
surroundings in which the patient lived, and by removing 
them from these surroundings they removed the cause. 
He thought that the most interesting point in the morbid 
anatomy and clinical history of the disease was the 
remarkable and serious interference with the neuro¬ 
muscular apparatus of the heart. The only other disease 
offering a pathological parallel to this was diphtheria, 
for in that disease, like in beri-beri. the heart was often 
heavily hit, and an interesting comparison might be 
drawn between the cardiac symptoms of these two 
diseases. 

Dr. Littlkdale remarked that the appearance and 
disappearance of anaesthesia was a curious symptom. In 
a case he had under observation he discovered anaesthesia 
and analgesia over the shins and peronei muscles On 
attempting to demonstrate this to a friend on the day 
after observing it, the patient immediately jumped on 
being pricked with a pin. On trying the electrical 
re actions in this patient he found that a current which 
would cause most violent contraction in his own muscles 
would have little or no effect on the patient. 

Dr. Dawson said he had had the opportunity of 
examining the phrenic and vagi nerves in a few of the 
Richmond Asylum cases, and he found these nerves 
degenerated, showing the ordinary lesions of peripheral 
neuritis. In some cases the myelin could be seen to be 
breaking up into globules. 

Mr. Croly, Dr. Knott, and Dr. Martley rIbo joined in 
the discussion. 

Dr. Norman, replying, said that Manson’s opinion 
that the poison of the disease lurked about the soil of 
buildings seemed to be supported by appearanoes. 
Several writers on the subject had pointed out the seem¬ 
ing liability there was to an outbreak of beri-beri where 
the soil had been recently turned over, and this led them 
to think that it was a miasmatic disease. Some even 
had gone so far as to say that it was malaria. In answer 
to questions, he said that he had not found the spleen 
or liver enlarged in his cases. He had not noticed any 
change in the hair or nails. He remembered one case in 
which the teeth had all fallen out, but he did not think 
this was due to beri-beri. One patient had exhibited a 
series of herpetic patches, which turned into bullae, and 
left littlo ulcers after them. ■ There were three or four 
cases ushered in by a curious eruption not distinguish¬ 
able by him from erythema nodosum. He could not 
enlighten Mr. Croly as to why beri-beri should occur 
chieSy in asylums in this climate, and among the epi¬ 
leptics in those institutions. He was disappointed in 
the use of electricity in this affection, more so, since 
some writers on this subject have said that it was pos¬ 
sible to diagnose beri-beri before other symptoms occur, 
by means of the electrical reactions. They bad not 
found changes of any consequence in the spinal cord, 
which was disappointing, as other observers have stated 
that the cells in the anterior cornua were frequently 
found to be degenerated. 

The Section then adjourned. 


Dr. Sherrington, F.R.S., Holt Professor of Physi¬ 
ology, University College, Liverpool, has received the 
Marshall Hall Prize, awarded by the Royal Medical and 
Chirurgical Society, for his researches. 


zed by Google 



Mar. 8, 1899. 


TRANSACTIONS OP SOCIETIES. The Medical Press. 245 . 


HARVEIAN SOCIETY OF LONDON. 

Meeting Held Thursday, February 15th, 1899. 

Mr. Henry Julek, F.R.C.S , President, in the Chair. 

Dr. Arthur Whitfield read a paper on 

VARIETIES OF ECZEMA AND THEIR TREATMENT. 

After pointing out that although eczema was one of the 
commonest of skin.diseases, there was no unanimity on 
the subject of its sub division, Dr. Whitfield referred to 
the old classificatione of eczema according to etiology, 
course, and distribution. All those were unsatis¬ 
factory, as they either implied a higher state of 
knowledge than at present eiisted, or else did 
violence to the truth by separating different 
stages of the same disease. The introduction by 
Unna of the class of seborrhceic eczemas was then dis¬ 
cussed, and the evidence upon which this variety was 
based was examined. Dr. Whitfield pointed out that 
some of Unna's grounds for including seborrha-a of the 
scalp and psoriasis in this class were, in his opinion, in¬ 
sufficient, since the histological characters were little 
else than those of simple inflammation, whilst the bac¬ 
teriological evidence was incomplete. He then described 
the characteristics of the seborrhceic groups of eczemas 
which remained after separating off pityriasis of the 
scalp and psoriasis These were (1) follicular origin, 
(2) sharplv defined margins to the patches. (3) serpigi¬ 
nous spread. After quoting a case of Andrej s to show that 
this variety could occur on parts devoid of glande and folli¬ 
cles, and was possibly parasitic in origin, Dr. Whitfield 
referred shortly to some other forms, including eczema 
folliculorism, eczema, mycoticum, and eczema circum¬ 
scriptum. These he considered had better be classed 
under the general heading of seborrhceic eczema until 
more was known about the parasites forming them. 
Passing on to the subject of so-called simple eczema, he 
said that there were two main opinions about its etiology, 
one that it was parasitic in origin, and the other that it 
was a constitutional disorder. He then reviewed the 
evidence in favour of the relationship between eczema 
and gout, and concluded that although it appeared that 
gouty persons were more prone to attacks of eczema than 
others, there was no evidence to show that eczema was 
invariably associated with gout, nor were there any dis¬ 
tinctive points of diagnosis between an eczema in a 
gouty subject, and one in an otherwise sound individual. 
Oolombine’s researches on the urine in eczema were then 
referred to as tending to prove that there was not any 
evidence of a toxaemia as a cause of eczema. Dr. Whit¬ 
field then summed up his remarks by saying that he 
thought there were at lenst two main classes of eczema, 
in one of which there was no proof of a parasitic origin 
Avhereas in the other there was a good deal of presump¬ 
tive evidence that the disease was infective in nature. 
He then pointed out that the value of an accurate 
diagnosis lay in the fact that it was much safer to use 
strong anti-parasitic remedies from the beginning in the 
treatment of the seborrhceic form than in the so-called 
simple variety. 

Dr. Galloway remarked that he thought that Dr 
Whitfield had taken an appropriate opportunity for 
protesting against the too easily accepted hypothesis of 
the bacterial origin of eczema, and he especially agreed 
with Dr. Whitfield in protesting that no special coccus, 
such as the “ morococcus,” had been discovered to act as 
a specific organism. If anyone took the trouble to 
examine carefully the evidence on which Dr. Unna had 
based his description of his morococcus as the specific 
cause of seborrhceic eczema.it would readily be seen how 
slight it was. In the case which Dr. Unna demonstrated 
before the Hamburg Medical Society, in which he had 
produced what he called his inoculation vesicle from 
pure cultures of this “ white ” coccus, the important 
clinical fact outstanding was that the lesion so produced 
was not eczema at all, but something much more closely 
resembling impetigo. From the time of this demonstra¬ 
tion, this coccus had been quoted by Unna and many of 
his disciples as the specific organism in his large group 
of “ seborrhceic eczema/’ About the same time as Dr. 
Unna, Prof. Welch, of Johns Hopkins University, pub¬ 


lished his observations on the bacteriology of the skin. 
He showed that the organism which he called the 
staphylococcus epiuermatis albus was a constant denizen 
in the skin, where it lived a saprophytic existence, and 
appeared to produce no pathogenic effects. No sufficient 
evidence is on record to prove that the morococcus is not 
an organism of the same class, and there is much to sup¬ 
port the view that it is simply a saprophyte. One could 
not help coming to the conclusion that if any organism 
does produce seborrhoeic eczema, at any rate, it is not the 
morococcus. He felt inclined to look upon eczema as the ordi¬ 
nary inflammatory reaction of the skin to many varieties 
of irritation. There was little doubt that among these 
various irritants bacteria exercised considerable influ¬ 
ence. The type of eczema which appeared to be of para¬ 
sitic origin was the seborrhceic variety, but he wished to 
emphasise the fact that the evidence in favour of this at 
the present time is almost completely clinical, and has 
no definite bacteriological support. 

Dr. Bazly Thorne said that he attached more import¬ 
ance to toxic conditions of the blood in relation to 
eczema than Dr. Whitfield was disposed to accord to 
them ; and that he could not regard as valid the argu¬ 
ment that, if the kidneys were sound they must be inno¬ 
cent of mischief, because they might, by habit and 
regimen, be inhibited from performance of their normal 
function. He gave as an instance the case of a lady 
who had, for seven years, suffered from a severe form of 
eczema palmaris with inflammation of the matrices and 
deformity of the nails, amounting, in the index fingers, 
to partial destruction. The total daily ingestion of 
fluids, consisting of tea, coffee, and claret, barely 
amounted to seven-eighths of a pint. In three weeks 
the disease was arrested by the use of an ointment con¬ 
taining ammoniated mercury, of a mixture containing 
grain doses of potassium iodide, and by the ingestion of 
two pints of water daily. The cure, which had been 
maintained up to the present time, was mainly, if not 
entirely, due. Dr. Thorne felt convinced to the water, 
which had restored to the kidneys the power of promot¬ 
ing the purity of the blood. He added that he enter¬ 
tained no fear of the local effect of salt water, as in 
every instance in which patients affected with seborrhceic 
eczema had, under his observation, undergone a course 
of saline baths, the skin had become sound before the 
termination of the treatment. That result might possibly 
be attributed to the diuresis which the baths, in all 
cases, induced. 

Dr. Alfred Eddowes said that he found Unna’s 
“ bottle ” bacillus so frequently in seborrhceic cases, that 
he was disposed to think with Unna that it probably had 
a causal relation to the disease. But this was hardly the 
time to deal with the bacteriology of eczema in detail. 
He thought the word eczema should mean a condition, 
not a definite disease, unless the word were qualified with 
an adjective. It was useful clinically to speak of 
seborrhceic eczema, impetiginous eczema, tuberculosis,.!!:c. 
As for treatment there was much that might be said. 
It was easy to lay down certain definite principles which 
were always useful. We should keep in mind the phy¬ 
siological state of normal skin. We must dry a wet skin 
and grease a dry skin Dabbing with spirit and dusting 
with powder answered the first requirement, and oint¬ 
ments the latter; while pastes occupied the intermediate 
place and were most valuable. Take, for instance, a bad 
case of “ scald head,” eczema of scalp in a child. One 
thorough dressing with a paste such as Lassar’s, fre¬ 
quently left nothing more to be done by doctor or mother 
for a whole week, and at once made the case greatly better 
and quite manageable. He was surprised to hear the 
reader of the paper say that he did not find pastes of great 
service. 


NORTH OF ENGLAND OBSTETRICAL AND 
GYNAECOLOGICAL SOCIETY. 

Meeting held at the Medical Institution, Liver¬ 
pool, Friday, February 17th, 1899. 

The President, Dr. Donald, in the Chair. 

The following specimens were shown:— 

Dr. Walker.- (1) Dermoid tumour of ovary. (2) 
Ovarian cyst. (3) Scrapings from endometrium. 



FRANCE. 


Mae. 8, 1899. 


246 The Medical Press. 

Dr. Bbioos: Diffuse benign adeno-myoma of the 
uterus, occurring in one horn of a bicomuate uterus. 
r Dr. Gemmell : Uterus removed for early malignant 
disease, together with microscopic sections. 

Dr. Grimsdale : Multiple fibroids of the uterus com¬ 
plicated with pyo-salpinx, removed by abdominal 
hysterectomy. 

Dr. S. Buckley read notes of two 

CASES OF FIBROIDS COMPLICATING PREGNANCY, 
in which abdominal section was performed. 

Case 1.—A patient, act. 28, pregnant three and a-half 
months. The fundus uteri was pushed tc the left by a 
firm rounded swelling reaching up to the umbilicus, and 
very tender to the touch. On opening the abdomen the 
mass was found to be a soft fibro-myoma springing from 
the right side of the uterus. It was not pedunculated, 
and could only be removed by abdominal hysterectomy. 
As the symptoms were not urgent the abdomen was 
closed. The patient made a good recovery, and five 
months later was delivered naturally of a full-term living 
child. 

Case 2.—Patient, ict. 28, five and a-half months 
pregnant. A tumour, the size of a large cocoa-nut, was 
found to be springing from the left side of the fundus 
uteri. It was freely movable, very hard and bad, caused 
severe pain, the result of localised peritonitis. The 
abdomen was opened, a pedunculated myoma found 
attached to the left cornu of the uterus and adherent to 
the omentum. The pedicle was transfixed and ligatured 
in the ordinary way, and the tumour removed The 
patient made an uninterrupted recovery, and is now 
almost at full term. 

Dr. Arnold Lea read the notes of a case of 

SARCOMA OF THE OVARY, 

occurring in a girl, set. 13. The tumour, which had 
attained the size of a seven months’ pregnancy, had been 
noticed for some months, and had grown rapidly. The 
mass lay somewhat to the left side, was very soft and 
freely movable. Per rectum the uterus was small and 
separate from the tumour, and a pedicle could be felt on 
the left side. There was no ascites. The patient had 
menstruated normally twice. Abdominal section was 
performed. The tumour was adherent to the great 
omentum, which was removed along with it. The right 
ovary was normal, and was not taken away. The patient 
made a good recovery from the operation. The tumour 
was a soft sarcoma, very vascular, and showing numerous 
haemorrhages. Microscopic sections showed it to be of 
the round-celled variety. The prognosis of sarcoma of 
the ovary in young girls is very bad. Of twenty-six 
cases recoided as operated upon, seven died as the result 
of the operation (27 per cent ). Recurrence within a 
short time is very frequent, many cases dying from 
secondary growth within a few months of the operation. 

Dr. W. K. Wall read a paper on the 

TREATMENT OF SEVERE ACCIDENTAL HEMORRHAGE 

generally concealed—based upon a personal experience 
of thirty-eight cases, and he discussed the treatment of 
this condition. He maintained that rupture of the 
membranes, as generally advised, was injudicious, owing 
to the inertia of the uterus generally present in these 
cases. He upheld the value of the plug and dilator 
combined as in de Ribe’s bag After summarising the 
methods of active delivery “per vias naturales ” he dis¬ 
cussed the value of abdominal section, expressing the 
opinion that it could only have a very limited field of 
usefulness. He suggested that after delivery of the child, 
if the uterus remained inert and did not respond to 
ordinary stimuli, vaginal hysterectomy might be justifi¬ 
able, alleging that many of the fatal cases of concealed 
accidental haemorrhage were brought about by the in¬ 
tractable post-partum haemorrhage so commonly ex¬ 
perienced. 

The discussion on this paper was adjourned to the 
next meeting. 


(Jfrancc. 


[FROM OUR OWN CORRESPONDENT.] 


Paris, Maich 6th, 18W. 

The Employment of Saline Solutions. 

At the Soci^te de Th^rapeutique, Prof. Bolognesi read 
a paper on the above subject, which was very exhaus¬ 
tive. In referring to the methods employed, he said 
that artificial serum could be introduced into the 
organism by four ways, the serous, vascular, subcutaneous, 
and intestinal. 

Intra-serous injections were first proposed by Ponfick, 
who had remarked that the blood effused into the serous 
membranes was rapidly absorbed. The injections were 
nearly always made into the peritoneum by means of an 
incision made above the umbilicus, and penetrating to 
the linea alba ; the needle was pushed in the operation of 
tapping for ascites. Perforation of the intestine, which 
many feared, was rare, but the operation was always 
painful, and followed by distension of the abdomen. As 
the slightest failure in antiseptic precautions could pro¬ 
duce mortal peritonitis, intra-peritoneal transfusion 
was but little practised. 

Intra-vascular injections were first employed by Hueter, 
Roux (Lausanne), and Kummel. The vessels chosen 
were the veins of the bend of the elbow, or the internal 
saphena vein over the ankle, which passing over the 
bone is more easy to discover in stout people, and whose 
calibre is larger than any of those at the bend of the 
elbow, while the introduction of air at such a distant 
point from the heart presented but little danger. The 
quantity of liquid injected varied between one to three 
litres, with an average of two litres, at a temperature of 
8t5 degs. F. The rapidity of the current should not 
exceed ten minutes per litre. 

Venous injections presented certain inconveniences 
not entirely exempt from danger. Consequently, many 
practitioners preferred for these reasons the subcutaneous 
methods. For inexperienced hands the venous injection 
was a regular operation -, the veins were frequently diffi¬ 
cult to discover ; timid operators were afraid of intro¬ 
ducing air into the veins, and in any case septic accidents 
might be provoked, such as phlebitis. Pozzi published 
one case of acute oedema of the lungs as a consequence 
of the operation. Further, the counter indications, 
cardiac lesions, and weakness of the myocardium in parti¬ 
cular, were more frequent. Bobc, of Montpellier, pre¬ 
ceded the injection of the serum by drawing off a litre 
of blood; while Barre invented a rather complicated 
apparatus to combine these two operations, so that the 
amount of blood withdrawn was replaced by its exact 
equivalent of artificial serum, but there was no necessity 
of being so precise, as the same effect could be produced 
by ordinary blood letting and the introduction of the 
serum subcutaneously. 

The subcutaneous method was at present the most fre¬ 
quently employed, and answered to every purp< >se except 
in urgent cases requiring the intravenous method. The 
region chosen should be that rich in cellular tissue, 
such as the axilla, the abdomen, the thigh, or the gluteal 
region. 

The instruments employed to make these injections 
were numerous, and varied from that of Dumouthiers to 
the simple funnel, but the simplest for all intent* and 


Digitized by v^,ooQle 



-Mar. 8, 1899. 


GERMANY. 


The Medical Press. 247 


purposes was the ordinary aspirator of Potain, possessed 
by every practitioner. 

The only trouble arising from the subcutaneous 
method was the pain from the introduction of the needle, 
which, however, was insignificant, and that produced 
by the distension of the skin; or, again, the formation of 
an abscess, but this latter could be avoided with a little 
care. 

Enemata of salt water were known and employed fora 
very long time, but it was only within the last two years 
that this method was substituted for the subcutaneous 
injections. All knew the facility and rapidity of rectal 
and intestinal absorption for medicated solutions, and 
no one was astonished at the extreme rapidity by which 
enematas of salt water were absorbed. Those enematas 
strengthened the pulse, rendered the urine abundant and 
suppressed thirst. They were used by Eitz with great 
success for imemia, and by Boulengier for post-partum 
hemorrhage and for intestinal hemorrhage in typhoid 
fever. 

In affections of the nervous system. Professor Grasaeti 
of Montpellier, advised saline injections in apoplexy 
with arterial hypotension. They were proposed in con¬ 
tagious affections such as erysipelas, measles, scarlatina, 
small-pox. while Professor Tommassi. of Palermo, in cer¬ 
tain skin diseases derived benefit from them, especially 
in chronic eczema, and in lichen attended with great 
itching. His colleague, Barbier, obtained considerable 
success with the saline injections in infantile cholera, 
and generally in all the intestinal affections of infants. 

Lancereaux published remarkable effects of subcu¬ 
taneous injections of a saline gelatine solution in cases 
of aneurysms (gelatine ."jj. saline solution 3x.) injected 
under the skin of the gluteal region, and renewed once 
or twice a week, ten to twenty injections were generally 
sufficient to effect a cure. 

Among the counter-indications of the treatment by 
saline solutions, he would mention heart affections, 
cedema of cardiac origin, dropsies, pulmonary congestive 
lesions, and renal sclerosis 


(icrmang. 

[from our own correspondent.] 

Berlin, March 4th. 18R0. 

Heroine. 

Dr. Franz Tauszk (Deutsch Med. Zeitung) has given 
us his experience with heroine, the new substitute for 
morphia. It was used in sixteen cases, mostly cases of 
cough. There were eight cases of phthisis, one of 
bronchial asthma, one of croupous pneumonia, one of 
pleuritis, and four of bronchitis. The effect was good in 
all, the irritability censed in all cases, or in a short time it 
was much alleviated. It was very rapid in its action. 
In the case of bronchial asthma the severe attacks did 
not return aftsr a dose of 0 003 gms. (0 046 grains.) As 
compared with morphia, in one patient who had taken 
0'0< *3 grm. of that drug for weeks for relief of her cough 
without relieving the distressing night attacks, 0003 
grm. of heroine at once gave relief. In another patient 
who had taken O'10 grm. of codeina per diem without 
relief, 0003 grm. of heroine acted immediately. In 
another case, one of phthisis, on whom the round of 
narcotic sedatives have been tried without benefit, the 
results of heroine were striking. Patients seemed to 


grow accustomed to the medicine, but the result could 
always be obtained by increasing the dose. 

Volkmann’s Sammlung contains a paper by Hans 
Kehr on 

The Results of 360 Operations for Gall-Stones 
with Special Reference to 151 Performed 
During the Past Two Years. 

The operations of the writer comprise all or nearly all 
that can be imagined in connection with gall-stones. 
The mortality of the operation in simple uncomplicated 
cases was 3 8 per cent. The writer advises early opera¬ 
tion before the gall-stones can have been forced into the 
deeper bile passages. In the earlier periods the opera¬ 
tion is less dangerous and also less difficult than when 
the choledoehus has to be opened. When symptoms of 
obstruction of the passages are present, he proceeds to 
operate unless evidence is present of the re-establish¬ 
ment of permeability of the duct. Cure of the chole¬ 
lithiasis by internal remedies the author looks upon as 
one of the rarest of events. Development of carcinoma 
he considers one of the dangers to be feared in cases of 
long continued irritation from gall-stones. The normal 
procedure is cholecystectomy, and although with this 
recurrence is possible, be has never seen it. Chole¬ 
cystectomy is a more radical operation, but it is also 
more difficult and more dangerous. Ideal cholecystectomy 
can only be exceptionally performed, a free drainage of 
the gall-bladder is the surest means of overcoming the 
catarrh that so often exists. 

Dr. Bruch (Budapesth) (D. Med. Z.) has lately made 
a study of the relation that exists between 
Bacteria and Chill. 

He concludes that air, water, and soil, i.e , cold air 
(draughts), cold water, and damp soil may act injuriously 
through the pathogenic bacteria they contain. These 
latter, so long as a physiological condition prevails, give 
no sign of their presence. In a latent or feebly virulent 
form they produce no effect on the normally healthy 
individual, but when an irritation is set up (in conse¬ 
quence of great change of temperature, for instance) 
that acts upon them and threatens to destroy them, they 
become virulent, and act injuriously on the organism 
already pathologically predisposed by a chill. Having 
given his views, he leaves it to a future collective inves¬ 
tigation committee of clinicists, pathologists, and bac¬ 
teriologists to unravel the remainder of the secret 
connection between these two factors. 

At the Medical Society, Hr. PiorkowBki showed a 

Simple Process for the Perfect Diagnosis of 
Typhoid Fever. 

Two years ago he introduced a method of differentiat¬ 
ing between bacterium coli and the typhoid bacillus, and 
since then he had been engaged in bringing to comple¬ 
tion a more perfect process. 

Starting from an observation of Hauser, of Erlangen, 
he suspected that with a small amount of gelatine in the 
nutrient soil, the growth of the firm offshoots of typhoid 
bacilli colonies would, perhaps, beoome even, more 
distinct. He found that a strongly alkaline reaction for 
the differentiation of the soil was an advantage. With 
five per cent, of gelatine the branching out of the 
colonies was greater, but this became still more 
characteristic when the concentration waa only three 
per cent. Finally, he decided that the nutrient soil 
should be prepared as follows:—Two days old normal 
urine, of sp. gr. of 10 20 made alkaline is mixed with 


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THE OPERATING THEATRES. 


Mae. 8, 1899. 


I percent, of gelatine, filtered without being wanned and 
placed in a reagent glass. After being stoppered with 
cotton wool it. is sterilised in steam at a temperature of 
110 C. This process can only be repeated on the follow¬ 
ing day, otherwise the mixture is damaged as a nutrient. 
The typhoid colonies can then be seen to appear in fibre 
form, proceeding in a peculiar arrangement from a 
central point in long tendrils, and thus quite different, 
from the'yellow round coli bacilli. The plates are always 
kept at a temperature of 22 C. (72F.) 

The speaker then described his experiments with 
typhoid stools. Here the typical form appeared in 
every case. The identity of the bacteria was otherwise 
proved in the ordinary way, and also checked by control 
experiments. Experiments were then made with mixed 
bacterum coli and typhoid bacilli growths, and although 
growing together the round yellow coli bacilli could be 
distinguished from the tendril-like typhoid bacilli The 
speaker finally mentioned some cases in which with his 
method a diagnosis had been made with certainty in 
twenty hours, whilst Widal’s reaction had given no indi¬ 
cation, although the disease was already in the second 
week. 

Tuberculin Tbeatment.—Further Contributions. 

The D. Med. Wochenach. contains the result of obser¬ 
vations made in the Victoria Augusta Home and Ebers 
walde by Dr. Bandelier. Twelve cases were treated by 
tuberculin, but in none was the treatment employed 
when fever was present. Koch never claimed that 
tuberculin would be useful in septic fever, even of tuber¬ 
culous origin. Patients were kept in bed during the 
treatment, but during the after treatment they went 
about. Only patients completely free from fever 
then were treated. The guiding principle was to 
enable the system to bear large doses by gradual 
increase. Local reaction always consisted in redness, 
swelling, and some pain, which passed off in a few 
days. Abscesses never formed. He could not speak 
as to any actual distinct local reaction at the seat of the 
disease. The changes took place gradually, and con¬ 
sisted in slow disappearance of the catarrhal symptoms, 
as well as in diminution of the area of dulness. The 
general reaction consisted of headache, weakness, heavi¬ 
ness, and dragging in the limbs, &c., a general feeling of 
unwellness like that of the initial stages of an illness. 
The symptoms increased with the height of the fever 
and with the size of the dose of tuberculine, but they 
were also present when there was no rise of temperature. 
The first eleven cases were selected with great care, but 
the physical signs of phthisis were unmistakable. The 
whole of the cases were undoubtedly influenced benefi¬ 
cially by the tuberculin treatment. By a comparison of 
the condition at the commencement and the close of the 
treatment, there was improvement in all, a cure in some. 
The writer does not deny that other factors contributed 
to the improvement, but he does not believe that the 
results would have been the same without the tuber¬ 
culine treatment. 


Jlustria. 

[from our own correspondent.] 

Vienna. March 4th. 1899. 
Alimentary Glycosuria in the Gravid State. 

In Prof. Schauta's Clinic Hofbauer gave an interesting 


lecture to the students on glycosuria in the gravid state. 
Commencing with the physiological condition and fixing 
the mean amount of saccharines used up in the animal 
economy he pointed out how easy a change in the assimi¬ 
lation would induce a form of glycosuria without any 
other morbid change being present. According to the 
labours of Strumpell and Strauss this condition is a 
relative one between the reception and burning of sugar 
in the organism. When a large amount of sugar was taken 
into the blood and a state of hyper-glycajuiia produced 
glycosuria was inevitable, although tolerance was 
another factor to be considered in the renal elimination. 
The various conditions modifying this temporary form 
of glycosuria may be classed as neurogenic, toxigenic 
and febrile. Hofbauer next brought forward a few cases 
in the gravid state, in which urine had been examined 
and carefully noted from the beginning of pregnancy. 
The first case was one where 100 grs. of chemically pure 
grape sugar had been given early in the morning in tea, 
sometimes in cognac and water. After administering this 
quantity of sugar the urine was drawn off by a 
catheter and carefully examined. Forty-five cases 
were selected in order to ascertain the normal 
power of assimilation of sugar in different stages of 
pregnancy. It is found that the early Btage of preg¬ 
nancy has a constant quantity about the second 
month, and gradually increases. This positive appear¬ 
ance has led him to recognise in the diagnosis of preg¬ 
nancy a confirmation of the gravid state. It is not 
present in the ectopic pregnancy, tubal abortions, or in 
hematocele formations. It is also negative in mole 
formations or where the foetus is dead. He concludes 
by affirming that the glycosuric test is a physiological 
condition of the undisturbed and developing ovum. The 
pathology of the reduced assimilation in the gravid 
state is attributed to changes in the nerve system 
and haematic circulation. The alteration in the abdo¬ 
minal organs and consequent metabolism are also recog¬ 
nised as factors in its production. 

From the experiments on animals, transitory glycosuria 
is recognised as the result of an injury to the glycogenic 
organ where there is an insufficient accommodation for 
hyper-glycscmia, and consequently an easy transmission of 
glucos to the urine. It is interesting to note how this 
glycogen is produced in the organism during pregnancy. 
In a normal state of the body, where no pregnancy or 
disturbance exists, the blood is almost free from glycogen 
although present in large quantities in pathologica> 
conditions. Livierato has proved that the blood 
in pregnancy contains large quantities of glycogen 
which on approaching the end of the pregnancy is asso¬ 
ciated with leucocytosis. The colostrum in the gravid 
state is another phenomenon, somewhat analogous to the 
glycogen. With Ehrlich’s test of potassic iodide mucilage 
(iodi pur. 10 gramme; potassium iodide 3 grammes ; 
mucilage of acacia 100 grammes) this constituent may 
be easily determined. Under the microscope the cellular 
element has the characteristic brown granular colour. 
There is still a controversy whether this micro-chemical 
iodide reaction indicates the presence of glycogen, or 
whether it must be interpreted as another constituent. 

^he Operating theatres. 

WESTMINSTER HOSPITAL. 

Exploration of the Thyroid foe Dyspniea.— 


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Mar. 8. 1899. THE OPERATING THEATRES. Tub Medical Press. 249 


Mr. De Santi operated on a woman, set. about 55, for j 
enlarged thyroid, causing stridulous breathing and | 
dyspnoea. The patient had had a large symmetrical j 
goitre for many years, but until within the last year had j 
suffered no particular inconvenience therefrom ; about I 
that time she commenced to suffer from difficult breath- j 
ing, which increased, especially when she attempted any j 
active exertion. She was admitted eight months ago I 
under Mr. de SAnti, having been sent to him by his col- ! 
league, Dr. Murrell; the woman then had a very cxten- 
sive hard, but well defined, symmetrical goitre, the worst j 
feature of which was that it extended mesially from the 
thyroid cartilage to the top of the sternum; there was 
no evidence of malignancy about the swelling. The 
laryngoscopic appearances showed good movements of 
cords. There was no dysphagia. When the patient was 
in the supine position she at once got severe 
dyspnoea. Mr. de Santi excised under an anaesthetic 
the middle portion of the isthmus of the thyroid. 
The wound healed by first intention, and the patient , 
experienced immediate relief. She was discharged, and 
remained thoroughly comfortable until about six weeks ; 
ago, when there was a recurrence of the bad breathing i 
and she was readmitted. The thyroid enlargement was 
somewhat greater than before, but still well defined, and : 
showing no malignant tendency. An exploration was 
again made of the central portion, the object being to 
relieve tension and possibly perform tracheotomy; the 
incision extended to the top of the sternum, and a 
careful exploration was made in the mid-line along the 
whole length of the wound; the trachea was not to be 
found mesially, but on examining further it was dis¬ 
covered embedded in a mass of thyroid tissue, and well 
over to the right side of the mid-line. The division of 
the cervical fascia, and of the mesial portion of the 
thyroid swelling gave bo much relief under the anaesthetic 
at the time that nothing further was attempted, 
and the wound was closed. Mr. de Santi said 
that the case was illustrative of the immense difficulty 
that may arise when a surgeon is suddenly called 
upon in such cases to perform tracheotomy; in this 
particular instance not only was the trachea considerably 
deflected from the middle line, but it was very much 
narrowed by lateral compression. Moreover, the central 
part of the tumour had extended to below the level of the 
top of the sternum, making it almost impossible to per¬ 
form a low tracheotomy. It was out of the question to 
attempt in so bad a subject the removal of half the 
thyroid, and the only measures that appeared to offer 
any hope of relief to the patient were those that were 
carried out. The patient made a good recovery 
from the operation, but about a fortnight later 
suddenly got light-headed, and died from an attack of 
cardiac syncope. At the post-mortem a vfry extensive 
bi-lateral goitre was discovered which implicated the 
trachea and oesophagus; the trachea was for some 
distance not only displaced to the right, but very con¬ 
siderably compressed from side so side. The oesophagus 
was also found compressed. The central portion of the 
goitre extended well down into the anterior mediastinum, 
and on examination of the deeper and lower part of the 
neck, a few suspicious-looking glands were discovered ; 
these were microscoped by the pathologist, and found to 
show commencing malignant disease. 

ST. THOMAS’S HOSPITAL. 

Gastrostomy by Albert’s Method. —Mr, Battle 


operated on a married woman, a?t. about 53, who had 
been in his out-patient department for some time, suffer 
ing from difficulty in swallowing. She had noticed the 
difficulty for some weeks, and it had gradually increased 
until no solid food could be swallowed. Examination 
with a bougie showed no evident obstruction, although 
its passage caused some pain behind the upper part of 
the sternum. There was no blood on the instrument 
when it was withdrawn. When she swallowed she com¬ 
plained that the food appeared to stick behind the upper 
part of her breastbone, but there was nothing abnormal 
to be discovered either in the thorax or in the glands of 
the lower part of the neck. She had lost strength, but 
was fairly vigorous, and her appetite was good. Treat¬ 
ment in the out-patient department had relieved her for 
a time, but the condition became gradually worse until 
no solid food at all could be swallowed, and after admis¬ 
sion to the hospital, when obstruction was more defi¬ 
nitely felt, the operation of gastrostomy was advised. 
This was performed in the following way. An incision 
about two and a half inches in length was made in the 
left rectus muscle and carried through the posterior layer 
of the muscle sheath until the peritoneum was opened . 
the stomach was easily found and drawn through the 
wound to some extent until a cone-shaped portion as near 
the cardiac end as possible had been held up- 
The peritoneum and rectus sheath were then united 
by means of a continuous stitch to the base of 
this projection. The remainder of the wound was 
then closed. The apex of the cone was then 
carried upwards under the skin and subcutaneous 
tissue of the lower part of the chest, and made to 
protrude through an incision in the skin about two 
inches from the upper end of the first incision; it was 
then sutured there. So far the stitches had not pene¬ 
trated beyond the submucous coat, but after the sepa¬ 
rate suturing of the rectus muscle and of the skin of the 
lower wound, four stitches were placed in the upper 
portion of the stomach wall, and after the stomach had 
been opened these were tied so as to hold the edges 
of the opening back. A No. 4 catheter was then 
passed into the stomach and secured in position; 
cyanide gauze dressing was applied. The advantages 
claimed for this method of operation, Mr. Battle said, 
are that there is less likelihood of regurgitation from its 
employment, and to this the length of passage between 
the opening in the stomach and the point where it passes 
through the muscle, as well as the contraction of the 
muscle itself, are supposed to contribute. There is 
another advantage in the fact that the stomach is opened 
at a distance from the peritoneum, and is opened early 
so that the benefits of the operation are at once experi¬ 
enced. He remarked that ho had previously performed the 
same operation, and the result had been satisfactory. 
The case just operated on was also interesting in the fact 
that the patient was a female ; epithelioma of the oeso¬ 
phagus, or, indc d, any malignant structure in that 
situation, being very rare in that sex. The patient 
was fed through the catheter which protruded 
through the dressing, and up to the present has pro¬ 
gressed extremely well, having had a normal tempera¬ 
ture, complete absence of pain and great relief from the 
sensation of hunger ; her expression is much improved, 
and she looks much stouter in the face. 

-♦- 


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250 The Medical Pbess. 


LEADING ARTICLES. 


Mae. 8, 1899. 


Registered for Transmission Arroad. 


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“ SALUS POPl'LI SITKEMA LEX.” 


WEDNESDAY, MARCH 8, 1899. 


ROYAL COLLEGE OF SURGEONS IN 
IRELAND. 

On this day week Mr MacArdle, of St. Vincent’s 
Hospital, Dublin, opened, as President, the session of 
the Medical Society of the Catholic University with 
an address which, in a general way, would not deserve 
notice from us, it being only a reiteration for the 
thousandth time of the politico-religious “ screech ” 
about anti-catholic intolerance of which Irish readers 
are so weary. We are called upon, however, to 
analyse Mr. MacArdle’s address because in it his 
blatant oratory was chiefly devoted to villifying the 
Irish College of Surgeons, whose “ reputation, 
honour, and dignity" he, as a Fellow, strove to up¬ 
hold. Putting aside the orator for a moment we 
cannot refrain from expressing surprise that the 
authorities of the Catholic University should have 
countenanced a scurrilous attack on a sister institu¬ 
tion with which it has always been on the most 
friendly terms, and that any Fellow or ex-Fellow 
should, by his presence and silence, have tolerated 
the proceeding. The charge of Mr. MacArdle against 
his College was that— 

“ Out of the numerous class of Catholic students, 
many of them distinguished, the College had failed 
to select one to occupy any position of trust or emolu¬ 
ment and when they came to examine the encourage¬ 
ment given to the (Catholic) students who thus 
supported (the College) they found that of all the 
oflices in (its) gift not one was in the hands of our 
co-religionists." 

We shall 8ave time by saying, at once, that these 
statements are demonstrably, totally inaccurate and 
misleading, and that there is probably no medical 
institution less open to the odious charge which Mr. 
MacArdle makes than the College which he 


abuses. To begin with, the candidates for col¬ 
legiate examinations, as a matter of fact their 
names, much less their religion, are not known 
to the examiners. Very many of them, and the 
College says, the more the better, are Catholics, 
and we challenge Mr. MacArdle to substantiate his 
suggestion that they are not on a perfect examina¬ 
tional equality with those of any other religion. Next, 
as regards the Fellowship of the College, we emphati¬ 
cally repeat the same challenge. Any licentiate can 
become a Fellow bypassing an examination of a higher 
standard. No one canstop him if he knows his work, 
least of all does the College want to do so, and, as a 
matter of fact, a large and increasing number of Catholic 
diplomates obtain the Fellowship. There is not, here, 
as in some other Colleges, any selection of Fellows, by 
Catholic or otherwise. It is, indeed, a subject of regret 
that many do not take the Fellowship, and that many 
hospital and school teachers in Dublin do not hold it. 
but this arises from circumstances over which the 
College has no control. For the past forty years the 
whole of the Queen’s College students have gravitated 
either to the Queen’s University or to its successor, 
the Royal University, or have migrated to Scotland. 
This has arisen chiefly through local school 
association and a saving of money, and 
even Mr. MacArdle will scarcely aver that 
religion has anything to do with it. But the 
fact remains that the number of Catholic Fellows 
who are in a position to offer themselves for 
collegiate office is relatively few. Yet of those that 
are available almost every one (save Mr. MacArdle, 
who complains that he did not get even one vote) has 
served or is serving the College. For a seat on the 
College Council every Fellow can ofEer himself, 
once a year, to the 280 electors, and no power 
can prevent his election if his character and 
professional standing recommend him to these 
Catholip electors. As a fact, four Catholic sur¬ 
geons are now Councillors, of whom one has 
been President, and two others Examiners. Mr. 
MacArdle'8 own colleague at St. Vincent’s was both 
Councillor and Examiner, and, we believe, might be 
so again if he wished. The other specially Catholic 
hospital, the “Mater," contributes two of its surgeons 
— one of whom has been an Examiner for several 
years — Jervis Street Hospital — also supposed 
to lie Catholic in sentiment—contributes two 
Catholics of its staff, one of whom has been an 
Examiner. The Professor of Anatomy in the 
Catholic University School is now an Examiner, 
and the Professor of Physiology was so for 
several years, while three of the Catholic learners* 
of Mr. MacArdle, two of whom have ceased to be 
Fellows of the College, were all examiners in their 
time. As to Professorships in the College school—the 
only other offices of emolument—we may remind Mr- 
MacArdle that Dr. E. D. Mapother was both Pro¬ 
fessor and Councillor for many years. That only one 
new election of a Catholic or anyone else to a Pro¬ 
fessorship arises from the fact that there has 
I been no vacancy in any chair—save that one 


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Mas. 8, 1899 


LEADING ARTICLES 


Thb Medical K'ress. 251 


— since the amalgamation of the Carmichal 
and Ledwich School with the College School 
ten years ago. We hope we have now suffi¬ 
ciently refuted Mr. MacArdle’s rash statements and 
calumnious inuendos, and that he may now appreciate 
the[fact that even the making of politico-religious 
capital does not justify an orator in saying “the 
thing which is not.” 


A CHARITY PRIMROSE LEAGUE. 

Ik anything were really wanting to show that 
another mistake had been made in connection with 
the Prince of Wales's Hospital Fund, that evidence 
is amply supplied by the chilling silence with which 
the inauguration of the so-called “League of Mercy ’ 
has been received by the public Press, from the \ 
Times downwards. It is remarkable and curiously 
significant that this proposal, to which Her Majesty 
the Queen, together with the Prince and Princess of 
Wales, had announced their support, should have 
been so received. We fear that it means that the 
Prince cannot be congratulated upon those who are 
responsible for advising him as to the exploitation of 
schemes designed for the benefit of hospital charities. 
Thus it is impossible to avoid expressing sorrow for 
the Prince in the circumstance in which he is placed. 
With every possible intention of doing everything 
in his power to advance their interests, he is asked to 
lend his name and support to impracticable schemes 
which from the first have no chance of success. We 
are grieved, for His Royal Highness’s sake, to have to 
admit that his Hospital Fund has proved to be a 
failure ; it is a matter of regret to have to record 
that the Hospital Stamps Scheme with its “ minister¬ 
ing children ” enterprise has failed to infuse life into 
the Fund, and lastly it is obvious that to make a 
further attempt to bolster up a failure by an im¬ 
possible and impractical organisation such as the 
“ League of Mercy,” the ending of which is likely to 
be rather more disastrous than anything which the 
Prince’8 advisers have attempted before, is to follow 
a policy which no sane person could possibly com¬ 
mend. There would have been no need for such 
tinkering in order to maintain the success of the Fund 
to which His Royal Highness had lent his name had 
its administration commanded the confidence 
of those whom it was designed to assist- 
But from the first it was regarded askance by 
those in authority in the hospital world. There were 
many, for example, well known as workers and 
organisers in hospitals, men to reckon with in their 
sphere of work, who were severely left out in the cold 
when the announcement of the scheme was made. 
Thus the promoters of the Fund courted opposition 
before the work of the Fund was commenced, and it 
is not unnatural to believe that that opposition, as 
time progressed, has been fostered, and has had not 
a little to do with the present disappointing position 
to which the Fund has reached. But all this might 
have been otherwise had the Prince headed a move¬ 
ment which was accepted from the first as a national, 
as apart from a one man scheme. This is some¬ 


what the position assumed by the Daily News, whose 
trenchant article upon the ‘ ‘ Prince's Primrose League ” 
has attracted so much attention. “ The hospital 
stamps,” says our contemporary, “the League of 
Mercy, the dependence on the name of the Prince of 
Wales, should be given up frankly, completely, and 
at once, and the Prince should be invited to place 
himself at the head of a movement for a thorough 
review and reform of hospital administration. When 
the hospitals are under a central and representative 
board, and are more amenable to public criticism 
and control, the money for their successful working 
will not be wanting ; the Prince of Wales's Hospital 
Fund will not languish.” Herein, after all, is possibly 
the solution to the question. The hospital world in 
London is made up of so many rival interests, that the 
only chance for any successful working of the same, 
at all events so far as the distribution of public funds is 
concerned, is, perhaps, the organisation of a central 
authority composed of representatives from each 
charity. There would then be no fear of each hos¬ 
pital, special and general, not receiving its due; there 
would be no room for favouritism with regard to the 
distribution of public funds; confidence would be 
felt in the decisions of such a board, and the public, 
imbued with the same confidence, would scarcely 
fail to do their part in providing the funds. The pro¬ 
posal of having a Central Hospital Board for London 
was, it will be remembered, submitted to the Execu¬ 
tive Council of the Prince of Wales's Hospital Fund, 
and, as was to have been expected, the Council de¬ 
clined to have anything to do with it, no doubt 
because it emanated from the Charity Organisation 
Society, with whom Sir Henry Burdett has for long 
had variances. But since then the Executive Coun¬ 
cil aforesaid, having failed to make a success of the 
Prince of Wales's Fund, their authoritative control 
over the Hospitals has dwindled almost to vanishing 
point, and thus has made plainer than before that 
some central administrative organisation in the 
interests of these charities is needed. 


PREMATURE BURIAL. 

Among a multitude of popular errors there ig 
probably none more widely spread and more deeply 
rooted than the belief in the frequency of live burial. 
Of recent years the subject has been fanned from a 
smouldering ember to a hot flame in various parts of 
the world, chiefly, it may be remarked, by folk who 
are interested in furnishing patent coffins, in the 
sale of special literature, in the paid certification of 
deaths, or in other ways productive of direct or in. 
direct pecuniary benefit. The possibility which they 
maintain is terrible indeed, and one certain to grip 
tenaciously the imaginations of folk whose faith is 
not founded on logic. In America the movement 
has been so industriously engineered that a 
Bill is actually being introduced into the Legislature 
with the object of preventing premature burial. The 
ways and means by which it is proposed to compass 
that end are such as might be expected from men 
who have accepted the theory of so grim and ghastly 


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Mab. 8, 1899. 


an occurrence. Provision is made for the retention 
of a supposed dead body for at least twelve hours in 
a well ventilated public mortuary chamber open to 
inspection. The most important innovation, however, 
is that which demands from the medical attendant or 
the coroner a death certificate making specific mention 
of the following signs of death (1) Permanent cessa¬ 
tion of respiration and circulation; (2) purple discolora¬ 
tion of the dependent parts of the body ; (3) absence 
of blistering around a part of the skin touched with 
a red-hot iron; (4) rigor mortis ; (5) signs of decom¬ 
position. Exceptions are made as to the exposure of 
those dead from certain communicable diseases, and 
also when vital organs are obviously destroyed or the 
body has been discovered in an advanced state of 
putrefaction. There is nothing in these proposals 
which reasonable persons anywhere need hesitate to 
accept; indeed, for that matter, the institution 
of a universal. mortuary system in the United 
Kingdom would be a most desirable step in the 
right direction. Nor would they refuse any 
measure that rendered careful personal and skilled 
inspection of a dead body imperative before 
the granting of a certificate of death. At the same 
time, it seems likely that the whole theory of the 
frequent occurrence of premature burial is a bogey, 
a popular error, an imaginative myth that melts 
away before the prosaic touch of scientific investiga¬ 
tion. A year or two ago a small volume was pub¬ 
lished in London under the title of “ Premature 
Burial : Fact or Fiction ?” The author did not deny 
the possibility of the occurrence of live burial, but 
altogether doubted its probability. He further analysed 
the literature of the subject, and asserted positively that 
of the many hundreds of reported cases he could not 
find a single one trustworthy from a scientific point 
of view. He pointed out the many fallacies that sur¬ 
rounded the subject, such as the impossibility of life 
being sustained for any length of time inside an air¬ 
tight coffin, and the numerous ways in which the 
position of a body might be disturbed in a coffin 
between death and burial; and he showed that the 
cases of resuscitation, if accepted, went to prove 
the difficulty of burial under such circumstances. 
Briefly stated, his main conclusion was that 
while no cases of premature burial could be 
taken as established, yet that under certain 
conditions demanding rapid burial it might be 
remotely possible, but at the same time it became 
practically out of the question after the supposed 
corpse had been subjected to a skilled medical exa¬ 
mination. We allude to this little book because it 
is the only one with which we are acquainted that 
deals with the matter from a scientific standpoint. 
Its contentions have never been upset, indeed, the 
only attempts to meet them have been by untrained 
writers who have trusted to unsupported contradic¬ 
tions, and to the further testimony of hearsay and 
unsifted evidence which would not be accepted in 
any court of law. The course that will probably 
be adopted by the American legislature as regards 
the above-mentioned Bill is not within our knowledge, 


but, if passed, it will be by no means the first 
occasion upon which a knot of agitators has diverted 
the current of legislation into non-scientific channels 
although, fortunately, in this case, no actual harm is 
likely to ensue. For some years past the introduc¬ 
tion of a similar measure lias been hinted at in certain 
quarters in our own country, but it is to be hoped 
that Parliament will stop at the establishment of 
public mortuaries and the much needed strengthening 
of death certificates. Of late not a little has been 
heard of the coming millennium of social legis¬ 
lation. When that happy era is at hand it 
may be pretty safely predicted that a new Medical 
Act will occupy a foremost place in the scheme of 
reform, wherein the other points mentioned will 
also figure prominently. Meanwhile, the timorous 
citizen may be advised to disregard the bogey of 
premature burial, and the timorous legislator to 
exclude it from his list of matters that press for 
attention in the field of practical politics. 


4toUB on Current topics. 

Nitrous Oxide as an Anaesthetic. 

Nitrous oxide is a very useful ana3sthetic, but it is 
generally regarded as an agent which does not lend 
itself to operations requiring prolonged unconscious¬ 
ness. Recent researches show that this view is 
founded on an imperfect appreciation of its proper¬ 
ties, for it has been demonstrated that by a judicious 
and carefully regulated admixture of oxygen, or even 
of air, the anaesthetic effect can be maintained for an 
indefinite pei’iod. Moreover, this admixture removes 
the asphyxial phenomena which constitute the only 
danger which the use of this agent entails. It is 
evident that we have not reached finality in the 
matter of general anaesthetics, for there are many 
alternative ways of inducing insensitiveness to pain. 
Pure nitrogen and hydrogen, for example, produce 
anaesthetic effects very similar to those following the 
administration of nitrous oxide. It is a curious fact 
that the addition of about 5 per cent, of oxygen gets 
rid of the lividity and stertorous breathing which 
characterise the effects of nitrous oxide as usually 
given, and as the anaesthetic effect is not thereby 
lessened, we may infer that nitrous oxide does not 
produce its effect merely by depriving the nervous 
centres of their quota of oxygen, but in virtue of a 
specific action. It is suggested that it leads to an 
accumulation of carbonic acid in the blood sufficient 
to deprive the sensorium of its functional activity in 
spite of a provision of the element oxygen. Though 
possibly less convenient of administration than the 
anaesthetics in general use, the fact remains that 
nitrous oxide is by far the safest general anaesthetic 
we possess, and if a simple and not too expensive 
apparatus could be devised for its administration in 
combination with measured quantities of air or 
oxygen its more general use in surgery might con¬ 
ceivably do something to reduce the present lament¬ 
able mortality from anaesthetic narcosis. Neverthe 


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NOTES ON CURRENT TOPICS. 


The Medical Press 253 


Mar. 8, 1899. 

less it does not appear likely to displace chloroform 
which, when properly administered, is safe enough 
for all practical purposes. When the profession and 
the public have come to regard every death under 
chloroform as entailing a presumption of careless or 
unskilled administration only to be foregone on proof 
of adequate experience, and the employment of the 
best apparatus procurable, the mortality under this 
head will, we doubt not, promptly fall, if not to zero, 
at any rate to the extent of liecoming a negligeable 
quantity. 

The Right of Prosecution. 

In the course of a reply to Mr. McNeill on certain 
statements charging Dr. Hime with practising vivi¬ 
section, it was stated by the representative of the 
Home Office that the performance of an experiment 
upon an animal calculated to give pain, by a person 
without a licence, was an offence under the ordinary 
law. in respect of which anyone might prosecute. We 
were under the impression that under the Vivisection 
Act the right of prosecution was vested in the Home 
Secretary, but closer scrutiny shows that this restric¬ 
tion only applies to proceedings against licensed 
persons, and amateur vivisectors unprovided with a 
licence would render themselves liable to prosecution 
under the ordinary law for the protection of animals. 
They would presumably lie charged with “ causing 
unnecessary pain," but the magistrate would 1 ave to 
decide whether such a thing as an inoculation with a 
specified object in view amounted to the infliction of 
unnecessary pain, and we feel sure that the average 
magistrate would hesitate to place the scientific 
investigator on the same footing as the irate coster 
who twists off his donkey’s tail, or the wanton rough 
who sets his dog to worry a cat. We are not likely 
to see this point settled in a hurry, because, on the 
rare occasions on which a private and unlicensed 
person infringes the Act. he does not carry out his 
experiments on the doorstep for the information of 
the man in the street, but, in Biblical language, goes 
into his closet and shuts the door. 

Operations for Enlarged Prostate.. 

At a recent meeting of the Clinical Society Mr. J. 
R. Lunn read notes of a series of six cases of castra¬ 
tion for enlarged prostate with results which ought 
to go far to popularise recourse to what, so far, 
may lay claim to be the only surgical procedure 
which holds out any substantial prospect to these un¬ 
fortunate patients of permanent relief from the 
terrible sufferings and permanent discomfort entailed 
by an enlarged prostate. There is, of course, a 
reverse to the medal. We cannot with impunity 
temper with glands which, in addition to their 
ordinary secretions, doubtless exert a far-reaching 
effect on the organism by means of the internal 
secretions of which Claude Bernard was the first to 
suspect the existence. Although Mr. Lunn does not 
appear to have observed any instance of mental 
trouble as a sequel of the operation, other surgeons 
have been less fortunate, and, in a certain proportion 
of the cases, mental disturbance accompanies or 


follows vesical relief. Even when a reduction in 
the size of the prostate has been attempted by this 
operation the necessity for measures having for object 
the removal of the mechanical conditions created by 
past difficulties remains. As a rule considerable 
damage has been inflicted on the genito-urinary 
tract before this dernier ressort is consented to, and. 
unless these are met, the supervention of renal 
disease is but too likely. 

The Asepticity of Urine. 

In former days it used always to be assumed that 
the extravasation of urine into the peritoneal cavity 
meant the development of an attack of acute 
peritonitis. Later experience, however, has taught 
us that this is by no means the case. Whether or 
not the peritoneal inflammation begins depends upon 
the character of the urine. If, for example, a ruptured 
bladder discharges healthy aseptic urine into the 
peritoneal cavity, no inflammation occurs; in other 
words, everything seems to depend upon the asepticity 
of the urine. Tuffier was the first to draw attention 
to this fact, and cases have been recorded in which 
the proof of his statement is placed beyond dispute 
Confirmatory too cf the fact is the case recently 
published of a farmer who was kicked by a horse, 
after having been thrown, as the result of which he 
sustained an intmperitoneal rapture of his distended 
bladder, followed by extravasation of the urine into 
the peritoneal cavity. The perforation presumably 
was a small one, and, occurring at the time when the 
bladder was very much distended, it was closed by 
the contraction of the empty organ, and rapidly 
healed. The man recovered without a bad symptom, 
the whole of the extravasated urine having been 
absorbed by the peritoneum. Such cases as these 
are gratifying examples of what Nature can do when 
she is so disposed. 

The Plash Point Crusade. 

We are glad to see that the Star is still carrying 
on its able campaign against the dangerous low flash 
American mineral oil sold in this country. There 
must be no compromise in the matter. The public 
should understand that nothing short of a minimum 
flash point of 100 degs. F. is safe, so far as petroleum 
is concerned. It has been proved beyond dispute 
that the present low minimum flash point of 73 degs. 
F. is deadly dangerous to the consumer, apart from 
the construction of the lamp, and the only plea which 
can be urged in favour of its retention is one solely 
advanced in the interests of the monopolists by whom 
the oil is supplied. The Standard Oil Company, we 
understand from the Star, having taken alarm at Mr. 
Reckitt's Bill which is set down for second reading 
in the House of Commons on the 15th instant, are 
bringing pressure to bear upon oil vendors in order 
to cajole them into petitioning the Government 
not to raise the flash point to 100 degs. F., as the 
Bill proposes to do. It is to be trusted that the trade 
will do nothing of the sort. This attempt by the 
company to influence their customers adversely will 
probably defeat the object which the former are 


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254 The Medical Press. 


NOTES ON CURRENT TOPICS. 


Mar. 8, 189ft. 


seeking to obtain. In the midst of all the discussion 
upon the subject it is difficult to understand the posi¬ 
tion assumed by the Government. The chairman of the 
Petroleum Committee, Mr. Jesse Collings, as is known, 
has opposed the proposal to raise the flash point, but 
why should the Government seem to be favourable to 
this view also ? Surely enough evidence has been 
brought forward to show the evil that the low flash 
petroleum is capable of producing. Moreover, it is 
iniquitous that the lives of the people in this country 
should be imperilled by the sale of an oil which is not 
allowed to be sold in America. 

“The Cry of the Children.’’ 

It was wise on the part of Lord Salisbury to leave 
the “ Children’s Bill ” to the decision of Parliament. 
Consequently the second reading of the Bill was 
carried by a very decisive majority of 258, on 
Wednesday last. Convinced of the great physical 
and educational evils inseparable from the half-time 
employment in factories, it was time this step should 
be taken. We may now hope, after the commanding 
success of Mr. Robson’s Bill for raising the age of 
the children from eleven to twelve, the Bill will be 
placed on the Statute Book on a very early day. The 
measure is a necessity if this country is to compete 
successfully with France, Germany, Switzerland, and 
other countries in the commercial world, and because 
the physical deterioration arising out of the half-time 
systems means stunting and weakening the raw 
material of our Army and Navy. Indeed, the system 
of “ half-time ”—that is, of setting young children to 
premature toil—is cruel as well as fundamentally 
wrong. We, therefore, heartily endorse the senti¬ 
ment expressed in Parliament by the author of the 
Bill, that “No nation can expect to prosper by 
hindering the physical and mental development of 
the young.” 

Plymouth Guardians and the Local 
Government Board. 

As the world knows, the policy of the Local 
Government Board has hitherto been to interfere 
as little as possible with matters of local administra¬ 
tion. As a rule it is only when some scandal has 
stirred up the indignation of the public that the 
central bureau has taken decisive action—that is to 
say, so far as a brave show of authority goes. But local 
bodies have learned to disregard the brutum fulmen 
of Whitehall as an empty threat to be laughed at 
and evaded. A case in point may now be witnessed 
at Plymouth, where the condition of the Poor-law 
infirmary has long been notoriously inadequate and 
bad. For two years the Guardians have played the 
familiar parochial game of battledore and shuttlecock 
with the central Board, until the latter has lost patience 
and addressed a peremptory letter calling upon the 
Guardians forthwith to provide the necessary accom¬ 
modation. The results of this official order has been 
a simple declaration of defiance on the part of most 
of the local administrators, whose chairman openly 
advocated a policy of masterly inactivity. So far as 
can be gathered, the chief objection to rebuilding is 


the cost, which will be about £50,000 ; but, of course, 
that is no argument for failure to discharge a legal 
duty. From the uncontradicted statements of Guar¬ 
dians, the present infirmary is inadequate both in 
space and in construction; in fact, a number of 
patients have to sleep in the main workhouse build¬ 
ings, and one lunatic sleeps on the floor, while the 
bathing arrangements are described as “ scandalous.” 
Of late years the Poor-law administration of the 
West of England has gained an unenviable notoriety, 
and it is somewhat curious that Guardians should 
court further publicity in similar unfavourable direc¬ 
tions. The next move of the Local Government 
Board will be awaited with some interest. 


The Irish Medical 'Association Reform 
Meeting'. 

We publish in our Irish Supplement of this day 
an extended report of the aggregate meeting of the 
profession held in the Irish College of Surgeons on 
Thursday last, and organised by the Association. We 
may truthfully describe the meeting as an unequivo¬ 
cal success. It was admirably administered by Sir 
Thomley Stoker, the President; was distinguished 
by the presence and by the advocacy of its objects by 
the Presidents of the Colleges and other leaders of 
public opinion on professional affairs; was the 
largest gathering of Poor-law Medical Officers which 
ever assembled in the College or elsewhere; and was 
characterised throughout by the calmness and argu¬ 
mentative discretion of the speakers, none, of whom 
asked for more, in the way of reform, than might 
reasonably be granted. Such a meeting must have, and 
we hope, has already had an excellent public efFect, 
and will, we doubt not, do much to bring the authori¬ 
ties into line with the reasonable aspirations of the 
Poor-law Medical Officers of Ireland. 


Modern Views on Graves’ Disease. 

Exophthalmic goitre, or Graves’ disease, is by no 
means the implacable morbid entity that is pictured 
in most text-books. On the contrary, it would seem 
that a very large proportion of the patients suffering 
from this malady sooner or later undergo partial 
spontaneous recovery. When death does occur 
therefrom, it usually takes place during the first 
eighteen months, and in view of the inefficacy of 
ti eatment, it is comforting to recollect that Nature 
has a way of her own of discarding the most trouble¬ 
some symptoms. Of these, palpitation is certainly 
the most constant, and it is precisely the one which 
most uniformly undergoes spontaneous subsidence. 
The outward and visible manifestations in the shape 
of enlarged thyroid and prominent eyes, on the other 
hand, rarely do more than to cease developing. The 
pathology of the disease is still Bhrouded in much 
obscurity. The hyper-secretion of thyroid juice, to 
which are ascribed the clinical manifestations of the 
disturbance, may after all only be an effect of an 
underlaying disorganisation of the nervous system. 
Certain it is that the results of partial removal of the 
gland do not give better results than less drastic 


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NOTES ON CURRENT TOPICS. 


The Medical Pbkss. 255 


measures, while the intervention is -of itself a highly 
hazardous proceeding. 

Myths About the Mahdi. 

The discussion which has been taking place in the 
House of Commons about the late eminent prophet 
of the Devrishes has not been edifying as an example 
of British intelligence. Great umbrage was displayed 
at the treatment meted out to the Mahdi’s body by 
the Sirdar, and great pains were taken in the 
endeavour to discover what had become of his skull. 
The opinion still seems to prevail among a certain 
class of people that the Mahdi’s skull is not now 
lying peacefully deposed at the bottom of the Nile ; 
on the other hand, the conviction seems to be firmly 
implanted in the minds of some persons that it 
is now adorning the craniological collection in the 
Hunterian Museum at the Royal College of 
Surgeons, England. As a matter of fact, there is 
no evidence to show that the Mahdi's skull is not 
exactly in the place to which the Sirdar ordered it 
to be consigned, and the officials at the college afore¬ 
said are just as ignorant of its whereabouts as pro¬ 
bably the Mahdi is now himself. Again, someone is 
reported to have handed round to the guests at a 
dinner the other day one of the Mahdi's little fingers. 
There is, however, probably just as much truth in this 
as in the other canards about which so much unne¬ 
cessary fuss has been made regarding the defunct 
prophet. But in all these transcendental displays 
of wounded sentiment no one seems to have recalled 
what the Mahdi did to the body of our great country¬ 
man, General Gordon. In their efforts to make 
political capital out of a necessary incident in the 
Soudan campaign, the busy-bodies, both within and 
outside the House of Commons, have overlooked the 
fact that nothing which may have been done with the 
Mahdi s remains could equal the savage indignities 
heaped upon the body of one of England's greatest 
sons who m fate placed in the power of the Mahdi. 

The Health of the Pope. 

The surgical intervention which the medical 
advisers of his Holiness thought necessary to 
practise last week, consisted in the removal, through 
a five inoh incision, of a sebaceous cyst, the size ; 
of an orange, situated over the iliac bone on one 
side. The cyst had been slowly increasing in size 
for the last twenty-five years, but beyond preventing 
its illustrious possessor from sleeping on that side, it 
had seldom caused any trouble or inconvenience. As 
is not uncommon with this kind of cyst, its long¬ 
standing quiescence suddenly gave place to acute 
inflammation, causing a disquieting rise of tempera¬ 
ture and considerable local distress. As the use of a 
general anaesthetic was obviously unadvisable in a 
patient nearly ninety years of age, sensation was 
diminished by the use of cocaine and a refrigerant, 
and the inflamed cyst, including its envelope, was 
removed without difficulty by Dr. Mazzoni. The 
temperature at once returned to normal, and in the 
absence of septic complications, no evil results are to 
be apprehended. 


A Reported Antitoxin for Pneumonia. 

The recent life-and-death struggle in which Mr. 
Rndyard Kipling has so happily gained the upper 
hand will focus for a time the minds of mankind 
generally upon the why and wherefore of pneumonia. 
The pathology of that scourge has been recently 
discussed in these columns, and the only reference 
that need now be made in that direction is the 
causative nature, in many if not in all cases, of a 
specific pneumo-coccus bacillus. With regard to that 
microbe a notable announcement was made last week 
by a disciple of Koch, Professor Wasserman, who 
hopes that he has discovered an antitoxin that 
may be curative of pneumonia. From the re¬ 
ports which are at hand it seems that the 
Professor first inoculated rabbits with active 
pneumococcic cultures. After prolonged experiments 
he discovered that the antitoxin produced in the 
animal was elaborated in the red marrow of the bones, 
so that red marrow taken from a human subject dead 
from pneumonia, and used as serum, will cure mice 
infected with that disease. Whether this observa¬ 
tion will be upheld in the long rim or not, there is little 
doubt that, sooner or later, in some such way the 
ravages of the deadly pneumococcus will be set at 
naught by the scientific medical man. It is well, how¬ 
ever, to accept news of this kind with a good deal of 
caution, for it is the way of mankind eagerly to clinoh 
the belief of whatever it wishes to believe. The wild 
excitement that ran through all ranks and conditions 
of society, medical and non-medical, rich and poor, 
at the announcement of Koch’s supposed remedy for 
tuberculosis, will remain a standing memento of the 
unwisdom of accepting a theory that has not been 
subjected to the stem test of everyday practice. 


Prize Fight v. Boxing Contest. 

Those who abide by the law will rejoice over the 
decision of the Glasgow Bailies that the modem 
match with light gloves is no mere boxing contest. 
Two men named Dobbs and McDonald were charged 
with assault and breach of the peace on February 22nd 
by engaging in a prize fight in the city mentioned. The 
police evidence testified to the fierce and determined 
nature of the conflict. In the second round Dobbs 
knocked McDonald down twice, on one occasion 
through the ropes and off the platform. The fighters’ 
object was to knock each other senseless, and the 
encounter could not have lasted for the stipulated 
twenty rounds. The truth oE the last state¬ 
ment has since been abundantly upheld at New¬ 
castle, where the same two pugilists met while under 
remand from the police-court. The Scotchman was 
beaten before the second round by some tremendous 
knock-down blows. All this brutality reads like a 
newspaper outting from the barbarous days of our 
forefathers, when prize-fighting was a fashionable 
art. The milder manners of recent generations, how¬ 
ever, have changed all that, and have declared these 
brutal encounters illegal. In the name of common- 
sense, then, let the police stop the revival of the prize¬ 
fight under the specious pretence of being fought with 


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256 The Medical Press. NOTES ON CURRENT TOPICS. Mas. 8. 1899. 


light boxing-gloves, which afford about as much pro¬ 
tection as would a pair of ordinary riding gloves. At 
the same time no one wants to hinder the healthy 
sport of boxing with ordinary gloves. Surely some 
rules increasing the weight of gloves, and making 
glove fights for money prizes or wagers illegal, 
would go far to scotch the spurious glove fight. 

Suicide in a Hospital Padded Room. 

The padded room of the London Hospital seems 
bentupon winning its way into notoriety. A few weeks 
ago it witnessed the death of a patient suffering 
from delirium tremens, and bound hand and foot in 
some form of mediaeval shackles. Now, it has been 
brought to the coroner’s notice as the scene of a 
suicide of a temporarily insane patient. From the 
evidence it appeared that the deoeased cut his throat, 
and that it was within the knowledge of the two male 
attendants that he had a knife in liis possession. It 
would be interesting to learn what were the qualifi¬ 
cations of the men to whom the arduous and respon¬ 
sible duty of attendance was entrusted. That they 
were unworthy of the confidence bestowed on them is 
to be gathered from the foreman’s rider to the ver¬ 
dict : “ We unanimously wish to pass a vote of censure 
on the attendants Green and Clark, as we do not 
believe a word they say.” 


The Death of Dr. Boyd. 

There are severel points worthy of attention in 
connection with the lamentable catastrophe which 
entailed the sacrifice of a valuable life. First and 
foremost, is the carelessness which characterised the 
fatal error. No precautions can ever avail against 
accidents of this kind if patients will not even take 
the trouble to look at the bottle and its label, and 
in this instance, if the wrappers had been removed, 
as they normally would be, the error would . have 
been impossible. Another striking feature is the 
extraordinary rapidity with which the acid produced 
irreparable mischief. There was immediate warning 
of the mistake and every opportunity, had skilled 
aid been promptly forthcoming, for antidotal 
measures, a dose of oil, or milk, or white of egg, or 
Epsom salts, and the mischief might have been 
limited to the local damage. What a splendid 
opportunity for “ first aid ” intervention! The oc¬ 
currence serves to emphasize the singularly deadly 
nature of the poison which the Government, with in¬ 
explicable obstinacy, declines to safeguard. It sug¬ 
gests, moreover, the desirability of insisting that the 
label on all bottles containing a deadly poison shall 
tear directions for treatment in the event of a mis¬ 
hap. The extra cost of such labels would be trifling, 
and the gain of time all important. An additional 
precaution would be to have all poison bottles 
triangular in shape, thus calling attention in a way 
that could not possibly be misinterpreted to the 
nature of their contents. 


In 1870, there were 527 medical women in the 
United States; in 1897 there were 6,882. 


The Medical Society of Victoria. 

The Medical Society of Victoria, which has elected 
Sir T. N. Fitz-Gerald as its president for the current 
year, is a very flourishing colonial medical body. Its 
membership now amounts to a total of 276, and thus 
entitles it to be regarded as one of the first—if not 
the first—of the societies among the British Colonies, 
devoted to medical work. Our contemporary, the 
Intercolonial Medical Journal, the organ of the 
Society, publishes in its January issue a long list of 
valuable communications read at the Society’s meet¬ 
ings during the past year, and a reference to the 
treasurer's report shows that the balance in favour 
of the Society now stands at upwards of £1,130. We 
congratulate our confreres in Victoria upon their 
successful organisation. 

The second reading of the “Sale of Food and 
Drugs Bill ” was moved by the Secretary of the Board 
of Agriculture, Mr. Walter Long, on Monday night, 
and stood adjourned. The debate is expected to be 
a prolonged one, much opposition being already 
manifested to some of its provisions. 


PERSONAL. 

Surgeon-Gen. Muir has been selected as Deputy 
Director-General of the Army Medical Service. 

Sir T. N. FitzGerald has been elected President of 
the Medical Society of Victoria for the current year. 

Mr. E. F. Eliot, F.R.C.S., L.R.C.P.E., F.F.P.S., 
Ac., has been appointed a magistrate for the County 
Borough of Southampton. 

Mr. W. F. R. Weldon, F.R.S., has been elected 
Linacre Professor of Comparative Anatomy at Oxford 
in succession to Professor Ray Lankester. 

Dr. Rat, who for the past thirty years has been in 
practice in Dulwich, was last week presented with a 
silver bowl and salver, together with a cheque for £116, 
subscribed for by his patients and friends in the district. 

Professor Rat Lankester, Superintendent of the 
Natural History Museum, South Kensington, has been 
appointed a corresponding member for the Anatomical 
and Zoological section of the Academy of Medicine in 
Paris. 

We understand that the Senate of the University of 
Aberdeen has decided to confer the honorary degree of 
LL.D. on Dr. James F. Goodhart, Physician to Guy’s 
Hospital, a former graduate of the University with 
highest honours. 

Lord Robebert has been nominated by the Liberal 
section of students of the Glasgow University for the 
Lord Rectorship. The Conservative section have not 
yet decided on their candidate, but are expected to 
settle the point this week. 

Surgeon-General Albert Gore, who has recently 
retired, with much distinction, from the position of 
Principal Medical Officer of the Indian Army, and on 
whom devolved the entire medical management of the 


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The Medical Press. 257 


extremely difficult campaign in North-West India, is 
temporarily residing in Kingstown. 

The Dnke and Duchess of Fife visited the Hospital 
for Sick Children, Great Ormond Street, on Thursday 
last. The Duchees gave toys to 154 children in the 
wards, and the Dnke gave .£100 towards the £20,000 
required to complete the purchase of the Nurses’ House 
and the garden for the sick children. 


Th e fact that a member of our profession has reached 
the patriarchal age of a century is of such rarity that we 
are prone to call attention thereto. What is more remark¬ 
able in the present instance is that Surgeon-Major John 
Bouron Berved the best years of his life with the Army 
in India, dying at Brighton on Sunday last in the 101st 
year of his age. 


Jfcotlani). 

[from our own correspondent.] 


The Glasgow Corporation and Medical Fees.— 
Recently a Glasgow practitioner became dissatisfied with 
a fee of five guineas for some work which he had done 
on behalf of the Corporation, and returned the cheque, 
accompanied by a note, “ with compliments.” The inci¬ 
dent was duly reported to the committee interested, and 
they agreed to accept the gentleman’s compliments and 
cancel the cheque. Probably the amount of work done 
would have been badly remunerated by the acceptance of 
this small cheque, but it is proverbial that the Glasgow 
Corporation does not consider medical men’s time as of 
much value. Some time ago a medical man was sent 
for by the police in a case of accident, the beet part of a 
whole day was taken up, an exhaustive report written, as 
well as evidence before officials. After a while a modest 
account for the large sum of one guinea was sent in, to 
which the Watching and Lighting Committee replied that 
if the charge had been, say, 3s. 6d. they might have con¬ 
sidered it. and as no written order was sent to the medical 
man, even although summoned by the police on the beat, 
they would not entertain for a moment any indebtedness, 
and the claim was accordingly disallowed. Let Glasgow 
flourish! 

Chair of Zooloot at Aberdeen. —A testimonial in the 
form of a letter is being largely signed by the professors 
and medical students in the Glasgow University in 
favour of the candidature of Mr. James Rankine, B.8c., 
M.B C.M., Professor Young’s assistant, for the vacancy 
caused by the death of Professor Nicholson. Mr. Rankine 
has been for several years assistant and demonstrator in 
the Glasgow University under Professor Young. He 
graduated B.Sc. in 1892 with first-class honours in 
zoology and botany, being awarded at the same time the 
George A. Clark Scholarship in Natural Science, of the 
value of £180, tenable for four years. He received his 
M.B.C.M. in July, 1897, with commendation. 

Government Lunacy Board, Scotland. —As Dr. 
Sutherland is likely to be raised to a higher grade on the 
Board, there is a rush of candidates for the post of 
Deputy Lunacy Commissioner. The appointment is in 
the hands of the Secretary of State for Scotland, and 
a great deal of canvassing is being carried on and wire¬ 
pulling done by certain Glasgow physicians, in order to 
secure the coveted post. Of course, influence will carry 
the day, and if a Glasgow man does not secure the 
appointment there will be great wailing and gnashing 
of teeth, in some instances of gums. It must be admitted 
that lately Glasgow men have been very fortunate in 
securing comfortable and lucrative appointments, and if 
their good luok continues, they will, after a while, expect 
to fill any vacancy to the exclusion of all others, as a 
matter of right. 


fterlramntterg Jletoe. 


Among the new Bills introduced is “ The Inebriates 
Act Amendment Bill,” the object whereof, comprised in 
two clauses, is to remedy omissions in last year's Act. 
It has been found necessary to provide that the expense 
of prosecutions under Section II. should be payable as in 
cases of felony, while the second clause gives power 
to deal summarily with breaches of the regulations 
made by the Secretary of State with respect to inebriate 
reformatories. The Home Secretary promised to 
consider the appointment of a lady inspector should this 
appear necessary. 

The Sale of Food and Drugs Act Amendment Bill is 
before the House. The first part deals with dairy pro¬ 
duce. The Margarine Act is extended and rendered 
more precise, and cumulative penalties are proposed in 
connection with the adulteration of food and drugs. 

In reply to a question by Mr. W. Ambrose, Mr. Long 
said that no case of rabies was known to have occurred 
in Middlesex during the past six months, but he did not 
consider that the muzzling order at present in force in 
that and other parts of the Metropolitan Polioe District 
could as yet be safely withdrawn. 

lit reply to a question by Dr. Farquharson, it was 
stated that an increased establishment had been given to 
all companies of the Volunteer Medical Staff Corps, in 
order to complete the personnel for transport sections. 
There was no present intention of making any alteration 
in the rank of Volunteer Medical Officers. The question 
of the reorganisation of the Volunteer infantry bearer 
companies was stated to be under consideration. 

In reply to Mr. Channing, Mr. Balfour stated that the 
Government did not at present contemplate the intro¬ 
duction of legislation having for object to provide that 
questions dealing with tuberculosis should be dealt with 
as for the whole country, the better to secure uniformity 
of administration. 

The nursing arrangements in the Egyptian campaign 
were again the subject of discussion on the initiative of 
Captain Norton. It was admitted that the principal 
Medical Officer of the army of occupation had asked for 
a hospital ship, and that the General commanding in 
Egypt had promised to consult Lord Cromer and make 
the application if necessary. No such application, how¬ 
ever, was made. The Under-Secretary was fain to con¬ 
test the advantages of a hospital ship, as if there could 
possibly be two opinions on such a subject, but he had 
to admit that considerable delay was entailed by the 
want of the ship in respect of the 280 men sent home. 
There were at the hospital base 226 men nurses and 10 
women nurses, all trained, for an average of 541 
patients. The difficulty of enforcing discipline was 
alleged as a reason for not increasing the number 
of female nurses. As this is a matter which closely 
concerns the comfort and well-being of those who have to 
do the actual fighting, we may expect it to crop up again, 
when it is to be hoped the weight of the Government 
will not be used to prevent the responsibility for short¬ 
comings being brought home to the proper parties. 

In reply to Captain Norton, Mr. Powell Williams said 
there was not the same necessity for establishing con¬ 
valescent homes for soldiers in Ireland as in England, 
the Irish barracks being mostly situated among small 
populations and in healthy surroundings. So far as cir¬ 
cumstances would permit arrangements would be made 
for the reception of convalescing soldiers in Ireland 
similar to those in other parts of the United Kingdom. 

In reply to Mr. Strachey, Mr. Chaplin said he had no 
information to the effect that objections are felt by many 
medical men at having their patients visited by the 
public vaccinator. The duty of the public vaccinator to 
visit the home of an imvaccinated child does not arise 
until the child has attained the age of between four and 
five months, unless the parent requests him to visit the 
home at an earlier date. There is, therefore, ample 
opportunity for the private practitioner to perform the 
operation if it is desired. 

In reply to Mr. McNeill, Mr. Collings said he had 
caused inquiries to be instituted concerning the state¬ 
ments made at the meeting at Bradford referred to, but 

,oog!e 


Diqiti2 


268 The Medical Press. 


LITERATURE. 


Mar. 8. 1899. 


he had been unable to obtain any clear statement of what 
was actua'ly alleged, nor any evidenoeof any illegal vivi¬ 
section being performed by Dr. Hime. Ho added that 
the performance upon an animal of an experiment calcu¬ 
lated to cause pain without a licence was an ordinary 
criminal offence for which any person could prosecute. 

In reply to Mr. B. Simeon, Mr. Collings said the Secre¬ 
tary of State had requested the Inspector of Experiments 
on Living Animals to expedite his annual report as much 
;i8 possible this year, but no date is fixed for it, and 
returns to be included in the report are not yet complete. 

Sir Francis Powell obtained leave to introduce a 
Bill to extend the Infectious Disease Notification Act, 
1899, to districts in which it has not been adopted. The 
Bill was read a first time. 


(Eorrcepmtiience 

We do not hold ourselves responsible for the opinions of our 
correspondents. 

THE PROPOSED “LEAGUE OF MERCY.” 

To the Editor of The Medical Press and Circular. 

Sir, —I am hardly disposed to think the Prince of 
Wales has been wisely advised as to the founding of a 
“ League of Mercy ” for the further promotion of his 
Hospital Fund, which, so far, cannot be said to have 
achieved great success. The idea of a special order, 
with all its dazzling tinsel and paraphernalia of grades 
of Grand Cross Knights down to members ranking the 
Fifth Class, is inconsistent with, and repugnant to, the 
cause of charity and the work of philanthropy, which 
have hitherto escaped evil communications, since it is 
admitted to be in the interest of charity that the “ right 
hand should not know what the left doeth.” This will 
clearly not be so in connection with this brand new order, 
as in the printed statement it is said that “ founders and 
benefactors will be eligible for the decoration.” No 
doubt the Prince believes that he has taken every pre¬ 
caution in this respect, but the wire-pullers that surround 
him will take Care to make it appear to the public there 
is something more to be got by subscribers to this fund 
than has ever before been offered to annual subscribers 
to the hospitals, and in an indirect manner there will be 
a proportionate falling off in the direct receipts of the 
hospitals. Indeed, some of them are complaining that 
the Prince of Wales’s Hospital Fund has had the effect 
of withdrawing subscribers already ; at all events, it has 
not improved their position. The motives of the Prince 
in this matter command universal respect, but as one 
officially connected with hospitals for very many years, I 
cannot but regret these have been diverted into so 
questionable a channel. Moreover, it will seem to imply 
that we all have our price, and herein lies the tempting 
offer for a higher bid What has gone before did not 
go far enough. Agreeing as I do with the remark of 
one of your lay contemporaries that the motives to 
which appeal is made by this finery and flummery of a 
Knight of the Grand Cross of the League of Mercy, “ are 
not those which brought our hospitals into existence, nor 
will such motives serve to maintain them.” 

I am Sir, yours truly, 

A Hospital Surgeon. 

March 4th, 1899. 


SALOPHEN IN INFLUENZA. 

To the Editor of The Medical Press and Circular. 

Sir, —I happened to notice Dr. Wright’s letter draw¬ 
ing attention to the value of salophen in influenza in 
your issue of March 1st, and, with your permission, 
would corroborate, as the result of practical experience, 
some of his statements, having used salophen in influ¬ 
enzal oases for over two years. Just as it is difficult to 
say in a case of rheumatism whether salicylate of soda 
is more likely to be of service than some other of the 
commoner anti-rheumatic remedies, so is it difficult, at the 
present stage of our medical knowledge, to judge in what 
cases salophen is more likely to prove beneficial than 


some of the other drugs in common use for treatment of 
influenzal symptoms. 

The experience which I have had of salophen leads me 
to believe that its greatest value and efficacy lie in its 
employment for relief of muscular, gastric, gastro¬ 
intestinal, joint and head pains associated with influenza. 

As to its anti-pyretic value I cannot speak highly, as 
I find that salophen is much more uncertain in action 
than phenacetin, for example, and the action is more de¬ 
layed, and the effect passes off much sooner than when 
phenacetin is administered. 

As affording relief for influenzal headache, especially 
when associated with giddiness and noises in the ears, 
salophen in doses of 15 grains, three or four times a day, 
is particularly valuable. 

Compared with phenacetin, its hypnotic effect, espe¬ 
cially in children, is slight. On the other hand, its dia¬ 
phoretic action is, I believe, greater than phenacetin, 
antipyrin, or antifebrin, and I nave never noticed any 
depression following upon its administration. 

I am Sir, yours truly. 

West Hartlepool, March 3rd, 1899. W. Gbat. 


?Citcratur£. 


STEWART'S PHYSIOLOGY, (a) 

Thib is the third edition of a work which promptly 
conquered for itself a high position in the teaching world. 
It is not a mere reprint, the work as a whole having been 
revised and in parts rewritten. A considerable amount 
of new matter has been added especially in the depart¬ 
ment of practical exercises. These “ practical exercises ” 
constitute the most salient feature of a work which covers 
some 850 pages, and comprises upwards of 300 illustra¬ 
tions with five coloured plates. The author has adopted 
the plan of “ interweaving formal exposition with 
practical woik.” On looking over the directions for 
practical work, one is Btruck forthwith by the fact that 
many of the experiments suggested would expose the 
confiding student to the penalties provided by the law 
against vivisection, but tne author explains that “ for 
various reasons,” a somewhat wider range of experiment 
is open to the student in America than in this country, 
and English students will have to do many of them by 
proxy, t.p., learning from demonstrations. The arrange¬ 
ment of the exercises iB intended to secure that practical 
work on a given subject shall actually be going on at the 
time as it is being expounded in the lectures, obviously 
an admirable way of securing a proper correlation of theo¬ 
retical and practical knowledge. 

A text-book of physiology does not readily lend itself 
to detailed criticism, especially as the author is not per¬ 
sonally responsible for the views and hypotheses therein 
contained. These have to be grasped by the student 
without reference to their ultimate fate. Moreover, in 
regard to the manner in which the subject is treated, for 
which alone the author can claim credit and incur 
responsibility, we have nothing but praise. When one 
compares the work with the text-books from which 
past generations of medical men gleaned their somewhat 
perfunctory knowledge of physiology, one is impressed 
by the progress that has been effected in teaching 
methods. The proper introduction to the study of a 
natural phenomenon is obviously an explanation of the 
mechanical laws which underlie the particular organic 
manifestation, and that is a rule which the author 
rigidly adheres to. We cannot adequately comprehend 
the circulation, unless we have previously acquired a 
knowledge of the elementary laws which regulate the 
behaviour of fluids under various and varying conditions 
and this holds good in respect of all the bodily func¬ 
tions. This method constitutes a truly rational and 
scientific method of teaching such a science as physio- 
logy, its mechanism being further elucidated, when 
necessary, by reference to the data of comparative phy- 

(a) “ A Manual of Physiology.” By G. N. Stewart. M. A, D 8c„ 
M.l). Bd , Ac. professor of Physiology in the Western Kewrve 
University,Cleveland, U 8.A , Ac (University Series;) London: 
Bailliere Tindall, and Cox. 1893. Pp. 850. With five coloured 
plates. Price IBs. nett. 

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MEDICAL NEWS. 


The Medical Press. 259 


Mar. 8, 1899. 

siology, a knowledge of which indeed assists the Btudent 
quite as much as comparative anatomy does in the study 
of morphology. There is, strictly speaking, no such 
thing as human physiology, the various organs and 
functions having their counterparts throughout the 
whole animal kingdom. By such means physiology is 
lifted out of the category of dry-as-dnst sciences, and is 
invested with an interest all its own. Instead of a series 
of more or less dubious “facts,” we have a series of 
explanations leading up to certain conclusions which are, 
to a large extent, capable of actual demonstration. We 
must congratulate the student on the progress that has 
been accomplished in this matter, and on the enormously 
increased facilities placed at his disposal for an acquisi¬ 
tion of this special and fundamental knowledge. The 
volume is clearly printed, tastefully bound, and the illus¬ 
trations are both numerous and excellent. 

SNfiLL ON THE EXAMINATION OF THE 
EYE. (a) 

This book is likely to meet the requirements of 
students of ophthalmology, traversing as it does ground 
which in the past has been too much neglected so far as 
this special subject is concerned. The author, therefore, 
in this small manual has made up for the obvious defici¬ 
ency present in this regard, in the majority of modern 
text-books on ophthalmic surgery. The work includes 
chapters on the external examination of the eye, mydri- 
atics and myotics, the ophthalmoscope, testing the sight, 
abnormalities of refraction, the field of vision, the move¬ 
ments of the eyeball and their anomalies, and simulated 
blindness—in all of which, in concise and clear language, 
he gives the necessary details which form the ground¬ 
work of the study of eye diseases. In brief, we can 
strongly recommend Mr. Snell's book, and no dresser in 
the eye wards of a hospital should be without it. 

4ftebit*l ^etoe. 

The Medical Sickness and Accident Society. 

The monthly meeting of the executive committee of 
the Medical Sickness Annuity and Life Assurance 
Friendly Society, was held at 429, Btrand, London, W.C., 
on 24th ult. In the absence of Dr. de Havilland Hall, 
the chair was taken by Dr. Major Greenwood, one of the 
vice-chairmen of the Society, and there were also present 
Dr. J. B. Ball, Dr Walter Smith, Dr Alfred S. Gubb, Dr. 
J. W. Hunt, Dr. W. Kiiowsley Sibley, and Dr. F. J. Allan. 
As is usual during the early part of the year, a large 
number of sickness claims are being received by the 
Society, but not in excess of what is expected and pro¬ 
vided for in the table of premiums. The list of those 
members who are permanently disabled also grows, and 
as all these are provided by the Society with pensions 
till aged sixty-five, varying in amount from 150 to 50 
guineas a year, a considerable sum of money is expended 
in this manner. This, however, has been specially pro¬ 
vided for, and there is a very reason to hope that the 
valuation of the Society’s premises, now in progress, will 
show ample reserves. In 1894, the date ot the last valua¬ 
tion, a surplus of .£5,000 was returned to the members as 
cash bonuses. Prospectus and all information on applica¬ 
tion to Mr. F. Addiscott, secretary, Medical Sickness and 
Accident Society, 33, Chancery Lane, W.C. 

Vital Statistics. 

The deaths registered last week in thirty-three great 
towns of England and W ales corresponded to an annual 
rate of 20 6 per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of this year. 

Birkenhead 20, Birmingham 18, Blackburn 32, Bolton 
22, Bradford 21, Brighton 18, Bristol 15, Burnley 13, 
Cardiff 16, Croydon 18, Derby 20, Dublin 30, Edin¬ 
burgh 26, Glasgow 25, Gateshead 19, Halifax 15, Hud¬ 
dersfield 20, Hull 17, Leeds 18, Leicester 14, Liverpool 26, 

(a) “ A Practical Guide to the Examination of the Eye. for 
Students and Junior Practitioners. ” By Simeon Snell. F.R.C.S. 
Edin.; Ophthalmic 8urgeon to the Boyal Infirmary and to the 
School for the Blind ; Professor of Ophthalmology, University Col¬ 
lege, Sheffield. With eighty-eight illustrations. Edinburgh and 
London: Young J. Pentland. 1898. 


London 21, Manchester 25, Newcastle-on-Tyne 20, Nor¬ 
wich 12, Nottingham 17, Oldham 20, Plymouth 22, 
Portsmouth 15, Preston 21, Salford 22, Sheffield 19, 
Sunderland 23, Swansea 20, West Ham 15, Wolver¬ 
hampton 15. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were:—From measles, 13 in Bolton, and 1 5 in Man¬ 
chester; from whooping-cough, 11 in Bradford, 1'4 in 
Sunderland, and 2 7 in Birkenhead ; from “ fever,” 19 in 
Blackburn and 2 3 in Wolverhampton. In none of the 
large towns did the death-rate from scarlet fever oi 
from diarrhoea reach l'O perl.OOO. The 103 deaths from 
diphtheria included 29 in London, 12 in Leeds, 11 in 
Swansea, 9 in Sheffield, 6 in Liverpool, 5 in Blackburn, 4 
in West Ham, and 4 in Birmingham. No death from 
8iuall-pox was registered in any part of the United 
Kingdom. 

Mortality in Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death rate per 1,000 of the several 
populations :—Calcutta 34, Bombay 100, Paris20, Brussels 
21, Amsterdam 15. Rotterdam 19. The Hague 15, Copen¬ 
hagen 29, Stockholm 24, Christiania 26, St. Petersburg 
27, Moscow 24, Berlin 16, Hamburg 17, Breslau 33, 
Munich 23, Vienna 25. Prague 29, Buda Pesth 27, Rome 
18, Venice 32. 

Death of Mr. Sargeant, of the Apothecaries Hall, London. 

W r k have to record the death of Mr. J. C. Sargeant, of 
the Apothecaries Hall, which took place at Lewisham, 
on February 27th, 1899, in his eightieth year For nearly 
forty years he acted in the capacity of Bedell to the 
Society. Ever kind and courteous, he will long be 
remembered by former candidates at the Hall. The 
funeral took place at Lewisham Cemetery, on Thursday 
last, March 2nd. 

Dr. Wliliam Hughkr Willshirk, whose death was 
announced on Wednesday from syncope, in his 83rd year, 
was formerly physician to, and lecturer on, the Practico 
of Medicine at Charing Cross Hospital. 

Dr. Arthur David White, who died on February 
18th, at Sidi Omar, Tangier, Morocco, set. 83 was. at the 
time of death, the oldest graduate in medicine on the 
books of Pembroke College, Cambridge, having graduated 
Bachelor in 1842, Licentiate in 1844, and Doctor of 
Medicine in 1848. 

Aa Unsuccessful Appeal. 

The dental practitioners of the Manchester district 
were invited to attend a meeting last week, convened for 
the purpose of discussing whether the practice of den¬ 
tistry should continue to be left under the General 
Medical Council, as at present, or be transferred to a 
dental council pure and simple. Some 240 dentists hail 
formally refused the invitation, so that the number of 
persons present was small, and the meeting was ulti¬ 
mately adjourned to enable the moving spirit in the 
agitation to draw up his conclusions in more precist' 
form. 

Hunyadi Janos Substitution. 

A Marseilles pharmacist was recently fined 200 frs. 
and costs for selling a purgative water from a spring 
called Lozer Janos, of Budaors, Hungary, the same being 
described on the label as “ genuine Janos water.” As 
Hunyadi Janos water is generally known in France as 
“ Eau de Janos,” it was held that this constituted ille¬ 
gitimate competition, and the judgment was ordered to be 
published in a local newspaper. 

PA8S LISTS. 


Royal College of Surgeon*, Ireland. 

Fellowship Examination. 

The following candidates having passed the necessary 
examination have been admitted Fellows of the College : 

Mr. I. Knox Denham, L.R.C.S.I., Ac., Mr. E. J. Moore, 
L.B.C.S.I., <fcc. and Mr. T. G. Stevens. L.B.C.S.I., Ac. 

The following candidates have passed the primary part 
of the examination for the Fellowship of the College:— 
Mr. R. J. Coulter, B.Cb..Ac., Vniv. Dub.; Mr. J. P. Frengley. 

B. Ch , Ac., Hoy. Uuiv.• Mr. R. D. Joyce. M.R.C.8.Entr., Ac.: Mr. 

C. B. Boyce, Mr. E. Glenoy, Mr. P. 1. Han&flo, Mrs. H. I.. 
Hennessy, Mr. J. M. 8. Levis, and Mr. J. P. Pesrt. 


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260 Thk Medical Press. 


NOTICES TO CORRESPONDENTS. 


Mar. 8, 1899. 


^txrticts to 

Comspottbento, Short &c. 

99 “ Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive eignature or 
initiate, and avoid the practice of signing themselves “ Bernier, ’ ’ 
“Subscriber,” “Old Subscriber,” See. Much confusion will be 
spared by attention to this rule. 

GLYCEBINATED CALF LYMPH. 

To the Editor of the Medical Press and Circular. 

Sir,—I think it would be very desirable to find a shorter aud 
more easily pronounced name for Glycerins ted Calf Lymph, and I 
propose “ Glycalymph," which is shorter by eleven letters and 
much easer to say, the “ y ” retaining, of course, its sound in gly- 
ceriae. 

The descriptive words might be used in full for a few years in the 
notices to vaccinate, and in a few other cases; but in by far the 
greater number the word glycalymph would be preferable, and 
would satisfy all requirements. 

Yours faithfuBy, 

J. P. H. Boileau. M.A.. M.D., 

Late Brigade-Surgeon-Lt.-Col. Army Medical 8taff. 

Trowbridge, Wilts, March 6th, 1899. 

Mr. B. B. Anderson.—W e are unable to accede to your request 
for publication, it not being in accordance with our practice to call 
in question the discretion of the editor of other journals. 

Mr. W.—We must leave to you the responsibility for the flews 
expressed, against which, though we publish, we protest. 

M. H. 8.—We will make inquiries, and will send our correspondent 
a private note in the course of a few days. * 

Mr. Shaw.—I t is decidedly unprofessional for a medical maji to 
recommend or prescribe a quack medicine to his patients. 

Messrs. Potter and Clare.— The book will be reviewed indue 
course. 

Mr. Ernest C. Clifford (Anerley).—We do not care to continue 
a correspondence on vegetarianism. The facts of the case have so 
often been thrashed out and the matter seems to have become so 
much one of sentiment rather than reason, that little good can be 
expected from dishing them up afresh. 

Dr. Tatlor (Nottingham).—Your very long letter came to hand 
as we were at press, too late, in any case, for insertion in present 
number, and.t oo long, we fear, for our next. _ 

Meetings of the Societies ant) lectures. 

Wednesday, March 8th. 

Derkatolooical 8ociett of London (11, ChandoB Street. 
Cavendish Square, W.).—8.15 p.m. Demonstration of Clinical 

Cases. 

Medical Society of London.— 7for 7.30p.m. 126th Anniversary 
Dinner at the Whitehall Booms, Hotel Metropole. 

Hunterian Society. — 8.30 p.m. Pathological Evening. Speci¬ 
mens will be shown by Sir H. Beevor, Dr. Goodall, Mr. Oliver, Mr. 
Targett, and other Fellows. 

Botal Colleoe of Surgeons of Enoland.— 5 p.m. Prof. F. G. 
Parsons; Joints of Mammals contrasted with those of Man. 

The Sanitary Institute (Parkee Museum, Margaret Street, 
W.h—8 p.m. Discussion on the Establishment of Public Abattoirs 
in the Metropolis in relation to the Prevention of Tuberculosis. 
Opened by Dr. W. A. Bond. 

Botal London Ophthalmic Hospital (Moorfields).- 1 p.m. Mr 
Nettleship : On Retro-bulbar Neuritis. 

Thub8Dat, March 9th. 

British Gynecological Society (20, Hanover Square, W.) — 
8.30 p.m. Specimens will be shown by Mr. C. Ryall and Dr. W. 
Ramsay. Papers : Dr. G. Ban took : The Modern Doctrine of Bac¬ 
teriology, with special reference to Gyn{ecology. Dr. J. Oliver: 
Adenoma Universale of the Endometrium. 

Society of Arts (Imperial Institute, South Kensington).— 4.30 
p.m. Mr. H. A. Acworth : Leprosy in India. 

Ophthalhological 8ociett of the United Kingdom.— 8 p.m. 
Card Specimens. 8.30 p.m. Papers : Mr. C. D. Marshall: Epithe¬ 
lial Implantation Cysts of the Iris. Mr. W. Dodd : Green Vision in 
a Case of Tabes Dorsalis. Mr. A. Lawson and Mr. Sutherland: 
Further Note on a Case of Albuminuric Retinitis in a Child. Mr. 
E. Donaldson : Strabismus Fixus. 

Royal College of Physicians of London.— 5 p.m. Dr. G. R. 
Murray: The Pathology of the Thyroid Gland. (Goulstonian 
Lecture.) 

St. John’s Hospital for Diseases of the Skin (Leicester 
Square, W.C.).— 4.30 p.m. Dr. A. Eddowes : Cases of Keloid and 
other Affections of Scars. 

Friday, March 19th. 

Clinical Society of London (20, Hanover Square, W.).— 8.30 
p.m. Papers : Mr. B. Robinson : Hydatid Cysts of the Upper Lobe 
of the Bight Lung and Liver successfully removed. Mr. A. E. 
Barker and Dr. N. Nabarro: A case of Pancreatic Cyst treated by 
Incision and Drainage. Mr. Battle: Removal of u large Fuugating 
Tumour of the Skull with subsequent Grafting of the Dura Mater. 
Mr. A. Lane: A Case of Erosion of the Ankle-joint, illustrating a 
new Operative Procedure. 

Royal College of Surgeons of England.— 5 p.m. Prof. F. G. 
Parsons : Joints of Mammals contrasted with those of Man. 


Uatattcies. 

Bristol City Hospitals.- Resident Medical Officer at the Ham Green 
Fever Hospital. Bristol, for one year. Salary iilOO per annum, 
with board, lodging, and washing. (See advert.) 


Cumberland and Westmoreland Asylum. Garlands, Carlisle.—Junior 
Assistant Medical Officer, unmarried. Salary £80 a year, with 
board and residence. 

County Asylum, Whittingham, Lancashire.—Junior Assistant 
Medical Officer, unmarried. Salary commencing at £100 per 
annum. Apartments, board, attendance, and washing. 

Liverpool Northern Hospital.—Assistant House Surgeon. Salary 
£70 per annum, with residence and maintenance in the house. 

Roxburgh District Asylum, Melrose.—Assistant Medical Officer. 
Salary, £100 per annum, with furnished quarters, board, wash¬ 
ing, and attendance. 

Royal College of Physicians of London, and Royal College of 
Surgeons of England Conjoint laboratories.—Director of the 
Conjoint Laboratories. 

St. George, Hanover Square, Provident Dispensary, Little Gros- 
venor Street, London,—Resident Medical Officer. Salary. £100, 
with allowance about £80 and residence at the dispensary. 

Stockport Infirmary.—Assistant House and Visiting Surgeon. 
Salary £70 per annum, with board, washing, and residence. 

Uuiversity of Glasgow.—Professor for Chair of Pathology. Normal 
salary £1,100. 


Cameron, J., L'R.C.8.P.Edin., Parochial Medical Officer and Vaccina¬ 
tor by the Fintrav Parish CounciL 

Cuppaidge, J. L., M.D., B.Ch.Dub., Medical Officer for the Stoke 
Gabriel District by the Totnes Board of Guardians. 

Gordon, J. E.. L.B.C.P.Lond., M.B.C 8., Medical Officer of Health 
for the Salisbury Rural Sanitary District. 

Kempe, Gilbert, M.D., B.8.Durh., M.B.C.8, L.B.C.P. Lond. 
Medical Officer of Health for the Salisbury Rural District. 

Lambert, J. R., M.B.Vict., L.B.C.P., L.B.C.8.Edin., L.F.P.S. 
Glasg., Medical Officer of Health by the Farsley District 
Council. 

Langston, J. J., L.B.C.P. Irel., Medical Officer for the No. 6 Sani¬ 
tary District of the Lambeth Union. 

Laverick, J. T. B., M.B., M.8., D.P.H. Glasg., Medical Officer for 
the L.vthe Sanitary District of the Whitby Union. 

Miller, W. R., B.A., M.D., B.Ch., Admiralty Surgeon and Agent 
for Penzance and District. 

Nott, A. H., Captain, M.B., M.B.C.S., I.M.S., Clinical Assistant to 
the Chelsea Hospital for Women, Fulham. 

Ross, E. H., L B.C.P. Lond., M.B.C B., Assistant Medical Officer to 
tne Infirmary, Parish of St. Mary, Lambeth. 

Sproulle, A. E., L.B.C.P., L.B.C.S. Irel., Medical Officer of Health 
by the Withernsea Urban District CounciL 

Stuart-Low, William, F.B.C.S. Eng., Assistant Surgeon to the 
Hospital of St. Francis, New Kent Road, London. 

Taylor. E. C., M.D.Lond., F.B.C.8., L.B.C.P.. M.B.C.S . Medical 
Officer for the Workhouse, Parish of St. Jonn, Hampstead. 

Weldon, W. F. R., M.A., F.B.S., L inacre Professor of Comparative 
Anatomyat Oxford, vice Professor B. Lank ester. 

Whittome H., M.D., C.M.Edin., Assistant Physician to the Hos¬ 
pital of St. Francis. New Kent Road, London. 


Anderson. —On March 1st, at East Street. Favermham, the wife of 
Charles Macdonell Anderson, M.D., M.B.C.S., of a daughter. 
Barker.— On March 1st, at Corfe Castle, Dorset, the wife of Toft 
Barker, M.B.C.S., L.B.C.P.Lond., of a son. 

Fuller.—O n March 4th, at 7 Oxford Bow, Bath, the wife of A. 

Leonard Fuller, M.R.C.S., L.R C.P.Lonrt., of a son. 
Shaw-Mackenzie.— On March 4th, at 31 Grosvenor 8treet, London, 
W., the wife of John A. Shaw-Mackenzie, M.D.Lond., of a son 
and daughter. 


^ftarriages. 

Bell-Pekruddocke.— On Feb. 28th, at St. John's Cathedra), 
Hong-Kong, by the Bev. F. B. Cobbold, M.A., Dr. John Bell, 
Government Medical Department, to Annie Elizabeth, eldest 
daughter of J. H. Penruddocke, Esq., late H.E.I.C.S., of 
Winkton,Hants (by telegram). 

Green—Yatb8.— On Feb. 14th, at St. Thomas's, Howrah, Bengal, 
Major C. B. M. Green, L.M., F.B.C.S. Eng., to Alice Whitworth, 
daughter of Robert Yates, Esq., of Bolton, Lancashire. 

Morton- Macpherson.—O n Feb. 28th, at Christ Church, Bays- 
water, by the Bev. C. Ridgeway, William Britain Morton, 
M.D.Lond., of Brislington, eldest son of William Morton, Esq., 
of Govles, Yorks, to Louisa Elizabeth, daughter of the late 
Hon. John A. Macpberton, of Melbourne. 

Pkdlet— Wolset.— On March 1st, at Denmark Place Raptist 
Chapel, London, Samuel Edward Pedley, M.B.C.S., L.B.C.P.. 
L.D.S., of Camberwell, to Ada Eliiabeth, daughter of James 
Wolsey, of Shelford Lodge, Camberwell. 


_ g*athe. 

Bernard.— On Feb. 25tb, at Woodford Green, Essex, Flora E. 
Bernard, daughter of the late Charles Edward Bernard, M.D., 
of Weston-Super-Mare. 

Bouron.— On March 5th, at Hove, Brighton, Surgeon-Major John 
Bouron, M.D.. Bengal Army (retired), in his 101st year. 

Brennan d.—M aich 3rd, at St. Thomas' Home, Westminster, 
Sophia, widow of James Brennand, Singapore, and daughter of 
the late Robert Little, M.D., F.R.C.S.E. 

Forbes.— On Feb. 23rd, Arthur Danieil Forbes. M.B., fourth son of 
the late Dr. Chas. Forbes, B.N., at Horsmonden, Kent, 
aged 33. 

Heath.- On March 2nd, at 248, Brunswick 8treet, Manchester, 
F. Ashton Heath, M.B.C.S., aged 69 years. 

McBride.— At Arundel) Villas, Weston-super-Mare, suddenly, 
Alexander McBride, M.D., Fleet Surgeon, R.N., aged 67. 

W iLLSHiRE. —On Feb. 24th, at Great Marlborough Street, Linden. 
W., Wm. Hughes WillBhire, M.D., in his 83rd year. 


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Much 15, 1899 


The Medical Press Md Circular Advertiser. 


xiu 


<h <h 



<h <h '<h 

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‘Saxin’ 


‘Emol-Keleet 


Has been aptly termed the 
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It is about 600 times sweeter 
than sugar and more delicate 
in flavour. ‘Saxin’ undergoes 
no change in the system, and 
may be safely prescribed in 
all cases where sugar is 
harmful. 

Qaxln,’ 1/4 gr., la aupptfad In bottlaa of 100 and 200, 
at 7d. and la. Id. par bottla. 


Is a natural powder, contain¬ 
ing a large proportion of native 
silicates. It v has proved 
successful for drying weeping 
surfaces when all other pow¬ 
ders have failed. Its soft, silky 
texture, soothing influence 
and other physical qualities 
enhance its healing action. 

‘Emot-Kaloet la auppllad In naat matal boxaa, 
at Od. par box. 


Burroughs Wellcome and Co., London and Sydney. 


[oopyriohtJ 


3^ —‘Solo id 


Lead Subacetate 





gr. io [0.648 gm.] 

THE MOST CONVENIENT MEANS OF PREPAR 
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dissolved in five ounces of distilled water, yields a solution 
containing about the same quantity of Lead Subacetate as 
an equal volume of Liq. Plumbi Subacetatis Dil. BJ\ & & 
‘Soloid f Lead Subacetate is extremely portable and promptly soluble4 


In botties of 25, at Od. per bottle. 


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London and Sydney. 


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XI c 


Thfl Pr«fiR awt-G’r'UjIai' Advertiser. 


March 15, 1899 


On an Exact Bacteriological Investigation made to ascertain the Value of , * 

“Sanitas” Fluid, “Sanitas” Oil, & “Sanitas” Emulsion 

As DISINFECTANTS for GENERAL USE, 

By O. G-. MOOR. M.^.. (Oaatab.), X*.X.O., P.O.S., 

Member of the Society of Public Analysts, Joint Author of “Applied Bacteriology," Ac., <fcc. 


4 Danes Inn, W.C,, London, July 2nd, 1898. 

C. T. Kingzktt, Esq., F.I.C., F.C.S., 

The “Sanitas” Company, Limited, j 

Bethnal Green, London, E._ 

Dear Sir, 

1 beg to present you my report cm the experimental investiga¬ 
tions I have conducted on the preparations manufactured by your firm, 
named “Sanitas" OU, “Sanitas" Emulsion, and “Sanitas' Fluid. 

The experiments were made to ascertain and establish, if possible, 
on a scientific basis, tne efficiency of these preparations, and their 
suitability for the purposes for which they are designed as indicated 
by your publications and labels giving directions for use. 

■Die experiments instituted for this purpose were as follows 

(а) In the case of the preparations above mentioned, various 
disease organisms - namely, those of Anthrax. Cholera, Diph¬ 
theria, Staphylococcus Pyogenes Aureus ana Typhoid were 
brought into contact with the disinfectant for a given time and 
in a manner detailed below, and means were taken to ascertain 
whether the disinfectant employed was sufficiently powerful to 
determine the death of the organism in a given time. 

(б) A second series of experiment* was undertaken to ascertain 
the effect when similar cultures were exposed to different 
strengths of these disinfectants for a standard time. 

(c) Experiments were also made to ascertain the effect on 
orolnary air, as regards the removal or extermination of 
organisms suspended in it, by spraying with “Sanitas" Oil and 
“Sanitas" Fluid. 

(6) In the case of “Sanitas" Oil, I have experimented as to the 
action of the vapour given off at a temperature not exceeding 
that of the human body. 

(e) Finally, I have tried some experiments to ascertain the 
action of “Sanitas” Oil and “Sanitas” Fluid on the Bacillus of 
Plague 

Table l. 

EXPERIMENTS WITH “SANITAS” OIL. 

Silk threads infected with cultures of the following organisms were 
exposed in "SANITAS" OIL for the times shown below and then 
lncnbated in broth. Growth is shown by a + sign, no growth by a 
— sign. __ 


Times of Exposure. 


Anthrax and 8. P. Aureus were also killed In 30". exposure 
Controls all grew well. 

Table 2. 

A similar experiment was carried out in the case of “ 8ANITAS 
FLUID. (Threads.) 


Organisms. 


Anthrax 
Cholera .. 
Diphtheria 
8. P. Aureus 
Typhoid.. 


I next proceeded to ascertain the strengths of these disinfectants 
reauired to ensure the death of the above-named bacteria in a given 
time—and in the following experiments the time of exposure of the 
bacteria to the action of the disinfectant was in all cases ten minutes. 

In these experiments I used the method of shaking together an 
actively growing broth culture of the organism to be tested, with such 
a an ntity of disinfectant that the resulting mixture contained the 
strength of disinfectant specified in the tables below ; the exact details 
of ‘he method of experiment are described in Pesnuain A Moors 
Applied Bacteriology, 2nd Edition, pages 877-382. (Balltere, Tindall, 
and Cox). 


Organisms. 


50% 

-25% 

10% 

Cholera. 

_ 

1 

— 

Diphtheria. 

— 

— 


Typhoid.. . 

— 

— 




X" 

10" 

30" 

Cholera. 

— 

— 

— 

Diphtheria. 

— 

— 

— 

Typhoid .. . 

— 




Times of Exposure. 

1 1" 

10" 

80" 

—- 

— — 

— 

+ 

- 

— 

— 

— 

— 

— 

— 

— 

+ 


— 

— 

— 

' 


Table 8. 

“SANITAS ’ OIL.— -As the Oil is not readily miscible with water 
the “Sanitas” Emulsion, which oontains 45 per cent, of “ Sanitas 
Oil, was employed. 

Ten minutes’ exposure. 


Organisms. 


Anthrax 
Cholera .. 
Diphtheria 
8. P. Aureus 
Typhoid.. 


Strength employed in Terms 
of “Sanitas" Oil. 


26 % 


10 % 


5 % 


Controls all grew well. 

Table 4. 

‘SANITAS” FLUID tested against Broth Cultures, as above. 
Ten minutes' exposure. 


Strength Employed. 


Anthrax and 8. P. Aureus were also both destroyed by the 60 e /o 
mixture in ten minutes' exposure. 

Controls all grew well 

(»). I have made several experiments as to the destruction of 
bacteria floating in the air of a room by spraying the air with 
“ Sanitas " Oil, and with “ Sanitas ” Fluid—testing the air by means of 
He. 886'1 tube. 

The removal of bacteria from air by spraying will, doubtless, depend 
very greatly on the mechanical action of the particles of spray, because, 
as is well known, bacteria are very largely removed from air by & 
shower of rain, therefore, too much Importance must not be attached 
to such experiments. 

Taking, however, the mean of several experiments, whereas the air 
of the room contained a considerable number of bacteria before spray¬ 
ing, the numbers were reduced, after spraying, to under five per cent, 
of those previously found. 

(6) . "Sanitas" Fluid does not give off much vapour at ordinary 

temperatures; but, Sanitas" Oil, on the other hand, is sensibly 
volatile at room temperature, and I have tested the action of the 
vapour given off by “ Sanitas " Oil. at blood-heat on bacteria similar to 
those used in the broth and thread experiments. ■- • 

Some of the growth from agnr tubes was smeared on HI ter. paper and 
suspended in a wide-mouthed Jar containing a little “Sanitas " OIL 
The whole was placed in the incubator (87° €.), and, after an hour, 
cultures were made on to nutrient media. The result was that only 
the two most resistant organisms -namely, Anthrax and Staphylo- 
loccus Pyogenes aureus - had survived, while Cholera, Diphtheria, and 
Typhoid failed to grow. 

(7) . Having a culture of Bubonic Plague brought by a student from 
Hong-Kong I tried the effect of “ Sanitas" Fluid and “Sanitas " OU 
on it. The bacillus was killed in each case by a ten minutes' exposure 
to a strength of 33 per cent, of etch disinfectant—the only strength 
tested. 

In conclusion, I regard the results of my investigation as affording 
ample evidence that the “Sanitas” preparations are thoroughly 
reliable, when employed in the strengths and for the purpose^ 
specified in the directions issued by the proprietors, while their non- 
polsonous nature and pleasant cbaracter render them applicable In 
many instances where such substances as carbolic acid or mercurial 
chloride would be inadmissible or dangerous. 

C O. MOOR^LA., (Cantab.X F.I.C., F.C.S., 
Member of the Society of Public AnalytU, 

Joint Author of—“ Applied BacteHoloov," 

„ “ The Analv*i«of Food and Drue8.' 

“ The Chemical and Biological Examination 
Water." 


THE “SANITAS” CO., Lim., Bethnal Green, E., 

Disinfectant and Embrocation Manufacturers. 


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• “ 8ALUS POPULI SUPREMA LEX." 

Vol. OXVIII. WEDNESDAY, MARCH 15, 1899. No. 11. 


Xettsomian Xertum 

ON 


SOME OF THE CLINICAL ASPECTS 
OF GRANULAR KIDNEY, (a) 

By 8AMUEL WEST. M.D., F.R.C.P., 

Assistant Physician, «t. Bartholomew's Hospital; Senior Physician, 
Boyal free Hospital, Ac. 

Symptoms. 

Granular kidney may exist for a long time with¬ 
out appearing to affect the health or producing sym¬ 
ptoms. When symptoms appear, no matter what, 
the disease is far advanced and in its later stages. 
The symptoms are multifarious, and, unless there be 
intercuiTent nephritis, in no way of thetnselves sug¬ 
gest renal disease, so that they are very misleading, 
and the true nature of the case is often overlooked. 

The symptoms fall into two groups,' the cardio- 
yascular and toxaemic. Speaking generally, the sym¬ 
ptoms occur in the order in which they are ranged, 
the cardio-vascular first and the toxsemic subse¬ 
quently, though they may both be present together. 
The cardio-vascular are important, because they often 
■cause death earlier than might otherwise occur. The 
toxsemic always develop if the patient live long 
enough. They depend upon the wasting of the 
kidney, become manifest when it has reached a certain 
degree, and progress with it pari passu. 

The cardio-vascular symptoms are more or less 
mechanical or accidental. The cardiac are summed 
up in heart-failure. The vascular fall into two 
groups: the first is formed by haemorrhage and its 
results; the second by chronic degenerative affections, 
especially in the nervous system, the result of imper¬ 
fect nutrition through the diseased vessel. Heart- 
failure is often the first symptom to cause anxiety. 

These symptoms are usually gradual in onset, but 
may come on suddenly. The pain, though usually 
slight, may be severe enough to be called angina. 
Cardiac symptoms are, however, not constant even 
where the heart is greatly hypertrophied or the valves 
diseased. Acute pericarditis belongs rather to the 
toxsemic group, ana even where it does not of itself 
cause death it is a warning that the end is near. 

The vascular lesions produce three sets of sym¬ 
ptoms : 1, Those due to rupture and consequent 
haemorrhage; 2, those which result from nutritive 
disturbances in the parts supplied by the diseased 
■vessels. This is especially met with in the central 
nervous system and in the eye; 3, besides these it is 
necessary to refer to aneurysm, and that not only of 
the smaU vessels but of the main trunks. 

Haemorrhage may take place in almost any part of 
the body. . It is m the Drain that its most serious 
effects are produced. Post-mortem statistics prove 
the remarkaole frequency with whioh granular kidney 
is found associated with cerebral haemorrhage. 

Epistaxis is common, and. may be the first symptom 
of disease-arid its importance lie missed. Even in the 
young granular kidney must not be disregarded as a 
okuse of repeated epistaxis. 

(a) Abstract of lector* delivered at the Medical Society of London 
©n Monday, March 6th, 1886. 


Hsematuria .—The next most important group of 
cases is that in which blood is found in the urine. 
This form of haematuria has led to frequent mistakes, 
as, for example, to the diagnosis of calculus in the 
bladder, for which operation has been suggested and 
performed. The haemorrhage is not often copious, but 
in slight amount it is common and recurrent. 
Haemorrhage may also occur from other parts in con¬ 
nection with granular kidney, stomach, lungs, 
uterus, &c. 

In the last stage of granular kidney the patient 
may pass into an almost haemophilic condition in 
which slight, though continuous and almost uncon¬ 
trollable, oozing takes place from various parts of the 
body, from the gums, nose, tongue, lips, vagina, or 
from any wound or scratch in the skin. 

The next group of cases to which I wish to refer is 
that in which, as a consequence of arterial disease, 
degenerative changes result in various tissues; the 
most delicate of these is the nervous system. To this 
Gull and Sutton long ago drew attention and the sub¬ 
ject has not, since they wrote, received the attention 
it deserves. 

The toxsemic symptoms fall into two groups; in the 
one they are of acute onset and great severity and 
usually lead rapidly to death. In the other they are 
of more gradual onset and of longer duration and of 
less apparent severity, and of a very indefinite 
character. They are respectively called acute and 
chronic uraemia; but as the groups stand in Btrong 
contrast with one another it would be well if different 
terms were employed to denote them. For the acute 
cases, uraemia in its ordinary acceptation might be 
retained. For the chronic group, on account of its 
varied and indefinite symptoms, chronic and renal 
toxaemia would be the better term. 

Of the three main theories of uraemia the third only 
remains, viz., that which refers the symptoms only to 
perverted metabolism. According to this theory the 
poisons are produced in the body, and by processes 
not differing essentially from those which take place 
in health. The kidney plays its part only so far as 
it makes the elimination of the poison defective. 
Uraemia would, thus be brought into close relation 
with other conditions in which the normal metabo¬ 
lism of the body is perverted. Symptoms resembling 
uraemia may arise under conditions with which the 
kidney may have nothing to do. When, as in 
uraemia, the kidney plays the chief part, it is very 
tempting to refer uraemia to defective internal secre¬ 
tion, for it is certainly not simply due to defective 
elimination. 

If then we are thus led to associate the symptoms 
of chronic uraemia with chronic extractive poisoning, 
i.e., with the presenoe of abnormal amounts of 
extractives in the tissues and the blood, we are 
tempted to refer the acute symptoms which often 
develop with so little warning to defective elimination 
by the kidney, and we might thus associate acute 
uraemia with the condition of the cells in the kidney 
just as we do in acute nephritis. It is to the chronic 
toxaemic form that most of the symptoms belong 
which bring the patient suffering with granular 
kidney under medical observation. They may be of 
such a kind as to point to almost any part of the 


Dig! 


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262 Thx Medical Prbss. ORIGINAL COMMUNICATIONS. Mar. 15, 1890. 


body as the seat of disease rather than the kidney, 
and may thus lead to frequent errors in diagnosis. 

The gastro-intestinal symptoms are often pro- 
nounoed, and may be very misleading. Obstinate 
dyspepsia, especially if associated with pain, might 
suggest ulcer of the stomach, and this might be 
attributed, if there were much cachexia, to malignant 
disease. Vomiting is often a source of difficulty, for 
it is very obstinate, and does not stand in relation to 
tne takin'g of food. When to the vomiting retinitis 
is added confusion with cerebral tumour is only to be 
expected. Morning vomiting, which is not rare, 
might suggest pregnancy, and I have seen cases 
confused with both these conditions. 

The symptoms in connection with the bowels are 
not aB a rule so puzzling. Diarrhoea is common with 
any form of kidney disease, but there are cases in 
which diarrhoea is practically the only symptom, 
extremely obstinate, and almost uncontrollable. 

The dyspetic symptoms are often associated with 
cramps, and cramp leads naturally to the considera¬ 
tion of gout. Gout naturally suggests lead-poisoning, 
for these three affections, gout, granular kidnty, and 
lead-poisoning, stand in dose relation to one another. 
The close association of chronic lead-poisoning and 
granular kidney is interesting as supporting the view 
that granular kidney is the result of the circulation 
of some toxic substanoe in the blood, which like lead 
excites cirrhosis in the kidney with all its results, 
just as alcohol produces cirrhosis in the liver. On 
the other hand, it is also possible considering that all 

e irsons who work with lead do not develop granular 
dney, that the opposite relation may exist, viz., that 
they suffer so much from lead symptoms just as 
others do from gout because their kidneys are 
granular already. 

Cachexia .—Patients with granular kidney may for 
a long time preserve their normal appearance of 
health, and even when the signs of granular kidney 
are well marked, but, as a rule, as the kidney disease 
advances the nutrition suffers greatly. The cachexia 
of granular kidney is characterised by antenna and j 
asthenia, and to some extent by loss of flesh, but 
emaciation is rarely carried to that degree which is 
met with in advanced malignant disease. 

It is in connection with the nervous system that 
some of the most interesting conditions arise. Head¬ 
ache often oocurs in such severe paroxysms as to 
closely resemble migraine. The vomiting is no doubt 
often central or nervous, for it stands in no relation 
with food and is frequently periodical. The dyspnoea, 
which may be paroxysmal, is very often cardiac and 
occasionally due to bronchitis and emphysema. 

Pits are, of oourse. the common form in which 
acute ursemia manifests itself, but epileptiform con¬ 
vulsions are not rare as one of the early symptoms of 
the late stage independent of unemia. In connection 
with fits may be placed the curious attacks of cerebral 
irritation, which are not at all unoommon. They 
may take the form of attacks of general nervous 
irritability, of emotional excitement, or of almost 
maniacal delirium. 

The cases fall into two groups according as there is 
general oodema or not. (1) Rashes associated with 
oedema. These are for the most part erythematous 
in nature, transitory in duration, produce but few 
symptoms, and when localised have hut little clinical 
importance. Sometimes the rash is of a papular, 
licnenous character, and is then generally met with 
on the backs of the thighs and arms. Eczematous 
eruptions are not at all uncommon, if there be much 
oedema, where the parts lie in contact with each 
other. 

I have .met with erythema in a patient of 42; 
pityriasis rubra—one in a man of 47, and the other in 
a woman of 42 ; dermatitis exfoliativa; a general 


eruption. Rashes of this kind in granular kidney 
seem almost invariably to end fatally. 

The symptoms of acute unemia have by no means 
that definite and uniform character which seems to 
be often assumed. The cases really vary very much 
from one another, almost as much as do cases of 
so-called diabetic coma. Fits and coma are the two 
most characteristic symptoms, and yet patients may 
not have fits, or, at any rate, no marked convulsions, 
and they need not be comatose. A patient may be 
oomatose without any fits, or at most with but very 
slight twitching, and the condition may then closely 
resemble apoplexy. In other cases the condition 
almost resembles that of narcotic poisoning. In 
others, again, symptoms of the most profound col¬ 
lapse develop, The patient seems to have been sud¬ 
denly poisoned, and presents symptoms very much 
like those met with in acute ptomaine poisoning. 
Whatever the form acute ursemia may take, the 
prognosis is as grave as it can be. 

If any of the forms has a less grave significance 
than the others, it is, perhaps, that in which there 
are epileptiform convulsions, for these uraemic fits end 
in recovery now and then. The most interesting fact 
about uraemia in the course of granular kidney is 
that it may develop so suddenly, and with little or no 
warning in the midst of apparent health. 

The objects we should nave in view in treatment 
are—1. To prevent the disease getting worse if 
possible, and to relieve the damaged organ in every 
way possible. 2. To guard against the accidents 
specially likely to occur. These are failure of the 
heart and rupture of vessels. 3. To counteract or 
relieve symptoms as they arise. 

Of drugs I do not know of any more useful than 
nitrate of pilocarpin given in small doses two or three 
times a day by tne mouth, or in urgent cases sub- 
cutem. 

There is one noteworthy fact about pilocarpin in 
chronic renal disease—viz., that it often does not pro¬ 
duce the sweating which under normal circumstanoee 
and in similar doses it causes, and yet without the 
sweating its effect is striking. 

There remains, however, one line of treatment to 
which I wish more particularly to refer, for it has not 
so far been investigated as fully as it deserves—viz., 
the treatment of chronic renal disease by means of 
renal extracts. I have already said that there is no 
positive evidence at present of the existence of an 
internal secretion in the kidney; yet the cachexia 
which develops in chronic renal disease is not at all 
unlike that which is met with in Addison’s disease, or 
■even myxoedema. 

Granular kidney also presents other resemblances 
with these diseases in that the grave symptoms do 
not arise until the organ is very considerably diseased. 
There can be no doubt clinically that the late sym¬ 
ptoms of granular kidney do depend upon the 
disappearance of the glands, and it is, therefore, 
not at all improbable that the kidney has an internal 
secretion, though absolute proof is not yet forth¬ 
coming. 

I have had two or three cases of the same kind, 
and in all the result has been the same, viz., an 
increase in the amount of urine, and an improvement 
in the general condition. This improvement followed, 
and appeared to be due to the action of the remedy. 

The use of renal substance extracts is still in a 
purely experimental stage. Judging by the analogy 
of myxcedema, it would be in tne cases of chronic 
renal cachexia only that we should look for striking 
results, and this requires early and correct diagnosis. 
In acute unemia there is so little time to act that 
recourse must be had to other and more active 
measures. 

My ohoioe of granular'kidney as my object wa a 
inspired by the hope that what had interested m? 

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Mar. 16, 1899. ORIGINAL COMMUNICATION'S. Thx Mxdical Press. 


would prove of intereet also to others. I trust I may 
not have misjudged. I have not hesitated to express 
my own opinions, even at the risk of appearing 
egotistic, though I trust with sufficient modesty to 
escape the charge of dogmatism. On a subject so full 
of difficult and contentious questions I cannot expeet 
that my views will commend themselves to all. Yet 
defined opinions challenge criticism, and criticism 
tends to advance knowledge. 

(Original Communications. 

“ VANISHING "tumours.” (a) 

By D’ARCY POWER, F.R.C.S., 

Asat.-Sargeon, 8t. Bartholomew’s Hospital, <fcc. 

In the course of a paper on ’* Vanishing Tumours,’ 
the author applied the term to swellings which dis¬ 
appeared after such slight surgical operations as 
incision, puncture, or even simple exposure. Such 
tumours were not to be confounded with phantom 
tumours for they were real swellings, more often 
innocent, but sometimes malignant in nature. Mr. 
Power then proceeded to quote the following cases 
of vanishing tumours, which had occurred in his own 
experience. 

Case 1.—A boy, set. 8, was brought to me a few 
years ago Buffering from a large cystic lymphagioma 
whioh occupied the whole of the left side of the neck, 
reaching upwards behind the pinna of the ear, the 
lobule of which it had invaded, and extending aoross 
the middle line in fiont of the neck. The swelling 
had been noticed directly after birth and it had been 
tapped before I saw it about 150 times with a trocar 
and cannula. It had not undergone much change in 
size, and though it did not increase proportionately 
to the growth of the boy, it got no smaller. The 
tumour consisted of an elastic and slightly lobulated 
tissue to which the skin was closely adherent. It 
clearly contained many cysts varying greatly in size 
and tenderness. With a full appreciation of the 
difficulties to be encountered 1 advised that the 
tumour should be removed, and in due course I 
extirpated as much of it as lay in the posterior 
triangle of the neck. The wound healed by first 
intention and without any trouble except for a sharp 
attack of lymphangitis about a fortnight after the 
operation, due to a long railway journey home in the 
frosty weather. 

Five months after the operation the boy had a 
tecond attack of lymphangitis in the tumour and in 
the following month he had a third attack. After 
each attack the swelling seemed smaller. He was 
brought to me again nine months after the operation 
with the information that the tumour had vanished. 
I examined the neck carefully and found that the left 
anterior triangle was so soft that the beating of the 
carotid artery could be clearly felt and there was no 
trace whatever of the former swelling. I have seen 
the boy several times since, but there is no return of 
the tumour and the two sides of the neck are now 
quite symmetrical. 

Case 2.—This case is an equally remarkable one and 
does not seem to be easily capable of an explanation. 
A girl, at. one year ana ten months, was admitted 
into the Victoria Hospital for Children, at Chelsea, 
under the care of my colleague, Dr. J. W. Carr, on 
November 1st, 1898. She had been ailing for six 
months, suffering at first from whooping cough, and 
afterwards from bronchitis and diarrhoea. During 
the week before her admission to the hospital she had 
. been getting worse, being feverish, siok, and passing 
dark-coloured and slimy motions which contained 

(a) Abstract of paper 'read before the HarreUn Society, March 
2nd, 1889. 


i blood, whilst for the last day or two her mother had 
j noticed that she had been getting yellow. The ward- 
1 note states that on admission the child was fairly 
| well nourished, with a pale yellow complexion ana 
i vellow conjunctive^ the skin of the body generally 
being rather pale. The liver was enlarged and a 
little tender, and its edge could be felt about an inch 
below the costal margin. All the other organs 
appeared to be healthy. The temperature was 102 2 
deg. F. Four days later the jaundice was deeper, the 
abdomen was distended, and the liver was rather 
larger, for it now reached about one and a half inches 
below the costal border of the ribs, the upper limit of 
the liver dulness being on a level with tne sixth rib. 
After an interval of another four days a note was 
again made that the liver was considerably larger. 

And again, on November 15th and 18th, the notes 
repeat the statement that the liver maintained its 
large size and that the jaundice was still present. 
The child was then handed over to the secular arm 
on November 22nd in the hope that an exploration 
of the liver might afford her some relief, and on the 
same day I opened the abdomen in the upper part of 
the right semilunar line. The liver was much con¬ 
gested, but its surface was perfectly smooth and free 
from any adhesions I passed a trocar and cannula 
deeply into its substance in three different directions 
as I thought it possible that there might be an 
hepatic absoess, but blood alone issued from the 
punctures. The lower border of the liver was then 
examined, and a cyBtic swelling was felt which at 
first I took to be the gall-bladder, for the liver tissue 
was firmly adherent to it, and was so thin that a 
part of the cyst projected through it at some distance 
away from the edge. A closer examination showed 
that the apparent cyst was in reality part of the 
small intestine which was so densely adherent to the 
liver that it was not thought advisable to separate 
them. The abdomen was closed and the child was 
said to have suffered very little from the shock, the 
pulse being almost, if not quite, as good at the end 
as it was at the beginning of the operation. The 
temperature fell to 96 2 deg. in the nignt, and though 
it rose on the following day it was never more than 
100 deg. during the rest of the patient's stay in the 
hospital. The abdominal wound was quite healed 
on December 2nd, and it was noted on that 
day that the liver was not quite so large, and 
from that date it gradually declined, and on 
January 17th. 1899, the patient was allowed to get up 
and was walking a little dv herself, and on the 24tn 
as the liver appeared to' be of its natural size and 
the abdomen was quite soft, she was discharged from 
the hospital. 

A third case occurred in a man, set. 21, with a 
large and seemingly inoperable tumour situated 
between the umbilicus and the pubes, and appa¬ 
rently fixed to the pubes. Three months after the 
tumour had been exposed it had completely dis¬ 
appeared, and the patient had gained a stone and a 
half in weight. The fourth case occurred in a tailor, 
set. 54, who had a well-defined tumour, shown by abdo¬ 
minal section to be adherent to the external abdominal 
wall, to the stomach and duodenum, and to the under 
surface of the liver above. The gall-bladder seemed 
to be surrounded by the new growth, which thus 
proved quite irremovable and was thought to be 
malignant. He was examined four months after the 
operation by many of the surgeons at St. Bartholo- 
l mew's Hospital, who were unanimously agreed that 
, no tumour could then be felt in his abdomen. A few 
; months later he died in another hospital with all the 
symptoms of malignant disease in or near the head of 
his pancreas. A fifth case was that of a man admitted 
to tne Royal Free Hospital, where he was seen by Mr. 
James Berry, who opened his abdomen to explore a 
rounded and bard lump as big as a fist, and situated 





264. The Medical Prebp. ORIGINAL COMMUNICATIONS. Mar. 15. 1899. 


in the region of the pylorus. Some adhesions were 
broken down, the man made an excellent recovery, 
and nothing more was seen, or heard of the tumour. 
Mr. Bryant had also described cases of vanishing 
cysts which he had seen in the breasts of women. 

Mr. D'Arcy Power considered that these five cases 
of vanishing tumour wer^ in all probability innooent 
in nature and inflammatory in origin. But his sixth 
case was on the borderline between an innocent and 
a malignant growth. It occurred in a man, set. 24, 
who had received a blow on the top of his head from 
the flywheel of an engine. A few months after the 
injury a tumour appeared at the seat of injury. It 
grew until it attained the size of a sparrow’s egg, 
and then it disappeared. Six or eight tumours sub¬ 
sequently appeared in different parts of the head and 
then diminished in size. One of the tumours, 
however, continued to grow uotil it attained 
a size of ten inches when it was removed. 
Microscopic examination showed it to be a fibro¬ 
sarcoma, and Mr. Morrant Baker, who had charge of 
the case, gave it the name of “ withering sarcoma.” 
Mr. Power also drew attention to the fact that car¬ 
cinomatous ulcers of very considerable size have been 
known to heal, sometimes only superficially, the 
cancerous process continuing beneath the scar, but 
in some few cases the repair has been complete and 
permanent. Instances of atrophying scirrnus, too, 
are not very uncommon in old and spare people, He 
also alluded to another class of vanishing tumours : 
cancers which disappear after -the removal of an 
ovary ; hypertrophied prostates which become smaller 
when a testicle has been cut out, or when the vas 
deferens has been divided and adenomata of the 
breast, which vanish as a result of pregnancy and 
lactation. The cause of the disappearance in these 
cases is to be looked for in the intimate physiological 
connection which exists between the organ removed 
and the part diseased. 

Mr. Power considered that many interesting points 
for discussion arose in connection with vanishing 
tumours. He raised the question, what would have 
happened if no operatic® had been performed ? The 
cvstic tumour would probably have shrivelled up in 
the course of eight or ten years, when it might have 
become a wen, or it might have disappeared entirely. 
The enlarged liver, he thought, would have suppu¬ 
rated, and a similar fate seems to have been imminent 
in the cases of abdominal swelling. 

It was of extreme interest from a purely pathologi¬ 
cal standpoint to recognise that such apparently 
oauseless swellings might appear and disappear in 
the body. It indicated that the connective tissue 
cells of the part were in a very unstable condition, 
and it is easy to understand that given the necessary 
predisposition and the exciting cause such a swelling 
might determine the position of a malignant growth. 

The effect of surgical interference in these cases 
seemed to be identical with that produced by the inci¬ 
sion of any inflammatory swelling. Tension is 
relieved, and a series of complicated physiological 
changes are set up which end in resolution—changes 
which seem to be the direct outcome of alterations in 
the trophic and vaso-motor functions. The older 
surgeons set these changes in action by bleeding, 
their successors with improved surgical methods have 
ceased to interfere with the blood pressure generally, 
and are content to modify it locally. 

Mr Power concluded his paper by deorecating any 
attempt to remove a tumour locally, when it was in 
any way possible to eradicate it wholly. He said that 
modern surgery, based as it is upon pathology, 
teaches most emphatically that tumours should be 
removed as completely and as early as possible, and 
that the more a swelling is thought to be malignant 
the eariie • and more complete should be the removal. 
But it has happened in these cases of vanishing 


tumours that from one cause or another so complete 
a removal was impossible, and yet by accident or good 
luck, coupled with some unusual modification of the 
, morbid prooees, the result obtained was most satis¬ 
factory, though the method adopted was in the 
highest degree unsatifactory if we look to the means 
rather than to the end. 



KAR COMPLICATIONS IN 
INFLUENZA. 

By MACLEOD YEARSLEY, F.R.C.S., 

Assistant Surgeon to the Royal Ear Hospital: Surgeon in Charge of 

Dept, for Die. of the Throat, Nose, and Ear, the Farringdon 

General Dispensary ; Hon. Surgeon for Die. of the Throat and 

Ear, the Governeeaes' Home. 

The British Medical Journal for February 25th. 
1899, remarks that in the present epidemics of 
influenza the most common complications are 
pneumonia and otitis, “ the latter being particularly 
frequent.” Since the otitis of influenza is often of a 
rapidly destructive type, requiring prompt treatment, 
a few remarks upon it and its varieties may not come 
amiss to those who come much in contact with 
influenza. 

Influenza may attack an ear hitherto normal and 
it may light up old troubles which have been for 
some time dormant. Like other middle-ear inflam¬ 
mations the influenzal forms may be nonsuppurative 
or suppurative. The latter are much more common 
than the former, as the inflammation is usually so 
intense that suppuration is inevitable. When, how¬ 
ever, suppuration does not occur there often remains 
a persistent tinnitus which either disappears after 
several months, or is the forerunner of a middle-ear 
catarrh with progressive deafness. I have found 
influenza assigned as a cause of a fair percentage of 
cases of middle-ear sclerosis, the latter condition 
being either due primarily to the influenza or follow¬ 
ing an acute non- suppurative influenzal otitis. I do 
not, however, remember to have seen a single case of 
sclerosis traceable to influenza in which there was not 
also present some nasal or naso-pbaryngeal condition 
which would have acted at the least as a predisposing 
cause. 

The acute otitis of influenza occurs in two types, 
(1) that coming on at the same time as the primaty 
disease, and (2) that coming on some seven to ten 
days later. The symptoms of both types are sub¬ 
stantially the same, only that in the former the pain 
is more intermittent and more severe, the duration of 
the deafness less, and the general prostration greater 
than in the latter. 

The difference between an ordinary attack of acute 
otitis media and one due to influenza is marked and 
oannot fail to strike those who have much experience 
of the two diseases. In an influenzal otitis the pain 
is much more sudden <n its onset and has more of a 
neuralgic character; it is distinctly intermittent, and 
its paroxysms are more frequent and last longer 
during the night. Perforation of the membrana 
tympani (operative or natural) gives scarcely any 
relief to the pain, the intensity of which does not 
correspond to the objective symptoms. The deafness 
is more gradual in onset than in simple otitis media, 
but becomes well marked and lasts three or four 
weeks, or longer. The nervous prostration is great, 
and there is marked insomnia. 

On examination the membrana tympani- appears 
swollen and intensely congested, with, very fre¬ 
quently, punctate or diffused ecchymoees. When 
perforation oocurs it will be found that there is great 
swelling of the tympanic lining membrane with a 
special tendency to the formation of granulations 
and polypi of the flabby, oedematous type. Thi # 

Digitized by GoOgle 


Mab. 15, 1899. 


ORIGINAL COMMUNICATIONS. 


Th* Mxdical Pb*88. 265 


great tumidity of the mucous membrane explains the 
marked deafness and the want of relief by Politzer- 
isation. The discharge which follows perforation 
may be rarely abundant and purulent, but is more 
usually scanty, and may remain sero-sanguinolent 
during its whole continuance. 

These acute suppurative inflammations of the 
middle ear occurring during influenza may take one 
of three forms:— 

1. The distinctive type of haemorrhagic otitis, of 
which some description nas just been given. 

2. A primary mastoiditis, due apparently to direct 
infection and not to extension. 

3. A rapid caries and necrosis of the ossicles or 
mastoid. 

Probably all these forms are due to the direct 
influence of Pfeiffer’s bacillus. 

The second type enumerated is a very important 
one, needing, as it does, prompt treatment on account 
of the tendency to rapid caries and necrosis, with 
consequent cranial or sinus complications. Accord¬ 
ing to Politzer (a) the form of mastoid process most 
frequently affected is the “pneumatic,” in which 
there are numerous cells communicating with each 
other and the antrum by very small openings. These 
tiny communications become closed by the inflamma¬ 
tory swelling, and a pent-up collection of pus results. 
Politzer found these abscesses in the middle or in¬ 
ferior segment of the vertical portion of the process, 
notably in the superficial oells situated under the 
cortical layer of bone. In most cases the tympanic 
suppuration had already ruptured the membrane, 
otherwise the ordinary symptoms of that condition 
were present. It must, however, be borne in mind 
that the invasion of the mastoid—antrum or cortical 
cells—by Pfeiffer’s bacillus is not alwaye preceded 
by a discharge at the external meatus, and therefore, 
pain in and tenderness over the mastoid should at 
once be the indication for a careful examination of 
the tympanic cavity. 

The usual symptoms observed in influenzal mas¬ 
toiditis are as follows :—Local lancinating pain of a 
radiating character, tenderness on pressure or per¬ 
cussion on the mastoid, local heat, general rise of 
temperature. There may be bulging of the tympanic 
membrane and of the posterior superior meatal wall. 

The course of influenzal mastoiditis is usually 
towards rapid destruction rather than resolution and, 
although it tends occasionally to open externally, its 
inclination is more towards caries and serious lateral 
sinus, or cranial complications. 

The third type of influenzal otitis is one in which 
the destructive process is marked, there being rapid 
caries of the ossicles, caries of the tympanic wall and, 
when the mastoid is implicated, caries and necrosis 
of that process. 

Treatment .—The treatment of influenzal otitis re¬ 
quires to be undertaken with care, and before anything 
is done, the surgeon should, as far as possible, satisfy 
himself as to the precise condition of the patient. As 
has been pointed out, pain in the mastoid occurring 
in the course of an attack of influenza should always 
be a danger signal to the medical attendant, and he 
should at once make a careful examination of the ear 
so that prompt measures may be taken. 

At the onset of an attack of influenzal otitis 
leeches should be applied promptly, one over the 
mastoid process and one in front of the tragus. 
When they drop off bleeding should be encouraged 
by hot antiseptic fomentations. For the relief of 
pain hot, dry cotton-wool applications should be 
used, together with hot instillations of cooaine in a 
strength of 10 per cent. Any bulging of the mem- 
brana tympani should be met at once by paracentesis. 
This will be disappointing, in most cases, in its 
effect upon the pain, but it should be done more 

(a) “ Ann&lM dee Maladies de roretlle,’’ May, 1882. 


with the intention of relieving tension, and for that 
reason the incision made should be large and free. 
Ordinary antiseptic treatment should follow, and 
when the acute stage has subsided granulations and 
polypi should be removed with the curette, and the 
tendency to their formation checked by astringent 
instillations and applications. Bronner (a) has 
found instillations of nitrate of silver (10 per cent.) 
to be especially useful in influenzal cases. Until all 
pain has ceased and the acute congestion has disap¬ 
peared no attempt should be made to inflate the 
tympanum either by the Eustachian catheter or by 
Politzer’s method. 

The severe prostration must be met by careful 
general treatment, antipyrin and morphia being spe¬ 
cially useful. In some cases large doses of quinine 
appear to have a good effect. The insomnia should 
to be met by sedatives and hypnotics, of which sul- 
pbonal, trional, and paraldehyde seem to give the 
best results. When the otitis appears during the 
attack of influenza the patient should be kept in bed, 
when it comes on later m the disease confinement to 
one room will suffice, although bed is better. 

When influenza attacks the maistoid as above 
described, and perforation of the tympanic mem¬ 
brane has occurred, leeches and the use of cold or heat 
by means of ice, Leiter’s tubes, or hot antiseptic 
fomentations should be tried. The application of 
counter-irritants or blisters should not be employed, 
as such agents mask the symptoms and confuse the 
surgeon. Should the intensity of the symptoms not 
abate in about three days, an operation on the 
mastoid should on no account be delayed. If the 
case is first seen several days after the onset of 
symptoms, no delay should be permitted for the 
trial of antiphlogistic remedies. Bulging of the 
posterior-superior meatal wall, nystagmus, cnanges in- 
the retina, or facial paralysis, should also decide the 
question of immediate surgical interference. When 
it is found that the abscess is in the superficial 
mastoid cells, Politzer insists that on no account 
should any artificial communication be made between 
them and the antrum (if they do not already com¬ 
municate). This axiom is, of course, the opposite of 
that which holds good in ordinary mastoid cases. 
The importance of not delaying operation, is accen¬ 
tuated in influenzal mastoiditis on account of the 
destructive nature of the inflammation, and the 
tendency to caries and necrosis. 

ON SERUM INOCULATION. 

By T. R. WOLFE M.D., F.R.C.S.Ed., 

Melbourne, Victoria. 

An edict has just been issued by the Board of 
Public Health of Victoria that “every dairy cow 
must be subjected to the tuberculin test, and if shown 
to be tuberculous is to be at once disused and 
slaughtered.” This edict is in accordance with the 
report of the British Royal Commission on Tuber¬ 
culosis. The mention of Koch’s tuberculin has 
brought to our recollection the incidents which must 
be fresh in the memory of us all, viz., the proclama¬ 
tion of a discovery for the cure of consumption, the 
rush to Berlin, the exultation of medical men in all parts 
of the world over the discovery and its disappointing 
results. So wild was the enthusiasm during its acute 
stage that in Vienna, the Professor of Surgery was 
hooted for excising a scrofulous joint instead of inject¬ 
ing it with the serum. Manufactories established for its 
production could not cope with the demand, the cry 
from every part of the inhabited globe being, send us 
more of the precious fluid. The cures continued 
merrily, and it was firmly believed that consumption 
would soon be counted among the diseases that were; 

(o) The Lancet, March 8tb, 1890. 

D 


266 The Medical Press. 


TRANSACTIONS OF SOCIETIES. 


Mar. 15, 1899. 


for the serum was not only to cure, but also to dia¬ 
gnose. Then Virchow demonstrated by post-mortem 
appearances upon victims of the new cure, that, it not 
only aggravated the disease, but that it gave rise to 
disseminated tuberculosis, to acute hsemorrbagic 
pneumonia, and to pulmonary cavities. Then almost 
suddenly came the collapse. 

One would have thought that no more would be 
heard of the new remedy. But it is astonishing how 
hard superstition dies, when nourished by a cohort of 
zealous devotees. 

In connection with the general subject of serum 
inoculation. Sir Charles Gordon’s article in The 
Medical Press and Circular of December 7th, 
brings the gratifying intelligence that, in the mother 
country there, at least, some influential voices were 
raised against certain prevailing practices based upon 
dreamy incoherences. I have always thought that, 
among English-speaking people, the philosophy of 
common sense is sure to assert itself in the long run. 
Sir Charles Gordon mentions Pasteur—the father of 
these systems. In discussing Pasteur’s cure for 
hydrophobia with some of the Professors of the Paris 
Medical Faculty, I expressed astonishment that suoh 
a burlesque on medical science should have been 
allowed to exist, the bare mention of which would 
have raised “shouts of inextinguishable laughter” 
from my old masters and friends, Claude Bernard, 
Trousseau and the other authorities of that period. 
Their reply was “We raised our voices in the 
Academy against it, mais que voulezvous ? We were 
told it was unpatriotic, and Messieurs les Anglais 
have given kclat to the affair by contributing 
some thousands of pounds to the Institute.” Let 
us glance for a moment at Pasteur's cure for 
hydrophobia. All we know of hydrophobia is that, 
demonstrated by Claude Bernard, it is a disease 
of the brain manifesting itself in a poisonous secre¬ 
tion of the salivary glands. When a dog is attacked 
by la rage , hyperexcitation of the brain changes the 
secretion of the salivary elands into a poisonous 
substance. It is not a blood poison, for when 
the blood of the rabid dog is inoculated or 
transfused into a healthy animal, that animal 
is not affected in the least, while in a blood 
disease such as glanders, infection immediately 
follows inoculation. When a rabid dog bites a man 
there is a risk of it communicating hydrophobia. 
When it does so, the symptoms of hydrophobia do 
not set in at once. There is always an indefinite 
period of incubation intervening, between the bite 
and the manifestation of the symptoms. Bacteriology 
has thrown no light upon the nature of the contagium, 
no partic ular coccus is associated with the disease, 
nor have any bacteria been isolated. 

Something, however, may be said in favour of 
Pasteur’s treatment. Cases of hydrophobia are 
extremely rare, and when a person is bitten by a 
dog there is generally a state of neurasthenia, the 
result of constant dread, and the mind mav become 
unhinged. The treatment by Pasteur has a beneficial 
effeot by soothing the nervous system, and we may 
take it for granted that, as a rule, the virus is so 
attenuated that it can do no harm. 

But unfortunately, Pasteurism has produced a 
therapeutical epidemic to the prejudice of bac¬ 
teriology and serumtherapy. "Bacteriology has 
rendered excellent service to medicine, and will still 
achieve great conquests, while serumtherapy may 
yet dominate medical treatment; but they retard 
the advent of this practical application who rush 
crude schemes upon the profession. 

1 hold that each new discovery should be properly 
tested, and not issued for circulation till it is, like the 
sovereigns from the mint, of sterling value. 

Oh ! the irony of fate! Christopher Columbus, the 
discoverer of a new world, was loaded withjchains and 


imprisoned, as a reward! but now— if one discovers, 
or imagines that he has discovered, a bacillus, he 
cries Eureka! and collects a host of adherents, who 
ooncoct a serum, and proclaim him a benefactor of 


his species —tic iter ad astro. 

But to return to the compulsory inoculation of 
cattle with Koch’s serum, which according to the 
Report of the Royal Commission, is still good enough 
for diagnostic purposes. At the Paris Congress on 
Tuberculosis, August, 1898. it was reported by a 
Committee that Koch’s new tuberculin (T. R.), 
although free from the lethal properties of the 
original fluid, nevertheless contained a poison which 
lowered the heart’s action, spread tubercle to the 
lymphatic glands, and favoured the development of 
specific inflam mation. Moreover, it was also re¬ 
ported that of the cattle injected for diagnostic pur¬ 
poses from April, 1896, to May, 1898, that of 69,971 
animals which did not react to tuberculin the first 
time, and got a clean bill of health, 4,524, i.e., 14’6 
per cent, reacted the following year, or have since 
become tuberculous. We find it, therefore, necessary 
to bring the subject under the notice of the British 
profession to consider whether, with such informa¬ 
tion before us, we are justified in enforcing inoculation 
of all animals. 


^nmsaitionfi of goriciies. 

CLINICAL SOCIETY OF LONDON. 

Meeting held Friday, March 10th, 1899. 

The President, Mr. Langton, in the Chair. 

Mr. H. Betham Robinson described a case of 

HYDATID CY8T8 IN THE UPPER LOBE OK THE RIGHT LUNG 
AND LIVER BOTH 6UCCE88FULLY REMOVED. 

The patient was a little boy, ®t. 6, admitted under 
hie care into St. Thomas's Hospital on June 7th, 1898. 
There was not anything to note in the previous history 
except that for some time he had had a cough About 
three years before the abdominal tumour had been first 
noticed, the size of a marble This had gradually in¬ 
creased without any pain. Up to his admission there 
had been no suspicion of the oyst in the lung, un 
examination he was found to have a firm 
elastic swelling in the right hypochondriac and lumbar 
regions, reaching almost to the middle line and telow 
the level of the umbilicus. There was a rounded nodular 
projection on its inner side just under the umbilicus. 
The liver dulness began at the seventh nb m the nipple 
line, and was continued down over the tumour, ine 
whole swelling moved with respiration, and ^ could be 
grasped between the hands placed in front and behind, 
and shifted out of the line. The urine was slightiy 
albuminous. His chest on examination showed that the 
upper part of the right side in front bulged. The Per¬ 
cussion note was duH down to the third rib, and dulness 
was also present high in the axilla and at the apex 
of the lung posteriorly. Over the dull area m 
front the breathing was tubular, and vocal reson¬ 
ance increased, but behind all sounds were dimimslmd. 
No crepitations were elicited on coughing. There was 
no elevation of temperature, bo the physical sigiia 
pointed to a hydatid in the lung. On June 22nd the 
liver hydatid was operated on by an incision in the linea 
semilunaris. The liver came well below the costal 
margin, and a cyst was seen springing from the inferior 
surface having the gall bladder on its upper surface and 
left margin. The cyst, having been pushed into the 
wound, was incised, and the finger was , 
and hooked the cyst well out of the abdominal 
wound, preventing any contamination of tne peri¬ 
toneum. The hydatid membrane was removed with 
forceps after about a pint of clear fluid had escaped. 
The fibrous wall was not interfered with, the cavity was 
washed out with 1-1000 perchloride of mercury solution. 


Mab. 15. 1899. 


TRANSACTIONS OF SOCIETIES. The Medical PB*6b. 267 


and the opening almost sutured up with catgut exoept 
for a hole for a gauze drain which was brought out of 
the abdominal wound. By packing the abdominal and 
cyst wounds were kept as closely apposed as possible. 
It will be noted that the cyst was not fixed to the 
abdominal wall. The subsequent progress was uneventful 
exoept that the discharge Decame purulent on the 10th 
day with a slight rise of temperature. In spite of this 
the wound was soundly healed at the end of a month 
and tucked up under the liver. During this time his 
lung signs underwent no change, but his liver still 
remained pushed down. A skiagram made by Dr. 
Berry Blacker showed a well-marked opacity in the 
upper lobe of the right lung, so dense as to oblite¬ 
rate the rib shadows. On August 15th the lung was 
operated on. The pectoralis major being split, an inch 
and a half of the second rib was resected, and then on 
careful incision it was evident that the pleural layers were 
adherent. Turning the boy on his right side so as 
to allow free exit for the fluid and to prevent a possible 
flooding of his bronchial tubes on the collapse of the 
cyst, a hollow needle was introduced to get a knowledge 
of the depth of the cyst from the surface, immediately a 
drop of fluid appeared, which was about one quarter of 
an inch in, a free incision was made and several ounces 
of hydatid fluid gushed out. The finger was introduced 
and the cyst membrane removed whole with the aid of 
forceps. The cyst was about the size of an orange, with¬ 
out any daughter cysts. There was fortunately no 
communication of the fibrous sac with the larger tubes, 
for there was no marked coughing nor bloody expectora¬ 
tion after the incision, nor from the physical signs after¬ 
wards. A large indiarubber drain was introduced. For 
some few days afterwards he had a high tempera¬ 
ture, and physical signs indicative of some localised 
pneumonia, but without any signs of pleuritic effusion. 
At the end of ten days his temperature was only slightly 
raised at night, and the tube was removed and a gauze 
drain substituted. At each daily dressing the boy was 
turned on his face so as to thoroughly drain the cavity, 
which was then insufflated with equal parts of aristol 
and boracic acid. On September 7th (the twenty-second 
day) the wound was quite superficial, and the lung on 
examination was resonant all over, air entering well 
right down to the base of the lung with expiration, still 
in places tubular, but no adventitious sounds. On the 
9th he got up, and on the 19th, when the wound was 
quite healed, the lung on examination gave no evidence 
of any cavity. He went to a convalescent home on Sep¬ 
tember 22nd, and has remained well since. 

Dr. Kingston Fowler asked whether the patient had 
continued in good health, mentioning that he had 
recently heard of two similar cases successfully operated 
upon, but in both instances the patient had subsequently 
developed pulmonary tuberculosis. 

Mr. B. Rob in so n, in reply, said that up to two months 
ago at any rate the patient had remained perfectly well. 

CASE OF PANCREATIC CYST TREATED BY INCISION AND 
DRAINAGE. 

Mr. A. Barker related the case of a boy, set. 14, admit¬ 
ted July 12th, 1897. He had had a fall some weeks 
previously striking his left side. He was rendered un¬ 
conscious and remained so for some hours, and for a 
fortnight after he was stated to have been delirous, also 
to have spit blood several times. A large swelling 
occupied the left side of the abdomen throughout 
the left hypochondriac, lumbar and left half of the 
epigastrio and umbilical regions. There was also slight 
fulness in the right halves of the corresponding regions, 
especially the umbilical. The swelling came from 
beneath the left costal margin which was distinctly bulged. 
The tumour was dull on percussion, and on the left this 
dulness was continuous with that of the spleen. The tumour 
moved with respiration. There was apparently a small 
amount of fluid in the peritoneum. Considering it to 
be a pancreatic cyst he, on July 15th, 1897, opened the 
abdomen by a three inch vertical incision through the 
left rectus muscle close below the ribs. On opening the 
peritoneum the stomach was found stretched over the 
tumour and the transverse colon lay below it. Between 
the two there was a small space through which the cyst 
was tapped giving issue to three or foqr pints of fluid, at 


first clear and light coloured, but becoming slightly 
brown towards the end. He sutured the lips of the cyst 
to the edges of the wound and left in an iodoform gauze 
drain. The patient did well, and left the hospital on 
August 15th with the wound quite healed. There had 
been no return of the trouble. A careful analysis by Dr. 
Nabarro and Dr. Sidney Martin gave the following 
resultsthe fluid was of a brownish-yellow colour, sp. 
g. 1010, with a sweet aromatic smell, not urinous, re¬ 
action alkaline, no sugar or bile, but a trace of peptone. 
On boiling it gave one-half (3 per cent.) albumen. Total 
solids 1-63 per cent.; ash 0-81 per cent.; total proteids 
0*66 per cent. The fluid displayed marked amylolytic 
action, but no fat splitting or protolytic action. 

Mr. Alban Doban remarked that one could not have 
a better clinical subject for surgeons to discuss than this 
cyst question. The author’s paper seemed to clinch what 
a surgeon ought to do in the surgical treatment other 
than operating. In reference to the question of diagnosis 
he remarked that a broad-based cyst, if rather large, 
though fixed to bone or adjacent organ, could, when 
grasped, be made to move laterally very freely. That 
had been the case with his own patient. He pointed out 
that it was exactly the same with a pelvic oyst, which 
could often be freely moved, although so firmly fixed 
as to require enucleation. He agreed that the best treat¬ 
ment for pancreatic oysts was incision and drainage. It 
often happened that the nature of the cyst could not 
be diagnosed, even half through the operation, some¬ 
times not till the very end of it, and several of the 
operators had openly admitted that they would not have 
done the operation had they known beforehand what it 
was, the risks being too great. He recalled that Kronlein 
had successfully removed a oyst, but the patient died on 
the tenth day, and post-mortem the transverse colon was 
found to have sloughed. Ponoet, who bad operated on 
several cases, did a very bold operation on an almost 
sessile cyst in which he left seven clamp and pressure 
forceps sticking out of the wound. One of them when 
removed was followed by htemorrhage and had to be 
hastily reapplied, though it was impossible to see what 
one was taking hold of. The patient recovered, but it was 
obvious that in reapplying the forceps he might have 
grabbed anything. lives and Nashville had removed a 
cyst of the tail of the pancreas which was a compara¬ 
tively easy situation, yet not only the meso-colon but 
also the transverse colon were torn across. These were 
repaired, and the patient recovered, but that was a risk 
which few of them would be prepared to face. In other 
cases the splenic vein and artery had been wounded. 
Evidently therefore the risks of removal were too great 
if one bore in mind the excellent results of drainage, as 
in the author’s case, in his own and in the three cases of 
Mr. Bilton Pollard s, reported in the Brxtieh Medical 
Journal. The right treatment was not to perform an 
operative feat but to drain. 

The President concurred in the view that drainage 
was the best treatment. He referred to the case of a 
gentleman with an enormous tumour in the situation 
mapped out by the author. It was not an ordinary 
pancreatic cyst, there being haemorrhage into the sub¬ 
stance of the organ. The patient was from the Sister 
Isle, and the case was supposed to be one of malignant 
disease far back. He thought, however, that he could 
feel fluctuation, but the exact situation of the tumour 
could not be decided. He made a median incision and 
went above the stomach through the gastro-hepatic 
omentum giving issue to 9J pints of old blood. The 
patient, although very ill for a few days, did remarkably 
well with drainage. The interest in the case lay in the 
fact that three years afterwards he was taken ill and 
ultimately died, and post-mortem it was found that the 
portal vein had become so constricted in the scar tissue 
that there was practically no circulation through the 
hepatio area. 

Mr. Arbothnot Lane mentioned the interesting fact 
that in one of his cases the cyst, though distinctly pan¬ 
creatic, was made up of three cysts. 

Mr. Barker, in reply, insisted on the fact that the boy 
was delirious, a fact which suggested reflection as to the 
cause thereof. Many cases of multilocular cysts had 
been recorded, but he was interested to hear that Mr. 


>S 



268 Th, Medical Perm. TRANSACTIONS OFlSOCiKTfeS. - Mae. 16.1809- 


Lane bad dealt with one successfully, a successful result 
being the exception. 

Mr Battle brought forward the account of a case of 
SUCCESSFUL REMOVAL OF A LARGE MALIGNANT FRONTAL 

TUMOUR WITH UNDERLYING BONE. 

The patient, a married woman, eat. 3o, was admitted to 
the Royal Free Hospital on June 21st, 1898. Eight 
years before a small lump had been noticed in the scalp, 
a little to the left of the middle line hehind the hair of 
the frontal region. Several operations had been per¬ 
formed for its removal, and the present growth bad been 
growing for two years. In some months there had been 
intermittent haemorrhage from it, and her general health 
had greatly deteriorated. A large irregular nodular 
mass with overhanging edges presented in the frontal 
region. This measured about 3 ins. by 4$ ins., and pro¬ 
jected 31 ins. from the level of the scalp. Vascular 
and foul smelling it presented a formidable aspect, 
whilst the removal of the dressings caused troublesome 
bleeding, which required steady pressure to arrest it. 
Firmly attached to the bone, it did not pulsate, and was 
not accompanied with glandular enlargement. On 
January 27th, after the application of an elastic bandage 
circularly to the head te oontrol bleeding from super¬ 
ficial vessels, the tumour was removed from the surface 
of the bone, and pads applied to arrest the bleeding 
which ensued from the skull where the growth had in¬ 
vaded it. This pressure was removed next day. On 
February 7th the bone affected was removed; a trephine 
was first applied, and from the opening thus made a 
circular saw worked by a hand motor was guided so as 
to divide the bone above and below, after which a few 
strokes of the chisel were sufficient to free the impli¬ 
cated portion. The growth had not invaded the dura 
mater, but presented a series of closely set elevations 
with flattened tops where it had completely eaten away 
the skull. Very little haemorrhage (comparatively) fol¬ 
lowed the removal of this piece of bone, but one 
vessel in the dura mater required the pressure of a 
pad and a bandage to arrest the bleeding from it. 
She got up on February 25th. Granulations soon 
sprang up, and on March 2nd skin grafts after Thiersch's 
method were taken from the thigh and placed on the 
dura mater—with full success. She left hospital on 
Marsh 22nd—greatly improved by her stay. There was 
then aa irregular circle of dead tissue around the area of 
operation, which gradually separated during the next few 
months, and cicatrisation took place around. The relief 
to the patient and the improvement in her general con¬ 
dition and appearance are very great. Wearing a 
handkerchief across the forehead and round the head 
she is comfortable, and there is no suspicion aroused of 
the underlying deformity. No attempt has been made 
to cover over the area left after removal of the bone, by 
means of a plate Mr. Battle drew attention to the 
various methods of removing portions of the skull now 
available, and Messrs. Down showed instruments adapted 
to this object during the course of the evening. The 
rarity of such cases was mentioned, and the unusual 
character of this fungating growth, the microscopical 
examination of which showed it to be a sphenoidal- 
celled carcinoma. The case was also interesting from 
the fact that it was necessary to apply grafts to the 
dura mater in order to provide for its better protection 
from the air. 

Mr. Barker agreed with the author that the motor 
had very considerable drawbacks being difficult to direct 
and apt to jam. Possibly with a large fly wheel it 
might be more practical. He recommended the use of 
Gigli’s wire-saw which he himself had recently used with 
very satisfactory results. He suggested, however, that 
instead of the loops, if the ends were shaped like a sound 
it would be more easy of introduction. 

Mr. Battle, in reply, said that at the time he did this 
operation he was not acquainted with Gigli’s wire-saw. 

Mr. Arbuthnot Lane read notes of a case illustrating 
an operative procedure for 

ERASION OF THE AN K LK-JOINT 

whioh gave a clear field for the complete removal of 
tuberculous material from this joint without offering 
some of the objections he had fonnd to arise occasionally 


in that he described in the “ Trans. Clin. Soc,” Vol. 
XXV. In that operation he divided by means of a 
transverse incision all the structures around the joint 
except the internal lateral ligament, the tibialis posticus 
and the flexor tendons of the toes. The divided tendons 
were carefully sutured,‘but in spite of this, often owing- 
to infection of the joint previous to operation, they 
occasionally united imperfectly, and deformity and 
imperfect control of the foot resulted. Besides the 
transverse incision through the skin, he now made 
vertical incisions of sufficient length to enable him to 
expose the several tendons for a considerable length. In 
the voung infant he found he could expose the interior 
of the joint by dividing the peroneus tertius alone a» 
well as the external, anterior, and posterior ligaments, 
the other tendons being turned out of their sheaths and 
hooked aside. In older children he also divided the 
peroneus longus and high up, cutting through 
muscular and tendinous fibres, securing larger and 
more vascular areas in accurate apposition, and keeping 
the sutured portion at a distance from the joint and so 
minimising infection of it. He took the same precaution 
with the peroneus tertiuB. By this means the objections 
to the other operation are practically completely avoided 
without diminishing its thoroughness. 


HARVEIAN SOCIETY OF LONDON. 
Meeting Held Thursday, March 2nd, 1899. 


Mr. Henry Juler, F.R.C.S., President, in the Chair. 


Mr. D’Arcy Power read a paper on “Vanishing 
Tumours,” of which we publish a full abstract elsewhere. 

The President referred to the case of a woman who 
had been under his care, in whom both eye-balls were 
protruding, and there was extensive anesthesia of the 
forehead and almost complete blindness. In each orbit 
an indurated mass could be felt at the outer canthus and 
below the globe. The growths were believed to be 
malignant, and a portion of one of them which was 
removed for microscopic examination presented appear¬ 
ances which were believed to be sarcomatous rather than 
gummatous. After a few months’ treatment with 
mercury and iodide of potassium, however, the tumours 
entirely disappeared. They were in all probability 
gummatous. 

Mr. Alban Doran suspected that Morrant Baker’s 
“ withering sarcoma” of the scalp was akin to the 
fibromas of the abdominal wall, a large specimen of which 
he had himself removed from the sheath of the rectus 
that very day. They caused danger by their size, but 
sometimes disappeared spontaneously. Reed, of Cin¬ 
cinnati had reported one case where the tumour seemed 
irremovable when exposed by the knife ; the skin-wound 
was closed and the tumour, certainly a fibroma, dis¬ 
appeared. Mr. Doran knew of a case where the patient 
refused operation for what seemed to be a fibroma of the 
abdominal wall. She became pregnant, and the tumour 
vanished. The majority of vanishing tumours in the 
abdominal cavity itself were simply cases of tuberculous 
peritonitis. When a “cyst” was diagnosed, and a cir¬ 
cumscribed collection of serum, bounded by intestine 
bearing old tuberculous deposit, was laid open by the 
knife, it was apt to be mistaken for a cyst of the urachus 
or for a malignant ovarian tumour with metastatic 
deposits. Even after long experience the surgeon often 
found such a case very puzzling. But it nearly always 
got well. Mr. Doran had seen perfect cure follow incision 
in a large number of cases where he had designedly 
incised the peritoneum for the relief of tuberculous 
disease, and also in two instances where he suspected the 
dense deposit in the parietal peritoneum to be malignant. 
He had never known improvement to follow exploratory, 
incision where real sarcoma or carcinoma was detected. 

Dr. Cock mentioned the case of an old lady, set. 71, 
who was feverish. On examination, a hard mass reach¬ 
ing from the right side of the pelvis to the lower border 
of the liver, easily defined from side to side, not doughy 
to the touch, and extremely tender, was discovered, 
uterus partly fixed and a bloody discharge noted 



Mab. 15, 1899. _ TRANSACTIONS 

Purgatives had no effect and there never were any signs 
•of faecal accumulation. Consultants were of opinion that 
the mass was carcinomatous. After an illness of ten 
weeks patient became better, the mass shrank, and at the 
end of a six months’ holiday at the seaside patient 
returned quite well with no tumour. She ultimately 
-died five years afterwards from bronchitis 

Mr. Eastes referred to the large number of vanishing 
tumours which were associated with- various parts of the 
■organs of generation (male and female), including the 
female breast. A striking instance was furnished by 
fibromata of the uterus occurring in middle life He 
had seen an uterine fibroid (as large as a pregnant uterus 
towards the end of gestation) disappear almost entirely 
within a year after cessation of menstruation, and the 
patient recover health, though previously she had almost 
died on several occasions from excessive “ monthly 
floodings.” But, the vanishing tumours most often seen 
in general practice were probably foccal accumulations 
in the colon. One patient, who found aperient remedies 
always produce pain and consequently neglected them, 
had twice within the last two. years allowed such an 
accumulation to occur, and passed through a severe 
illness before she was relieved. She probably had adhe¬ 
sions ; at any rate, there was a history of peritonitis in 
•childhood, with constipation ever since. During each of 
these latter illnesses the cylindrical accumulation in the 
ascending colon, measuring six inches in length and 
four inches in diameter, had occupied a fortnight in 
vanishing, and on several days in that period some ten 
-or twelve distinct hard, almost spherical, masses-of faces 
were removed by finger, or large enemata from the 
rectum. The medicine which had accomplished the 
removal in the last illness was a pill composed of resin 
podophyll and ext. belladonna, an eighth of a grain of 
■each in each pill, given once twice or thrice daily, accord¬ 
ing to the necessities of the case 

Dr. Leonard Guthrie believed that there are well 
authenticated instances of the spontaneous disappear¬ 
ance of tumours, both malignant and benign. He 
suggested that the phenomenon might be due to 
interference with the blood supply of the tumours. 
This explanation might be opposed to the effects of 
phrynin and various drugs vaunted as cures for cancer. 
For instance, carbonate of lime, chian turpentine and 
•cinnamon, which latter contained tannic acid. Finally, 
the success which sometimes followed oophorectomy for 
inoperable cancer of the breast was possibly due to the 
profound effeot produced by that operation on the work 
of the sympathetic system. 

Dr. Washboubn mentioned some observations which 
had been made by Mr. Bellingham Smith and himself 
upon infective sarcomata occurring in dogs, and which they 
had published in the Pathological Society’s Transactions, 
and in the British Medical Journal. The sarcomata were 
■originally situated in the mucous membrane of the 
vagina and penis, and were transmitted from animal to 
animal during the act of coitus. They consisted of round 
cells with an alveolated arrangement, and were similar 
in structure to the round-celled alveolar sarcomata met 
with in the human subject. By inoculation they would 
"be transmitted to the subcutaneous tissue of dogs. At 
the end of two or three months the resulting tumours 
reached their maximum development, fqrming lobulated 
masses about two inches in diameter. They then took 
•one of two courses. Either they became disseminated, 
seoondary nodules appearing in the internal organs 
causing the death of the animal; or they disappeared. 
Jn the latter case. they either slowly dwindled away, 
being replaced by fibrous tissue, or they disappeared by 
a process of ulceration. A most interesting point was 
the fact that after the tumour had disappeared, the 
animals were absolutely immune to subsequent inocula¬ 
tion. Up to the present time no micro-organisms bear¬ 
ing a causal relationship to $)ie tumour had bqen 
discovered. ’ . . . 

Mr. D’Abcy Power replied. ' 

A NEW FORM OF ETHER INHALER. 

v Mr. Bellamy Gardner showed an improved ether 
inhaler which he- had devised. Its advantages were-; 
(1) a breathing channel two inches in diameter t (2) a 
reservoir for six ounoes of ether, the quantity required- 


OF SOCIETIES., _ The Medical Press. 269 

being emitted upon a sponge by simply turning a tap; 
(3) compactness and portability in the filled condition. 
He had used it in over 700 cases during the past two 
and a-half years, and recommended it as combining the 
advantages of Clover’s and Ormsby’s inhalers. 

In answer to questions by Dr. Cock and Mr. Eastes, 
Mr. Gardner stated that the supply of ether could be 
accurately regulated, and that with ordinary care there 
was no fear of any fluid ether entering the face-piece. 

LIVERPOOL MEDICAL SOCIETY. 

Meeting held February 23rd, 1899. 

The President, Dr. Macfie Campbell, in the Chair. 

Mr. Hugh E. Jones exhibited patients on whom the 
operation of discission of the crystalline lens had been 
performed for high myopia. 

Mr. F. T. Paul submitted a case of cholecystectomy 
for gall-stones and cancer. The tumour was a small 
villous carcinoma of the fundus of the gall-bladder, 
which was removed, together with the upper half of the 
organ and thirteen gall-stones. The patient recovered 
from the operation in a few weeks, but two-and-a-half 
months subsequently died from enlargement of the liver, 
which was apparently not due to recurrent cancer, but 
to some inflammatory condition, probably set up by 
stones in the hepatic ducts. 

Mr. Rushton Parker remarked that few operations 
were more gratifying to the surgeon and patient than 
the removal of gall-stones. He took it that Mr. Paul in 
this case excised the gall-bladder, because being dis¬ 
covered in the search for gall-stones to be cancerous it 
appeared removable, and was not thereby advocating the 
general removal of similarly affected gall-bladders as 
Hinted at by one speaker. 

Mr. Robert Jones related the case of a youth of 16 
who came to him because of difficulty in flexing his 
knee, caused by a hard mass apparently attached to the 
upper two-thirds of thigh, which interfered with 
muscular action. Further growths were found on 
the inner aspect of right jaw below ramus a 
small lump below right olecranon; thickenings at 
insertion of right patella, and at each first tarso¬ 
metatarsal joint. His back presented an extraordinary 
spectacle. Over the spinous processes a continuous line 
of hard material, cartilaginous or bony, extended from 
the level of the fifth dorsal to the fourth lumbar spine. 
This central ridge bifurcated at the lower end, the ex¬ 
tremities of the bifurcated portions almost reaching to 
the iliac crests. From the central tissue two transverse 
strips projected at the upper end, and two at the lower, 
almost symmetrical in appearance. The upper ones 
arose about the level of the seventh dorsal and were 
about two inches in length: the lower ones at the level 
of the second lumbar, the right, being about three inches 
long, and the left two inches. These prolongations were 
movable, and the fingers could. be placed under their 
tips. The boy was unable to stand absolutely erect from 
the fact that extension of the spine resulted in the 
jamming of structures in contact with the lower end of 
the prominence. Four years ago the patient fell on a 
door-step and hurt his back; a year later the growth 
started in the centre of the spine. The origin of the 
tumour of the jaw cannot bq fixed. The thickening at 
the elbow started after a blow, and the tumour of the 
thigh has lasted four months. Mr. Jonqs purposes 
removing the growth on the back, and any other 
deposits which may interfere with breathing. 

Dr. Alexander read notes of a case of " Pylorectomy ” 
for Stenosis of the Pylorus, Murphy’s button was 
employed, and the patient quickly recovered. 

Dr. Briggs read a paper on 

VAGINAL SECTION. 

The paper was mainly! based 1 on sixteen operations in 
-the- author’s practice.-In thirteen posterior vaginal 
section, and in three anterior vaginal section .was the 
operation performed.. -The cases treated by posterior 
vaginal section included- five pf htematocele due to 

Digitized by GoOglC 


270 The Medical Press. 


LUNACY DEPARTMENT. 


Mar. 15, 1899. 


ectopic pregnancy, three of tubo-ovarian cyst (ovarian 
hydrooele), one of simple papilloma of both ovaries, one 
of hydro-salpinx, one of chronic infective Balpingo-oopho- 
ritis, two of chronic infective metro-salpingo-oophoritis 
(with hysterectomy)—thirteen in all. The cases treated 
by anterior vaginal section included three of chronic 
salpingo-oOphoritis with retroversion, for each of which, 
after the removal of the ovary and tube, the uterus was 
steadied forwards by vaginal fixation. In hematoceles, 
the vaginal drain was employed in chronic cases, and the 
important question seemed to be : Was it neoessary to 
empty or remove the Fallopian tube, in cases of incom¬ 
plete tubal abortion or tubal mole ? The uncertainty of 
being able to recognise the tubal condition ought not to be 
disregarded until it had been shown that drainage alone 
was sufficient. Dr. Briggs explained that in three of his 
cases a portion of the outer end of the tube was 
removed, and in two cases the tube was neither felt nor 
seen. All the cases recovered equally well, with the ex¬ 
ception of one where the patient was lost sight of and 
the unhealed sinus suppurated. Operators seemed to 
agree that the tubes and ovaries might be left 
behind. In the one case where suppuration occurred the 
tube8 were excised by another operator and found empty, 
four months afterwards available evidence pointed 
towards posterior vaginal section as the operative treat¬ 
ment of chronic htematooele distending the pouch of 
Douglas. Similarly tubo-ovarian cysts (ovarian hydro- 
oeles), simple papilloma-growths, and salpingo-oophoritic 
lesions, if accessible from below, could be removed from 
the pouch of Douglas by posterior vaginal section. It 
is evident that where there is matting, thickening, and 
firm fixation, especially towards the lateral walls of the 
pelvis, there is difficulty in securing the pedicle. More 
room is obtained by removing the uterus, which in 
infective inflammation is often, as Landau has urged, 
in an incurable state. Dr. Briggs removed the uterus 
in two of the cases quoted because of the conditions 
alluded to. One patient lost her life from haemorrhage 
thirty hours after operation, the haemorrhage had been 
ooncealed behind the cyanide-gauze pack, and escaped 
the notice of the attendants in charge of her. This case 
was a posterior vaginal section for adherent hydro¬ 
salpinx, with thickened broad ligaments and enlarged 
stiffened uterus. The specimen (pelvic organs) post¬ 
mortem was carefully examined, the stump was appa¬ 
rently securely held by the silk ligatures, still t» ritu, 
the end of the stump swollen and its margins recurved; 
the uterine artery was tested by injection, water oozed 
through the vessels of the stump, but a thicker pig¬ 
mented starchy solution would barely pass. Shrinkage 
of the stump and probably difficulty in securing the 
proper constriction of thick rigid tissues, rendered tense 
by forcible traction during operation, explained the 
incomplete, heemoetasia. The results in the cases of 
removal of the appendages with vaginal fixation for 
retroversion affected by anterior vaginal section, were 
too recent to report upon. In sixteen cases there had 
been one death from haemorrhage. A summary of the 
difficulties and dangers would lead one to advocate the 
exclusion of densely matted and thickened appendages. 

Dr. Bcbton congratulated Dr. Briggs on the way in 
which he had brought forward his paper. He had not 
himself opened Douglas’s pouch for hsematoceles, as all 
his cases during the year had got better without, and he 
agreed with the reader of the paper that they generally 
did if left alone. At the same tune he was of opinion 
that by operation the patient’s stay in hospital would 
often be shortened. He had opened the peritoneum per 
vaginum himself six times during the year, for inflamma¬ 
tory tubal affection, removal of enlarged ovaries, and 
once for removal of a dermoid containing about 12 ozs. 
of fat, there was less shock than by the abdominal route. 
He was rather enamoured of the operation, as by it a 
scar was avoided, as was also danger of ventral hernia in 
cicatrix. 

Dr. Gbimsdals said that he considered that owing to 
the want of aoourate diagnosis in pelvic disease the 
vaginal operation should be limited to the most simple 
oases. Slight errors in accurate diagnosis were more 
likely to assume graver proportions during vaginal oper¬ 
ations than during abdominal operations. He did not 


suppose that anyone would contend that the actual 
opening of the peritoneum was safer in one spot than in 
the other. The ease of the operation would, therefore, 
be in the long run, the measure of the safety of any par¬ 
ticular method of attack. 

Drs. E. T. Davies and Gemmell also made remarks, and 
Dr. Bbioo8, in reply, stated that the advantages of the 
vaginal route were indisputable in suitable cases. 


WEST LONDON MEDICO-CHIBURGICAL 
SOCIETY. 

A Clinical Meeting was held in the Society’s RoomB at 

the West London Hospital, Friday, March 3rd, 1899. 

Dr. S. D. Clippinqdale, President, in the Chair. 

Dr. Andrew Elliot showed a case of well marked 
locomotor ataxy in a women. Mr. William John asked 
a question. 

Mr. McAdam Eccles showed tor Dr. G. P. Shuter a 
woman who was a Burvivor of the Faversham detonator 
explosion She had lost her sight, and suffered amputa¬ 
tion of the left forearm. 

The President showed a young woman who exhibited 
a want of development of the forearm and hand. 

Mr. Howland Pollock showed two brothers with 
multiple want of development of hands and feet 

Mr. McAdam Eccles showed a man with marked arrest 
of growth of the right upper limb 

These cases of deformity were admirably demonstrated 
on the fluorescent screen by Dr. F. H. Low. 

Remarks were made by Messrs. H. P. Potter, E. P. 
Paton, P. Abraham, F. Savory, W. C. Musson, and 
Vaughan Pendred. 

Mr. Brindley James showed a young man with a 
deep sulcus above and behind the upper part of the 
manubrium stemi. Messrs. McAdam Eccles, and E. P. 
Pator made remarks. 

Dr. Andrew Elliot for Dr. Seymour Taylor showed 
a man who presented many of the symptoms of myxce- 
dema. 

Mr. McAdam Eccles showed a man with a marked 
nevoid condition of the penis and scrotum. 

Mr. Vadohan Pendred exhibited (1) a girl, set. 19, 
who had marked symptoms of what appeared to be 
pseudo-hypertrophic paralysis; (2) a case of possibly 
early acromegaly. 

Dr. Arthur Haydon discussed the cases. 


JCumtcp Department. 


ROYAL EDINBURGH LUNATIC ASYLUM. 

The Annual Report of the Edinburgh Royal Asylum 
for the Insane has always been looked forward to of late 
years with interest by all interested in the management 
of ^asylums and the treatment of the insane, for especially 
in Scotland is Momingside looked to as a plaoe of light 
and leading, and Dr. Clouston as an advanced and 
original thinker and observer. The prosperity of Mom¬ 
ingside everyone hopes for, for many excellent advanoee 
have been made in the last twenty-five years—the period 
of Dr. (Houston's regime —in the direction of more liberal 
treatment of the insane and more skilled methods of 
treatment, so that the present advanced methods which 
distinguish many asylums are largely due to the promul¬ 
gation of Dr. Coul8ton’s ideas of the hospital, as distinct 
from the old asylum, as the proper conception of the 
treatment of insanity. One therefore looks with interest 
for the annual report of Dr. Clouston to learn what 
he may have to say. It is not so much that he often 
appears to be original in his views, for it may truly be 
said of many that here there is really nothing new under 
the sun, but that he dresses them up in such an attrac¬ 
tive garb so as to give the freshness of a new dressing or 
new fashion to the idea. For example, he repeats the 
statement that cases are now sent more readily to 
asylums, and it has been stated time and again by 
others in their annual reports, vis., that the number of 

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Mab. 15, 1899. 


GERMANY. 


The Medical Press. 271 


admissions to asylums increases, not mnch from increase 
of insanity, but from a more favourable conception in 
the public mind of the resources and conditions of 
asylums. The generally accepted fact that there are 
many degrees of insanity, and there are as well many 
degrees of sanity, Dr. Clouston expresses in this way: 
—“ It is getting better understood that many forms of 
mental disease are just morbid aooentuations of 
natural disposition — in one case, temper shading 
off into mania; in another, keen sensitiveness of 
feeling passing into melancholia ; and in a 
third, suspiciousness verging into insane delusions 
so that the subjects of such changes become unfit 
for family or social life. The world is getting too 
busy to be able to attend to its mental breakdowns at 
home, and it is getting more intolerant of very marked 
divergencies from social order and even of the neglect of 
the conventionalities of life. The man with typhoid 
fever is now more frequently sent than he was formerly 
to an infectious hospital on account of the risk to others. 
For somewhat the same reason a patient who from 
morbid peculiarities is causing a mental strain and risk 
of breakdown in other members of bis family is sent to a 
mental hospital.” The outcome of this seems to be, and 
it is one real explanation of much of the so-called 
increase of insanity, that human nature has become more 
selfish. Men and women are not willing to deny them¬ 
selves their comforts, luxuries, and ease : and their social 
enjoyments for the sake of their less fortunate brothers 
and sisters. If this is true it is as well to face the matter 
honestly, and, instead of continually trying to throw the 
blame on other and wrong causes, to acknowledge the 
fact and, therefore, to admit that we must pay for our 
selfishness. 


Jfrance. 

[from OUR OWN CORRX8PONDKNT.] 

Paris, March 18th, 1890. 

Surgical Anesthesia in Urinary Affections. 

M. Bazy drew attention to the modes of anaesthesia in 
the surgical treatment of the urinary tract, these being 
local, general, and mixed. Local anaesthesia rendered 
incontestable services, but he was of the opinion that the 
employment of oocaine was not unattended with danger, as 
hehad heard of cases in which the injection of a solution of 
cocaine into a health y bladder was followed by a fatal result. 
However, he himself had introduced very large doeee of 
oocaine into diseased bladder for a considerable time, and 
without any inconvenienoe to the patient, yet he did not 
feel warranted in disregarding the accidents experienced 
by others, and at the present time in the very rare cases in 
which he used oocaine in exploring the bladder he did not 
inject more than two grains. On the other hand, he used 
freely cocaine in affections of the urethra at a dose of 
1 — 100 . 

In very nervous persons he had recourse to the mixed 
form of ajuetheeia; concurrently with the local applica¬ 
tion of oocain, he gave a few drops of chloroform in 
inhalation, just enough to allay the fears of the patient 

For general anaesthesia he employed chloroform, ether, 
or bromide of ethyl. Although he preferred the chloro¬ 
form, he used ether in young persons of weakened con¬ 
stitution and chloroform in elderly patients, and who 
in general supported ether badly. As to bromide of 
ether, he reserved it for operations that took but a short 
time to execute, such as internal urethrotomy, phymoeis 
and some cases of lithotrity. 

The effect exerted by chloroform on a healthy 
bladder was rapid and continued, even in small doses. 
The organ was patient and tolerant, and did not present 
those irregular contractions which hindered so much the 


surgeon and obliged him to suspend the operation until 
the muscular walls had become flaocid. The influence 
of the anaesthetic on the urethra in its three divisions is 
well marked, allowing catheters of considerable dimen¬ 
sions to pass through a canal rendered rigid and tortuous 
by a diseased or enlarged prostate. 

The Treatment of Appendicitis. 

M. Tillaux in referring to this constantly recurring 
subject at the Academy of Medioine, said that he pro¬ 
tested against the declaration of his colleague, M. 
Dieulafoy, that no one should ever die from appendicitis, 
for it was in contradiction with facts observed by him 
and many others of his colleagues almost daily. He 
similarly protested against the aphorism that there was 
no medical treatment of that affection. On the oontrary 
they all knew that the greater number of appendicitis 
terminated in resolution. The medical treatment 
was not therefore a chimera, for it was frequently 
successful. An operation should only be performed 
where the formation of an abscess was suspected, and the 
time for executing it was when the acute symptoms had 
subsided, that was to say, d froid. It was there, in his 
opinion, that consisted the great progress in the treat¬ 
ment of appendicitis. They knew to-day that that affec¬ 
tion was subject to relapses, more or less frequent, and 
that the first attack was less grave than those that 
followed. 

Consequently it was the imperative duty of the sur¬ 
geon to propose the ablation of the appendix to subjects 
who had had their first attack, for the return to health 
was always incomplete, and the patient was consequently 
exposed to a serious relapse. 
k Blbnorrhagia. 

Menthol, 1 gr. 

Salicylic acid, ii gr. 

Phenic acid 
Lactic acid 
Essence of eucalyptus 
Salicylate of methyl 
Resorcin, x gr. 

Water, 5»v. 

This formula is based on the principle that a mixture 
of several antiseptic agents is endowed with more ener¬ 
getic properties than one of those substances employed 
in strong doses. 

Half a syringe is injected twice a day. 


iv gr. 


(Sermattp. 

[from our own correspondent.] 

Berlin, March 10th, 1899. 

Surgery of thf Stomach in Cancer and Ulcer. 

Prof. K ocher, of Bern, whose experience in the sur¬ 
gery of these diseases is probably second to none in. the 
world, gives (Deutach . Mid,. Zeit., March 9th, 1899) 
an interesting aooount of the present state of 
this subject. The indications given by him for 
operation are practically those formulated by Leube 
at the Surgical Congress, 1897, adding, however, 
that it is also indicated in cases where violent 
pains and vomiting persist after a lengthened course of 
careful internal treatment. One should not wait until 
the patient has exhausted nearly all his strength by 
haemorrhages or exoeesive digestive disturbances. Opera- 


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272 The Medical Press. 


GERMANY. 


Mae 15, 1899. 


tion should be considered as a refuge, but not as a last 
refuge. 

As regards the choice of operation, the author only 
recommends simple excision of uloer when it is well cir¬ 
cumscribed and surrounded by healthy structure. With 
simple pain and dyspepsia gastroenterostomy or pyloro- 
plastique is sufficient, but when there is haemorrhage 
partial resection is called for. 

If there is suspicion of carcinoma—and there always 
must be when the patient is elderly and the pains have 
lasted long—laparotomy is indicated, even when there is 
no palpable tumour and the chemical composition of the 
gastric contents is not greatly altered. The earlier the 
operation the better are the prospects of permanent 
recovery, and with the small amount of danger 
associated with exploration, the operator has no need to 
reproach himself even when nothing is found, and the 
pain is discovered to be neuritic, especially as such pains 
are frequently surprisingly relieved by exploration. 

How far the carcinoma has advanced still to justify 
operation must be judged by the individual case, but 
Prof. Kocher has seen cases where there were metastasis 
in the adjoining peritoneum, and with lymph tracts 
that could not be removed, when the disease thus left 
behind retrogressed after operation. The more widely 
an operator extends his indications for operation, the 
more unfavourable will be the results. 

Besection with subsequent gastroduodenoBtomy has 
given the author the best results: complete closure of 
the wounds of the stomach and duodenum, and then 
implantation of the duodenal wall int j the stomach, with 
silk (not catgut) sutures, and without Murphy’s button, 
as when this is used there is no guarantee that it will^e 
ultimately expelled. 

He promises shortly an exhaustive report on his 
stomach operations, saying at present only so much, that 
on the basis of his own statistics, with resection and 
gastro-duodenostomy, he can promise with a probability 
bordering on certainty, a favourable result in all uncom¬ 
plicated cases of carcinoma of the stomach. 

ECLAMP8IA. 

Dr. Carl Winkler has a paper on this subject in 
Virchow's Archiv. 154, 2, based on nine cases observed 
by him, in which a careful microscopic and histological 
examination was carried out. His main conclusion is 
that eclampsia is ah intoxication of the organism with 
the products of tisane .change. The occurrence of the 
intoxication is connected with a serious change in the 
kidneys, which are Anatomically considered as the one 
fixed point in the disease. The kidney disease is a 
glomerulo-nephritis, it manifests itself in swelling of the 
glomeruli, excessive fatty degeneration of the epithelium 
among them, the tortuous and straight canaliculi, exuda- 
dation into the lumen, and haemorrhage into the 
parenchyma 

The glomerulo-nephritis may be an exaggeration of 
the physiological alteration of the kidneys that occurs 
during pregnancy or a recurring chronic nephritis. Here 
the grave symptoms are brought about by exacerbation 
of the disease and overburdening of the kidneys in the 
act of birth. 

Along with these fundamental changes a Beries of 
others are observed, necrosis of the parencyhma of the 
liver, cell, emboli. Ac. These changes are not all con¬ 


stant, they are not characteristic of eclampsia, and to 
some extent they are results of the attacks of eclampsia 
or of the pregnancy itself. 

Limitation or Abdominal Section bt Anterior 
Kolpoccbliotomt 

Is the title of a work of 266 pages just published by A 
Duhrssen. The aim of the work is stated by the author 
to be “ to help truth to its rights,” but this may be said 
to be the aim of all books. I bring the book before the 
notice of your readers not because I endorse all the 
writer says but rather as an illustration of how things 
may be carried by an enthusiast. I would not minimise 
Duhrssen’s deserts in the least, he has done as much as 
most men of his years for the advancement of his 
specialty, but one cannot help wondering sometimes 
whether with some people enthusiasm may not get the 
better of judgment. 

In a tabular form he gives a review of 461 cases of 
vaginal abdominal section, 359 of them were vaginal 
fixation for retroflexion of the uterus, 35 vaginal fixations 
of the round ligaments, 6 vesical fixations for retroflexion 
of the uterus, 73 vaginal adnexa operations and operation 
on the uterus for anteflexion, 18 vaginal cceliotomies for 
tubal pregnancy. In 16 further cases the attempted 
vaginal operation had to be completed through the 
anterior abdominal wall or by hysterectomy, 15 cases 
died, 2 of them belonging to the latter group. No 
death occurred in the group when simple retroflexion 
was reduced by vaginal fixation, and so far it seems a 
safer operation than that of shortening the round liga¬ 
ments, but whether it is as effectual as a method of treat¬ 
ment time alone can show. What strikes one as remark 
able is the enormous number of vaginal cutting opera¬ 
tions for the comparatiyely harmless and easily treated 
condition of retroflexion of the uterus. Evidently 
gynrecology is becoming even more and more surgical - 
As regards this operation the author himself thinks some 
excuse necessary, for he compares retroflexion with 
hernia without symptoms, and he asks whether any 
competent surgeon would advise a patient who suffers 
from hernia without symptoms to leave it alone. 

He suggests that midwives should be instructed to 
direct all their patients to go to a doctor to be examined 
14 days after their confinement. By doing so any post¬ 
partum retroflexion could be put right in good time- 
He is not in favour of the use of pessaries, which rarely 
lead to a cure of the condition. 

After describing the indications for anterior vaginal 
cceliotomy afforded by various diseases of the uterus, 
adnexa and pregnancy, he describes the method of 
artificially inducing Bterility by vaginal resection of the 
tubes. In this way he has operated on 26 women, and 
so far he has only met with one case that was not success¬ 
ful. He based his procedure on the standpoint that the 
introduction of artificial sterility is not only permitted, 
but demanded in the cause of humanity under certain cir¬ 
cumstances and conditions, and in suoh cases vaginal 
resection ia the most suitable way of bringing the 
condition about. 


The Plymouth Guardians have at length decided 
to build a new workhouse infirmary, and have opened 
up for consideration the question whether they shall 
not build a new workhouse as welL 


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Mah. 15, 1899. _ THE OPERATING THEATRES. 

Jlustrin. 


[tbom our OWN CORRESPONDENT.] 

Vibnna, March 11th. 18V9. 

CAMPHOR AND PULMONARY TUBERCULOSIS. 

Camphor has been employed to protect the person 
Against attacks of different diseases from early times, but 
has often been condemned in our more recent literature 
as a worthless agent for antiseptic purposes. Bruno- 
Alexander has been experimenting with camphor, and 
-comes to the conclusion that it is a valuable drug in pul¬ 
monary tuberculosis. When administered subcutaneously 
he finds it to be an antihydrotic, antipyretic, and 
effectual in checking purulent discharges and sputa 
formation. It does not impair the digestion in phthisical 
-cases, but on the contrary improves the appetite, while 
it reduces the hyper-reflex action and thus e&ectually 
checks the irritable cough that usually accompanies the 
-disease. The oil of camphor must be administered in 
small doses of 0*1 to 0-2 of a cubic centimetre (Germ- 
Phar.) daily, which would contain about 0 01 to 0 02 of 
camphor. 

This treatment should be applied without intermission 
for four or six weeks, when a pause of one or four weeks 
may intervene before recommencing. If the patient have 
no fever 0 3 to 05 cubic centimetres of the oleo-camphor 
{German Pharmacopoeia) may be given for eight or four¬ 
teen days, when an interval of eight days should be 
made. These patients can often be given one cubic 
centimetre of camph.—equal to 0‘1 gramme of camphor 
—at one dose daily. The treatment should be continued 
acme time after improvement has been established. 
Hamoptysis is no barrier to the use of the drug. 

Erysipelas and Metacresolanytol. 

The therapeutic value of metacresolanytol in erysipelas 
seems, from Keizer’s experiments, to be that of a powerful 
antidote. Loftier drew attention to anytol and anytine 
some time ago as antidotes, but from more recent experi¬ 
ments the metacresolanytol appears from the evidence 
of Kolzer to be still more potent. He produced erysi¬ 
pelas artificially in the ears of guinea-pigs with strepto¬ 
cocci and'mouse septicaemia bacilli. When the florid 
inflammatory rash was induced, a quarter of a o.c. of a 
three per cent, solution was injected well into the car¬ 
tilage with the best effect. The same result could be 
obtained by painting the surface every five minutes for 
two hours with a piece of cotton steeped in the solu¬ 
tion. The control animals throughout proved to be 
-still suffering from a dangerous virulent infection after 
all symptoms and danger had disappeared from the 
protected animals. He has treated five human beinga 
with the drug, and obtained wonderful results. Paint¬ 
ing with the solution causes a brownish colouring with 
swelling of the Bkin. Further experience is necessary 
to oonfirm these results. 

Recurrent Fevxb and Anti-Spirochbtic Sebum. 

.. Lowenthal, who has recently been devoting his atten¬ 
tion to the subject of recurring fever, relates the result 
of 84 cases which he has treated with ariti-spirochetic 
serum. On an average 18 45 c.c. of the serum was used. 
In the 84 treated 47 per cent, had no relapse, 37 3 per 
-cent, had one relapse aftet injection, 11M per cent, had 
two telapses. Under ordinary treatment' with drugs 
128 percent, had one paroxysm, 329 per cent, had two 
paroxysms, and 46-6 per cefit. had three paroxysms 


The Medical Pb esb. 273 

Onoe in 328 injections an abscess formed in the abdo¬ 
men. 

The frequency and quality of the pulse suffered no 
alteration by the injections, while hepatic and splenio 
enlargement was rarely met with. In 131 injections a 
general rash with swelling of the joints and albumi¬ 
nuria with cylinders appeared twice. The so-called 
albuminuria febriles was temporary, and passed away 
after the serum treatment was stopped without leaving 
any bad effects. 


^he Operating theatres. 


HOSPITAL FOR WOMEN, SOHO SQUARE. 

Debmoid Cysts of the Ovaries — Mr. S. Osborn 
operated on a woman, set. 38, who had been married 
nineteen years, having had four children, the last five 
years ago. The patient had noticed her abdomen getting 
bigger during the last eighteen months; at one time she 
thought she was pregnant. For the last five months she 
had a burning continuous pain in the hypogastrium, 
which was only relieved when she laid down. There were 
no pressure symptoms; the bowels acted well, and 
micturition was normal/ For the last five months she 
had suffered from sickness, generally the first thing in 
the morning. The catamenia had been regular, profuse 
during the last eighteen months, lasting about six days 
and being accompanied by very little pain ; there was no 
oedema of the feet. After examination a diagnosis was 
made of ovarian cyst, and it was decided to perform 
ovariotomy. Mr. Osborn pointed out the patient’s sister 
had been operated on for ovariotomy some ten years 
previously at St. Thomas’s Hospital. A median incision 
about 4 inches long was made and the abdomen opened. 
A cyst rather larger than a cricket ball was easily 
removed from the right side, and then a corresponding 
one from the opposite side, this last one being a little 
smaller than the first. Both the cysts shelled out 
easily. Both the pedicles were ligatured with Japanese 
thread, and the abdomen was closed without flushing as 
the cysts had been removed entire. The cyst on the 
right side contained matted hair, with hair also grow¬ 
ing from the inner wall; the cyst on the left side was 
about the size of a tangerine orange, and contained 
some hair, but its contents consisted mostly of gelatinous 
material. Mr. Osborn said the interest of the case lay 
more especially in the fact of a dermoid ovarian cyst 
existing on both sides and the woman having had 
children. He pointed out that the hair in the larger 
cyst was matted together in a similar manner to the 
stuffing of a cricket ball, and that hair was also grow¬ 
ing-from the interior of the cyst wall. He considered, 
also, that an interesting point with regard to the case 
was the fact of the patient’s sister having been operated 
on for a similar complaint some years ago. 

It is satisfactory -to -record that the patient never had 
a bad symptom after the operation, and made an unin¬ 
terrupted recovery. 


£>r. Hogarth, in practice at Ilfracombe, was found 
dead in his moms on March 9th, with a bottle con¬ 
taining poison by his side. He had only been in Ilfra¬ 
combe about ten months, having for many years 
previously been in practice at Cheltenham. No motive 
can at present be attributed for the act. 


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274 The Medical Press. _ LEADING ARTICLE8. 


Mas. 15, 1899. 


Registered for Tbabsiiissiob Abroad. 


<&ht Jftebical ftoss mb Circular. 

Published every Wednesday morning, Price 5d. Poet free, 5id. 

ADVERTISEMENTS. 

Fob a Series of Ibbertiobs Whole Page, thirteen insertions 
(weekly, fortnightly, or monthly), at £8 10s. 6d. : twenty-six 
insertions (weekly or fortnightly) at £3 3s. Od. : fifty-two 
insertions (weekly) at £3 each. Half Page, thirteen insertions 
at 36s.: twenty-six at 82a.: flfty-two insertions at 80s. each. 
Quarter-page, thirteen insertions at 18s.: twenty-six insertions 
at 16s.: flfty-two insertions at 15e. each. One-eighth page, 
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For Obe Ibskrtiob Whole Page, £S Os. Od.: Half Page, 
£2 10b. Od.: Quarter Page, £15e.: One-eighth, 12s. 6d. 

Small announcements of Practices, Assistances, Vacancies, Books, 
Etc.—Seven line? or under, 4s. per insertion ; 6d. per line 
beyond. 

Letters in this Department should be addressed to the Publishers. 


cPtebical fir ees mb Circular. 


41 8ALD8 POPULI SDPREMA LEX.” 


WEDNESDAY, MARCH 15, 1899. 


THE GENERAL MEDICAL COUNCIL. 

A meeting of the Executive Committee of the 
Co un cil was recently held at which several important 
matters were touched upon. The Committee had 
been entrusted by the Council with the conduct of 
an inquiry into the alleged illegal issue of certificates 
of proficiency in medicine, surgery, or midwifery, but 
the Committee decided to recommend that, as the 
Midwives Bill is now before Parliament, it should at 
present refrain from taking any action. As regards 
the certificates granted to spectacle makers it is 
obvious that the Council has no jurisdiction over 
opticians, but the Council would be prepared to 
oonsider any properly substantiated charge of 
improper conduct made against a registered medical 
practitioner in this connection, an intimation which 
we commend to the notice of those whom it may 
concern. The most interesting subject was that of 
the employment by medical men of unqualified^dis- 
pensers, which had been brought to the notice of the 
Council by various communications. After dis¬ 
cussing the subject the Committee arrived at the 
following halting and illogical conclusion—viz., 
that the Privy Council advised that while occa¬ 
sional accidents may arise from the employment 
by medical practitioners of careless or incompetent 
dispensers, the cases, in their opinion, are very rare, 
and the committee hold that probably the beet pro¬ 
tection is afforded to the public by the responsibility 
of the practitioner for the acts or defaults of the 
servants whom he employs. First of all, it must be 
apparent to everyone that the oommittoe, in assuming 
that such accidents are very rare, is jumping to a 
conclusion. No data other than the published law 
and inquests reports are open to its members, and no 


weight is given to the fact that in any case only fatal 
cases are likely to become publio. Moreover, in the 
majority of instances, it must be easy for the 
practitioner to hush the matter up, a course which 
he has every inducement and every facility to adopt. 

A more straightforward way of dealing with thie 
important question would be to state formally that 
the matter is not one which comes within the scope 
of the Council’s jurisdiction, though none can ques¬ 
tion that if so minded the deliberate employment of 
incompetent dispensers might legally be declared by 
the Council to be inconsistent with the duty of the- 
practitioner towards the public. We shall await with 
considerable interest the view taken by the Council 
of this recommendation. 

We' are pleased to see that a feeling is gaining 
ground in favour of reciprocity of practice as between 
Italian and English physicians. A letter has beam 
received, via the Privy Council, from the Italian 
Ambassador, asking whether, without obtaining a 
fresh diploma, Italian physicians can exercise their 
profession in this country, or at least attend on 
foreigners resident in Great Britain, and whether, if 
the answer to this question be in the negative, Her 
Majesty’s Government would be willing to grant; 
permission to Italian physicians so to do if the Italian 
Government would grant similar privileges to English 
physicians residing in Italy. The Committee decided 
to inform the Privy Council that they would welcome 
such a recognition of English practitioners in Italy 
as would enable Her Majesty in Council under Sec¬ 
tion XYir. of the Medical Act, 1886, to extend 
similar privileges to Italian practitioners in this- 
country. 

A communication was read from the Home Offioe- 
stating that fresh legislation would be required to 
alter existing arrangements in respect of the allocation 
of penalties incurred under the Medical Act, 1858, 
within the Metropolitan Police district, but the 
Home Secretary did not see his way, for the present 
at least, to introduce a Bill for the purpose. 

The Russian Ambassador having asked to be 
furnished with information as to the law of thie 
country in regard to the professional secrecy of 
medical practitioners, Mr. Muir Mackenzie was- 
requested to formulate an opinion, from whioh it 
appears that on the question of violation of profes¬ 
sional secrecy a medical man is in no more favoured 
position than anyone else, and, further, that circum¬ 
stances which, according to the custom of the medical 
profession, might be deemed to exonerate him from 
the imputation of improper violation of secrecy might, 
nevertheless, in a court of law, be deemed an insuffi¬ 
cient justification. This oracular, but somewhat 
ambiguous, pronouncement does not throw much 
light on this very delicate and important question, 
but we hope next week to be able to find space for 
the full text of this opinion. 

In respect of the identification of registered 
practitioners the Committee recommend that no 
application for the restoration of names of persona 
who have been removed from the Register shall be 
entertained unless it be accompanied by a Statutory 


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Mae. 15, 1899 


LEADING ARTICLES. Ths Medical ^kess. 275 


Declaration made by the applicant setting forth the 
facts of the case, and stating that he is the person 
originally registered, and by a certificate from a 
clergyman or magistrate or registered practitioner 
as to his identity. We are fain to confess that we 
doubt the trustworthiness of this precaution, which 
does not appear certain to offer complete security 
against personation. Among the other matters 
which came before the Committee was the promulga¬ 
tion of the conditions under which the documents, 
the property of the Council, shall be made accessible 
to members of the Council who may desire to take 
cognizance thereof. These are very fair, and will go 
far to undo the mischievous impression created by 
the ill-advised and arbitrary action of the President 
on a recent occasion. 

An opinion which strikes one as curious was 
received from Mr. Muir Mackenzie to the effect that 
it would not be legal to add to the name of a practi¬ 
tioner registered in the list of colonial practitioners 
of a British qualification which he had obtained. 
We can only ask, if not, why not ? 


THE IRISH UNIVERSITY QUESTION. 

Although the proposal to erect and endow a 
special Catholic University for Ireland is much too 
strongly redolent of religion and politics to be dealt 
with in an unsectarian medical journal, it appeal's to 
have so intimate a relation to higher medical educa¬ 
tion in Ireland that we desire to put before our 
readers a plain statement of the case which, indeed, 
is not accessible to the readers of Irish newspapers, 
every one of which is the exponent of and partisan of 
one or other politico-religious view. In August, 
1850, fifty years ago save one, the Queen’s University 
was established in Ireland, the principle of which 
was absolute unsectarianism. The teaching work of 
the University was provided for by the establishment 
of the three Queen’s Colleges in Belfast, Cork, and 
Galway, the University itself being a nominis 
umbra which occupied an obscure office in 
Dublin Castle. From the first day of the inception 
of this system the Catholic Hierarchy, and the large 
population which followed their dictates, set them¬ 
selves to “ boycott ” the Queen’s Colleges on the 
ground that they were “godless,” i.e., secular, 
and their efforts proved quite effectual, save in the 
case of Belfast, where the write of the Catholic Hier¬ 
archy do not run with as great authority as elsewhere. 
To emphasise this hostility to unsectarianism, the 
Catholic University as it now exists was opened 
on November 3rd, 1853, but it has carried on its 
functions, ever since, as a purely teaching institution, 
lacking Charter powers to confer degrees of any 
sort. On November 3rd, 1882, the Government of 
that day made a further effort to conciliate the 
Catholic Hierarchy by abolishing the Queen’s 
University and substituting for it the Royal, an 
institution strongly flavoured with thorough-going 
Catholicity, but managed by a mixed Senate, 
in which the Belfast Nonconformist party have 
a potent voice. The “ Royal ” has, in the eighteen 


yea re of its life, been exoellently administered, and 
has preserved the standard of education in Ireland 
exceedingly well, but, after all, it is only an examin¬ 
ing body, and does not teach anything, and—irre¬ 
deemable sin—it is not purely and wholly Catholic 
in its constitution. It is enough to say that the 
Catholic Hierarchy, after more than half a century 
of effort to settle the University question in Ireland* 
are just where they were, clamouring for a University 
which shall be under their control but supported out 
of the public funds. The question is, therefore, by 
their attitude, converted into one, simply, of deno- 
minationalism against secularism. They insist that 
the Catholic population cannot be expected, and ought 
not to be permitted, to study or graduate anywhere 
save in a Catholic sectarian University. The Protestant 
party on the other hand fight against denominationa- 
lism of any sort as being the setting up, for all time, of 
an impassable barrier between the religious parties in 
Ireland, and the consequent perpetuation of social 
and political rancour. The Government, if Mr. 
Balfour speaks its mind, wishes to conciliate the 
Hierarchy and, to that end, is trying to bribe off the 
opposition of the Northern Protestants, as he bought 
off the resistance of the landlords to the Local 
Government Bill, by promising money for the 
establishment of a special Belfast University, but 
the bait has not been jumped at as might have been 
expected. 

Our readers may at once clear the ground for the 
consideration of this subject by getting it out of 
their heads that any one in Ireland, be his religion 
what it may, suffers from any real educational 
disability whatsoever. There is not alleged to be 
the slightest hindrance to any Irishman obtaining 
the best education on the cheapest terms or the best 
degrees which he may wish for, save a sentimental 
grievance which we admit is none the less, material* 
In the very heart of Trinity College, a Catholic student 
may compete for and win and enjoy every distinction 
and monetary advantage which one of other religion 
can aspire to, and, as far as we know, his social life 
is made as pleasant to him by his brother students as 
is possible. Nevertheless, the Catholic Hierarchy 
have justice for their complaint that a Catholic 
student in Trinity College breaths in an uncongenial 
“ atmosphere,” just suoh as a Protestant student, if 
permitted, would breath a Catholic mther at May- 
nooth. Indubitably Trinity College (which is the 
University of Dublin), is, for the Catholic, offen¬ 
sively Protestant in tone. It has a Protestant 
Chapel in its grand square, and a subsidised School 
of Divinity of the Church of Ireland, and it ie 
governed by a Board of Fellows, and a Council 
of whom, we believe, not one is a Catholic, or, under 
existing circumstances, is likely to be. Clearly the 
straightforward, statesmanlike way out of the educa¬ 
tional impasse would be to make the University 
of Dublin the National University, removing from it 
at one swoop, all these anomalies, reforming, with 
liberal hand, the constitution of the governing bodies 
and, in fact, making the University perfectly free to 
allcomers without a suspicion of religious bias in 

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276 The Medical Press. NOTES ON CURRENT TOPICS. Mae. 16, 1899. 


any one’s favour. But this will not be done. The 
Catholic Hierarchy would not aooept such settlement, 
because it would deprive them for ever of the 
grasp which they desire to retain on education in 
Ireland. The University itself would also resist, 
because the change would involve reform which, of 
all things, it dreads most, and therefore its Parlia¬ 
mentary representatives will vote a sectarian Univer¬ 
sity when the time comes. The Government will, no 
doubt, do whatever is opportunist. It will throw 
Irish education to the strongest political party, just 
as it threw the vaccination question to the anti- 
vaccinationists. If Mr. Balfour finds that the Scotch 
and Welsh Nonconformists and the contingent of 
Protestants and Secularists in the House of Com¬ 
mons are too strong for him, he will find reasons to 
drop the subject, and the Catholic Hierarchy will be 
remitted to another quarter of a century of agitation 
and Trinity College to the same period of inertia. 


THE SURGERY OF THE EPIPHYSES. 

Among the manifold achievements of modern 
scientific medicine the more brilliant results have 
undoubtedly fallen to the lot of the surgeons. In¬ 
deed, it has been claimed with a not inconsiderable 
show of reason, that the days of the pure physician are 
numbered — that is to say, in other words, that he will 
be ousted by the surgical craftsman. Should that pro¬ 
cess of extinction occur it will undoubtedly also be 
hastened to no small extent by the raised standards 
of general health that stand like signal posts 
to mark the onward march of the sanitarian. Mean¬ 
while, surgery itself is becoming yearly a more and 
more perfect art, with an increasingly accurate 
knowledge of details, and a wider application 
of general principles. Nowhere, probably, has 
the surgeon made greater strides of late than in 
the surgery of the epiphyses. Until lately all 
information upon this class of injury was of 
the scantiest and most meagre description, derived 
from the comparatively rare evidence afforded by 
operations and by museum specimens. Now, how¬ 
ever, all that has been changed by the advent of the 
Rontgen method of diagnosis, which permits the sur¬ 
geon to investigate with ease and accuracy every case 
of epiphyseal injury with which he may be confronted. 
The obscurity and the complex nature of traumatism 
of the kind are naturally great, a fact which is ex¬ 
plained by the frequent combination of complete 
or partial separations with fractures of every possible 
kind and direction, both of the shaft and of the 
epiphyses themselves. The bulk of these injuries are 
inflicted during the age of growth, and date from the 
intra-uterine period up to about twenty-three years 
of age, the greater incidence being between the ages 
of twelve and eighteen. Keeping this age-incidence 
in view, the common occurrence of subsequent 
deformities will be readily understood, as by 
such injuries growth will be arrested, and the 
relations of joints altered by the various nutri¬ 
tional and anatomical changes that are en¬ 
tailed in and around long bones and- joints. It 


is only of reoent years, however, that surgeons 
have begun to recognise the nature and the import¬ 
ance of these lesions, from causes doubtless nearly 
connected with the above - mentioned difficulty of 
obtaining direct evidence. Mr. John Poland, who 
has just published a classical monograph on the 
subject, puts the matter as follows:—“ Eyen at the 
present day,” he writes, “ we see that there are very 
contradictory opinions with regard to these injuries; 
one surgeon detects them very frequently, while 
another never does so, or only admits that they are 
rarely met with. This difference of opinion has been 
due in part to the absence hitherto of direct 
examination in a large proportion of cases, and in 
port to the ease with which the epiphyseal separation 
may be confused with dislocation or fracture of the 
end of the diaphysis.” But the surgeon is in this 
instance indebted to the marvellous discovery of 
Rontgen not only for diagnosis, but also for valuable 
indications as to the need of operative measures, and 
of the subsequent progress of the case. In the whole 
range of surgery there has been no one particular 
field in which the application of the new method of 
diagnosis has been attended by moie brilliant 
and mox-e immediate results. Moreover, it must 
be remembered that many other pathological 
conditions involving the epiphyses may be dis¬ 
closed with equal directness and certainty. Mr. 
Poland has been the first to apply the Rontgen 
methods systematically and universally to the investi¬ 
gation of epiphyseal separations, and he has been 
enabled thereby to bring the labours of many years 
to a triumphant issue. Had the discovery of the 
Wurzburg .Professor resulted in no other practical 
gain to humanity than in this matter of the bony 
epiphyses, it would have vindicated its claim to a 
permanent niche in the Temple of Fame. Yet it is 
only a little over three years ago that the news of 
these wonderful rays ran like wildfire through the 
length and breadth of the scientific world. Despite 
of all that has since been done by workers in many 
directions, it seems likely that we have scarcely 
passed the threshold of the new art. Meanwhile, 
epiphyseal surgery has now been established, thanks 
chiefly to radiography, upon a sound and unassail¬ 
able basis. 


states on (Current topics. 

The Great Atropine Poisoning Case. 

The great sensation of the past week in Paris 
was the'trial of a faithless spouse on a charge of 
having attempted to poison her husband by the 
administration of atropine. From a medical point of 
view the interest lies in the employment for 
criminal purposes of such a drug as atropine, and the 
difficulties which surrounded the diagnosis. Grant¬ 
ing that no suspicion was entertained of the real 
nature of the symptoms, it is easy to imagine the 
number and variety of explanations suggested first 
by one doctor and then by another. Looking at the 
clinical tableau one wonders how it was that the 


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Mab. JL5, 1899. ,. _ NOTES OS CtJB^IN^ ^(j)PICS. _ Thb Medical Paxes 277 


dilatation of the pupils, the dryness of the throat, 
and the peculiar kind of delirium, did not excite a 
suspicion on the part of the medical man in atten¬ 
dance of possible accidental poisoning. It is pro¬ 
verbially easy to be wise after the event, but the 
case shows how necessary it is for a medical 
man to take a broad grasp of the situation, 
and not to reject an hypothesis merely because 
it is improbable. The French are very proud of 
the strictness of the regulations in respect of the 
sale of poisons, but nothing is easier than to 
forge a prescription, and though no chemist would 
supply a chance customer with such a poison as 
cyanide of potassium, this can be obtained by the 
pound by going to a dealer in chemical products 
instead of to a pharmacy. In this case the doctor 
was only put on the scent by the accused frankly 
asking him to give her a prescription for six grains 
of atropine on the pretext that it was wanted to 
make a colly rium for a pet dog, an explanation which 
was not thought adequate. An analysis of the urine 
promptly settled the matter by revealing the pre¬ 
sence of the alkaloid, and the removal of the patient 
to a home was followed by speedy recovery. 
Fortunately for society criminals of this class are 
generally blunderers, otherwise their discovery and 
conviction would often be a very difficult matter. 
It would, however, not be wise to congratulate our¬ 
selves over much in this connection, because, as only 
the blunderers are caught, it is possible that the 
cleverer rogues escape detection. 

The Liverpool School of Tropical Diseases. 

Two meetings of the Liverpool Association of 
Foreign Consuls have been held during the past few 
days for the purpose of explaining the objects and of 
promoting the interests of the proposed new sohool 
of tropical medicine. Prof. Boyce, at the request of i 
the consuls present, briefly explained the intentions 
of the Council with regard to the school. There 
were to be four courses of lectures every year, to be 
given to qualified men, each course lasting two 
months. They had now a laboratory second to none 
in the world, and they had already appointed able 
men to the various branches, and within the next 
few days he anticipated that they would have 
acquired the services of a lecturer on tropical diseases, 
who, by his long experience in the tropics, and his 
scientific attainments would extend the usefulness of 
the school. There would also be on the staff a pro¬ 
fessor of zoology. Liverpool, he thought, was the 
best place in the world in which to establish such a 
school, as they had examples of the diseases brought 
from all parts of the world. They also intended 
giving a particular training to missionaries for dis¬ 
tricts where there were no medical men. They 
would give them microscopes and encourage 
them in various ways. Then there would be 
the training of nurses, including black women, 
who would go back and help to fight these dreadful 
tropical diseases. From evidence furnished by the 
Medical Officer of Health, it appeared that the number 
of cases of malaria in Liverpool, 1897, was 242, of ’ 


b^ri ben,"14, of dysentery, 30, of tropical anemia, 39, 
squryy, I? In 1898 the number of tnalarial cdses was 
2$4, and the number increases from year to year. 
The material was therefore at their doors, and as the 
Royal Southern Hospital had placed a floor at the 
services of the committee, they had a ward and 
chemical laboratory wholly devoted to tropical cases. 
In less than ten days the ward and the laboratories 
would be ready, the one to receive patients, the other 
to investigate the condition of the blood and the 
excreta. Subsequently a resolution, proposed by 
Mr. A. L, Jones, was unanimously carried to the 
effect: ’ **''That this meeting of consuls expresses its 
appreciation of the great importance of the wort 
undertaken ,l>y the Liverpool School of Tropical 
Diseases, and' suggests that each consul bring the 
matterho the notice of his Government, and also 'of 
the medical' profession and others interested,” M 
such a way as may be best according to his judgment.” 

The Plague. 

The latest reports from India are very disquieting. 
A far higher death-rate from plague in Bombay has 
once more created quite a panic. The recorded mor¬ 
tality for the week exceeded eighteen hundred. 
These were wholly among natives; nevertheless, the 
richer and better classes have taken fright, and have 
been leaving the city as quickly as possible. The 
artisan classes are also following their example, so 
much so, that a serious commercial stagnation is 
looming in the distance. The death roll of this 
alarming visitation of plague has already exceeded 
two hundred thousand, while a very large number 
of natives secretly stole away from the city 
by night and have not since been heard of. The 
latest reports from the Kolar Goldfields show 
that the plague continues to spread in spite of 
strenuous precautionary measures. The panic among 
coolies continues, and the Mysore mine presents a 
desolate appearance, owing to the exodus of miners. 
The Secretary of State for India has received a 
further telegram from the Viceroy to the effect: 
‘‘That the hospital arrangements are excellent; 
evacuation and segregation being vigorously carried 
out; panic somewhat ceased, but at Mysore mine 
1,000 out of 4,000 coolies have left.” The outbreak at 
Nasik, a town of 25,000 inhabitants, 500 cases of 
plague occurred in the first epidemic visitation, and 
200 in the second up to the present time. Nasik 
was probably infected from Igatpuri by human 
agency. The epidemic proved to be more fatal 
during the cold weather. The ward system adopted 
here has proved satisfactory. From Constantinople 
we learn that plague has broken out at Jeddah, and 
that the issue of strict sanitary regulations led to 
serious disturbances, which led to their withdrawal. 


The Use of Colouring Agents in Food. 

Margarine manufacturers profess to regard the 
threatened prohibition of colouring matter in mar¬ 
garine as a great hardship of the nature of an in¬ 
justice seeing that no restriction is placed on the use 
thereof in preparing butter, &c., for the market. But 


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278 Th* Medical Press. NOTES ON. CURRENT TOPICS. Mae. 16, 1899. 

---- 1 -;- 


the only object of colouring margarine ie to inorease 
its resemblance to butter, not perhaps exclusively for 
the purposes of fraudulent sale but because purchasers 
who affect this substitute for butter conceivably ' 
might not wish to be continually reminded that what 
they are eating is not butter. We can quite under¬ 
stand, too, that the proprietors of boarding-houses 
and eating-houses might be averse to flaunting the 
identity of this particular alimentary substance before 
the eyes of their guests and customers who might 
otherwise not notice the substitution. While Par¬ 
liament is tinkering at food and drugs adulteration 
legislation would it not be well to take advantage of 
the opportunity to forbid the use of colouring agents 
in butter as well P Colour is not added merely 
because the public is supposed to have a decided 
taste for butter of a particular hue, but because 
inferior butter can thereby be made to resemble that 
of much higher quality. It follows that it is as much 
a fraud to use colour in butter as in margarine, and 
there is no obvious reason why it should not be 
treated as an adulteration. 

Extension of Hospital Accommodation for 
Infectious Diseases in Liverpool. 

At the instance of the Local Government Board, 
an inquiry was held at Liverpool on the 9th inst., 
before Mr. T. Thomson, M.D., barrister-at-law, 
respecting the application by the City Corporation 
for sanction to borrow the sums of £3,500 for the 
purohase of additional land in Fagakerly, an out¬ 
lying village, and £20.000 for the erection of a small¬ 
pox hospital in the same village, and also £40,000 for 
the extension of the City Hospital East in Mill 
Lane , Old Swan. There was not the least difficulty, 
either on the part of Dr. Hope, Medical Officer of 
Health of the City of Liverpool, nor of those 
associated with him, in supporting the proposal, 
among whom was Dr. Clarke, Chairman of the 
Hospital Committee of the Liverpool Corporation, 
in making out a strong case, the hospital accommoda¬ 
tion for infectious diseases, and for small-pox cases 
as a separate item, being far behind legal require¬ 
ments. A large sum of money is required it is true, 
but it will certainly be cheaper to spend it in the way 
proposed than to allow matters to drift on as they 


unless the sinus were laid open, a procedure which he 
considered would not have been justifiable under the 
circumstances. A verdict was returned in favour of 
the defendant. These cases, which may occur in the 
practice of the most careful and conscientious of 
practitioners, emphasise the desirability of becoming 
a member of the Medical Defence Union, because 
even a successfully defended case is, after all, a very 
costly affair for the unfortunate practitioner. 

The Yorkshire College and Vivisection. 

Enlightenment upon the subject of vivisection 
moves only slowly among a certain class of 
otherwise estimable persons, and the truth of 
this has just been abundantly shown at Leeds. The 
Council of the Yorkshire College have for long 
reoognised the inexpediency of not having 
a licence under the Vivisection Act for experiments 
upon animals, the application for such a licence 
having been delayed in consequence of the opposition 
of its chairman, Mr. Rawlinson Ford. The Medical 
School authorities in Leeds, however, recently again 
urged upon the Council the great need of having a 
licence, and, the request having been duly considered, 
it was at last agreed that permission should be given 
to apply to the Home Office for a licence under the 
Act. This action of the Council caused the resigna¬ 
tion of the chairman, Mr. Ford. So far as Mr. Ford 
is concerned, he has, no doubt, by resigning his post, 
satisfied his conscience; but regret must be felt that 
he should have allowed his conscience to perturb 
him in this matter to the extent that it seems to have 
done. The late chairman of the Council earned a 
high reputation for the ability with which he dis¬ 
charged the duties of the post, and general regret 
has since been felt and expressed by his former col¬ 
leagues that he should have deemed it necessary to 
retire. The wonder is that his connection with a body 
of scientific workers had not enlightened him upon 
the legitimacy and need of experimenting with 
animals. Anti-vivisectionists cannot be called 
reasonable persons, so far as their fad is concerned, 
and therefore a broad-minded view of the matter was 
to have been expected of a chairman who, like Mr. 
Ford, had shown so much capacity in conducting the 
affairs of the Yorkshire College. 


are at present. 

A Missing Drainage Tube. 

Dr. Findlatee, of Edgware, had occasion as far 
back as the summer of 1895 to open an abscess for a 
barmaid, in dressing which he inserted a short 
drainage tube. The next day the tube had disap¬ 
peared, and Dr. Findlater probed the wound without 
finding any trace of the missing appliance. The 
wound healed, but the arm remained more or less use¬ 
less, and in 1898 a fresh swelling formed, was lanced, 
and gave exit to the long lost drainage tube. There¬ 
upon the patient sued Dr. Findlater for damages on 
account of negligence. It transpired that the plain¬ 
tiff herself thought the tube had been lost in the bed¬ 
room, and evidence was given by Mr. Stonham to the 
effect that the tube would not have been discovered 


A New American Medical Editor. 

The Journal of the American Medical Association 
is one of the best and one of the most successful of the 
medical papers published in the United States, and 
it is now being edited by Dr. George H. Simmons, 
who was appointed to the vacancy created by the 
death of Dr. Hamilton. For English readers the 
Journal has only one drawback, and that is the prevail¬ 
ing irritating method of spelling which disfiguros its 
pages. There are some orthographic maniacs in 
Philadelphia and elsewhere who have left no stone 
unturned in order to diffuse this form of spelling 
among American editors. But the curious and most 
significant point is that, despite every persuasion, the 
New York medical journals have refused to follow 
any such lead. Another matter which claims atten- 


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Mae. 15, 1899. 


N0TE8 ON CURRENT TOPICS. The Medical Pbkss. 279 


-fcion is the remarkable inconsistencies of this 
American method of spelling. The plan is to “ lop 
off ” the “ al" in adjectival words, such as anatomical, 
physiological and so forth. But we fail to see why the 
-“al” should be allowed to remain in other words of 
the same kind. The following sentence will illustrate 
our meaning. “The case is really a gynecio [This 
word actually appeared in an American contem¬ 
porary.] one. But doubt may be felt whether snrgic 
-treatment would be better than medic under the cir- 
oumstanoes. The patient is obviously not strong in a 
physic sense, and probably, therefore, the most 
practic way of treating her would be first of all to 
-try the effects of therapeutic measures.” The new 
editor of the Journal of the American Medical Asso¬ 
ciation has now the opportunity of purging the pages 
of this admirable publication from a new-fangled 
system of spelling English words which is both 
Inconsistent, unnecessary, and irritating. 

The Chelsea Hospital for Women 
Appointments. 

Thb current number of Truth calls attention to 
the fact that the Board of the Chelsea Hospital for 
"Women recently passed a resolution to the effect 
that no general practitioner should in future be a 
member of the staff, and points out that since then 
two general practitioners have been appointed. One 
of the latter is now pathologist to the hospital, and 
this circumstance, our contemporary states, is the 
more remarkable inasmuch as in the advertisement 
declaring the post vacant it was expressly laid down 
that candidates “ must be engaged in consulting 
practice only.” We mention these facts mainly for 
the purpose of showing that it is evident the feeling 
against the Board in question is still alive, otherwise 
the editor of Truth would not have been asked to 
.give publicity to these matters. Obviously, however, 
if the rule above mentioned has not been rescinded it 
should be adhered to, and the Board cannot be com¬ 
mended for their action in this matter. It does not 
appear to us to be a straightforward proceedingto say 
in an advertisement for a vacant post that a general 
practitioner is ineligible to compete and afterwards 
to appoint one. 

Sanitarianism in Excelsia. 

When we deprecated, a couple of weeks since, the 
-flights of fansy of the ultra-sanitarians as being the 
obstruction to the tuberculosis crusade which is most 
to be dreaded just now, and when we pictured the system 
•which these enthusiasts advocate under which every 
one who coughs should be challenged by the sanitary 
police; investigated, if found guilty of consumption, 
notified; and promptly isolated, “ willy-nilly,” or, at 
the least, compelled to carry about a spit-cup in their 
pocket, and expectorate into it on all public occasions, 
some of our readers thought we were poking fun at 
the sanitarians. By no means. Some of these 
idealists go far beyond these proposals. A Dr. Knoff 
writes to the North-American Review to expound his 
suggestion. He wants in every State a commission 
of special examiners to examine each cough patient* 


to make domiciliary visits to the home and investigate 
all members of the family, to put the sanitary 
authority in motion for the renovation of the house, 
or even to bum it down if considered to be badly 
infected, and—to cap the edifice of coercion—to 
inquire into the financial ability of the patient, and, 
if he is not able to pay for his own maintenance in 
the consumption jail to which he is to be relegated, 
to compel the municipality to do so, paying, also, for 
the sustenance of the whole family. Say we not truly 
that such sanitary visionaries as Dr. Knoff. are the 
most dangerous enemies of any movement for the 
improvement of the public health ? 

Tuberculin as a Test Inoculation. 

We publish this week a short paper from a Mel¬ 
bourne correspondent, who apparently holds very 
strong views in respect of the use of tuberculin as a 
test for the presence of tuberculosis—views to which 
we are quite unable to subscribe, and which he 
himself does not appear to us to have justified or 
substantiated. Experience on a large scale, carefully 
scrutinised and discussed by highly competent 
persons, has shown conclusively that it is a trust¬ 
worthy means of diagnosing latent and otherwise 
undiscoverable tuberculosis in cattle. We are not 
concerned with the value of tuberculin in therapeu¬ 
tics, though it would be rash to assume that because 
it proved a failure some years ago it can never render 
any service in this direction. Its activity in procur. 
ing the cicatrisation of local tuberculous lesions of 
the skin, e.g., lupus, proves beyond a doubt that under 
one set of circumstances, at any rate, it is possessed 
of curative properties. We welcome the news that 
the colonies are awakening to the importance of safe¬ 
guarding their herds against contaminat ion, one of 
the most important elements in the war against 
tuberculosis being the ability to isolate diseased 
animals before they have had time to infect their, as 
yet, uncontaminated fellows. 

Is it Illegal? 

An inquest was opened at Southport on the body 
of a man, set. 26, who had died after taking a certain 
quack “ fit remedy,” sold by a “ Dr. ” Fanyaa. This 
nostrum, which is largely advertised, contains, we 
believe, bromide of nickel and arsenic, so that it is 
really a very poisonous preparation when taken in 
other than a very careful manner. The circumstance 
that appears to us to call for remark, is that the soi 
disant Dr. Fanyan had written to the deceased 
advising him as to the manner in which to carry out 
the treatment, and this seems to be sailing very close 
to an infringement of the privileges of the Apothe¬ 
caries’ Society. If any means could be found of 
inhibiting these pestilential foreign quacks from 
vending their nostrums in this country, the publio 
would be the gainers. In any event it ought to be 
possible to prevent them from carrying on this kind 
of irregular medical practice under an unregistrable 
and possibly fictitious medical title. 


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280 r ITm P RK88. 


NOTES ON CURRENT TOPICS. 


Mae. 15, 1899. 


The PreeSdeaotfofi the Royal College of 
IPhyoicianes Liondon. - 
Sib Samvel Wiwt^ President of. the London 
College o£ Rljysicians,. h$$ Voided not to seek re- 
election tttrthe Qwminati,on of his year of office on 
the 25thnUftJ)fej -Consequently, great speculation is 
taking placethe .cljpice of his successor by the 
Fellows. ; The election will be held at the College on 
Mopdpy ,thp 27th, and although several names are 
now heiag. discussed in connection with the post, 
nothing approaohing certainty is known. Sir William 
Broadbent, of course, is mentioned, and we should 
not be surprised if he were to be ultimately chosen 
by the Fellows. 


Stillborn Children. 

A petition is being drawn up by the “ British 
Institute of Undertakers ” in favour of legislation, 
with the object of regulating the interment of infants 
alleged to be stillborn. This is an admitted scandal, 
and one which calls urgently for remedial measures. 
It is thought that the petition would gain in weight 
if it were endorsed by the medical profession, and we 
are requested by the secretary of the British Insti¬ 
tute of Undertakers to solicit adhesions thereto, but 
we must confess to a distaste for any combined 
notion of this character, and if a medical petition be 
really considered likely to further the object which 
we all have in view there is no reason why one should 
not be organised as and from the profession. 

The Government Adulteration Bill. 

This project of legislation is now denounced in 
every quarter—except by the adulterators—as a 
miserable pusillanimous makeshift. It makes some 
right improvements in the method of prosecuting— 
but, in other respects, perpetuates most of the short¬ 
comings of the present law. 

The Palmar Sign of Typhoid Fever. 

What has been called the palmar sign of typhoid 
fever is a yellowness of the palms of the hands and 
soles of the feet. This change in colour is said to be 
more marked in proportion as the integument is 
thickened by toil, but is still present when the skin is 
thin. The change comes on in the early days of the 
disease, and lasts until the end, disappearing in con¬ 
valescence. The yellowness has been attributed to 
feeble circulation by which the subcutaneous fat 
becomes apparent through the skin. We are not 
aware that this symptom has been looked for or 
observed in this country. Probably not. 

The Peculiar People. 

The firm attitude of the judiciary which has 
fastened upon the members of this misguided sect 
the responsibility—common to all the world—of pro¬ 
viding for the medical care of their families, seems to 
be producing its effect. It is stated that the elders 
of that cult are deliberating as to whether they shall 
give way, at least, to the extent of permitting their 
disciples, if they wish, to call in medical aid for their 
sick children. Should this course be adopted it will 


at least deprive these fanatics of any legitimate- 
excuse for allowing their children to die of neglect. 


Aatragaleotomy. 

This little-known operation of removal of the 
astragalus, should- have a future before it in the 
relief of various forms of equine talipes. The bone 
in question is removed by a ourved incision across the 
upper surface of the arch of the foot from a spot in 
front of the peroneus longue, to the tibialis anticus. 
The joint is opened, and the bone dissected out, the 
extensor tendons of the toes, and the achilles- 
tendon divided; the foot brought into a right-angled 
position and fixed for six weeks or more in a plaster- 
of-paris splint. The malleoli soon adapt themselves 
to the tarsal bone, and a new joint is established, 
which is almost as useful as the ordinary 
ankle-joint. The operation is not altogether easy, 
but its i-esults are most satisfactory, and it has the 
great advantage that it may be applied in the case of 
adults, when the chance of relief by other measures 
is of the scantiest. This brilliant illustration of 
modern joint surgery, which, by the way, appears to- 
be more practised in America than in our own 
country, has been rendered possible only by the 
methods of aseptic surgery. With its aid the ortho¬ 
paedic surgeon will be enabled to undertake with con¬ 
fidence the treatment of a common deformity. 

Salaries of Medical Officers of Health. 

The rate of remuneration adopted by the various 
authorities of the United Kingdom as regards their 
Medical Officers of Health may be described as arbi¬ 
trary and chaotic. In one place we find a first-class 
man doing a great amount of work at a miserable 
salary, while in another a less able official draws an 
extravagant sum in return for the services of a few 
spare hours. Of late years there can be no doubt 
that a considerable change has taken place generally 
in the attitude of sanitary authorities towards 
their medical officers. The advance of demo¬ 
cratic opinions, for example, has made local 
administrators far more exacting in their demand for 
actual routine and personal work. Their tendency on 
the whole has been to employ “ whole-time ” men as 
apart from the hybrid “half-timer,” who undertakes to 
discharge in his own person the conflicting duties of 
general practitioner, and of a medical officership of 
health. Clearly a standard is wanted in these 
matters, not only as regards salary, but also to settle 
the important particulars of the duties to be per¬ 
formed, and the amount of time to be given to the 
service. An equalisation of this kind would be of 
inestimable value in many directions, and might 
engage the attention of the Local Government Board 
with advantage. At present many authorities having 
vast and teeming populations under their control pay 
their medical officers a wretched and inadequate dole. 
Someday the growing national wisdom will doubtless 
recognise that money sunk in public health improve¬ 
ment is a prudent investment. 


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Mar. 15, 1809. 


PERSONAL. 


The Mbdical Press. 281 


The Mortality among the American Troop* 
During the Late War. 

Some significant figures dealing with the mortality 
among the American troops arising out of the late 
Hispano-American war, were cabled to this country 
through Reuter’s Agency last week. The figures in 
question are taken from the reports submitted to 
the Adjutant-General of the American forces, and 
show that between May 1st. 1898, and February 
18th of this year the following deaths occurred 
among the American troops in Cuba. Porto 
Rico, and the PhilippinesKilled in action, 
329; died of wounds, 125; died of disease, 5,277. 
The enormous disproportion of deaths under the 
latter heading at once claims attention. The figures 
plainly show that the Spaniards were quite correct in 
believing that they would have a firm ally in disease, 
in the contest with their opponents, and, possibly, 
unless the campaign had not been carried on with 
that brilliant rapidity, which the world now knows 
of and has acknowledged, the Americans might have 
found their task an exceedingly more onerous one, in 
the face of such a foe, than ultimately proved to be 
the case. Admitting, however, all the difficulties 
encountered in fighting against the unhealthy 
climates in the seat of war, it is still, neverthless, 
startling that such an enormous number of- the 
American troops should have died of disease. In 
earlier days, perhaps a catastrophe of this nature 
might have been anticipated. But we are living in 
modem times, and thus irresistibly the question 
arises, was everything done to prevent the inroads of 
disease which modem science and organisation could 
suggest ? _ 

Gout and Intellectuality. 

Horace, Leibnitz, Erasmus, Franklin, Milton, and 
Darwin, we learn, were sufferers from gout, that aris¬ 
tocratic but disobliging malady. Tiberius and Louis 
XI. of France were rheumatic, while Michael Angelo, 
Galvin, Montaigne, Colbert, Louvois, Buffon, and 
D6sangiers—to mention but a few—were the victims 
of gravel. This enumeration would give a high idea 
of the intellectuality associated with the gouty 
diathesis; but to balance accounts we ought to men¬ 
tion a number of political and social eminences whose 
intellectual status would prove that gout is not neces¬ 
sarily, or even generally, allied with a high order of 
intellect. On the whole, it is safer to assume that 
gout and intellect are not incompatible, but that they 
^n, and do, exist separately. Each gouty sufferer can 
thus decide for himself or herself whether gout is 
oomplicated by excessive intellectuality or the 
reverse, though we do not undertake to accept the 
verdict without cavil. 

An Exhibition of Antique Surgical 
Instrument*. 

Not one of the least interesting sections of the 
forthcoming Paris Exhibition will be the collection 
of antique surgical instruments. Appeal is now 
being made to collectors, museum authorities, and 
all possessors of rare or unique surgical instruments 


and appliances for a loan of their specimens. Pro¬ 
perly arranged and catalogued such an exhibition 
would have not only an instructive but an historical 
value, and would be worthy of some permanent 
record. We wish success to this enterprise, for 
nothing of the kind that we know of has ever been 
attempted before. ' 


Alleged Malpraxis. 

An action was tried a few days since in which a 
lad who had been injured in a street accident claimed 
damages against Mr. Zebulon Mennell, a Notting 
Hill practitioner, for having omitted to discover until 
some time after the accident, that the plaintiffs leg 
was broken. The defence was that there were 
surgical reasons for not putting the leg in splints at 
an earlier date, and this view was corroborated by 
Mr. Pitts and Mr. Ballance, with the result that a 
verdict was returned in favour of the defendant. 


Extension of the Medical Acts to the Isle 
of Man. 

The necessity for some means of differentiating 
between qualified practitioners and quacks has been 
severely felt in the Isle of Man, to which bailiewick the 
Medical Acte have never been extended. To provide 
such means a Bill will be introduced to-day into the 
Manx Legislature to provide for the island such safe¬ 
guards—inefficient though they be - as are provided 
in the mother country. 

Typhoid Fever in Philadelphia. 

An epidemic of typhoid fever on a large scale 
has broken out at Philadelphia, and the number of 
victims already exceeds two thousand. The case 
mortality is high, as it usually is at the commence¬ 
ment of an epidemic. The occurrence is attributed 
to pollution of the tributaries of the river from which 
the city draws its water supply. 


A daily paper announces that “ one of our most 
most distinguished medical baronets ha9 been lying 
seriously ill for a month,’’ and comments upon the 
fact that not a word has been published on the sub¬ 
ject in deference to the express wish of the patient. 
Under the circumstances it would ill become us to lift 
the veil of anonymity, though, as medical baronets 
are not as thick as leaves in the valley of Yalom- 
br^sa, it cannot be difficult to read between’the 
lines. 


Surgeon-Major Quinton, who retired from the 
Army Medical Service in 1884 after prolonged service 
in India, was found dead in a field near his house at 
Kings Teignton, Devon. The cause of death had 
not transpired at the time of going to press. 


PERSONAL. 

Da. George H. Simmons, of Lincoln, Neb., has been 
appointed editor of'the Journal of the American Medical 
Association. 


Digitized by v^ooQle 




282 The Medical Pax as. MEDICAL SOCIETY OP LONDON. 


Mb. Chamberlain will take the chair at a dinner in 
aid of the proposed School for Tropical Medicine on 
May 10th, next. 

Pbof. Koch has written expressing his regret at his 
inability to be present at the Inaugural Dinner of the 
Liverpool School of Tropical Diseases. 

Mb. Fbkdxbick Treves, Consulting 8urgeon to the 
London Hospital, has been appointed an Emeritus Pro. 
fessor of Surgery to the hospital. 

Db. (1. A. Maconachie, late Principal of the Grant 
Medical College of Bombay, has been offered the Lecture¬ 
ship on Tropical Medicine at the University of Aberdeen. 

The Khalifa is reported to be suffering from leprosy’ 
indeed, there is every reason to believe that the symptoms 
of the disease are well marked, sufficiently so for it to be 
necessary to wear a veil. 

Sib William Tcbneb, President of the General 
Medical Counoil has been chosen as the President¬ 
elect of the British Association, which will meet in Brad¬ 
ford in the oourse of the summer. 

Db. G. A. Gibson, of Edinburgh, has accepted the 
appointment of Inspector of the examination of the 
Apothecaries’ Hall. Dublin, and Dr. Church has accepted 
that of Visitor for the same examination. 

Db. Frederick Hbtley, a former student of the 
Middlesex Hospital, has contributed the sum of £1,000 to 
perpetuate the “ Hetley Clinical Prize,” in the Medical 
School, of £25 per annum founded in 1884. 


gcotlartb. 

[from our own correspondent.] 

The Royal Medical Society's Dinner. —A large and 
representative gathering met on Friday last week at the 
annual dinner of the aucient Royal Medical Society of 
Edinburgh to meet Sir William Priestley, member of 
Parliament for the Universities of Edinburgh and Glas¬ 
gow, the guest of the evening. The senior president of 
the Society, Mr. R. F. McNair Scott, officiated as chair¬ 
man, supported by numbers of former members and presi¬ 
dents. The number of well-known names of men present, 
who once had filled the presidential chair in the Society, 
emphasised the prescience displayed by the various 
generations of members in electing them to this office 
Among those present were 8ir William Gardiner, of. 
Glasgow, Professors Chiene. and Simpson, Sir H. Little¬ 
john, C. Brown, Cossar Ewart, and Hunter Stewart; 
Drs. McMarin, Bury, Beatson, Allan Jamieson, Noel 
Paton, Ac. 

The Vacant Edinburgh Chair of Physiology.— 
The election by the Patrons of the Chair of Physiology 
in the University of Edinburgh, the Board of Curators, 
seven in number — four nominated by the Town Council 
of Edinburgh, three by the University Court—will not 
take place until after May 20th next, so that candidates 
will have a more prolonged breathing-space than usual, 
and a longer time during which to canvass. Dr. NoSl Paton, 
Professors 8cheefer, Stirling, and Weymouth Reid, and 
Dr. Carlier are the names of those who up to now have 
shown signs of an intention to apply. The poet will be 
worth about £1,400 in the future. 

Glasgow University Medico-Chibubigical Society. 
—The following office-bearers have been elected for 
Sessions 1899-1900 :—Honorary President, Professor 
Stoekman; President, Mr. E. P. Cathcart; Vice-Presi¬ 
dent, Mr. James Davidson, M.A.; Demonstrator, Mr. 
Themes Richmond; Corresponding Secretary, Mr. 


Mar. 15, 1899. 

Matthew Aikman, M.A.; Minute Secretary, Mr. John 
Muir; Treasurer, Mr. Alexander Fraser, M.A ; Librarian, 
Mr. A. M. Pollook. 




[from our own correspondent.] 


Medical School. —Considerable ohanges in the 
teaching staff are likely to oocur during the present year. 
An aural Burgeon and an additional assistant surgeon are 
to be appointed to the Royal Infirmary immediately. 
Dr. Milligan and Messrs. Cox and Larmuth are candi¬ 
dates for the former post, while for the latter it i» 
understood that the following gentlemen are applying:— 
Messrs. Collier, Pomfret, Smith, Platt, and Montgomery. 
Next year two vacancies on the surgical staff are likely 
to ocour. The Senior Physician, it is rumoured, intends 
to resign this summer. At the College, Professor 
Del6pine is seeking to secure the Chair in Pathology at 
Glasgow. 

Tuberculosis. —Much interest continues to be taken 
in the “ campaign ” against tuberculosis. The Hospital 
for Consumption is about to start the working of the 
Liegehallen system. Mr. W. T. Crossley, a philanthropic 
citizen, has offered to erect an institution containing 10O 
beds if the city will guarantee something like three to 
four thousand pounds annually to support them. Dr. 
Ransome has been advocating the destruction of the many 
“ tubercle nests,” as he rightly calls them, in the orowded 
parts of the city 

Mea8lb8. —The School Board authorities have been 
expressing disapproval of the action of the Sanitary 
Committee in closing schools when the cases exceed lO 
per cent, of the average attendance. They show that 
this is a much more stringent practice than is carried on 
elsewhere. It is to be hoped there may be no c la s hin g 
between the Medical Officer of Health and the School 
Board, but mutual forbearance may be neoessary. 

Inebriety. —Manchester has long taken a practical 
interest in the inebriate class. One of the most successful 
of the retreats for women is maintained by some of the 
citizens. The following statistics oompiled by the ohief 
oonstable of the city have important bearing on the new 
Act:—The tabulated statement shows the number of 
persons convicted in towns in the Salford hundred of 
drunkenness or of offenoes mentioned in the first schedule 
to the Inebriates Act, 1898, and amenable under Section 
2, for the three years ended Deoember 81st, 1898. In the 
year 1898, it appears, there were convicted in Manchester 
13 males and 72 females; in 1897, 16 males and 76 
females; in 1896, 11 males and 65 females In Salford 
there were convicted, in 1898, 18 males and 19 females; 
in 1897, 8 males and 10 females; in 1896, 13 males and 
12 females. 


MEDICAL SOCIETY OF LONDON. 

The meeting on Monday evening last (March 13th) 
was devoted to the reading of, and the discussion upon, 
a paper by Mr. John Langton on “ The Radical Opera¬ 
tion for Inguinal Hernia—And Afterwards.” After 
sketching the history of surgical attempts to deal with, 
this disabling infinpity and the various modifications of 
practice and innovations of principle that had from time 
to time been introduced the author stated his preference 
for the operation which aimed at the reconstruction of 
the oanal with transplantation of the vas deferens and 
its vessels to the upper angle of the incision so as to 
form a new inner ring. He insisted on the importance 
of a month’s rest in the recumbent position after operation, 
and then proceeded to discuss the frequency and causes of 
suppuration after operation. At Bart’s the proportion of 
suppurative cases had been about 16 per oent. At this 
institution the mortality in about 660 cases had been only 
two, and death was due in these, in one to septic pneumonia 
and in the other to scarlet fever. He remarked on the 
great preponderance of male over female patients—9,900 
males against 870 females—at the City of London Trues 
Society, the reason for which he discussed. He approved 


Digitized by Google 



Mae. 16, 1899. 


LABORATORY NOTES. 


The MedicaI Perm 1(283 


patients who applied for relief by reason of failure of the 
operation were persons who had been advised not to wear 
a truss at all, or had only done bo for a short 
time. Operation was contra-indicated (1) under 
six years of age. (2) in presenoe of organic dis¬ 
ease, (3) when the hernia was so large that the 
abdomen could not retain it under moderate pres¬ 
sure. (4) in very old patients, (5) with small hernias 
when the abdominal walls were unusually weak, and 
(6) in septic peritonitis after strangulation. He com¬ 
mented on the extreme, even insuperable difficulty of 
ascertaining the ultimate results of the operation in 
hospital praotioe, but gave figures from which it might 
be inferred that the total number of failures must be 
considerable. In private practice the results were more 
encouraging, probably about 80 per cent, being 
successful. 

The President (Mr. Edmund Owen) objected to the 
expression “radical cure," preferring to style it the 
operation for radical cure. He urged that unless the 
infant were well looked after it might be necessary to 
operate under six years of age. He himself operated as 
young as three. 

Mr. Stanley Boyd entered very fully into the subject, 
insisting on the importance of leaving the peritoneum 
smooth and tense, and of rearranging the muscular 
arches in the manner met with in nature. In the event 
of suppuration he advocated removing some of the 
outer stitches, passing through the internal oblique, and 
placing a drainage tube close to the neck of the sac. He 
himself had fixed three as the limit of age in children. 
It was not his practice to recommend the us- of a truss 
after operation. 

Mr. Osborn pointed out that in a young child the use 
of a truss would often dispense with the necessity for an 
operation, tie approved of the recommendation to use 
a truss after operation, though this often disappointed 
patients who had looked forward to being enabled to 
dispense with its use. 

Mr. Langton replied, pointing out that before puberty 
and after the menopause, inguinal hernia was the rule, 
and femoral hernia, when it occurred, usually did so 
during the child-bearing period, though even then 99 
per cent, of hernias in pregnant women were inguinal and 
not femoral. 


garliamentarg <itetos. 

Notification of Infectious Diseases —Sir Francis 
Powell has introduced a Bill, having for object to extend 
the Act of 1898 so as to make its application general 
throughout the country. Unless opposition from some 
unexpected quarter is manifested, there is great hope 
of this useful measure becoming law in the near future. 

The BrvER8 Pollution Bill, which came on for dis¬ 
cussion last week, was favourably received by the Govern¬ 
ment, but at the last moment it was “ talked out" by 
one Jackson, the member for Leeds, so that for one more 
year, the sixth in succession, this very necessary piece of 
legislation fails to become law. 

The Constructive Murder Bill is set down for dis¬ 
cussion to-day (Wednesday). It is very unlikely that 
any serious objection will be offered to a measure whioh 
proposes to abolish a judicial farce whioh has shocked 
the minds of all thinking people. 

Disease in the Army —Major Basch asked the Secre¬ 
tary of State for India whether, in view of the facts 
stated in the Army Medical Report of 1897 that the 
number of admissions to hospital for venereal disease 
per 1,000 was 607, only 3 per oent. less than in 1896, and 
that the number invalided to England in 1897 was 662, 
an increase of 183 over the previous year, the Govern¬ 
ment would consider the advisability of permitting the 
Indian Government to take such measures ata they might 
think fit for the detection of diseased persons of both, 
sexes, and to detain such persons in hospital ^til cured; 
and whether the Government Had received any reports 
as to the effectiveness 'or otherwise ef.the new oantpn- 
ment rules enforced in' 1&89. .Lord G. Hamilton, in 
reply, said the statement related to troope in canton¬ 


ments only. Including those on field service, the admis¬ 
sion rate for venereal disease wa< 485 per 1,000 in 1897 
against 511 in . 1896, a reduction of 26 per thousand. The 
new cantonment rule* were not brought into operation 
until towards the end of 1897, and could not be expected 
to have much effect in lowering the ratio for the 
whole year. No report has yet been received as to their 
effectiveness or otherwise ; and until the results of their 
working have been ascertained he did not propose to 
take any further action. The returns for 1898, so far as 
they were known, were very encouraging, and showed a 
considerable further decrease. 

As might have been expected, a block has been put by 
Mr. Ascroft against the Bill which proposes to repeal 
the Conscientious Objector’s Clause of the Anti-Vaccina¬ 
tion Act of last year. This opposition does not affect the 
chanoe of passing the Bill, inasmuch as, with the Govern¬ 
ment against it, it had no chance. 


Jaboratorg Jtotee. 


LITHIATED JOHANNI8 WATER. 

It has been a desideratum to find a natural mineral 
water suitable in its composition for regular and con¬ 
tinuous use, and containing a definite and adequate pro¬ 
portion of a salt of lithium. This is exactly what we 
now have in “ Lithiated Johannis." The proprietors of 
this spring have had the very happy idea of adding, 
under the most careful and skilled supervision, one gram* 
of lithium bicarbonate to each small bottle of Johannis. 
We have examined samples, and find on analysis that 
the proportion of lithia contained is as stated on the 
label, viz., 1 grain of bioarbonate of lithia per bottle of 
360 c.c. This proportion is one which may be safely 
commended for regular and general use. This is a point 
of some importance, because the much larger proportion 
of lithia contained in the B P. solution renders its habi¬ 
tual use as a table water quite inadmissible. 

In lithiated Johannis the drug is exhibited in an 
agreeable and convenient form, ana in doses which can 
under no conceivable circumstances become excessive. 
So that we now have a natural mineral water of extremely 
advantageous composition containing just that amount 
of a salt of lithium which experience has shown to be 
beet adapted for regular and continuous use. 

PEPTARNIS. 

[Prepared by the Liebig’s Extract of Meat Company, 
Limited.] 

The sample on analysis yielded the following results:— 
Proteids (or nitrogenous matter) ... 53 0 

Extractive matter. 6*0 

W ater . 33 - 0 

Mineral matter (phosphates, Ac.) ... 8 0 


The above results show this extract to be of high 
quality, in particular the amount of mineral matter is 
satisfactory as showing that the article is not over¬ 
loaded with salt. 

THYROGLANDIN. 

Messrs. Evans and Co., of Liverpool, have submitted 
to us samples of Stanford’s “• Thyroglandin,” a standard¬ 
ised product of the thyroid gland, prepared, we are 
assured, under conditions which preserve the active prin¬ 
ciples intact, under the Patented Process of Mr. E. C. C. 
Stanford, F.C.S. It is claimed to represent five times 
the strength of the raw gland, and to be free from any 
tendency to undergo decomposition. The sample befor% 
us iB a light brown powder, non-hygroecopio and free 
from any appreciable odour. The powder is also put up 
in pill form, pearl-coated, each pill containing one grain 
of thyroglandin A product of this high standard is 
obviously in evety way preferable to the B.P. prepara¬ 
tions, which is simply the gland freed from fat, dried and 
powdered, and in whioh the characteristic odour of de 


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MEDIC A.L NEWS. 


Mar. 15, 1899. 


234 The Medical Press. 

•composition is soon manifested. The activity of 
“ Thyroglandin ” has been experimentally tested, with 
uniformly satisfactory results, by Dr. Wm. MacLennan, 
■ of the University of Glasgow, who made use of it in a 
number of cases either for the relief of symptoms of 
myxpedema or for the reduction of pronounced obesity. 
This observer attributes the therapeutical activity of 
the product to its containing iodoglobulin and thyroiodin 
in tne form and in the proportion in which they exist in 
the gland, and to the absence of any injurious impurities 
of glandular origin. 


(Dbituaru. 


DR. PEANCIS N. MACNAMAEA. 

The death is announced of Dr. Francis N. Macnamara, 
late of the Indian Medical Service. After a brilliant 
■career at King’s College, says the Times, he obtained, in 
1853, an appointment to India, and, having particularly 
distinguished himself in chemical science, was at the 
■early age of 22 appointed by the court of directors of the 
East India Company Professor of Chemistry at the Cal¬ 
cutta Medical College, to which was united the office of 
Chemical Examiner to the Government of India. In 
that capacity he devoted much time and skill to detect¬ 
ing in water the germs of cholera. By analysing various 
spec'mens of water from different parts of the country 
he was enabled to identify disease with the presence of 
impurities, and the necessary precautions were taken 
under his advice, though considerable prejudice and 
opposition had to be overcome. In conjunction with his 
brother, Charles Macnamara, he raised the question of 
supplying pure water to Calcutta, a work which was 
subsequently accomplished. Dr. Macnamara attracted 
to him the native students, by whom he was greatly 
respected and beloved, and from whom, on leaving India, 
he received sincere marks of esteem. He was as modest 
And retiring as he was earnest and persevering, and 
public notice scarcely followed his successful efforts. 
Upon his return to England after leaving the service, h« 
was appointed by the Secretary of State Examiner of 
Medical Stores at the India Office. He was about to 
relinquish this appointment when death overtook him, 
on the 5th inst., at the age of 67. Dr. Macnamara was 
-the author of “Climate and Medical Topography in 
their Eolation to the Disease Distribution of the Hima¬ 
layan and sub-Himalayan Districts of British India” 
(Longmans, 1880), and contributed articles on “ Goitre ” 
to “Davidson’s Hygiene and Diseases of Warm Cli¬ 
mates ”; on “ Pathological Chemistry ” to the “ Indian 
Annals of Medicine on “Abscess of the Liver” and 
other papers to the Indian Medical Gazette. 

Mr. Henry Butler, M.E.C.S, Bradford, died on 
Wednesday last, at the early age of 35, from blood- 
poisoning, resulting from a prick from a safety-pin while 
applying a dressing. He was formerly on the staff of the 
Leeds Infirmary. 


(EomBpottOeitce: 

We do not hold ourselves responsible for the opinion* of »ur 
correspondent*. ‘ 

THE HOSPITAL FUND “HAT” AGAIN. 

To the Editor of The Medical Press and Circular. 

Sir, —It is gratifying to note that there is, at least, 
■one .weekly* exponent* of-medieal opinion-which • has -the 
courage to protest, in the name of the profession, against 
the shameless fiunkeyism of those who have dragged the 
name and rank of the Prinde of Wales through the mire in 
order to make the Hospital Fund fashionable. His 
Eoyal Highness, in his proverbial good nature, was per¬ 
suaded—first, to start the Fund without due inquiry as 
to whether the hospitals deserve or require more money 
than they have; second, when the monied public shoWed 
-their distrust of hospital administration by standing 
severely aloof, the Prince was induced to countenance 
the issue of stamps bearing bia impress, and the organ¬ 


ised importunity of Society people and school boys to buy 
and preserve them—to remind them, let us hope, in 
future, of what fools and toadies they once were; third. 
His Eoyal Highness is now again pressed into the beg¬ 
ging service as the patron of a sham order of knights 
errant, who are to purchase, by a small donation, the 
privilege of calling themselves dames, or members, or 
whatnot of the “League of Mercy,” pose as philan¬ 
thropic associates of royalty, and figure about with a 
pretty little decoration, pinned oh their dress or, perhaps, 
in a neat and becoming distinctive dress. 

It is, Mr. Editor, very pleasant to observe that the 
feeling of the general public disapproves of this form of 
mendicancy, and that it declines to listen to the blan¬ 
dishments of the Fund wirepullers until the prevalent 
suspicion that London hospitals neither merit nor need 
additional subsidy is set at rest. Even if it were possible 
to satisfy them of this, the method of importunity 
would be distasteful. His Eoyal Highness’s advisers 
have misconceived the motives of the great body of 
monied philanthropists, and, gauging public sentiment 
by their own, have appealed to the weaknesses of human 
nature among the upper classes. They know that 
the Society would-be’s are willing to pay anything to be 
in the fashion, and if hospital benevolence is the oorrect 
thing they would just as soon have that sort 
of fashion as any other. They know that such 
people will go any distance to preserve their con¬ 
nection with the Society craze by buying stamps 
and little medallions which they can afterwards show 
admiring friends, and by preserving newspaper reports 
in which their names are mentioned as attending some 
meeting at which the Prince of Wales presided—coached 
by medical toadies and supported by Duchesses and 
other leaders of fashion. The Fuhd wirepullers knew 
the money value of such incentives, and they have 
worked them—to use a vulgar phrase— * for all. they are 
worth.” But they forgot that in resorting to such 
methods and in refusing to allow any questions to be 
asked as to where the hospital money goes to, they have 
disgusted the infinitely more valuable clientele of 
wealthy philanthropists who care nothing at all about 
“ Sassiety,” and who — as business men -are accustomed 
to look into an investment in philanthropy or anything 
else before they make it. 

There is, as you say, Mr. Editor, but one way of 
recovering the lost confidence of this class, and that is, 
to cease all this foolery of stamps, medallions, and empty 
titles and make a clean breast and a root-and-branch 
reform of the abuses and maladministration of hospital 
incomes. With infinite respect and humility I suggest 
to his Eoyal Highness that he will do well not to continue 
his patronage of the begging movement until this is done. 

I am Sir, yours truly. 

The Young Man from the Country. 


iflebical 

Sixth International Otologic&l Congress, 1899. 

The Hon. General Secretary asks us to publish the 
followmgas the latest arrangements. The Congress is 
to be held in London from August 8th to 12tb, under the 
presidency of Dr. Urban Pritchard. The British Organi¬ 
sation Committee, which numbers over seventy members 
from Great Britain and the Colonies, has Mr. A. E. 
Cumber-batch for its treasurer, and Mr. Cresswell Baber 
for.Secretary-General. - It has also appointed the follow¬ 
ing sub-committees, viz.:— 

*• 1. /fecepfion.’—‘Vioe-chairman, Mr. Field; Hon. 8ocl, 
Mr. E. Lake. 

2. Excursion. —Vice-chairman, Dr. Dun das Grant; Hon. 
Sec., Mr. P. Macleod Yearsley. 

3. Dinner. —Vice-chairman, Mr. Mark Hotell? Hon. 
Sec., Mr. L.-A. Lawrence. ; . • 

4. utewm.j—Vice-chairman, Mr. C. A. Ballanoe; Hon. 
Sec., Mr; Arthur H. Gheatle. 

' The president-elect is chairman of all the sub-commit¬ 
tees. The meeting will be held at the Examination Hall 
of the Eoyal College of Physicians of London, and Royal 
College of Surgeons of England, and the following details 



MEDICAL NEWS. 


Mar. 16, 1899. 


> Tbn: .Myn mir, Pmm 285 


have been arranged:—On Monday evening, August 7th, 
a preliminary reception will be held by the president¬ 
elect. On August 8th, 9th-,-10th* Tlth, the Congress will 
be in session, add will be followed on Saturday, August 
12th, by an excursion for members and their lady friends. 
The official languages of the Congress are English, 
French, German, and Italian. The subscription, 
to include a copy of the transactions, is fixed at 
.£1, to be paid to the treasurer, Mr. A. E. Cumberbatch, 
80, Portland Place, London, W , before the opening of 
the Congress. The subject chosen for special discussion 
is “ Indications for Opening the Mastoid in Chronic 
Suppurative Otitis Media,” which will be introduced by 
Prof. W. MacEwen, of Glasgow ; Dr. H. Knapp, of New 
York ; Dr. Luc, of Paris ; and Prof. Politzer, of Vienna 
A Museum of Specimens and Instruments relating to 
Otology, shown by members, will be held during the 
meeting. Communications regarding the museum should 
be addressed to Mr. A. H. Cheatle, 117, Harley Street, 
London, W. 

Intending members of the Congress are requested to 
send in their names to the Hon. Sec Gen. as soon as 
possible, and in any case not later than May 1st. Titles 
of communications together with a short abstract of 
the same, to be sent to the Hon. Sec. Gen. by the same 
date According to the regulations of the Congress no 
papers shall exceed fifteen minutes in reading, therefore 
all long communications should be read in abstract. 

The Manchester Committee of the David Lewis 
Trust have purchased Sandlebridge Estate, near Knuts- 
ford, for the purpose of turning -it into a colony for 
epileptics. The estate is 450 acres in extent. The colony 
will consist of villas with gardens, a social hall, and ad¬ 
ministrative buildings, and the land will be sufficient to 
find employment for the patients,- who are to be treated 
after the German method. Insane- or feeble-minded 
cases will not be taken, and there is to be an endowment 
for the admission of some patients free of charge. 

Medical Practice in the I*le of Han. 

The English Medical Acts do not extend to the Isle of 
Man, and as an outcome of the recent agitation in the 
island, a Bill will, on Wednesday next, be introduced into 
the Manx Legislative Council, providing that only 
persons registered under the Imperial Medical Acts can 
sue for or recover fees for medical attendance, and only 
registered persons can be appointed to public medical 
positions. The penalty for pretending to be registered 
practitioners is a fine not exceeding twenty pounds. 

Dr. Author David White, news of whose death has 
only just come from Tangier, was the oldest graduate in 
medicine on the books of Pembroke College, Cambridge. 
He graduated Bachelor in 1842, Licentiate in 1844, and 
Doctor of Medicine in 1848. The doctor was eighty- 
three years old. 

The annual meeting of the Asylum Workers’ Associa¬ 
tion will take place on Monday, the 27th inst., at 4.30 
p m., at the rooms of the Medical Society of London, 11, 
• 'handoe Street, under the presidency of Sir Jas. Crichton 
Browne, M.D., F.R.S. 

Medico-Psychological Association. 

The next examination for the certificate in nursing 
and attending on the insane will be held on Monday, 
May 1st. Candidates should obtain from the Registrar 
(Dr. Spenoe, Burntwood Asylum, near Lichfield) a 
schedule to be filled up, signed, and returned to him at 
least four weeks before the date of the examination. 
Monday, April 3rd, will be the last day upon which, 
according to the rules, candidates can enter their names 
for the May examination. 

Mr. M'Ardle's Address. 

The Registrar of the Royal College of Surgeons in 
Ireland requests us to insert the following: Mr. 
Cameron’s History of the College, page 187, the author 
says:—“ From their foundation to the present time the 
College, in at least their corporate capacity have never 
exhibited religious or political intolerance. Although a 
large majority of the members have always professed the 


Protestant religion, the.Roman. Catholic. oninority|have 
never been deprived of thefr ftiii ,J proportion of the 
honours and emoluments in the power of the College 
to bestow. At a time when the municipal corporations 
and many public boards rarely appointed a Roman 
Catholio to any offioe of honour or profit, the College of 
Surgeons elected Roman Catholics to be their presidents 
and professors — Williams Dease (President, 1789), 
Francis M'Evoy (thrice President, 1791, 1804, and 1807), 
Richard Dease, James Rivers, Cusack Rooney, James 
Kerin, Francis White, JameB O’Beire, Andrew Ellis, 
Leonard Trant, and Christopher Fleming, all Roman 
Catholics, occupied the presidential chair during the 
first three-quarters of a century of the existence of the 
College.” 

Annual Dinner of the Medical Society of London. 

The 126th Annual Dinner of this venerable society 
took place at the Whitehall Rooms on Wednesday last 
(March 8th), Mr. E. Owen, President, in the chair.?! In 
point of view of numbers it proved to be the record 
dinner of the society, no less than 168 persons joining, in 
the alimentary fray. Among the guests were the Pre¬ 
sidents of the Royal Colleges and of the principal sister 
societies. In proposing the toast of the evening the 
President gave a humorous sketch of difficulties with 
which the Society had to contend in its earlier days,, 
and made some very pertinent remarks on the qualities 
expected of papers expected to be read before the- 
Society. He deprecated non-contentiouB papers wbieb 
could only excite admiration, urging that a paper 
should be' bold in outline, here and there a little aggres¬ 
sive, with some apparently straying lines, so that when 
read it should excite a desire to discuss it in the mind* 
of the listeners. He added that a paper should not be- 
too long or “ gaseous,” and when printed should not 
contain too many footnotes referring the reader to other 
writings which had not come from the author’s pen. 
Nothing, he remarked, would be lost if the writer now 
and then feigned a transient disbelief in his own 
omniscience. An interesting feature was the presenta¬ 
tion to Dr. Monckton Copeman, of the Fothergillian 
medal, the award whereof we recently announced. The 
musical arrangements, which were of exceptional excel¬ 
lence, were under the management of Dr. R. Maguire, te 
whom the Society was indebted for the pleasure of hear¬ 
ing Dr. Plimmer on the piano and Mr. Foster Ferguson 
in his admirable rendering of various ditties. 

Mortality In Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations.-—Calcutta 38, Bombay 112, Madras 46, Paris 
20, Brussels 20, Amsterdam 16. Rotterdam 16, The Hague 
13, Copenhagen 25, Stockholm 24, Christiania 23, St. 
Petersburg 27, Moscow 26, Berlin 17, Hamburg 18, 
Breslau 29, Munich 22, (Vienna 23. Prague 30, Buda 
Pesth 31, Trieste 19, Rome 19, Turin 21, New York 18, 
Philadelphia 23. 

George Vince, the most notorious exponent of the 
doctrines of the “ Peculiar People,” has lost another of 
his children, the fourth out of nine, so that whatever the 
ethical importance of the treatment may amount to, it 
cannot be regarded as therapeutically successful. He waa 
charged last week at the West Ham Police Court with 
having caused the death of his child by withholding 
medical assistance. As the medical evidenoe did not sup¬ 
port the suggestion that death would have been averted 
by skilled advice, the prisoner was discharged. The case 
subsequently came before the Central Criminal Court on 
the coroner’s inquisition, where he was also found not 
guilty, but the question was raised whether, as the 
prisoner was under recognizances in respect of a con¬ 
viction for manslaughter in 1897,.he ought not to be 
called up for sentence. The judge pointed out that it 
was for the Crown to decide whether the prisoner ought 
to be called upon to surrender to his recognizance, and 
in the meantime he was discharged. It is time this 
playing at justice ceased, and that a definite pronounce¬ 
ment was made for the future guidance of judges and 
magistrates in these cases. 




The Medical Pbkm. 


NOTICES TO GO&RESPONDENT8. 


Mas. 15, 1890. 


^oticre to 

CormpoftbrntB, Short JtetttrB, &t. 


«#■ Correspondents requiring a reply in thin oolnnrn are par- 
-ticnlarly requested to make nee of a disMttetfoe tignatw* or 
initial*, and avoid the practice of signing themselves “ Header,” 
■“Subscriber,” “Old Subscriber,'’ Ac. Much confusion will be 
spared by attention to this rale. 

Beading Cases.— Cloth board cases, gOt lettered, containing 
-twenty-six strings for bolding the number* of The Medical Pubs 
asdI Circular, may now be had at either office of this journal, 
•price 2a. 6d. These cases will be found very useful to keep each 
weekly number intact, dean, and flat after it has passed through 
the post. 

MEDICAL ETHICS IN INDIA. 

The following is the oopy of a placard posted up at all the public 
places in Lucknow, w£fcn we reprint from the Indian MtdieaL 

“ Dr. M. S. Varis, M.B., C.MJSdin., consulting physician and 
•tu-geon. Consultation, all hours free, 9-11 a.m. Share Darvosa. 

oNotioe.—Dr. Sayad Mahomed Varis, surgeon. ‘ Good news to 
thee, O heart; a Jesus-like man has come. Be it known to the 
weaker* after bodily health and to these in the’clutches of deadly 
diseases that the Aristotle of the times and Galen of the universe. 
Dr. Sayad Mahomed Varis, M.B., C.M., after learning the art of 
medicine and practising it in Great Britain, has oome to this town 
(Lucknow). He studied for six or seven years in modern Athene— 
wig., Edinburgh, which is the capital of Scotland, and he obtained 
the diploma of a physician and surgeon ; and there for three years 
he established himself in practice and performed Christ-like 
miracles. It is our good fortune that he has established himself 
here. It is hoped tut whosoever will apply to him for treatment 
-will fill his pocket with pearls of health. He lives dose to Kaiser 
Bag near Snare Darvoza, opposite the telegraph office, in house No. 
1. Patients can consult him all day." 

Croydon.— The extraordinary condition in the will you mention 
was doubtless due to a dread of being buried alive on the part of 
-the testator. Upon the more general question as to the probability 
■of such an occurrence, we must refer you to a little book entitled 
•** Premature Burial, Pact or Fiction ? (Bailliere, Tindall and Cox), 
published in London last year. From an examination of published 
reports, the author concludes that no scientifically authentic 
instance is on record, and that the possibility of such an alarming 
wvent as live burial is exceedingly remote. 

THE VALUE OF PULPIT UTTEBANCE8. 

Mb. F. Lawrence writes us that the late 8ir Douglas Galton was 
■olive to the influence exercised by the pulpit in regard to sanitary 
matters, and thought that set sermons should be preached on such 
■subjects as “ Consumption, and How to Prevent It ’’ But for the 
fatal termination of his illness he would have presided at the forth¬ 
coming annual meeting of the Church Sanitary Association at 
‘Westminster. 

Db. A. Dbpaoe (Brussels).—Our “ Exchange List ” is already too 
full, we regret we are unable to accede to the request on behalf of 
J ‘ The Socfcte Beige de Chirurgie." 

Ergo. It has been calculated that a cyclist weighing between 
eleven and twelve stone, riding a machine weighing 40lbs., at an 
■average rate of ten miles an hour, oonsumes 4 5 o.c. of oxygen per 
yard. This falls 6 per cent, when the rate is reduced to six miles 
an hour, and increases 10 per cent, if the speed is accelerated to 
fifteen miles an hour. At ten miles an hour the cyclist consumes 
seventy-two litres of oxygen per hour, as compared with the 
pedestrian, who, at four miles an hour, does not consume more than 
jixty litres. _ 

JftwtittQS of the §orietus artb JCcttures. 

Wednesday, March 15th. 

Boyal Microscopical Society <20 Hanover Square, W.) — 8 p.m. 
Mr L. Wright: The Projection Microscope. 

North-West Loudon Clinical Society (North-West London 
Hospital).—8.90 p.m. Annual General Meeting. Election of 
Officers. Demonstration of Cases. 

Boyal Colleoe of 8cbgeons of England.— 5 p.m. Prof. C.' 
Stewart: Alternation of Generation and Becent Additions to the 
Museum. 

Thursday, March 10th. 

Harveian 8ociett of London (Stafford Booms, Tichborne 
8treet, Edgware Boad).—8.30 p.m. Dr. Mouillot: Modern Views 
on Gout in Belation to Treatment. 

Boyal Society.— Prof. Burdon-Sanderson: The Electrical Con¬ 
comitants of Motion in Plants and Animals. (Croonian Lecture). 

Boyal Colleoe of Phtsicians of London.— 5 p.m. Dr. 8. 
Gee: The Causes and Forms of Bronchitis. (Lumleian Lecture). 

St. John's Hospital por Diseases op the 8xin iL eicester 
Square, W.C.)—4.30 p.m. Dr. M. Dockrell: Cases of Purpura and 
.otner Heemorrhngic Affections. 

Friday, March 17th. 

Dental Hospital op London (Leicester Square).—Annual 
General Meeting of Governors, at 5.30 p.m., to receive the Annual 
Report, and elect the Committee of Management, the Treasurer, and 
Auditors for the ensuing year. 

Epidemiological Society of London (11, Chandoe 8treet, 
Cavendish Square, W.).—8.30 p.m. Paper; Dr. W. H. Crosse: 
Blackwater or Hiemoglobinuric Fever. 

Society or Anesthetists (20, Hanover Square, W.)—Papers by . 
Mr. H. B. Gardner and Mr. A. Granville. Casual Communications. < 


Boyal College or Surgeons or England.— 5 p.m. Prof. C. 

8tewart: Alternation of Generation, and Beoent Additions to the 

Museum. 

TBaomrifBL 

Belmullet Union.—Medical Officer for the Knoeknalower Dispensary 
District. Salary £B0.with £10 extra as Health Oflioag w*tb ttie 
usual extra fees. Immediate applications to the Clerk of the 
Union, (flee advert). 

Chorlton-upon-Medlook Dispensary, Manchester.—Besident House 
Surgeon, unmarried. Salary £100 a year, with furnished 
rooms and attendance. 

County Asylum, Whlttingham, Lancashire.—Junior Assistant 
Medical Officer, unmarried. Salary commencing at £100 per 
annum, with furnished apartments, board, attendanoe, 'and 
washing. 

Cumberland and Westmoreland Asylum, Garlands, Carlisle.- Junior 
AssistantWftMcwlOfca, unmarried. Salary £100 a year, with 
board and residence. 

Dinorwic Quarry Hospital.—Assistant to act as Assistant Surgeon. 


Dinorwic Quarry Hospital.—Assistant to act as Assistant Burgeon. 
Salary £150 a year, with half midwifery fees attended by him. 
Applications to Mr. H e b er ts , Dinorwic Quarry Hospital. Llan- 
beris. North Wales. 

Essex County Asylum, Brentwood.—Junior Medical Assistant 
Officer, unmarried. Salary £120 per annum, with board, resi¬ 
dence, and washing. 

Monmouthshire Asylum, Abergavenny.—Third Assistant Medical 
Officer. Salary £100, increasing by two yearly instalments to 
£'50, with board, lodging, and washing. 

Boyal College of Physicians of London, and Boyal College of 
Surgeons of England Conjoint Laboratories.—Director of the 
Conjoint Laboratories. 

Staffordshire County Asylum, Stafford —Junior A ssistan t Medical 
Officer, unmarried. Salary, commencing at £100 a year, with 


furnished apartments, board, Ac. 
West Biding Asylum, Menston, n 
Medical Officer. Salary comma 


apartments. 


n, Menston, near Leeds.—Fourth Assistant 
Salary commencing at £100, with board and 


SS.’S.'SSS appoint mtnta. 

o the probability Brtke, P. K., M.D., B.S.Lond., Medical Officer for the Christ- 
Je book entitled church 8anttary District of St. Marylebone, London. 

WndaDand Cox). Chesson, H., L.BXLP.Lond., M.B.C 8., Assistant Medical Super- 
aon or published intendent to the Hospital for the Insane, Qoodna, Queensland, 
ically authentic Cooper, A., F.R.C.S.Eng., an Honorary Consulting Physician to the 
ich an alarming 8t. Mary's Hospital. City Boad, London . 

Forster, Fred. C., M.R.C.S , L.B.C.P., Assistant House Surgeon 
rCES. to the Boyal Berkshire Hospital, Beading, 

nirla* Galton was Hoppman, A. H-, M.D. St. And., L.B.C.P., L.B.C.S.Edim, Medical 
to ranlrar. Officer of Health for the Knighton Bund District, 
raohed^onrach *>»*■. F - F..M.B.C.8., Medical Officer of the No. 2 Sanitary District 
. ,, of the Bath Union. 

ied at the forth! Kbltnack, T. N., M.D., M.B.C.P., Honorary Pathologist to the 
.t Manchester Clinical Hospital for Women and Children. - 
Associauon at Kenny, A. 8., M.B.C.8., Medical Superintendent of the Govern- 
. „ . , . ment Sanatorium at Botorna, New Zealand. 

6 *■ Kerr, J. L., M.D.Aberd., C.M.. Medical Officer for the Biddenden 

icet on behalf of (Sanitary District of the Tenterden Union, Kent. 

Maceenzie, E., M.D. Clang., C.M., Medical Offioer for the Work- 
eighing between house and the Cheadle Sanitary District of the Cheadle Union, 
og 40 lbs., at an Miller, Victob, M.B., C.M.Edin., Honorary Ophthalmic Surgeon 


for the Fifth District of the Chipping Sodbury Union. 

Thurnam, H. L., M. A. Cantab,, M.B.C.S., L.B.O.P.. Public Vacci¬ 
nator for the whole District of Gravesend and Milton. 
Woodroofe, B. P., L.B.C.S.Irel., Medical Officer by the Eccleehill 
Urban District Council. 


flirths. 


Cox.—On March 6th, at 58 High Street, Watford, Herts, the wife of 
Alfred E. Cox, L.B.C.P., M.B.C.8., of a son. 


4 R**riagtB. 


Brown-Pope.— On March 9th, at St. Margaret's Church, West¬ 
minster, Henry Beynolds Brown, M.B.C.M., of Maldon, Essex, 
to Helen Evelyn Pope, of Latchingdon Rectory, Essex. 

deaths. 

Barxlet. —On March 8th, at Brighton, suddenly, after a long 
ill ess, Charles Horace Barkley, L.B.C.P., L.B.C.S., aged 40 
years. 

Burns. ^-On March 5th, at his father’s residence, Betar, Vale Bond, 
Ramsgate, Alfred Hugh Burns, L.B.C.P.I., L.8.A., aged 44 
years. 

DAMBRiLL-DAVixs.-On Feb. 26th, at his residence, Alderley Edge, 
W. R. Dambrill-Daviee, M.B.C.8., Lieut-Col. Vol. and Army 
Medical Reserve. 

Gartlet.— On March 4tb, suddenly, at Sackville Street, Picca¬ 
dilly, W. John Alexander Gartley, L.D.S.B.C-S.Enf aged 63 
years. 

Rose. —On March 7th, at Dole Bank, Chesterfield, suddenly, John 
Bose, M.D. (Retired List B.NJ, aged 76 years. 

Smith.— On March 1st, at Stuart Lodge, Polwarth Terrace, Edin-. 
burgh, John Stuart Smith, M.D., retired Surgecn-Majorw 
Army Medical Department, aged 84 years. 


Digitized by Vj 



March 22. 1890 


The Medical Press and C'rtftar Advertiser. 


Alleitburps 


5oft, Demulcent, 
Palatable. 


Cbroat Pastilles 



These Pastilles have 
now for many years been 
employed by the Faculty 
in the relief of Throat 
Affections. Their form 
enables them to be more 
easily sucked than the 
ordinary hard lozenge; 
while the Pate de Jujube 
from which they are 
manufactured is particul¬ 
arly palatable, soluble and 
demulcent in its action. 


The following are examples only of the Pastilles in 
very general use : 

No. 9.. Menthol, Cocaine, and Red Gum. 

Menthol et Cocainae, aa. gr. 1-20 ; 
Gummi Rubri, gr. ii. Antiseptic, 
Sedative, and Astringent. 

„ 11. Chlorate of Potash. 1 grain in each. 
Better than the B.P. form. 

„ 27. Compound Eucalyptus. (Red Gum, 
Chlorate of Potash, and Cubebs. 
A valuable astringent. 

„ 29. Compound Rhatany and Cocaine. 

Ext. of Rhatany, gr. ii. ; Cocaine 
Hydrochlor., gr. 1 - 10 . A very 
efficacious astringent and anodyne. 

„ 38. Cocaine, Chlorate of Potash, and 
Borax. Especially useful for the 
. tickling of a slightly relaxed throat. 

„ 44. Menthol and Cocaine. i- 2 oth of a 
grain of each in a Pastille. The 
antiseptic and stimulating action of 
the Menthol, combined with an 
effective Anodyne. 

„ 48. Menthol and Rhatany. i- 2 oth of a 
grain of Menthol in a Pastille. 
Stimulating, antiseptic, and mildly 
astringent. 

„ 48. Tannin, Cayenne and Black Currant 

Is far more palatable and efficacious 
than the ordinary lozenge. 


In prescribing it is only necessary to add the letters A. 6* H., these being registered 
as a Trade Mark ; thus—Tannin Pastilles A. &• H. 

A list of 54 varieties, and a sample box containing specimens of 
six kinds, supplied free to medical men on application. 

Allen & Hanburvs Ltd., London. 


Digitized by 


Google 






-Th« Medical Press and Circular Advertiser. 


March 2S, 1896 





‘LANOUNB’ 

PREPARATIONS. 

'LANOUNB* 
i lb. and 7 lb. tfau, 
a/8 per lb. 

LANOUNB’ (Anhydrawi 
i lb. tine, 3/4 per tb. 


TOILET 'LANOUNB* 

In email and large 
collapsable tubce, 4/6 and 
9/- per dox. 


'LANOUNB* 
TOILBT SOAP 
In boxes containing three 
tablets. 

4/6 per doses tabl et s. 




\ / 
V 


‘CanolitK’ 

Preparations 

^ANOLINE' is a preparation of the purified 
fat of lamb's wool, and is similar to the 
natural fat of the human skin. 

TOILET ‘LANOLINE/ 

The most natural and therefore the best emollient 
for the skin. The * British Medical Journal * says: 
—“Useful for chapped lips and hands, abrasions 

and eruptions of many kinds. In a thin layer over 

• 

a wound it is an effective protective. . . . Such a 
layer forms an impassable barrier to disease germs.” 

'LANOLINE' TOILET SOAP. 

A pure neutral soap carefully superfatted with 
‘Lanoline*. It thoroughly cleanses the skin and 
renders it beautifully supple without causing the 
slightest irritation even to the most delicate and 
irritable integument. “An excellent and valuable 
preparation ."—* The Lancet. ' 

Sole Licensees — 

Burroughs Olellcoim and Co., 
'Eonoon ma svDnev. 


Digitized by V^OOQle 


March 22, 1899 The Medloal Press and Circular Advertiser. 


-'TABLOID'- 



HILST the therapeutic values of many of the 
animal substances, which have been made the 
subjects of physiological and clinical research, 
still remain undecided, there can be no doubt 
that certain of the ‘Tabloid’ Animal Substances 
have proved most useful in the treatment of 
.disease. 

'Tabloid' Thyroid Gland Substance 

has been, from the first, most closely associated with successful 
Thyroid-Therapy, and reports conclusively demonstrating its value 
are repeatedly appearing in the British and Foreign Medical 
Journals. 



'Tabloid' Supra-renal Gland Substance 

has also been the subject of clinical investigation and favourable 
report. It causes contraction of the arteries, and consequently 
increases the blood pressure. Reprints of articles will be gladly 
forwarded to medical men on request. For Therapeutic Notes see 
Wellcome’s Medical Diary , page 130. 

‘Tabloid 1 Thyroid Gland Substance is supplied in two strengths, gr. 1-1/2 andgr. 5, 
m bottles of 100, at 1 Od. and 2s. per bottle. 

* Tabloid Supra-renal Gland Substance is supplied in bottles of 100, 
at 4s. 6d. per bottle. 


Burroughs Wellcome and Co., LONDON and SYDNEY. 

Telegrams —" BURCOME, LONDON ." 

[MnMHT] ■ *•* 


Digitized by 


Google 







The Medical Press and Circular Advertiser. 


March 22, 1899 


Antikamnia & Codeine. 

AK., 43 gr. Sulphate Codeine, 3 gr. 



“I had to leave home on short notice to see a patient 
who is suffering from granular contracted kidney 
with pronounced retinitis. 

“ The patient has suffered the most maddening 
pain in her head especially at night. 


“ I happened to have a sample box 
lately received from you and admin- 
one tablet at night. This gave relief 


which I 
KǤ istered 

to the 



pain very rapidly so that the patient enjoyed a 
refreshing sleep for two hours. One night, the dose 
was repeated (one tablet) and the patient slept for about 
five hours. In a case of this kind it is a comfort to be 
able to treat a symptom with so happy an effect.” 



Antipyretic. 

Analgesic. 

Anodyne. 

does not depress the hear! 


In the neuralgias and nervous headaches, resulting from over-work and prolong! 
mental strain, paroxysmal attacks of sciatica, brow-ague, painful menstruation, la g ' 
and allied conditions, ten grain doses of Antikamnia in an ounce of sherry wine, 
every two to four hours, will carry the patient through these painful periods with 
satisfaction. 


Ant.Hm.mnln powder and tablet* (5-gr. A8-gr.) 
Antikamnia combination* ,5-gr. tablet* only) 


l-o*. packages, price to the Profession 8/10 poet free. 
Antikamnia Chkm. Co. (3t. Louis), 46 Hoi bom Viaduct, E 


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•3 &!' 









®ke Mtdital fgttta and (Tirrular. 


“ SALUS POPULI SUPREMA LEX." 

Vol. OXVIIL WEDNESDAY, MARCH 22, 1899. No. 12. 


^Iht Jjarbett Matures. 

THE ADMINISTRATIVE CONTROL 
OF TUBERCULOSIS. 

By Sib RICHARD THORNE THORNE, 
K.C.B., M.B., F.R.S., 

Medical Officer to the Local Government Board. 

Abstract of Lecture II. 

I hate had hesitation in adopting some of the more 
advanced views which have been put forward, both as to 
the amount of risk to which man is subjected through 
the consumption of the meat of tuberculous animals, and 
as to the measures of control which have in consequence 
become necessary, I know no grounds which would 
justify me in attempting to minimise either the risk 
which arises from the consumption of the milk of 
tuberculous cows, or the grave consequences to which 
the practice gives rise in this country. Indeed, I am 
profoundly convinced that the danger is great and wide¬ 
spread, and that it is absolutely necessary for those 
e. gaged in the pursuit of preventive medicine to take a 
prominent place in arousing the public to a proper 
appreciation of the fatal consequences to which it gives 
rise. 

I have already pointed out that the form of tubercu¬ 
losis most identified with the reception of the tuberculous 
infection into the digestive tract is that which in its fatal 
form is registered under the heading “ Tabes Mesen- 
terica.” While the mortality from tabes mesenterica 
at ages between 16 and 45 years is only 44, it rises to one 
of 1,577 per million living under 6 years of age ; and 
under 1 year of age it reaches no less than 4,046 per 
million births. 

Then, too, if we contrast the reduction of 27 9 per 
cent, which has taken place during the last 45 years in 
all forms of tuberculosis, and that of 66 per cent, in 
phthisis with the corresponding one from tabes mesen¬ 
terica, which only reaches 2 9 per cent., you will see that 
in considering the latter cause of death we are dealing 
with a totally different state of affairs. 

If we limit ourselves to the first year of life, when milk 
is most largely used as a food, we find that the reductions 
in the rate of death from the various forms of tubercu¬ 
losis, which reduction has been going on for about half 
a century, not only disappears, but is actually trans¬ 
formed into a large increase, reaching no less than 21 7 
per cent. 

From whatever point of view we regard this ominous 
increase in the rate of death from Tabes Mesenterica 
among infants, we are forced to the conclusion that it is 
largely related to the use as an article of food of the 
milk of the bovine animal. 

We must not overlook the fact that there is some 
relationship between tabes mesenterica and diarrhoea, 
indeed, the rates of death from these two diseases oom- 
monly rise and fall together. Apart from errors of 
diagnosis I infer that the existence of an intestinal 
condition leading to diarrhoea, or the absence of any 
such condition, largely explains whether or not an infant, 
or even an adult, will be susceptible to, or experience 
immunity from, the infection of tuberculosis. It seems 
to me that a really healthy animal, whether man or one 
of the lower animals, is not easily susceptible to the 
effects of a pathogenic organism such as that which we 
are, considering, and to which he must so often be 


exposed, whether the bacillus be conveyed aerially or 
by means of food; whereas, on the other hand, when 
that organism reaches a surface which exhibits an 
evanescent or more lasting departure from that normal 
state which we describe as healthy, the matter is 
different. • 

It now becomes necessary to consider more in detail 
what is the nature of the evidence to the effect that the 
milch-cow is a danger to man, in the matter of tubercu¬ 
losis, through the agency of her milk. 

We know that the bovine race is peculiarly susceptible 
to tuberculosis, and that it is the female which, to a 
much greater extent than is the case in the human 
subject suffers most. The conditions favouriog tubercu¬ 
losis are also altogether exceptional in the case of the 
milch-cow. In the first place, there is the exhausting 
process involved in the production of milk, a process 
associated in the milch-cow with the constant loss of fat, 
albumen and salts contained in milk, and with a conse¬ 
quent tendency to emaciation. Then, too many cows are 
kept and fed under conditions which are altogether 
opposed to Nature, especially in towns where they are 
kept in cowsheds in which, for the purposes of warmth, 
they generally lie in couples in close contact with each 
other, with inadequate ventilation; and it is no uncom¬ 
mon thing to find that cows which, in their natural state, 
live and graze in the open air, never for one moment 
leave their sheds for the outer air during the whole 
period—often ranging from 8 to 12 months—in which 
they are used for milking. Their food, too, is especially 
selected with a view to the production of milk. In fact, 
they are artificially turned into milking machines. By 
my reference here to towns I by no means exclude 
couotry cowsheds in so far as conditions are favourable 
to tuberculosis are concerned. That is a point to which 
I shall revert. 

In forming some estimate as to the number of milch- 
cows in England and Wales affected with tuberculosis, 
very varied evidence is available, but if I take it for the 
purposes of these lectures that 25 per cent, of our milch- 
cows are tuberculous, I feel confident that I greatly under¬ 
state the case. There are in England and Wales about 
2,100,000 milch-cows, and on this low estimate some 
525,000 would be tuberculous 

All tuberculous cows are not, however, necessarily a 
source of danger through their milk. Indeed, in so far 
as immediate danger to the human subject is concerned, 
it is only the cow with tuberculosis of the udder that 
exhibits tubercle bacilli in the milk, as proved by an 
experiment carried out under the auspices of the Royal 
Commission of 1890, by Dr. Sidney Martin, on seven¬ 
teen cows believed to be tuberculous. Only fifteen 
turned out ou slaughter to be so, and of these ic was 
found post-mortem that five had Borne tuberculous affec¬ 
tion of the udder. In the case of ten out of the 
tuberculous cows, eight had healthy udders, and two had 
an udder affection which was ultimately found not to be 
tuberculous. In no single samples of milk from these 
ten tuberculous cows with non-tuberculous udders could, 
tubercle bacilli be found, and sixteen test animals, which 
were fed on, or inoculated with, their milk, remained 
perfectly free from tuberculous disease. Of the five cows 
which turned out to have tuberculous disease of the 
udder, three exhibited tubercle bacilli in their milk, and 
two did not Fifteen test animals were fed with the 
milk that contained tubercle bacilli, with the result that 
tuberculosis was produced in every one of them, i he 
milk of one or other of the two cows having tuberculous 
udder disease, without evidence of tubercle bacilli in the 

zed by Google 


Die 



288 Thk Medical Puses. ORIGINAL COMMUNICATIONS. Mab 22. 1890. 


milk, was used as food for twelve test animals, and four 
of these became tuberculous. On the other hand, 
similar experiments, including the inoculation of animals, 
made with the milk of the two cows having an udder 
affection, which was found to be non-tuberculons, failed 
to give tuberculosis to any of the test animals employed. 

The deposit of small tubercular masses in a bulkv 
organ such as the udder of a milch-cow is moht difficult 
to detect, and it is by no means always possible to detect 
the existence of tubercle bacilli in milk which is potent 
to communicate tuberculosis. In fact, it is very im¬ 
portant to remember that the failure to detect tubercle 
bacilli in a single sample of milk in no way implies that 
another sample taken at another time from the same 
cow will not contain them, for the spread of tubercle in 
the udder “goes on with alarming rapidity.” Ihis 
difficulty of detecting tuberculosis of the udder in its 
earlier stages, indeed constitutes ODe of the principal 
dangers to man as a consumer of cow’s milk. 

In determining what are the administrative measures 
of control which are necessary to meet this evil, the one 
which first presents itself to most minds is the exclusion 
of all tuberculous cows from dairies. The presence in a 
dairy of a tuberculous cow, as Drs. Martin and Woodhead 
have shown, is a decided source of danger to the public, 
especially having regard to what we have learnt respect¬ 
ing the rapid development of tuberculosis in the udder, 
and the degree of danger to milk-consumers incurred by 
the invasion of the udder in tuberculous cows. 

What would be the effect of at once eliminating every 
tuberculous cow from our dairy-farms and cow-sheds? 
Even on the low estimate which I have already given 
you more than half a million cows would have to be at 
once withdrawn from the milk-supply of England and 
Wales, and yet the majority of these cows are probably 
supplying milk which is derived from healthy udders; 
and if we held the view that every cow which, in the 
hands of an expert working with material prepared ac¬ 
cording to an acknowledged standard, responded to the 
tuberculin test, then the proportion to be condemned as 
milk suppliers would be very much greater. Whatever, 
therefore, the ultimate end which we may rightly seek to 
attain, we must at least commence on lines that are 
practicable of application. 

Foremost among the measures to be advocated is the 
adoption throughout the country of regulations as to 
cowsheds which will give our dairy cows a better chance 
han they now have of avoiding the infection of tubercu¬ 
losis during the term in which they are confined in sheds 
and byres for the purposes of milk production. 

At present both the law and practice are deficient in 
this matter. No department of Government is invested 
with the power of laying down regulations as to the 
construction, ventilation, or provision of air-space in 
cowsheds, the details of which they can enforce. All that 
the Government can do is to refuse sanction to the opera¬ 
tion of any regulation which they “ are satisfied on 
inquiry ... is of too restrictive a chsracter, or other¬ 
wise objectionable.” The result is that the existing 
regulations differ widely in different districts in matters 
which we now know to be of vital importance. 

The Royal Commission of 1896, whilst recognising 
the immense difficulty—indeed, impossibility—of at once 
attaining all that is needed in this respect, endeavoured 
to meet the more pressing need in this matter by laying 
down certain rulesastotheregistration and construction of 
cowsheds, and they urged that power should be conferred 
upon the Local Government Board to require the adop¬ 
tion of those rules. Their recommendations as to this 
were as follows:—(a) That in future no cowshed, byre, 
or shippon, other than those already registered shall be 
permitted or registered in urban districts within 100 feet, 
of any dwelling-house; and that the discontinuance of 
any one already existing shall be ordered on the certifi¬ 
cate, either of the medical officer of health that it is injuri¬ 
ous to the health of human beings residing near ir, or of 
the veterinary inspector that it is not a place wherein 
cows ought to be kept for the purpose of milk supply, 
and that it is incapable of being made so. (6) That the 
conditions of the attached cowsheds that shall warrant 
the registering of a dairy in a populous place, whether 
technically urban or rural, in the future shall include 


I the following:—(1) An impervious floor. (2) A suffi¬ 
cient water supply for flushing. (3) Proper drainage. 
(4) A depot for the manure at a sufficient distanoe from 
the byres. (5) A minimum cubic contents as regards 
such districts of from 600 to 800 feet for each adult 
beast, varying according to the average weight of the 
animals. (6) A minimum floor-space of 50 feet to each 
adult beast. (7) Sufficient light and ventilation. 

While we have prescribed a minimum cubic contents 
and floor space, without mentioning definite dimensions 
affecting ventilation and lighting, we are distinctly of 
opinion that these are by far the most important, and 
that requirements as to cubic and floor space are mainly 
of value as tending to facilitate adequate movement of air. 
The same conditions as those recommended for populous 
places should apply to cowsheds in sparsely populated 
places, except in so far as cubic contents per cow are 
concerned In hospital construction the first point to be 
aimed at in the matter of air-space is to secure adequate 
movement of fresh air at the level above the floor at 
which the patient is breathing, and hence that the pro¬ 
vision of adequate floor-space, and still more of wall- 
space per bed, outweigh in importance the mere pro¬ 
vision of cubic space. In the case of milch-cows the 
need for maintaining bodily warmth is held to be one 
that cannot be ignored, and hence it is that so small a 
minimum as 50 square feet is all that it was deemed 
expedient to require at the present time. But it is a 
step in advance to maintain that a minimum amount of 
floor-space must go hand in hand with a requirement as 
to cubic capacity; and to insist that both these shall be 
controlled by the requirement that the ventilation and 
the lighting of cowsheds shall be adequate. 

There is a general impression that cowsheds in rural 
districts need less control in this respect than those ia 
urban districts, but I can only say that, according to my 
limited experience, by far the worst constructed, worst 
ventilated, and the dirtiest cowsheds are to be found in 
villages, hamlets and rural areas. In small farms on 
hillsides and exposed places, where movement of air is 
said to abound, I have often found that a most inade¬ 
quate cubic capacity has coincided with the blocking up 
of every opening and cranny that could afford reason¬ 
able means of ventilation. 

Whilst I am certainly no advocate for the retention of 
cowsheds in towns and cities, yet I am bound to say that, 
with the present, neglect of rural cowsheds, the city 
byres often take precedence of the country ones in the 
matter of tuberculosis. Thus, of 144 samples of milk 
taken from cowsheds in the city of Liverpool, 4, or 2*8 
per cent., exhibited the tubercle bacillus ; whereas of 24 
samples taken at railway stations of milk arriving from 
“ the country, - ' the tubercle bacillus was found in 7, or 
29 - l per cent Later investigations in Liverpool showed 
that a total of 228 samples of milk from city cowsheds 
gave 12, or 5 2 per cent, as infected with the tubercle 
bacillus, whereas in 67 samples derived from country 
cowsheds, 9, or 13 4 per cent, were found to be so 
infected. In Manchester similar inquiries have for 
some time past been carried out, and it has been found 
that out of 93 samples of milk taken at the railway 
stations on their arival from the country, 17, or over 18 
per cent., contained the tubercle bacillus. Comparison 
between this country milk aud that of cows in the city 
shippons was on this occasion not practicable, because 
earlier inspections had led to the removal from these 
city shippons of a number of cows suffering from 
suspicious udder disease, including five the milk from 
which contained tubercle bacilli. 

Facts such as those to which I have adverted, taken 
together with the prolonged detention of milch-cows in 
sheds point Btrongly to the need for more stringent and 
uniform control of these constructions. This will, I trust, 
l>efore long be effected. I only wish I could also antici¬ 
pate the speedy adoption of a regulation that would pre¬ 
vent cows being placed, as they now almost invariably 
are, with their nose and nostrils to the wall. If the object 
is the most effectual manner to deprive them of all 
chance of breathing fresh and moving air, nothing could 
better have achieved that end than the now prevailing 
system; and when we call to mind the fact that tubercu¬ 
losis in the cow is, in the main, a matter of direct infeo- 


Mar. 22, 1899. 


ORIGINAL COMMUNICATIONS. 


Thi Medical Press. 289 


tion through the respiratory apparatus, this point 
becomes all the more important. To enact a require¬ 
ment involving the abandonment of this practice would, 
of course, mean the provision of additional air-space ; and 
this would under some climatic conditions involve 
measures of artificial warming to secure the temperature 
deemed necessary for milk production. In other words, 
it would mean increase of cost in construction, if not for 
the purposes of maintenance. 

As to this, however, it may be interesting to put on 
record a piece of personal experience. On a somewhat 
recent visit to a large, well-managed dairy-farm on the 
outskirts of London, I observed that the cows were stalled 
down the centre of a shed measuring 17 feet 6 inches in 
width, a passage 4 feet 6 inches wide being provided both 
in front of and behind the cows. On inquiring, at a later 
date, how far this excellent arrangement necessitated 
artificial warming in the winter months, I was informed 
in writing by one of the owners of the dairy-farm that, 
although steps were taken during the colder weather to 
avoid actual draught, no artificial warming was ever 
resorted to. The “ winter feed ” for the cows, it was 
added, was found “ sufficient ” to enable them “ to with¬ 
stand any ordinary change of temperature.” The writer, 
referring of course to an experience based on the climate 
of the metropolis, added : “ I do not think a properly 
ventilated shed requires any artificial heating.” 

Proper regulation of cowsheds would bring about 
other advantages in our milk supply than those which 
are concerned with the prevention of tuberculosis. To 
name one of these only. I would refer to the necessity 
of forbidding the storage of cows’ dung within a specified 
distance of the sheds. At present the air of sheds con¬ 
taining large numbers of cows is laden with the smell of 
decomposing dung piled up in proximity to them, and it 
must necessarily be highly charged with those bacilli— 
such as the bacillus coli —which find in the large intes¬ 
tine their principal habitation. But enough has been 
said to show that proper control in the construction and 
management of cowsheds and their surroundings is an 
administrative measure that is urgently called for; and 
I may add that uniform efficiency in this respect can 
only be attained as the result of further legislation. 

Another point has to do with the need of systematic 
inspection of dairies and sheds, and of all cows the milk 
of which is placed on sale. This should be carried out by 
the officers of the sanitary authority of the locality in 
which the premises are situated. But since the milk 
used in one district is now so often derived from one or 
more outlying or even distant districts, power should be 
conferred by statute for the inspection of cows, wherever 
they may be situated, by the officers of the authorities 
within whose districts milk from the premises in ques¬ 
tion is supplied; and this power should everywhere be 
supplemented by the further one to suspend or prohibit 
the sale within the district of an authority of milk from 
any dairy, whether obtained within or without the dis¬ 
trict, whenever this is deemed necessary either by the 
medical officer of health or veterinary official by reason 
■of the health of the cows. 

Just as Scotland is ahead of England in the matter of 
public slaughter-houses, so also has she set us an 
example in this matter of the control of milk from tuber¬ 
culous cows, wherever they may be situated. Sections 
24-27 of the Glasgow Police (Amendment) Act, 1890, 
deserve consideration in England in this respect. And. 
further, there should, to use the terms of the Royal 
Commission of 1896, be power to prohibit the sale of milk 
from any cow certified by a veterinary surgeon to be 
suffering either from such disease of the udder as in his 
opinion renders the animal unfit for the supply of milk, 
or from any cow exhibiting clinical syinptons of tuber¬ 
culosis. And lastly, udder disease in the cow should be 
made a notifiable disease, and a penalty should attach to 
the sale of milk from any cow so suffering, unless the 
•owner of the animal is in possession of a veterinary 
certificate to the effect that such disease is not tuber¬ 
culous. 

The possession of these powers as to suspending or of 
prohibiting the sale of milk from certain cows will, in 
many instances, involve the seizure of the animals in 
question by the local sanitary authority, acting on 


veterinary advice; and here again, as in the case of the 
seizure of tuberculous carcases, we are met with the 
claim for compensation. But the circumstances are 
quite different. I have given my readons for objecting 
to grant compensation for an article of food, like meat, 
which is placed on sale for the sole profit of its owner 
when it is seized because it is unfit for human consump¬ 
tion. But in the case of a milch-cow believed, or found 
on inspection, to be tuberculous, the animal has not been 
placed on sale. Apart from her milk, which is “ seized ” 
by reason of its sale being prohibited, the animal may be 
of value for, and quite fit for. the purposes of meat 
supply ; hence confiscation of the cow herself would be 
wrong. 

If, therefore, in the exercise of a power conferred by 
statute the sanitary authority should seize such a cow 
in the interests of the public, the seizure should be ac¬ 
companied by compulsory slaughter. And if, on 
slaughter, the animal should turn out not to be tuber¬ 
culous, then her full value as a milch-cow should be 
given to the owner out of the local rates ; whereas if, on 
the other hand, the animal be found to have been tuber¬ 
culous, only the value which the carcass may possess as 
a food supply or otherwise should be paid in compensa¬ 
tion The principles here laid down are, I believe, just 
and equitable. And it is worthy of note that whereas 
our national death returns from tuberculosis call for no 
departure from these principles in the case of our meat 
supply, those same returns point strongly to the need of 
their application in the matter of our milk supply. 

Measures such as I have indicated would go far to 
control tuberculosis through the agency of milk ; but it 
would be manifestly unfair, as well as wrong to the 
community, to apply them to the dairy-farms and cow¬ 
sheds of this country, and at the same time to admit 
milk and milk products from abroad without submitting 
these to restrictions resembling, as nearly as practicable, 
those applied at home. Holding this in view, the Royal 
Commission, of which 1 was a member, made a recom¬ 
mendation to that effect, and they added that any costa 
thus incurred should be borne by the importers. 

There remains the danger of the direct infection of 
tuberculosis from cow to cow—a danger which is the 
greater by reason of the fact that, to quote the words of 
the report of the Royal Commission of 1896, “ the insani¬ 
tary conditions under which dairy stock are often kept 
constitute highly favourable circumstances for the 
encouragement of tuberculous disease, and for its dis¬ 
semination among sound animals.” The experience 
derived from Denmark as to the action taken on the 
basis of the results of the tuberculin test, goes to show 
how much may be done to avoid this danger. Dairy 
cows to the number of 144,800 were submitted to the 
tuberculin test, with the result that in 45,899, or 31'7 
per cent., tuberculosis in some stage or other was 
detected. The detection of unsound animals is followed 
by their immediate isolation from t he healthy ones by 
the Bimple and inexpensive process of placing one set on 
one side of a wooden partition erected across the byre, 
whilst the other set are stalled on the other side. Each 
spring and autumn the sound set of cows are re-tested, 
and any that respond to the test are placed on the un¬ 
sound side of the partition, the process being repeated so 
long as any react to the tuberculin. 

In one typical form, at Thurebylille, this process had 
been carried on for five years. When the test was first 
applied, in 1892, it was found that 131 out of 208, or 
nearly two-thirds of the animals, were tuberculous, 
whereas in 1897 the matter was reversed; for out of 204 
animalB only 55, or one-fourth, reacted, the bulk of the 
animals being sound, and this notwithstanding the fact 
that the disease must constantly have been introduced 
afresh by means of newly purchased animals. Such 
action, if combined, in England, with proper administra¬ 
tive control of cowsheds, would probably be even more 
efficacious than in Denmark in securing the elimination 
of tuberculosis from our dairy stock. But the testing, to 
be trustworthy, must be applied under the supervision 
of experts, and the tuberculin must be of a guaranteed 
standard potency. How far control of tuberculosis in 
this direction should be administeied under the direc¬ 
tion of the State is, I believe, a matter on which there is 


Mar. 22, 1899. 


290 The Medical Press. ORIGINAL COMMUNICATIONS. 


some difference of opinion. The Royal Commission was, 
however, unanimous in making recommendations in this 
sense; and I am bound to say that I find it difficult to 
understand how the desired end of protecting the publio 
health in this way can be properly attained, except as 
the result of some such action by the 8tate as that which 
is adopted for the control of small-pox, and in which both 
the vaccinator and the necessary lymph can be obtained 
at the public cost. 

Thus far the measures of control which I have sug¬ 
gested have had concern with the cow, and the means of 
housing her; but, knowing as we do that the dried sputa 
from phthisical persons are easily mingled with the air, 
that the tuberculous infection of the cow takes place 
mainly through the medium of the air, and that aerial 
infection of milk easily takes place, it should be an in¬ 
variable rule that no individual suffering from tubercu¬ 
lous consumption should be employed in connection with 
milch-cows, with dairy processes, or in the sale of milk, 
and such inspection and control as I have already 
advised should be accompanied by periodic examination 
of dairy employes, and certification as to their freedom 
both from tuberculous and other infections. Regulations 
can already be made under the Dairies, Cowsheds, and 
Milkshops Order, rendering it unlawful “ to allow any 
person suffering from a dangerous infectious disorder . 

. . to milk cows or to handle vessels used for contain¬ 
ing milk for sale, or in any way to take part or assist in 
the conduct of the trade or business of the cowkeeper or 
dairyman, purveyor of milk or occupier of a milk-store 
or milk-shop, so far as regards the production, distribu¬ 
tion, or storage of milk. . . .” But when this regu¬ 
lation was drawn up in 1886, the term “dangerous 
infectious disorder” was not regarded as including 
tuberculosis, and further restrictions, based on the 
assumption that an acute infectious disorder, such as 
scarlet-fever, was in question, and controlling persons 
who had even *• been in contact” with a person so suffer¬ 
ing, may raise some difficulty in applying this to a disease 
lasting at times for many years, besides which no pro¬ 
vision is made for ascertaining whether a person is so 
suffering. This point raises the question of the notifi¬ 
cation of tuberculous disease notably phthisis, in man, 
a question to which I shall refer in my next lecture 
Then again, the adoption of such a regulation cannot be 
enforced, and it t-eems clear that to effect this, as well as 
other necessary reforms in relation to our milk-supply, 
fresh legislation will be required. 

It is a somewhat curious fact that the inhabitants of 
the United Kingdom stand a'most alone among civi¬ 
lised nations in the habitual use of uncooked milk as a 
food. This is the more to be regretted because, by 
reason of this practice, human life, especially that of 
infancy and childhood, is being sacrificed on a scale 
which, to use the mildest term, is altogether deplorable. 
That this should be bo is also altogether unreasonable 
in the face of the certain knowledge possessed, and which 
is set forth in the report of the Royal Commission of 
1890 in the following words : “ The most deadly tuber¬ 
culous material can be rendered absolutely innocuous, in 
so far as any spreading of infective disease is concerned, 
by the action of a temperature at which water boils.” 
imd again: “ It is sufficient to state that boiling, for an 
instant even, renders the tubercle bacillus absolutely 
innocuous.” 

Even the taste which attaches to boiled milk, and to 
which infants become at once habituated, may be largely 
avoided if the milk boiled after the morning delivery be 
stored in the cool for use in the afternoon, and if the 
afternoon milk be similarly set aside until morning. 

But some maintain that cooked milk is less nutritious 
than raw milk. There may be an element of truth in 
this. Milk is a fluid having a biological character; it 
is a living fluid, and this character is destroyed by boil¬ 
ing or sterilisation. From the purely scientific point of 
view it is most desirable to bear this in mind, but in its 
practical aspect it is well to remember that the slight 
diminution in nutritive value which cookiug brings 
about in milk cannot be named side by side with the 
immense gain in freedom from the risk of infectious 
disease and death which is thus insured. 

One word more. Milk, as it comes from the normal 


milk gland, is a sterile fluid, and it would be well for 
future generations if mothers could be brought to 
realise that “ there is no sterilising apparatus that 
give results comparable with those provided by Nature 
in the healthy female breast.” Happily I can add that 
tuberculosis in the human milk glands is a disease so 
rare that it hardly needs consideration in connection 
with the feeding of infants. At the child-bearing age it 
is all but unknown. 

Dr. Sidney Martin informs me that out of some 9,000 
patients, mostly suffering from tuberculosis—namely, 
phthisis—which have come under his own care, he ha« 
never met with tuberculosis in the mammary gland. He 
adds that in only one instanoe has such an occurrence 
been brought under his notice, in the patient of another 
physician, and even that case he regarded as more than 
doubtful. The need for educating the public of this 
country as to the risks involved in the use of raw cow's 
milk, and as to the simple methods by which these risks 
can be effectually avoided, is a pressing one, and it can 
only be met by enlisting the active services of my own 
profession. Our influence in such a matter is necessarily 
considerable; our responsibility is a correspondingly 
heavy one. 


THE MODERN DOCTRINE OF 
BACTERIOLOGY, OR THE GERM THEORY 
OF DISEASE, WITH SPECIAL 
REFERENCE TO GYNAECOLOGY, (a) 

By GEO. GRANVILLE BANTOCK. M.D.* F.R.C.S.E., 

Consulting Surgeon to the Samaritan Free Hospital for Women. 

After a few preliminary remarks Dr. Bantock said, I 
am quite aware that my views will probably be regarded, 
by a majority of those present, as very heterodox, but 
that does not deter me from giving expression to them 
and boldly courting publicity, notwithstanding the belief 
that they are only too far in advance of those held by my 
contemporaries for immediate acceptance. I am very 
anxious to call attention again to this subject, for I am 
driven to the conclusion that few of you took any interest 
in a discussion which occupied the correspondence 
columns of The Medical Press and Circular, a little 
over two years ago, on the modern doctrine of bacteri¬ 
ology, and which arose incidentally out of the question, 
“ What is Listerism ? ” It is a fact worthy of note that 
no follower of Lister, no modern bacteriologist, dared to 
enter into that discussion, or, if there were such an one, 
had the courage to disclose his name. 

Before proceeding further it will be well to define 
what I undei stand to be the modern doctrine of bacterio¬ 
logy. It is thiB, viz., that in the majority of, or as some 
extremists would seem to hold, all acute diseases, the 
condition is due to the influence of a specific so-called 
pathogenic micro-organism. Hence we hear of the 
typhoid bacillus, the diphtheria bacillus, and so on. 
This is the doctrine that I proceed to combat by pro¬ 
pounding the very opposite doctrine, that the presenoe 
of these various micro-organisms is the result and not 
the cause of disease—in other words, that the bacilli are 
found in association with the disease because of the 
disease, or that the disease furnishes the conditions 
necessary for the presence of the special micro-organism. 

You may have overlooked or forgotten a very im¬ 
portant fact told us by Dr. Newman. He told us that in 
the examination of the vaginal discharge of a healthy 
woman, obtained for him bv one of his colleagues, he 
found a great variety of organisms, and among them 
the staphylococcus pyogenes and streptococcus 
pyogenes. In the abstract published in the Journal of 
this Society, he tells us that “ more than thirty different 
species of micro-organism have been isolated from the 
female genital tract, or from discharges.” This is 
confirmed by numerous observers. Dr. Whittridge 
Williams also tells us that in the vaginal discharge 
of pregnant women “pyogenic bacteria were found 


(a) Abstract of Paper read before the British Gymeoo logical 
Society, March Oth, 1899. For discussion see page 201. 


Mab. 22, 1899. 


ORIGINAL COMMUNICATIONS. 


Th* Medical Pbbsb. 291 


in the vulval secretion in nineteen cases (76 per 
oent.) ” and within the vulva in 48 per cent. Among 
those enumerated by Dobbin we find, in addition to the 
two just mentioned, the bacillus coli communis, the 
bacillus of tetanus, Klebs-Lceffler bacillus of diphtheria, 
and the bacillus typhosus. Dr. Newman adds that 
“ the most frequently present is the staphylococcus 
pyogenes aureus, which is the commonest of the group 
of suppurative bacteria." Here we have the doctrine 
plainly indicated—and I need not trouble you with any 
more examples—viz., that the staphylococcus pyogenes 
and the streptococcus pyogenes are, as the name implies, 
the cause of suppuration. A strange part of this doctrine 
is this, viz., that the vagina is said to be the habitat 
of a bacillus—Doderleins—which “ is inimical to the 
presence or prolonged existence of so-called pathogenic 
bacilli ”—like the good fairy in the pantomime defeat¬ 
ing the machinations of the wicked fairy. 

A great deal of light has been thrown on this subject 
within the last three or four years. I presume you are 
all acquainted with the fact that Dr. Geo. Stoker has 
been treating ohronic ulcerative conditions, with the 
most gratifying results, by means of oxygen gas. Now, 
it happened that in the early days of his work he had 
under his care a woman who had been bed¬ 
ridden for many years with a large ulcer involv¬ 
ing the whole of the instep of each foot. These 
ulcers were almost precisely alike in form and extent, 
and it was suggested to him that one should be treated 
with corrosive sublimate and the other with oxygen gas, 
for the purpose of comparison. In a very short time it 
was easy to perceive a difference between these two 
uloers ; for while in the former the surface was certainly 
cleaner than at the beginning of the experiment, yet it 

E nted an ashey-grey appearance, and exhibited very 
sign of healing, the latter presented a healthy 
granulating surface with a good margin already healed 
over. A gentleman from the Clinical Research Associa¬ 
tion now appeared upon the scene, and took some of the 
discharge from each with a view of obtaining a culture. 
This was the astounding result, viz., that the first was— 
to use the current language—sterile, while the latter 
(oxygen case) gave a copious crop of bacteria, and what, 
think you, was the organism which stood out most pro¬ 
minently ? It was this very staphylococcus pyogenes, which, 
with the streptococcus pyogenes, we are told, is the prime 
cause of suppuration. From that time Dr. Stoker took 
up the study of bacteriology as applied to this part of 
the subject, and at the annual meeting of the British 
Medical Association in this city, in 1895, he gave an 
account of his work. As reported in the Journal of the 
Association, one of the important points to which he 
called attention was thus expressed: “ (8) The bacterio¬ 
logical aspect of one case was surprising and rather upset 
one’s preconceived ideas." Dr. Stoker returned to the 
subject at the next meeting—at Carlisle—but I fear his 
communications have had few readers. Having, from 
the time of the incident above referred to, taken to the 
study of bacteriology as applied to this subject. Dr. 
Stoker found that whenever the healing process 
appeared to falter, either under a diminished or 
an insufficient supply of oxygen, this was an indication 
for an increase, or for inoculation from a more 
healthy sore; and his observations led him to the 
conclusion that in proportion as the staphylococci were 
numerous and well developed so the healing process 
progressed. What, then, is the natural, common-sense 
conclusion from this F It is this, that the staphylococcus 
pyogenes, which, as its name implies, has hitherto been 
regarded as the prime cause of suppuration, and there¬ 
fore of the destructive process, must henceforth be 
regarded as, to say the least, doing no harm, and, it may 
be, as playing a beneficent rOle in the economy of nature, 
and. in non-technical language, may be looked upon as 
playing the part of a scavenger. 

It will probably be regarded as the rankest heresy when 
I express any doubt as to, much more a decided opinion 
against, the influence of the gonococcus as the prime agent 
in the production of gonorrhoea. As in the case of diph¬ 
theria, numerous observations are on record of cases 
of gonorrhoea without gonococci, and rice versa. Dr. 
Newman tells us that “ it is now well known that the i 
gonococci diminish in number as the disease becomes 


chronic.” That is to say, that as the disease becomes less 
acute the amount of the poison—the food on which they 
live—diminishes in quantity, and the gonococci are less 
numerous. It is marvellous, if it were not ridiculous, to 
what lengths some will go in their endeavour to bolster 
up a favourite theory. As an example take the following. 
To account for the recurrence of this disease in a subject 
who had presented no Bign of it for several years, and 
in support of the doctrine of latent gonorrhoea, it has 
been suggested that an old decrepit gonococcus has been 
roused into activity by sexual excess, and thus there has 
been brought about a recurrence of the disease—as pro¬ 
bable as the case of the fatted calf that had been in the 
family for many years. 

I am also aware that I am a heretic as to the import¬ 
ance of gonorrhea in the production of pelvic inflamma¬ 
tions, but I claim Dr. Newman as at least a tacit 
supporter; for has he not these words without adverse 
comment P “ It is said that gonooocci are present in one 
of every four cases of pyosalpinx.” Surely that is a very 
small proportion on which to establish the proposition 
that gonorrhoea is answerable for the majority of cases 
of pyosalpinx. On the contrary, it supports my conten¬ 
tion that it is only a factor in the minority of cases. 

As an example of the difficulty into which a rigid appli¬ 
cation of this doctrine leads one—I refer you to Dr. 
Sobinson’B paper on “ Vulvitis in Children.” 

You are doubtless aware that it is generally admitted 
by bacteriologists that the skin of the hand, and indeed 
aU parts of the body, though not all equally, teem with 
a bacillus to which the name staphylococcus albus has 
been given; that this bacillus is supposed to be possessed 
of pathogenic properties, and that elaborate processes 
have been invented for the purpose of destroying it. I 
refer especially to that described by Howard Kelly as 
perhaps the most elaborate. You are probably also 
aware that no process hitherto invented has yet suc¬ 
ceeded in getting rid of these micro-organisms, so deeply 
are they situated. Hence the skin itself—including the 
hands of the operator and that part of the patient 
involved in the operation—is said to be in a septic condi¬ 
tion requiring more or leas elaborate treatment. I might 
refer to innumerable observations by different workers in 
this field; but one will be sufficient for my purpose, and 
I take a paper published by Mr. Lockwood (British 
Medical Journal, September 17,1898), entitled, “ Further 
Report upon Aseptic and Septic Surgical Cases." In 
that report Mr. Lockwood tells us that, with regard to 
his hands, “ the skin was aseptic thirty-five ana septic 
six.Once it was some variety of staphylo¬ 

coccus albus.” Just before he “ had operated upon a case 
of ruptured perineum in which there was a vaginal dis¬ 
charge." One would like to know what became of that 
case, in which we may assume there must have been an 
abundance of micro-organisms—such as the staphylo¬ 
coccus and streptococcus (pyogenes), which so abound 
at the vulvar opening whenever there is any discharge. 

With regard to the patient’s skin, he says, ** The skin 
of the scrotum is extremely difficult to disinfect, and 
with the exception of the scalp, has a higher proportion 
of sepsis than any other.” “ Nevertheless, the scrotal 
wounds have done exceedingly well." “ Since 18941 
have done twenty-five, and none of them suppurated. 
Thus the sepsis of the scrotal skin has evidently a very 
small influence upon the repair of scrotal wounds." What 
an extraordinary comment! 

Now let us see what is the meaning of this word sepsis. 
It is as follows, as given in Funk’s “ Standard Dictionary 
of the English Language : ” “ (1) Poisonous putrefaction 
causing noxious effects on the vital properties or texture 
of organs. (2) Infection from a putrescent virus con¬ 
taining microscopic organisms, as sepsis from putrid 
matter or bacteria in a festering wound.” The equiva¬ 
lent, then, of this, in plain English, is “ poisonous ” or 
“ poisoned.” I give Mr. Lockwood his choice of these 
definitions. Does he contend that the skin of a healthy 
subject, in any part of the body, is in a condition which 
answers to either of these definitions ? But this is the 
natural oondition of the skin. How absurd, then, does 
it not all seem ! How much more rational and logical 
the view that these organisms are there for a specific 
and beneficent purpose! How is it that he has not per- 

by Google 



292 The Mkdical*Pbk?b. 

oeived the force of his own conclusion in the words I 
have already emphasised. 

On this subject a very interesting abstract, furnished 
by ita Berlin correspondent, has been published in the 
Medical Press and Circular for November 23rd, 1898, 
under the title, “The Bacteriological Condition of 
Wounds under Antiseptio Treatment.” Dr. KopinBki, 
having concluded a series of bacteriological investiga¬ 
tions on animals has arrived at certain definite conclu¬ 
sions, as follows:— 

“ The performance of operations, whether aseptically 
or anti-septically, assures no absolute sterility of wounds, 
and it is difficult to say whioh of the two methods, in 
this respect, is the better. Antiseptic means in opera¬ 
tions on healthy tissues must be given up, as they do 
not approach an attainable degree of sterility so nearly 
as asepticism does. In healing by first intention, both 
approphytes and pathogenic micro-organisms are retained 
in the wound. In a wound healed by first intention both 
8taphylococcuB aureus and alb us were met with Skin 
cocci frequently found their way into wounds, and, as a 
matter of fact, the skin Showed itself to be a chief hin¬ 
drance to sterility, as its microbes were deep-seated, and 
on this account were only removed with difficulty.” 

Hence it follows that sepsis, according to Mr. Lock- 
wood’s phraseology, or the presence of the Staphylo¬ 
coccus pyogenes aureus itself has evidently a very small 
or no influence upon the repair of wounds, and surgery 
has not ceased to be a possible art. 

Probably it will not be news to you that I adopt none 
of the elaborate precautions of Dr. Howard Kelly, or the 
less complicated method described by Mr. Lockwood, 
beyond the simple washing of my hands previous to opera¬ 
tion, and of my instruments after. W hile I am content 
with making my hands as clean as an ordinary washing 
with soap-and-water will make them, thus removing 
Lister s “ grosser forms of septic mischief,” I fear Mr. 
Lockwood will think they must be horribly septic. Yet 
with this simple precaution I stitch up a recent rupture of 
the perineum, it may be Borne hours after its occurrence, 
merely taking the additional precaution of wiping off any 
lochial discharge from the raw surface with a sponge and 
then placing another in the vagina to keep back the dis¬ 
charge, and I have never had a failure. I make a fresh 
wound in a ruptured perineum, stitch it up and obtain 
union by first intention. If I happen to pull a stitch too 
tight, the tissues become strangulated, their vitality is 
lowered, and I may get some suppuration in the track of 
the suture, but so uniform have been my final results that ; 
I have never had a case break down In a case in which i 
the whole perineum and vulva were in a a tat- of extreme 
irritation from the relaxed or irritable state of the 
bowels—due to the exposure of the muoous membrane 
of the rectum—and without any precaution beyhrid 
wiping the surface with a warm, wet sponge, I secured 
union by first intention, the diarrhoea ceasing from the 
moment of the completion of the operation. I dissect 
out vulvo-vaginal glands, obliterating the cavity in 
stages; I remove growths from the vulva, stitching up 
the wounds, and have never failed to obtain union by first 
intention. I sew up a bilacerated cervix and have yet to 
record a failure. I have excised a considerable number 
of breasts, and the one in which I have failed to obtain 
union by first intention was the first and only one I did 
under the carbolic spray. So uniformly favourable have 
b'enmy results since that case that I have come to 
regard it as one of the most simple operations in surgery. 
Moreover, in one case in which it was impossible t6 bring 
the flaps together I left the wound freely exposed to the 
air, with the result that the healing process went on as 
well as, if not better than, under the most approved 
dressing, and, aided by two orthree skin grafts, the wound 
healed over completely. This in a public hospital. I 
have removed sebaceous cysts from the sculp-—'which, 
according to Mr. Lockwood, most abounds in septic 
micro-organisms — without any trouble resulting. 

I have, either by accident or of set purpose, 
opened the small intestine, the rectum, urinary 
bladder an! vagina in abdominal operation, in which 
the bacillus coli must, for a short time at least, 
have had free access to the peritoneal surface, without 
any harm. And if I obtain these good results by the 


■ Mas. 22, 1899. 

adoption of simple cleanliness—in the common, every-day 
acceptation of the term — and such arrangements as any 
well-ordered private house can afford — where is the 
necessity for all those elaborate precautions which we 
hear of in the case of private and even publio “installa¬ 
tions" as they are tilled—for instance, “the floor of 
encaustic tilee, well-laid parquet thoroughly saturated 
with wax and highly polished, oement or highly-glased 
linoleum,” all angles of walls rounded off, the walls and 
even the shelves and doors covered with a hard, smooth 
cement, ooated with some kind of enamel, such as Flioo- 
teaux’s “ lacquered paint ”; the sterilising of instruments 
and dressings, the spraying of the room for an hour or 
two before the time of operation, and so forth—precau¬ 
tions and preparations so eloquently satirised by Mr. 
Treves in “ The Ritual of an Abdominal Operation P ” 
For instance, “These words ‘strict antiseptic precau¬ 
tions ’ have been with many a kind of mystic writing on 
the wall. . . . Those who come after us will read 
with interest of the operating theatre built like a diving- 
tank, of the glass table for the patient,” so different from 
hiB own which is not even “ bacteriologically clean,” *• of 
the exquisite oeremonial of washing on the part of the 
operator, of the rites attending the ostentatious cle ansing 
of the patient, of the surgeon in his robes of white 
mackintosh and his indiarubber fishing boots, and of the 
onlookers beyond the pale who are exoluded, with infinite 
solicitude, from the sacred circle as septic outlaws.” ... 
“ This exhibition may be scientific, but it is no part 
of surgery. It is more allied to a fervent, idolatrous 
ritual brought down to the level of a popular perform¬ 
ance.” 

But does the observance of this elaborate “ ritual ” 
yield any better results than the observance of simple 
cleanliness P I aver that it does not. The operations I 
have named may be regarded as test operations; for are 
we not told that the orifioes of the mucous passages 
especially swarm with bacteria—the bacillus coli, for 
instance—and that vaginal discharges contain the staphy¬ 
lococcus and streptocooous pyogenes in abundanoe P And 
how are you going to carry out these elaborate precau¬ 
tions in a private house—the home of the patient - where 
cases do so well f I often wonder how the men who hold 
these views ever dare to operate on a deft palate or hare 
lip, seeing that the mouth contains a greater variety of 
bacteria than any other part of the body, from the most 
innocuous to the most virulent, so-called. 

There was a time when the bacillus coli was regarded 
as a most virulent microbe—a veritable wild beast - and 
when, if the intestine, by an unluoky chance, sot 
wounded in the course of an abdominal operation and the 
patient died, the death was attributed to the baneful 
action of this organism. The late Professor Kantback 
showed that this organism is a natural inhabitant of the 
digestive tract, and that its absence or reduction in 
number must be regarded as a departure from perfect 
health. 

Thus it has come about, from the observations of Dr. 
Stoker, that the staphylococcus pyogenes can no longer 
be regarded as the prime cause of suppuration, but rather 
as a beneficent organism; from the investigations of the 
late Professor Kanthack, that the bacillus ooli must be 
relegated to the same category ; and from the observa¬ 
tions of a host of investigators, that the staphylococcus 
pyogenes—and even the streptococcus—is found in con¬ 
ditions oonBistent with, at least, apparent health. 

But it has been affirmed that Nature has provided & 
wonderful mode of escape from the ravages of these 
noxious organisms, and has provided us with an arrange¬ 
ment for their destruction. I refer to the doctrine of 
phagocytosis of Metchnikoff, to whioh Sir Joseph Lister 
(as he then was) pinned his faith less than three years 
ago. I never ootUd accept this comforting doctrine. It 
was far too circumstantial for my ideas of what was 
possible in the way of microscopical demonstration, 
much too clear to be regarded as anything but the pro¬ 
duct of a lively imagination, much too like seeing through 
a milestone for my acceptance. I take credit to myself 
for my unbelief, for the theory is now almost universally 
discredited. But I do not ask you to accept my esti¬ 
mate of it. Read what Professor Buohner said of this 
absurd doctrine at the Munich Medical 8ociety last year. 


ORIGINAL COMMUNICATIONS. 


Di- 


Google 


Mas. 22, 1899. ORIGINAL COMMUNICATIONS. The Medical Press. 293 


as published in the Medical Press and Circular of 
April, 1898, in which he came to this conclusion:— 
“ Metchnikoff s explanation is, therefore, a fable.” 

It is perhaps necessary to remind the younger genera¬ 
tion, who may not have studied the question from the 
beginning, that the antiseptic system was founded on the 
hypothesis that germs floating in the atmosphere fell 
into woundB, there developed into their respective bac¬ 
teria and produced all the evil affects that sometimes 
followed surgical operations. J cannot but think that 
the address of the inventor « f the system, delivered 
before the International Medical Congress at Berlin, has 
not been read so extensively as it deserved to be, and 
therefore it is that I feel obliged to direct your attention 
to it, at the same time commending it to you for perusal. 
Want of time forbids me to quote largely, as I oould 
have wished, and I must be content with directing your 
attention to some only of the most salient points. He 
says: that “ by means of the phagocyte theory of Metch¬ 
nikoff”—which I have already shown you is now univer¬ 
sally discredited—"we can account for what would 
otherwise have seemed to me incomprehensible—the 
use, without evil consequences, of silk ligatures, 
•which have not been subjected to any antisep¬ 
tic preparation. . . . Dr. Bantock, whose re¬ 

markable series of successful ovariotomies may seem 
to justify his practioe, does not, I believe, prepare his 
ligatures antiseptically. The success achieved by Bantock 
and Tait, without, it is said, the use of antiseptic means, 
proves a stumbling-blook to some minds.” No doubt, 
so long as they hold to the germ theory. “ I can see 
that while the measures ” (comprehended under the term 
cleanliness) “ to which I have referred are, so far as they 
go, highly valuable, it must be in itself a very desirable 
thing to avoid the direct application to the peritoneum 
of strong and irritating antiseptio solutions.” This 
latter is in itself a strong justification of my abandon¬ 
ment of carbolic acid. He continues, " As regards the 
spray, I feel ashamed that I should have ever recom¬ 
mended it for the purpose of destroying the microbes in 
the air. If we watch the formation of the spray and ob¬ 
serve how its narrow initial cone expands as it advances 
with fresh portions of air continually drawn into its 
•Vortex, we see that many of the microbes in it, having 
only just come under its influence, cannot possibly have 
been deprived of their vitality. Yet there was a time when 
1 assumed that such was the case, and trusting the spray 
implicitly, as an atmosphere free from living organisms, 
omitted various precautions which I had before 
supposed to be essential.” He then describes how, in a 
ease of operation for empyema, “ the air passed freely 
in and out of the pleural cavity ” in a cloud of spray, and 
he arrives at the conclusion that “ it is physically impos¬ 
sible that the microbes in such air can have been, in any 
way whatever, affected by their momentary presence in 
the air.” “ If then,” he continues, “ no harm resulted 
from the admission day after day of abundant atmo¬ 
spheric organisms to mingle unaltered with the serum 
in the pleural cavity, it seems to follow logically that 
the floating particles of the air may be disregarded in 
our surgical work, and if so we may dispense with anti¬ 
septic washing and irrigation, provided always that we 
can trust ourselves and our assistants to avoid the intro¬ 
duction into the wound of septic defilement from other 
than atmospheric sources.” What these sources are we 
learn from his address at Liverpool, on September 16th, 
1896, six years later, “ Hence I was led to conclude that 
it was the grosser forms of Beptio mischief, rather than 
microbes in the attenuated condition in which they ' 
existed in the atmosphere, that we had to dread in sur- | 
gioal practice.” 

All these things, which are facts, not opinions, capable 
of demonstration and proof, go to show that the modern 
doctrine of bacteriology is a gigantic mistake; that we 
are already at the parting of the ways, and that it is 
safe to predict that, ere long, it will oome to be recognised 
that these various bacilli play a beneficent rdle in the 
eoonomy of nature. I am very far from having exhausted 
my subject; for, while I have only touched with a light 
hand upon some portions of it, I have omitted others 
altogether. 

[On account of' the great length of Dr. Bantock’s 


address, we have been compelled to hold over those 
portions of it relating to typhoid epidemics, tuber¬ 
culosis, and the plague.—E d.] 


PERITONITIS 

▲8 A CAUSE OF INCREASED 

PERISTALSIS IN THE RECTUM 
AND OTHER PARTS OF THE BOWEL. («) 
By C. WALKER CATHCART, F.R.C.S., Ac., 

Assistant Surgeon, Edinburgh Royal Infirmary. 

It is generally stated that peritonitis always 
causes paralysis of peristalsis. I was first led 
to doubt this on meeting with the, following 
cases:—(1) A woman had begun to 'menstruate 
a fortnight before being seen; the period suddenly 
stopped, and then, after ten days’ interval, returned. 
The patient then suffered from an attack of tonsil¬ 
litis, and during this illness she was suddenly 
seized with severe pain in the lower part of the 
abdomen. When first observed, her chief complaint 
was constant tenesmus, so great as to compel her 
to lie straining over a bed-pan. The temperature 
was normal, the pulse fairly good, and the abdo¬ 
minal wall, though resistant, moved with respira¬ 
tion. A diagnosis of the presence of an impacted 
mass of faeces in the sigmoid flexure, causing the 
desire to empty the bowel, was made. The patient 
died suddenly within three hours of the onset of the 
abdominal pain, and on post-mortem examination a 
purulent pelvic peritonitis was found. The pus con¬ 
tained streptococci, and the infection appeared to 
have originated from the tonsillitis. (2) A woman, 
five months pregnant of her first child, got a chill 
ten days before being seen. This was followed by 
pelvic pain and dysuria, the latter requiring the 
nse of the catheter. Suddenly, after a purge bad 
acted, the patient felt a lump in the perineum, 
and began to suffer from great bearing down 
and tenesmus. When I saw her, she was 
suffering from recurrent attacks of pain, resembling 
those of impending abortion. There were, how¬ 
ever, no other signs of this, and, on examining the 
perineum a resonant swelling was found. It was 
thought that this was probably a hernia, and that it 
was causing the straining efforts. An attempt to 
reduce it under chloroform failed, and, as the 
‘.Symptoms were not very urgent, operation was post- 
poped. Next day the swelling showed its true 
character by rupturing into the vagina and disclosing 
a very foetid abeoess cavity surrounding the rectum. 
With the escape of the pus the tenesmus ceased. 0) 
While in charge of the Lock wards, I noticed tint 
prostatitis was almost invariably accompanied by tenee- 
mus. If of prolonged duration tbis produced a patulous 
condition of the anus, which might be regarded as due 
to recurring contractions of the bowel above. A 
similar condition of patulous anus was often seen in 
senile enlargement of the prostate. (4) A patient had 
been operated on for appendicitis some days 
previously. He became apathetic and drowsy, his 
temperature rose, his abdomen distended, and he 
oeased to have control of the bowels—small motions 
were constantly passed in bed. The anus was dis¬ 
tinctly patulous. A diagnosis of pelvis peritonitis 
was made, and on opening the abdomen some werj 
fcBtid pus was found; after its removal the patient 
made a rapid recovery. 

This symptom—increased peristalsis—has been 
little noted by modem writers on rectaLdisease. Pott, 
in 1712, alludes to it, and in Pozzi’s recent work 
mention is also made of it. It has been expen¬ 


ds) Abstract of Paper read before the Edinburgh Medlco- 
Chiruxgical Society, March 1st. 1899. 


Digitized by GoOglC 



294 In Medical Press. TRANSACTIONS OF SOCIETIES. Mab. 22, 1899. 


mentally proved by Griinbaum (working under 
Nothnagel’s supervision) that peritonitis increases 
peristalsis. He round that after tne injection of chemi¬ 
cal and bacterial irritants into the peritoneal cavity 
of the rabbit, active peristalsis was set up, and was 
not replaced by paralysis until twenty-four hours 
had elapsed. According to Treves, about 28 percent, 
of all cases of peritonitis suffer from looseness of 
the bowels. Gee has suggested that the pain in colic 
and the pain in peritonitis were due to the same cause. 
I agree with this, and think that the pain in peri¬ 
tonitis is really colic; as soon, however, as the 
muscular coat of the bowel becomes inflamed, the 
C' lic ceases. When cases of severe abdominal pain 
come before me, the question I put to myself is no 
longer, Is this colic or peritonitis r but, as this is colic; 
to what is it due P 

- • - 

Clinical fiecoriiB. 

SECONDARY PULMONARY OSTEO-ARTHRO 
PATHY IN A CHILD, (o) 

By Da. R. Whitman, 
of New York. 

A qibl, set. 8, reoently came under my notice. 
She was rather undersized, but in fair physical condition. 
There was moderate kyphosis and rigidity of the spine, 
the result of Pott’s disease of the tenth dorsal vertebra, 
accompanied by an abscess in the left iliac fossa, for 
which she had been treated by the application of a 
plaater-of-Paris jacket in 1893 when she was two years 
old. The abscess disappeared and the patient was re¬ 
covering favourably till 1896, when persistent cough and 
expectoration followed an attack of whosping-cough. 
In 1897 enlargement of the fingers was noted, the gait 
was feeble and shuffling, and there was pain in the knees 
and ankles, with exaggerated patellar reflex and ankle 
clonus, and marked effusion into the knee and ankle- 
joints The terminal phalanges and the nails were 
enlarged and there was cough with abundant expectora¬ 
tion and rales at the apex of the left lung. In 1898 the 
pain was relieved by the anti-rheumatic administration 
of salicylate of soda, and although there was a marked 
general improvement the swelling of the knees and 
ankles persisted, and the increased clubbing of the 
nails had attracted much attention, and was thought to 
be an instance of the so-called Hippocratic fingers, due 
to obstruction of the circulation caused by disease of the 
lungs. Expectoration was moderate in amount and bacilli 
were not found. In October, however, an examination 
showed thickening and enlargement of the bones of the 
lower arms and sensitiveness to pressure and swelling 
of the wrist joints. This made the diagnosis clear, and 
at onoe connected the clubbing of the fingers, the 
arthritis, and the enlarged bones as symptomatic of the 
affection known as secondary pulmonary hypertrophic 
osteo-arthropathy. The child was found to have no 
psoas contraction or other trace of abscess, and there was 
apparent recovery from the disease of the spine. There 
was slight dulness at the apex of the left lung, and 
increased respiratory sounds at the base of the right. 
The most marked peculiarity was the great size of the 
hands as compared with the size of the child and of the 
lower arms and legs as compared with the upper seg¬ 
ments of the extremities, giving the impression of 
atrophy of the thighs and upper arms. The bones of the 
legs and fore-arms were sensitive to pressure. The knees, 
ankles, and wrists were enlarged by an effusion into the 
joints, and by thickening of the surrounding parts with¬ 
out redness, heat, or muscular spasm. Motion was very 
slightly limited. The digits were thickened, and their 
terminal phalanges remarkably enlarged with nails rose 
red in colour, but not especially thickened or curved. 
The circumference of the ends of the fingers and the 
breadth of the nails were twice as great as normal. This 
condition was Bomewhat less marked in the feet than in 

(a) Abstracted by permission from notes of & case brought 
before the New York Academy of Medicine (Orthopaedic 8ection), 
January 20th, 1899. 


the hands. The affection of the bones in this disewafi 
appeared to be a form of malacia in which the 
organic material is somewhat increased, and the mineral 
substanoe, correspondingly diminished, so that the struc¬ 
ture of the bone is weakened. The characteristic change 
is a deposit of new bone beneath the periosteum of the 
shafts of the phalanges, the metacarpal and metartarsal 
bones, and the lower part of the bones of the lower arm 
and leg with local sensitiveness, sympathetic arthritis, 
and clubbing of the ends of the digits and hypertrophy 
of the nails. The affection had been first described in 
1888 by Bamburger and independently by Marie, who 
differentiated it from acromegalia with which it had been 
confounded. In practically all of the cases reported, 
upward of 80 in number, it was secondary to chronic 
disease of other parte, in 75 per cent, to tuberculous or 
suppurative disease of the lungs or its coverings. The 
cause of the periosteal and other changes was supposed 
to be the absorption of irritating substances from the 
focus of suppuration in or about the long, combined with 
impaired circulation. Thus the first evidences appeared 
in the ends of the fingers. It was a rare disease, and this 
was believed to be the first typical case reported in a 
child. 


^raitsactiottB of Societies. 

BRITISH GYNAECOLOGICAL SOCIETY. 
Meeting held Thursday, March 9th, 1899. 

The President, Dr. H. Macnaughton-Joneb, in 
the Chair. 


Specimens. 

Dr. H. Jbllett (Dublin) showed a specimen of myo¬ 
matous uterus undergoing carcinomatous degeneration. 

The President observed that cases of this kind were 
always of interest. He showed such a case some two 
years ago, in which the uterus was removed by vaginal 
hysterectomy. The patient lived for six months, and 
then she died; although no post-mortem examination 
was made, the probability was that Bhe died of recurrence 
of this disease. 

Dr. Inglib Parsons asked Dr. Jellett whether in this 
case the carcinoma began separately or was to be traced 
to a degeneration of the myoma. He had a case of this 
kind at the Chelsea Hospital for Women. She presented 
a polypus hanging from the cervix; and also had a car¬ 
cinoma of the cervix; but whether the latter began 
independently, or as a degeneration of the myoma, he 
could not tell. But, in any case, such instances were a 
Btrong argument in favour of early removal. 

Mr. Bow reman Jessett believed that myomata take 
on malignant degeneration much more frequently than 
was generally supposed. When operated on early 
enough such cases did very well; and he hoped that a 
good result would follow in Dr. Jellett’s case. 

Dr. Jellett, in reply, said that when the operation 
was begun, by the vagina, the finger went through the 
uterus into the uterine cavity, as if through putty, while 
separating the bladder, and while separating the rectum 
the same thing happened; so he had to complete the 
operation through the abdomen. The operation took 
place in October, 1898; for two months she did very 
well; then she began to lose ground again, and he feared 
that at the present time she was already Buffering from 
a recurrence of the disease. 

Dr. Bantock read a paper on 

THE MODERN DOCTRINE OF BACTERIOLOGY WITH 
8PECIAL REFERENCE TO GYNECOLOGY. 

a full abstract of which appears in another column. The 
paper gave rise to an animated debate. 

The President said that no subject could be brought 
before any society more pregnant with interest or more 
important than that of the doctrine of bacteriology. It 
was important, not only to the gynaecologist, but to the 
whole scienoe and art of modern medicme, and there¬ 
fore, now that it was before them, he was glad that there 
was such a large audience present. It would take a 


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Mi r, 22, 1899. TRANSACTIONS OF SOCIETIES. The Medical Press. 295 


whole session of their meetings to deal, even in oatline, 
with the different points referred to in the paper, and 
therefore he would ask the speakers to confine their re¬ 
marks to the bearings of the germ theory on gynaecology. 
There were two classes of observers present: first, expert 
bacteriologists who had spent their time on the study of 
the life-history and morphology of micro-organisms in 
all their bearings, physiological and pathological; second, 
those, more numerous but whose evidence was not less 
important, who, in their practical work, had put the 
views of the experts to the test. So, in order to make 
this discussion of greater value, inasmuch as the reports 
of it would go out to the whole world, their Fellows in¬ 
cluding gynecologists of note in every civilised country, 
he would ask those present to address themselves to one 
of the two attitudes he had mentioned. He would first 
call on Dr. Allan Macfadyen, Direotor of the Jenner 
Institute of Preventive Medicine, to address the meeting. 

Dr. Macvadten remarked that he had attended the 
meetings of many scientific and medical societies, but it 
was the first time that it had fallen to his lot to listen to 
such a paper as had just been read by Dr. Bantock 
before a society of repute. It was a unique experience 
that in the country which produced Lister such views 
should be held and put forth. He had come prepared to 
listen to, and take part in, a serious discussion. The ex¬ 
perimental research of the last ten years did not appear 
to exist for Dr. Bantock, nor had he brought forward one 
word of proof for the statements he had made. It was 
difficult to appreciate or to deal with such a mental 
attitude of pure negation, and he therefore abandoned 
any hope of convincing Dr. Bantock, and felt it would be 
useless on his part to bring forward in connection with 
such a paper the remarks he had intended to make upon 
the bacteriological questions pertaining to asepsis and 
antisepsis. Dr. Bantock had asked, “Where did the 
germ theory of disease stand now ? ” He replied that it 
stood exactly where it did before Dr. Bantock commenced 
his attack. What they had listened to was simply a 
“ confession of faith ’’—and nothing more. He would 
not indulge in any comments upon opinions brought 
forward without any basis of experimental proof or fact, 
but would leave it to the members of the Society, who 
were well acquainted with the elementary facts of 
bacteriology, to make their own choice as to whom they 
would follow, Pasteur, Listor and Koch or Dr. Bantock. 
Dr. Macfadyen concluded that if he were a guest of the 
Society on some future occasion he would be pleased to 
discuss the questions raised in a more serious fashion 
than they had listened to that evening. 

Dr. 8tokeb said he had listened to Dr. Bantook’s 
interesting paper with great attention. Dr. Bantock 
had travelled over a very wide field, into many parts 
of which he (Dr. Stoker) was quite unable to follow 
him. He (Dr. 8toker) proposed to offer a few remarks 
in reference to his own work as to the effect of staphy¬ 
lococci in wounds, Ac., treated by oxygen gas. He felt 
he was placed between two extremes, on the one band 
it was stated that all micro-organisms in wounds were 
bad, and on the other that none were bad; he stood 
midway, and believed that some were harmful and some 
useful, and of the latter were the staphylococci. It was 
a perfectly reasonable belief that certain micro-organisms 
under healthy conditions were good and useful, and 
that these same bodies under unhealthy conditions were 
harmful, and that was his view about staphylococci. 
They were to be found all over the body, both on 
the surface and elsewhere; as long as the parts con¬ 
taining them were normal they carried out their 
functions, but if, for instance, the skin were cut 
or bruised then pus formed, because the condi¬ 
tions were altered, owing to the equilibrium esta¬ 
blished by nature having been upset by the accident. 
He (Dr. Stoker) said that he had made hundreds of 
observations on over 260 cases, and in all, rapidity of 
healing was in proportion to the presence of staphylo¬ 
cocci. He quoted cases of sterile wotinds and ulcers that 
had stopped healing; when put into oxygen these wounds 
after thirty-six hours were found to be plentifully 
supplied with staphylococci, and healed rapidly. He also 
quoted two cases and showed photographs of a girl who 
had a burn on her hand and one on her thigh. The 


wound on the hand contained a plentiful growth of 
staphylococci and healed rapidly, the wound on the leg 
which had no staphylococci did not heal. The micro¬ 
organisms were taken from the hand and plaoed in the 
leg wound which at once began to heal. These were 
facts, and not theory. His investigations were not carried 
out in any unworthy spirit of opposition to any theory 
or system that had been propounded. He was simply 
looking tor the light, and to find the exact way in which 
oxygen produced its results. 

Dr. R. T. Hewlett remarked that any evidenoe given 
by Dr. Bantock in support of his views was entirely of a 
negative character, and negative evidence unless over¬ 
whelmingly supported was of little value. With regard to 
the Maidstone epidemic. Dr. Bantock was hardly fair; it 
was true that no typhoid bacilli had been isolated from 
the water, but Dr. Bantock omitted to mention that at 
least a month, and probably six weeks had elapsed 
between the date of infection and the commencement of 
the examination. In other epidemics, notably that of 
Worthing, the typhoid bacillus had been isolated from 
the water. With regard to diphtheria, the diphtheria 
bacillus could be detected in the vast majority of cases. 
In splenic fever of cattle, the whole cycle of which 
could be observed in a lower animal, he could not 
conceive that anyone who read the history of the investi¬ 
gations into that disease could come to a conclusion other 
than that the bacillus anthracis was the causative agent. 
Tuberculin had been attacked, but he considered there 
were still cases in which it might be useful, and as 
regards risk that was inseparable from all forms of drug 
treatment. Lastly, Dr. Bantock had stated that as good 
results were obtained in ovariotomy from the use of 
ordinary cleanliness as with the most elaborate precau¬ 
tions for asepsis, but he would remark that the peritoneum 
was exceptional and would suffer with impunity a treat¬ 
ment which would be tolerated by no other serous mem¬ 
brane. He believed that all attempts to open the knee- 
joint without the strictest antiseptic and aseptic pre¬ 
cautions would end in disaster. 

Dr. Inqlis P arsons felt sorry that so distinguished a 
surgeon should hold such erroneous views on pathology. 
The results obtained by Dr. Bantock in his operations 
were against his own views, and in favour of the germ 
theory of disease, because he took yie most scrupulous 
care to ensure cleanliness in his nurses, instruments, and 
surroundings, and thus by aseptic measures prevented 
infection. When there were no germB, antiseptics were 
not required. The Samaritan Hospital was comparatively 
modem and the surroundings were good, but in some of 
the older hospitals, unless strict Listerism was carried 
out, the results were disastrous He could instance the 
practice of two surgeons when he was a student. One of 
them, using strict Listerism, was able to perform excision 
of the knee, and put up compound fractures, and open the 
peritoneum with impunity, while the other, who decried 
Lister, was obliged to give up these operations on account 
of the frightful mortality that followed. Such instances 
could be multiplied indefinitely. With regard to epi¬ 
demics of typhoid and other diseases Dr. Bantock had 
quoted one instance only where the bacillus could not be 
found, but he had omitted to mention hundreds of 
instances where it had been found and traced to a 
definite source of infection. He found it difficult to 
believe that Dr. Bantock seriously entertained these 
extraordinary views. 

Mr. F. Bowreman Jessett said he had had the 
privilege some years ago of witnessing Dr. Bantock do a 
number of abdominal sections. Dr. Bantock had most 
courteously also allowed him to see the patients with 
him when he dressed the wound. In several of them 
stitch abscesses had formed, and Dr. Bantock was in the 
habit of syringing these out with sulphurous acid. Mr. 
Jessett would like to ask Dr. Bantock if he still continued 
this practice, and whether he did not look upon 
sulphurous acid as a powerful antiseptic agent? He 
would also like to ask Dr. Bantock what, in his opinion, 
caused these abscesses ? Dr. Bantock originally used 
silk for suturing the abdominal wound, but on account, 
as he (Mr. Jessett) understood it, of these abscesses, 
abandoned the silk for silkworm gut. Mr. Jessett 
would further like to ask Dr. Bantock if he now did not 



296 Thx Medical Press. TRANSACTIONS OF POCTETIES. Mae. 22, lWBr 


boil all his silk before using P and pointed ont that boil¬ 
ing or heat was admittedly the beet disinfecting agent 
we had. Would Dr. Bantock explain why he boiled his 
silk P With respect to the typhoid bacillus Dr. Bantock 
had alluded to the Maidstone and King's Lynn epidemics. 
Did Dr. Bantock remember the Worthing and Caterham 
Valley epidemics ? In the latter, two sides of a street 
were supplied by two different companies. On one side 
the inhabitants had typhoid, on the other they were free. 
On investigation it was discovered that the first case of 
typhoid occurred in a man who was working in a well 
which supplied the affected side, and he admitted that 
while working in the well, although then ill, he 
defecated into it. Henoe the epidemio. Could Dr. 
Bantock explain that ? 

Dr. Godson thought it would be very disastrous if Dr. 
Bantock’s paper had the effect of shaking the faith of 
midwifery practitioners in the employment of antiseptics. 
In an address which he had delivered to the Society 
when President, he had shown the marvellous change 
which had taken place in the City of London Lying-in 
Hospital in the death-rate since corrosive sublimate had 
been in use there. This was happily maintained, last 
year’s annual report showing that only one death (from 
puerperal eclampsia) had occurred among the 665 women 
delivered in the hospital. There had not been a single 
case of septicemia during the year. It would be indeed 
sad to revert to a mortality of 1 in 19, which existed 
when he first became attached to the hospital, and he 
had no doubt that the change was due to the thorough 
way in which antiseptics were now employed. 

Dr. Macpherson Lawrie declared himself an ad¬ 
herent of the germ theory of disease. Had Dr. Godson, 
not referred to the subject, he had intended to recall to 
their recollection the remarkable paper delivered by that 
distinguished obstetrician before this Society. The facts 
brought forward by Dr. Godson furnished overwhelm¬ 
ing evidence in favour of the antiseptic treatment of 
disease and he was somewhat surprised that none of 
the previous speakers had commented on those facts. 
He pointed out as a curious anomaly that while the 
extreme Listerites like Howard Kelly, and Lockwood, of 1 
London, emphasised the absolute necessity of adopting 
aseptic treatment in all its details, equally good results 
were apparently obtained by men like Dr. Bantock, who 
relied practically on Boap and water. Such contradic¬ 
tions were very puzzling to the' ordinary man who would 
be greatly helped if some definite rule of practice could 
be enunciated by such a Society as this, and he felt 
rather disappointed that some of the distinguished 
bacteriologists who were with them that night had not 
thrown more light on this part of the subject. 

Dr, C. H. F. Bouth remarked that the whole question 
was in a nutshell. Assume that the germ theory was 
nonsense: then how could they explain the fact that 
certain fluids coming in contact with healthy persons 
produced disease? How could they account for the 
phenomena of putrefaction? Some time ago he read 
before the Royal Medical and Chirurgical Society a paper 
on Puerperal Fever in Vienna. It was shown that in the 
department of the maternity attended by midwives the 
deaths were few, whilst in that worked by students there 
were 600 deaths a year. Semmelweis showed that the 
difference was due to the fact that the students went 
direct from post-mortem examinations to the maternity 
cases. Howoould they account for this except on the 
germ theory ? Then they must remember that the causes 
of disease might be active at one time of the year, 
and not at another: this was a fact which cut the ground 
from under Dr. Bantock’s feet. The plague in India 
was another case in point. Dr. Bantock ridiculed those 
who used antiseptic precautions; but he had not proved 
his thesis. 

Dr. P. Z. Hebert asked Dr. Bantock what was the 
exact relation which he considered existed between 
disease and micro-organisms ? He told them that 
bacteria were the result, not the cause of disease. This 
was a rather obscure statement. Disease was a condition, 
not a material entity. Did Dr. Bantock contend that 
bacteria were produced de novo by disease, or, in other 
words, was this a case of creation of something out of 
nothing ? Or were bacteria formed out of the diseased 


tissues ? If not, where did they oome from, sioee Dr. 
Bantock told them that bacteria were not to be found-in 
the air. Would Dr. Bantock also give them bis own 
definition of what a septic poison was P 

Dr. A. W. Addinrell did not think that Dr. Bantock 
could congratulate himself on his powers of prophecy, 
because the doctrine of bacteriology held the field more 
triumphantly to-dav than it did twelve years ago, when 
Dr. Bantock made his eloquent prophecy of its speedy 
downfall. There were many statements in the paper 
made without proof, in a negative sense, and as far 
as he could see there was only one statement made in a 
positive sense, and that was the reference to staphylo- 
cooci in wounds. Dr. Stoker, like Dr. Bantock, explained 
the healing of wounds as due to the preaenoe of staphy- 
looocci. The non-healing aseptic wound was said to have 
been treated with mercury, the strength of which was'not 
stated. Granting the facts, Dr. Addinsell contended that 
the oorrect explanation was that the mercury had killed 
not only the staphylococci but also the granulations on 
which the healing depended. The other ulcers healed be¬ 
cause the oxygen favoured the granulations, and also 
diminished the virulence of the staphylococci. This 
view was proved by experiments in the laboratory at 
King’s College where he had been working. It had been 
shown that though oxygen did not prevent the growth 
of staphylococci it did diminish their virulence, the proof 
of whioh was that a much larger amount of a culture of 
staphylococci passed through oxygen was needed to pro¬ 
duce ulcers in guinea-pigs than was required in the 
case of a culture not so treated. Dr. Bantock seemed 
also to stumble over the gonoooocus. He had told them 
about a washed gonococcus which did no harm when 
placed in a healthy urethra; but how could he prove that 
in the process of washing the gonococcus had not been 
killed ? Dr. Bantock disagreed with Dr. Newman in 
the latter’s statement that the gonococcus caused 
pyosalpinx; there was no real difficulty in accepting Dr. 
Newman’s view. It had been proved again and again 
that in a pus tube that had been removed the pus might 
be sterile, whilst a cultivation taken from below the 
surface of the pyogenic membrane was not sterile; thus 
affording scientific proof that under given conditions the 
gonococcus might lose its vitality. 

Dr. Henrt Jbllett (Dublin) said that he had had 
the honour of discussing the question with the author 
about a year ago. He thought that Dr. Bantock 
neglected to pay sufficient attention to two very impor¬ 
tant points, when considering the question of the presence 
of bacteria in the human body without causing disease. 
The first of these was the difference in virulence of 
bacteria which were morphologically the same. He (Dr. 
Jeilett) thought that accounted for the presence of strep¬ 
tococci in wounds and other places without giving rise 
to any symptoms of septio poisoning, although in other 
cases morphologically the same bacteria were un¬ 
doubtedly the cause of grave infection. The seoond 
point was the immunity acquired by patients to the 
action of a particular form of bacteria as the result of 
the continued presence in the body of that bacterium. 
He thought this explained cases in whioh the diphtheria 
bacillus was found in the throats of patients some long 
time after they had recovered from the actual disease. 
Then Dr. Bantock had talked of the slight degree of 
mischief brought about by the gonoooocus as exemplified 
by the fact that they were only met with in one out 
of four cases of pyosalpinx. He (Dr. Jeilett) thought 
that this was a very high proportion, if one took into 
acoount the number of cases of sterile, of undoubtedly 
tuberculous, and of presumably septio, pus tubes. In 
conclusion, he would like to ask Dr. Bantock two ques¬ 
tions. First, why did he (Dr. Bantock) wash his hands, 
even to the slight extent that he did? Was it a speoies 
of ritual ” ? Dr. Bantock said, “ That it was in order to 
remove what Lord LiRter called the grosser forms of 
septic mischief.” Dr. Jeilett thought that in this case 
Dr. Bantock must either perform the washing solely as 
a tribute to Lord Lister and because he directed it, or he 
(Dr. Bantock) must believe in the existence of these 
grosser forms. If Dr. Bantock believed in the grosser 
Forms which could be removed by any slight washing, 
why should he not believe in forms which required a more 

Digitized byGOOgle 



Mah. 22, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Mb dioal Press. 297 


scrupulous washing to remove P And if some people be¬ 
lieved in a slight washing, and others in a careful washing, 
and others in an antiseptic washing, he, Dr. Jellett, 
thought there was only a difference in degree of the 
same idea between Dr. Bantock’s washing and other 
peoples. The second question was, supposing Dr. 
Bantock operated on a really septic case, as shown by 
the occurrence of high temperature, rigors, rapid pulse, 
Ac., and that his hands were bathed in pus, would he 
operate on a non-septic patient the next day, or would 
he wait P If Dr. Bantock constantly went straight from 
a septic case to a non-septic case without any evil con¬ 
sequences arising, there was undoubtedly some cause to 
consider that his reasoning was correct. If, on the other 
hand, he waited for four or five days before operating 
again. Dr. Jellett thought that his hands would have 
had time to become sterile again, and that there was not 
the same reason to be astonished at his results. 

The President said he had been a strict adherent to 
the teachings of Lister from the days of the impermeable 
shellac with carbolic putty dressing to the present time, 
in stan c ing cases which would have been unquestionably 
amputated by the older surgeons, restored to usefulness 
even by these old Listerian methods. The p%per of Dr. 
Bantock, he said, bristled with contentions matter, but 
he—the President—entirely disagreed with the deduc¬ 
tions which the reader had drawn. With regard to 
some of the matters touched upon, his eleven years’ ex¬ 
perience of epidemics in a large fever hospital, and in a 
Government Poor-law appointment outside it, as well as 
in a maternity institution, confirmed his belief in the 
teachings of bacteriologists. He altogether denied that 
the inferences drawn from the cases referred to by Dr. 
Bantock as occurring in Dr. Stoker's practice with 
oxygen on uloere in any way refuted the germ theory of 
disease. Dr. Bantock was in opposition to the views of 
all the most distinguished living gynaecologists on the 
subject of the gonocoocus and its relations to pyosalpinx. 
His views on antisepsis were entirely opposed to the 
practice and the teachings of surgeons for the last 
twenty years. The President ridiculed the idea of draw¬ 
ing those deductions, with regard to what Dr. Bantock 
called “ cleanliness ” in the practice of gynaecologists, be¬ 
tween what he referred to as “ the grosser forms of septic 
mischief ” and the lesser. He was not quite correct in saying 
that micro-organisms had not been found specially asso¬ 
ciated with the pustulation of variola, and he overlooked the 
fact that those cases of scrotal surgery to which he had 
referred might possibly be accounted for by the condi¬ 
tions antagonistic to septic germs which were inherent 
in this part and in the testicular organs. Everything 
that Dr. Bantock had said with regard to the micro¬ 
organisms of the skin and their presence in wounds 
healing by the first intention was in accordance with, 
widely known and acknowledged bacteriological facts. 
Given, however, sufficient aseptic preventive steps and 
resistant vitality on the part of the subject, and such 
micro-organisms were harmless. Such teachings as 
those enunciated in this paper set back the hands of the 
clock, so far as medicine was concerned, some five-and- 
twenty or thirty years, and were all the more serious and 
dangerous because they emanated from one who was 
acknowledged to be a brilliant operating gynaecologist, 
and if endorsed by the imprimatur of that Society would 
go forth to the whole medical world, encouraging men 
who possibly had not his skill or favourable surroundings 
to pursue methods of operation which might prove most 
disastrous. In carefully listening to the paper, he, the 
President, could not help coming to the conclusion that 
Dr. Bantock had not made himself fully conversant 
with the researches of bacteriologists within recent 
years, or he would have been acquainted with the fact 
that the various questions which tended to make him 
sceptical, were by them fully and thoroughly discussed, 
such as that of the Klebs-Lee flier bacillus, in its relation 
to diphtheria, the presence or absence of the gonococcus, 
the differentiation of the bacillus typhosus, and. in fact, 
every question raised by him. The attitude of the 
Society to these views should be such that its verdict 
would be unmistakable, and that the British Gynaeco¬ 
logical Society could in no way be involved by them. 

Dr. Bantock, in reply, said he was very much disap¬ 


pointed at the oourse the discussion had taken, for 
although two experts in bacteriology had taken part in 
it, no attempt had been made to refute a single point in 
his paper. They had not even referred to the oxygen 
treatment and its bacteriological results, which they 
evidently regarded as being unworthy of their notioe. 
All the speakers avoided the points in the paper, and, 
while professing themselves followers of Lister, snowed 
that they had taken no notioe of his latest teaching, but 
adhered to that of twenty years ago. One of the bacte¬ 
riologists accused him of disparaging Lord Lister, but 
the contrary was the fact, for he had gone out of his 
way to compliment him, and he was forcibly reminded of 
the legal advice “No case, abuse the plaintiff’s attorney.” 
He was twitted with having studiously avoided the 
typhoid epidemio at Worthing. He could retort that 
his critio bad equally avoided the Maidstone epidemic, 
as to which Dr. Poore substantially agreed with him in 
his Milroy lecture. 


ROYAL ACADEMY OP MEDICINE IN IRELAND. 
Section of Anatomy and Physiology. 


Meeting held Friday, February 3rd, 1899. 
The President, Dr. D. J. Coffey, in the Chair. 


EFFECTS OF SODIUM CHLORIDE ON THE SECRETION OF 
URINE. 

Professor W. H. Thompson read a communication 
dealing with the effects of minute quantities of sodium 
chloride on the secretion of urine. Solutions of sodium 
chloride ('6'66 and D per oent. strength) were injected 
into the external saphenous vein of dogs in quantities 
varying from 30 c.c. to 5 c.o. Urine was collected 
from both ureters by means of cannula. The 
animals were given a hypodermic injection of morphine, 
and were anaesthetised with a mixture of chloroform and 
ether (1 to 2) during the operative procedures. Urine 
was oollected for definite periods of time before and after 
the injection of salt solution. The results showed:—1. 
A marked increaso in the amount of urine recreted, which 
reached its maximum in the seoond hour after the injec¬ 
tion, but had not wholly subsided even at the end of 
four hours. The average of ten experiments showed 
an augmentation of over three hundred per cent. 
2. Both the total nitrogen and the urea also suffered an 
increase, though the urine secreted was more dilute. This 
augmentation reached its maximum in the hour 
immediately following the injection. The above effects 
were found not to be due to a dilution of the blood or 
hydrsemic plethora caused by the injection, nor could 
they be ascribed to any supposed necessity for getting 
rid of the sodium chloride injected. In many oases the 
actual output of chlorides was diminished. No adequate 
cause has so far been found to account for the diuresis. 

THE 8ENSORY DISTRIBUTION OF THE SEVENTH CRANIAL 
NERVE IN MAN. 

The Secretary read for Professor Dixon, of Cardiff, 
an abstract of a paper on this subject. The views 
which Prof. Dixon advanced may be summarised as 
folio wb :—1. The facial nerve in man is in a condition 
comparable with what is found in lower vertebrates. It 
clearly resembles in its distribution what has been called 
a typical branchial nerve. 2. The facial possessees two 
sensory branches—namely, the chorda tympani and the 
great superficial petrosal nerve. Both of these nerves 
are probably nerves of taste; the chorda tympani 
certainly is so, but this has not been definitely proved 
in the case of the great superficial petrosal nerve. The 
proved function of the corresponding nerve in lower 
vertebrates seems to justify the assumption that the 
great superficial petrosal is a nerve of taste also. 3. The 
fibres to which the term chorda tympani has been applied 
by physiologists do not form the chief part of that nerve; 
they do not represent the pre-spiracular nerve of lower 
vertebrates nor the corresponding nerve in man, whioh 
appears early, and passes into the developing tongue. 

The President thought that the point of greatest 
value in Professor Dixon’s paper was the definite state- 



298 Thb Medical Presb. 


TRANSACTIONS OP SOCIETIES. 


Mar. 22, 1809. 


ment that fibres could be traced from the cells of the 
geniculate ganglion in both directions. This had, to his 
mind, established for oertain that it is a sensory ganglion, 
and that both the prolongations must be sensory. 

Professor Symington said that with regard to the 
distribution of the chorda tympani and the great super¬ 
ficial petrosal, on theoretical grounds he was in harmony 
with Professor Dixon. He attached more importance to 
the mode of development of these nerves than to any 
number of clinical observations or experimental work on 
nerves. 

Dr. A. R. Parsons said if the course which the taste 
fibres take were known with certainty it would be a 
great aid in the localisation of disease. If the demonstra¬ 
tion just given were correct, the question at once arose 
was the pars intermedia of Wrisberg to be looked upon 
as a continuation backwards of these taste fibres, and is 
the pars intermedia the nerve of taste of which the 
chorda tympani and the great superficial petrosal are, to 
a oertain extent, branches ? If the great superficial 
petrosal nerve is not the motor nerve of the palate, what 
is it P 

The President thought it highly probable that the 
pars intermedia arises as part of the nucleus of the 
glosso-pharyngeal, and then the glosso-pharyngeal 
would be established as the nerve of taste. 

The Secretary, in reply, said Professor Dixon did not 
hold it proven that the great petrosal is a nerve of taste, 
but he considered this view extremely probable. Accord¬ 
ing to Professor Dixon’s embryological researches, there 
ought to be no efferent vaso-dilator or secretory fibres 
in the chorda tympani nerve; if there are efferent fibres 
in it, they probably come from the sympathetic or some 
other cranial nerves. 

Professor Symington exhibited four specimens of 
separate acromion process, which he had dissected, and 
discussed the question as to whether such cases are to 
be regarded as non-union of the epiphysis or ununited 
fractures, favouring the former view. 

ANJE8THETIC8 AND URINARY SECRETION. 

Professor W. H. Thompson made a preliminary com¬ 
munication to this subject, of which the following is a 
brief summary :—1. A mixture of ether and chloroform 
(2 to 1) did not cause an increased diuresis. This was 
the antesthetic used in his Bodium chloride research. 
Six experiments were performed on dogs. 2. A. C. E 
mixture on the oontrary did, in most cases, markedly 
increase the amount of urine. In one case suppression 
was caused. This dog proved to have albuminuria. 3. 
Ether also produoed an increase of urine, as did chloro¬ 
form likewise, but with this latter anaesthetic only one 
experiment had so far been carried out. 4. Little or 
no effect was produced by the various anaesthetics on 
the total output of nitrogen and of urea, even in cases 
where marked diuresis was caused. 5. The after-effect 
on the output of chlorides showed a marked diminution. 
What the immediate effect was had not so far been 
definitely decided. 6. In eight experiments (with I 
different anaesthetics) the urine was examined for carbo¬ 
hydrates with chloride of phenyl hydragin and sodium 
acetate. All but one gave crystals. Some of these were 
undoubtedly glucosazone, others glycuronic acid, while 
in one case it is probable the crystals were those of 
galactosazone. In all cases the dogs were injected with 
a solution of morphine. 

The Section then adjourned. 


EDINBURGH MEDICO-CHI RURGICAL SOCIETY. 
Meeting held Wednesday, March 1st, 1899. 

Sir John Batty Tuke. President, in the Chair. 


The following patients were shown :— 

By Dr. Elder : (1) A case of absence of the first 
metacarpal bone (with skiagram); (2) a case of lupus 
vulgaris, which had developed shortly after vaccination, 
and had lasted for seventeen years; (3) an unusual 
example of amyotrophic lateral sclerosis affecting the 
lower extremities only, and causing double club-foot. 

By Dr. Scot Skirving : Case showing double Charcot's 


disease, simulating double congenital dislocation of the 
hip. Other symptoms of locomotor ataxia—the Argyll- 
Robertson pupil, absence of the knee-jerks, and light¬ 
ning pains—were present. 

By Dr. Scot Skirving and Dr. Cameron .- A patient 
with total necrosis of the frontal bone, the result of 
syphilis. The orbital plates of the frontal bones were also 
gone ; there was, in addition, a perforation of the hard 
palate. 

By Mr. Stiles : (1) A case of infantile paralysis affect¬ 
ing the right hand and both legs. The lower extremities 
were completely paralysed below the knees, and dragged 
after the patient as he crawled about. It was proposed 
to do a double amputation at the seat of election; the 
muscular weakness of the thighs was too great to permit 
of a good result following exoision of the knee-jointa. 
(2) A baby, aged seven months, with a very large 
hydrencephalocele implicating almost the whole cranial 
vault. It resembled, in fact, a case of hydrocephalus in 
which no ossification had occurred. (3) A child with 
coxa vera, which had greatly improved under the use of 
antirachitic treatment. Mr. Stiles thought that sur¬ 
geons should not be in too great a hurry to operate on 
these cases when they were seen early. 

Mr. Stiles also showed specimens of (1) viscera from 
a case of lympho-sarcoma of the abdomen. The sym¬ 
ptoms had set in suddenly, and resembled those of 
abdominal tuberculosis. At the operation, the belly was 
found to be filled with small tumours, and the liver and 
spleen had secondary growths in them. The chief point 
of interest was that the patient had been supposed to be 
quite well up to five days before the operation. ( 2 ) The 
thoracic viscera of a child who had suffered from dyspnoea 
with excessive expiratory stridor. This was the third 
Buch case he had seen recently ; tracheotomy had been 
of no avail in them. The symptoms — expiratory 
dyspnoea and absence of up and down movement of the 
trachea—had in all cases been due to the pressure of 
enlarged bronchial glands. The reason why it occurred 
only during expiration was probably explained by the 
increased intra-thoracic pressure during the act. 

Dr. Scot Skirving showed (1) sequestrum of the 
entire frontal bone; (2) microscopic specimens of tubercle 
of the mamma; (3) a compound fracture of the carpus 
with comminution of the individual bones. 

Mr. Cathcart exhibited a clinical research case, 
which contained within small compass all the requi¬ 
sites, including stains, a microtome, &c., for the exa¬ 
mination of tumours. It was specially designed for the 
use of clerks and dressers working in surgical wards. 
PERITONITIS AS a CAUSE OF INCREASED PERI8TAL8I8 IN 
THE RECTUM, ETC. 

Mr. C. W. Cathcart read a paper on this subject, an 
abstract of which will be found in another column. 

Drs. Ronaldson, P. A. Young, and Cottrrill dis¬ 
cussed the paper. The last-named drew attention to the 
serious significance of diarrhoea occurring about ten days 
after an otherwise satisfactory operation for appendicitis. 

Dr. Chalmers Watson read a paper on “The 
Etiology of Gout.” After mentioning some of the lead¬ 
ing theories of the relationships between gout and uric 
acid, the speaker described some observations he had 
made on the seat of formation of uric acid. He had found 
uric acid in the blood of snakes and birds in greater 
quantity than in the kidneys. In mammals, he had 
found a very high percentage in the spleen, and a larger 
amount in the liver than in the kidneys. He had 
examined the blood of patients dying from various 
diseases not of a gouty nature, and had always found 
traces of uric acid in it. His results thus contraindicated 
those of Luff and Garrod, and led t* the belief that the 
kidneys were not the seat of uric acid formation. 


I It is reported that the question of the right of 
licentiates of the Society of Apothecaries to style 
themselves physicians is not to be allowed to remain 
in the position established by the case of Hunter v. 
Clare, the Society having decided to take an early 
opportunity of reopening the matter. 


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Mak. 22, 1899. 


FRANCE. 


The Medical Prime. 29b - 


%mutcp department. 

THE MEDICO-PSYCHOLOGICAL ASSOCIATION. 
SCOTCH DIVISIONAL MEETING. 

Dr. Clouston in the Chair. 


The Spring Meeting was held in the Faculty of 
Physicians’ and Surgeons’ Hall, Glasgow, on Thursday, 
9th inBt. 

Dr. Ireland read a paper on 

The Causbs op Increased Frequency op Suicide. 

In his recent excellent paper contributed to the dis¬ 
cussion of suicide at the annual meeting of the British 
Medical Association in Edinburgh, Dr. Sibbald expressed 
the opinion, and his statistics seemed logically to prove 
it, that there is no real increase of suicide at home or 
abroad. Dr. Ireland is inclined to dispute this state¬ 
ment, and the impression one gathered from his paper at 
the meeting in Glasgow was that he did not prove his 
case. He showed some excellent tables illustrating the 
numbers of suicides by different methods in Scotland 
for many years, and distinguishing between male and 
female suicides. He also showed an interesting table 
which compared the proportion per million in various 
European countries, showing a striking contrast between 
Italy at the lowest poll and Saxony at the highest. One 
very difficult question is to determine to what extent 
suicide is pathological, and to what extent deliberate, 
rational, and, as some would say, physiological. Statis¬ 
tics for different countries vary slightly, but in England 
there is a very considerable discrepancy, according to 
Wynn Wescott, who gives the pathological proportion at 
only 20 per cent., a very low rate indeed, and one which 
one iB entitled to regard with some discredit. In regard 
to the question of causation, there are many points of 
view and many explanations. In the course of the dis¬ 
cussion which followed the paper. Dr. McPherson ex¬ 
pressed his surprise that in Italy the number was so well, 
considering that, according to Lombroso, Italians are the 
most degenerate of civilised races. This statement of 
LombroBo’s Dr. I relax)d emphatically repudiated, being 
of opinion, from his own study of Lombroso’s works, that 
the latter is guilty of many inaccuracies, and of none 
greater than this reflection on the physique and mental 
character of the Italians. Dr. Ireland does not believe 
in degeneration as a cause, nor does he believe, like so 
many pessimists, in the growing degeneracy of the race. 
He rather thinks, and we are inclined to agree with him, 
that there is a gain of vigour and greater development 
seen among the youth of to-day as compared with a 
quarter of a century ago. In discussing further the 
causation of suicide, the author of the paper went into 
the various chief ideas pro and con, and expressed the 
opinion that the weakening of the religious sentiment in 
France has much to do with suicide. He summed up 
his idea of causation in one sentence, thus, greater 
sensitiveness, greater strain, less endurance, change of 
religious belief. 

Dr. Clouston's contribution to the discussion dealt 
chiefly with causation under five heads, first, certain 
individuals are born with congenital absence of the love 
of life ; second , melancholia and other forms of insanity ; 
third, neuropathic, over-sensitive people ; fourth, sympa¬ 
thetic, for example, couples commit suicide together, 
for example a man and his fiancie or man and wife, and 
this is especially noticeable in Paris, fifth deliberate 
suicides. 

Dr. Campbell Clark drew attention to the inter¬ 
national differences as evidenced by the statistical tables 
and put some pertinent questions as to the explanation 
of these, particularly the great excess in Saxony over 
other countries. He drew attention to the selection of 
particular methods lesB painful in the case of women, and 
to the great discrepancy between the number of known 
suicides in the Clyde as compared with the number of 
persons found drowned. 

Dr. McPhbrson, in reply to Dr. Campbell Clark, 
stated that Saxony was regarded as the most drunken 
country in Europe. This statement rather astonished 
Dr. Ireland, who gave it as his opinion that insanity in 


Saxony was not greater than in other Continental 
countries. If this is so, it is rather an argument against 
the potency of alcohol as a cause of insanity. 

Dr. Carlyle Johnston directed his attention chiefly 
to minimise if possible the value of the religious theory 
which he declined having anything to do with it. 

Dr. Clouston thereafter gave a short statement regard¬ 
ing the Inebriate Act, and explained a scheme for the work¬ 
ing out of it which he assisted in by drawing up regula¬ 
tions for the operation of the Act. These regulations apply 
for the present to what may be called the criminal 
inebriate, though perhaps the criminal is rather a strong 
term, but they will also do equally well for the non¬ 
criminal inebriate when an Act comes to be passed for 
him. They provide first for a State inebriate refor¬ 
matory, second for certified inebriate reformatories set 
up by private individuals or local authorities; third, for 
licensing out of inebriates to respectable trustworthy 
families. 


Jfrancc. 

[from our own correspondent.] 

Paris, March 19th, 1899. 

Picric Acid. 

Dr. Thery read, at the recent Surgical Congress, a 
paper on picric acid dressing for burns, in which he 
examined the toxic action of the drug. Could picric 
acid provoke grave symptoms of intoxication ? That 
was a point he wished to discuss first, for although it was 
contested by a certain number of the members of the 
Congress, it had been affirmed bo stoutly by others that 
if the fact were proved, picric acid dressing would lose 
the greater portion of its value. With all deferenoe to 
the opinion of many esteemed colleagues, he would say 
from an experience of twelve years that never under any 
condition did he observe symptoms of poisoning from 
this dressing, and to furnish absolute proof that intoxica¬ 
tion by the cutaneous surface, no matter how extensively 
denuded, was impossible, he would cite several cases 
where the salt was injected accidentally in considerable 
quantities without more than temporary injury to the 
patient. 

The first case was reported by Prof. Halla. A patient 
swallowed by mistake a tablespoonful of picric 
acid. Vomiting, diarrhoea, and a pronounced yellow 
coloration of the urine were the results. The stomach 
was washed out and the man recovered. A second case 
was observed by West (1896). A similar dose was 
absorbed. Duringthe first twenty-four nothing abnormal 
was remarked; afterwards the urine became bloody and 
the patient jaundiced. Three days afterwards the patient 
was well. A third case was also one of Prof. Halla’s. 
Here a teaspoonful of crystallised picric acid was taken. 
The symptoms observed were vomiting, diarrhoea, urine 
coloured red, skin and conjunctiva yellow, pruritus and 
erythema of the abdomen and of the feet. The patient 
recovered rapidly. The fourth and last case he would 
cite was published by Karplus. The symptoms were 
the same as the preceding as well as the result. From 
these cases, in which enormous doses of the salt had 
been absorbed without permanent prejudice to the 
victims of the accident, it could be inferred that the 
simple dressing of a denuded surfaoe by a solution of 
the acid was absolutely innocuous. The adversaries of 
this treatment accused it also of provoking such suffer¬ 
ing that they had to abandon its application. He, on 
the contrary, found that it almost always attenuated 
the pain of the burns, and out of some thousands of 

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oases he had known it bat onoe to prodaoe such violent 
pain that it had to be abandoned. 

In conclusion M. Tfe^ry insisted on the fact that the 
picric dressing should not be considered as a wet dress¬ 
ing, for in oases of burns wet dressing should be abso¬ 
lutely excluded. Immersion of the parts in a bath of 
picric acid, followed by a light cotton wadding dressing, 
was the best method when it could be applied. The 
application of any greasy substances to burns should be 
avoided on all occasions. 

Extra-Uterine Pregnancy. 

M. Pinard presented to the meeting of the 8oci6tl de 
Chirurgie a woman in whom he had diagnosed an extra 
Uterine pregnancy of six months in October last. He 
placed her under special treatment until the time when 
the child might be supposed to have a chance of living, 
and then operate. Christmas Day he extracted the child 
by incising the walla of the abdomen and of the cjst; 
he then sutured the wound and allowed the placenta to 
eliminate spontaneously, and which arrived a fortnight 
ago. The child was doing well. That case, as well as 
another which he reported four years ago, showed that 
Don-uterine children could arrive at a viable term more 
frequently than was believed, provided that the mothers 
were submitted to a special hygienic treatment, includ¬ 
ing absolute immobility. M. Gufeniot said that extra- 
uterine children were not always enclosed in a cyst; they 
were sometimes free in the abdominal cavity. He had a 
case of the kind, and where the placenta was grafted on 
the intestines. He extracted a living child almost at 
term, and to all appearances healthy and vigorous, but 
in spite of all the care taken it died on the fifteenth day. 
He considered that there was very little chanoe for 
obildren under those conditions. 


tormang. 

[FROM OCR OWN CORRESPONDENT.] 

Berlin, March 18th, 1889. 

Peculiar Cas* of Intestinal Incarceration.— 
Traumatic Gastroectast.— Operation.—Recover?. . 

Dr. Eohn publishes the following peculiar case in. 
the JSrut. Sarhverstand Zeit., 3/99. The patient was a 
healthy man of 34, who had suffered from constipation 
in youth, who, whilst engaging in unloading a boat fell 
from the height of one or two metres, the right side 
striking bulwarks of the boat. At once there was pain 
and great difficulty of breathing, and soon afterwards 
constipation and frequent copious vomiting. Three 
years later, sudden spasmodic pain came on in the epi¬ 
gastrium and right side, obstruction, distension of the 
abdomen, the general condition being bad; in short, 
signs of internal strangulation. A striking feature was 
that the liver was pressed downwards, and tympany 
between the liver and the lung. 

Gradually, under rest and washing out of the bowel, 
the tympany disappeared, and the bowels once more 
beoame free, and the general condition improved. Ex¬ 
treme dilatation of the stomach, however, still remained, 
the cause of which was subsequently discovered to be 
perigastritis. Laparotomy, which was performed, also 
revealed adhesive perihepatitis, with dragging of the 
liver towards the middle line. The relation of the train 
of symptoms was explained as follows:—The injury had 
set up perihepatitis and perigastritis. The latter rendered 


Mar. 22, 1899- 

the passage of food difficult, which led to dilatation of 
the stomach, whioh revealed itself the following year by 
the copious vomitings. By these acts of vomiting loops 
of intestine were forced into the pseudo-ligament between 
the liver and diaphragm, and hence internal strangula¬ 
tion. This was the rarest form of hernia, and had only 
been once before observed by Leiohtenstern, and had 
been described by him as unique. Clinically it had been 
impossible to distinguish whether the loops of intestine 
had their seat above or below the diaphragm. 

Immediate Suture of Vesical Fistulas. 

In the D. Med. Zeit. is a* reference to a paper on this 
subject by Dr. Stankiewicz. For a long time in cases of 
vesico-vaginal fistula be had been in the habit of sutur¬ 
ing the bladder and the vagina separately. Proceeding 
from his own observations that wounds of the vagina* 
made in oolpotomy for instance, healed very rapidly, he 
at first paid greater attention to the vaginal suture, and 
took the greatest care in bringing the edges of the 
wound accurately together. Later on, however, he satis¬ 
fied himself by observation that the walls of the bladder 
itself possessed the property of rapid healing, even if 
not to a great degree than those of the vagina, oertainly 
not in a lesser. Farther observation showed him that 
for closure of a vesical fistula accurate suture of the 
bladder walls alone was sufficient to effect the object, 
and that the vagina could be disregarded. In confirm¬ 
ation of this the author gives a number of illustrative 
oases, in which he has recently operated in this way with 
success. 

Protection Against Infection During Labour 

Prof. Doderlein ( Berl. Klin. Wochensch., 60/98) 
convinced of the difficulty of always thoroughly disin¬ 
fecting the hands of students about to examine a 
parturient woman, he attempted the use of the india- 
rubber glove of Friedreich. Since May of last year 200 
parturient women have been examined by students, 
some of them as often as 30 or 40 times, and the 
experience gained has been in favour of the new method. 
The examining glove affords a protection agaimt germs 
clinging to the hands, that cannot be assured by the 
most rigorous and careful disinfection, with the ungloved 
hand. The Professor intends publishing a further con¬ 
tribution on the subject shortly. 


Jtaotria. 


[from our own correspondent.] 


Vieeea, March 18th 1899. 

Hydropathy and Malaria. 

Winternitz, who is Professor of Hydropathy in the 
Vienna Faculty, has laboured assiduously for years past 
to plaoe his department on a firm, reasonable basis. All 
the diseases human flesh is heir to have been tried in 
succession, and the results noted with scientific accuracy 
in order that the principle of hydropathy may be gene¬ 
rally accepted as a oomplete form of treatment and not 
a mere adjunct as it is at the present time in many 
countries. With this object in view Winternitz has 
taken different forms of disease seriatim ; the latest being 
malaria which he confesses is not always amenable to the 
“ water treatment/' It seems from his history of this 
method of treatment that Currie and Glannini were the 
first to practise this curative form of water application* 
which was administered by them by pouring water over 


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THE OPERATING THEATRES._ Tm* Medical Pbbss. 301 


MaBt 22, 1899. 

the patient in theiorm of a doaohe. The latter records 
several cases of malaria he oared' by dipping the patient 
in the water. Later Priessnitzi treated malaria 'ih a 
similar manner with equal success. • 'After him Fischof 
treated 34 severe cases of pernicious malaria with only 
-one failure, or 2*941 per cent. He administered sitz baths 
before the fever commenced. 

Fleury Bee ms to have added the largest number of 
suooess to our literature. He administered the cold bath 
from a quarter to half an hour before the febrile attack 
commenced at 12 degs. to 14 degs. Cent., 43*9 degs. to 
47*2 degs. Fahr. This was applied as a douche passing 
through an aperture of 3 centimetres or 1*18 of inch. He 
treated 117 recent and chronic cases with quinine with 
very little benefit as he affirms in his writings. In 114 of 
these cases, after they had reached the malarial cachectic 
state, he commenced the hydriotio treatment with per¬ 
fect success. Fleury had many imitators and opponents 
in his time, but was never induced to return to quinine 
-for the treatment of malaria. Sinoe 1859 the hydro¬ 
therapy has had many adherents. Winternitz reported 
several malarial cases in the Wiener Medirin Prexte, 
■of 1865, which he had treated successfully, while Mosler 
records others in the Wiener Medirin Wochentchrift 
for 1873, with equal beneficial results. Since that time 
Wintemitz tells us he has treated 261 cases of quotidian ( 
-tertiary and quartan fever, associated with the cachectic 
malaria, with 61 per cent, perfectly cured, and 39 per 
■cent, improved. In acute tertian he had not 3 per cent, 
which were not permanently cured. In the whole 
literature 600 cases are recorded, with few failures. 

Wintemitz put before his clays a case of acute tertian 
fever, which he said had been a failure under hydro¬ 
therapy. He is now inclined to believe the former cases 
were not correctly diagnosed, and were not genuine 
tertian malaria. 

An example of a failure is given where quinine rapidly 
■did what water would not. 

He concludes very logically with the assertion that the 
water treatment raises the organic functions, increases 
development, and fortifies the natural defence of the 
body in warding off infection, while the antizymotic 
action is doubtless possessed by quinine by transforming' : 
-the metabolism. 

HyPERIDB08I8. 

Kaposi exhibited a youth, set. 15, who- had suffered 
from partial hyperidrosis from childhood. When an 
infant the point of the nose was often covered with 
beads of perspiration. 

As years passed this extended to the lips, ears, chin, and 
neck, as well as the flexor and extensor portions of 
the extremities. The anterior and posterior surfaces of 
the thorax as far down as the sixth rib are affected. 
During the last seven years the invasion has been bw 
and circumscribed to small areas on various parts of the 
body. 

The perspiration oould be induced by a drink of oold 
water, while work or warm weather would check it. 

The internal organs were perfectly normal but the 
nose, ears, fingers, Ac., had a decided cyanotic appear¬ 
ance ; and with the exception of a kyphoscoliosis appeared 
to feel perfectly well. 

A peculiarity in this case was the irregular occurrence. 

The perspiration did not commence simultaneously on 
the nose, chin, and extremities, but rather in the order 
of oitation. 


Pilocarpin produced general idiosis; but if oqa arm 
was “ligatured ” no sweating took place in that member 
till it was relieved, when immediately colossal drops of 
perspiration would appear. A tropin had the power of 
counteracting the effects of the pilocarpin. 

Physiologically the sudatory secretion depends on two 
factors — vascular congestion and nerve influence* 
Psychical influences, such as fright and emotion are long 
known causes, but it is to Claude Bernard and Strieker our 
later anatomical knowledge is derived that the secre¬ 
tory nerves have their origin in the large ganglia of the 
cord. Injuring a mixed nerve will, paralyse motor, 
sensory, and secretory action. Injury to the interverte¬ 
bral ganglia will produce herpes t> the spine or brain 
migraine, Ac. In the same manner hemieplegic hyperi¬ 
drosis is produced. The most common form, however, is 
the acro-hyperidrosia occurring in people with a low 
vascular tonus, such as the hands and feet. These 
usually have cold hands, dark red ears and nose. 

In the case before us it is bilateral, and from the test 
with pilocarpin, central. In conjunction with scoliosis 
and other progressive symptoms, it may be diagnosed as 
hydromyelia in origin. 


Operating theatres. 

GUY’S HOSPITAL. 

Operation fob Congenital Hypertrophy of the 
Tongue.— Mr. Arbuthnot Lane operated on a boy, et. 
14, who had a very large tongue which protruded 
between his teeth, affecting his appearance and speech 
very prejudicially. Owing to all the air passing habit¬ 
ually through the mouth on aocount of its being con¬ 
stantly open the speech was rendered still more indis¬ 
tinct, and there was a constant discharge from the 
anterior nares which kept the upper lip in a very 
inflamed and hypertrophied condition. Excepting that 
the tongue was exceptionally large, it appeared and felt 
perfectly normal, and it had borne the same relationship 
to the surrounding parte since birth. A long triangular 
area having its base anteriorly was removed from the 
tongue, sufficient of the organ being left to represent its 
normal size and form. The triangular piece, which com¬ 
prised the whole thickness of the organ, was out out by 
means of sharp-pointed scissors, the raw surfaoes of the 
lateral flaps being brought accurately into apposition by 
flahing gat and horsehair sutures. 

It is interesting to note that the edges of 
the wound united so accurately that within a 
few days no evidence of any operation remained. 
The child had not learnt to oontrol the new 
organs by the time he left the hospital, yet his speech 
was muoh more distinct than it had been previously to 
the operation, and he kept his mouth shut and breathed 
comfortably through his nose; the discharge from the 
anterior nares had oeased, and the upper lip had 
acquired its normal form and relationship to the lower. 
The stuttering from which the boy suffered originally f 
and which, as in stuttering generally, Mr. Lane said was 
due to a very imperfect respiratory capacity, is being 
steadily cured by exercises which increase the amount 
of air changed habitually by the patient. 

Operation for So-called Pott’s Fracture. —The 
same surgeon operated on a young artilleryman, at. 24, 
in whom the fibula had been fractured about an inch 
and a half above the tibio-fibular articulation, and the 

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302 The Medical Press. 


LEADING ARTICLES. 


Mae. 22, 1899. 


Bb0I8tuxd r or Transmission Abroad. 


nner malleolus had been broken through its base and 
dislocated outwards. The accident oocurred in June, 

1898, and he was invalided out of the service in January, 

1899, as being physically unfit to perform his duties. He 
was quite unable to follow any occupation because of the 
pain he suffered in his foot and ankle when he walked, 
when the parts swelled up very much. Owing to the 
displacement of the tibial and fibular fragments the 
astragalus was rotated considerably round a vertical 
axis, so that its general direction was from behind, 
forwards and outwards. The tibial fragment was ex¬ 
posed and separated from its connection with the arti- 
o ular surface of the tibia ; the fibular junction was also 
defined and cut through obliquely in a direction running 
from behind, downwards, forwards, and inwards in order 
to render it possible to rotate the lower fragment around 
an axis corresponding to the tibio-fibular articula¬ 
tion, so that the malleolus was brought forwards 
into its normal relationship with the rest of the foot; 
it was then retained there by wiring the fibular 
fragments together in their new position. Mr. 
Lane pointed out that in the foroible abduction of 
the foot upon the astragalus the external malleolus 
represents the fulcrum of a lever of the first order, the 
interval between it and the great toe forming the long- 
arm, and the foroe exerted upon it is in such a direction 
as to tend to drive its lower extremity backwards. When 
the fibula breaks this tendency becomes an actuality, 
and while the tip of the malleolus is driven backwards 
and outwards the upper extremity of the lower fibular 
fragment is displaced forwards and inwards. It is be¬ 
cause of this mechanical arrangement that such an 
adduction of the foot as is permitted by such an apparatus 
as Dupuytren’s, or any other similar splint, serves no 
practical purpose in restoring the fibular fragments to 
their normal relationship to one another; there is, he 
said, no means by which force can be exerted on the 
external malleolus in a direction the reverse of that 
which is brought to bear upon it in the forcible and 
exoessive abduction that produces Pott's fracture. It is 
on this account, he believes, that it is impossible to restore 
the fibula to its original form by any procedure other than < 
operative. This, of course, he remarked, was purely a 
matter of personal experience, since there are many sur¬ 
geons who assert without the slightest hesitation that 
they are able to restore the fragments to their normal 
relationship by manipulation and splints. He would 
like very much to know how this was done, as a large 
number of cases, some of which had been treated by 
surgeons of great experience, had come under his obser¬ 
vation, but in these he was unable to find that the parts 
had been restored to their normal condition. The so- 
called Pott’s fracture, he pointed out, differed in its 
mechanics from fracture of long bones generally, in that 
the resistance offered by ties shortened in their length 
by hemorrhage and inflammation does not play an im¬ 
portant part, the obstacle to the restoration existing in 
the fact that it is impossible to bring force to bear on 
the inner fragment in suoh a direction as to correct its 
displacement. 

It is interesting to note that the progress of the case 
two weeks after operation is most satisfactory. 

- • - 

Professor Strutheks, whose death we recently 
recorded, has, we understand, left a bequest of £500 to 
the Glasgow University for Bursary purposes. 


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“ 8ALU8 P0PULI SUPREMA LEX.” 


WEDNESDAY, MARCH 22, 1899. 


THE PATHOLOGICAL STATUS OF THE 
GENUS BACILLUS. 

In the warfare against disease-producing organisms, 
we must assuredly not lose sight of the fact that they 
are, after all, but one factor in the production of 
disease ; the other, and possibly the more important 
factor, being the impairment of vitality, constitu¬ 
tional or induced, permanent or ephemeral, which 
deprives the organism of the power of defending 
itself against the ubiquitous foe. There is indeed a 
danger lest, in studying the means of .destroying 
the organism recognised to be intimately and 
constantly associated with this or that disease, 
we may overlook the importance of arming the 
organism against the enemy, instead of merely 
slaying a few marauders. Moreover, a very small 
amount of experience is sufficient to show the prac¬ 
tical impossibility of warding off a foe who lies in 
wait in every article of food, in every puff of wind, 
in every contact with the outside world. Unless the 
defenders are well organised, well provisioned, and 
fully equipped, the enemy will sooner or later gain a 
footing. The serum treatment from this point of 
view holds out vastly greater promise of a successful 
intervention than any system based on the employment 
of antiseptics, which of necessity must prove use¬ 
less once the enemy has forced an entry. Serum- 
therapy has for object to impart to the organism an 
immunity or a capacity for resistance which it does 
not possess or has forfeited; in other words, it acts 
by rendering that organism an unsuitable milieu 
for the development of the particular microbe. This 
may be done without detriment to the organism itself, 
whereas antiseptics, to be of service, must be given in 
such doses that the hypothetical benefit which they 


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Ma*. 22, 1899 


LEADING ARTICLES. 


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confer in one direction is more than compensated 
"by the effects pi*oduced on the organism which they 
are intended to protect. But, it is urged, would it 
not be better to cultivate the natural means of defence 
rather than concentrate our attention on the enemy ? 
This is precisely what the serum treatment does, and 
the method ot treatment of feeding and reinforcing the 
defensive cells of the organism forms part of our every¬ 
day armamentarium. Certain individuals are born 
with a natural predisposition to particular diseases; 
in other words certain of their tissues do not possess 
the normal standard of resistance. If by serum- 
therapy we can remedy this constitutional 
defect, who will venture to affirm that we 
have not gained a march on the enemy? Thera- 
peusis is essentially a biological rather than a 
chemical science. We cannot defend those who are 
utterly unable to defend themselves, though greater 
vigilanoe may, under certain circumstances, make up 
for inferiority of strength. If a person with weak 
lungs can be placed in surroundings free, as far as 
possible, from the means of infection, the predisposi¬ 
tion remains a predisposition, and never becomes an 
infection. While, therefore, we may ooncede that 
the rehabilitation of the organism itself would, if 
practicable, be a more certain means of defence than 
the destruction of the attacking microbe, we must 
fully recognise that in proportion as we reduce the 
chances of an attack we increase the chances of 
escape of the organism in the unequal struggle. In 
the matter of tuberculosis this view is steadily gaining 
ground. The present movement for the preven¬ 
tion of tuberculosis has a double object—first, 
to place the threatened organism under conditions 
calculated to stimulate and organise its powers of 
resistance, and secondly, to prevent the dissemina¬ 
tion of the materiea morbi. The progress already 
effected in safeguarding the purity, or failing that 
in the sterilisation, of articles of food, is incontestable 
evidence of our ability to circumvent the spread of 
this particular disease. While we by no means 
despise curative treatment, we must remember that 
treatment saves individuals, while prevention spares 
thousands. The serum treatment of diphtheria, for 
example, may reduce the case mortality, but until we 
can discover a mean ; of preventing the spread of 
infection, we shall oontiuue to register a large annual 
mortality from this cause. Beyond the fact that 
diphtheria is readily conveyed from one individual to 
another, we know little or nothing of the conditions 
which favour its spread, and it follows that, in spite 
of an improved and more successful treatment, it 
still ravages our youthful population. 


MODERN SURGERY IN INDIA. 

It is certain that not the least of tl.e beneficent 
advantages resulting from our rule in India is the 
relief afforded to the suffering natives by tLc practice 
of modem surgery to which the well trained end able 
officers of the Indian Medical Service are abb to give 
effect. India, of course, is a huge country with a * 


teeming population, the medical needs of which are 
almost entirely provided for by this department, and 
when we come to consider the statistics detailing the 
number of surgical operations performed upon the 
inhabitants in the course of a year, it is impossible to 
avoid being impressed with the stupendous nature of 
the work undertaken, and of the enormous amount of 
relief whioh must thus be afforded. In a recent 
number of the Indian Medical Gazette some figures 
appeared having reference to the work done in the 
Indian hospitals during 1897. The hospitals are of 
three classes, (1) State hospitals and charitable 
dispensaries, (2) local fund institutions, (3) private 
institutions. In 1897, throughout India, the number 
of patients treated in all the charitable institutions, 
numbering 2,055, reached the enormous total of 
18,356,962. These figures are almost incredible, that 
is to say, even imagination almost fails to help us in 
understanding the magnitude of such a work 
Again the figures which relate to the number of 
surgical operations performed in certain of the 
provinces are scarcely less remarkable. For example 
we learn that in the Punjab 173,808 operations were 
performed in that province upon 171,419 patients, of 
whom no less than 164,164 were cured, and only 
296 died. Of these, 4,671 were for cataract, 
among which the percentage of success was 85 94. 
Again included among the operations were 1,811 for 
stone, of which 1,521 consisted of litholapaxy, with a 
mortality of 3 3 per cent.—a most excellent record. 
Lateral lithotomy was performed 249 times, and 
supra-pubic lithotomy upon only nine occasions. 
Furthermore, in Madras the surgical operations 
numbered 150,766, on 145,528 persons of whom 9316 
per cent, were cured, 5 52 temporarily relieved, and 
only 0T3 died. Included among these the operations 
for cataract and stone were remarkably few in com¬ 
parison with those in the Punjab. Lastly in Bengal, 
excluding Calcutta, the surgical operations amounted 
to 135,505, with the result that 125,454 of the patients 
were cured, 6,542 relieved, 1,880 otherwise discharged 
and 216 died. The number of cataract extractions 
performed was 2,718 of which 2,206 were suc¬ 
cessful, 248 relieved, and 296 were failures 
A point of some interest is that 97 of the major 
operations in Bengal were performed by women 
practitioners, one of them being a native. These 
operations included 17 removals of tumours, 9 opera¬ 
tions on bones, 1 amputation of the leg, and 48 ex¬ 
tractions of the lens. We think we have now said 
enough to show what modern surgery is doing for the 
natives of our Indian dependency. Not only is relief 
being given to millions every year, and thousands 
upon thousands of lives saved by the aid of surgery, 
but every effort is made to educate natives, desirous 
of becoming medical men, up to the standard of pro¬ 
ficiency required in the medical schools in Europe. 
Thus the native population inlndian have every reason 
for being grateful for the English rule, so far as these 
beneficent results are concerned. Nothing is more 
humanising than to relieve physical suffering, and 
nothing is likely to have such wide-spreading good 
effects. 


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304 Th« Mxdioal Psase. NOTES ON CURRENT TOPICS. _ Mae. 22 . 1899. 


ARMY MEBiCAL AND PENAL ADMINISTRA¬ 
TION. 

The unfortunate death of a young soldier in Ireland 
has been under discussion in the House of Commons, 
where it can hardly have failed to open the eyes of 
legislators to the absolute need of reform in various 
directions more or less directly concerned with 
medical administration. The facts of the case, 
briefly summarised, are that a young trooper, recently 
enrolled in the 21st Lancers at fiallincollig barracks, 
had been punished for various consecutive minor mili¬ 
tary offences, and was pronounced to be fit for duty 
by the barracks surgeon, whereupon he was promptly 
sentenced to shot-drill and a further three days’ im¬ 
prisonment, but within two or three of that sentence he 
died. The unfortunate youth had a clot in the left 
ventricle, and appears to have been suffering from 
dysentery, a condition that was aggravated by enforced 
activity, want of proper medical treatment, and the 
starvation diet which this enlightened age still mortifies 
the flesh and enfeebles the will of transgressors. There 
can be little doubt that this unhappy soldier was prac¬ 
tically dying all the while he was undergoing such 
senseless penalties as low diet, cells, and shot-drill, and 
that his technical offences were almost certainly the 
outcome of his physical condition. That being so, it 
becomes a matter of importance to make some 
inquiry into the administrative system that admits of 
the possibility of such barbarous accidents. So far 
as can be gathered from the reply of the Secretary for 
War, his chief palliative argument was that the 
deceased might have been sentenced to seven instead 
of three days imprisonment had his colonel not been 
mercifully inclined, and that the existing system 
was to blame for the low diet. It is to be hoped that 
the matter will not be set at rest by such meagre and 
unsat isfactory answers as those accorded by Mr. 
Wyndham, and that Parliament will lose no time in 
over-hauling both the penal system and the medical 
administration that could admit the possibility of 
such an occurrence as that reported from 
Ballincollig. As to the prison diet, it is 
simply indefensible to punish a man by depriv¬ 
ing him of food, no less than it is unwise to 
goad him to despair by the imposition of shot-drill 
and other useless and degrading punishments. In a 
word, the aim of those responsible for military dis¬ 
cipline should be to substitute rational and minimised 
sentences for the present exoessive punishments, in 
many cases administered in civilian prisons. As to 
the medical aspect of the question, it was elicited in 
the House of Commons that the name of the local 
surgeon who declared the deceased to have been 
malingering was not to be found in either the 
Medical Register or the Medical Directory. The 
certificate, therefore, must have been granted pre¬ 
sumably by an unregistered, if not by an unqualified ) 
practitioner. The Government have incurred a 
grave responsibility if they have entrusted the 
care of Her Majesty’s troops to a man not on the 
Register , as averred by a medical member of | 
Parliament. It is to be hoped ' that this, 


inoident will not be lost sight of when the- 
Commons are invited to consider the new Medical 
Act, which has been for so long a time looming over 
the professional horizon. To detect malingering is 
an art that requires long practice, failing which the 
neophyte is apt to fall at any moment into errore 
that simply mean playing fast and loose with death. 
Henoe the necessity for the Medical Officer engaged 
in the public services to be most wary in acting upon 
mere suspicion of that offenoe. Moreover, a con¬ 
firmed malingerer may be overtaken with actual 
disease, and it is obvious enough that each symptoms 
as diarrhoea and a weak pulse require treatment, even 
when the result of the man’s own machinations. In 
another case last week, where a recruit dropped dead 
on parade at Windsor, the condition of deceased’s 
heart had been recognised by the brigade surgeon, 
who noted that it was in an irritable condition, and 
placed him under observation as a “ special ” recruit. 
Here, at any rate, the state of affairs was noted and 
precautions taken, so that the unfortunate issue may 
reasonably be regarded as unavoidable. With such 
facts as those we have discussed in this article before 
us, it can hardly be claimed by the War Offioe that 
the powers and administration of the Army Medical 
Department and the penal system enforoed in the 
British Army are above reproach. 


£lotts on (Knrrent topics. 

Fabrication of Vaccination Certificates. 

The trial and acquittal at Inverness of a medical 
practitioner on the charge of fabricating vaccination 
certificates has excited considerable interest in Soot- 
land. It appears that while the accused was acting 
as medical offioer of health for South Uist he trans¬ 
mitted to the registrar sixteen certificates of “ suc¬ 
cessful vaccination,” without having ascertained that 
the operation had been successful. The registrars, 
gifted with unusual prescience, had, however, only 
inscribed “ vaccination,” without the qualifying 
adjective, in their books. The whole evidence leaves 
a somewhat curious impression on the mind. The two 
medical witnesses for the prosecution agreed that 
there was no sign that the sixteen persons in question 
had been successfully vaccinated ; they also 
admitted that they were unacquainted with 
the effects of pin-point vaccination. One of 
them thought that there ought to be some sort of a 
mark in consequence ; the other said that it was quite 
possible to have successful vaccination leaving no 
trace behind it. For the defence, no less than six 
medical practitioners stated that they were in the 
habit of granting certificates of successful vaocination 
without seeing the patients, and solely on inform¬ 
ation from any/* reliable person ” that the operation 
had been successful. The case of the defendant 
appears really to have been a hard one. About the 
time that the alleged offences were committed he was 
acting as medical officer of health for the whole 
island, over thirty-six miles long, with a population 


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Mae. 22, 1809. NOTES ON CURRENT T0PI08. The Medical Press 305 

of nearly 6,000. A virulent outbreak of typhus The Resignation of the Staff of' th) 


took place, and according to the notorious 
custom of the wee tern islander in the presence 
of epidemic disease, the inhabitants expected 
the doctor to perform some of the duties of 
an undertaker and nurse in addition to his proper 
functions. He was apparently over-worked, as only 
a country doctor is, and was highly complimented 
by the Local Government Board, while the local 
authorities were severely censured by the same body. 
According to his own evidence, the defendant ordered 
a school to be closed, exciting the intolerant wrath 
of the Bumbles of the district and leading imme¬ 
diately afterwards to his being relieved of his duties. 
A further point of interest is the fact that the 
warrant for his apprehension was granted by one of 
the medical witnesses for the prosecution—also an 
Honorary Sheriff substitute. It seems hard that the 
defendant should not only have been compelled to 
make four journeys at his own expense in connection 
with the case, but that he should also have been con¬ 
fined for two nights in the cells, to receive the some¬ 
what tardy satisfaction of a unanimous acquittal by 
the jury (the jury has our respect) after an absence 
of three minutes, with the recommendation that all 
bis expenses should be paid. 

The Middlesex Hospital Medical School. 

Wednesday of last week was a red-letter day in 
the history of the medical school attached to the 
Middlesex Hospital, when a conversazione was held on 
the premises to celebrate some important additions 
to the educational facilities offered by this well- 
known school. The new buildings consist of two 
blocks—the Gordon block and the Union Street 
block. The former comprises the large lecture 
theatre and the bacteriological research laboratory, 
the museum, the chemical department, with its 
appurtenances and dependencies, the pathological 
and bacteriological laboratories, the operative sur¬ 
gery theatre, and the dissecting room. The Unidn 
Street block comprises two physiological laboratories 
and several class rooms. The fittings and appliances 
throughout are thoroughly up to date, and reflect 
great credit on those responsible for the organisation 
of the details. A very large number of guests, 
lay and medical, put in an appearance during 
the evening, and many objects of interest 
awaited their inspection. Skiagraphy was well to the 
fore, and the exhibit of course comprised Dr. 
Mackenzie Davidson’s ingenious apparatus for the 
localisation of objects. There was a large and varied 
series of museum specimens prepared by Dr. Yoelcker 
by the Kaiserling method, and, further on, some very 
interesting microscopical specimens of yeast tumour, 
mycosis of the lung, &c. The band of the Royal 
Artillery discoursed sweet music in the museum 
during the evening, and altogether a very pleasant 
and instructive evening was spent. The excellence 
of the arrangements thus placed at the disposal 
of Middlesex students cannot fail to enhanoe the 
popularity of the sehool. 


Seamen’s Hospital. 

The announcement of the resignation of the 
medical staff of the Seamen’s Hospital, at Greenwioh, 
can scarcely be a matter of surprise'‘to those who 
have followed the course of events in connection with 
the scheme of a Tropical Sohool df Medicine for 
London. As a dignified protest against the rude and 
unwarranted treatment meted out to them by the 
lay authorities of the charity which they served, 
these resignations are both timely and natural. 
Moreover, in so doing, the staff have vindicated 
their honour both as gentlemen and members of the 
profession to which they belong. However, we fear 
that not much more has been attained. What do lay 
committees care for the susceptibilities of the medical 
staff attached to hospitals. It is well-known before¬ 
hand that, quite regardless of the circumstances, 
any vacancies upon hospital staffs which may be 
declared oan be speedily filled. We do not doubt 
for a moment that this will be the oase at the 
Seamen’s Hospital. Even, perhaps, this committee 
counted upon their staff resigning when the full 
scheme of the proposed Tropical School was made 
known.. At all events, it is quite oertain that 
the staff in removing themselves have unavoid* 
ably played into the hands of the committee, for now 
the promoters of the Tropical School will have a free¬ 
hand to make use of the Dreadnought Hospital in the 
furtherance of their scheme. Developments in this 
direction may now be expected. In marked contrasty 
however, to the reception of the proposal to found a 
Tropical School of Medicine in London is that 
accorded to a similar enterprise in Liverpool. In 
Liverpool the medical profession has taken the matter 
up most warmly, and with this stimulus to urge them 
pn, the public have liberally responded. With the 
exposure, however, of the treatment accorded to the- 
staff oL the Dreadnought before them, we doubt 
whether the profession in London will ever give their 
.support to the scheme, respecting which Mr. 
Chamberlain has so Bignally failed to accept good 
advioe. 

The Chloroform-Burglar Bogey. 

Last week our old friend the burglar of scientific- 
craft who lulls his sleeping victims into ames- 
thetio silence came boldly to the front in the 
Metropolis itself. Possibly the enterprising writer,, 
feeling that the provinces had received sufficient 
notice, turned his attention to the great still 
unworked centre of civilisation and of enterprising 
journalism. At any rate he did not do the thing by 
halves, for he placed the chloroformist boldly in 
the midst of a medical man's household. With 
circumstantial detail his narrative told how the- 
servant going downstairs in the early morning 
found 4he place ransacked, and the doctor’s trousers 
lying at the foot of the stairs. The maid then 
tried to rouse her master and mistress, but failed, and 
on entering the room, found them both suffering from 
the effects of chloroform: The theory is that the- 


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306 Thb Medical Press. 


NOTES ON CURRENT TOPICS. 


Mar. 22, 1890. 


“burglars got a bottle of chloroform from the surgery and 
saturated a handkerchief, which they thrust beneath 
the door. The idea of being able to saturate the 
lower part of a room with this heavy anaesthetic 
vapour to the level of the sleepers in a bed by means 
of a single handkerchief and an ordinary stock bottle 
of chloroform is too ridiculous to discuss. This view 
we should be prepared to defend in the face of all 
comers. Meanwhile, should the story be maintained, 
we shall have the greatest pleasure in investigating 
the matter to its furthest confine. For us, this bogey 
of the burglar-chloroformist has always had a curious 
attraction, shedding as it does a halo of romance 
around an otherwise sordid calling. Possibly it may 
find now and then a rare use by way of veiled adver¬ 
tisement. Man is a curiously cunning animal in 
some of his intellectual developments. 

Foreign and Colonial Graduates, Beware ! 

There is a Bill now before Parliament which, 
although it has attracted but little public attention, 
will affect very materially the interests of Colonial 
and Foreign graduates in medicine. Its short title is 
the “ University Degrees Act, 1899.” It is backed 
by, among others, Sir John Lubbock, Sir William 
Priestley, and Dr. Farquharson. Its provisions are 
of an extremely stringent nature, and it is enacted 
that any foreign graduate who writes M.D. after his 
name, or who is responsible for the attachment of 
M.D. to his name, and who does not place and clearly 
indicate after such degree the source from which it 
has been received, shall be liable to be summoned 
before a court of summary justice and subjected to 
fine and various other penalties. No exception is 
made in the case of practitioners who are otherwise 
fully qualified in this country, and even the fact of the 
M.D. being registered as an additional qualification 
affords no protection. There are among us many men 
of good standing both in London and in the Pro¬ 
vinces who have taken or have had conferred on 
them foreign degrees in medicine or science. Should 
this Act become law, and it is being pushed on very 
actively, such men as Sir Hermann Weber, Sir Walter 
Foster, Sir Felix Semon, and Dr. Dreschfeld, of Man¬ 
chester, not to mention others, would be liable to 
prosecution simply for writing M.D. after their 
names. It is proposed that the Act shall come into 
force on the first of January next, and it will be 
retrospective in the sense that it will apply equally 
to graduates who took their additional qualification 
twenty or thirty years ago, and who have always 
used their M.D. both in public and private without 
interference. The Act is probably directed primarily 
against unqualified practitioners, and in that respect 
is commendable, but it is certainly very drastic and 
may easily be made the means of attacking the 
privileges of practitioners who have done nothing 
to deserve such treatment. It either goes 
too far or not far enough. If, for example, 
Sir Hermann Weber is to be rendered liable to 
prosecution for neglecting to inform the publio that 
he is a graduate of the University of Bonn, why 
should not Sir William Priestley or Dr. Farquharson 


be equally summarily dealt with for failing to indi¬ 
cate that their M.D.’s are of Scotch extraction ? The 
University Degrees Bill was moved last week, but from 
accidental circumstances its second reading was post¬ 
poned till a later day. It is understood that many 
medical graduates of colonial and foreign universities 
have written to members of Parliament with whom 
they are acquainted, urging their objections, and 
there is no doubt that there would have been a very 
determined opposition had the provisions of the 
proposed Act been more clearly understood. 


The Petroleum Bill. 

Mr. Reckett’s Bill for raising the flash point of 
petroleum to 100° F. was lost by a majority of eighty- 
five in the House of Commons last week, and the 
impression seems to be that this result was largely 
due to a statement by Mr. Healy, who remarked that 
the passing of the Bill would merely mean a change 
of the Petroleum tradefrom Rockefeller of New York, 
to Rothschild of Paris. There is no doubt that the 
whole question is being discussed not from the point 
of view of the public safety, but from that of the 
manufacturer. The struggle is one for trade 
supremacy—nothing more. The unanswerable fact 
remains that the American oil with the 73° F. flash 
point now sold in this country, is prohibited from 
being offered for sale in America. That is to say 
public safety in the United State£{ is clearly considered 
to be of more moment than appears to be the case in 
England. The fact that the resolution to raise the 
flash point to 100° F. was only carried by a 
majority of one on the Petroleum Committee is 
quite immaterial. For some months now a 
current of public opinion has been gathering in 
favour of raising the flash point, and it would be 
best were the Government, despite Mr. Jesse Collings, 
to bear this fact in mind. Whatever the promise 
of the Government Bill may be, so far as its clauses 
relating to the construction of lamps are concerned, 
it is imperative that it should contain a clause raising 
the flash point to 100 deg. F. 


The Phosphorus Report. 

We are now in possession of the report of the Com¬ 
mission of experts appointed by the Government to 
inquire into the U6e of yellow phosphorus in the manu¬ 
facture of matches. So far as the experts deal with 
scientific facta we are prepared to lend them our 
ears, but in other respects their utterances do not 
necessarily command respect. They do not deny the 
existence of “ phossy jaw,” but the tenour of the 
report is that its occurrence is mainly due to faulty 
methods of manufacture. This may be so though we 
have our doubts on this point, but the onus probandi 
in any case lies with the manufacturers. If adequate 
precautionary measures are of themselves sufficient to 
eradicate this disease from our midst it is impossible 
to exonerate the Government from serious responsi¬ 
bility in that these precautions have so long been 
neglected. It is not a question what manu¬ 
facturers wish or do not wish nor even wh&t 


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Mar. 22, 1809. 


NOTES ON CURRENT T0PIC8. 


Thb Medical Press. 307 ''Q 


the public desire. If the yellow matches can¬ 
not be put on the market without exposing the 
workpeople to this painful, disabling, and even fatal 
affection then no Government worthy of the name 
would hesitate a moment in prohibiting its use. If 
needed it would be easy to allege many other reasons 
for discarding the use of matches that will light any¬ 
where, notably the risk of fire, but these concern us 
not. We do, however, emphatically maintain either 
that regulations must be made and enforced which 
will render phossy jaw impossible, or else that the 
public must put up with the so-called safety matches- 
We trust as this is not a party question that our 
legislators will see that effective action is taken to 
improve this old standing scandal out of existence. 

Medical Officers of Health and Tuberculosis. 

As may be expected, the subject of the prevention 
of tuberculosis has aroused the enthusiastic atten¬ 
tion of Medical Officers of Health throughout the 
United Kingdom. In many places, as for instance, 
at West Derby, the guardians have provided accom¬ 
modation for phthisical patients in separate and 
special wards. They have not yet determined, how¬ 
ever, upon the erection of hospitals for tuberculous 
persons above the Poor-law classes. The report of Dr. 
Felix Jones to the Llanfyllin Rural District may be 
taken as the type of scores that are being issued 
daily in all parts of the country. It em¬ 
phasises the curability of the malady, and 
describes the precautions necessary to prevent 
the spread of its specific infection. In short, it 
demonstrates for the behoof of the local populace 
how the preventible is to be prevented. All this 
energy cannot fail to be most reassuring to the 
apostles of public health, but it is to be hoped that 
they will not stop at the merely palliative measure 
of isolating and curing human beings, or as many of 
them as prove amenable to the latter attempt. What 
is needed to make good the logical claim of prevention 
is to attack the disease in the lower animals, 
especially those that contribute to the food of man. 
To regulate the butchers and the dairies, however, 
means an interference with vested interests, so that 
there will probably be time to discuss and investigate 
the matter at leisure. 

A Declining Birth Rate. 

Fob the last ten years the Registrar-General’s 
returns have shown a perceptible decline in the birth 
rate in this country. In the first years of that period 
the rate never fell below 30 per 1,000 of the popula¬ 
tion ; twice it rose to something over 31. In the last 
five years it has reached 30 per 1,000 only once, 
while last year (1898) it touched the lowest figure in 
the decennial period, namely, 29 -t. From an Imperial 
point of view a declining birth rate is not a matter 
which can be complacently regarded by us as a nation, 
despite the fact that the shrinkage in number so far 
is not great. Nevertheless, we have the experience of 
our neighbours on the other side of the channel to 
prove that as soon as the birth rate of a nation 
steadily begins to decline, it goes on declining at a 


rate which nothing can stop. Had the birth rate of 
last year been equal even to that of the five last years 
before it, the births in England and Wales would 
have exceeded the deaths by 371,530; as it was the 
excess was only 370,833. In this connection, however, 
it is not a little significant to learn that while 
the birth rate has declined the marriage rate has 
almost as steadily increased, so much so that in the 
Jubilee year, 1897, it touched the highest figure in 
ten years—namely, 16 0. These are facte and figures 
which, taken by themselves, do not perhaps convey 
much meaning to the ordinary individual, but their 
significance nevertheless cannot be overlooked. In 
truth, the Registrar-General’s returns show that 
while in 1897 more persons entered upon matrimony 
than had been the case for the past ten years, in 1898 
the birth rate was the lowest recorded for the same 
decennial period. Our readers may draw what con¬ 
clusions they please as to these facts, but it would be 
difficult to explain them in accordance with natural 
laws. 


Life on a Rubbish Heap. 

As we all know, a vast amount of sickness comes 
about in a mysterious manner, that is to say, no man 
knows whence it cometh. To discuss this subject 
would require a treatise, more or less, but there is one 
particular item that may be adverted to with the full 
and certain hope of instructiveness to be gathered there¬ 
from. That detail is nothing more than the modern 
dwelling which is built upon “ made ” ground, the sub¬ 
stance whereof has been built up by the slow incre¬ 
ment of cartloads of ashes, rubble, manure, dust, 
dead cats, mud, ashes, and the rest of the multi- 
furious abradacadabra of house refuse. The re¬ 
sult of building oa such a foundation is 
that the body of the house, when heated, 
draws up all the ground air, laden with noxious 
effluvia, and possibly with pathogenic bacteria. Of 
course, the provision of perfectly sound, impermeable 
concrete under the whole house would prevent the 
main part of the mischief. But how many suburban 
houses are thus provided ? Not long ago the present 
writer, out of curiosity, went over some houses in the 
course of erection, the rent of them being from £70 
to £80 per annum. The damp-proof courses were 
made of a kind of tarred paper, and the garden 
level was raised by a tight packing of wet clay, while 
the foundation of the hall space—that is to say, a 
long passage running through the house—was filled up 
with the same material. In that case life on a mud- 
bank was substituted for that on a dust-lieap, which 
we began by contemplating. By all means, let 
intending purchasers or tenants inquire carefully 
into the history of the sites of the houses in view, 
and let them have a skilled inspection made by a 
competent surveyor. 

The treasurer of St. Thomas’s Hospital, London, 
has received an anonymous donation of £1,000 for the 
endowment of a bed, to be called the “ Tom Hughes 
Bed,’' in memory of Mr. T. Hughes, Q.C., author of 
“ Tom Brown's Schooldays.” 


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308 The Medical Pebbs. NOTES ON CURRENT TOPICS. Mas. 22, 1899. 


Heat in Haemoptysis. 

The literature of haemoptysis is voluminous, a 
remark that applies to a number of equally urgent 
symptomatic emergencies, but it has hardly yet 
attained the dignity of an exact and trustworthy 
therapeutic gospel. In other words, the logical chain 
has been weak in one or more of its links, and has 
not withstood the stream of practical experience. To 
take an illustration of the lack of knowledge of 
principle that underlies many of the physician’s prp- 
oedures, take that of the application of cold to the 
cheBt, a step that has been time out of mind the 
sheet-anchor of the medical attendant. What 
more simple, what more reassuring to the 
patient and his friends, and we may now add in 
the light of modem wisdom what more ridiculous 
and ineffectual measure coaid be undertaken ? 
Any candid medical practitioner who has had a fairly 
wide experience of haemoptysis will probably admit 
at once that he can do little in severe cases even in 
the way of palliation. The stock remedies are gallic 
acid, styptics and ergot internally, with hypodermic 
injections of morphia, rest and the external applica¬ 
tion of ice. Sooth to say, it is not unlikely that we 
hitherto have all been wrong, and the proper thing 
is an application to the chest as hot as the patient 
can bear it. At any rate, many practical men do not 
hesitate to Bay that ice never yet stopped a bad 
hfflmoptysis. As the point is one of considerable 
interest and importance, some of our readers might be 
good enough to favour us with their particular views 
and experiences upon the subject. 


The Parked Memorial Prize. 

The subject for the next Parkes Memorial Prize, 
which is open to Medical Officers of the Royal Navy, 
Army, and Indian Medical Services of executive rank 
on full pay (with the exception of the Assistant Pro¬ 
fessors of the Army Medical School during their 
term of office) is “Venereal Diseases in the British 
and Indian Armies: their Prevalence and Prevention.” 
Essays, which must be illustrated asfar as practicable 
from the personal experience of the writer, must be 
sent to the Secretary of the Parkes Memorial Fund, 
Royal Victoria Hospital, Calcutta, on or before 
December 31st, 1900. Each essay to have a motto 
and to be accompanied by a sealed envelope bearing 
the same motto, and containing the name of the 
competitor. 

The Death of Major Evans, I.M.S. 

We regret to have to record the death of Major 
Evans, I.M.S., which occured on the 15th instant, at 
Calcutta. According to a telegram through Reuter's 
agency, he died from plague, contracted, it is 
believed, through making a post-mortem examination 
upon a plague patient. Dr. Evans was Professor of 
Pathology at the Calcutta Medical College, and his 
loss will make a great gap in the teaching staff 
thereof. He was, moreover, engaged upon some 
important investigations regarding the disease to 
yvhich he has just fallen an untimely victim Thus 


another valuable life has been sacrificed in the cause 
of science and of the public good—and last, but not 
least—at the post of duty. 


Secret Commissions. 

There is no calling or profession in which the 
demoralising influence of secret commissions may 
not hypothetically make itself felt, and even in the 
medical profession it behoves us to be on our guard 
against the insidious practices complained of. 
Fortunately there is not much scope in medical 
practice for direct bribery of the kind with 
which the recent inquiry has made us familiar, 
but there are indirect ways in which, neverthe¬ 
less, medical men might conceivably be interested 
in articles of commerce to the detriment of their pro¬ 
fessional honesty, such, for example, as the holding 
of shares in companies engaged in the manufacture 
of proprietary preparations and products, or of the 
thousand and one things which they might be tempted 
to recommend on other than strictly professional 
grounds. We do not believe, however, that even this 
attenuated and indirect form of corruption does, or 
has ever obtained in the ranks of the profession, and 
any obvious breach of this article of the unwritten 
code of ethics would entail upon the sinner social 
ostracism and professional ruin. 


The New Polyclinic in London. 

We understand that matters are by no means 
going smoothly among the powers that be at the 
New Polyclinic, in Chenies Street, W.C. It is the 
same old story, a striving after the position, to use a 
vulgar expression, of “ boss of the show.” Thus two 
camps have been formed, one represented by a well- 
known surgeon, and the other by a specialist, and a 
struggle is now going on for the mastership. What 
the internecine discord will end in can hardly be 
predicted, but it cannot be good for an infantile 
organisation, such as that under discussion, to be 
exposed to the risks and disadvantages of disagree¬ 
ment among those responsible for its up-bringing. 

The Clinical Research Association, Limited, 
announces that it is launching out into a department 
which can only by a great stretch of imagination be 
connected with clinical research—viz., that of medical 
agent for the sale of practices and the supply of 
assistants. So many local authorities and other 
bodies now offer facilities for bacteriological investi¬ 
gations as a help to diagnosis that the need for such 
an association daily becomes less, though there must 
always remain a large, if narrower, sphere of useful 
activity open to it. 


A dramatic representation took place at Cannes 
last week, under the patronage of Princess Louise, for 
the benefit of the English hospital there, from which 
a considerable sum was realised for the charity. A 
second performance is to be given this week, when the 
Prince of Wales will be present. 


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Mar. 22, 1899. 


CORRESPONDENCE. 


Ths Medical Press. 309 


PERSONAL. 


Dr. Thomas Barlow has been selected to fill the 
vacancy on the University of London Commission, 
created by the resignation of Sir William Roberts. 

Mr. Alexander Anderson, Professor of Natural 
Philosophy in the Queen’s College, Galway, has been 
appointed President of the College. 

Dr. Kinnier, of Saltcoats, having this month. com¬ 
pleted his jubilee of practice in the town, the townsfolk 
have resolved to present him with a public testimonial 
in token of their esteem. 

One among the small remnant of Lucknow heroes 
passed away last week in the person of Deputy-Inspector 
General Gee, V.C., C.B. He was present at the Relief of 
Lucknow, under General Havelock, and, on retiring, was 
made Honorary Surgeon to the Queen. 

A report has been extensively circulated in the Mid¬ 
lands that Dr. George Elder, of Nottingham, has retired 
from practice. We have the authority of Dr. Elder 
himself that, although he has resigned his appointment 
as Hon. Surgeon to the Samaritan Hospital for Women, 
owing to the pressure of professional work, he has no 
thought of retiring from practice. 


gcotlunb. 

[from our own correspondent.] 

The Lord Rector's Address to the Students of 
Edinburgh Univfrsity.— Lord Balfour of Burleigh de¬ 
livered his somewhat belated Rectorial address to the 
students of Edinburgh University on Tuesday of last 
week. His term of office is nearing a close, and that 
chief function, which forms the major part of a Lord 
Rector's duties, is usually carried out earlier in the day. 
Lord Balfour was at the same time made the recipient of 
an honorary degree of LL.D.—the first occasion, we be¬ 
lieve, on whioh a Lord Rector has delivered his address 
and been capped on the name occasion. The subject of 
the address was given as “ National Character, and the 
function of the Universities in forming that character, 
and in preserving, developing, and strengthening it.” An 
able and scholarly exposition of this theme followed, 
flavoured, excusably enough, by the addition of words in 
praise of the Universities of Scotland, their democratic 
characteristics, and the enormous influence they have 
exerted in the past, and possess at present, over the 
national thoughts and habits in Scotland. 

Winter Session Medical Students. —The number of 
students attending the different course-* in the Medical 
School of the Royal Colleges of Physicians and Sur¬ 
geons, Edinburgh, during the closing Winter Session is 
officially estimated at 1,217. This represents an increase 
of 133 or 114 per cent, over last year’s figures. The 
classes end upon March 24th, while the Summer Session 
opens on May 2nd. 

Vacant Chair of Pathology at Glasgow. —For the 
vacancy there is a large list of candidates, of whom there 
are some able men. A very strong candidate is Dr. 
Terry, of Aberdeen ; another hails from Queen’s College, 
Belfast. 

A testimonial has been got up and numerously signed 
by the students at Gilmner Hill in favour of Dr. Lewis 
Sutherland, senior-assistant to the late Professor Coats, 
and who for the past two years carried on the work of 
the class. The students are anxious for and greatly 
desire his appointment to the vacancy. 

A subscription list has been opened among the 


members of the University Union to collect a sum of 
.£20 with a view to placing in the Union buildings some 
permanent mark of esteem for the late Professor Joseph 
Coats, who took a veiy real and lively interest in the 
management of the Union, and who was its vice-presi¬ 
dent from 1891 till his death. 

Windfall to Glasgow Charities. —The late Mr. 
James Orr, of Harviestoun and Castle Campbell, has 
left to the Glasgow Royal Infirmary .£2,500, to the 
Western Infirmary £2,250, Victoria Infirmary £2,000, 
Quarrier’8 Homes for Children, Bridge of Weir, £2,000, 
and to the following £250 each : Deaf and Dumb Institu¬ 
tion, Glasgow. West of Scotland Seaside Convalescent 
Home, Lenzie Convalescent Home, Relief of Incurables, 
Asylum for the Blind, Glasgow, Maternity Hospital. In 
fact, to every charitable institution in Glasgow, and their 
ntme is legion. The Salvation Army comes in for the 
largest amount, viz , £5,000; this sum is to be the given 
to General Booth for the special use of the Salvation 
Army work in Scotland. A similar sum would have 
helped the University of Glasgow vastly, but there is no 
accounting for idiosyncracies. We must smile content 
for mercies as they come. 

Epidemic Typhus at Leith —Leith is at present 
suffering from a small epidemic of typhus fever The 
outbreak appears to be quite limited, and, though the 
source of infection has not yet been traced, there seems 
no reason to suppose that it is in any way connected 
with the epidemic which visited Edinburgh some 
months ago. As a sea-port town, with a large 
immigrant population, Leith is peculiarly liable to out¬ 
breaks of infectious disease; smallpox was formerly 
common, and, up to quite recent times, typhus was 
almost endemic It was not until compulsory notifica¬ 
tion was enforced, and suitable accommodation provided 
for fever oases, that this reproach was removed from the 
community. 

The Edinburgh (Lothians and Fife) Branch of the 
British Medical Association held a conjoint meeting 
with the Dundee Branch, on Friday last, in Edinburgh, 
at which numerous interesting clinical cases were shown, 
and demonstrations of special and new appliances, elec, 
trical, surgical, Ac., given at the Royal Infirmary. The 
members then dined together, and, as usual, passed a 
very enjoyable sederunt. 


dorrcBpottOettce, 

We do not hold ourselves responsible for the opinions of oar 
correspondents. 


SYPHILIS IN THE ARMY, 1812 -1898.—LETTER 
FROM DR. C. R. DRYSDALE. 

To the Editor of The Medical Press and Cihculak. 

Sir, —I notice that two distinguished physicians, Dr. 
Ogilvxe and Dr. Shaw Mackenzie, have been good enough 
to refer to a little work of mine on the “ Non-Mercurial 
Treatment of Syphilis,” published in 1863 ; and, as that 
discussion throws some light upon the severe cases we 
hear of, of tertiary syphilis at Netley, perhaps I may be 
permitted to cite the passages from Dr Fergusson’s 
“ Notes and Recollections of a Professional Life,” London, 
1846, which has attracted the attention of these two able 
writers. 

On page 117 of that work, Fergusson thus wrote:— 
“ Until our experience dn the Peninsular war there had 
been but one opinion among us of its (syphilis) utter 
incurability without mercury; and if by chanoe the dis¬ 
ease got well without it, we had as little hesitation in 
declaring that it could not possibly have been syphilis, 
but some other disease putting on that form ” 

“On my appointment to be Chief of the Medical 
Department of the Portuguese Army, in 1810, I found 
that the native faculty never used mercury for primary 
symptoms, and very little, if any, for secondary 
ones; and they obstinately contended for the right 
and propriety of their conduct. Such infatuation, as 1 
then thought it was, was not to be reasoned with. I 
applied to the Cemmander-in-Chief, and obtained the 

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310 Th* Medical Press. 


EXAMINATION PAPERS. 


Mab. 22, 1899. 


strongest general order that could be penned, ordering 
the use of mercury in every stage of the venereal disease. 
Still I was beat. Whenever I could not personally 
superintend, the remedy was neglected. At first the dis¬ 
like and horror for the remedy was so great that they 
would rush from the room when it was applied, and wash 
it off with soap and water. In faot, I saw that I was 
playing a losing game, when I could not help myself; 
jet, at the same time, I could not help acknowledging 
that the gross consequences I apprehended must have 
ensued from their preposterous conduct did not follow; 
and that our soldiers who were mercurialised, I may say, 
to extremity, often suffered in a lamentable way. Were 
I now to make a scale of the applicability of mercury, I 
would say that the tithe of what formerly used to be 
administered is the proper initiatory quantity in any 
case until it is ascertained whether it suits the 
patients constitution or not; that again, a tithe 
of that tithe, or a centime, is the allowable 
preliminary dose in secondary symptoms; for, 
wonderful to say, it seems to me to have been dis¬ 
covered that mercury was, after all, making its own 
work, by producing th9 very, appearances of ulceration 
it was given to eradicate.” On page 122 he wrote : “ I 
shall conclude this part of my subject, at present, by 
stating the incontrovertible faot that the British Army 
at this moment contains thousands in perfect health, 
and has contained thousands more, who have been per¬ 
fectly cored of every stage or state of the syphilitic 
disease without ever having taken a particle of mer¬ 
cury " 

Perhaps some of our present Army Medical Officers 
may interest themselves in this matter again; for I 
feel convinced that even yet, both in Aix-la-Chapelle and 
in London, and in our Army, some “ heroic ” practitioners 
still give far more mercury than is sanctioned by expe¬ 
rience since Fergusson wrote. The introduction of 
iodide of potassium by Wallace, in 1836, has done away 
with all excuse for mercurial treatment in tertiary cases, 
and I am very sceptical of its use in any stage as a 
germicide. 

I am, Sir, yours truly, 

Charles R. Drysdalk, M.D., 

Late Phys. Rescue Soc. of Lond. 

March 17th, 1899. 


MEMORANDUM ON PROFESSIONAL 
SECRECY. 

Ok the Law of the Obligation of Medical Practitioners 
with Regard to Professional Secrecy. 

There are two aspects of the question of the professional secrecy 
of medical practitioners—namely, first, whether a medical man can 
be made to divulge professional confidence in a court of law ; and, 
secondly, whether he may under any circumstances be permitted to 
divulge professional confidences in the intercourse of daily life. 

.1) As regards the first question, it is settled law that a medical 
man cannot claim the privilege, to which lawyers have been held to 
be entitled, of refusing to disclose matters communicated to them 
professionally. “ A surgeon has no privilege, where it is a material 
question in a civil or criminal cause to know whether parties were 
married, or whether a child was corn, to say that his introduction 
to the parties was in the course of his profession, and in that way 
he came to the knowledge of it. If a surgeon was voluntarily to 
reveal these secrets, to be sure he would be guilty of a breach of 
honour and of great indiscretion ; but to give that information in a 
court of justice, which by the law of the land he is bound to do, will 
never be imputed to him as any indiscretion whatever ” - per Lord 
Mansfield in the Duchess of Kimrston’s case, 20 8. T. p. 573. The 
same position is recognised by Buller. J., in Wilson v. Rastall, 4 
T. R., p. 760, where he says: “There are cases to which it is muoh 
to be lamented that the law of privilege is not extended; those in 
which medical persons are obliged to disclose the information which 
they acquire by attending in their professional characters; ” and 
similarly in a later case Lord Chancellor Brougham, after referring 
to a lawyer's right of privilege, continues as follows : “ The founda¬ 
tion of this rule is not difficult to discover; it is not las has some¬ 
times been said) on account of any particular importance which the 
law attributes to the business of legal professors, or of any particu 
lar disposition to afford them protection; though certainly it may 
not be very easy to discover why a like privilege has been refused to 
others, especially to medical advisers. —Greenough v. Gaskell, 1 
p. 103. 

In Rex v. Gibbons, 1 P., 97, where the prisoner was indicted 

for the murder of her child, and a surgeon was called to prove con¬ 
fessions made to him. Park, J., overruled the objection that the 
witness was at time attending the prisoner in his capacity of sur¬ 
geon, adding “ That is no sufficient reason to prevent a disclosure 
for the puiyose of justioe ; ” and the same rule, that “ there is no 
privilege of this description in the case of a medical man,” was 
repeated by Best, C.J., in Brood r. Pitt, 3 C. P., 518. 


From these oases it is oloar that a medical man not only may, bat 
must, if necessary, violate professional confidences when answering 
questions material to an issue in a oourt of law. 

(2) Upon the second question there have been, not unnaturally, 
very few expressions of judicial opinion. It is admitted as a general 
principle that a medical mrn should not disclose communications 
made to him in his professional capacity, and in the Sootch Court 
of Session it has been judiciall v decided that “ secrecy is an essential 
condition of the contract between a medical man and his employers, 
and breach of secrecy affords a re volant ground for an action or 
damages," A. B. ti. C D„ 14 Dunlop, 2nd Series. 177. But upon 
this rule of the general inviolability of professional confidences 
(outsidea oourt of law) the custom of the medical profession has 
engrafted two exceptions (1) in cases of criminal communica¬ 
tions, (2) wheie violation of secrecy is considered for the pro¬ 
tection of wife or children (to which may be added a third 
exception, suggested by the Court in A. B. v. C.' D„ cited above, 
namely, instances conducive to the ends of science, though 
concealment of individuals should in suoh oases be secured). 
These two exceptions were the subject of testimony given 
by eminent medical witnesses, in the case of Kitson v. Playfair in 
1896, as being generally recognised among medical men, but they are 
not judicially recognised as invariable exceptions, as is shown by 
the summing-upof Sir U. Hawkins in that case. The defendant pleaded 
privilege on the ground of the second of the above exceptions, and 
though the point was not decided, owing to the jury finding that the 
defendant had been influenced by an indirect motive, the following 
passages are relevant to the matter of the obligation of stcrecy 
among medical men. On medical evidonce as to professional privi¬ 
lege being given, 8ir H. Hawkins said : “ The question of privilege 
is for me to decide, and, so far as it concerns that question, I shall 
not be influenced by this evidence.March 26th, 1896. 

The following passage occurs in the report of the judge's sum¬ 
ming up: " The medical profession might, no doubt, discuss among 
themselves rules for their own guidance ; but they had not power 
to impose the rules they made upon the public The medical men 
called skid there were two exceptions to the rule imposing on them 
secrecy as to confidences gained during professional attendance. 
The first was to giving evidence in a court of law. His lordship 
did not altogether agree with what they said as to that. It aU 
depended on the judge. The judge might in some cases refuse 
to oommit a medical man for contempt in refusing to reveal 
confidences. Each case would be governed by particular cir¬ 
cumstances, and the ruling of the judge would be the test. 
Secondly, that if there were circumstances from which they supposed 
a crime was intended to be committed they would have to inform 
the Public Prosecut »r. If the doctor were called in merely to attend, 
a woman needing physical aid, his lordship doubted very much, 
whether he would be justified in going to the police and saying, 
‘ I have been attending a woman who has been trying to procure an 
abortion.' That would be a monstrous cruelty. Therefore to 
say there was a general rule was going too far. There was a third 
exception, namely, a communication between the doctor and his 
wife or children. That required a great deal of limitation For 
instance,there were cases in which the wife did not require protection, 
and where it would be a wanton act to oommunicate a secret to her. 
That was a delicate question, but did not arise in the present case. 
Tbe law as to words spoken on a privileged occasion was pretty 
well known.’’—Timas. March 28th 1896. 

From this it seems clear that on the question of violation of pro¬ 
fessional secrecy a medical man is in no more favoured position 
than anyone el«e, and further, that circumstances which, according 
to the custom of the medical profession, might be deemed to exoner¬ 
ate him from the imputation of improper violation of secrecy, might 
nevertheless in a court of law be deemed an insufficient justification. 


QUESTIONS SET AT THE LAST ARMY MEDICAL 
AND INDIAN MEDICAL EXAMINATIONS. 

Chemistry and Materia Medica. 

1. What is an alkaloid ? What are the tests for (o) 
morphinte hydrochloridum, (i>) strychnina, (c) atropina ? 
What official preparations contain strychnina, and what 
are their respective strengths. 2. How do you prepare 
oxygen ? How would you administer it to a patient ? 
3. Give the official doses (for an adult) of liquor thyroidei, 
pepsinum, liquor trinitrini, tinctura camphoric composita, 
pulvis kino compositns, scammoniae resina, injectio 
apomorphinae hypodermica. How is liquor thyroidei 
prepared ? What are the constituents of mistura ferri 
composita ? 4. Describe the preparation of infosum 

cinchona} acidum, infusum digitalis, infusum gentians 
compositum, infusum scoparii, intusum senegas, 
glycerium. 5. Give the formulae for acidum sulphuricnm, 
acidum sulphurosum, acidum nitricam, Explain how 
each may be made, and give the tests for each. 

Medicine and Pathology. 

1. (o.) What points in the history and symptomatology 
of pneumonia—apart from physical signs (percussion, 
auscultation, &c.)—would enable you to diagnose that 
disease? (6.) Give, in tabular form, the differences in 
the physical signs in pneumonia in the stage of consoli¬ 
dation, and in fluid effusion into the left pleura. 

2. A labourer, set. 45, was admitted into hospital on 

j September 4th, 1898. Four years previous to this he 
I injured h’s right elbow-joint, which led to bone disease 




Mar. 22, 1899. 


PAR LI AMENT A.RY NEWS. 


The Medical Press. 311 


with protracted suppuration. On admission it was found 
that several of the internal organs were affected. What 
was the probable nature of this disease ? Enumerate the 
symptoms pertaining to each of these organs, and, in the 
event of a fatal issue, state in detail what you would find 
‘post-mortem. 

3. Under what circumstances is cerebral disease likely 
to be followed by descending sclerosis? Indicate the 
path which the sclerosis follows, and give a sketch of 
the superadded symptoms indicative of that complica¬ 
tion. 

4. How would you treat typical cases of— (a.) Diabetes 
mellitus? (6.) The night-sweats of phthisis? (c.) An 
obstinate specific ulceration of the tongue of old stand¬ 
ing? 

Natural Sciences. 

Geology and Physical Geography. 

1. What is meteoric iron ? In what situations does it 
occur, and how is its presence explained ? 

2. What are the chief strata in which fossil remains 
of (a) mammalia, (6) reptilia, (c) cephalopoda, occur? 
Mention examples. 

3. What is meant by denudation ? How would you 
recognise its effects on a tract of country ? Mention 
localities where its effects may be seen in tbe British 
Islands. 

Physics. 

1. Describe the structure and uses of (a) the baro¬ 
meter, (6) the hygrometer. What are the peculiarities 
of an aneroid barometer ? 

2. What is meant by the magnetism of the earth ? 
Describe the structure and explain the action of the 
Mariner’s compass. 

3. Sta'e Newton’s laws of motion. Illustrate each by 
an example. Explain the following terms : —(a) gravi¬ 
tation, (b) tide, (c) temperature. 

Botany. 

1. Give the characters of tbe following natural orders : 
Labiates, Gentianacese, Scrophulariacese, Solanacess, 
Liliacese, Orchidacese Compare the structure of the 
flower of a rose with that of the flower of an anemone. 

2. Describe the chief forms of inflorescence, of placent- 
ation, of vernation, of rostivation, and of roots, giving an 
example of each. 

3. Write a short account of the general structure of 
any flowering plant with which you are familiar. 

Zoology. 

1. What are the chief peculiarities of tbe fauna of 
(a) New Zealand, (6) Australia, (r) South America, (d) 
Madagascar, (e) Great Britain, (/) Ireland P 

2. Write a short account of the development of the 
frog from the spawn to the adult condition. 

3. What are the chief peculiarities in the anatomy of 
(a) Camel, (b) Elephant, (o) Crocodile, (d) Rattlesnake, 
(«) Gymnotus. 

Surgery. 

1. Give the pathology, symptoms, and treatment of 
rickets. What changes, immediate and remote, does it 
produce in along bone, the femur for instance ? 

2. Describe a case of acute traumatic tetanus. Give 
the symptoms, pathology, treatment, and prognosis of 
the disease. 

8. Give the causes, complications, and treatment of 
entropion. 

4. What abnormal conditions may be associated with 
an imperfect descent of the testis ? Give their differ¬ 
ential diagnosis, and briefly indicate the treatment of 
each-. 

Anatomy and Physiology. 

1. Describe the manner in which tbe flexor tendons 
of the fingers and thumb are arranged in front of the 
wrist, in the palm, and in front of the digits. This 
description must include an account of the anterior 
annular ligament, of the flexor digital sheaths, and also 
of the synovial sheaths in relation to the tendons. 
Special value will be given to the practical points brought 
out in the description. 

2. Trace the vagus nerve through the neck and thorax 


to its termination in the abdomen. Enumerate its 
branches and state the points in which the left nerve 
differs from the right. Have these differences in the 
relations presented by the two nerves any practical bear¬ 
ing in connection with aneurisms occurring within the 
thorax ? 

8. Within what area of the cerebral oortex do the 
nerve-fibres which form the pyramidal tract arise f 
Trace this tract in its downward path through the 
brain and spinal cord, and state how its component 
fibres end. 

4. Give the minute structure of a hepatic lobule, and 
state very shortly what you know of the “ glycogenic 
function” of the liver. 


Jparlianuittarp JlctoB. 


The New Cantonment Rules in India. —In reply to 
a question by Major Rasch, Lord George Hamilton stated 
that the admission rate for venereal disease in the Indian 
Army was 485 per 1,000 in 1897, against 511 in 1896, a 
reduction of 26 per 1,000. The new rules were not 
brought into force until the end of 1897, which would 
explain the comparatively small reduction so far 
effected. Pending the reception of more circumstantial 
reports, he did not proposo to take any further action, 
adding that tbe returns for 1898, as far as they were at 
present known, were very encouraging. 

Sale of Food and Drugs Bill.—T his Bill was read 
a second time, and a motion to refer it to the Standing 
Committee on Law stands over for discussion. 

Water Gas —In reply to a question by Mr. Ascroft. 
Mr. Jesse Collings stated that the recommendations of 
the Departmental Committee on the dangers of water 
gas were under consideration, but no decision had as yet 
been arrived at as to what action, if any, should be taken 
thereon. 

The Study of Tropical Diseases.— Dr. Clark having 
raised the question of the special study of tropical 
diseases, Mr. Chamberlain took advantage of the oppor¬ 
tunity to make a statement on the subject. He explained 
his views and intentions on the subject with which our 
readers are by this time fully acquainted. The cost of 
this instruction would be provided partly by private 
subscription, partly by contributions by the Colonies, and 
the remainder by a grant in aid. He promised that men 
who had undergone a special course of instruction in this 
subject at other schools would receive a preference when 
making appointments for the Colonies, but he did not 
relinquish the safeguard that the candidates would also 
have to undergo the two months special training at the 
Dreadnought. The vote in aid was passed in committee. 

The Sale of Carbolic Acid. —In reply to a question 
by Dr. Farquharson, Mr. Jesse Collings stated that, while 
the Privy Council did not think it expedient to include 
carbolic acid in the schedule of the Pharmacy Act, that 
body was opinion that regulations should be made with 
regard to its sale, and had prepared a Bill with this ob¬ 
ject in view. It was open to question, however, whether 
the Bill could be introduced during the present session. 

Contaminated Oysters. —In reply to Mr. Loder, Mr. 
Chaplin said he hoped to introduce a Bill dealing with 
the subject of contaminated oysters at an early date. 

The Promotion of Naval Medical Officers. —In 
reply to Capt. Norton, Mr. Macartney said it was not 
thought desirable to alter the rules affecting the pro¬ 
motion of medical officers in the Navy, but directions 
had been given that when the time approached for the 
promotion of the officers who entered in 1878 to the 
rank of deputy-inspector general, their position on the 
list would be specially considered. 


An inquest was opened on March 16th, at Southend, 
on the body of a woman who was stated to have been 
attended by a Madame Comber, who was described as a 
French lady doctor. 


Digitized by 



312 The Medical Prkss. 


LA.BORATOB.T NOTES. 


Mae. 22, 1899. 


ptcrarj) Jtotee anb (Hoseip. 


As far back as last August a Commission was appointed 
to compile a new Swiss Pharmacopoeia, hut it has never 
met as there was no money wherewith to pay anybody. 
That difficulty having been now adjusted, the meetings 
of the Commission will commence immediately. 

• • 

• 

Messrs. Bailliere, Tindall, and Cox announce as 
in the press an important work on '* The Administrative 
Control of Tuberculosis,” by Sir R. Thorne Thorne, 
Medical Officer to the Local Government Board. Also 
the Arris and Gale Lectures on “ The Anatomy and 
Surgery of the Peritoneal Fossae,” bv Mr Berkeley 
Moynihan, and a third edition of Sir William Broadbent’s 
work on “ Diseases of the Heart.” 

V 

The Medical Chronicle , which has been bo closely 
associated with Manchester for many years, is to appear 
in a new dress with the April number. During the past 
few years it has been in the hands of the Medical mem¬ 
bers of the Council of the Owens College. It is now to be 
controlled by a committee of which Professor Leech is 
chairman. It is thought that under this new manage¬ 
ment the magazine will enter upon a career of increased 
usefulness. 

• • 

• 

We understand that the “Irish Medical Directory ” 
will not be published this year, the entire of the type 
and manuscripts for it having been destroyed in the 
recent fire which occurred at Messrs. Sealey, Bryers, 
and Walker, its printers. The Directory was started in 
the early seventies by Dr. A. H. Jacob, in connection 
with the Medical Press, and was fairly successful up to 
the present. It had a predecessor of the same title 
which was published for a year or two in the forties by 
Dr. Henry Croly, of Ratbfarnham, but was not continued. 
• • 

• 

Under the editorship of Drs. E. Besnier, K. Dehio, 
A. Hansen, A. Neisser, and Mr. Jonathan Hutchinson, it 
is proposed to publish a journal to be called the Inter¬ 
national Archive» of I.' prosy, and it is believed that such 
a publication would be of great service in promoting the 
study and dissemination in an accessible form of the 
various points in connection with the disease which 
still demand inquiry. Those who are desirous of 
further information regarding the journal are invited 
to commmunicate with Prof. Albert Neisser, 11 Museum 
Strasse, Breslau. 

• * 

• 

Wb understand that Messrs. Green and Sons, printers 
and publishers, of Edinburgh, have projected an 
•* Encyclopaedia Medica,” to be issued in twelve volumes, 
at twenty shillings each, net. It is intended to publish 
the first volume shortly, and to complete the series in 
three years. If the work be well done, we shall wish for 
it complete success, but with “ The Twentieth Century 
Practice,” of twenty volumes, in the course of issue, we 
fear the project to be somewhat venturesome. The fact 
iB, the profession as a whole in this country are not rich 
enough, and those few who are have neither the space 
for, nor the time to read, these monumental works. 

* • 

• 

“ Modern Dairy Sanitation ” is the title of a booklet 
issued by Messrs. Welford and Sons’ Dairy Company, 
Limited, in which are set forth the regulations carried 
out by that firm to ensure a milk supply of absolute 
purity, highest quality, and safeguarded against disease 
The booklet states that the company adopt the application 
of the tuberculin test to the milking stock, which ensures 
the supply being from healthy cows only, special atten¬ 
tion being given in this respect to milk used for the 
nursery, and which is produced on their own farms. The 
cows are under the careful and constant observation of 
the company's veterinary surgeons, periodical examina¬ 
tions being made of the cows, and the whole system 
adopted by the company is one that should reassure the 
public that their interests are thoroughly safeguarded in 
the milk supply. 


NEW BOOKS AND NEW EDITIONS. 

The following have been reoeived for review since the 
publication of our last monthly list:— 

Bailliere, Tindall, and Cox (London and Paris). ■ i , 

The Pocket Pharmacopeia, including the Therapeutic Actios of 
Drugs, their Natural Orders and Active Principles. - By P. 
Hudson-Cox, F.I.C., F.C.S., and John 8tokes, M,D., M.K.C.8. 
Price 38. 6d. 

Aids to the Treatment of Diseases of Children. By John MoC»w, 
M.D., L.B.C.P. Second Edition. Pp. 242. Price 3e. 6d. 

Les Regenerations d'Orgaues par Le Dr. Paul Carnot, D.Sc. Pp. 
96. Price 1 fr. 50. 

The Administrative Control of Tuberculosis (Harben Lectures* 
1898. ( By Sir Richard Thorne Thorne, K.C.B., F.R.8.» 
F.R.C.P.Lond. Pp. 76. 

Adam and Charles Black (London). 

The Pennycuik Experiments in Telegony. By J. Coaaar 
Ewart, M.D., F.R.S. Pp. 177. Price 10e. net. 

Henrt Kimpton (London). 

Elements of Alkaloidal iEtiology. Pp. 86. Price 2s. 6d. net. 

H. K. Lewis (London). 

Tho Principles which Govern Treatment in Diseases and Dis¬ 
orders of the Heart. Lumleian Lectures. By Sir R. Douglas 
Powell, Bart., M.D. Pp. 118. Price 6s. 

Treatment of Lateral Curvature of the 8pine. By Bernard Roth, 
F.R.C.S. Second Edition. Pp. 14'. Price 10s. 6d. 

J. B. Lippihcott Comfant (Philadelphia). 

An Experimental Research into Surgical Shock. By Geo. W. 
Crile, A.M., M.D. Pp. 160. Price 12e. 6d. 

E. and 8. Livingstone (Edinburgh). 

Posological Tables, with Appendix on Poisons. New Edition, By 
We Craig, M.D., F.R.S.Ed. Pricels.net. 

LONGMANS, Green, and Co. (London). 

The London Water Supply. By Arthur Shadwell, M.A., M.B. 
Oxon. Pp. 272. Price 5e. 

The Essentials of Chemical Physiology. By W. D. Halliburton, 
M.D., F.R.S. Third Edition. Pp. 199. Price 5e. 

Sampson Low, Mavston, and Co. (London). 

Twentieth Century Practice. Vol. XVII. Infectious Diseases 
and Malignant New Growths. Edited by Thos. L. S ted man, 
M.D., New York. Pp. 715. 

Macmillan and Co., Limited (London). 

General Physiology: an Outline of the Science of Life. By Mk 
V erworn, M.D., Ph.D. Translated by F. S. Lee, Ph.D. r 
Columbia Univ. Pp. 614. Prioe 15e. net. 

John Murrat (London). 

Kirke's Handbook of Physiology. Edited by W. D. Halliburton, 
M.D., F.R.S. Pp. 872. Fifteenth Edition. Prioe 14s. 

Regan Paul, Trench, Trubner and Co. (London). 

The Principles of Bacteriology. By Dr. F. Hueppe. Translated 
by Dr. E. 0. Gordon, Univ. Chicago. Pp. 466. Prioe 6s. 

George Routledge and Sons, Limited (London). 

The Microscope: Its History, Construction, and Application. By 
Jabex Hogg, M.R.C.8., F.R.M.S. Pp. 704. Price 10s. 6d. 
Fifteenth Edition. 

Smith, Elder, and Co. (London). 

The Hunterian Oration. 1899. By Sir Wm. MacCormac, Bart., 
K.C.V.O. Pp. 60. 

Growing Children, their Clothes and Deformity. By E. Noble 
Smith, F.R.C.S.Ed. Pp. 21. 

Spottiswoodb and Co. (London). 

Minutes of the General Medical Council for the Year 1898, with 
16 Appendices. Vol. XXXV. Pp. 707. 

Army Medical Department Report for 1S97, with Appendix. Vol- 
XXXIX. 


XaborHtorg Jtoics. 

H2EMATOGEN. 

Wx have received samples of Dr. Hommel’s Hssma- 
togen, technically described as heemoglobinum depuratum 
iterilisatum liq«xdum. Its basis is an organio and 
readily assimilable compound of iron especially adapted 
for the treatment of diseases and conditions in which the 
exhibition of a ferruginous preparation is indicated. In 
addition to the haemoglobin, this product is stated to 
contain all the salts of fresh blood, as well as the serum 
albumen in its natural, i.e., undigested, form. It is a 
dark red, mobile fluid, with a sweet, somewhat astrin¬ 
gent taste, in which a large proportion of iron is very 
perceptible. Its effects in cases of anaemia, after the 
bowels have been attended to, are very marked, and no 
difficulty is experienced by the most fastidious persons 
in taking it. It haw been tried on a large scale in 


Digitized by VjOO^lC 




Mar. 22, 1899. MEDICAL 

hospital practice in this country with very satisfactory 
results, having first been introduced on the continent 
with marked success. 

“RISO FLOUR.” 

This is a good specimen of fine wheaten flour, and is 
conspicuously free from grit and indigestible fibre. It is 
self-raising, but it is nevertheless free from an undesir¬ 
ably high quantity of added mineral salts, the percentage 
of ash being only 1‘4. The application of the logwood 
test showed the entire absence of alum. Microscopic ex¬ 
aminations proved the absolute purity of the sample and 
showed its freedom from moulds or other objectionable 
matters. It is prepared by Messrs. Henry Roberta and 
Son, Mold. 

CARBOLIC ACID SOLOIDS. 

Cabbolic acid, which still holds its own among the 
antiseptics at our disposal, is not very convenient of 
transport, and for this reason Messrs. Burroughs, Well¬ 
come and Co., have been well advised in issuing the acid 

S ressed into “ Soloids.” Each soloid contains a 
m of the acid mixed with a harmless colouring 
agent, and this serves to distinguish the solution from 
other liquids. One soloid dissolved in three-quarters of 
a pint of water yields, approximately, a 1/100 solution. 
Surgeons will appreciate the convenience of hiving this 
substance provided in a portable and readily soluble 
form from which any desired strength of solution can be 
promptly prepared. 


SWAN WHITE FLOATING 80AP. 

Messrs. Lever Brothers, Limited, have aided to 
their soap preparations a new product, which has beer, 
called “ Swan White Floating Soap.” as its name im¬ 
plies, it is of light specific gravity, and as Buch floats 
upon water. It is intended for washing delicate 
fabrics, and for toilet and bath use. From the sample 
sent us we can testify that the so«p gives an exceedingly 
soft, quick lather, and iB highly adapted for use in the 
nursery and for persons with tender skins. The soap is 
one of a high-class character and should soon become 
popular. 


^letos. 


Diseases of Tropical Climates. 

We are asked by the Dean of the Medical School of 
St. George's Hospital to announce that a Course of 
Lectures will be delivered by Dr. Patrick Manson, on 
Tuesday, May 16th, and every succeeding Friday and 
Tuesday till July 18th, at 5 p.m. each day. The course 
is intended for medical men intending to practise in the 
Tropics or in Eastern Asia. It will embrace the fevers 
of warm climates, including malarial fevers, dengue, 
Mediterranean fever, and other unclassed varieties, 
dysentery, sprue, liver abscess, filariasis (elephantiasis, 
chyluria, etc.), ankylostomiasis, guinea worm, bilharzia 
and other parasites, beri-beri, tropical skin diseases, etc. 
The fee for the course will be three guineas. Applica¬ 
tion should be made to the Dean of the Medical School, 
St. George’s Hospital, London, S W., from whom cards of 
admission may be obtained. 

Irish Medical School and Graduates’ Association. 

The St. Patrick’s Festival Dinner of this Association 
took place on Saturday evening last at the Caf4 Monico, 
Sir William Thomson, F.RC8.I, president, in the’ 
chair, when a large number of members with their 
friends, including a large proportion of ladies, met to 
celebrate the occasion. Among those present were Sir 
George White, V.C.,G.C.B.. Ac., the guest of the evening. 
Sir Wm. and Lady McCormac, Professor Alexander 
MacAlister, F.R. 8 , General Sir Thomas Gordon, Inspector- 
General William Lloyd, R.N., and Sir Dennis Fitzpatrick. 
After the usual loyal toast Professor MacAlister pro- 


NEWS. _T he Medical Press. 313 

posed the toast of “ Our Defenders,” which was responded 
to by General Sit Thomas Gordon and Inspector-General 
William Lloyd. The toast of “ Our Visitors," proposed 
by Sir William McCormac in a telling and much- 
applauded speech, was responded to in a brilliant and 
enthusiastically received oratorical improvisation by 
General Sir George White, who feelingly defended the 
British Army against the insinuation that it could be 
regarded as a negligeable quantity. The intervals 
between the toasts were charmingly filled by various 
Irish songs, rendered by Miss Lilian More ton, Mr. 
Douglas Powell, and Mr H. L. Fulkerson, while Miss 
Maude Jaque gave an exquisitely rendered violin solo. 
Needless to say that in such company a very enjoyable 
evening was spent, the charm whereof was greatly 
enhanced by the presence of the ladies. 

The Dental Hospital of London. 

The forty-first annual meeting of the Governors and 
friends of this institution was held on Friday last, when 
the Committee of Management were able to show in their 
report a slight increase in the amount contributed to the 
general fund during the past year, and by exercising 
careful control over the hospital expenditure, whilst 
maintaining its efficiency, were able to transfer a con¬ 
siderable sum to the building fund To place this fund 
in a satisfactory position, the report stated that it was 
absolutely necessary that .£3,000 be raised during the 
current year, and the Committee very earnestly appealed 
for financial help. Donations and subscriptions may be 
sent to the Secretary, Mr. Pink, to the Treasurer, Joseph 
Walker, Esq.. M.D., or to the Bankers, Messrs. Barclay 
and Co., Limited, 1 Pall Mall, S.W. 

Mortality In Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations:—Bombay 117, Madras 49, Paris 21, Brussels 
23, Amsterdam 15. Rotterdam 20 The Hague 17, Copen¬ 
hagen 28, Stockholm 20, Christiania 16, St. Petersburg 

27, Moscow 24, Hamburg 17. Breslau 29, Munich 25, 
Vienna 25, Prague 28, Buda Pesth 30 Trieste 33, Rome 
18, Turin (lOdays) 21, New York 20, Philadelphia 22. 

Vital Statistics. 

The deaths registered last week in thirty-three great 
towns of England and Wales corresponded to an annual 
rate of 22 2 per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of this year. 

Birkenhead 22, Birmingham 17, Blackburn 21, Bolton 
22, Bradford 21, Brighton 20, Bristol 20, Burnley 19,- 
Cardiff 13,Croydon 16, Derby 19, Gateshead 13, Halifax 30, 
Huddersfield 18, Hull 19. Leeds 20, Leicester 21, Liverpool 

28, London 22, Manchester 27, Newcastle-on-Tyne 28, 
Norwich 22, Nottingham 17, Oldham 29, Plymouth 21, 
Portsmouth 18, Preston 29, Salford 26, Sheffield 27, 
Sunderland 18, Swansea 16, West Ham 19, Wolver¬ 
hampton 17. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were :—From measles, 2 8 in Manchester; from scarlet 
fever 1 0 in Derby, and l - 2 in Salford ; and from whoop¬ 
ing-cough, 2T in Plymouth, and 2'7 in Birkenhead. In 
none of the large towns did the death-rate from “ fever ’ 
or from diarrhoea reach PO per 1,000. The 93 deaths 
diphtheria included 36 in London, 7 in Sheffield, 5 in 
Leicester, 5 in Leeds, 4 in Cardiff, 4 in Liveipool, 3 in 
West Ham, 3 in Portsmouth. 3 in Swansea, and 3 in 
Salford. No death from small-pox was registered in any 
part of the United Kingdom. 


4totia« to 

(Eorreopoitbents, Short Setters, &c. 

V Correspohdents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive ttQ nature or 
initial*, and avoid the practice of signing themselves “ Reader," 
“Subscriber," “Old Subscriber,’’ Ac. Much confusion will be 
■pared by attention to this rule. 

Bkadiro Cases.—C loth board cases, gilt lettered, containing 
twenty-six strings for holding the numl^ers pf The Medical Press 

Digitized by G00gk 







314 The Medical Press. 


N0T1CRS TO CORRESPONDENTS. 



and Circular, may now be had at either office of thin Journal, 
price 2e. 6d. Theae cases will be found very useful to keep each 
weekly number intact, dean, and flat after it has passed through 
the post. 

Local Exports and Nxws.— Correspondents desirous of drawing 
Attention to these are requested kindly to mark the newspapers 
when sending them to the Editor. 

INFORMATION WANTED. 

Wx are asked for information concerning Dr. G. H. Griffin, 
described as B A , M.D., Montreal, who, in oomp&ny with Dr. 
Anthony Hope, runs a “ sure rheumatic curecompany, in 
Parliament Mansions, Westminster. We presume that our Cana¬ 
dian eonirtrm bare their code of ethics and a medical oouncil to 
deal with eccentricities, but we are, however, by no means sure 
that it is an offenoe, even in this country, to advertise in connection 
with a trading concern. What our own Council condemns is adver¬ 
tising with a view to practice, not advertising with a view to 
business or notoriety. Nevertheless, when a medical man goes 
into business, especially into the quack nostrum business, he would 
be well advised to relinquish the use of titles which imply that he 
is a medical practitioner. That, however, is a matter of taste and 
not of law. 

Housx Surgeon. -The matter entirely rests with the coroner. 
He uses his discretion. If he thinks that an inquest is unnecessary 
an order for burial is issued forthwith. 

Anthropos. —The Ophthalmologioal Society of the United King¬ 
dom is, we believe, the only one m London which has decided to 
admit medical women to its membership. 

TBUE WORTH OF THE APPENDIX. 

The eminent surgeon closed up his pocketbook with a snap on 
the one hundred guinea fee a wealthy patient had just paid him for 
a successful operation for appendicitis. “ Tell me the appendix 
vermiform is is a useless organ."—Public Health Journal. 

D. P. H —Information upon the subject might be obtained by 
applyipg to the General Pui^joses Committee of the London County 

Dr. Bernard T. —As the patient dearly misrepresented what our 
correspondent stated, no harm could be done Dy writing to the 
friends in order to correct the wrong impression. 

PRESENTATION OF A GOLD CUP T ) THE HON. 

T. H. BAYARD. 

Mu Henrt S. Wellcome has sent us an iUustration in photo- i 
gravure of the gold loving-cup presented to the Hon. T. H. Bayard, 
late American Ambassador to this country. The cup, which is 
191 inches in height, is of solid gold, supported by American 
eagles with spread wings in sterling silver. Encircling the base 
is the 8criptural quotation, “ On earth peace, good will toward 
men.” The design is highly artistic, and is, we understand, 1 
from drawings made by Mr. Wellcome, whom we congratulate on 1 
having forged another link in the chain of Anglo-American brother- j 
hood. ! 


i Uaxanxtes. 

Bracebridge Asylum, Lincolnshire.—Senior Assistant Medical 
j Officer, unmarried. Salary £150 per annum, with furnished 
| apartments, board, attendance, and washing. Applications to 
, the Clerk to the Visitors, Bank Street, Lincoln. 

Brixton Dispensary.—Resident Medical Officer for two years, un¬ 
married. Salary £150. with apartments, attendance, coals, and 
gas. Applications to the Secretary, Brixton, S.W. 

Chester General Infirmary.—Visiting Surgeon for two years. 
Salary £80 per annum, with residence and maintenance in the 
house. Applications to the Secretary, 
i Cumberland and Westmoreland Asylum, Garlands, Carlisle. - Junior 
Assistant Medical Offioer, unmarried. Salary £100 a year, with 
| board and residence. 

i Derby County Asylum,—Assistant Medical Officer. Salary com- 
I mencing at £100, with board, lodging, and washing. 


! Applications to Mr. Roberts, Dinorwio Quarry Hospital, Llan- 
' bens, North Wales. 

Parish of St. Leonard, Shoreditch.—Second Assistant Medical 
l Officer for the Infirmary, Hoxton Street, N. Salarv at the rate 
of £70 per annum, with rations, washing, and apartments. 
Applications to the Clerk to the Guardians, 218 Kingsland Road, 

Roxburgh District Asylum, Melrose—Assistant Medical Officer. 
, Salary £100 per annum, with furnished quarters, board, wash¬ 

ing, and attendance. 

Batelt, John, M.D.Durh., L.R.C P.Lond., M.R.C8., Medical 
Officer to the Belton Medical District of the Mutford and 
i Lothingland Union. 

Batlis H., R.C.P.Lond., M.R.C.8., House Surgeon to the Queen’s 
1 Hospital, Birmingham. 

, Cave, Edward J., M.D.Lond., M.R.C.P.Lond., Physician to the 
Royal United Hospital, Bath. 

I M.B., Ch.B.Vict., a Medical Officer to the Coventry and 

Warwickshire Hospital. 

| Dempsey, Martin Joseph, M.D. and M.Ch.R.U I., Demonstrator 
| of Anatomy in the Catholic University School, and recently 

| Assistant Physician to the Whitworth and Hardwicke Hoe- 

6 itals has been appointed Physician to the Mater Miserioordije 
loapital. 

Dunn, William. M.B., C.M.Aberd., Medical Officer to the Milden- 
hall Sanitary District of the Mildenhall Union. 

Horder, Thomas J., M.B.Lond., M.R.C.P., Casualty Physician tc 
i Bartholomew's Hospital, London. 

, Mallam, W. A , L.R.C.P.Lond., M.B.C.8., Out-door Medical Officer 
I to the Eastern District of the Parish of Hampstead. 

: Pkrshouse, F„ L.R.C.P.Lond., M.R.C.S., Medical Officer to the 
| Bradwell Sanitary District of the Maldon Union, 
i Stone, K. D. Aloes, L.B.C.P.&S.Irel. Medical Officer of Health to 


Dr. J. O’KELLT.-The subject is a delicate one to handle, and | Kelston by the Keyns'ham Urban bistrict Council 10 

“°“ der -1 WMM**. «ACA, 


jng the matter, and will deal with it in our next. 

JEeetmgs of the Societies arth lectures. 

Wednesday, March 22nd. 

Royal College op Surgeons of England. —5 p.m. Prof. C. 
Stewart: Alternation of Generatioa, and Recent Additions to the 
Museum. 

Hunterian Society.— 8.30 p.m. Mr. A. H. Tubby: 8ome Cases 
Illustrating the Surgery of the Stomach. Dr. F. Fox : On Some 
Unusual Nervous Symptoms. 

Thursday, March 23rd. 


8.30 p.m. Specimens will be shown by Mr. Jessett, Dr. Bantock, 
Dr. Lawrie, Mr. Ryall, Dr. R. T. Smith, and Dr. Oliver. Paper: 
Dr. J. Oliver: Adenoma Universale of the Eudometrium infiltrating 
the Myometrium in a Virgin. 

British Balneological and Climatological Society (20 Hanover 
Square, W.).— 8.30 p.m. Adjourned Discussion on Dr. D. Kerr’s 
and Dr. Hedley's Paper on the Therapeutics of Heat. Dr. Ward- 
Humphreys, Dr. K. Sibley, Dr. Bain (Harrogate), Dr. H. Campbell. 


Assistant Medical Officer by the Whitby Urban District 
Council. 

Todd, G. D., L.B.C.P.Edin., M.R.C.S., District Medical Officer to 
Selby and the Union Workhouse by the Selby Guardians 
Tubb, Thomas J.. L.R.C.P.Irel., L.B.C.Edin., D.P.H., County 
Medical Officer of Health for Wiltshire. 

Walsh, L. H„ M.B.Durh., L.R.C.P.Lond., M.R.C.S., Honorary 
Assistant Physician to the Royal United Hospital, Bath. 

Wylie, D. S., M.B., Ch.B.. Junior Resident Medical Officer to the 
Manchester Children's Hospital. 

Dirths. 

Boswell. —On March 13th, at Ashbourne, Derbyshire, the wife of 
Alexander Boswell, M.D., of a son. 

Norton. —On March 14th, at Iddesieigh Mansions, Westminster 
the wife of John Norton, M.D., D.P.H., of a son. ’ 

Saxbt.— On March 15th, at Haliigarth, Shetland, the wife of 
Thomas Edmonston Saxby, L.R.C.P., L.R.C.8.E., L.F.P.S.G 
of a daughter. ' 

White.—' >n March 16th, at the White House, Coventry, the wife of 
F. Faulder White, F.R.C 8., of a daughter. 


(Llandrindod Wells), the President, and others will take part in the 
discussion. 

Royal College op Physicians op London.— 5 p.m. Dr. 
Gee: The Nature of Asthma. (Lumleian Lecture). 

St. John’s Hospital pob Diseases op the Skin (Leicester 
Square, W.C )—4.30p.m. Dr. M. Dockrell: Cases of Rodent Ulcer 
End other Malignant Diseases of the Skin. 

Friday, March 24th. 

Royal College op Surgeons op England.— 5 p.m. Prof. C. 
Stewart: Alternation of Generation, and Recent Additions to the 
Museum. 

Clinical Society op London (20 Hanover Square, W.).—8.30 p.m. 
Parers : -Mr. J. Langton (President : A Case of Aneurysm of the 
Abdominal Aorta successfully treated by the Introduction of Silver 
Wire into the Sac. Mr. Rutherford Morison: Patients showing 
results of Stomach Surgery, with descriptions of the Operations 
Performed. Dr. Radcliffe Crocker: A Case of Lymphangioma 
Tuberosum Multiplex. Mr. W. G. Spencer: Wound of a large 
Superficial Artery, in which the Blood was flowing from the Trunk 
to the Thigh. 

Monday, March 27th. 

Association op Astlum Workers (Rooms of the Medical Society 
fit London).-3.30 p.m. Annual Meeting, under the presidency of 
fjir J. Crichton Browne* M.p., F.R.6. 


4&anriages. 


Howden—Scott.— On March 15th, at Benwell Parish Church, New- 
castle-on-Tyne, Robert Howden, M.A., M.B., Professor of 
Anatomy in the University of Durham, to Gertrude Mary 
daughter of the late Alderman John O. Scott. J.P., of Benwell 
Newcastle-upon-Tyne. * 

Deaths. 

Druitt,— On March 19th, at 8 8trathmore Gardens, Kensington 
Isabella, widow of Robert Druitt, M.D., F.R.C.P.Lond.. 
aged 76. 

Jeb.—O n March 17th, at his residence, Queniborough Hall, near 
Leicester, Dep.-Insp. General Jee, C.B., V.C., Honorary Surgeon 
to the Queen. 

Key worth.— March 19th, at 33 Augusta Flaoe, Leamington, Arthur 
F. Kevworth, M.R.C.S., L.R C.P.IreL, of Beechfleld, aged 38. 

Budge.— On March 12th, at Fakenham, Norfolk, Edward Drosier 
Budge, M.D. 

Willi ARSON. - On March ISth, at Petherton Road, Highbury New 
Fork, N„ James Williamson, M.D., aged 84 years. 


jOOQle 



March 29, 1899 


The Medical PresR and Ocular Advertiser. 


xiii 




BIIOM SKUOV1L OP 
SHJATH.—8IDK VIEW. 



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LIST. Pe rb J* 

of one doz. 

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‘HAZELINE’ COMPOUND.Is. 6d. 

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MEAT (Predigested). Is. 6d. 

MILK (Predigested) .Is. 6d. 

MORPHINE HYDROCHLORIDE, gr. 1/4... Is. 2d. 
MORPHINE HYDROCHLORIDE, gr. 1/2... Is. 4d. 
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QUININE BISULPHATE, gr. 5 Is. 4d. 

[oopyrioht] 


Burroughs Wellcome & Co., 

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H 110 


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The Medloal Press and Circular Advertiser. 


Maroh 29, 1899 


xiv 


WITH 



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“ 8ALUS POPULI SUPREMA LEX.” 

Vol. CXVIII. WEDNESDAY, MARCH 29, 1899. No. 13. 


(Original (DmmumcatimtB. 


NOTES ON THE PLAGUE. 

Collated 

By Sib CHAS. A. GORDON, K.C.B., M.D.. 

Burgeon-General (retired), Hon. Physician to Her Majesty 
the Queen. 

The object with which the following Notes have been 
collated is to present to the readers of the Medical 
Pbe8s and Circular the gist or purport of information 
telegraphed from day to day to the Timet with reference 
to the present epidemic of plagne in India. The informa¬ 
tion thus obtained has been re-arranged under paiticular 
headings, so that comparison may be rendered the more 
easy, with the substance of reports already furnished, as 
well as with those which may hereafter be sent in. (Con¬ 
tinued from page 584, December 7tb, 1898). 

1. Diagnosis 

Dr. Muller, who subsequently died in Vienna from 
laboratory plague, pointed out that the diagnosis between 
plague and influenza is extremely difficult at an early 
stage. In cases where pneumonia was present, it was 
not possible to decide whether it was the characteristic 
plague-pneumonia except by post-mortem examination. 
In three cases which they dissected. Dr. Muller's 
colleagues were unable to discover characteristic 
symptoms of primary bubo. He contends that Bitter 
has gone too far in asserting that the presence of bacilli 
in the blood indicates a fatal termination. A patient, 
he says, does not die because he has bacilli in his blood, 
or recover because of their absence. On the contrary, 
the question whether the organism will triumph over 
the disease depends upon the degree of its natural power 
of resistance to the poison of the plague. 

Colonel Hendley stated that the plague at Selcori in 
1897 was identical with the Pali plague of 1836. At 
Calcutta, cases of fever with enlargement of the glands 
were common, but indistinguishable from a mild form 
of plague except by bacteriological examination. 

2. Endemicity. 

Colonel Weir thought that the disease was endemic in 
Kathiardar, North-Western Provinces, Bengal, and the 
Himalayas. Colonel Hutcheson stated that there had 
been periodical outbreaks of tbe disease called maka- 
mare in epidemic form for thirty years in Kumaon, 
Gathwal, and other places. Tbe symptoms corresponded 
exactly with those of the plague, but he had not seen 
any pneumonic form. In Calcutta there was no reason 
to believe that the plague was endemic. The earliest 
cases in that city were among persons long resident in 
it, and it is improbable that they acquired the plague 
elsewhere. It was introduced by infected articles arriv¬ 
ing by rail and tea. 

8. Liability to Attack. 

Males appear to be more liable to attack than women. 
The most liable age i9 thirty •, the general period 
twenty to forty. At Bangalore there was no racial in¬ 
feriority. At Hyderabad tbe classes most affeoted were 
low-caste Hindoos. Mahomedans were not so liable to 
infection, nor were herdsmen who lived in the open air. 
Age and sex made no apparent difference. Mashar 
Husain, of the same place, stated that no case occurred 
among infants. At Calcutta mortality was high among 
the Christians, they being the hospital-going class. 
Of 98 cases admitted 80 died, of whom 69 were natives, 
only one Chinese, and one Burmese. There was no case 
among Africans. 


4. Season. 

In 1898 the Monsoon season lasted longer than usual, 
and the preventive measures adopted seemed less efficient 
during it. In 1897 the plague at Selcori began in 
December. At Calcutta, in 1898, the decrease of mor¬ 
tality from May to August was 3-5 upon the average of 
the same months in the previous five years. 

5. Bacteria. 

The plague bacillus seems unable to propagate or even 
live for any length of time in sewers, where it is said to 
be destroyed by other bacteria. It soon perishes in the 
dead body, and in the excreta of patients. Light and air 
are in a high degree unfavourable to its development. 
At Bombay, Dr. Gibson stated that he had been experi¬ 
menting for fourteen months, but had failed to find the 
(plague) bacillus in the floors of huts. In Calcutta, 
Major Charles said that the plague bacillus was found 
in the blood. The bacillus was imported in merchandise. 

6. How Communicated. 

Rats appear to be active agents in spreading the 
plague. But the chief sources of danger are contaminated 
clothes and bedding. 

Mr. Vincent believed that the plague was introduced 
into Bombay by religious Asiatics from Kumaon, 
where he thought it was endemic. 

Mr. Capel thought it was introduced into Hubli and 
Dhanwar through the one way of human agency. 

Mahdava Rao considered that it was introduced into 
Bangalore from Hubli by goods and rats. 

Captain Robertson, of Anantapur, traced the spread of 
the disease by human agency from the railway. Colonel 
Hendley considered that the infection was spread by 
human agency. At Calcutta, Dr. Cook was unable to 
find out the original source of the infection. At Bara- 
saul only fifteen cases of infection were traced to Cal¬ 
cutta. At Calcutta the (plague) organism generally 
entered by abrasions of the hands and feet. No nurse 
or hospital attendant contracted plague, nor did friends 
of patients attending them in hospital. Two natives 
employed in the post-mortem room were infected and 
died. The method of infection was unascertainable from 
post-mortem appearances. 

Major Charles believed that the contagion arrived (in 
Calcutta) in bales of goods from Bombay. 

7. By means of Water, Milk, etc. 

At Bangalore, Mr. Slight said the milk was sent to 
large dairies where the oream was removed, and the milk 
was then resold to the cow owners, and distributed by 
them diluted with wellB contaminated with subsoil 
drainage. 

8. In Relation to Animals. 

Certain animals, especially rats, are liable to the dis¬ 
ease. Colonel Weir was of opinion that in Bombay the 
disease was spread by rats. At Bangalore there was a 
large mortality from the plague among monkeys, squirrels, 
and rats. In every instance, after the first case among 
the population, increased mortality among rats was 
observed. 

At Calcutta the disease was imported by sea and 
spread by rats from the landing jetties. Dr. Clemow 
considered that rats might produce disease in a house 
but not in a city. Dead rats frequently found in the 
streets during an outbreak were conspicuous by their 
absence. In seven cases out of 32 there was concurrent 
mortality of rats. 

9. Anti-Plaque Serum. 

Dr. Haffkine said that his prophylactic was an arti- 


Digitized by v^ooQle 






Mab. 29, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 317 


15. Stamping Out the Plague. 

The hope of stamping out the plague by means of 
sudden and violent measures must be dismissed. 

16. Native Opinion. 

The Indian press continues week after week to protest 
against a stringency of oppressive measures which could 
with difficulty be forced upon a European population, 
and which are so opposed to the most sacred traditions 
of Eastern life as to lead to armed risings wherever they 
have been insisted on. 

At Bangalore, Colonel Robertson stated that the 
attitude of the people was uncompromisingly hostile; it 
was impossible in the large cities to deal effectively with 
the epidemic, the fear of which destroyed natural affec¬ 
tion. 

At Bombay the high priest of the Bohras explained 
that there were no religious grounds for objecting to 
inoculation as a preventive against the plague. The ex- 
.Sheriff and his son having set the example, a large 
portion of those present at a meeting of inhabitants 
Allowed themselves to be inoculated by Professor 
Haffkine and his assistants. 

At Calcutta 200,000 people left the town out of a popu¬ 
lation of 700,000. Unscrupulous people fomented the 
panic. The greatest difficulty in dealing with the plague 
was the distrust with which the officers were treated. 


C &\it Jjarbett Xettares. 

THE ADMINISTRATIVE CONTROL 
OF TUBERCULOSIS. 

By Sir RICHARD THORNE THORNE, 
K.C.B., M.B., F.R.S., 

Medical Officer to the Local Government Board. 

Abstract or Lecture III. 

Up to the present stage of these lectures I have felt no 
difficulty in expressing my views without reserve on the 
subject of the administrative measures which ought to 
be adopted in order to the control of tuberculosis. But 
I have now to consider a proposal with regard to which I 
know that my views are at variance with those of some 
of the most distinguished members of the public health 
service of this country. I refer to the question of the 
compulsory notification of tuberculosis in man. 

Applications have been made to the Local Government 
Board from time to time for their approval to the addition, 
at one time,of tuberculosis, at another, and more frequently, 
of phthisis, to the list of infectious diseases which are to 
be the subject of compulsory notification. Hitherto no 
such approval has been granted, and I can perhaps best 
approach my subject by giving some account of the con¬ 
siderations which that Board has held in view in refrain¬ 
ing from granting the necessary approval. 

At the outset, I would desire to express my entire 
sympathy with those who advocate compulsory notifica¬ 
tion of phthisis. If I cannot concur with some of my 
fellow-workers in their conviction that we can best save 
life and promote a higher standard of public health by 
thiB particular measure of control, it is because I feel 
certain that the compulsory notification of phthisis is 
calculated to retard the very object which they have in 
view, not only by alienating the public in regard to 
measures of prevention which cannot succeed unless they 
have the support of public opinion, but by placing in¬ 
superable hindrances in the way of that early treatment 
of the disease on which the arrest of its further progress 
and its cure are so largely dependent. 

One of the first objections to the compulsory notifica¬ 
tion of phthisis under the Infectious Disease (Notifica¬ 
tion) Act, 1889, is that phthisis is a disease the inclusion 
of which among the infectious diseases to which that 
Antapplips was never intended. 

Now nU these diseases therein specified have special 
.chaiftp&iristics which lend themselves to notification, 
,an4 to such restriction of the liberty of the subject as 
be rightly demanded in the interests of the public. 
■They are all diseases of an acute character, which, quite 


apart from the question of notification, renders it 
necessary to place certain restrictions on the sufferer for 
his own personal benefit. They all are diseases in which 
the infective stage is of a limited, and as a rule of very 
short, duration; and during a substantial portion of 
this infective stage the physical condition of the sick 
persons makes it necessary that they shall be under the 
control of those who are tending them, whilst for the 
remainder they are generally quite willing to be sub¬ 
jected to a control which, at the outside, will be of a few 
weeks’ duration. And, again, they are all diseases in 
which the sick persons are, for an important portion of 
the limited time of their illness, unable, by reason of 
their physical condition, and notably by reason of their 
presenting obvious indications of their infective state, to 
take part in ordinary pursuits. These are conditions 
which justify the State in giving to those who are 
responsible for the public health and for preventing the 
spread of disease the power to require the notification to 
them of the existence of such dangerous disease, in order 
that they may, for a few weeks, so control the sick per¬ 
sons to prevent their being a danger to others by the 
diffusion of their infection. 

In the case of phthisis, however, we find not only that 
every one of those conditions is absent, but that, on the 
contrary, precisely opposite conditions obtain. Thus, 
phthisis is commonly a chronic, not an acute, disease, 
and it often happens that during a long term of years 
there is no reason, other than their opportunity of 
ejecting infective sputa, which can be urged for placing 
phthisical persons under any control or restrictions. 
Then, again, the infective stage is not limited to a few 
weeks, during most of which time the patients are, 
quite apart from their infectiveneBs, necessarily under 
the control of friends or relations, doctors and nurses. 
And lastly, it is commonly the case that, during a long 
period, perhaps extending to years, during which they 
are suffering from phthisis, the patients are physically 
able to perform the ordinary duties of life. In these 
respects, therefore, there is absolutely no parallel 
between the diseases named in the Infectious Disease 
(Notification) Act and the vast majority of Cases e! 
phthisis. On the contrary, the two sets of diseases stand 
in striking contrast. And the same want of similarity 
applies also to those infectious diseases which have, on 
the demand of the local sanitary authority, been added 
from time to time in a number of towns, either tem¬ 
porarily or permanently, to the statutory list of noti¬ 
fiable diseases, namely, measles, whooping-cough, 
cholera, and, in a few instances, that form of infectious 
diarrhoea in infants and children which is known under 
such names as epidemic or autumnal diarrhoea. 

It is only right, however, whilst pointing out how 
phthisis differs in so many respects from the several 
diseases named, to state that it resembles them in one 
important respect, namely, that it is an infectious disease, 
communicable from person to person, and that in this 
sense it is, to use a statutory term, a “ dangerous infectious 
disorder.” But whilst this is so, yet it should be remem¬ 
bered, on the other hand, that phthisis as an infectious 
disorder differs from the other infectious diseases in the 
circumstance that the infection, instead of being almost 
entirely beyond control of the affected persons, is all but 
limited to the sputa, the disposal of which they can 
easily control. 

A second objection to the compulsory notification of 
phthisis has to do with the difficulty of ascertaining how 
far practical measures for its prevention can be applied 
as the result of such notification. The duty of approving 
or not approving of the addition of phthisis to the 
statutory list of notifiable diseases is one imposed on the 
Local Government Board by the Legisture: and hence 
that Board has the responsibility of deciding how far 
any such application is reasonable or not. With a view 
of determining this, it was at one time a not infrequent 
practice on the part of the Local Government Board to 
ask sanitary authorities who wished to make phthisis 
notifiable in their districts to inform the central authority 
in the first instance as to the precise action which they 
proposed to take on the information which notification 
would provide as regards a disease which might often 
last for a number of years, during which period it would 


318 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


Mas. 29 1899. 


as a role, be essential that the persons whose disease 
would be notified to them should be able to follow an 
occupation which would enable them to maintain them¬ 
selves, and at times also to maintain a family. I have 
read a number of these answers, and I am bound to say 
that I never yet saw one which, in my opinion, would 
have justified the statutory approval which was asked 
for. Some authorities, indeed, appeared to find no 
answer at all, for the letter of inquiry brought the 
correspondence to a close. Others made it clear that 
they had never fully realised the import of their request; 
indeed, a number of them at once limited their proposal 
to the adoption of such measures as the disinfection of 
rooms, clothing, bedding, &c., after the death of any 
phthisical patients; and some of these explained the 
limitation to action after death by stating that it would 
be useless to take these steps before death because 
patientB would be liable at once to reinfect the rooms and 
articles dealt with so long as they remained in contact 
with them. Action of 60 restricted a character does not 
appear to me to require or to justify compulsory notifica¬ 
tion of the disease; it could equally be carried out if 
deaths from phthisis were included among those deaths 
from infectious diseases of which so many sanitary 
authorities now obtain immediate information from the 
Registrar of Deaths for a trivial payment of twopence 
per entry. 

At the other extreme, proposals have been made for 
the periodic visitation of patients at their homes, in 
order in the first instance to inculcate certain practices 
which are moat desirable from the point of view of con¬ 
trolling infection. I refer to the giving of advice as to 
the avoidance of expectorating on floors or in the 
streets; the use either of special spittoons containing 
disinfectants or of special Japanese handkerchiefs, to be 
burned after use; the desirability of sleeping alone 
when this is practicable, &c. It is often proposed that 
on the occasion of these visits codes of directions em¬ 
bodying the necessary suggestions should be handed in 
in the form of leaflets printed by the local sanitary 
authority, and that both the patients and members of 
their families Bhould be advised as to the conditions 
involving danger, and how these may be avoided. But 
a single visit of this sort is naturally deemed to be in¬ 
sufficient ; it is hence to be followed up from time to 
time by other visits, in order to see if the directions given 
are or are not being carried out, to ascertain if the patient 
has removed t^ another residence, and in order to the 
adoption of additional precautions, including measures of 
cleansing and disinfection, either during the serious 
illness of the patient, or on removal to hospital or else¬ 
where, or, again, on the occurrence of death. Then, 
again, it has been stated by some authorities, who 
appeared to anticipate some difficulties in the matter of 
these visits, that they would only be paid, and the advice 
would only be given, in co-operation with the medical 
practitioner in attendance on the patient. A further 
proposal has been made—but in no case, as far as I 
know, by a local authority—that sanatoria should be 
erected under the statutory powers conferred on such 
authorities as to the construction, at the cost of the 
rates, of hospitals for the prevention of infection; and 
that persons who are deemed by reason of phthisis to be 
a marked source of danger to their families and to the 
community should be induced to go into a sanatorium 
until at least they had been taught the several measures 
of precaution that they should adopt against the diffusion 
of their infection. 

Such measures, if they could be and really were carried 
out systematically for such a period—whether a term of 
years or less—during which they were required, could 
not fail to be of value in the prevention of tuberculous 
disease. But is it likely that they would be bo carried 
out in this country ? 

Let us see how the demands which have been made as 
to this would be likely to operate if the statutory 
approval required by the Infectious Disease (Notification) 
Act were granted. 

We will assume the practice to be in operation, and 
that notifications of phthisis in its early stages take place 
among some of the hundreds of thousands of young men j 
and young women who work in large houses of business. 


and who, besides, are obliged to share their sleeping’ 
accommodation with others either in those houses of 
business or elsewhere. In the first place, they must be 
visited. But by whom ? Some may answer, “ By the 
Medical Officer of Health.” But every such officer knows 
that even as regards the infectious diseases that are now 
notifiable, this has already beoome quite impracticable, 
not only in large centres of population, but still more so 
in those combined sanitary areas where medical officers 
of health have charge of eight, ten, or twelve san i t ar y 
districts, spread over areas at times as large as oountiee. 
The consequenoe is that even now this work has to be 
largely carried out by the sanitary inspectors; but I am 
certain that if this duty were so relegated as regards 
such classes as I refer to, very great friction would arise 
even if the inspectors acted under some ge neral super¬ 
vision of the Medical Officer of Health. Whether, how¬ 
ever, the visit of inspection be paid by one or another 
officer, it will necessarily have to take cognisance of both 
the home and the place of occupation of the pht hi s ic al 
person; and the action taken, whether by leaflets or by 
personal advice, cannot fail to become known to 
fellow-employes, and in many cases to employers 
also. The justification for the demand that 
phthisis shall be compulsorily notified lies in the 
fact that the person in question is suffering 
from a dangerous infectious disorder communicable 
from person to person. Hence the question is already 
arising whether it is right to allow such a person to be 
in constant association with hitherto healthy people by 
day and still more so by night; and it is quite certain 
that the need for adopting special precautions as to 
sputa, <Lc., would lead to a large number of such persons 
being quietly dismissed from their posts. If such 
persons found fresh employment, they would certainly 
take care not again to afford any outward evidence of 
their malady by the adoption of the precautions urged 
on them in the interests of the public; and it is equally 
certain that they would to the utmost avoid consulting 
another medical practitioner, because their disease 
would again be notified, and precisely the same conse¬ 
quences that followed on the first notification might 
again be brought about. 

Without following out such cases as these for several 
years, and to the bitter end, it will suffice for me to say 
that, in my opinion, a large amount of harm would 
result if phthisis were included in the list of notifiable 
diseases under the English Act. The certain knowledge 
that notification and the intervention of public 
officers would ensue would prevent resort to medical 
advice in the early stages of the disease, when its pro¬ 
gress can best be arrested. The loss of employment 
consequent on notification would often tend, both physi¬ 
cally and mentally, to deprive the ailing persons of their 
best, if not their only, chance of cure or improvement; 
for there are few diseases the cure of which is more 
dependent than is the case in incipient phthisis on good 
food, wholesome sui roundings, and freedom from mental 
anxiety. Indeed, it is of the first importance to a vast 
number of persons so suffering that they should be able 
continuously and without hindrance to follow an occupa¬ 
tion sufficiently remunerative to keep them from any 
approach to physical want or anxiety of mind. Is this 
result likely to be brought about by the compulsory 
notification of phthisis ? I believe it is not. 

But objection may be raised to my line of argument. 
In the first place, it may be said that I have chosen by 
way of type a class of cases which presents exceptional 
difficulties. I am free to admit that this is, in some 
respects, true. But, on the other hand you would hardly 
expect that, when I was setting out the difficulties which 
would, in my opinion, follow on the addition of phthisis 
to the list of diseases to be compulsorily notified, I should 
try to exemplify my point by reference to cases which 
were most free from such difficulties. My point is to 
emphasise the difficulties and the mischief that might 
result from such notification, and cases such as, or in 
every essential respect comparable to, those to which I 
have referred would soon come to be counted by their 
thousands. 

Or, again, it may be objected that even if all that I 
anticipate should come to be true, the hitherto healthy 


Google 


zed by 


Mab. 29, 1899. ORIGINAL COMMUNICATIONS. Thb Medical Press. 319 


are entitled to be protected from those whose health and 
whose prospects of life are already to some extent com¬ 
promised. My answer is, that 1 believe that the attempt 
on the part of phthisical persons to avoid notification 
would in itself do a great amount of harm, not only to 
the individuals already suffering, but to those with 
whom they are in hourly and daily association. The 
English law as to the oompulsory notification of in¬ 
fectious diseases was never intended to bring under a 
system of public sanitary supervision even a single in¬ 
dividual who during a long series of years would 
have to follow his or her usual avocation. This super¬ 
vision might in a majority of cases be carried out with 
every discretion and every effort to avoid publicity; but 
if it were carried out under our present system of sani¬ 
tary organisation, and under our present law, it could 
not but run the risk of leading to hardship beyond that 
which the public have a right to expect others to suffer 
on their behalf, and indirectly this would in the end 
defeat the primary object held in view. 

I am glad to know that I by no means stand alone in 
entertaining this view. A Special Commission was 
appointed some time since by the Academie de M6decine 
in Paris to study the question of the prophylaxis of tuber¬ 
culosis. This Commission was composed of a number of 
the most eminent physicians in France. They submitted 
their report in May of this year, and the Academie 
adopted it, together with a series of resolutions. The 
report lays special stress on the danger whioh the 
hthisical patient involves to the public, especially 
y reason of the infective sputa, and it makes a 
series of recommendations, some of which affect the 

E hthisical person. The proposal that the disease shall 
b made the subject of compulsory notification is then 
discussed at length, and two principal reasons, in addi¬ 
tion to others, are given against the proposal. The first 
sets out the consideration that the moral effect of divulg¬ 
ing by means of an official declaration that which is in 
effect a medical secret would be harmful It recalls the 
fact that phthisis is not a disease that can be classed 
with infections such as diphtheria or Bmall-pox; but 
that, in the estimation of the public at least, it has an 
hereditary as well as an infectious aspect, and as such it 
is a disease the incidence of which should not be noised 
about beyond the family circle. In brief, it is held that 
the public would not accept such a legal enactment 
without protest and resistance (“ sans protester et sans 
ee defendre ”). The grounds on which this conclusion ] 
was arrived at may, in some respects, have more force in 
France than in this country. 

The second reason is deemed to be the more important. 
It is that, in a family unwilling to adopt the needed pre¬ 
cautions, it would be impracticable to impose any restric¬ 
tion, applying as they would to a disease that would 
necessitate an almost continuous intervention on the 
part of the sanitary officers for months, and even for 
years. One alternative alone is deemed sufficient to 
meet such cases, namely, consignment of the sick person 
to a hospital, and this, it is explained, is the actual 
practice followed in Norway. 

The final conclusion of the French Commission as 
regards the compulsory notification of this disease is: 

“ It must not be dreamt of—at least for the present ” 

(“ II n’y faut done pas songer, au moins actuellement ” ). 

But let it not be imagined that I am callous to the 
fact that in England and Wales alone considerably over 
40,000 deaths are still registered every year as due to 
phthisis, the form of tuberculous disease which is so 
especially identified with an aerially-conveyed infection, 
and with which dried sputa may reasonably be held to 
have important concern. For us in this country it is 
important to remember that all our sanitary legislation 
has been based on antecedent education, whether this 
has been acquired as the result of bitter experience or 
by repeated teaching and example. And it has been 
wisely held that whilst our legislative and administra¬ 
tive measures should always be just bo far in advance of 
public opinion as to draw that opinion further along the 
path of progress, it is most necessary to avoid so great 
or so hurried an advance as may tend to alienate 
the public and thus to. lead to resentment, and even 
resistance. 


During the last few years scientific research has indi¬ 
cated how the phthisical patient himself becomes a 
danger, and the physician engaged in the practice of 
curative medicine has joined those who, carrying on the 
work of preventive medicine, have for many years waged 
so successful a contest against pulmonary tuberculosis. 
To the former the so-called “crusade” against tuber¬ 
culosis is new; but happily he joins it just at the 
moment when his influence in promoting the necessary 
education for the further control of this disease is 
likely to be of overwhelming importance. 

His advice is sought by a phthisical person, and 
counsel which is sought is generally followed. There are 
also many who would te careless, even indifferent, to 
precautions which they might be urged to adopt in the 
interests of the public, but who, when told by their 
physician that unless they adopt one and another simple 
precaution they will necessarily diffuse a fatal infection 
within their own homes and to their immediate relations, 
would readily do all that they were bidden by way of 
precaution. And when once the adoption of precautions 
had become the habit at home they would equally be 
carried out elsewhere. It is, therefore, to the advice 
given by those who practise the curative branches of 
medical science, whether in hospitals or in private, that 
we must so largely look for the first steps towards pro¬ 
gress in this matter. The, action.of the physician with 
regard to the individual patient, coupled with that of 
the medical officer of health in diffusing knowledge as to 
the causes of tuberculosis among the public generally, 
will, in my opinion, be more akin to the measures which 
have been adopted in New York than that of making 
phthisis a notifiable disease under the English law. 
Already a number of excellent codes of advice and of 
ruleB as to this have been laid down by the medical 
staffs of certain hospitals for the treatment of phthisis, 
by certain medical officers of health who have induced 
the sanitary authorities to distribute them in the form 
of leaflets, and by certain associations. 

Whilst discussing the question of the notification of 
phthisis, I would recall the fact that before any infec¬ 
tious diseases were made notifiable under statute, certain 
sanitary authorities had arranged to pay fees for a volun¬ 
tary notification of some of the infectious maladies, and 
that the results of this action went in large measure to 
educate the public to the need for embodying the neces¬ 
sary requirements in a general statute, and this prece¬ 
dent seems to me to be worthy of imitation for the pur¬ 
poses of phthisis. 

I can also see great advantage in the construction, for 
public health purposes, of isolation hospitals for phthisi¬ 
cal patients. The educational effect of even a temporary 
residence in such an institution, where the adoption of 
precautions against the diffusion of the tuberculous in¬ 
fection would form a rule of life, would, in my opinion, 
be very great. Such institutions would also have other 
advantages. They would provide the conditions favour¬ 
able to the complete cure of persons suffering from 
incipient phthisis, and who, if left to themselves, would 
ultimately succumb, leaving those dependent on them 
to be a burden on the public rates; and they would 
further serve to provide, in separate buildings, for those 
who, whilst suffering from the more advanced forms of 
the disease, could not fail to act as diffusers of the 
infection around them and to add to the misery of their 
own homes. 

Three administrative measures, therefore, deserve 
attention. First, the education of the public by phy¬ 
sicians, health authorities and others in the causes of 
tuberculosis and in the means for preventing its spread. 
Secondly, the provision of means for the temporary 
isolation of persons suffering from phthisis in its various 
stages. And lastly, certain corporate public health 
authorities might find themselves able to carry out as an 
experiment a system for the voluntary notification of 
phthisis, and even of all forms of tuberculosis in their 
districts. 

Since these lectures were delivered great prominence 
has been given to the question of the prevention and 
control of tuberculosis by the important gathering which 
was summoned by His Royal Highness the Prince of 
Wales, to meet at Marlborough House on December 20th, 

P 




320 The Medical Press. ORIGINAL COMMUNICATIONS. Mah. 29, 1899. 


1898, in connection with the formation of “The National 
Association for the Prevention of Consumption and 
Other Forms of Tuberculosis,” and I was struck with 
the fact that among the speakers there was 
absolutely unanimity on two points, namely: (1) That 
the greatest danger which man incurs of receiving the 
tuberoulouB infection lies in the use of milk from tuber¬ 
culous cows; and (2) that the best chance of destroying 
the tuberculous infection when once received into the 
lungs is by treatment in the “ open air.” 

The knowledge we now possess as to the striking effects 
of the “ open-air treatment ” on pulmonary tuberculosis 
when it already exists, needs to be applied for the pre¬ 
vention of that disease; for the cost of erecting sana¬ 
toria in sufficient numbers for the cure of tuberculous 
consumption so long as we allow a principal cause of 
tuberculosis to remain in operation would, in itself, 
largely defeat the object which is aimed at. It is, there¬ 
fore absolutely necessary that the public should be 
aroused to the danger of confining milch cows, whose 
place in Nature lies in the open air of our pas¬ 
tures, in the small amount «f air-space now allotted 
to many thousands of those animals in cowsheds and 
byres, some of which they never leave for the whole 
period during which they are supplying milk for human 
beings. 


SOME INTERESTING CASES OF 
DISEASE OF THE OVARY WITH 
AMEN ORRH (E A. 

By JAMES OLIVER, M.D., F.R.S. (Edin.), F.L.S., 

Physician to the Hospital tor Women, London. 

Case I.— Dermoid of the Left Ovary with Amenor- 
rhcea in a Patient with Acromegaly — Operation — 
Recovery. —Mrs. P—, set. 34, married four years, has 
had one child. This child was born on January 10th, 
1897, and was suckled until February, 1898. She 
consulted me on September 19th, 1898, and the 
following facte were then elicited. Since the birth of 
the child there bad been complete amenorrhcea. Two 
months before her visit to me she was suddenly 
seized with pain in the left iliac region, and since 
then she has complained more or less of pain in the 
lower portion of the left abdomen. There had never 
been any symptoms referrable to the bladder or 
rectum. 

Physical Signs. —Palpation of the abdomen reveals 
nothing unusual. 

Vaginal Examination. —The cervix uteri is located 
well forward and towards the right wall of the pelvis. 
The os is slightly open. The vaginal roof to the 
left of the cervix is pushed down by a swelling which 
appears to be a thick walled cyst with a slightly 
nodular mass projecting from its summit (this 
irregular nodule was easily detected by bi-manual 
examination). The body of the uterus is directed 
somewhat backwards, and its left border is incor¬ 
porated with the pelvic tumour. The temperature is 
99 degs. F., and the pulse numbers 100 per minute. 

History of the Acromegaly.— The hands, which are 
broader and generally larger than those of any male 
engaged in arduous manual work, began to enlarge 
soon after marriage. Twice since marriage patient 
has had the size of her rings increased. Tne feet are 
much broader and bigger than they were four years 
ago. The face, too, is wider and altogether heavier 
looking than it used to be. The tongue is very large. 
During the last eighteen months patient has com¬ 
plained of pain and numbness in the middle and 
ring fingers of both hands, but to a less extent in the 
left than in the right. In warm weather the pain 
and numbness have been so slight that they nave 
scarcely attracted attention. 

Operation. —The abdominal cavity was opened 
me8ially by an incision measuring five inches. The 


tumour which was a dermoid of the left ovary was 
imbedded in old inflammatory material, ana was 
firmly adherent to the posterior surface of the left 
broad ligament and to tne uterus. With much diffi¬ 
culty it was enucleated. The mesovarium was very 
broad, and had to be secured by four interlaced liga¬ 
tures. The tumour contained cartilage and bone, but 
the irregular nodule, which was detected by bi¬ 
manual examination springing from the summit of 
the tumour, proved to be a very cirrhotic portion of 
the ovary. 

Remarks. —It was difficult to account for the 
amenorrhcea in this case, as the confinement had 
been an easy one, and no untoward condition con¬ 
nected with this event had been noted. I was disposed 
to believe it was quite independent of the pelvic 
tumour, and was attributable rather to the general 
condition of the patient. 

Case II.— Multicystic Disease of Both Ovaries, 
occurring soon after Marriage, causing Amenorrhcea 
and Colostrum to be'obtained from the Breasts — Opera¬ 
tion — Recovery. —Mrs. B., set. 39, and married 18 
months, has had no child and no miscarry. Menstrua¬ 
tion began at the age of 14, and the discharge, which 
has always been rather free, has usually flowed for 
seven days. She was last unwell 12 months ago, 
having menstruated regularly for six months after 
marriage. After two menstrual periods had been 
missed patient observed that her abdomen and breasts 
were increasing in size, and she naturally considered 
herself pregnant. The abdomen gradually increased 
in size until the menstrual discharge had been in 
abeyance eight months, but during the last four 
months patient thinks it has remained fairly sta¬ 
tionary. Movements have been felt since about the 
fifth month. There has been throughout no sickness 
and practically no pain. She consulted me because 
she had gone nearly three months over the time when 
she had expected to be confined. 

Physical Signs. —The abdomen is prominent. It 
bulges more especially a little to the left of the 
umbilicus over an area with a diameter of about four 
inches. The upper border of this bulging is located 
two inches above the level of the umbilicus. Palpa¬ 
tion detects a swelling which is irregular in outline 
and consistence. It arises from the pelvis and 
extends to three inches above the umbilicus. At the 
level of the anterior superior spines of the ilium it 
measures transversely seven inches, and the greater 
portion of the swelling is located in the left half of 
the abdomen. Over a small area an inch below and 
a little to the left of the umbilicus the percussion 
note is resonant, elsewhere the note over tne tumour 
is dull. 

Vaginal Examination. —The cervix uteri is located 
high, in close apposition with, and somewhat to the 
right of, the pubic bone. It is rather soft, but 
the os is not open. Douglas’s pouch is occupied by 
a solid or very tense cystic swelling, which is con¬ 
tinuous with the right half of the abdominal swell¬ 
ing. The body of the uterus cannot be differentiated. 
Colostrum is obtainable from both breasts. No 
sounds are heard on auscultating over the tumour. 

Operation. —The abdomen was opened mesially. 
It contained a small quantity of tree fluid. Both 
ovaries contained a large number of cysts, varying 
in size from that of a walnut to an orange. The 
right one was partially concealed by its correspond¬ 
ing broad ligament. The left one was peculiarly con¬ 
cealed by small intestine. Several of the cysts in 
each had to be tapped in situ before the delivery of 
either could be attempted. 

Case III. Unilocular Cyst of the Right Ovary with 
a Solid Fibro-myoma in the Cyst Wall, occurring in a 
Virgin and associated with a Six Months' Amenorrhcea — 
Operation— Recovery. —Miss S., set. 36, began to men¬ 
struate at the age of 12. The menstrual discharge. 


Digitized by GoOglC 


Mab. 29, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Medical Press. 321 


which had usually flowed for six days, had recurred 
regularly until six months ago, since which time 
there has been complete amenorrhcea. For two 
months she has remarked that her abdomen has been 
increasing in size, and since she was last unwell she 
has complained occasionally of sickness. 

Physical Signs .—The abdomen is full, but some¬ 
what flat. It is occupied centrally by a swelling 
which arises from the pelvis and extends to one inch 
above the umbilicus. Projecting from this swelling 
on the left side about the level of the anterior superior 
spine of the ilium is a small tumour of about the size 
of a small orange. The small tumour can be moved 
to a slight extent on the surface of the larger one. 
Fluctuation is obtained. 

Vaginal Examination .—The cervix uteri is located 
fairly centrally. The vaginal roof in front and to 
the right of the cervix is pushed slightly down by a 
portion of the abdominal swelling. The body of the 
uterus cannot be differentiated. 

Operation .—The abdomen was opened mesially. 
The tumour was an unilocular cyst of the right ovary, 
with a solid fibro-myomatous tumour (encapsuled) in 
the cyst wall. The left ovary was quite healthy. 


MODERN VIEWS ON GOUT IN 
RELATION TO TREATMENT, (a) 

By A. DE THIERRY MOUILLOT, 

B.A., Dub., M.A., M.D., 

Harrogate. 

The author alluded to certain chemical facts 
which he considered to have been settled by the 
researches of Sir William Garrod, Sir William 
Roberts, and Dr. Luff. He observed that gout was 
accompanied by the presence of uric acid in the 
form of quadriurate m the blood in recognisable 
quantity wnich is deposited in the tissues in the form of 
sodium biruate owing to the action of the serum salts, 
particularly sodium chloride. He then argued that the 
presence of an abnormal quantity of uric acid in the 
blood must be due to a loss of the balance between 

{ jroduction and excretion, and that as in gout rather 
ess than the normal amount of uric acid is eliminated 
in the urine, it was necessary to assume that there was 
a relative inadequacy on the part of the kidneys to 
eliminate all the uric acid formed, whether in 
excessive quantity or not. 

Although believing that this relative inadequacy 
was a necessary concomitant of gouty deposit, Dr. 
Mouillot did not believe that the kidneys were solely 
at fault or that uric acid was produced, as well as 
excreted, bv those organs. Dr. Luff’s argument that 
if uric acid were made elsewhere it must be carried 
to the kidneys by the blood was doubtless a strong 
one, and his failure to find any uric acid even in the 
blood of birds was a strong point in favour of the 
renal origin of uric acid, but Dr. Chalmers Watson's 
recent investigations which show that uric acid is 
present in the blood of birds, were opposed to Dr. 
Luff’s negative evidence. Minkowski's experiments 
on geese were strongly in favour of the hepatic 
origin of uric acid, which origin is also strongly sup¬ 
ported by clinical evidence. The assumption that 
the kidneys are sufficiently healthy to perform a syn¬ 
thetical process, and not healthy enough to eliminate 
the substance formed, is not so rational as that the 
failure on the part of the kidneys is in power to 
eliminate uric acid made elsewhere. Besides, both 
the supposed antecedents of uric acid, urea and 
glycocme, are made in the liver, and it is probable 
that their conjugation takes place there also. 

Dr. Mouillot believed that the proximate cause of 

(a) Abstract of paper read at the HarreUn Society of London, 
March 16th, 1886. 


the gouty state lies in a defective metabolism of 
proteids due to a functional disease of the liver or 
intestinal glands, and that the deposit of sodium 
biurate is due to deficient elimination by the kidneys, 
owing to a diseased condition or through their 
action being inhibited by an impure condition of the 
blood. 

Dr. Mouillot took Sir William Robert’s view as to 
the deposit of sodium biurate being the cause of 
the articular symptoms and many of the non-arti- 
cular symptoms. 

In the differentiation of gout from rheumatism, 
stress was laid on the condition of the fingers, and 
also on the deposit so often found in the conjunctival 
surface of the lower eyelid. 

In speaking of the treatment, Dr. Mouillot argued 
from the action and success of colchicum that the 
objects aimed at should be to diminish the quantity 
of uric acid formed and stimulate the intestinal 
glands and liver, whilst endeavouring to remove all 
the uric acid formed through the excretory organs. 
Colchicum probably acts by its effect on the liver and 
intestinal glands, which increases the quantity of 
bile, thus removing, in the form of glycocholic acid, 
one of the antecedents of uric acid. Colchicum com¬ 
pletely meets the indications in acute gout. 

Chronic gout and goutiness must be treated mainly 
by diet and periodic visits to watering places. The 
main points in diet are to drink fluid freely apart 
from meals, and to make the meals as little complex 
as possible. Stimulants should never be taken 
except at meals on account of their effect on the 
liver. As to watering-places, Dr. Mouillot considered 
that British Spas were sufficient for every purpose, 
and that the medical man was as important as the 
place. 

He considered that Sir William Roberts's objec¬ 
tion to Spas, the waters of which contained sodium 
salts, ana his preference for indifferent waters was 
unfounded. With respect to Harrogate it was found 
that the exhibition of a full course of treatment by 
the waters reduced the amount of uric acid, whilst 
increasing that of urea, eliminated. This is what is 
required in gout, and is a similar action to that of 
colchicum, the reason evidently being that the sulphur 
Baline waters remove by the bowels some of the ante¬ 
cedents of uric acid, whilst their stimulating effect on 
tissue change, increased the principal product of 
metabolic activity—urea. The charge made by Sir 
William Roberts that saline waters can only do good 
by precipitation of the sodium biurate out of the blood 
into the joints is unfounded as far as Harrogate is 
concerned, for acute gout developing under treat¬ 
ment there is rare. 

Dr. Mouillot concluded by reading notes of the 
only two cases of acute gout which had occurred in 
his practice whilst the waters were being taken. One 
case was remarkable in that the patient had never 
tasted meat in his life, and lived entirely on milk 
and vegetables. 


^nmoattiono of §orietit6. 

CLINICAL SOCIETY OF LONDON. 
Meeting held Friday, March 24th, 1899. 

The President, Mr. Lanqton, F.R.C.S., in the Chair. 


ABDOMINAL ANEURYSM TREATED BY INSERTION OP SILVER 
WIRE. 

The President read notes of a case of aneurism of the 
abdominal aorta successfully treated by the introduction 
of silver wire. The patient was a woman who had had an 
abdominal swelling sinoe the birth of a child three months 
before. She had wasted having lost two stones in weight 


Dio 


-oogle 



Mar. 29. 1809. 


322 Ibi Medical Press. TRANSACTIONS 

' in twelve months. On admission there was a pulsating 
tumour in the epigastrium three and a half inches in 
diameter, which was moveable laterally but not vertically, , 
and there was a loud systolic murmur over it. In April, 
1898, as the swelling was increasing, and the pain very 
severe, an exploratory laparotomy was performed, and 
the tumour was found to be aneurysm of the upper part 
of the abdominal aorta. A trocar was introduced into 
the sac and not much blood issued from the cannula when 
the trocar was withdrawn As there was some difficulty 
in introducing salmon gut into the sac, silver wire 
was used and five feet thereof was introduced without 
difficulty. The puncture was secured with a silk ligature. 
There was some vomiting, and a good deal of restlessness 
after the operation. A month later the tumour was 
carefully examined, and it was found that consolidation 
was occurring As a result of the manipulation, how¬ 
ever, there was return of the vomiting, severe rigor, and 
collapse. These alarming symptoms yielded to treat¬ 
ment, and the after progress was uneventful. She had 
been seen from time to time, and there was at the present 
time a hard mass in the middle line much smaller than 
before the operation, and the thrill and bruit had disap¬ 
peared. Her health was excellent. The author observed 
that there were only a few successful cases of this kind 
on record. 

OPERATIONS FOR PYLORIC OBSTRUCTION. 

Mr. Rutherford Morison related an interesting 
series of cases illustrating the results of operations 
for pyloric obstruction. The patients were shown, 
and sections from the growths removed, were exhibited 
by the lantern. 1. A case of recovery after pyloroplasty 
for stricture of the pylorus. The patient was a woman 
who was operated on in October, 1894, the case being 
published in the Lancet in April, 1895. At the time of 
operation she was fed entirely by the rectum. She was 
now in perfect health and could eat anything. He made 
an incision an inch and a quarter from the pylorus, 
passed a guide through it, and then made an incision 
through all coats, and then sutured the incision so that 
the line of union was transverse to his incision. 2. A 
woman, set. 40, who had had severe pain after food for . 
six months, and vomiting and emaciation for two 
months. There was a tumour the size of an orange j 
which could be felt near the umbilicus, and which proved \ 
to be a scirrhous mass. Pylorectomy was performed in 
October, 1897. She could now eat anything, was in good 
health, weighed a stone and a half more than before the 
operation, and there was no evidence of recurrence. Mr. 
Morison said he had performed this operation nineteen 
times and all had recovered. No relapses had ever occurred. 
3. A man, tet. 48, who had had severe pain after food and 
emaciation for some time. There was a growth of en- 
cephaloid cancer reaching nearly up to the pyloruB, which 
was excised with the growth. He was now in good 
health, and had gained nineteen pounds in weight in the 
six months after the operation. 4. A woman, ait. 41, who 
had had pain and vomiting for a year. There was great 
dilatation of the stomach, due to an adeno-carcinomatous 
growth, the size of a walnut, in the pylorus. She 
had gained two stones since the operation in Sep¬ 
tember, 1898. 5. A man, $t. 38, who had rapidly 

emaciated and suffered from pain and vomiting for 
ten weeks. There was an extensive colloid carcinoma 
involving the pyloric half of the stomach which was \ 
removed, and the cardiac end joined to the duodenum, 
hy a modification of Billroth’s method. A chain of 1 
glands was affected, and had to be removed. The 
patient was now in excellent health, and there were no j 
signs of recurrence. 6. A man, a*t. 41, on whom he had i 
performed pylorectomy for a small scirrhous mass six 
weeks ago. The man was now quite well, and had 1 
gained more than a stone in weight. The operation was 
in Mr. Morrison’s opinion safer than gastro-enterostomy, 
and should be performed whenever the tumour was 
movable, size of the tumour not being an important 
consideration. 

Mr. Charters Symonds congratulated the author on 
his excellent results. He had tried the method of 
pyloroplasty described in one instance with a satisfactory 
result, and he had to operate on the patient later for 
some other trouble, and found- that no adhesions had 


OF SOCIETIES. 


occurred. In one case of pylorectomy he had found 
that no adhesions had ooouxred. In one case of pylorec¬ 
tomy he had found difficulty in joining the duodenum 
and stomach, and he had finally to employ a Murphy's 
button. The ultimate result was good, the patient being- 
able to return to work. He was inclined to think more 
favourably of gastro-enterostomy than Mr. Morison 
did. He had performed the operation twenty times, and 
had seen nothing but good result from it. It had given 
great relief where removal was impossible. 

Mr. W. G. Spencer also congratulated Mr. Morison on 
his splendid results, and observed that there Beemed to 
have been unusually little involvement of lymphatic 
glands in his cases, considering the size of the tumours. 
He thought the end-to-end approximation of stomach 
and duodenum was better than the method employed in 
Germany of closing the cut end of both organs, and then 
making a lateral opening between the two. Mr. Spenoer 
had performed pyloroplasty successfully, but he preferred 
to pass his sutures only through the peritoneal and 
muscular coats, using a Lembert’a suture of fine silk, 
and an ordinary round sewing-needle. He thought that 
gastro-enterostomy was of great service in cases where 
excision was impracticable. 

Dr. Radcliffe Crocker described a case and showed 
drawings of a case of 

LYMPHANGIOMA TUBER08UM MULTIPLEX. 

The patient was a female, who had first noticed 
the lesions at the age of eighteen. There were 
numerous small smooth papular elevations on the skin 
over the upper part of the chest. They were most 
abundant under the clavicles, and without any definite 
arrangement, although there was a tendency for them to 
follow lines from the shoulders to the sternum. They 
were confined to the upper part of the chest with the 
exception of a few outlying papules on the neck and in 
the axilla. Some of them were yellowish or brown, 
but some of them were the same colour as the surround¬ 
ing skin. There was milium between the spots and on 
some of them. Microscopically they had a cystic struc¬ 
ture with some glandular elements. The patient was in 
robust health, and experienced no inoonvenience from the 
Bpots beyond their preventing her from wearing low- 
dresses. The condition was a rare one, only ten cases 
having hitherto been recorded. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Obstetrics. 


Meeting hbld Friday, February 10th, 1899. 
The President, Dr. F. W. Kidd, in the Chair. 


DISCUSSION ON THE ROTUNDA HOSPITAL OB8TETRICAI. 

REPORT. 

After some remarks by Dr. More Madden, Dr. W. J. 
Smyly thought it was a very great gain to have done 
away with the plug in the treatment of abortion. In 
the treatment of placenta prtevia the same method was 
used at present as during his tenure of office at the 
Rotunda Hospital, when there was not one death as the 
result of haemorrhage from placenta praevia, though two 
cases had ended fatally. One of these patients had 
been delivered by the old method of version and imme¬ 
diate delivery, and had died after a short time from 
haemorrhage and rupture of the cervix, and the other 
had died on the tenth day of pulmonary embolism. 
Coming to accidental haemorrhage, he considered that 
the best treatment was still practised—namely, that if 
the patient had not strong labour pains it was a mistake 
to rupture the membranes, and if there was external 
haemorrhage the uterus should be plugged. In London, 
students taught at the Rotunda had been rejected at 
examinations for not saying that they would rupture 
the membranes in such cases. Even the nuiBes who go 
up for the examination of the Obstetrical Society were 
instructed beforehand to say, if asked what they would 
do in a case of accidental haemorrhage, th at they would 
rupture the membranes, which, he thought, would 
most improper. 


Mar. 29, 1899. 


TRANSACTIONS OF SOCIETIES. 


Dr. Macan pointed ont that the mortality of the 
internal department was, contrary to what they would 
-expect, twice that of the external department. Me 
deprecated the time limit of four hours as an indication 
for the application of the forceps as given in the Report. 
Indications on the part of the mother or child were 
admissible, but the time indication was ridiculous. He 
noticed a case of eclampsia which was stated to be 
absolutely free from albuminuria, and therefore not 
-capable of being explained by the ordinary theories. 
There was a case of brow presentation above the brim 
where the forceps had been applied. He thought that 
the forceps were contra-indicated in such a case. 

Dr. Kidd referred to the fact that in about 50 per cent, 
of the cases of rise of temperature after delivery no 
-explanation of the cause of this rise could be given. 

Dr. Purefoy, Master of the Rotunda, in reply, said 
that, with regard to the use of ergot in post-partum 
haemorrhage, it was needless to say that they only used 
it when the placenta was absent. They employed 
Squibb’s preparation of ergot, and he commended its use 
as it had given satisfactory results. One possible 
•explanation of the fact that the mortality was greater in 
the internal than in the external department was, of 
-course, that the bad cases in the external maternity were 
admitted into the hospital The four-hour limit was 
only one, and the least important, indication in the use 
of the forceps. The other indications on the part of the 
mother and the child were also taken into account. He 
agreed that it was unsatisfactory not to be able to assign 
a cause to the cases of rise of temperature which Dr. Kidd 
had referred to, but the fact remained that they were 
unable to give a tangible cause for the elevation, as a 
large number were not interfered with, even to the extent 
of a vaginal examination. 

The Section then adjourned. 


HARVEIAN SOCIETY OF LONDON. 

Meeting held Thursday, March 16th, 1899. 

Henry Jdler, F.R.C.S., President, in the Chair. 

Dr. Mouillot, of Harrogate, read a paper, entitled 

MODERN YIEW8 ON GOUT IN RELATION TO TREATMENT, 

a full abstract of which will be found in another 
column. 

In the discussion following, Dr. Bezly Thorne said 
that it had been a pleasure to him to listen to an 
exposition of views so largely in accordance with his 
own. He particularly wished to emphasise his con¬ 
viction that granular kidney is a cause neither of gout, 
high tension, nor heart affection. All three, he believed 
to be consequential expressions of a general condition of 
blood-impurity in the maintenance of which a chronic 
gastro-duodenal catarrh, bringing in its train pan- 
creati co-hepatic obstruction and gastro-intestinal 
fermentative changes, is the fundamental cause. The 
gastro-duodenal factor might possibly have much to do 
with the part which the liver plays in the uric add 
-diathesis. Dr. Thorne thought that he could not better 
indicate his views as to the relation which diet bears to 
the toxaemia of which uric acid is one of the most -easily 
recognised, but probably by no means the most active, 
agents, than by giving his own personal experience. 
Starting with the worst possible inheritance as to uric 
acid, some sixteen years ago he became subject to tender 
nodular enlargements on the bones, mainly of those of 
the hands and feet, as well of the articular ends of the 
clavicles. Soon he had to abandon the use of the phalanges 
of the left hand as pleximeters in percussion on account 
of the periostitis which it induced. Migraines which 
had occurred at rare intervals, become more and more 
frequent until they disabled him two or three times a 
week, and at length a permanent tenderness of the left 
lateral sinus became established, and for two years com¬ 
pelled him to step with the greatest caution lest an 
aocess of pain should be brought on. All this time there 
were evidences of biliary obstruction or inhibition, and 
the daily evacuation of considerable quantities of uric 
acid. The failure of his health culminated about thir¬ 
teen years ago, in two accesses of what would now be 


The Medical Press. 323 

probably called appendicitis, an affection which he 
believed to be intimately associated with that condition 
of the digestive tract which is characteristic of the urio 
acid diathesis. While laid aside with the second attack, he 
became convinced that a gastro-ahodenal condition, 
identical with that which had been denominated 
“ mucous disease ” and “ cceliac disease ” of young 
children, was the causative factor of his own ill-health, 
and he resolved to effect a revolution in diet and treat¬ 
ment. What that involved they would understand when 
he stated that from the beginning he had abandoned all 
wine and sweets, taken almost daily a dose of saline 
aperient, and one of calomel once or twice a week, and that 
for more than a year not one shred of butcher’s meat 
had passed his lips. As soon as the subsidence of 
the acute symptoms allowed, he adopted a diabetio 
dietary, foreswore saline aperients, and took to drinking 
about two pints of water, generally warm, at such times 
as would not interfere with gastric digestion, instead of 
vainly trying to quench thirst with draughts of efferves¬ 
cing mineral waters, and in about three weeks returned 
to a state of health which he had not known for years, 
and, moreover, had maintained in increasing degrees 
ever since. It was, he said, necessary to add that he 
had treated the condition of the digestive organs with 
preparations of bismuth and of soda, and that he had 
found it necessary to maintain that treatment during 
the greater part of the seven succeeding years in order 
to prevent relapse. He had now, for many years, treated 
his patients on the same lines and with varying success, 
and. for that reason, he was inclined to regard the em¬ 
bargo on sodium salts as a bugbear based on laboratory 
experiments rather than on clinical observation. One 
of the secrets of success he believed to be the enforce¬ 
ment of simplicity of diet, because the stomach of a 
gouty patient could deal effectually with a meal of 
animal food and succulent vegetables, but would utterly 
break down in the effort to digest half a dozen kinds of 
food at the same time. Monotony of diet also had its 
drawbacks, and occasionally he found it necessary to 
place an inveterately gouty patient on an exclusively 
milk or vegetable diet for a few days or a week in order 
to give the stomach a change of digestive function. 

Dr. A. P. Luff urged the importance of avoiding the use 
of salicylic acid or sodium salicylate in the treatment of 
gout, since it was not only useless, but in many cases he 
had found it do positive harm. He entirely supported 
Dr. Mouillofs statement that many gouty people drank 
too little, and especially he had found this to be the case 
with female gouty patients, in whom the total amount of 
daily fluid consumed would frequently average not more 
than 18 to 20 ounces. He thought that his investiga¬ 
tions on the influence of alkalies on the solubility of 
gouty deposits had been misunderstood by many medical 
men. He had never advocated the abandonment of 
alkalies in the treatment of gout. What he had shown 
was that alkalies and their congeners were useless when 
administered with the object of dissolving gouty deposits, 
but he (Dr. Luff) frequently employed alkalies in the 
treatment of gouty dyspepsia and of gouty affections of 
the liver. 

Mr. Wm. Armstrong (Buxton), while agreeing with 
Dr. Mouillot that gout was more frequently met with 
than rheumatism, thought that there was just now 
rather a tendency to consider all articular and muscular 
pains gouty, and to underestimate the rheumatic 
element which was often of considerable importance from 
the point of view both of therapeutics and of dietetics. 
Dr. Luff’s valuable work had shown that in cases of 
persistent gout and goutiness there waB almost constant 
failure to excrete the normal amount of uric acid; and 
he (Mr. Armstrong) had been greatly aided in the 
diagnosis of doubtful cases by the estimation of the 
twenty-four hours’ urine by the Gowland-Hopkins method. 
With regard to dietary—as a general rule a certain 
amount of butcher’s meat was necessary. In a consider¬ 
able number of cases on a non-meat diet he had observed 
that although the actual amount of uric acid formed got 
lees, the rate of excretion diminished to a still greater 
degree. Beef and mutton certainly stimulated the pro¬ 
cess of excretion. In nearly a hundred cases dieted 
exclusively on min ced meat and hot water there was at 




324 The Medical Press. 


TRANSACTIONS OP SOCIETIES. 


Mar. 29, 1899 . 


first an enormous increase in the quantity of uric acid 
excreted, which, no doubt, the advocates of a non-meat 
dietary would say was conveyed into the system by the 
beef, but as the gouty troubles improved the excretion 
gradually fell to normal, although the food was un¬ 
changed. In giving red meat to the gouty it was neces¬ 
sary to cut down as far as possible the consumption of 
carbo-hydrates and of milk, and also to insist upon the 
drinking of hot water one hour before each meal. Fresh 
vegetables were of the greatest value, but they should 
be well cooked, and freed from crude, indigestible 
matter. A separate vegetable course at dinner was most 
useful. Certain gouty cases could be treated with an 
equal amount of success, either on the lines suggested, 
or by the dietary advocated by Dr. Alex. Haig, consisting 
mainly of carbohydrates, milk, and fruit, but it was of 
the first importance that the two classes of food should 
not be mixed as in that direction lay disaster for the 
gouty. Modern researches concerning gout seemed to 
resolve its treatment into two portions. (1) The pre¬ 
vention of the formation of the antecedents of uric acid 
by attention to the condition of both the gastric and 
duodenal digestions, and to the action of the liver, that 
much-abused organ, so frequently the victim rather than 
the culprit. (2) The stimulation of excretion by atten¬ 
tion to the functions, of the kidneys, skin, bowels, and 
nervous system, to a lowered condition of the last-named 
so much of the modem irregular gout is due. 

Dr. Mouillot, in reply, said that he was much inte¬ 
rested in Dr. Bezly Thome’s experience. It bore out his 
view that the initial difficulty in gout was a digestive 
one, and that the gouty were unable to digest the 
various classes of food at the same meal. The rigidity 
of the diet rules must be in proportion to the severity of 
the symptoms as a sacrifice which it might be worth 
while making in a severe case might not be so in a mild 
one. He said his view was that the true cause of gout was 
digestive, and that the uratic deposits which were 
responsible for most of the symptoms were due to sub¬ 
sequent failure of the kidneys, either as a coincidence or 
caused by the toxic poisoning due to the uric acid, or per¬ 
haps other poison. Dr. Mouillot was quite sure that Mr. 
Armstrong’s practice of calling in the aid of the skin 
to assist the diuretic action of the Buxton waters was 
sound, and would limit the number of cases of gouty 
attacks whilst taking the waters. Dr. Mouillot confessed 
himself unable to judge of the aocuracy of Dr. Chalmers 
Watson’s work which Dr. Luff had so ably criticised, nor, 
if accurate, did it prove that uric acid was not made in 
the kidney, but merely removed a difficulty out of the 
way of those who held that view. 


SHEFFIELD MEDICO-CHIRURGICAL SOCIETY. 
Meeting held Thursday, March 2nd, 1899. 

Dr. Alfred Robinson, President, in the Chair. 


Dr. Keeling showed the specimens removed, and 
gave details in the following cases :—1. “ Cystic Myoma 
of the Uterus.” successfully removed by abdominal 
section in an unmarried woman, the uterine wound being 
treated intra-peritoneally. 2. “ Dermoid Cyst and 
Ovary,” patient single. Recovery good. 3. “ Broad 
Ligament Cyst,” removed from married woman, set. 30, 
sterile, married ten years. Recovery excellent. 4. 
“Menstrual Fluid removed in a case of Imperforate 
Hymen.” The patient, otherwise a healthy, well-grown 
girl, set. 17, had never menstruated. 6. “ Cancerous 
Uterus, removed by Vaginal Hysterectomy from a 
Married Multipara, tet. 42.” Recovery had been excel¬ 
lent, with the serious exception that an urinary fistula 
had resulted, probably from the bladder having been 
caught by one of the forceps used in securing the broad 
ligaments. 

A discussion followed on the operative treatment of 
fibro-myomata and cancer of the uterus, in which Dr. 
Martin, Mr. Richard Favell, Dr. Sinclair White, Mr. 
Pye-8mith, Dr. Andrew Walker, and Mr. Sydney 
Barber took part. 

Dr. Arthur Hall showed the following pathological 
specimens :—(1) “Heart with stenosis of the pulmonary 


artery, imperfect ventricular septum, and patent ductus 
arteriosus.” The specimen was taken from a boy, set. 11, 
who died of pneumonia, The cyaooeis was not 
ertreme, except during the last few days of life. (2) 
“ Liver with gall-stones in the gall-bladder, an 
impacted stone in the ductus choledochus, several 
stones in the intra-hepatic bile ducts, which were 
largely dilated.” The left lobe was breaking down 
with multiple abscesses secondary to well-marked 
cholangitis. At the left extremity of the liver there was 
a large subphrenic abscess, which seemed to be secondary 
to the suppuration, in the left lobe of the liver. (3) 
“ Caroinoma of the bodies of the ninth cervical and upper 
three dorsal vertebrae, part of a widely distributed Can¬ 
cer,” the primary seat of which was not discovered. The 
bodies of the vertebrae had given way and produced 
transverse myelitis, which was the immediate cause of 
death. (4) “ Typhoid ulcers,” preserved by Kaiserling's 
method with formalin and glycerine. 

Dr. Cairns showed the specimen and gave the details 
of a case of “ Ectopic Gestation,” which was diagnosed by 
Dr. Andrew Walker and himself, and sucoeesfuUy 
operated on by Dr. Sinclair White. 

Dr. George Wilkinson gave an account of a case of 
“Subphrenic Abscess,” operated upon by him at the 
Royal Hospital. The patient was a man, set. 47, who 
was admitted acutely ill, with a prominent, tense, fluc¬ 
tuating swelling in the epigastric region. Hepatic 
abscees was diagnosed, the swelling was incised, and 
two pints of pus and hydatid fluid evacuated. The 
patient complained of much pain in the left side when 
being lifted on to the operating table. Next day there 
were signs of a subphrenic collection of fluid on the left 
side. This was evacuated and drained after resection of 
a portion of the 7th rib in the anterior axillary line, and 
suture of the costal pleura and the diaphragm. Drainage 
was continued for two months, after which the cavities 
healed, and patient was discharged. 


NORTH OF ENGLAND OBSTETRICAL AND 
GYNAECOLOGICAL SOCIETY. 

Meeting held at Sheffield, March 17th, 1899. 

Dr. Donald, President, in the Chair. 

Specimens. 

Dr. Keeling showed the following specimens:— (1) 
Large cystic myoma of the uterus, (2) dermoid cysts of 
both ovaries, (3) tubo-ovarian cyst. 

CA8E8. 

(1.) Dr. Favell related a case of canoer of the cervix 
associated with three months’ pregnancy. The uterus 
was successfully removed by vaginal hysterectomy. 

(2.) The President (Dr. Donald) reported a case in 
which he had performed vaginal hysterectomy for post¬ 
partum hemorrhage The patient, a primipara, was 
observed, before labour, to have an extremely thin 
uterine wall. Labour came on spontaneously, accom¬ 
panied, however, by extreme inertia, and was completed 
by forceps. Profuse and intractable post-partum 
haemorrhage ensued, resisting all the usual methods of 
treatment, including plugging with gauze. The patient 
was apparently moribund, but it was decided to perform 
vaginal hysterectomy as a forlorn hope. The operation 
was easy and only occupied ten minutes, clamps being 
used. The patient temporarily improved, but died an 
hour later. Dr. Donald was of opinion that if the 
operation had been done a few minutes earlier the 
patient’s life would probably have been saved. 

Dr. Wall6 introduced for disoussion the subject of 
“ the treatment of some oases of Accidental Haemor¬ 
rhage,” adjourned from the last meeting. In theee 
cases Dr. Walls advised that the membranes Bhould not 
be ruptured until the cervix was fully dilated or dila¬ 
table. There was no objection to plugging the vagina, 
especially if combined with a hydrostatic dilator, Buch 
as de Ribe’s bag. After delivery by forceps or version the 
great danger was from the almost invariable post-partum 
hemorrhage. If the usual measures, including plugging 
with iodoform gauze failed, he advised vaginal extirpa- 


Mas. 29, 1899. 


FRANCE. 


The Medical Press. 325 


tion of the uterus as a last resort, believing that in this 
■way certain lives would be saved. 

Dr. Glynn Whittle, in an experience of 10,000 
labours, had met with severe accidental haemorrhage in 
sixteen cases. Of these all the infants died with ooe excep¬ 
tion, but fifteen of the mothers recovered. He had never 
used hydrostatic dilators, but preferred to firmly plug 
the cervix and vagina, followed by manual dilatation 
of the cervix and delivery by forceps or version. The 
poet-partum haemorrhage was, in his experience, always 
controlled by a hot uterine douche. He could not sup¬ 
port the suggestion to perform Porro’s operation or 
vaginal hysterectomy in such cases, believing that a 
woman who could survive hysterectomy would certainly 
be saved by a vigorous application of the above princi¬ 
ples of treatment. 

Dr. Martin considered that oases of very severe acci¬ 
dental haemorrhage were of great rarity, but in Ruch 
cases he agreed with Dr. Walls that if other methods 
fail to check the bleeding hysterectomy was quite 
justifiable. 

Dr. Lea suggested that in cases of severe internal 
bleeding with the os nndilated and extreme uterine 
inertia accouchement force by the aid of free incisions 
in the cervix should be carried out. 

Ee marks were also made by Drs. Briggs, Keeling, 
and the President, and Dr. Walls replied 



[from odr own correspondent.] 

Paris, March 25th, 1899. 

Osteomalacia in Man. 

At the meeting of the Academy of Medicine, M. 
Berger communicated details of Ithe case of a young 
man who entered his wards for double genu valgum. 
Osteotomy above the left condyle was practised, the 
knee straightened out, and some time afterwards the 
femur was found to be consolidated. Towards this 
period, however, the patient complained of violent 
spontaneous pain in all the extremities, except in the 
operated limb. These pains were first considered to be 
those of rheumatism. It was only three months sub¬ 
sequently that abnormal mobility was remarked in the 
bones of the two lower extremities, which became the 
seat of considerable deformity. Analogous pains were 
felt in the arms, and these became deformed in their 
turn, and finally the thorax and the head were attacked 
in a similar manner. The vertebral column alone 
resisted the process of disintegration. The patient was 
besides suffering from interstitial nephritis, which by its 
rapid progress threatened his life. All treatment 
failed to arrest the progress of the primary disease. 

Volvulus of the Sigmoid Flexure. 

M. Routier spoke on a case of volvulus of the sigmoid 
flexure. A woman presenting all the signs of intestinal 
occlusion entered the hospital in July last. For a year 
previously she suffered more or less from violent attacks 
of colic, and two or three day6 before applying to the 
hospital, without any apparent cause, in the middle of 
the night she felt a sudden pain over the whole abdo¬ 
men, and since that moment no matter nor gas had been 
ejected; some vomiting supervened, but not very 
abundant. When examined the predominating symptom 
was considerable tympanitis; the thermometer marked 
96 degs., and the pulse was 100. After seeking in vain 
for the cause of the ocolusion the speaker performed 
laparotomy. As soon as he opened the abdomen he fell 
on a loop of the large intestine greatly distended, and 
which he recognised as the Bigmoid flexure. In pushing 


further his exploration he discovered that the strangu¬ 
lated loop was retained by a thin ring which tightened 
it at its base on a level with the sacro-vertebral angle. 
He found himself in presence of a volvulus twisted from 
left to right. The obstacle was removed without 
difficulty, and the patient left the hospital cured, a 
month afterwards. 

Treatment of Epithelioma. 

MM. Cemy and Trunecek have published at great 
length in the Stmaxtu MSdicale their treatment of 
epithelioma by daily applications of a solution of arsenic 
composed as follows :— 

Arsenious acid, xx grs. -, 

Proof spirit") 

Water $&**■ 

The result of these applications was a successive trans¬ 
formation of the cancerous tissue in sloughs which be¬ 
came detached, and finally left an ordinary granulating 
sore, which healed under the influence of antiseptic 
treatment. No prejudice was caused to patients by the 
application of the arsenic when care was taken to avoid 
touching the healthy skin. The pain caused by the 
action of the caustic was never so great as to oblige the 
patient to abandon the treatment. The curability of 
cancer by this method depended, however, on the degree 
of evolution of the neoplasm and on the seat of the lesion. 
As regards the first condition, it was necessary that the 
ganglions should not be indurated, and as to the second, 
the application of the toxic should be realisable Such 
were cases of primary cancer of the teguments, the nose, 
the lips, the mouth, and certain limited lesions of the 
larynx. As to the duration of the treatment, it was 
impossible to fix any period with precision | Yery small 
ulcerations only required three or four weeks to heal, 
while in other cases several months were necessary. 
However, it was sufficient to see the patient once or 
twice a week as he could apply the caustic himself. As 
to the action of the arsenical solution, the cancerous oells 
were first dehydrated by the alcohol, then their proto¬ 
plasm became coagulated under the influence of the 
arsenic, degenereecence of the cells of the conneoctive 
tissue followed, provoking a serious exudation which 
determined in its turn certain alterations in the modi¬ 
fied cancerous cells; finally, a distinct inflammatory 
line of demarcation was produced between the diseased 
and the healthy parts, after which the neoplasm became 
eliminated as a foreign body. 


Germany. 

[from our own correspondent.] 

Berlin, March 24th, 1899. 

Cajsarean Section. 

In the Therapeut. Monattch., 11/98, Dr. Everke, 
Bochum, has an article on the subject. The author’s 
opportunities for observation comprise thirty-five cases, 
two of which operations were in mortva. Twenty-five of 
the cases were examples of the conservative operation’ 
six were Porro’s operation with intraperitoneal treatment 
of the pedicle, two total extirpations. As regards results 
to the mother, some of the cases have to be excluded 
before a calculation could be made. There were two 
operations after the death of .the mother, two deaths 
from eclampsia one from pre-existing exudative pleuritis, 
and one case in which the operation was performed to 


Digitized by v^ooQle 


326 The Medical Press. 


GERMANY. 


Mae. £9, 1899, 


save the child in a woman suffering from septic peri¬ 
tonitis. Of the remaining twenty-eight cases, four died 
of sepsis, one from haemorrhage, The remaining twenty- 
three cases did well daring childbed, only a few having 
slight febrile symptoms. Nearly all the mothers were 
able to suckle the child. Oat of the whole thirty-five 
cases, thirty living children were bora. 

As regards technique, the author thinks that on the 
basis of his own extended experience, he can recommend 
the following mode of procedure. It is best to wait until 
regular pains have set in. In place of elastic ligature 
it is better for two assistants to compress the broad 
ligaments manually. Anterior or posterior longitudinal 
opening into the uterus is preferable to the transverse 
one, as the latter entails imperfect nourishment of the 
wounded part and poor healing. The most important 
step in the operation is the oareful suturing of the 
uterine wound. In the conservative operation the author 
always avoids the decidua with the deep sutures, and 
puts in superficial sutures of silk. In order to avoid 
gaping of the wound at the decidual part, and danger of 
infection from the uterine cavity, and also the occur¬ 
rence of gangrene, too many and too deep sutures should 
not be applied from the peritoneal side, but in order to 
ensure a deep firm cicatrix he ties three to six threads 
from the cavity of the uterus. These sutures take in the 
decidua or at most the inner layer of muscle, and are 
easily placed in position. 

He is now inclined to demand that no perforation of 
a living foetal head should ever be performed, at least 
not in a properly appointed hospital, as by means of 
timely Caesarian section there is almost an equal 
certainty of saving both lives, as even in early operation 
in excessive contraction of the pelvis, the prognosis for the 
mother is equally good, in a good hospital, whether 
the labour is terminated by perforation or Caesarian sec¬ 
tion. The prognosis becomes more unfavourable with 
the length of labour. Bruising and necrosis of the soft 
parts, soiling by examinations predispose to infection, 
and if a case does badly after these, the method of opera¬ 
tion is not at fault, but the blame should rest on what 
has preceded it. 

Neuritis Gravidarum and Neuritis Purrperalib. 

A paper on this subject in Graefe’s Sammlung, by Carl 
Marhold, brings some scattered fragmentary views into 
something like order. In neuritis the author includes 
those affections of nerves that have come on in connec¬ 
tion with a normal or pathological gravidity, or in con¬ 
nection with a confinement, in a woman otherwise 
healthy. 

The neuritis of gravidity is, according to the author, a 
rare condition. If it occurs during a normal pregnancy, 
it can only be explained on the assumption of the pro* 
duction of toxins setting up degenerative processes in 
the nervous system. The comparatively frequent com¬ 
bination of hyperemesis and neuritis in pregnancy is 
in favour of this view. The neuritides of the lower 
extremity, especially sciatica are possibly caused by 
compression of the pelvic nerves, but with a normal con¬ 
figuration of the pelvis the author thinks this explana¬ 
tion an improbable one 

The distinguishing mark of neuritis of pregnancy is 
that there is no special preference for any particular 
nerve region, and the form is generally the purely 
motor one, The disease usually commences in the early 


months of pregnancy, and disappears at delivery or 
shortly after. He characterises the paresthesia that 
affect the fingers, hands, and toes as the mildest form 
of the affection. 

Puerperal neuritis may be a continuation of one 
arising during pregnancy; it may arise through 
puerperal infection, or the labour itself may be the 
(etiological factor. As regards the latter form of origin, 
pressure from the foetal head, by application of foroeps, 
turning, Ac., must be taken into account. The most 
frequent form of paralysis associated with forceps 
delivery is that of the nervus peroneus. All these 
traumatio neuritides are confined to the lower ex¬ 
tremities. Other neuritic diseases may come on during 
puerpery, they may be localised or general; of some of 
these no satisfactory explanation is at present forth¬ 
coming, and to some extent the diagnosis is un¬ 
favourable. 

At the Medical Society Hr. Buske showed a case of 
so-called acne cheloid in a negro. The patient was from 
St. Domingo, and was 34 years old. The disease began 
two years ago without any antecedent syphilis, the 
patient being otherwise in good health. At first very 
small nodules and pustules appeared at the nape of the 
neck and on the head. He sojourned for a year at the 
Cameroons and was there treated by Dr. Plehn, but 
without result. On the patient’s return the tumour 
disintegrated and discharged a sanguineous pus. He 
was then admitted into the Charity where he was 
treated by Professor Schweninger with thyosine-amine 
injections, but also without result. Kaposi had described 
.the first case in 1869 as dermatitis papillaris capillitii, 
the French later called it acne ch61oidienne. Not¬ 
withstanding the tendency in the disease to return 
he had at the expressed wish of the patient operated 
by Thiersch’s method, and was apparently oontented with 
the present condition of affairs, although there was 
already some recurrence. 

He then showed a patient from whom he had removed 
a lead pencil from the bladder by cystotomy. 

Hr. Czempin showed two 

Abdominal Tumours 

removed by him by operation—(a) A smaller one re¬ 
moved from a female, set. 66, who was supposed to be 
suffering from some disease of the stomach, but in whom 
no organic disease oould be discovered. A dermoid was 
suspected, but the tumour proved, to his surprise, to be 
a sarcoma of the mesentery. 

(6) A large myofibroma of the cervix uteri, weighing 
27 lbs., and from which the patient had suffered from 
her 22nd year to her 60th. The patient had persistently 
declined operation until the tumour had increased enor¬ 
mously in size, and her girth had increased so much by 
this and by a large amount of ascites that she could no 
longer walk. The operation passed off successfully, ex¬ 
cept that in separating the last adhesion a small piece of 
the bladder slipped into the way of the knife. The mis¬ 
hap was discovered at once, and the edges of the cut 
were brought carefully and accurately together. After 
passing through many dangers the patient had recovered. 
There was first atony of the intestines. The stomach, 
as soon as it became filled with food, sank deeply into 
the abdominal cavity, then decubitus occurred; but the 
patient, as already intimated, finally pulled through. 


Digitized by CjjOO^Ic^ 




Mab. 29, 1899. 


THE OPERATING THEATRES. 


Thb Medical Press. 327 


JluBtria, 


[FROM OUR OWN CORRESPONDENT.] 

Vienna. March 24th, 1899. 

Obesity. 

At the “ Doctoren Collegium ” Kolisch. read an ex¬ 
haustive paper on pimelosis or lipomatosis circumversalis 
He first divided the disease into two large groups—l8t, 
overfeeding without exercise ; 2nd, imperfect metamor¬ 
phosis. In the first the fat represented a surplus accu¬ 
mulation of calorific force; in the second a diminution of 
-calorific force, but in both the adipose surplus was the 
common result. 

The pathogenesis of this condition, he said, had not 
yet been clearly explained'to the satisfaction of scientists 
as the chemical and physiological estimates of food stuffs 
was not a practical basis upon which to found a principle 
owing to the diversity of results which have already 
been obtained, and which Professor Eassowitz has shown 
to be quite untrustworthy. 

For the temporary form of obesity the calorifio tests 
may be useful, and an average man of 65 or 70 kilos. (143 
to 154 lbs.) in weight, and 170 cm. (6 5774 ft.) in length, 
taken as % standard. Having diagnosed such cases, the 
treatment may be safely presented in two meals a day. 
The so-called “ Banting,” “ Epstein,” and Oertel systems 
are simply underfeeding, which may be conducted too 
suddenly and do harm, but, if moderate, is effectual in 
healthy cases. 

The obesity depending on a congenital metamorphio 
anomaly is the disease which ought still to receive our 
most serious attention. Fat will be taken on with the 
very minimum of calorific nutrition without any explana¬ 
tion whatever. Carbohydrates were long accused of pro¬ 
ducing this troublesome affection, and later the oxyda- 
tion of the food stuffs, but the more recent cause is pro¬ 
nounced by Hirschfeld to be an existing anomaly in the 
metabolism of nutrition, from which the accumulation of 
fat can also be estimated by the calorific test. This 
anomaly in the production of fat is, like many other 
human infirmities, hereditary in its occurrence, belong¬ 
ing to particular races and families. It not infrequently 
occurs in childhood, which cannot always be explained, 
as some authors would have us believe that the quiescent 
state of the muscular and nervous systems was the real 
source of the fat accumulation. No doubt climate and 
extensive haemorrhage are factors that provoke obesity 
in the absence of any ancestral disposition; but, with 
these exceptions, the disease may be acoepted as heredi¬ 
tary. The same analogy seems to exist with respect to 
age in obesity as in diabetes: the younger the patient 
affected the more severe and dangerous to life it becomes, 
•while in advanced life it is usually milder in form. 

To elucidate this mystery physiologists have 
-endeavoured to show that the animal organism has the 
power of maintaining the equilibrium from the nutritive 
mass, that is, if the vital force manufactured by the 
-cellular affinity be not used up it is stored, and there¬ 
after inhibits the production. 

This theory appears somewhat reasonable with respect 
to fat as its presence can hardly be denied in the 
amaciated appearance of the neurasthenic where the 
albumenoids are inhibited, although the patient may be 
a polyphagic and polydipsic. 

Thyroid treatment is not satisfactory, besides the 
-danger that accompanies the use of the drug. 


When the gland does act, nucleo-albumen and casein 
should be liberally provided. The safest method is 
under feeding in some form or other, and the older idea 
of avoiding the carbohydrate group is still to be recog¬ 
nised. Epstein prescribes a diet of fat and albumen. 

A Digital Chancre. 

At the Medical Club, Nobel showed a patient with a 
deep infiltrated ulcer on the face with a maculo-papulose 
syphilide. 

The efflorescence pointed to enlarged vessels, which is 
peculiar to the syphilide of the potatoe. The initial 
sclerosis seems to have been on the terminal phalanx 
of the index finger, which is not uncommon in extra¬ 
genital chancres. The practical point in this case, he 
said, waB the confusion of such cases for paronitis, whose 
treatment was fraught with much danger to the patient. 

Tuberculous Ulceb. 

Nobel exhibited another comparative case with an 
ulcer on the under lip, and vesicles around it. It had 
the appearance of primary syphilis, but the infiltra¬ 
tion of the neighbouring glands was slight. 

A few weeks previously the patient appeared with 
a similar ulcer, which left no doubt of its tuberculous 
origin. He suffered also from an incomplete anal 
fistula, as well as an hereditary blemish. 

Headache and Nasal Diseases. 

Weil opened the discussion on Hajek’s paper, who said 
that neuralgia was often caused in the head by empyema 
of the m a xillar y Bin us. Weil said that fluids from nasal 
douches often passed into the ductus naso-frontalis and 
caused neuralgia. Cocainising locally was the best 
treatment. 

Elschnig thought that many cases of orbital neuralgia 
were not empyemic in origin. 

Teleky agreed with the latter and could not under¬ 
stand how empyema of one side could be reconciled with 
bilateral neuralgia. 

Konigstein thought that the nasal disease might be 
transferred to some other part of the head, but could not 
agree with empyema alone producing it. 


^he Operating theatres. 

KING’S COLLEGE HOSPITAL. 

Operation in a case of Arachnoid and Supposed 
Pontine Hemorrhage.— Mr. Peyton Beale operated 
on a woman, ®t. about 46, who had been admitted four 
hours previously with a small scalp wound over the 
occiput, and who was in a comatose condition. The 
patient was attendant in one of the underground female 
lavatories; she had been found lying on her back on the 
tiled floor, bleeding from a small scalp wound, and only 
partially sensible. On admission she was much collapsed, 
in a state of concussion, but both pupils were contracted 
to pin's points. It was thought that she might have 
taken a large dose of an opium preparation, so the stomach 
was washed out, but no indication of the drug was found. 
She rapidly became more and more comatose, with 
complete paraplegia and anaesthesia; symptoms of 
cerebral compression then supervened, and it was 
decided to trephine. At this stage the possi¬ 
bility of a lesion of the pons, probably a 
haemorrhage, was fully discussed, and was con¬ 
sidered probable on account of the condition of 
the pupils. The scalp having been shaved and cleansed 


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328 The Medical Press. 

Mr. Beale enlarged the scalp wound in a triradiate 
manner, and applied a one-inch trephine just to the left 
of and above the external occipital protuberance. The 
< ^ ura * ma ^ er was opened, and about two ounces of liquid 
blood immediately escaped. Hitherto no anaesthetic 
had been used, but as the patient now began to move 
somewhat a little chloroform was administered. The 
wound was stuffed with a piece of gauze, which was pushed 
for about two inches in an upward direction into the 
arachnoid space, and, as no bleeding vessel could be seen, 
and as very little blood came from the wound, the scalp 
was sutured, and the wound dressed. Mr. Beale 
remarked that in all probability there had been a fairly 
extensive haemorrhage from the pia-mater over the 
Bolandic area, seeing that the immediate relief of the 
tension caused by the effused blood was followed by some 
voluntary movement; he thought that, at the same 
time, there was also an intra-pontine hemorrhage. 
As no fracture of the skull could be found at the seat of 
operation, and as there were no symptoms of any frac¬ 
ture by coutre-coup, which if present would have been 
probably in the anterior fossa of the skull, and which 
would have produced local symptoms, he did not con¬ 
sider it advisable, considering the amount of shock that 
was present:, to undertake any further operative pro. 
cedures at that time. 

The subsequent history of this patient is worth 
noting. On the next day the symptoms of compression 
had disappeared. The patient then appeared to be in a 
marked state of of cerebral irritation, lying in a “ curled, 
up ” position, being very irritable when spoken to, and 
exhibiting complete paralysis of the left side of the 
body, and distinct weakness of the whole of the right 
side. The temperature was beginning to rise, but the 
pupils remained fully contracted. In this condition 
the woman remained for about three weeks, taking 
liquid food, but with difficulty, and the tem¬ 
perature rapidly became normal and fell to sub¬ 
normal. The knee-jerks which were absent immedi¬ 
ately after the operation became exaggerated. The 
patient now began to improve) and her wandering speech 
became more and more intelligible; she complained of 
great pain in the left arm and leg, movement in both of 
which she began to regain. The stuffing from the wound 
was removed on the third day after the operation, and the 
wound healed uninterruptedly. It was not until four 
weeks after the operation that the patient was able to 
give an intelligible account of the manner in which she 
reoeived her injury. She then stated that while stand¬ 
ing on a ledge cleaning a window in the lavatory she fell 
suddenly to the ground; she supposed she must have 
slipped. 

The following is Mr. Beale’s interpretation of the 
case.-—He considered it probable that the patient 
had an intra-pontine apoplexy, probably on the right side 
of the pons, which partially accounted for the hempiegia 
on the opposite side, and fully accounted for the per - 
sistent pin’s point pupils through pressure on the nuclei 
of both third nervee. The rapidly advancing coma and 
symptoms of compression which were evident immedi¬ 
ately prior to the operation were, without doubt, due to 
the extensive haemorrhage from the pia raater. 

It is satisfactory to note that the patient, some two 
months after operation, has completely recovered, with 
the exception of complaining of pain and tingling in the 
left forearm and hand. 


Mab. 29, 1899. 

Registered fob Transmission Abroad. 


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^he Jttetacal Jrcsa ant) Circular. 


“ 8ALU8 POPULI SDPREMA LEX.” 


WEDNESDAY, MARCH 29, 1899. 


THE LIMITS OF EXPERIMENTAL 
MEDICINE. 

Medicine is essentially a science of observation 
and, to some extent, of experiment, but it is obvious 
that the limits within which experiments on the 
human subject are permissible are, and must be, very 
strict. To the enthusiastic investigator the tempta¬ 
tion to make use of the opportunities at his disposal 
to elucidate certain moot points in medical science 
may be great, but his disinterestedness cannot be 
admitted to constitute a justification for experiments 
on human beings of a kind likely to prove injurious 
to the subject, even with the consent of the latter, and 
a fortiori without his consent. Our readers may 
remember the sensation created some years ago by 
the publication in France of certain observations by 
an investigator, who prudently preserved his 
anonymity, bearing on experiments carried out by 
him, having for object to demonstrate the trails- 
missibility of cancer. His observations met with 
unanimous and unequivocal condemnation, for it was 
felt that not even the advance of science could 
justify recourse to experiments which constituted a 
gross abuse of professional confidence and a not 
less gross violation of common humanity. The 
thesis has just been dramatised in Paris in a piece 
which is likely to excite a movement of public opinion 
very detrimental to the best interests of medical 
science. The physician of the piece is represented as 
having attempted the transplantation of cancer od 
the person of a young woman in the last stage of 
phthisis, having quieted his conscience by the reflec¬ 
tion that his patient would succumb to her lung disease 
before the cancerous graft could be productive of any 
serious results. His experiment proved successful. 


LEADING ARTICLES. 


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Mah. 29, 1899 


LEADING ARTICLES. 


ThiMbdical Pbess. 329 


but pari passu with the development of the artificially 
communicated cancer, the cheat symptoms diminished, 
and the clou of the piece is the moral plight of the 
doctor when he discovers that he has been the 
means of conveying cancer to a young and other¬ 
wise interesting woman, whose recovery, but for 
the experiment, was assured. Of course, this 
is all pure speculation, and as a dramatic con¬ 
ception it strikes one as rather feeble. By a 
curious coincidence, however, the very day this piece 
was being played at the Paris theatre, a member of 
the German Parliament called attention to the fact 
that a certain professor had actually published 
observations from which it appeared that he 
had injected eight healthy persons with the 
serum of syphilitio subjects, with the result of 
communicating syphilis to four of them. The 
Minister admitted the gravity of the charge, and 
promised an inquiry, adding that if the facts were as 
stated no consideration of persons would be allowed to 
stand in the way of justice being done and of steps 
being taken to exonerate German science from such 
a reproach, with the object of effectually prerent¬ 
ing the repetition of any similar scandals. We 
gather from an interesting article on the subject, 
which appeared in a recent number of La Semaine 
Medicale, that the incriminated professor is Dr 
Neisser, and that the observations referred to are 
comprised in Vol. XLIY. of the Archiv fur Derma- 
iologie und Syphilis. Before undertaking these 
experiments, in the course of an inquiry into the pos¬ 
sibility of immunising against syphilis, Neisser asked 
himself the question whether the serum of syphilitic 
subjects was capable of communicating the disease to 
healthy persons. Proceeding on the assumption that 
serum deprived of cellular elements is, in most in¬ 
fectious diseases, devoid of infective properties, he 
made use of serum obtained from syphilitic subjects, 
which he had proved to be sterile by preserving it for 
days, and even weeks. With this serum he injected 
eight girls, five by subcutaneous and three by intra¬ 
venous injection. A girl belonging to the first series, 
who had not meanwhile developed any symptom of 
the disease, came to the hospital three years later 
suffering from cerebral syphilis. All three girls 
belonging to the second group developed syphilis, 
one a month, another between five and six months, 
and the third a year after the inoculation. Of these 
eight girls, five were prostitutes and of these five four 
developed syphilis. Dr. Neisser denies that the 
syphilitic infection was in any way the result of the 
injections, basing his denial on the ground that as the 
girls were prostitutes they might have contracted the 
disease before or after the inoculations. That objec¬ 
tion, however, can hardly apply to the case in which the 
classical symptoms developed within a month, unless 
indeed he was the victim of an unfortunate coincid¬ 
ence. Looking at the facts, as stated, it is difficult to 
acquit Dr. NeisBerof a large measure of responsibility 
in respect of the causation of Byphilis in these cases. 
We, however, are less concerned in establishing the 
culpability of Dr. Neisser than in condemning the 


spirit which prompted such experiments. All 
measures, even if novel, which may reasonably be 
expected to assist in bringing about the recovery of 
the patient without injury to his health, may legiti¬ 
mately be resorted to with the consent of the patient, 
but measures, whether by drugs or by operation, 
which have not for direct object the cure of the patient 
and which may prove inimical to his health or condi¬ 
tion, are inadmissible under any circumstances, and 
must expose the perpetrator to professional ostracism 
and to penal rebuk$. 


PRESERVATIVES IN MILK. 

It is high time that the question of the legality 
of the addition of preservatives to milk should be 
placed on a sound basis, and not left to the whim or 
caprice of the presiding magistrate, who may or may 
not be in a position to appreciate the importance 
of the subject. We are first called upon to decide 
whether, as a general principle, the addition of pre¬ 
servatives to milk is admissible, apart from the eligi¬ 
bility of any particular antiseptic. There are many 
and obvious objections to the use of antiseptics in 
an article so largely consumed as milk, especially 
when we reflect that a very large proportion of the 
milk sold is destined for the alimentation of the 
very young, whose delicate digestive apparatus is 
exceedingly apt to resent every departure from the 
normal standard. Antiseptics owe their value in this 
direction to the inhibitive effect which they exert on 
the changes of decomposition; but in virtue of this 
very property they must, pro tanto, retard the changes 
which the milk has to undergo in the human stomach 
before it can be assimilated. The obstacle may con¬ 
ceivably not be one of any great importance in adults, 
whose digestion is normally well able to take care of 
itself; but it is quite otherwise with infants of 
tender years, who already have all the trouble 
in the world to make use of this substi¬ 
tute for the maternal supply. Then, too, the 
preservatives usually employed are not added 
in sufficient quantity to exert any destructive effect 
on the organisms which may find their way into the 
milk, while, on the other hand, they enable those who 
handle milk to relax to some extent the precaution of 
extreme cleanliness, which would otherwise be the 
sole available means of protecting milk against prompt 
decomposition. This is a question which must not 
be lightly decided, because in hot weather the pro¬ 
hibition of preservatives must mean the inevitable 
loss of immense quantities of the valuable fluid, whioh 
would otherwise be utilised as food. This question, 
simple as it may seem, is surrounded by diffi¬ 
culties as soon as one sets to work to apply 
the test of experience. It is so difficult to elimi¬ 
nate the action of other possible causes of gastro¬ 
intestinal irritation in infants and so difficult 
to show that it is this particular constituent of the 
milk as sold which is at fault. On the whole, and 
looking at the matter as one of principle, we are 
rather disposed to question the wisdom of forbidding 


joogle 


Digitized by 


330 The Medical Press. LEADING ARTICLES. Mar. 29, 1899. 

EARLY TREATMENT OP INSANITY. 


the use of milk preservatives under all and every cir¬ 
cumstances. We then come to the particular pre¬ 
servative employed, and here we are, perhaps, on 
surer ground. A few years since salicylic acid was 
largely used for the purpose, and it cannot be denied 
that the anti-putrefactive properties of this drug are 
very great, but so is its physiological acti on, and little 
hesitation was shown in condemning its use on this 
account. To obviate the objections to salicylic acid the 
trade now make use of boraoicacid instead. Analytical 
chemists in support of trade interests do not scruple 
to assert that this substance is quite harmless but 
we formally deny their competence in the matter. 
What can a chemist know of the toxicity of this 
substance indeed P But what, on the other hand, can 
Dr. Corfield and other experts know to the contrary P 
They cannot have made any direct observations, or if 
so, they have not been made public, and in a case just 
now under consideration a witness who boldly stated 
that boracic acid was injurious to human beings was 
fain to admit on cross-examination that he had 
never tried its effects on any person, infant or 
adult. The same destructive criticism assails 
the evidence of the Corfields and Cassals who 
affirm the injurious effects of boracic acid, and that of 
the Smiths and Gibbons who affirm its innocuousness. 
They are all expressing opinions not based on actual 
observation. It is generally assumed that the quan¬ 
tities employed are so small that an injurious effect 
is out of the question. Apart, however, from the 
fact that there is, not improbably, a cumulative 
action when these drugs are introduced into the body 
over long periods of time, the actual quantities are 
really not as small as we are asked to believe. In a 
reoent case the preservative contained six pounds of 
carbonate of soda, six pounds of borax, and twelve 
pounds of sugar in from eighteen to twenty gallons 
of water, and a pint of this precious blend was added 
to each churn of milk with liberty to the retail 
dealer to add what he might consider a suitable dose 
on his own account, for, be it remembered, the use of 
these preservatives by the wholesale man or farmer is 
not necessarily or even generally made known to the 
retailers, who take their own measures to prevent the 
milk from going wrong. These manipulations, more¬ 
over, are carried out by men who have no practical or 
scientific knowledge of the nature or physiological 
aotion of the substances employed by them, theironly 
object being to preserve the milk at all cost. While 
therefore we hesitate to condemn the use of preserva¬ 
tives as a matter of principle, we have little hesita¬ 
tion in condemning the practice, simply because it 
must be next to impossible to assign and enforce the 
limits within which their use is innocuous, and there¬ 
fore hygienically permissible. We are glad that 
sanitary authorities are waking up to their responsi¬ 
bility in this important matter; but if the judges on 
appeal are unable to affirm their objections, it will be 
necessary to apply to Parliament for further and more 
definite powers in this direction. 

Da. E. W. Sykes has been appointed a Justice of the 
Peace for the borough of Halifax. 


We have referred to this important matter in our 
columns from time to time on the principle that, 
because of our importunity and the importunity of 
others, the legislature may be forced to yield to 
representations on the subject. There are few ques¬ 
tions that have so logical and urgent a raison dctre 
than that of the treatment of insanity, because it 
practically means to some extent the diminution of 
registered lunacy as reported by the Commissioners. 
A Deputation from the British Medical and the 
Medico-Psychological Associations recently waited 
on the Lord Chancellor with a view to bringing 
under his notice the advantages, which would accrue 
by a recognition in the new Lunacy Bill of the 
practice which has obtained in Scotland, of allowing 
the treatment of incipient cases in private houses for 
a period not exceeding six months. As pointed out 
by Dr. Rayner, the advantage of the clause in the 
Scotch Act is that the Commissioners in Lunacy are 
informed of the number of cases treated, the duration 
of treatment and the persons undertaking the treat¬ 
ment. They have powers of supervision when neces¬ 
sary, and there is no excuse left to persons to evade 
the law as has frequently been done in England of 
late. Dr. Rayner, who first addressed the Lord 
Chancellor, remarked that he had been impressed in 
his experience in London at the out-patient depart¬ 
ment of St. Thomas’s Hospital, with the amount of 
recovery possible in the early stages. He thought 
that every improvement that could be made in the 
treatment of these stages ought to be made in the 
hope of checking that large increase of insanity in 
the country, which all deplored. In every case of 
mental disease there is a stage between acute and 
certifiable insanity. This has been shown by many 
recoveries taking place without certification when 
the intermediate stage has been recognised. Dr. 
Blandford rather fell foul of the right bon. gentleman 
by his statement that the Lunacy Act of 1890 
enacted that every person of unsound mind should 
be incarcerated by the order of a magistrate. The 
Lord Chancellor repudiated this view, contending 
that the law was that the person should not be 
incarcerated unless the magistrate should so. order. 
This, however, is rather a reverse side of the shield, 
and the difference in meaning a matter not worth 
quibbling about. What Dr. Blandford and Dr. 
Savage wanted was, to remove the risk of patients 
being sent away or out of sight, in order to avoid certi¬ 
fication and facing a magistrate. This is a danger 
of very serious significance. There is no doubt that 
a strong feeling exists against anything amounting 
to publicity in the treatment of the insane, as well 
as an objection to patients being certified and treated 
as registered lunatics, and for this reason and 
because there is no proper provision for treat¬ 
ment in private houses as uncertified patients, there 
is a disposition to evade the law and, therefore, to 
jeopardise the prospect of recovery in many 
cases. Still further, as pointed out by Dr. Savage, 

I many will not put their relatives in asylums, 


Digitized by GoOgle 



Mak. 29, 1899. 

because once certified and committed, the stigma 
of lunacy is unmistakable, and affects, socially and 
otherwise, the sane as well as insane members of 
the family. Certification has, moreover, a serious 
effect in the following ways. Thus, if a person is cer¬ 
tified as of unsound mind, it may put an end to a 
partnership in some important business, or it may 
lead to the discharge of a patient from an important 
position either in ousiness or in civil or other life. 
This is not necessary, because insanity is quite curable 
in many forms, and to treat a person once insane as 
for ever incapable of transacting business is altogether 
wrong. What the Deputation really desired, and in this 
they represent the profession, is that the law as set, 
should not be altered except to the extent that 
persons who are certifiable, but who are suffering 
from quite temporary maladies, may by the permission 
of the law be allowed to be placed, as in Scotland 
under private or single care and detained as patients 
under these conditions. The limit of time allowed 
by the Scotch Act is six months, but to this the Lord 
Chancellor somewhat demurred, being of opinion that 
the limit should be shorter, subject to sanction being 
renewed if necessary. The Lord Chancellor expressed 
his sympathy with the views of the Deputation, and 
promised to try and give effect to their suggestions. 
If this is done a great hardship will be removed, and 
many cases of incipient insanity will be effectually 
aborted by prompt treatment, before a certifiable 
stage is reached. Anything that can be done to miti¬ 
gate the growth of registered lunacy is worth doing, 
and such a change in the law as is here proposed 
bears the impress of common-sense and urgency on 
the face of it. 


4lote0 on Current topics. 

Condensed “Separated” Milk. 

With such elaborate and drastic legislation for 
the protection of milk consumers as we possess, it 
really appears odd that foreign merchants should 
have been left a free hand in pushing the sale of a 
pseudo-condensed milk, the use of which in the ali¬ 
mentation of infants is attended by the gravest con¬ 
sequences to health and life. The manufacturers of 
genuine condensed milk—that is to say, a product 
containing all the nutritive elements of milk in their 
normal relative proportions, minus the water—are 
interested, equally with the public, in seeking protec¬ 
tion against a fraudulent substitution which cannot 
but bring their own high-class articles into partial 
disrepute. We have long since protested that con¬ 
densed skimmed or separated milk ought not to be 
allowed to be sold as milk at all, for if that name be 
conceded ignorant and careless mothers are certain 
to be tempted by the smaller cost of the inferior pro¬ 
duct to prefer it for the alimentation of their offspring. 
In receiving a Deputation last week on the subject, 
Mr. Long premised that it was asking too much to 
expect the Government to prevent the public pur¬ 
chasing an article which they might choose to 
pin-chase, and which they were entitled to pur- 


Thb Mk&ical Press 331 

chase if they knew what it was. Now this 
condensed skimmed milk is, for certain purr 
poses, a perfectly admissible and nutritious article 
of food, but it is quite unsuitable for the rear" 
ing of infante. To feed a young infant upon 
such milk is to condemn it inexorably to rickets, 
tuberculosis, or other disease of malnutrition. We 
see no objection whatever to a proviso that the label 
shall comprise a statement in bold characters to the 
effect that the product is not intended for the food of 
infants. If, as the manufacturers pretend, they do- 
not intend it for such a purpose, this statement will 
not interfere with the legitimate sale, while a too- 
economical mother who made use thereof, in spite of 
this warning, would lay herself open to the charge of 
wilfully withholding proper nourishment from her 
infant. To oblige the vendors merely to state plainly 
on each box the exact nature of the contents, will, in 
any event, be a step in the right direction; but in 
view of the harassing restrictions placed on the sale 
of such a production as margarine, which, under no- 
circumstances, can prove harmful if properly pre¬ 
pared, it seems absurd to authorise the sale of 
skimmed milk without making perfectly clear that it 
is absolutely unsuitable as an article of diet for young 
infants. 

The Clinical Value of Albumosuria. 

Albumose is a body occasionally met with in the 
urine, the clinical significence whereof has not 
so far been thoroughly worked out; indeed, it 
cannot be said that we are as yet in possession of 
sufficient trustworthy data to enable us to appre¬ 
ciate its full importance as a clinical symptom. 
Its identification in the urine is not always an 
easy matter though. Should it ultimately prove 
the means of affording useful information in 
respect of morbid conditions as yet but faintly 
interviewed, physiological chemists will doubtless 
provide us with a readier means of recognising it 
with certainty. When present in any quantity it is 
sufficient to drop in enough acetic acid to give a strongly 
acid reaction to the urine, and then to add an equal 
quantity of a saturated solution of chloride of sodium. 
In presence of albumose this gives rise to a copious 
precipitate which disappears on heating and reforms 
on cooling. If, as is often the case, the urine also 
contains albumen, the urine may not clear up on boiling 
owing to the formation of an albumen precipitate. The 
si gnific ance of albumoBe as a constituent of urine 
was first pointed out by Bence Jones, who, in 1848, 
called attention to the presence in the urine of a 
peculiar proteid body which was remarkable in that 
it was soluble in boiling water. He had found that 
the precipitate which formed on the addition of 
nitric acid cleared up on boiling. In the case on 
which his observations were based, the patient was 
suffering from a peculiar disease of the bones 
characterised by softening ; in other words, by a form 
of mollitios ossium. After the lapse of half a century 
Dr. Bradshaw has just placed on record elaborate 
and carefully prepared notes of an almost identical 
case, and we are now asked to consider albumose as. 


NOTES ON CURRENT TOPICS. 


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332 The Medical Press. 


NOTES ON CURRENT TOPICS. 


•ttAfi. 29, 1899. 


an abnormal constituent of urine met with chiefly, 
if not exclusively, in association with a diffuse cellular 
infiltration of the bones, possibly of the nature of what 
is sometimes styled diffuse sarcoma. In view of the 
clinical possibilities which this discovery opens up, it 
is important that practitioners should be instructed 
to search for and recognise this obscure substance, the 
presence whereof is easily overlooked, and the patho¬ 
logical interest whereof remains to be established. 

The Special Enlistment Scheme. 

A SPEGiAL-enlisted recruit into the Scots Guards 
fell dead on parade af Windsor last week. This un¬ 
toward occurrence will doubtless have the effect of 
directing particular attention to the scheme origina¬ 
ting with Lord Lansdowne, who is particularly 
desirous of adding new battalions to the Guards and 
certain infantry regiments. During the past year 
these special enlistments increased from 32 per cent, 
to 72 per cent. It will occur to most people, that this 
wholesale enlistment of men physically incapable of 
undergoing fatigue duties, or unfit for the full duties 
of soldiering for the greater part of a year or so after 
enlisting, may become a very costly one in life as well 
as money. It unmistakably points to a more serious 
evil, namely, that a large proportion of the men who 
join the Army must necessarily be incapable to per¬ 
form the full duties of soldiering during many 
months after enlistment should they ever reach, 
as it is expected they will, to the proper 
standard. That they will is not implicitly 
believed by many regimental commanding officers, 
who greatly object to having weakly recruits foisted 
upon them, and therefore it should be clearly 
understood whether these specially enlisted recruits 
are passed by either a duly qualified man or a member 
of the Army Medical Staff. It is of very considerable 
importance the public should know whether this 
unfortunate soldier was, or was not, compelled to do 
duty for which he proved physically unfit, suffering 
from a weak heart. Some twenty years ago com¬ 
plaints were rife as to the way in which recruiting 
was habitually practised, and of the number of youths 
who were beguiled into premature engagement in the 
service without contributing permanently to its 
strength. Medical experience testified how practic¬ 
ally unfitted were young recruits to endure the wear 
and tear of laborious discipline, still less to exposure 
in foreign climates, ere their frames were knit, or 
their bones fully consolidated and united. Medical 
reports at that time frequently came from Netley of 
the deplorable numbers sent back after a brief service 
in the Tropics to be treated and subsequently sent 
back to their homes. Parliamentary inquiry 
ensued, and among the members of the pro¬ 
fession who gave evidence, was one of large 
experience. The late Professor Sir Thomas Longmore 
testified that “No rule whatever can be laid down for 
the height of growing lads between seventeen and 
twenty years of age, because the diversity is so great; 
still more, unfortunately, the powers entrusted to the 
recruiting authorities were so largely used in dis¬ 
pensing with physical qualification, so that the 


medical officer finds himself and his advice constantly 
set aside. In fact, there is still a very excessive waste 
going on in the Army during the early years of the 
soldier’s career, which is in great part due to a want 
of strictness in the first enlistment examination.” 
This it will be seen, strengthens the arguments of 
those who protest against such wholesale special 
enlistments of young men, more recently sanctioned 
by the Horse Guards authorities, a considerable per¬ 
centage of whom never' develop into full-grown 
soldiers. We confess to a desire to know what be¬ 
comes of the men who break down in the process of 
development, or otherwise fail to reach the full 
standard P We are even more curious to know 
whether this special mode of enlistment was before 
adoption duly submitted and sanctioned by a properly 
constituted Army Medical Board P 

Interesting Dublin Dispensary Election. 

A couple of months since Dr. Usher, who had 
occupied the position of Medical Officer of the Dun- 
drum and Glencullen Dispensaries for twenty-one 
years with great credit to himself, presented his 
resignation of that office, and it devolved on the 
Committee of these districts to make a new appoint¬ 
ment. As the suburb is populous and rising, there 
were a host of competitors, but the contest resolved 
itself into one between a Medical Officer who, for 
twenty years, had occupied the neighbouring district 
and another practitioner, who had resided in Dun- 
drum for some years and assisted Dr. Usher in his 
practice. The battle was so even that, in the end, 
success depended upon a single vote. At the first 
attempt at election the chairman sought to carry in 
his candidate by a casting vote, but, this being 
illegal, another meeting had to be called, and at that 
meeting, one of the supporters of the Dundrum can¬ 
didate failed to attend, and, accordingly, the appoint¬ 
ment went to the Medical Officer of the neigh¬ 
bouring district. The next day the cause of 
the absence of this gentleman came to light 
in the shape of a bogus telegram, which 
informed him that his shooting lodge, far away, was 
on fire, and calling for his immediate presence. In 
hot haste he went off, leaving the election behind 
him, but, when he arrived at the shooting-lodge, 
found that the message was a hoax. Immediately on 
his return he lodged a caveat against the election, 
and strict inquiry was instituted, with the aid of 
detectives and all the resources of the law, the result 
being that the Coroner for the Southern division of 
the County Dublin, who happens to be a member of 
the committee, and to be also the chairman who had 
given the invalid casting vote, has been accused of 
sending the bogus telegram, and has been identified 
rightly or wrongly, by the Post Office girls who trans¬ 
mitted it, and a writ in damages for the recovery of 
£500 has been served upon him. Moreover, the 
Local Government Board has held an official inquiry 
upon oath, and the verdiot waits upon the report of 
the Inspector, Dr. Edgar Flinn. Interesting ques¬ 
tions of law arise under these circumstanoes, which 
we may speak of without the least prejudice to any 


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Mak. 29, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Pbess. 333 


of the parties to the controversy. First, sup¬ 
pose that it should be proved that the absence of the 
member of the Committee was obtained by a fraudu¬ 
lent telegram, would that invalidate the election ? We 
think that it would decidedly not do so unless it 
could be shown that the elected officer was privy to 
the fraud. Were it otherwise any enemy of a suc¬ 
cessful candidate might invalidate his election by 
sending a bogus telegram. It is another question 
whether it would make a difference if the sender of 
the bogus missive were a member of the Committee 
and a known supporter of the successful candidate. 
Lastly, supposing it were proved in court that a 
coroner was guilty of this conduct, which, in this 
oase, we do not for a moment believe, would he be 
removed from his coronership ? It is to be recol¬ 
lected that a coroner in Ireland is the elect of the 
Parliamentary constituency, and therefore irremov¬ 
able, except by some very special legal authority as to 
which, we do not at present possess adequate informa¬ 
tion. It is scarcely necessary to add that, so far as 
the evidence discloses, neither Dr. Usher nor either of 
the two contestants had any privity with the sending 
of the inculpated telegram, or were in any way mixed 
up with it. 

School Nominations for the Army Medical 
Service. 

The Director-General has recently re-issued his 
invitation to certain colleges, universities, and 
medical schools to nominate, each, a diplomate for a 
Commission in the Army Medical Corps, subject to 
the approval of the War Secretary. The Irish 
College of Surgeons agreed last week to recommend 
Mr. Davies, one of its Licentiates, who had served 
some time as a civil practitioner in charge of troops 
at the Curragh Camp. There were, we understand, 
ten competitors. A nomination has also been 
offered to the medical school of the Catholic Univer¬ 
sity. We have long sinoe pointed out that there are 
grave objections to this nomination system from the 
collegiate point of view. In the first place, the Army 
Medical Officers may very naturally take umbrage at 
the admission, by a side entrance, to the pale into which 
they have been obliged to win their way by a stiff com¬ 
petitive examination, and they regard the nomination 
system as an official expedient to fill up the hiatus in 
the ranks of the corps which has arisen from the 
refusal of the authorities to do justice to the 
medical staff. The Licentiates and Fellows of 
the colleges, who have been agitating for that 
justice, will not thank the colleges for having 
come to the rescue of the authorities just 
when the victory of the profession is nearly 
won. Then, again, we cannot regard it as a kindness 
towards any young man to assist him in entering 
the Service by the back door. He is, no doubt, grat^. 
ful at the moment, because he is saved all the delay, 
expense, and risk of a competitive examination, but 
we apprehend that he will not appreciate the boon 
when he finds his method of entry thrown in his teeth 
by brother officers who dislike or are jealous of him. 
Say what he may, he cannot get over the fact, and, in 


our opinion, the temporary advantage is dearly bought. 
Lastly, in the interest of the Colleges themselves, we 
submit that the petty patronage of one or two student 
nominations for one or two years is not sufficient com¬ 
pensation for involving themselves in personal con¬ 
troversies. It is notorious that these nominations are 
the subject of contests between rival schools and 
hospitals, and of importunate canvassing by the 
personal friends of the competitors, and we feel 
that no matter how excellent the selection of 
a nominee may be, the College cannot escape 
the sneers and abuse of all those who are unsuc¬ 
cessful. We urge that it is altogether beneath 
the dignity of public institutions of high standing to 
associate themselves, in any way, with such proceed¬ 
ings, especially as, in so doing, they must accept the 
responsibility of acting as sponsors for their nominee, 
and for his professional competency, industry, and 
personal conduct ever afterwards. We are clearly of 
opinion that, all things considered, the game is not 
worth the candle. 

A Royal Academy of Medicine of the 
United Kingdom. 

This country is singularly deficient in having no 
representative medical body comparable to that 
which obtains among our Continental neighbours. 
To mention only three examples, an Academy of 
Medicine exists in Paris, Berlin, and Brussels, and 
each the centre of much useful activity in furthering 
the advance of medical science. The proposal to 
found an Academy in London by the amalgamation 
of the existing medical societies, as has several times 
been urged, would not be the same thing. No doubt 
such a scheme would be useful in centralising and 
disseminating the work of those who are the main¬ 
stay of the societies. ( But, on the other hand, 
no special distinction would be conferred upon the 
worker by submitting his contribution to such a 
tribunal. Under the present circumstance if any 
medical investigator alights upon some new dis¬ 
covery in the science of his profession, only 
one portal is open to him of gaining for 
it the distinction which it probably deserves, and 
that is by bringing it before the Royal Society by 
deputy should he happen not to be a Fellow of that 
august body. The obvious disadvantage of this posi¬ 
tion of affairs is that the Royal Society is accorded the 
credit of being the medium through which the dis¬ 
covery is made known to the world. Thus toa large ex¬ 
tent the medical profession is deprived of that honour. 
Whereas matters in this respect would be very dif¬ 
ferent were a “ Royal Academy of Medicine ” to stamp 
with its imprimatur an important and valuable com¬ 
munication upon a subject to which the attention of the 
whole world could be directed with an authorita¬ 
tive approval. The point which we desire to empha¬ 
sise here may seem to be a small one, nevertheless 
reflection must show that medicine stands alone in 
comparison with other sciences, and there is, therefore, 
much reason in claiming that it should have a high 
scientific tribunal of its own, apart from that, like 
the Royal Society, which is common to all the 


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NOTES ON CURRENT TOPICS. 


334 Tire Medical Pbess. 


sciences. But in another direction a Royal Academy 
of Medicine might prove of much value. It 
might be made the means of stimulating young 
scientists to undertake original work by the offer of 
prizes, and to gain a Royal Academy prize would be 
a distinction for which presumably many young 
workers would strive their best. In brief, if a Royal 
Academy of Medicine were to be founded it would 
distinctly fill a gap in our academic system, so far as 
the medical profession in this country is concerned, 
and it is impossible to dispute the benefits which it 
would confer. 

The Antiquity of Electrotherapy. 

It is curious that foul monster in bloodthirstiness 
and cruelty as Marat was, and thoroughly deserving, 
as he was of the death that Charlotte Corday dealt 
out to him, he yet should have found time in the course 
of his evil political life to work at such sciences as 
electricity and light. In his youth he studied medicine 
for some time, but practiced afterwards as a quack, 
and in this connection a somewhat curious letter 
written by him on September 26th, 1783, has just 
been found and made public. The letter is to the 
effect that he successfully cured two patients by means 
of electricity. The nature of the first case is not men¬ 
tioned, but the Becond was that of a prominent person 
who, by the use of electricity recovered his vision, 
after the sight has been lost for thirty years. The 
letter then proceeds, “ But it is in Spain that I am 
specially desirous of proving the value of this new 
remedy; for when employed by a medical man, it is 
simply admirable.'' It is, at this date, rather difficult 
to comprehend why Marat had set his heart upon 
using his remedy in Spain, but it is quite easy to 
understand why he should especially imply that the 
treatment was only to be trusted when administered 
by medical men. No doubt his object was to prevent 
quacks from making use of it. Upon the whole, how¬ 
ever, we are disposed to doubt the veracity of his | 
statement that a patient had the vision restored by 
electricity after having lost the sight for thirty years. I 
Nevertheless the fact is unquestionably interesting I 
that Marat employed electricity as a therapeutic 
agent as long ago as 1783. 

A Scientific Literary Poisoner. 

The well-known winter of fiction, Mr. Morley 
Roberts, achieves an enormous yearly output for the 
benefit of the publishers and of the world at large— 
the latter, of course, including himself. His inge¬ 
nuity of plot is boundless, and one of his latest 
efforts has been to conceive the idea of two clerks 
who tried independently to poison their chief, but 
who used substances that were antidotes the one to 
the other, so that virtue issued triumphant, and the 
ungodly fell straightway into the pit. From a note 
n Literature we find that a similar device was 
adopted by Dryden in the plot of “ San Sebastian.” 
In commenting upon this most ingenious fictional 
peg one is naturally averse from pouring cold water 
upon the subtle, yet harmless, imaginings of the fer¬ 
tile novelist. We will be content, therefore, to point 


Mar. 29, 1899. 

out that the author would do well, in the interests of 
realism, to arrange matters so that the intended 
victim should take both bane and antidote within a 
sufficiently short period of each other to allow of the 
prosaic chemical processes needful to neutralisation 
to take place in the stomach before that organ has 
absorbed the toxic stuff. Shades of Lucretia Borgia! 
But enough has been said of this tempting subject. 
By the way, Ausonius—no one lass—is said to have- 
hit upon a similar literary device. 

“ Caasaripe ” in the Treatment of Corneal 
Ulcere. 

A new remedy in the treatment of corneal ulcers 
is at present attracting some attention in America. 
It is known as “ cassaripe,” and is obtained from the- 
bitter cassava plant. According to Dr. Chandler, the 
followingis the mode of its preparation:—“ The natives 
in making Cassava bread grate the root, whereby a 
milky juice exudes. This juice is acid, and is 
supposed to be very poisonous ; heat, however, destroys 
its poisonous qualities, and in a concentrated 
semi-solid form the juice is known as “ Cassaripe ” 
Dr. Chandler adds that in certain parts of the Tropics 
the drug is used as a preservative agent for meat, and 
it was this fact which suggested its employment in 
corneal ulcere. In large sloughing ulcere in old per¬ 
sons cassaripe is said to have yielded excellent 
results. It may be used, in combination with atro¬ 
pine and eserine. Judging, however, from the refer¬ 
ence to the drug in the American Practitioner and 
News (Februaiy 1st, 1899), some difficulty has been 
experienced in obtaining it by those so far desirous 
of putting its qualities to the test. Apparently its 
value seems to lie in the fact that it is an antiseptic,, 
and if so, the reasonable conclusion is that any anti¬ 
septic used in the treatment ot a sloughing ulcer of 
the cornea would be likely to be similarly beneficial. 


A Proposed Centenary Celebration of the 
Royal College of Surgeons, England. 

A matter of some interest was discussed at the 
last ordinary meeting of the Council of the College 
of Surgeons, England, with reference to the advisa¬ 
bility of celebrating the hundredth year of the incor¬ 
poration of the College. The centenary event occurs 
next year, the date of the first charter being 1800, and 
it has suggested itself to Mr. Bryant and others that 
steps should be taken to signalise the occasion by 
means of some celebration. A committee of the 
Council has been appointed to take the matter into 
consideration, and report thereon at a subsequent 
meeting of the Council. We cannot doubt that a 
function of the kind could be made very attractive, 
and would meet with the general approval of the 
Fellows and members of the College. 

The Public Health Committee of the Hackney 
Vestry have issued a circular calling the attention of 
the public to the contagious nature of consumption 
and offering to disinfect all rooms, free of cost, after 
the death or removal of phthisical patients. 


Digitized by LjOOQLC 


Mab 29, 1899. KOTES ON CURRENT TOPICS. The Medical Pebss. 335 


The Perils of Judicial Garrulity. 

It is always to be regretted when a Judge on the 
Bench allows his personal views to induce him to 
diverge into unnecessary, and often inconvenient 
loquacity. He may have much to say which would 
be appropriate at a dinner table, and it may be 
excellent sense derive from special knowledge of cir¬ 
cumstances. But the Bench is not, in the opinion of 
the public, an elevation from which to crack jokes or 
interchange chaff with lawyers, or to sermonise. 
From it the public expects to hear exposition of the 
law and of the evidence, and not moral disquisitions, 
however great the temptation may be to give voice 
thereto. Judges advancing in life are particularly 
prone to this sort of thing, and we could name 
several who never can refrain from little humourous 
or didactic diversions. Mr. Justice Boyd, in the 
Dublin High Court, last week, favoured us with one 
of these totally unnecessary digressions in deciding 
a paltry motion to remit an action for damages to a 
lower court. Affidavits were presented for and 
against the application by Sir William Stokes and 
Mr. H. G. Croly, and the learned Judge is reported 
to have said that:— 

As a rule he did not place much reliance in doctors’ 
certificates or statements. The only statements 
which could be accepted were those of barristers, 
because they were bound by authorities, but doctors 
were not bound by any authorities. All these gen¬ 
tlemen could state what they liked, but unless they 
were pulled up by some acute person on the other 
side they would have it all their own way. However, 
Surgeon Croly had given evidence of serious in¬ 
juries in the case, and, as it was not his Lordship’s 
duty to determine the truth or otherwise of the 
affidavit, he should refuse the motion. 

If, as his Lordship sajs, it is not his duty to 
determine the truth or otherwise of an affidavit from 
a medical witness, it, certainly, is not his duty to 
insult the witness by proclaiming doubts of his 
veracity; still less has he any right to asperse the 
whole medical profession as, in a general way, a 
pack of liars. If it were left to public opinion to 
arbitrate as to the relative reliability of the state¬ 
ments of the medical profession and of Judge Boyd's 
own profession there can be no reasonable doubt 
which way the verdict would go. We hope we may 
regard this pronouncement of the learned judge as 
the result of a temporary aberration, and that he 
now regrets what he is reported to have said. 


Poisoning Mystery at Leaveaden Asylum. 

A coroner's inquiry was held on March 18th, 
regarding the death on March 14tb, of Caroline 
Ansell, set. 26, an epileptio inmate of the institution. 
The circumstances attending the death of this girl 
are somewhat peculiar for an asylum, and have given 
rise to many surmises and sensational reports. 
According to newspaper report, the deceased re¬ 
ceived on the 9th through the post a parcel contain¬ 
ing a cake. She partook of this, giving some to four 
other women, and soon after they all complained of 
pains, and vomited. Ansell died on the 14th. Some 
time before this she received a letter purporting to 


have been written by a cousin, informing her that 
her mother was dead, but this news was false- 
These are the facts; the rest is conjecture. Was 
the poison intended indirectly for one of the nurses, 
on the supposition that the patient would be sure to 
offer her nurse a slice of the cake ? Was the crime 
the act of a discharged patient P Who wrote the 
letter? Should the letter in the possession of the 
police not be photographed and published in the 
hope of establishing a clue ? Was it really a case of 
irritant poisoning as alleged, or was death due to 
natural causes ? Did the patient Ansell herself con¬ 
vey the poison P One paper remarks that “ the idea 
of the woman having poisoned the cake is not so far 
fetched as might at first sight appear. Carbolic and 
oxalic acids are both used in the asylum.” These are 
examples of questions and surmises running through 
the public prints. We are surprised to read that 
oxalic acid is in use in the asylum, and would like to 
know if it is true, and if so, if such a deadly poison, 
which can so easily be mistaken for other salts, is in¬ 
dispensable in the institution P Meanwhile, further 
comment may prudently be held over. 

The Chloroform Burglar Bogey. 

An enterprising evening contemporary—to wit, the 
Star —has taken the trouble to interview Dr. 
Meadows, of chloroform burglar fame, in reference to 
the remarks we made last week on the absurdity of 
the tale as related in the columns of the Star. Dr, 
Meadows iB reported to have declared his readiness 
to chloroform the winter by means of a saturated 
pocket-handkerchief pushed under the door, adding 
that he had done it himself with cats and dogs— 
surely a rather suspicious admission for one who lies 
under the imputation of having set afloat a story at 
which everyone who has any experience of chloroform 
must laugh. How much chloroform would be re¬ 
quired to saturate a handkerchief ? Barely enough 
to induce unconsciousness in the hands of a skilled 
anresthetist at close quarters. Yet we are asked to 
believe that this quantity sufficed to induce deep 
sleep in a room through which a tolerably free pas¬ 
sage of air was presumably taking place, apart from 
the fact that chloroform vapour, being very heavy, 
would tend to creep along the floor and to disappear 
up the chimney. The whole story is too preposterous 
for serious discussion, and is worthy of the 
novelists who, without having taken the trouble to 
look up the subject, chloroform their heroines with 
an ease and a promptitude which may amuse the 
groundlings, but must make the experienced man 
smile. Under these circumstances, we can only sug¬ 
gest that the Editor might find out (a) exactly how 
much chloroform was taken out of the stock bottle j 
( b ) whether the thief took anything beyond the 
doctor’s trousers; (c) what view the police hold as to 
the house having been entered by thieves, and upon 
the affair generally. As to personal advertisement- 
the possibility hardly applied at the time of our pre¬ 
vious remarks, when the name of the medical man 
concerned had not transpired. The Star itself has 
shown that the contingency is not altogether remote 


Digitized by GoOglC 



NOTES ON CURRENT TOP1GS. 


Mar. 29. 1899. 


336 The Mbdical Puma. 

by its detailed interview, and challenge of half a 
oolumn in length. The burden of proof, anyway, lies 
with those that father such an extraordinary tale. 

A Proposed Seamen’s Hospital for Cardiff. 

The Mayor of Cardiff has embarked upon a useful 
and praiseworthy scheme—namely, that of building 
and organising a Seamen’s Hospital for the town. 
Already the sum of £16,500, including a generous 
donation of £10,000 from Lord Bute, has been raised ( 
but £5,500 more are required before the work can 
be proceeded with. Cardiff is a wealthy town, and 
there is every probability that this sum will soon 
be forthcoming. Moreover, the object is so good a one 
that th^re can be no excuse for those able to do so 
from withholding their liberal support. The impor¬ 
tant shipping centre which the town has now become 
makes the needs of a seamen's hospital almost 
Imperative, and hence the activity and enthusiasm 
displayed by the townspeople in the mayor's enter¬ 
prise. It is proposed to hold a bazaar in aid of the 
building fund in December next. We wish the new 
charity every success. 

Pharmaceutical Penalties in Ireland. 

We have already called attention to the difficulty 
which the Pharmaceutical Society of Ireland 
experiences in its efforts to enforce the law against 
unqualified dispensing which Parliament has entrusted 
to it. The Society finds no trouble in detecting or 
proving the offence, or in obtaining a legal judgment 
for the £5 set down in the Act as the statutory 
penalty, but for some reason, which Dublin Castle 
has never attempted to explain, the authorities have 
■et themselves in a position of hostility to the 
Society, and make use of the Royal prerogative to 
protect the misdoer by reducing the fine, the effect 
of which proceeding is that the Society is heavily 
mulcted in costs, and, in fact, pays the penalty 
instead of the law-breaker. Obviously, if this policy 
is maintained the Society will have to abandon the 
attempt to protect the public. 

• The Alleged Sectarianism of the Royal 
College of Surgeons, Ireland. 

The flat con radiction of the statements of Mr. 
MacArdle respecting the alleged religious bias of this 
oollege. which we published recently, has been con* 
vincingly confirmed by letters which have appeared 
in the Dublin papers from the pen of the Vice-Presi¬ 
dent, Mr. Myles, and also of his four Catholic 
oolleagues on the College Council which public state¬ 
ments present practically the proofs which we offered, 
that Mr. MacArdle's assertions were totally at vari¬ 
ance with the facts. Our list of Catholics holding 
office in the college was in fact shorter than it ought 
to have been, inasmuch as it omitted mention of Drs. 
Alfred Smith, Edgar Flinn, and Daniel Corbet, who 
at this moment hold office as Examiners, though they 
are all Catholics. It may be added that, within the 
last week, the College Council has nominated a 
Catholic for Commission in the Army Medical Corps, 
though there were many eligible competitors of other 


religions, and we fully believe that, to most of the 
College Council, this gentleman’s religion was 
unknown. It can scarcely be agreeable to a public 
lecturer to have his deliberate utterances contradicted 
in every essential particular. 


Presidency of Queen’s College, Galway. 

Professor Alexander Anderson, formerly 
Fellow of Sidney Sussex College, Cambridge, andnow 
Professor of Natural Philosophy in the Queen's 
College, Galway, has been appointed president of 
that college in the room of Dr. Starkie, who has 
recently been chosen as Resident Commissioner of 
Education in place of Sir Christopher Redington 
deceased. The appointment is especially interesting 
because, as we believe, this is the first time that any 
one but a Catholic has held the Presidential office in 
this college, 

The Presidency of the Royal Oollege of. 

Physicians of London. 

The coveted position of President of the Royal 
College of Physicians of London, vacated by Sir 
Samuel Wilks after three years’ tenure, has fallen to 
the lot of Dr. Church, who has been duly elected 
thereto. The choice of the Fellows will, we feel sure, 
meet with general approval, Dr. Church combining in 
his person the physical and intellectual qualities 
which go to constitute a strong president. Of austere, 
yet not unfriendly, demeanour, of stalwart frame and 
deliberate utterance, Dr. Church is eminently adapted 
to adorn a post in which scholarship and business 
capacity must go hand in hand. Once again we con¬ 
gratulate the Fellows on their choice, and wish the 
new President a long ahd successful career as the 
foremost representative of medicine in the metropolis. 

Women Inspectors of Nuisances. 

The experience of the Southwark Vestry with 
their woman inspector of nuisances has, we learn, 
proved so far satisfactory that another is shortly to 
be appointed whose duty it will be more particularly 
to inspect factories and workshops in the parish. The 
remuneration, as things go, is fairly good, the salary 
being £110 per annum, rising by £10 to a maximum 
of £150, 

An inquest was held a few days since" at Hackney 
on the body of a woman who had succumbed to 
haemorrhage from abortion after taking some medi¬ 
cine prepared by the notorious Madame Frain. The 
jury added a rider to their verdict to the effect that 
Madame Frain’s business was “either fraudulent or 
felonious,” a truism which we commend to the notice 
of the authorities. The custom of leaving the prose¬ 
cution of these people to private initiative is one 
which reflects little credit on the police, to whom it 
properly belongs to decide under which head they 
ought to be dealt with. 

WE regret to have to announce the death of Dr. 
John Brunton, of Endsleigh Street, W.C., a well- 
1 known and successful practitioner who, throughout a 


Digitized by LjOOQle 



Mab. 29, 1890. 


SCOTLAND. 


The Medical Press. 337 


long and busy career, found time to make numerous 
interesting observations which saw the light in the 
journals and at the various medical societies. Ue 
held a large number of valuable appointments. 

We understand that the Surgeoncy of Dr. Stevens’s 
Hospital, Dublin, has been vacated by the resignation 
of Mr. Edward Hamilton, who has so long and 
honourably occupied the position. There is already 
an animated competition for the place, which secures 
to the holder an excellent surgical status in Ireland. 


A bali, for the benefit of the National Consump¬ 
tion Hospital in Ireland will be held at the Rotunda, 
Dublin, on the 19th of April. The Lord Lieutenant 
and the Countess Cadogan have promised, to be 
present. 

The Royal Academy of Medicine of Ireland has 
decided to convene an aggregate meeting of the pro¬ 
fession, and has invited the Medical Authorities and 
Societies to name two delegates each. The prelimin¬ 
ary conference will be held on the 13th of April at 
4.30 p.m., at the Royal College of Physicians. 


PERSONAL. 


Dr. Allen McLane Hamilton, of New York, has 
been elected a Fellow of the Royal Society of Edin¬ 
burgh. 

Dr. John Macphebson, Medical Superintendent of the 
Stirling District Asylum, Larbett, has been appointed 
Commissioner in Lunacy for Scotland in the room of Dr. 
Sibbald, who has retired. 

Mb. G. Verb Benson, M A. Cantab, M.R.C.S., L.R.C.P., 
who has been fulfilling the duties of Deputy-Coroner for 
West Middlesex, was last week elected Coroner for the 
Lewes Division of the county of Sussex. 

M. Haffkine, C.I.E., is about to leave India on sick 
leave, and come to London. During his visit to Eng¬ 
land he will read a paper before the Royal Society, in 
connection with his inoculation treatment. 

The Queen’s oldest honorary physician by many years 
is Sir Alexander Armstiong, who was appointed to the 
post forty years ago. He was engaged for several 
years in searching for Sir John Franklin in the Arctic 
regions. 

Dr. David Wallace, of Beckenham, who wag 
recently acquitted at the Maidstone Assizes of a serious 
charge, was presented last week with a purse contain¬ 
ing .£ 60 , which had been subscribed for by the members 
of friendly societies of Penge and Beckenham, as a 
mark of esteem for services rendered by him to the 
clubs. 


gcotlanb. 

[from our own correspondent.] 

Dr. John Sibbold.— Dr. John Sibbold, in virtue of the 
unalterable rule appertaining to holders of Government 


| offices on attainment to the age of sixty five, has had to 
I sever his long connection with the Lunacy Board of 
Scotland, of which for some time back he has been the 
Senior Commissioner. Dr. Sibbold has in a quiet way 
done a great deal of work in the cause of the treatment 
and housing of lunatics in Scotland. Graduating at 
Edinburgh University in 1854. he was appointed a 
Deputy Commissioner in Lunacy in 1870, after holding 
for eight years the superintendentship of the Argyll 
and Bute Asylums. In another eight years he became a 
full Commissioner, and for the last twenty-one years he 
has filled this office. His attention ha« chiefly been 
directed to the proper construction and arrangement of 
asylums, and his rapers on the subject have influenced 
in great degree the arrangement and planning of the 
more recently built asylums in Scotland. For some years 
Dr Sibbold has been regularly elected to the Council of 
the Royal College of Physicians of Edinburgh, for which 
his services it is hoped will still be available. 

The Residency in the Royal Edinburgh 
Infirmary.— The managers of the Royal Infirmary of 
Edinburgh, wishing to provide sleeping accommodation 
for three of the house physicians and surgeons at present 
non-resident in the hospital, and being rather hampered 
by the lack of available space, propose to carry out a 
series of evictions before the summer. Their plan of 
campaign appears to be most ill-advised and arbitrary. 
Each resident medical officer has at present a small 
sitting-room immediately adjoining his still smaller bed¬ 
room, while there is one common room for mess pur¬ 
poses. The managers intend to deprive the coming 
residents of their sitting-rooms make some of them into 
bed-rooms, and form a “reading and visitors’ room” 
common to the whole staff in place of the former private 
rooms. In this room they will be supposed to do their 
reading and to entertain their visitors; the second use 
the room is to be put to being highly conducive to the 
proper quiet so necessary forthe first The proposal seems 
really to be the outcome of mental aberration on the part of 
some one in authority who thinks the resident-staff are 
well provided if beds are given them, common rooms 
devoid of furniture, save a wooden table or two and some 
chairs, and no sitting-room where privacy and quiet 
are possibly attainable. The present residents have 
memorialised the Board on behalf of their successors 
and the Honorary Medical and Surgical Visiting Staff 
held a meeting on Monday to consider the matter. A 
senior public schoolboy has his study as well as his bed¬ 
room or cubicle; and it is a most ill-judged curtailment 
of the comforts offered by the residency, at present more 
akin to a licensed lodging-house than a home for followers 
of JSsculapius— officials who have to work hard, and 
ought at least to be able to seek solitude elsewhere than 
in a contracted bedroom either for rest, reading or 
meeting friends. 

St. Mungo's College. —The closing meeting of the 
winter session took place on the 24tn inst., when the 
medals and certificates were delivered to successful stu¬ 
dents. It is satisfactory to note that year after year the 
number of students attending the College is on the 
increase; in 1889-90 the number was 94; in 1894 95, 98 ; 
and for the past session, 108. 

The New Lunacy Commissioner,. —Dr. John Mac- 
pherson. Medical Superintendent of Stirling District 
Asylum, Larbert, has been appointed Lunacy Commis¬ 
sioner for Scotland, in room of Dr. John Sibbold, who has 
retired. Dr. Sutherland, Senior Deputy Commissioner, 
in his application for the vacant post, based his claims 
in part on the unbroken precedent of the promotion of the 
senior deputy Of course, like most such appointments, 
politics have, perhaps, a great deal to do with the result, 
and also in the breaking of such precedents, and Dr 
Sutherland may remember that he secured his Deputy 
Commissionership through Sir George Trevelyan. If it 
is any satis r action to Dr. Sutherland we may console him 
by saying he is not the only disappointed one, as it was 
confidently expected that a Glasgow man would secure 
the post, and no doubt many a pious prayer has been 
uttered in favour of the Secretary for Scotland. 

Glasgow Royal Infirmary Re-construction — 
Dissension in Committee.—I t has been said from 


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338 The Medical Press. 


CORRESPONDENCE. 


Mar. 29, 1899. 


appearances and attitudes assumed by some members of 
the Committee and the stand taken by the staff, the Lord 
Provost is not likely to enjoy the gratification of seeing his 
soheme for the reconstruction of the Royal Infirmary as 
a memorial of our Queen’s Jubilee practically realised 
before his term of office as Lord Provost to the City 
expires. Trouble, it is said, has been brewing for some 
time in the Executive Committee which may bring 
matters to a crisis at any time, and as a sign of the posi¬ 
tion of affairs several members have withdrawn from the 
Committee. There may be faults on both sides, but 
when a member of Committee who subscribed £1,000 
to the fund retires, we must advise caution at least, 
especially when it is an open secret that certain matters 
in the infirmary have been pre eminently critical from 
the very beginning. The present deadlock is to be regretted 
in more ways than one, especially when it is remembered 
that the fund is still short of about £20,000 of the esti¬ 
mated eum, and the fact that money has ceased to come 
in—this latter fact is looked upon as a very serious indi¬ 
cation of things, so much bo that begging circulars are 
being, and have been, sent out soliciting funds, and, in 
order to succeed, collectors are employed who must be 
paid, as such gentry are not at all inclined to give their 
time and service gratuitously. The scheme was launched 
exactly two years ago, and on April 28th, 1897, upwards 
of £50,000 had been subscribed, which has since then 
come up to between £70,000 and £80,000, the minimum 
sum aimed at being £100,000. The beat thing would be a 
general meeting, at which the whole facts of the case 
could be brought before the notice of the subscribers 
and calmly disoussed, and an endeavour made to get out 
of the difficult position. 


MEDICAL SOCIETY OF LONDON. 

The meeting on Monday evening last was devoted in 

f art to a paper by Dr. Maguire on “ Deaths from 
'unctional Nervous Disease.” He related four cases in 
which more or less prolonged unconsciousness without 
any other morbid sign was followed by death without 
anything being discoverable post-mortem. He main¬ 
tained that these deaths were due to exhaustion of the 
grey nerve matter. 

Dr. SAN 80 M instanced various analogous conditions 
such as epilepsy and angina pectoris in which nothing 
could be found to account for death. He suegested that 
the grey matter as a whole was not affected, but perhaps 
paralysis of the vagus might afford an explanation. He 
mentioned casually that fatty degeneration of the heart 
was an extremely rare came of sudden death. 

Dr. Tuke thought the author’s cases bore some resem- ; 
balance to the early stage of general paralysis -, and Dr. 
Richards questioned whether an affection of the cortex, 
capable of determining such serious symptoms, could 
exist without leaving some microscopical evidence 
thereof. 

Mr. Battle mentioned the case of a woman, tet. 30, 
with severe symptoms, suggestive of gastric perforation 
in which, after death.no lesion was anywhere discovered. 

Dr. Maguire pointed out that paralysis of the vagus 
would not account for the unconsciousness. 

The remainder of th-< evening was alloted to Mr. H. L. 
Barnard, who discussed “ Certain Points in the Patho¬ 
logy of the Pericardium.” He observed that the peri¬ 
cardium formed an integral part of the mechanism of 
the venous circulation which was largely carried on by 
the contraction of skeletal muscles. In violent exertion 
a large quantity of blood might be suddenly forced into 
the right heart. This, but for the tough fibrous peri¬ 
cardium, would hopelessly stretch and dilate the thin 
walls of the heart which, however, was supported there¬ 
by just as the leather case contained the foot-ball. He 
had shown by actual experiment that the pericardium 
limited about one half the capacity of a heart in diastole. 
He insisted on the importance of a well-developed 
abdominal muscular system in assisting the passage of 
the blood upwards from the great abdominal veins. In 
pericarditis causing softening of the pericardium any 
effort might be followed by strengthening which was 
probably permanent. 


Correspondence, 

We do not hold ourselves responsible for the opinions of oar 
correspondents. 


MEDICAL GRADUATES’ COLLEGE AND 
POLYCLINIC. 

To the Editor qf The Medical Press and Circular. 

Sir, —The attention of the Council of the Medical 
Graduates’ College and Polyclinic has been directed to 
an article in your journal of March 22nd, 1899, in which 
it is stated that “ matters are by no meanB going 
smoothly among the powers that be at the New Poly¬ 
clinic in Chenies Street, W.C. It is the same old story, 
a striving after the position, to use a vulgar expression, 
of' boss of the show.’ Thus two camps have been formed, 
one represented by a well-known surgeon, and the other 
by a specialist, and a struggle is now going on for the 
mastership.” 

The assertions contained in this statement are alto¬ 
gether inaccurate. No deliberative body, such as the 
Council of the Medical Graduates’ College, can carry on 
its proceedings without the discussion upon many points 
regarding which various and different opinions may be 
held among its members. In the proceedings of this 
Council differences of opinion have given rise to debate, 
but the differences have been such as arose from the 
determination of the Council to carry out the best 
measures for the success of the College, not for the 
supremacy of any person or persons. 

The instruction to send to you this rectification has 
been entrusted to me by a unanimous vote of the 
Council. 

I am, Sir, yours truly, 

William M. Ord, M.D., Chairman of Council. 

22 Chenies Street, Gower Street, March 25th, 1899. 


THE DANGERS OF ERYTHROL TETRANITRATE. 
To the Editor of The Medical Press and Circular. 

Sir, - An accident, by which a chemist lost his life, 
happened at a tabloid factory at Dartford, on December 
15th, 1897. He was engaged in mixing tetranitrate of 
erythrol with finely powdered lactose in a mortar when 
an explosion occurred. 

Again, at the end of 1898, an accident was caused by 
tetranitrate of erythrol being inadvertently thrown into 
a fire, and one person was injured. 

Tetranitrate of erythrol is possessed of explosive pro¬ 
perties, and is highly sensitive, more so indeed to per¬ 
cussion than dynamite or gun cotton. As it has lately 
come into some use in the place of nitro-glycerine as a 
remedy for angina pectoris, I should be glad if you would 
draw special attention in your paper to the dangers 
attending the handling of this drug. 

I have the honour to be, Sir, 

Your obedient servant, 

A. Ford, Colonel, 

H.M. Chief Inspector of Explosives. 

Home Office, Whitehall, S.W., 

March 24th, 1899. 


POOR-LAW MEDICAL SERVICE REFORM:. 

Deputation to the Local Government Board. 

On Thursday, March 16th, the deputation nominated 
by the public meeting which was held in the Royal 
College of Surgeons waited on the Local Government 
Board. The deputation consisted of the following mem¬ 
bers:—Sir Thornley Stoker (President Irish Medical 
Association), Dr. John William Moore (President Royal 
College of Physicians), 8urgeon Swan (President Royal 
College of Surgeons). Sir William Stokes, Sir William 
Thomson, Dr. Truell, D.L., Ashford, Co. Wicklow; Dr. 
Donnelly, Dublin; Dr. Stanley B. Coates, Belfast; Dr. 
Neale, Mountmellick; Dr. Oulton, Dublin; Dr. Joseph 
Smyth, Naas. 


Digitized by vjVJ 


°gle 



Mak. 22, 1899. 


MEDICAL NEWS. 


The Medical Press 339 


The deputation were reoeived by a full board, the 
secretary being also present. 

Sir Thomley Stoker, who introduced the deputation, 
said they came on behalf of the Poor-law medical officers 
with the authority of the largest meeting of the Irish 
medical profession that had ever been held in Ireland. 
The reforms they asked for were most reasonable. The 
grievances they complained of worked great injustice to 
Sie doctors, but still gieater injustice to the sick poor. 
The first, and far and away the most important and 
urgent of all, was superannuation. 

Surgeon Swan, President of the Royal College of 
Surgeons, emphasised the importance and urgency of 
superannuation. He asked : (a) The Local Government 
Board, in view of their official knowledge of all the 
circumstances, to exercise their influence with the 
Government to support the Medical Officers’ Super¬ 
annuation Bill (Ireland), 1899; (b) and further, to 
exercise their own powers to meet cases of lesser dis¬ 
ability due to advancing years and length of service by 
providing that a dispensary doctor of more than thirty 
years’ service and over sixty years of age should be 
enabled to have an assistant medical officer for his dis¬ 
trict on payment by him of such portion of the assis¬ 
tant’s salary as the Local Government Board should 
determine. He pointed out how the sick poor were 
wronged when they were left dependent for medical 
relief in their necessities on a doctor who was physically 
unable to attend them in the night time, or when the 
journey was difficult or the weather inclement, or the 
work unusual. He illustrated this from his own personal 
knowledge, when the dispensary doctor was absolutely 
unable to do his duty, was denied superannuation, and 
was too poor to retire. 

Dr. Joseph Smyth, Naas, said the Local Government 
Board were naturally the responsible advisers of the 
Government on this question. If the Local Government 
Board were of opinion that compulsory superannuation, 
though good in itself, had its necessity outweighed by 
other considerations, then superannuation would be 
delayed. But if they considered, as he believed they 
did, that a dispensary doctor who had passed the retiring 
age was in most cases physically unable to efficiently 
discharge the duty of an Irish dispensary district under 
all circumstances of difficulty in all kinds of weather, 
and at any hour of the night, and if they so advised the 
Government, not as a counsel of perfection, or simply of 
betterment, but as an imperative necessity, which the 
sufferings and lives of the sick poor demanded, then he 
believed that superannuation would become law during 
the present sessions of Parliament. 

Sir Thomley Stoker asked the Local Government 
Board when, for reasons of public policy, dispensary 
districts are deprived of one or more electoral divisions, 
that the medical officers of such districts shall be pro¬ 
tected against any diminution of their present salaries. 

Dr. Truell, D.L., supported the request. 

Dr. John William Moore, President Royal College of 
Surgeons, asked the Local Government Board to “ regu¬ 
late” the salaries of dispensary districts, so that the 
medical officers may be remunerated for the cost they 
are obliged to incur in travelling on dispensary duty. He 
complained of the anomaly and injustice of making the 
dispensary doctor pay out of his pocket so large a portion 
of his small salary for doing public work. He gave the 
case of a doctor in the west of Ireland who was obliged to 
keep two horses for the actual requirements of dispen¬ 
sary duty. His salary was only .£110 a year, and his 
district was over 80 square miles. There were several 
otherain the west still worse off. He showed how this 
must necessarily deprive the sick poor of their full 
measure of medical attendance, and he therefore urged, 
in justice to both the doctor and the sick poor, such 
regulation of the salaries as would provide for the cost of 
travelling. 

Sir W illiam Thomson said the public had no right to 
the use of a dispensary doctor’s horse without payment. 
In many places a horse would not be sufficient to do the 
travelling required by the dispensary duty. There were 
districts to his own knowledge where the private prac¬ 
tice did not exceed about £25 a year, though that was 
an extreme case. If in such a district the doctor decided 


to do his work on foot just as far as he was able, there 
was no power to compel him to provide a horse, and the 
sick would necessarily be neglected. 

Sir William Stokes asked the Local Government 
Board to have printed on the face of each visiting ticket, 
as is done in England, the following words : ” If this 
ticket be not presented before noon on the day of its 
date the medical officer will not be expected to visit the 
case that day unless the word * urgent ’ be written on it ” ; 
(b) and to specify the procedure to be followed where 
their rules were not observed, as for example where 
tickets are not filled and signed by the issuer, where the 
issuer, instead of exercising due diligence in ascertaining 
whether the applicant be a “ poor ” person or not, shows 
gross negligence or otherwise misuses his power ; and 
to suggest that this procedure should direct the medical 
officer to report the circumstances to the Clerk of the 
Union, who should then be responsible for the remainder 
of the proceedings, so as to avoid as far as possible 
personal conflict between the issuer and the medical 
officer. He said the abuses of the ticket system had 
been a scandal too long permitted. Visiting tickets 
were sometimes given recklessly. He knew a 
case within his own personal knowledge where 
the dispensary doctor was obliged to travel ten 
miles on a red ticket to find that it was not for a human 
being at all he was wanted, but actually for a pig. He 
held in his hand a letter from a dispensary doctor in a 
different county, which stated that he had received two 
visiting tickets, one for a cow and the other for a donkey. 
The one for a cow was filled in in the owner's name, 18 
miles away. The second, for a donkey, was also in the 
owner’s name, four miles away, and was signed by the 
chairman of the Committee. 

Dr. Coates, Belfast, said they felt it a very great hard¬ 
ship to have visiting tickets dropping in at all hours of 
the evening and night without the slightest necessity. 
They were always ready to give their services without 
complaining, no matter at what hour, when there was 
reasonable cause, but they asked to be protected against 
this abuse. He handed in a visiting ticket such as is 
issued in England. 

The Vice-President, in replying, said the Local Govern¬ 
ment Board would give the questions submitted to them 
careful consideration. They were bound to look at them 
from all sides, and to act in the interests of the public. 


Medical Fees In Law Courts. 

Replying to Dr. Farquharson’s question, whether the 
Government would consider the question of revising the 
scale for medical evidence with the view of more ade¬ 
quately remunerating the services of medical men who 
were compelled to give evidence, Mr. Jesse Collings 
replied that for the present the Secretary of State does 
not see his way to alter existing arrangements. 

Chelsea Physic Garden. 

Under the scheme of the Charity Commissioners the 
Physic Garden at Chelsea will be saved from the hands 
of the builders, the ground having been handed over to 
the Trustees of the London Parochial Charities on an 
agreement that they shall dedicate .£800 a year for the 
maintenance of the Garden, which is to be administered 
“ exclusively for the promotion of the study of botany, 
with special reference to the requirements of general 
education, scientific instruction, and research.” The 
practical management of the Garden will be vested in a 
committee formed of representatives nominated by the 
Trustees of the London Parochial Charities, the Treasury, 
the Lord President of the Council, the Technical Educa¬ 
tion Board, the Royal Society, the Society of Apothe¬ 
caries, the Royal College of Physicians, the Pharma¬ 
ceutical 8ociety, the London County Council, and the 
8 enate of the University of London. Earl Cadogan and 
his Ruooessors, as representing Sir Hans Sloane, who con¬ 
veyed the Garden in 1722 to the Apothecaries’ Com¬ 
pany in trust for the encouragement of botany, is a 
member of the committee. 

HJl.H. the Duke of Cambridge. E.G., has graciously 
consented to preside at the annual dinner of the Sani¬ 
tary Institute, to be held at the Whitehall Rooms on 
May 2nd. 



340 The Medical Press. 


NOT10E8 TO CORRESPONDENTS. 


Mar. 29, 1899. 


Notices to 

dtorreaponbentB, §hott Xettcrs, &c. 

Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive tig nature or 
initial*, and avoid the practice of signing themselve3 “ Re.vler,’’ 
“Subscriber,” "Old Sulwcriber,” Ac. Much confusion will be 
spared by attention to this rule. 

Beading Cases.— Cloth board cases, gilt lettered, containing 
twenty-six strings for holding the numbers of The Medical Press 
and Circular, may now be had at either office of this journal 
price 2s. 6d. These cases will be found very useful to keep each 
weekly number intact, clean, and flat after it has passedl through 
the post. 

Local Keports and News.— Correspondents desirous of drawing 
attention to these are requested kindly to mark the newspapers 
when sending them to the Editor. 

Original Articles or Letters intended for publication should 
be written on one side of the paper on’y, ani must be authenticated 
with the name and address of the writer, not necessarily for publica¬ 
tion, but as evidence of identity. 

Spes.— The facts of the case, if true, should be brought under the 
notice of the General Medical Council. 

M.D., F.B.C.P.—Our correspondent will find that the case is dealt 
with editorially in another column. 

THE NEW OBDER OP OPTICIANS. 

A Correspondent sends us the circular of a certain city trades¬ 
men who styles himself “ F.S.M.C., Sight Specialist, Certified Oph¬ 
thalmic Optician by Examination." Who would suspect that the 
substantive qualified by these adjec ives merely kept a shop for the 
sale of spectacles ? 

Mr. Kensman.— We do not recommend either specialists or 
general practitioners, in accordance with our rule. But surely our 
correspondent need not hesitate to take the advice of a friend as to 
the best medical man to consult in his neighbourhood. 

A QUERY. 

M.D. asks whether the central figure in the celebrated painting, 
“ The Doctor," by Luke Fildes, R.A., is the portrait of any living 
medical practitioner. 

J. B. Hydatid cysts of the parotid have been known to occur. 
A case of the kind was recently recorded in the transactions of the 
French Anatomical Society. 

Dr. O'Kelly —Unavoidably crowded out. 

Exprrtus. —Any good book on toxioology will be sufficient. 
Among other methods of treating carbolic acid poisoning trial may 
be made of camphorated oil, administered by the mouth. It is 
stated that camphor is an antidote to the acid. 

CONSULTATION WITH HOMCEOPATHS. 

F.R.C S. writes:—“ I have been asked by a homoeopathic prac¬ 
titioner to arrange to meet him in consultation with a view to 
operating upon n lady patient of his. What is the medical etiquette 
in such a case ? ” 

[The case being a surgical one we think that our correspondent 
would not lie offending any ethical rule in acquiescing in the request, 
especially since the Boyul College of Physicians (London) have 
refused to lay down any rule definitely deciding that it is unethical 
to meet a homoeopath in consultation.—E d.] 

L. B.C P.Ed.— If our correspondent will refer to the last week's 
issue of The Medical Press and Circular he .will find the subject 
fully discussed. 

M. R.C.P. - Professor Osier of the Johns Hopkins University is 
not an American, but a Canadian, and formerly held the post of Pro¬ 
fessor of Medicine in the University of Toronto. He has accepted 
the invitation to deliver the Cavendish Lecture before the West 
London Medico-Chirurgical Society, on Friday, June 16th, 1899. 

Acarus. —We have uot l>efore met with the term " seuilophobia," 
but the fear of growing old is certainly a widespread disease, if 
disease it can l>e called. It affects chiefly persons of the female sex, 
and it is characterised by a tendency to relapse on slight provocation. 
The prognosis on the whole is favourable in the absence of com¬ 
plications. 

THE GREATEST COLD EVER RECORDED. 

Professor Dewar, by the agency of liquified hydrogen, has re¬ 
duced tem(>eratnre to 234 degrees below the Centigrade Zero (which 
is equivalent to 336 below the Fahrenheit Zero, no temperature like 
this having ever previously been recorded. By the way, asks n cor¬ 
respondent, Is there any good reason why English scientists should 
persist in adhering to the Fahrenheit scale which is, admittedly, 
based upon an original error ? Fahrenheit was not an Englishman, 
and, therefore, we need feel no jealousy in adopting the Centigrade 
scale, unless there be some technical difficulty which scientists can 
produce. 


ItecanxieB. 

Belgrave Hospital for Children.—House 8urgeon for six months. 

Board and residence provided and a gratuity of £5 given. 

Central Loudon Ophthalmic Hospital.—House Surgeon. Residence, 
board, &c., in the hospital. 

Charing Cross Hospital.—Bacteriologist to the Hospital and Lec¬ 
turer on Bacteriology at the Medical School. 


Chester County Asylum.—Junior Assistant Medical Offioer, un¬ 
married. Salary £120 per annum, rising yearly by £10 to £150. 
with board (no liquors), lodging, and washing. Also Medical 
Officer to act principally as Pathologist. Salary £150 per 
annum, with board (no liquors), lodging, and washing. 

Dental Hospital of London Medical School, Leicester Square.— 
Demonstrator in Dental Surgery. Honorarium of £25 per year 
given. 

Derby County Asylum, Derby.—Assistant Medical Officer. Salary 
£100, rising to £120, with board, lodging, and washing. 

East London Hospital for Children and Dispensary forWomen.— 
Medical Officer for the casualty department for six months. 
Salary at the rate of £100 per annum. 

Fisher-ton Asylum.—Assistant Medical Officer. Salary £100 per 
annum, with board, lodging, and washing. Applications to Dr. 
Finch, the Asylum, Salisbury. 

Hospital for Diseases of the Chest.—House Physician for six months. 
Salary at the rate of £40 per annum, board, lodging, and 
washing. 

London Temperance Hospital.—Assistant Resident Medical Officer 
six montns. Residence in hospital, board, and washing pro¬ 
vided, and honorarium of 5 guineas given conditionally. 

North Biding Asylum, York.—Junior Assistant Medical Officer. 
Salary £100, rising to £150, with board, lodging, washing, and 
attendance. 

North-West London Hospital.—Honorary Anmthetist for twelve 
months. 

Roxburgh District Asylum, Melrose.—Assistant Medical Officer. 
Salary £100 per annum, with furnished quarters, board, wash¬ 
ing, and attendance. 

St. Pancras Workhouse with Infirmary Wing. - Assistant Medical 
Officer for two years. Salary £120 the first year and £135 for 
the second year. Residential allowances for a single man pro¬ 
vided. Applications Clerk to Guardians, Vestry Hall, St. 
Pancras Road, N.W. 

Victoria Hospital, Folkestone. - House Surgeon. Salary £80 per 
annum, rising to £100. with board, residence, and washing. 

West London Hospital, Hammersmith Road.—Assistant Physician* 

Westminster Hospital. Resident Obstetric Assistant for six months. 
Board and residence in the hospital provided. 


Appointments. 

Burt, W. C., L.R.C P.Lond., M.B.C.S., has been appointed Medical 
Officer to the Workhouse of the Torrington Union. 

Dbarden, V. G.B., L.B.C.P.Edin., L.F.P.S.Glosg., Medical Officer 
Carbrook Sanitary District by the Sheffield Board of Guardians. 

Dun. Robert Craig, M.B., C.M., B.Sc.Edin.. M.B.C.S.Eng., 
L.R.C.P.Lond., Honorary Surgeon to the Liverpool Infirmary 
for Children. 

Fullerton, Robert, M.D., C.M.Edin., Honorary Consulting Sur¬ 
geon to the Greenock Inflrmaiy. 

Mackenzie, D. J., M.D.Aberd., C.M., Medical Officer of Health by 
the Glossop Dale Rural District Council. 

Mus 80 N, A. W., M.B., B.C.Camb., Medical Officer to the Work- 
house of the Clitheroe Union. 

O'Donnell, John M.B., B.Ch Irel.. Assistant Physician to the 
Mater Misericordise Hospital, Dublin. 

Thompson, J. H., L.B.C.P.Irel., L.B.C.S.Edin., Medical Officer of 
Health by the Mytholmroyd Urban District Council. 

Thornton, Dr., Medical Officer of the Ilfracombe Sanitary District 
of the Barnstaple Union, vice A. A. Mackeith. 

Warden, A. A., M.D.Glasg., Private Assistant to Dr. Doyen, of 
Paris. 

Weightman, E. J., M.B., C.M.Edin., Resident Medical Officer of the 
Walton Workhouse of the West Derby Union. 

Whitfield, Arthur, M.D.Lond., M.R.C.P., Assistant Physician in 
Charge of the Skin Department to King's College Hospital, 
London. 


#irth6. 

George.— On March 15th, at St. John’s Wood Rood, N.W., the wife 
of Isaac George, L.R.C.P.Lond., of a son 
Harper. —On March 18th, at Rosary Gardens, South Kensington, 
S.W., the wife of James Harper, M.D., of a son. 

Rogers.—O n March 18th, at The Red House, Cliffe-at-Hoo, Kent, 
the wife of Arthur B. Rogers, surgeon, of a daughter. 


^ttarriageB. 

Cook—Maddox.— On March 25th, at Christ Church, Hampstead, 
John Howard Cook, M.S., F.R.C.S., youngest son of the late 
William Henry Cook, M.D., of Hampstead, to Ethel, youngest 
daughter of Mr. George Maddox, of Gainsborough Gardena, 
Hampstead. 

Griffiths —LEWNs.-On March 20th, at 8t. Gabriel's Church, 
Willesden Green. London, N.W., William Griffiths, B.Sc., 
M.D.,Lond., of Grosvenor Gardens, Willesden Green, to Ada 
Carrie, third daughter of Charles Frederick Lewus, of Grosvenor 
Gardens, Willesden Green. 


$eaths. 

Bbunton.—O n March 25th, suddenly, at 16, Endsleigh Street, 
London, W.C.. John Brunton, M.A., M.D., aged 63years. 

Clarke.— On March 17th, at Hors man’s Place, Dartford, Thomas 
Furze Clarke, M.R.C.S., aged 43 years. 

Port.—O n March 25tli, Heinrich Port, M.D., FB.C.P., of 48, Fins¬ 
bury Square, E.C., hon. physician of the German Hospital, 
Dais ton (late of Nuremberg/. 

Pound.—O n March 2nd, at sea, on board the B.I.S. Navigation 
Company's ship,' Goa,' Clement Pound, L.R.C.P.Lond., son of 
the late Dr. G. Pound, of Odiham, Hants, aged 38 years. 


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April 5, 1899 


The Medical Press and Circular Advertiser. 


xi 


“ The predominance of Magnesium Sulphate and the 
presence of Lithium in APE NT A WATER having been 
“ recently pointed out by Professor Pouchet, I determined 
“ to ascertain for myself the properties of this water, and 
“ for this purpose I prescribed it to a large number of my 
“ patients. 

“ My observations have proved that APENTA WATER 

“ is an excellent, very active purgative, and of strictly 
“ constant composition. Its action is mild and reliable, 
“ and a wineglassful or half a glass acts as an aperient 
‘ without producing either griping or discomfort It 
“ is the Water specially suited for the treatment of habitual 
“ constipation. Moreover, by its special and constant 
“ composition this Water appears to me to merit a place 
“ by itself in the therapeutics of Mineral Waters.” 

I 

Paris, 4th February, 1899 

Dr. E. Lancereaux, 

Profeeeeur a la Faculte de Medecine, Paris; Medecin honoraire deg Hupitaux ; 

Membre de F Academic de Medecine. 


APENTA 

THE BEST NATURAL APERIENT WATER. 


Sole Importers: THE APOLLINARIS COMPANY, Ltd, LONDON. 


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April 5, 1899 


xii 



This ramarfcably fin* Tonic Mineral Water i**u§* from a spring: 1,968 foot abort soa lovol at Ortua 
in the Island of Oorsiea. 


It was known and used In France during the last century, but came prominently under the notloe of the .Medical Profession in that 
country in the year 1863 through a report published by the Academy of Medicine of Paris of an analysis by a renowned Professor of Chemistry, 
Dr. Poggiale, confirmed by Mons. Ossian Henri. 

Since then the water nas been extensively used in France and her Colonies and in Egypt and South America, as well as in Spain and other 
European countries, and is considered to he the best of all Mineral Waters in cases of Aneemla, Chlorosis, Leucorrhosa, and all diseases arising 
from impoverishment of the blood, and has been found of the utmost value in Gastralgia, Dyspepsia, and affections of the Liver and Spleen 
caused by residence in tropical climates, and in Debility after long illness, and In Intermittent Fever. 

It is certified to contain 

IRON, Carbonate and Protoxide. I MAGNESIUM, Carbonate. I POTASSIUM, Chloride. 

SODIUM, Carbonate. I CALCIUM, Carbonate. I SODIUM, Chloride. 

Traces of Manganese and Araenlona Acid, and has sufficient “ free ” Carbonic Acid to cause 
It to effervesce on being poured Into a tumbler. 

It is the most palatable and digestible of all strong ferruginous waters, and with the addition of a little Lime Juice or Lemon 8yrup makes 
a pleasant table beverage. , - - — — ■ - .. 

Wholesale Orders for France and her Colonies to be sent to3 RUE ROSSINI, PARIS. 

And Orders for all other Countries to be Bent to 

MARK WHITWILL, SON & JUDGE, 6 St. Helen’s P l ace, London. 

Superior to Cod Liver Oil, Tincture of Iron, or Peptone 


HOMMEL’S H/EMATOGEN. 

Hsemoglobinum oonoentrstum et Glyoerinum purissimum [English Patent, No. 12,604, A.D. 1894], agreeably flavoured.) 

Entirely free from Antiseptic Chemicals. 

A BLOOD-FORMING TONIC, OF THE UTM08T VALUE 
In General Debility, An asm la. Chlorosis, Neurasthenia, Rickets, 
Scrofula, Weak Heart, Wasting Diseases of Children, Chronic Catarrh 
of the 8tomach and Bowels, Lass of Appetite, 8iow Convalescence 
after Fevers, and Over-Rapid Growth In Young Persons. 

Kept in Stock by all Pharmaceutical Chemists. Price of Original 9-ounce Bottle 4s. 


r DOM for young Infants, Hslf a Tea-spoonful, or one Tea-spoonful, twice a day in Milk, of the proper Heat for Drinking. For Children, 
One or two Dessert-spoonfuls, either pure, or mixed with any convenient liquid. For Adults, One Table-spoonful twice a day before 
food, so as to secure tne full benefit of its powerful appetising effect. 

NICOLA Y& CO36 & 36a St. Andrew’s Hill , London , E.C. 


HIPI.” 



CEO. NELSON DALE & CO., Ltd., 14 DOWGATE HILL, LONDON, E.G. 


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April 5. 1899 _The Medloal Press and Glrcnlar Advertiser. 


xiii 


PHARMACEUTICAL SPECIALITIES. 


A new intestinal Astringent contain¬ 
ing 87 per cent. Tannin and 13 per 
cent Hexamethylene Tetramin. A 
brown con-hygroscopic powder, insolu¬ 
ble in water weak acids, and alcohol, 
but dissolves slowly in diluted solution 
of soda and alkali. It passes through 
the stomach entirely unchanged, de¬ 
composition commencing only in the 
intestines. 


TANNOPINE 

(Hexamethylene Tetramin 
Tannin). 


Has an excellent effect, without 
secondary phenomena, in all the 
various kinds of enteritis when given 
in doses of to 8 grains for children, 
and 16 grains, 2 to 4 times daily, for 
adults. 

Has given especially good results in 
oases of tuberculous inflammation 
of the bowels, in oases of non- 
tuberculous, subacute, and 
Chronic intestinal inflammation, and 
also in cases of typhoid. 


The active principle of the Thyroid 
Gland, combined with sugar of milk in 
6uch proportions that one part of 
Iodothyrine is equivalent to one part of 
the fresh gland. Iodothyrine contains 
an exactly known quantity of Iodine 
and always produces uniform results. 
Is permanent and not liable to de¬ 
composition. In this it is distinguished 
from all Thyroid preparations at 
present on the market. 


Has been used with marked suooess in 
Myxcedema, Goitre, Cachexia, follow¬ 
ing extirpation of the Thyroid, 
Tetanus, Obesity, Acromegaly, some 
■ nn-TI I \M 1^ I AI I" skin diseases— suoh as Psoriasis and 
1111111 I H I II I N | Eczema—and some forms of mental 
I w/ wJ I II I I I I II !■ affections. The commencing dose is 

5 grains daily, to be gradually 
increased, according to results obtained. 
Prepared also in Tablets, each con¬ 
taining 5 grains. 


The new silver compound for the treat¬ 
ment of Gonorrhoea. Most strongly 
recommended as an antiseptic wound- 
healer, and as a general substitute for 
Nitrat e of Silver. Contains 8 per cent, 
of silver; is easily soluble in hot or 
cold water; absolutely non-irritating, 
and possesses a better penetrating effect 
than any other silver preparation. 


PROTARGOL 

(Proteinate of Silver.) 


Pkofbssob Nbi8seb declares that 
Protargol is the best, the safest, and 
the quickest remedy he has yet em¬ 
ployed in the treatment of Gonorrhoea. 
Protargol possesses high baoterioidal 
properties, and is therefore excellent 
for the treatment of wounds. Has 
been used with the greatest possible 
success in Ocular Therapeutics. The 
usual strength of the solution for 
injections is ± to 2 per cent. 

Put up in bougie form by Messrs. 
E. Sumner & Co., Lord Street, Liver¬ 
pool, and E. Manson, 76, Fortess Eoad, 
London, N.W. 


A perfect substitute for Iodo¬ 
form. Odourless and non-toxic. Five 
times lighter than iodoform. Non¬ 
irritating, and does not produce a rash. 
Adheres oloeely to mucous surfaces. Of 
great value in burns, its soothing and 
antiseptic action rendering it specially 
serviceable in suoh oases. A 3 per cent, 
ointment is recommended. 


EUROPHEN 

(Isobutylorthocresoliodide). 


Principally useful in venereal 
diseases; in this direction it accom¬ 
plishes more than any remedy hitherto 
tried. In oases of scrofulous, syphilitic, 
and varioose ulcerations a 5 per cent, 
ointment will be found most advantage¬ 
ous. May be used either pure or com¬ 
bined with equal parts of boric aoid. 


Trional, Tannigen, Salophen, Lycetol, Creosotal, Duotal, Heroin, Aristol, Tetronal, 
Analgen, Losophan, Somatose, Iron Somatose, Milk Somatose, Phenacetine- 
Bayer, Sulfonal-Bayer, Piperazine-Bayer, Salol-Bayer. 


Samples and Literature may be had on application to the Wholesale Depot for all Bayer’s Pharmaceutical Specialities. 

THE BAYER CO., Ltd., 19 ST.DUNSTAN’S HILL, LONDON, EX. 

Also at MANCHESTER GLASGOW, and BRADFORD. 


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XIV 


The Medical Press and Circular Advertiser. 


April 5, 1899 



LONDON, 1884. ADELAIDE, 1887. MELBOURNE, 1888. 


BENGERS 


GOLD MEDAL AWARDED 
Health Exhibition, London. 


FOR INFANTS, INVALIDS, 
AND THE AGED. 


FOOD. 


This delicious highly nutritive and most easily digested Pood is 
specially prepared for Infants, and for those whose digestive 
powers have been weakened by illness or age. 


The following letter addressed to F. B. BENGER <Sc GO., Ltd., is published by special ver mixsi/m 

of the Russian Court. 

“ Balmoral Castle , 

“ Scotland, 25tli Sept., 1896. 

‘ ‘ Sirs,—Please forward to Balmoral Castle one 
dozen 2/6 Tins of BENGER’S FOOD for H.I.M. THE 
EMPRESS OF RUSSIA, addressed to Miss Coster. We 
have received the box ordered from Peterhoff. 

“ Yours truly, F. COSTER. 99 


The Lancet describes it as “ Mr. Benger’s admirable preparation.” 

The Medical Press says:—“ Few modern improvements in Pharmacy have done so mnch as 
Benger’s Preparations to assist the Physician in his treatment of the sick.” 

The British Medical Journal says :—“ Benger’s Food has by its excellence established a reputation 
of its own.” 

The Illustrated Medical News says:—“ Infants do remarkably well on it. There is certainly a 
great future before it.” 

A Government Medical Officer writes :—“ I began using your Food when my son was only a fort¬ 
night old, and now (five mouths) he is as fine a boy as you could wish to see.” 

From an eminent Surgeon :—“ After a lengthened experience of Foods, both at home and in India, 
I consider Benger’s Food incomparably superior to any I have ever prescribed.” 

A Lady writes :—“ Really I consider that, humanly speaking, Benger’s Food entirely saved baby ’* 
life. I had tried four other well-known Foods, but he could digest nothing until we began the ‘ Benger.’ 
He is now rosy and fattening rapidly.” 

BENGER’S FOOD is sold in Tins at 1/6, 2/6, and 5/-, by Chemists, &c., everywhere. 

Wholesale of all Wholesale Houses and Shippers, or of the Manufacturers, 

F. B. BENGER & CO., Ltd., Otter Works, Manchester. 

TELEGRAPHIC An ?,?. ess : «« Bender’s, Winn oh eater." 


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(The fUsdiral Srrss anil (Similar. 

“ SALUS POPULI SUPREMA LEX.” 

Vol. CXYIII. WEDNESDAY, APRIL 5, 1899. No. 14. 


©rtginal Communications. 

THE TERM “ CONSERVATIVE SURGERY ” 
AS IT HAS BEEN PROPOSED TO APPLY 
IT TO THE UTERUS AND ITS 
APPENDAGES. 

By LAWSON TAIT, F.R.C.S.Eng., &c., 

Late President of Masons College, and Professor of Gynecology. 

I was very much amused some months ago by 
an article in the Nineteenth Century on Anaesthetics, 
in which it was recommended to the laity that each 
one of us should “ refuse resolutely to take chloroform 
or allow any member of our family to take it without 
first obtaining a guarantee from the anaesthetist that 
he will administer it on an open cloth held at a given 
<fistance from the nose, and that the time taken to 
ut us under shall not be less than eight minutes.” 

was amused because the Nineteenth Century is 
published in London, the very hot-bed of new anaes¬ 
thetics and new methods of administering them. I 
was amused because here was Simpson, of 1851, 
coming back after nearly fifty years and his method 
being forced back on the medical profession through 
a lay journal—an offence of the direst description. 
The offence was resented, of course, by a large 
number of medical journals in this country, on the 
•Continent, and in America, and, of course, the 
greatest amount of fun was to be had out of the 
criticism and opposition of our trans-Atlantic 
friends. One of the most prominent, and I think 
the best of the American medical weeklies had 
a leading article on the subject in which the 
very difficult task was fully accomplished of 
admitting the need and justice of the outcry on 
the part of the patients as voiced by the Nineteenth 
Century. “ The fault in this country,” says the article, 
*' is for the most part limited to the administration of 
ether, where the most inexcusable indifference to the 
patient’s comfort is often demonstrated. The man 
who gives the anaesthetic in a hospital is regularly the 
youngest man on the staff, a fresh graduate with 
theoretic teachings alone, or the example of another 
intern as his guide. The cone soaked with ether is 
crowded down over the patient’s face, and he makes a 
courageous effort to stand it for a time. Very soon, 
however, he struggles to save himself from what these 
patients afterwards describe as a feeling of imminent 
suffocation and death, and gains a breath of fresh air 
only in those cases when the orderly or orderlies are 
unable to hold him down.” It may be a little comfort 
that they are as bad in America in one way as we are 
here in another, but the whole thing is discredit¬ 
able to our profession, and absolutely subversive of any 
claim ever to rank as a science For here we have 
the greatest drug ever introduced, imperatively the 
greatest boon ever granted to humanity after opium, 
that is an ideal ansesthetic to my mind of course 
chloroform; and we are not yet agreed about it, 
its method of administration, its power and its 
method of fatality: in fact, we are agreed only 
that it is an anesthetic. The history of this 
magnificent subject during the half century is a 


record of proceedings not only entirely unscientific, 
but eminently discreditable to a body of men who 
are supposed to have, by their examination in 
Euclid’s six books, to have at least mastered the 
elements of the art and science of logic. It is a 
history of rash and unjustifiable introductions of 
new substances and new methods, going as far as 
the introduction of the old Bubstance under a new 
name, “ a substance much safer, more rapid, more 
and everything better than chloroform ” by a man 
who was for a time a medical Cagliostro. We had, 
of course, hundreds of courses of experiments on 
animals, in India and elsewhere, with conclusions as 
absolutely hostile as well could be. We have had 
initiated only one logical research in the shape of the 
“ Ansesthetic Committee,” inaugurated by our own 
Association which still dawdles its slow length along 
and will report, as I am informed, about the year 
1950. 

If I had time I could illustrate my purpose as well 
in the matter of new drugs, but I shall content 
myself with one short quotation concerning one of 
the newly passing foibles, “ Thyroid ” and its use in 
bleeding fibroids. In the Medical News (Phil.) p. 17, 
Moseley reports “That while some patients can take 
comparatively large doses of thyroid with impunity, 
others are injuriously affected by small amounts ” and 
having established this extraordinary conclusion con¬ 
cerning our cherished sweet-bread, he tells us that 
they have a marked influence in bleeding fibroids, in 
checking the excessive loss of blood, and in some 
cases in diminishing the size of the growth.. His 
observations were extended over five cases, and is an 
example of the sort of thing which almost renders 
our desire to see new drugs kept out of the market 
by Act of Parliament till they had passed through 
mill of judicious and stipendary investigation. 

The fault of this logical deficiency is not, of course, 
confined to affairs medical, for we find the general 
affairs of the whole nation ruled, say at a General 
Election, by the words and votes of the floating residuum 
of voters in the least important, and generally there¬ 
fore the most incompetent electoral country, and we 
seem now to be on the threshold of a vast upheaval 
within the serene demense of our National Church, 
the result of a ruthless spirit of innovation and desire 
for new methods and new manners, not even a 
revival of the good old things so faithfully followed 
by our ancestors for over a thousand years. 

But in mattera medical we oueht to do better than 
that, particularly is it possible in matters of surgery 
when we have proof of results not tangible in the 
sister art of medicine, save within very limited lines. 

For the last forty years, I think, hardly an 
inaugural address dealing with the generalities of the 
advances of surgery has omitted reference to the 
history of ovariotomy as one of its crowning glories. 
But I do not accept the story in that way at all. I 
think the whole thing discreditable, and for one 
reason only, even if no others were available, that 
whereas Nathan Smith penetrated the secret to the 
very depth, and published it in 1827, his great dis¬ 
covery was pushed aside by “ new methods,” and the 

reat advantage of it was withheld from suffering 

umanity for more than half a century. Surgical 


Google 


342 The Medical Press. ORIGINAL COMMUNICATIONS. April 5. 1899. 


historians, writing towards the end of the coming 
century, will not look on this as a brilliant record. 

Arrived at the year 1878 we put the removals of 
ovarian tumours down with a mortality of 5 per cent., 
and then paused to look round. The start of abdo¬ 
minal surgery from this point was made when I 
showed that 100 consecutive exploratory incisions 
could be done with a hardly appreciable mortality, 
and then I formulated and established the law that 
when conditions in the abdomen threatened life or 
made it unbearable, we were justified in opening the 
abdomen to discover the site and nature of the 
disease. Out of this, as a matter of course, arose 
one by one and rapidly, as my records show, all the 
modern and fully accepted operations for gall-stone, 
&c., which now fill large text-books. Among these 
records fully numerous operations on the uterus and 
its appendages, most of which have become classic, 
and will remain so, unless upset for a time by men 
merely restless and new methods wholly unnecessary. 

It is needless to say that in this long battle, going 
over now a period, so far as I am concerned, of more 
than thirty years, I have not, I did not consider it 
necessary, and it certainly would not have been advis¬ 
able to make public every step in the process. Mis¬ 
takes were made, methods employed were found to 
be faulty and unsuccessful, and nothing would have 
been gained by dilating upon them or even drawing 
attention to them. Just as I started, Dieulafoy had 
introduced his aspirator—an instrument in the device 
of which be had been anticipated by Bowditch and 
Protheroe Smith; indeed, by many others, until we 
get back to the Roman surgery of Pompeii; and 
Maisonneuve had fought the battle of the drainage 
tube. The pelvis did not escape either of those pro¬ 
ceedings, and they were fully employed. Between 
1871 and 1878 my carriage bag always had an 
aspirator, but for at least twelve years I have not 
used it. With it I carried a number of ingenious 
devices for making openings in the vagina, and get¬ 
ting drainage tubes into something, never knowing 
exactly what, sometimes curing, but more often fail¬ 
ing to do real permanent good. But as it dawned on 
me that the peritoneum had no real terrors if respect¬ 
fully treated, I found that it was better to ascertain 
accurately what was needed by careful ante-mortem 
examination, rather than make hap-hazard shots from 
below, and after a series of trials came my paper on 
“Treatment of Pelvic Suppuration by Abdominal 
Sutures,” which revolutionised thepracticeof pelvio sur¬ 
gery all over the world. Not only so, but it cleared up 
the pathology of the pelvis and put a stop to the eternal 
and ignorant wrangling about perimetritis and para¬ 
metritis which had gone on for nearly thirty years. 
Of this, of course, the present generation has no need 
to know anything, and truly it does not as may be 
seen from the contents of a paper by Dr. Noble in 
the Philadelphia Medical Journal of July last, 
entitled the “ Conservative Treatment of Pelvic 
Suppuration of Puerperal Origin.” He begins, as is 
not unusual with such people, by references to, and 
conclusions derived, according to his interpretation 
from my own writings, and succeeds, as is equally 
usual, in completely distorting my teaching. He goes 
so far as to quote my own words almost verbatim, 
and then commenting on them in this sentence: 
“ These elementary pathological facts are now gene¬ 
rally recognised, although some years ago they were 
sharply controverted, more especially by the disciples 
of Tait.” 

According to his contention the truth was first 
established by the publication of four cases of “ True 
Pelvic Abscess,” by Dr. Charles P. Noble, in August, 
1891, before English gynsecology was bora. He gives 
his idea of the differential diagnosis between pelvic 
cellulitis and pus-tubes or intraperitoneal abscess (re¬ 
garding these two as the same) and misses the funda¬ 


mental parts of my teaching on this subject first 
published ten year before his paper of 1891, that there 
are two varieties of intraligamentous suppura¬ 
tion, one in the outer half of the layers, which he 
has recognised and another in the inner half, quite as 
easy to recognise, found in the left side, having a 
sign which there is no mistaking, and then he goes 
on to describe such a case which he did not diagnose, 
but mistook when he need not have done; for which 
he opened the abdomen correctly enough but did not 
roceed to complete the operation as he should have 
one. Subsequently he attacked the abscess from the 
vagina, as he might have done at first if he had been at 
all familiar with my teaching, or had been one of 
those disciples upon whom he pours the vials of his 
contempt. 

It is not for such blundering as this that I now 
draw attention to Dr. Noble, but because he is an 
example, though a very bad one, of the clouding 
school of abdominal surgery. Of these most exist in 
Germany, and the movement seems to be reaching 
England, and whilst I Would be the last, by my 
utmost endeavour to deride change merely because 
it was new, I deprecate change when introduced for 
no other purpose than its novelty when its novelty 
leads us off the track of the investigation ot facts 
already quite familiar to us, but concerning which we 
have not arrived at final conclusions. 

That suppuration in the pelvis should not be made 
the subject of surgical rule different from that affect¬ 
ing other regions had to be my cry for nearly ten 
years, or as I put it that a surgical writ Bhall run in 
the pelvis as it does in the knee joint, and I 
carried my point against all comers. The chief 
opposition was, of course, from the uterine tinkerers 
who were overwhelmed by seeing their consulting- 
rooms emptied of the helpless sufferers, who came 
day after day for a glycerine plug, or month after 
month for new pessaries. They raised the cry of 
“ spaying women,’* “emasculation of women ” (a strange 
mixture of etymological definition), and even went so 
far as to say that we surgeons operated for the fees 
at the end of the cases. This cry ceased, however, 
when it was shown that the operating table of the 
surgeon was much cheaper in the long run than the 
consulting-room of the pessary-monger; and, per¬ 
sonally, I am now in a position to say that I should 
have been a much richer man if I had never seen any 
of these cases, for as I had to give bed room to the 
great bulk of them I was out of pocket, and largely, 
by the whole transaction. The strange thing is that 
the cry is still kept up by beardless boys who tell us 
what they can have no personal knowledge of, 
whether it be true or not, “ that the reckless way in 
which, in the past, gynecologists have removed 
uterine appendages without adequate justification, is 
the opprobrium of our art.” In the past I was in the 
habit of checking such nonsense by saying that such 
informers either knew of such proceeding or they 
did not. If they did not they were liars. If they 
did it was their business to give such infor¬ 
mation as would put the offenders on their 
trial for felony; and failing to give such in¬ 
formation, they were themselves accessories after 
the fact, and so liable to indictment. I went so 
far as to serve notice on a well-known London physi¬ 
cian who was guilty of this that I should prosecute 
him if he did it again, and since that time he has 
been quiet. 

Another parrot cry still being repeated was that 
most operations made the patients absolutely sterile. 
But then they were so rendered by the disease before 
our operation. Disease of the knee-joint makes a 
man lame, amputation of the limb confirms the lame¬ 
ness, and the best case of a “ conservative ” result of 
an excised knee-joint I have ever seen did not get 
about free from lameness—in fact, I think the lame- 


April 5, 1899. 


ORIGINAL COMMUNICATIONS. 


Thu Medical Press. 343 


ness was worse than it would have been with a first- 
class artificial limb. Double pyosalpinx renders a 
woman absolutely sterile. Nay more, as a rule she 
cannot have intercourse. Removal of the appendages 
does neither increase nor decrease the sterility, and 
it often removes completely and permanently a 
grave interference with marital life. Opening and 
draining a double pyosalpinx may do as much, but 
that it will cure sterility—pigs may fly, but I have 
yet to see a flight of them. 

Foiled in all such arguments, our critics have 
found another platform, and I take again Dr. Noble 
as my example; he is as good for my purpose as any 
other of the score from which I might select, they are 
all as deficient in logical acumen as he is, they put 
their cases quite as badly, and they are all as open to 
the same suspicion of quackery, there is no use 
mincing terms or using plausible phrases to hide the 
pill which must be swallowed. 

It is forgotten, or, at least, seldom acknowledged 
by gynaecologists, that the adoption of measures does 
not rest with them, but with the mess of the profes¬ 
sion, men in general practice, upon whom rests the 
responsibility of advising their patients for what 
seems to be the best. It is perfectly true that the 
profession will be and must always be governed by 
the weight of a great name, so that I had a very hard 
fight after the International Congress at Londcn in 
1881, when Spencer Wells said that he had only once 
seen such a case as I described in his life. I 
answered by publishing a long series of my own cases 
which had been previously under his own care. This 
cost me his personal friendship, a result I regretted 
as long as he lived, and still regret, but I won the 
battle. I silenced Mathews Duncan by compelling 
him, almost by threats, to come with me to a neigh¬ 
bouring house in London, to see me remove two huge 
bags of pus in a patient under the care of Dr. Chap¬ 
man Gngg, which had quite recently been under that 
of Dr. Duncan. I met the personal difficulty with 
another case in London, when six distinguished prac¬ 
titioners met me and assured themtelves chat I had 
exaggerated my diagnosis, that there was nothing 
much the matter, by taking Keith to London, making 
him operate, and then submitting to them his written 
report of the operation. 

Now another battle rages, and I shall halt no more 
in it than I did in the former, though my fighting 
powers are no longer as sharp as they were, nor my 
taste for warfare as great. We are told once more, 
though the contrary has been proved over and over 
again, that in a considerable majority of cases there is 
diminution or total abolition of the sexual ins.incts 
This is not true, in fact it is absolutely untrue. It is 
a subject on which, of course, the publication offsets 
is extremely difficult, either one way or the other. 
But my own facts establish the conclusion that the 
cases of abolition are extremely few, not more than 
5 per cent., but they get greatly tattled about by 
loose-minded women and by men whose sense of 
honour and proper reticence in matters concerning 
their wives is strangely defective. On the other hand, 
the instances of restitution of marital relations, 
which had been entirely destroyed by disease and 
restored bv the operation required are at least 60 per 
cent, of all the cases. In a few instances the mysteri¬ 
ous fact remains that women who before operation 
had little or no sexual appetite have it developed after 
treatment to an extent which becomes inconvenient. 
I removed the appendages, twelve years ago, of a lady 
noted in public estimation to the highest degree. 
She had had one child, and her husband 
had never shown any sexual response whatever, till 
after the operation, when it became oppressive to him 
and he died. She lived as a widow for three years, 
applying to me from time to time for arrest of this 
symptom, until it got eo bad that I advised removal 


of the uterus, and this I carried out, not only without 
benefit, but rather with an increase of the trouble. 
She greatly objected to the idea of a second marriage, 
and had always resented my advice and the advice 
of her parents, in that direction; but at last, and 
entirely to save her conscience from the reproach of 
wrong, she married again, and a few months ago the 
fact was announced in every paper in Europe. It is, 
therefore, perfectly useless to say that in a few cases 
the sexual tastes aie destroyed What kind of an 
argument it is, I shall consider afterwards, but mean¬ 
time I go on discussing it on what merits it has, to 
prove tne argument, and put in semi-decent form, 
the word “ conservative ” is introduced, a piece of 
rampant deceit and chicanery. 

Dr. Noble has two papers that I have already 
quoted, and another on “ The Conservative Treat¬ 
ment of Fibroid Tumours by Myomectomy.” The 
paper is hardly worth referring to, reeking as it 
does of all the work of Simpson, Penn, Marion 
Sims and others of less note, who brought myomec¬ 
tomy as far as it would go, more than a quarter of a 
century ago, and there it was left by all of us. But 
the paper is a useful warning of a common logical 
error, the use of the indistributed middle term, or 
in plain words, the use of a term devoid of definition 
and employed with various and irreconcileable mean¬ 
ings in the course of the same argument. Thus in the 
one paper he alludes to the preservation of parts of 
ovanes diseased and adherent, and bits of occluded 
tubes as “ conservative surgery,” whilst in the other 
the same thing means removal of the whole uterus, 
the absurdly so-called pan-hysterectomy, revived from 
the moral of Pean’s “ Morcellement," and hashed up 
as something new. 

The term ** conservative Burgery ” was introduced 
by Ferguson in the late “ fifties,” and was the 
cause of a hot feud between him and the more logi¬ 
cally-minded Syme. But, as Ferguson puts it, it 
was fair enough, and became afterwards limited 
almost entirely to its best example, that of excision 
of the knee-joint. Ferguson was a prince of opera¬ 
ting surgeons, and none who can remember his 
magnificent figure and wondrous features, unmoved as 
he made the knife fly, as things in the old days, with 
a rapidity which few eyes could adequately follow, 
can easily believed that such an operation as excision 
of the knee-joint would meet with his strong ap- 

J iroval. In theory it was all right. Conserve the 
ower limb; it must always be better than an arti¬ 
ficial one. But, alas ! though his pupils carried the 
banner of this conservatism far and wide, it did not 
keep its promise, and on Syme’s face there was to be 
seen, and then only, that strange little smile of 
triumph as he lopped off a “ conserved leg.” " Con¬ 
serve the parts,’ was his only comment, and the 
operation took, a back seat, and occupies now a very 
restricted area. 

Fancy my astonishment, therefore, when I read in 
the second paragraph of Dr. Noble’s second paper 
this sentence :—“ In the recent past true conservatism 
—that is, the welfare of the patient—has required,” 
&c. This is another theory, and completely confirms 
my lifelong belief in politics that the advanced 
Liberal is the truest Conservative. Certainly, with 
this definition, we all are, all hope to be, all must 
strive to be, truly conservative. But why should Dr. 
Noble pretend to be that and exclude others equally 
earnest in their efforts, and why should he use for 
himself a phrase which reminds one of the story of 
the two men who went up into the temple to pray. 
If he claims exclusively to be a Conservative, then I 
say he is also a Pharisee, as are also those who use 
this phrase as he uses it. 

Fot what is its real intention, other than to declare 
that he has, and uses, a method of operating which 
conserves the sexual instinct, as he plainly does in 



344 The Medical Pbess. ORIGINAL COMMUNICATIONS. April 5, 1899. 


his concluding sentence, together with a hope that 
the sterility may not be complete, nor completed. 

In all such cases the probability of the restoration 
of fertility is so minute in these cases that it is wholly 
unworthy of discussion or acceptance, save in some 
very unusual set of conditions, as when the succession 
to a crown is concerned, and then I, for one, would 
not accept the responsibility. Crowned persons are 
a rule unto themselves, and I never cared to share in 
the government. For the general public the terrible ; 
facts of over population, and the fact that of all 
children born one half die before they are five years was I 
enough to dismiss such a bagatelle from my mind. j 
When such patients have been married for years and ' 
remained sterile, it may be assumed that the sterility 1 
is complete, and when the mischief has resulted after ; 
the birth of one or more children the patients them- j 
selves usually dismiss the argument with impatience. 
The second question, I find, is now being directed ' 
towards the apprehension of the husband more 
than to his partner, and here is where the quackery 
comes in. 

In a recent case where I was concerned, and where 
it was strongly wished that the case should be got 
out of my hands, it was urged that where on the one 
hand I would geld his wife and make her like a log of 
wood, another surgeon who was strongly recommended 
as of the Conservative school, would leave her active, 
the husband promptly replied that the case was that 
of his wife not that of a strumpet, and the efforts 
failed. I confess that this is how I should look at 
the question, especially in the light of the published 
experience of Laudson and others who are practically 
the leaders of this new movement, aided by what is 
probably of far more importance, my own wish and 
longer established experience. The whole thing is based 
on a misconception of the function of the ovaries, which 
have no more to do with the sexual appetite than the 
kidneys. Nor have the Fallopian tubes, nor the 
uterus; as it is maintained, and as I have proved, 
sometimes increased by the complete absence of all 
five. The two most erotic women I have ever come 
across were two sisters in whom not the slightest 
trace of uterus or ovaries could be determined, and 
in one of them I had positive knowledge of the fact 
of that complete absence when I operated upon her 
for tuberculous peritonitis. They were in good social 
position, were not insane, jyet no kind of inducement, 
social, parental or restrictive could prevail upon these 
women to refrain from inspiring every man with 
whom they could get an opportunity to have inter¬ 
course with them, and faute de mieux, they were 
confirmed Sapphists. 

Finally is it an argument, even if it could be sus¬ 
tained, which we, as surgeons, can give weight toP • 

I do not often quote Scripture, but I think that a 
great clinical lesson on this subject may be got in the 
6th Chapter of Matthew, when at the 29th verse we 
are told that “ if thy right eye offend thee, pluck it 
out, and cast it from thee. And if thy right hand 
offend thee, cut it off and cast it from thee; for it 
is profitable for thee that one of thy members should 
perish, and not that thy whole body should be ” in; 
lected with bacilli, a lesson which is still more em¬ 
phatically localised as pertinent to the present man 
by my national poet in words which read— 

“ Geld you, quo he, and what for no ? 

If that your right hand, leg or toe, 

Should ever prove your spiritual foe 
You should remember 
To cut it off—and what for no 

Your dearest member ? ” 

We are not called upon to play the part of moralists, 
but this we are called upon to do, to adopt as our 
guiding principle to do the best we can for our 
patients and for our art, and then for ourselves. I ( 


have always held in detestation any surgical pro¬ 
ceeding which brings with it a risk that the patient 
shall have to submit to a second operation. I have, 
therefore, always steadily opposed all operations for 
malignant disease undoubtedly pronounced. Nothing 
brings so much discredit on our art, nothing so much 
discredits the individual practitioner. Not only so, 
but second operations in the pelvis are always more 
difficult than, the first, and according to all published 
facts far more fatal than operations completed at 
first. So much is this the case that I have been 
driven by the stern logic of facts to advise a more 
complete operation than ever in certain kinds of 
disease of the appendages. I refer to those in very 
young women, when the mischief has arisen appa¬ 
rently at, or even before, the molimenal period. 1 am 
certain that of all the cases of suffering from the 
results of chronic inflammation of the uterine appen¬ 
dages they sufEer the most, their sufferings begin 
sooonest, and they are the most difficult to relieve. 
Among them I have had my worst and most bitter 
disappointments of relief expected, and have had 
discredit in this class of cases. About eight years 
ago I removed the uterus in one young lady, from 
whom I had removed the appendages thirteen 
years before, not only with a failure as 
a result, but I had made her worse; she 
had taken to drinking, been placed in an asylum, and 
had altogether gone to the bad. I removed her 
uterus and cured ner promptly and, after nearly eight 
years’ success, I think I may say permanently. I 
followed this case up, and hunted up a number of my 
known failures, removed the uterus in eleven more 
cases, and have succeeded in all, and I am now hunting 
up some more. ThiB is conservative surgery. As a 
cross to it, I was called to London a few weeks ago to 
a consultation with one of the eminent West-end 
doctors in a case of this kind. I advised a complete 
removal, but the patient was conservative in the 
other way. She was sure that it was all in the right 
ovary, and the right ovary alone was to be removed. 
After much arguing and a full understanding in black 
and white, I consented to divide the operation, and 
removed the right ovary and tube. We shall see. I 
do not usually accept a fettered condition such as 
this, but my colleague is a man for whom I have a 
great reverence, and he took the responsibility; 
therefore, I acquiesced. 

My belief is consummate in such radical surgery 
as will preserve my patients from further risk, and 
I do not regard the sexual appetite argument ” as 
worthy of any but the brothel-keeper, with whom it 
would, of course, have great weight. Concerning the 
surgical difficulties and dangers of the so-called 
“ conservative ” operation, my old experience of the 
early “ seventies are confirmed in a paper by Mr. 
Stanmore Bishop, in the Medical Press and 
Circular for November 23rd, 1898, and I need do 
no more than refer to that common-sense contribution 
to the subject. 


ADENOMA UNIVERSALE OF THE 
ENDOMETRIUM 

INFILTRATING THE MYOMETRIUM IN A 
VIRGIN, FORMING AN ABDOMINAL TUMOUR 
-PAN-HYSTERECTOMY—RECOVERY. 

By JAMES OLIVER, M.D., F.R.S.Ed., F.L.S., 

Physician to the Hospital for Women, London. 

The patient who is the subject of this annotation 
is a virgin. She came under my care in the first 
instance in November, 1895, and was then only 
34 years of age. Menstruation was not established 
until she was 18, and during the four succeeding 



April 5, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 345 


years, i.e., until the patient was 22, the menstrual dis¬ 
charge appears to have been moderate in amount. It 
thereafter became more profuse, and during the last 
ten years it has on several occasions (about twelve in 
all) been extremely abundant. The menstrual period 
preceding her visit to me had been a profuse one and 
nad lasted six weeks and she was very anaemic in 
consequence. She had never experienced pain in 
association with menstruation. The following are 
the physical signs which were noted in November, 
1895. The hypogastrium is occupied by a small 
globular and regular swelling which arises from 
the pelvis and extends to two and a half inches 
above the pubes. It is uniformly firm in consistence. 
The hymen is intact. Hanging from the cervix uteri 
are two mucous polypi of about the size of Bmall hazel 
nuts. The hypogastric tumour is the uterus enlarged. 
On this occasion I merely removed the polypi. The 
patient thereafter enjoyed fairly good health, losing 
occasionally rather freely until October, 1897, when 
she consulted me because she had been losing con¬ 
tinuously for eight weeks. The physical signs then 
noted were the following. The hypogastric tumour 
is Blightly larger than it was in November, 1895, and 
its consistence is hard. Hanging from the cervix 
uteri is a mucous polypus of about the size of a large 
hazel nut. I now advised not only that the polypus 
should be ‘removed, but that the uterus should be 
dilated and explored. By means of a somewhat sharp 
spoon I removed on this occasion from the cavity of 
the uterus nearly, a teacupful of material which when 
examined under the microscope presented the appear¬ 
ance of a simple adenoma. The size of the uterus 
was thus so greatly reduced that it could not be 
detected abdominally. About two months after this 
operation patient began to complain of a watery dis¬ 
charge from the vagina, and in consequence of this 
troublesome symptom which necessitated in May, 
1898, the use of three and four diapers a day, 
she again came under ray care. I then found 
that the hypogastric tumour had reappeared, 
and that the uterus was of about the same size 
as it was prior to the last operation. Before submit¬ 
ting the patient to hysterectomy I decided to curette 
freely the endometrium once more, and this I did, 
removing again about a teacupful of adenoid mate¬ 
rial. The watery discharge reappeared soon after 
this operation, and as it became more and more dis¬ 
tressing the patient sought my advice again in 
October after an interval of only five months. The 
hypogastric tumour had now re-appeared, and was 
as Dig as it had ever been. I now advised, and per¬ 
formed, the operation of pan-hysterectomy, remov¬ 
ing the whole uterus by the abdominal way. The 
broad ligament on each side was secured by three 
ligatures of silk. The lower ligature only on each 
side, namely, that including the uterine artery was 
pulled down into the vaginal canal and was left long; 
the other ligatures were cut short. With fine silk 
the peritoneum at the top of the bladder was stitched 
to the peritoneum, whicn had entered into the for¬ 
mation of Douglas’s pouch, and thus the peritoneal 
cavity was shut off from the vaginal canal. The 
patient made an excellent recovery, and was able to 
go to the seaside after the operation. 

The uterus weighed twenty-eight ounces, and was 
equal in size to that containing a tnree months’ fcetus. 
On opening the organ anteriorly by a triangular 
flap, reflected from the cervix towards the fundus, 
the endometrium (corporeal and cervical) showed 
myriads of smooth prominences varying in size 
from that of a split pea to a walnut. Most of these 
new growths were practically sessile but a few were 
polypoid. The muscular tissue of the organ generally 
was much thickened, and to the naked eye even it was 
apparent that the new growth had infiltrated exten¬ 
sively this structure. Sections of the smooth pro¬ 


minences and of the underlying muscular tissue dis¬ 
play under the microscope the appearances charac¬ 
teristic of adenomata, namely, tubes lined with 
cylindrical epithelium. 

On account of the manner in which the neoplasm 
invades the muscular tissue of the organ, pathologists 
will aflirm that the disease is malignant. In attempt¬ 
ing, however, to settle this important question we 
cannot accept the tenets of the pathologist alone and 
discard altogether the clinical facts. In November, 
1895, when the patient in the first instance came under 
my care, the enlarged uterus formed a hypogastric 
tumour which was then almost, if not quite as large 
as it ever was on any subsequent occasion. At 
this period the muscular tissue was already 
extensively infiltrated by the new growth, as the 
consistence of the uterine tumour was on this occa¬ 
sion as firm as it was at the time the operation of 

r -hysterectomy was performed. It is impossible 
us to surmise how long the hypogastric tumour 
may have existed before the patient came under my 
care; as, however, it increased but little in size 
between November, 1895, and October, 1897—a period 
of nearly two years—it is more than probable that it 
had been in existence, and had maintained a more or 
less stationary state, for several years. It is quite 
evident that the disease must have progressed slowly, 
as the prolonged and excessive haemorrhage, which 
occurred when the patient was as yet only 24 years 
of age, was undoubtedly due to the neoplasm having 
already attacked the endometrium. With a clinical 
history, such as we have here presented, one would 
hesitate to characterise the disease as malignant. In 
the case which I have just recorded the specimen is 
an unique one, and the patient is probably the 
youngest that has ever been reported with adenoma¬ 
tous disease of the endometrium of so extensive a 
character. 

It is an interesting fact that the lining of the cornua 
uteri in horned ruminants shows smooth prominences 
devoid, however, of utricular pores. They are called 
“caruncles” or “cotyledonal processes, and they 
increase in number with the size of the species. In 
the giraffe as many as eighty of these processes may 
be detected. In the bison they are softer, thicker, 
and more obtuse than in the giraffe, and they are 
less regularly disposed than in the latter animal. 
They are also very pronounced in the uterine cornua 
of the goat and sheep. When gestation occurs in 
animals possessing these cotyledonal processes their 
surfaces which previously were smooth become some- 
'what papillose, and into the depressions thus formed 
the chorionic villi are thrust, and are there retained 
until parturition takes place. At birth the foetal 
villi are withdrawn from the maternal processes, an d 
soon afterwards the surfaces of the latter become 
again smooth. Occasionally the entire caruncle is 
shed after parturition, and when this happens it is 
never reproduced. 

Prof. Mettam, of the Royal Veterinary College, 
Edinburgh, informs me that the cotyledons in homed 
ruminants are upheavals of the mucous membrane, 
contain a good deal of corium and are very vascular. 
They are covered by the ordinary epithelelium. 

Now, the disease which I have just described as 
occurring in the human female is an overgrowth of 
the lining membrane of the uterus, and we may 
perhaps be justified in believing that it is the revela¬ 
tion of a “ reversion to type ” tendency. 


The magistrates at St. Albans have decided that 
bread is meat. A man had been prosecuted under 
the Poisonous Meat Act for having thrown some 
poisoned bread to his neighbour’s hens. He was 
accordingly convicted. 

Digitized byGoOgk 



346 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


. April 5, 1899 


ON THE PREVALENCE OF TUBERCU¬ 
LOSIS IN IRELAND AND THE 
MEASURES NECESSARY FOR 
ITS PREVENTION, (a) 

By THOMAS W. GRIMSHAW, 

President of the Medical Section of the Royal Academy of Medicine 
of Ireland, Vice-President of the Statistical Soc. of Ire. Ac. 

After some introductory remarks the author pro¬ 
ceeded to analyse the principal statistics of tuber¬ 
culosis, and especially ot phthisis mortality in Ireland, 
the analysis being mainly founded on a table of the 
deaths from tuberculosis in children under 5 years of 
age, and of phthisis at the various ages of active life 
from 15 to 45, in town and country districts. The 
result of this analysis showed the following remark¬ 
able results :—During the three years dealt with in 
the table, 1895, 1896 and 1897, the average annual 
death-rate from all causes for Ireland was 17 3 per 
1,000; the rate for the town districts (that is towns 
with a population of 10,000, and upwards) was 25 4, 
and for the rest of Ireland 152. .For Ireland the 
death-rate from all tuberculous diseases, exclusive of 
phthisis, was 0'7 per 1,000 for country districts 0 4, 
for town districts 15 or nearly four times the latter 
rate. For consumption alone the rates were 
for Ireland 2*0, for country districts 1‘7, for 
town districts 33, or nearly double the usual 
rate. Taking all forms of tuberculous disease, 
the rate for Ireland was 2 7—for country districts the 
rate was 2T, for town districts 4 8, or more than 
double. In the districts with six large towns the 
rates were—from all causes 26'2, as compared with 
15 2 in country districts; from tuberculosis other 
than phthisis 1'6, against 0 4, or exactly four times 
the rate; for phthisis 3 5, against 1*7, or slightly more 
than double the rate; and for all forms of tubercu¬ 
losis combined 5T against 2T, or considerably more 
than double as compared with country districts. It 
will be observed that by far the most important 
cause of death dealt with in the foregoing remarks is 
phthisis. This disease alone caused 11*7 per cent, of 
all the deaths in Ireland during the period under 
consideration, the percentage for the districts with 
towns of over20,000 population being 133. for those with 
towns of 10,000inhabitants and upwards 13 - 2, or slightly 
less, as compared with UT per cent, for the rest of 
Ireland. These figures point to a conclusion which to 
many will be somewhat unexpected, namely, that the 
proportion of deaths from consumption to total deaths is 
very high even in the country districts of Ireland. If 
we compare the death-rate from tuberculous disease 
in the six great town districts of Ireland as 
measured by the general population we find that of 
the forms of tuberculosis other than phthisis—Dublin 
and Belfast are the same, l - 8 per 1,000; Londonderry 
next, 1'6; Waterford 1"2; Cork 11; and Limerick 
0 7 only. In the case of phthisis we find Belfast leads 
with a rate of 3 9, Cork follows with 3‘8, then in order 
Dublin S'S, Waterford 3 2, Limerick, 30, London¬ 
derry 2'5. These figures are sufficiently serious, but 
when we consider the question of the ages at which 
tuberculous diseases are most fatal we find still more 
alarming results. In the case of death-rates there 
may be some errors owing to unestimated variations 
i n population since the last Census, but when we con¬ 
sider the rates of deaths from tuberculosis to those 
from all causes of death this element of doubt 
has little or no significance. 1 shall first deal 
with the question of tuberculosis as its affects young 
children—by this I mean children under five years of 
age. It has been shown by Sir Richard Thome, and 


(0) Abitraot of paper reftd before the meeting of the Academy of 
Medicine of Ireland (Section of 8tate Medicine), Feb. 17th, 1890. 


by the report of the British Medical Association, 
that the tendency to the disease of tuberculosis 
among young children in England and Wales is not 
so marked as it is in the case of phthisis. The 
forms of tuberculosis which kill young children are 
tabes mesenteries, tuberculous meningitis, and forms 
of tubercle other than pulmonary consumption. We 
find that in Ireland the death rate of children under 
5 years of age from these forms of tuberculosis was 
3 5 per 1,000 living at this age period. In the dis¬ 
tricts with towns of 10,000 and upwards the rate was 
8 7 as compared with 2'0 in country districts, or more 
than four timeB the rate. In the six large towns taken 
collectively it rises to 9'4. in Dublin it reaches 110, 
and in Belfast 10 0. In the other it is considerably 
below the 10,000 town’s rate, the rate for Limerick 
being only 3 3, or less than the average rate for 
Ireland. The very high proportion of deaths in Dublin 
and Belfast is very remarkable and very serious. If 
we now pass to the more active periods of life, and 
consider the deaths from tuberculosis between the 
ages of 15 and 45, the main working periods of life, 
we find that in Ireland during these age periods the 
death-rate from tuberculosis of all kinds was 3'8 per 
1,000 living at these ages (out of a total rate of 7 9 
from all causes, being nearly one half), 6f which the 
phthisis rate was 3'5. In the towns of 10,000 and 
upwards the rate was 5’5 out of a total rate of 12 2, of 
which the phthisis rate was 5‘1. In the six large 
towns the rate was 5 7 out of a total rate of 12‘6, 
phthisis having a rate of 5'3 It will be observed in 
the foregoing statement the death-rate from phthisis 
dominates the whole series of figures, and therefore 
we may confine our attention in detail to the propor¬ 
tion of deaths from that form of tuberculous disease, 
and here I shall deal only with the proportion of 
deaths from phthisis to the total number of deaths, 
as showing in the clearest manner the immense 
amount of damage done by phthisis at the most 
active periods of life in Ireland. At all the age periods 
from 15 to 45, except that between 35 and 45 the 
proportion of deaths from phthisis to total deaths in 
the country districts exceeds that in the town dis¬ 
tricts (of' populations of 10,000 and upwards) when 
taken collectively, and that this is also true of the 
towns with a population of 20,000 and upwards when 
compared with the country districts. Taking Ireland 
as a whole we find that during the whole age period 
of 15 to 45 the deaths from phthisi constituted 43 5 
per cent., in the period from 15 to 35, 49 6 per cent., 
or nearly one-half, in that from 15 to 25—which is 
apparently the most fatal age period— 52’8 per cent., 
or more than one-half, from 25 to 35, 46T per cent., 
and from 35 to 45, 291 per cent., compared with a 
total for all ages of 11'7 per cent, of the total deaths. 
It is important to emphasise the fact that the age at 
which phthisis causes the greatest proportion of the 
total mortality in Ireland is during the age period of 
15 to 25, and to point out that the percentage 
of deaths to total deaths during this period 
reaches the terrible total of 44'6 per cent, in Dublin. 
55‘4 per cent, in Belfast, 54'4 per cent, in Cork, 56 3 
per cent, in Limerick, 52 5 per cent, in Londonderry, 
and no less than 58*6 per cent, in Waterford. In the 
next decade of life, 25 to 35, the percentages fall some¬ 
what in each case, but are still so near one half of all 
the deaths at that age as to excite considerable alarm 
as to the ultimate result to what ought to be the 
most active portion of the community. I would again 
point out that this table is founded on the most 
recent information available at the present time. Dr. 
Grimshaw then proceeded to point to the remedies 
and mainly relied on those put forward in the report 
of the Tuberculosis Committee of the British Medical 
Association, and quoted with approval the recom¬ 
mendations of the last Royal Commission on 
Tuberculosis. 


Digitized by 


L-b 




le 



April 5, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Bbesb. 347 


^hc <§oulstom*n lectures 

ON THE 

PATHOLOGY OF THE THYROID 
GLAND. 


Abstract of Lecture I, delivered before the Royal 
College of Physicians of London. 

By GEORGE R. MURRAY, M.A., M.D.Camb., F.R.C.P., 

Heath Professor of Comparative Pathology in the University of 
Durham; Physician to the Royal Infirmary, Newcastle- 
upon-Tyne. 

The embryology and comparative anatomy of the 
thyroid gland furnish ua with important information as 
to the origin of its present situation, structure, and func¬ 
tion in man. The fully-developed gland consists of three 
parts, two lateral lobes and the isthmus which unites 
them. The two lobes are closely applied to the sides of 
the larynx and trachea, and extend backwards as far as 
the sides of the pharynx and cesophagus. At the level 
of the isthmus the recurrent laryngeal nerve lies in 
the angle between the oesophagus and the trachea, 
being covered externally by the lateral lobe of the 
gland on each side, In front the gland is covered by the 
stemo-hyoid, sterno-thyroid, and omo-hyoid muscles. 
Laterally the lobes extend outwards in front of the com¬ 
mon carotid arteries. Each lateral lobe is shaped some¬ 
what like an almond, but the upper end is narrower and 
more pointed than the lower. The lower end lies on the 
fifth or sixth ring of the trachea, while the upper is 
generally on a level with the middle of the thyroid 
cartilage. The position of the isthmus varies, but it 
generally lies in front of the second, third, and fourth 
rings of the trachea. In many cases, variously esti¬ 
mated at from 40 to 68 per cent., the pyramid or middle 
lobe extends as a thin process from the isthmus or from 
a neighbouring part of one of the lateral lobes up to the 
hyoid bone, to which it is attached by muscular or fibrous 
tissue. The gland is firmly fixed to the larynx and 
trachea by fibrous tissue, so that it follows the move¬ 
ments of these structures which take place during 
deglutition. The gland when freshly removed is of a 
dark brown-red colour. It usually weighs fr^m an ounce 
to an ounce-and-a-half (30 to50 grams). It is relatively 
larger in the infant than in the adult. The whole gland, 
however, iB liable to considerable variations in structure, 
such as inequality in size between the two lobes, absence 
•of one lobe, and absence or irregularity of the isthmus. 

There is a rich blood supply from four arteries, the 
superior and inferior thyroid arteries on each side, and in 
3ome cases there is a further supply by the thyroidea ima. 

Externally the gland is invested by a firm fibrous 
capsule from which septa extend inwards, partially 
dividing it into lobules of various sizes. The glandular 
structure consists of large numbers of closely aggre¬ 
gated follicles which vary in size and shape. The 
colloid substance which occupies the central Bpace 
of the alveolus is a yellow glairy fluid which stains 
uniformly in microscopical sections. Scattered through 
it may sometimes be seen white blood corpuscles, 
epithelial cells, and the remains of red blood corpuscles 
undergoing degenerative changes. 

The colloid substance is the secretion of the epithelial 
-cells which line the alveoli Hurthle has shown by observa¬ 
tions made on normal glands and on portions of gland in 
which increased secretory activity had been stimulated 
either by removal of the greater part of the gland or by 
ligature of the bile duct so as to cause absorption of bile 
products into the blood, that the secretion may be 
formed by the epithelial cells in two ways. The colloid 
may be either formed in droplets in the cells and then 
gradually extruded into the lumen of the alveolus, or 
whole cells may break down and be discharged into the 
colloid substance, a part of which they thus help to form. 
In the first method the same cell continues to secrete, 
while in the second its place iB taken by one of the 
reserve cells. It is doubtful if both these methods obtain 
during normal secretion, the first beiDg probably the 


usual manner in which secretion takes place. The large 
amount of secretion which is found in many alveoli indi¬ 
cates that under ordinary circumstances it is not dis¬ 
charged as soon as it is formed, but that the central 
portion of the alveolus serves as a resetvoir where the 
secretion is stored for a time before it finally escapes 
from the gland. 

Ab the thyroid is a ductless gland it is clear that the 
secretion can only escape by either the lymphatics or the 
veins. The evidence we possess shows that the former 
is the usual path, for it was shown by King and by 
Horsley, that by applying pressure to the gland the 
colloid could be squeezed from the acini into the inter- 
acinous lymphatic spaces, where it could be seen with 
the microscope. Biondi and Hurthle have found that 
this escape of the secretion from the alveolus may occur 
in two ways. The wall of the alveolus, not necessarily 
as the result of distension, becomes thinned out at one 
point and finally ruptures, allowing the colloid to escape 
directly into the lymphatic space outside, while the empty 
follicle collapses and forms the starting point for the 
growth of a new one. Hurthle has found that the secre¬ 
tion can also pass out from the alveolus without rupture 
of the wall. He injected Berlin blue into the lymphatic 
spaces of the gland, using an intermittent pressure, and 
found that it passed on into the interior of the alveoli 
through minute intercellular channels, in which it could be 
seen. He also found that when the secretory activity was 
stimulated the colloid itself could be seen lying in these 
intercellular channels continuous with the colloid in the 
alveolus at one end and with that filling the lymph 
spaceB at the other, proving that it was passing from the 
former position to the latter. By one or other of these 
methods, the secretion flows into and mingles with the 
lymph, which bathes the interalveolar spaces of the 
gland, and with it flows along the path already described 
to be discharged into the blood stream in the innominate 
vein, and so distributed to all partB of the body. 

No doubt, as in other glands, the activity of secretion 
varies according to circumstances. Of these, however, 
we possess but little information Stimulation of the 
laryngeal nerves or of the sympathetic with the faradic 
current produces no change indicative of increased secre¬ 
tion. Pilocarpin produces a marked increase in the 
secretion of the colloid, as was shown by Wyss, and 
Schaffer found that the changes produced in the cells 
were similar to those which occur in other secretory 
glands under the stimulating influence of this drug. As 
already mentioned, the presence of an excess of bile con¬ 
stituents in the blood after ligature of the bile duct also 
stimulates thyroidal secretion. Removal of the greater 
part of the gland was also shown by Hurthle to serve as 
a stimulus to more active secretion in the remaining 
portion. 

At one time the thyroid gland was considered to be 
an excretory rather than a secretory gland, and the ex¬ 
cretion a mucinoid Rubstance, the retention of which led 
to an accumulation of mucin in the body and the pro¬ 
duction of the subcutaneous swelling in myxoedema. 

Further investigation has shown that the colloid sub¬ 
stance is a true Becretion which does not contain mucin. 
Our knowledge of the actual composition of this secre¬ 
tion is by no means complete, but several important 
constituents have now been separated from it. Most of 
those who have examined the composition of the secre¬ 
tion have considered the proteids to be the important and 
active constituents of it. Notkin regards thyreoproteid, 
a substance which he isolated from the gland, as an 
active constituent which behaves like an enzyme. 
Gourlay found that a nucleoproteid was the only proteid 
to be obtained from the thyroid in any quantity, and 
that it contained phosphorus, which by Morkutun’s 
analysis has been shown to amount to 0‘32 per cent. 
Baumann and Roos made the important discovery that 
the colloid substance contains iodine in an organic com¬ 
bination with proteid which they named “ thyroiodin.” 
This substance contains 9 3 per cent, of iodine, and 0 56 
per cent, of phosphorus. 

Hutchison has found that two proteids are contained 
in the gland—a nucleo albumen, which is contained in 
the epithelial cells and the colloid material which fills 
the acini. The formed secretion of the gland is split up 


348 The Medical Press. ORIGINAL COMMUNICATIONS. April 5,1899 


by gastric digestion into two parts, one of which is pro- 
teid, contains only a small amount of iodine, and has but 
slight physiological action; the other is non-proteid, 
contains more iodine, and all the phosphorus of the 
original colloid, and is more active in removing sym¬ 
ptoms due to loss of thyroid secretion than the proteid 
portion. S. Fraenkel obtained a crystalline substance 
with the formula C g H u N s 0 5 from the gland, which he 
named “ thyieo-antitoxin.” There is, however, no satis¬ 
factory evidence to show that this body is endowed with 
active properties. 

It is evident from these observations that the secre¬ 
tion is a complex body, and we cannot as yet say whether 
its remarkable properties depend on one or, as is more 
probable, several constituents. Be this as it may, we 
shall now consider what functions are fulfilled by the 
secretion as a whole, for that is the form in which it 
mingles with the blood, and is thereby conveyed to the 
tissues. 

A large amount of valuable information as to the 
properties and functions of this secretion has been ob¬ 
tained by observing what occurs when it is no longer 
resent in the blood. This state of affairs is easily 
rought about by removal of the gland from an animal. 
Owing to the superficial position of the gland in the 
neck, this operation can easily be performed so as to 
entail no other secondary result than the loss of thyroid 
secretion forthwith, provided only that the parathyroid 
glands are not attached to the gland and removed with 
it, in which event the effects observed are the results of 
thyroidectomy plus parathyroidectomy. In man the 
results of failure of the normal supply of thyroid secre¬ 
tion from disease of the gland are seen in primary 
myxcedema, and from removal of the gland for goitre in 
secondary myxcedema, or cachexia strumipriva, as it is 
also called. 

My own observations of the results of thyroidectomy 
have been made on rabbits and monkeys. It has, how¬ 
ever, been shown that although no effects have been 
observed in fishes; in lizards, and snakes, the operation 
is followed by loss of strength and activity, ending in 
death in the course ot a few weeks. 

My own observations show that, although the immedi¬ 
ate effects of thyroidectomy are very slight, after a long 
interval a chronic cachexia develops closely resembling 
myxcedema in man. Thus in two rabbits which were 
kept for a long time under observation after the thyroid 
gland had been removed, there was an early development 
of hebetude and loss of appetite. No further change 
was noticed until an interval of eleven months in one 
case and twelve in the other had elapsed after the opera¬ 
tion. After this, in addition to the hebetude already 
mentioned, swelling of the subcutaneous tissues, dryness 
of the skin, loss of hair, and subnormal temperature 
developed, an entirely different condition to that 
described by Gley after removal of the parathyroids as 
well. These slides show you the appearance of one of 
these animals killed eleven months after the operation, 
and the ears of the other killed twenty-one months after. 
The ears were very dry, and rough, and cold to the touoh, 
though they flushed readily when handled. The edges 
of the ears were dry and cracked to a depth of i in. In 
many places this dried margin had broken off, leaving 
an irregular outline to the ear. In a third rabbit, which 
was kept for twenty-seven months after thyroidectomy, 
no symptoms appeared. When the animal was killed the 
reason of this was found to be that some of the glandular 
tissue had unintentionally been left at the time of the 
operation, and had undergone compensatory hypertrophy. 
The total amount of thyroid tissue found weighed only 
0-07 gram, or about one-third the weight of a complete 
gland, but it had been sufficient to maintain an adequate 
supply of secretion for more than two years. 

DogB and cats both develop a rapidly fatal cachexia 
after thyroidectomy, but the most important results of 
all have been obtained in monkeys, which have been 
employed by Munk, Horsley, and myself. In the bonnet 
monkey (macacus sinicus), which I have used, with one 
exception, in all my experiments, a parathyroid gland 
lies in close connection with, or actually embedded in, 
each lobe of the thyroid gland. As a result of thiB, 
when the thyroid gland is removed the parathyroids are 


removed along with it. It would be difficult to remove 
the one without the other, for distinctly as the parathy¬ 
roid can be seen in a transverse section, it is much 
more difficult to see it during life while the gland is in. 
situ. In two recent experiments I was unable to detect, 
even with a lens, the parathyroids on either side and 
remove them without the thyroid gland; they were, 
however, easily seen in transverse sections of the lateral 
lobes after removal of the whole gland. It is, therefore, 
important to bear in mind that thyroidectomy in the 
monkey involves removal of the parathyroids as well, so 
that the symptoms which occur afterwards are not solely 
due to loss of thyroid secretion, but in part are due to 
loss of the parathroids as well. 

I have removed the whole or a part of the thyroid 
gland in nine bonnet monkeys and one rhesus monkey, 
in four of the former the symptoms were allowed to- 
develop with the object of testing the influences of 
various preparations of the thyroid gland upon them. 
Some symptoms also occurred in the others, but these 
four form the basis for the description of the symptoms 
which result from the operation. These symptoms 
have been very carefully described by Horsley, but they 
have such an important bearing upon the whole subject 
that I shall briefly describe what I was able to observe 
in my own experiments. 

After the operation the animals have been kept in a 
room, the temperature of which ranged between 60 degs. 
and 70 degs. F. In about five days the symptoms first 
begin to develop, the early symptoms being entirely 
nervous. One of the first to appear is a fine regular 
tremor, which is most easily seen in the upper limbs, but 
which is also plainly visible in the lower limbs as well 
when the animal is held with the feet unsupported. 
Along with the tremor there is a marked change in the 
whole demeanour, which is the more noticeable owing to 
the naturally lively disposition and active habits of the 
healthy monkey. There is progressive apathy, with lose 
of natural curiosity and interest in surrounding objects, 
while the temper is irritable, interference being resented. 
There is loss of activity, as the animal sits still in one 
place on a perch or on the floor of the cage for long 
periods withe ut moving and increasing loss of muscular 
power, as climbing is done more slowly, and evidently 
with greater effort, as the symptoms advance. The 
attitude assumed is characteristic, the head is bent, 
the trunk curved forward, and the knees drawn up, 
so that the chin rests upon them, the joints of all 
four limbs being in a position of flexion. Con¬ 
tractures owing to tonic spasm of the flexor muscles 
frequently occur; in fact, I believe this attitude is partly 
a result of these contractures, as the limbs are often 
found to be rigid when it is adopted. Clonic contrac¬ 
tions of the muscles are common. There may be a 
single contraction of a group of flexor muscles, or a 
series of three or four may involve all the flexors of one 
arm, increasing in intensity until a position of extreme 
flexion at all the joints is reached, after which xelaxa- 
tion takes place until another series occurs. Irregular 
fibrillary contractions of the superficial muscles are 
often visible through the skin. In consequence of 
these symptoms the gait is stiff and unsteady, and when 
the contracture is excessive the animal is obliged to - 
walk on the heels owing to the tonic spasm of the flexors 
of the ankle raising the toes and sole of the foot from 
the ground. There is a marked tendency to fall over 
backwards, bo that if a banana is held over the animal’s 
head it loses its balance in looking upwards at it and 
falls over backwards, and a very slight push when the 
animal is sitting haB a similar effect. True epileptic 
fits of greater or less intensity may occur. There may 
be a sudden loss of consciousness, so that if the monkey 
is on the perch at the time, it falls to the ground. The 
temperature at first is raised and irregular, but soon 
becomes subnormal. 

During the second and third weekB the myxoedematous 
swelling becomes distinct, and as in man is most apparent 
in the face. Both upper and lower eyelids become 
swollen, and with this there is sometimes transverse 
wrinkling of the forehead. Both lips are also swollen by 
the elastic oedema. Examination of the blood showa 


A PHIL 5, 1899. 


CLTNTCAL RECORDS. 


The Medical Press. 349 


that the red corpuscles are diminished and the white 
increased in number. 

Without giving any further details of this interesting 
condition, its resemblance to primary myxcedema in man 
is remarkable. The course of the symptoms is much 
more acute than in man, partly because the supply of 
thyroid secretion is cut off suddenly by the operation, 
while in primary myxcedema the supply only gradually 
fails as the disease of the gland advances. 

In both conditions we have the same progressive loss 
of mental and bodily activity, subnormal temperature, 
elastic subcutaneous oedema, dry skin, and loss of hair. 
In the monkey we have, however, acute nervous sym¬ 
ptoms which do not occur in primary myxcedema, 
though some have been observed alter thyroid¬ 
ectomy in man. I would suggest, however, from 
the results of removing the parathyroid glands in rabbits 
and other animals, that these symptoms are in part 
due to the loss of the parathyroids, which, as we have 
seen, are removed along with the thyroid. This view 
receives further support from the fact, which will be 
considered later, that these acute nervous symptoms are 
not readily controlled by treatment with thyroid extract 
as might be expected were they purely thyroidal in 
origin. 

Opportunities for observing the effects of total 
thyroidectomy in man have occurred in cases in which 
that operation has been performed for goitre. It is well 
known that in a certain number of these cases, as a 
result of the loss of thyroidal secretion, symptoms 
develop which are identical with those of primary 
myxcedema. Indeed, it was the striking similarity 
between the two, noticed by Sir F. Semon, which led to 
the appointment of the committee by the Clinical 
Society, whose report proved the identity of the two con¬ 
ditions and their dependence upon loss of function of 
the thyroid gland. 

In man only three of the diseases which occur in the 
thyroid gland appear to be capable of causing a suffici¬ 
ently destructive lesion of the secreting cells to materi¬ 
ally diminish the amount of secretion. Syphilis and 
actinomycosis of the gland have thus caused myxoe- 
dema. If these diseases are successfully treated the 
gland recovers, sufficient secretion is once more formed, 
and the myxcedema disappears. The great majority of cases 
of primary myxcedema are due.to a fibrosis of the gland 
with atrophy of the secreting epithelium. Unfortunately 
we know very little as yet of the cause or mode of origin 
of thyroidal fibrosis. 

It may, according to the older views, be regarded as a 
chronic inflammation a chronic interstitial thyroiditis 
as a result of which new fibrous tissue is formed, which 
by its slow contraction and constriction of the blood 
vessels and alveoli leads to the destruction of the epithe¬ 
lial cells. On the other hand, it seems more probable 
that the atrophy of the glandular tissue take place 
primarily as the result of the action of some toxic agent, 
and that the fibrosis is only a replacement fibrosis, such 
as occurs in the spinal cord and elsewhere after more 
highly organised structures have been destroyed. 

The symptoms of myxcedema which occur in man as 
a result of this destructive disease of the gland were so 
ably described by Dr. Ord in hiB Bradshaw Lecture last 
year that they are familiar to all. I should, however, 
like again to draw attention to the fact that there are 
many cases of early thyroidal fibrosis in which the sym¬ 
ptoms are not nearly so definite as in the advanced cases. 
I have endeavoured in a recent paper to show what are 
the chief characteristics of these cases—such as slight 
subcutaneous swelling and]dryness of the skin, subnormal 
temperature, certain striking subjective nervous sym¬ 
ptoms, &c. The opportunity of examining the condition 
of the gland at this early stage can only arise if death 
should occur from some accident or intercurrent disease. 
In the absence of definite information we can only 
conjecture that a much earlier stage of fibrosis will be 
found, for it is evident that in any given caso the 
severity of the symptoms will vary directly with the 
amoant of atrophy of the glandular structure. 

The gradual changes in the appearance of a patient 
suffering from slowly progressing fibrosis of the thyroid 
gland will be illustrated by some photographs which will be 


shown at the next lecture, in which I shall deal with 
results of disease of the thyroid gland in the young and 
the rational treatment of myxcedema and cretinism. 


Clinical Jlecorbg. 


WESTMINSTER HOSPITAL. 

Eryripela* Migrant with High Temperature. 

(Under the care of Dr. Murrell.) 

Mrs. S. suffered from pain in the lumbar region and 
a sensation of chilliness from November 10th to 17th, 
but she had no distinct rigor. On the 18th the skin 
over the bridge of the nose and under the eyes was red 
and shiny, and there was some tenderness. She had no 
sleep that night On the 19th the whole face was red 
and swollen, and had to be covered with flour. On the 
following day she suffered from persistent vomiting. She 
continued to get worse, until she was admitted into the 
hospital on the 24th. Her husband stated that they had 
been married for five years, and that he had known her 
for three years previously, and that she had never met 
with any accident or injury. Her grandmother had 
erysipelas very badly, and patient’s sister had an attack 
about ten years previously. 

Patient’s temperature on admission at 0 p.m. was 
104 2 degs. and at 10 p.m. 104 8 degs. A bright-red shining 
blush extended over the whole face and half-way up the 
forehead. There was considerable oedema of the eyelids, 
which the patient was unable to open, and the lids were 
swollen and thickened. The tongue was dry, and she had 
much difficulty in swallowing. She was carefully 
examined, but no wound or abrasion was found either 
on the skin or on the mucous membranes. Her lungs 
were normal. The face was covered with cotton wool, 
and she was given 40 minimi of perchloride of iron 
every four hours. The following day the redness ex¬ 
tended from the face downwards to the left side of the 
neck. The temperature at night was 105 2 degs., and 
she was delirious. She was sponged with tepid water, 
but this had to be done carefully, as the pulse was weak 
and she showed signs of collapse. The delirium was 
quieted by the administration from time to time of ± 
grain of morphine hypodermically. On the 30th, at 
3 a.m, the temperature rose to 107 4 degs., she was 
wildly delirious, and was controlled with difficulty. At 
7 p.m. the temperature had fallen to 99 2 degs., but at 
3 a.m. on the following day it was 1000 degs. The 
rash was desquamating on the face and forehead, but 
was extending down the back. She took milk, beef-tea, and 
stimulants freely. Her pulse was 128, of fair volume, 
and there was no albumen in the urine. For some days 
there was very little change. The temperature was from 
101 degs. to 102 degs. in the morning, and from 104 
degs. to 1C 5 degs. in the evening, the pulse being 120. 
The patient was in a condition of low muttering 
delirium, and was constantly picking at the bed-clothes. 
The rash slowly and steadily progressed downwards at 
the rate of about 11 in. a day until it reached the first 
dorsal vertebra. On the 18th patient was found to 
have a fluctuating swelling on the occipital protuber¬ 
ance from which pus, watery and offensive, issued freely 
on pressure. In addition there were two sloughs on the 
scalp, one about 2 in. by ± in., and the other 1$ by i in., 
the surrounding tissues for an area of 44 degs. being 
boggy. This was freely laid open by Mr. Guy Coltart by 
means of three incisions, each about two inches long, 
and the wound was irrigated with 1 in 20 carbolic acid, 
and then dressed with hot boracic acid fomentations. 
The patient gradually sank and died on the morning of 
the 10th. A post-mortem examination was made six 
hours after death, but nothing of interest was found. 
The lungs were normal with the exception of hypostatic 
congestion, and some old adhesions at the apices. 

Remarks by Dr. Murrbll. —This case is of inteie3t 
from the high temperature, 107'4 degs, and from the 
fact that life was maintained for 18 days after admission. 
If we accept the 10th as being the first day of the 
illness, she managed to struggle on for exactly a month 




350 Thb Medical Press. TRANSACTIONS OF SOCIETIES. April 5. 1899. 


Death was warded off by the large quantity of nourish¬ 
ment she was able to take, and by careful nursing. It 
is curious that with the exception of the surgical incisions 
no wound or abrasion was discovered either during life 
or post-mortem. It is possible, however, that there may 
have been some abrasion of the cuticle or of a mucous 
membrane which escaped detection, or may have healed 
during the period of incubation, and before the patient 
came under observation. Erysipelas is an acute con¬ 
tagious disease characterised by a special inflammation 
of the skin caused by the xtreptococcu* eryxipelatox. How 
the streptococci managed to get into the system in this 
particular case is by no means clear, nor is it very 
obvious why the disease should have assumed such a 
virulent form. It is well known that people who are the 
subjects of chronic alcoholism or of Bright's disease are 
especially predisposed to erysipelas, and often do badly, 
but this woman was temperate, and there was never 
more than a trace of albumen in the urine. The mor¬ 
tality from erysipelas in hospital practice is only 7 per 
cent., and 4 per cent, in private practice, but the pro¬ 
gnosis in S. migrant is less favourable. The treatment 
was purely expectant, for although it has long been 
customary to give large doses of perchloride of iron in 
this disease there is no evidence that it modifies its 
course. Tepid baths, or cold baths, to reduce the tem¬ 
perature might have proved useful, but this object was 
attained by tepid sponging [Her condition from the first 
was so serious that the safest course seemed to be to 
trust to good feeding and careful nursing. 

The case affords an unfortunate illustration of the 
risks run by house physicians and house surgeons in the 
discharge of their duties. Mr. Guy Coltart operated 
on the' patient on December 8th, and on the 
morning of the 22nd he performed a. post-mortem 
examination on a non septic case and slightly 
punctured his finger. At half-past one on that day his 
arm was much inflamed, he looked extremely ill, and 
was unable to go round the wards. The wound was 
promptly laid open and cauterised with pure carbolic 
acid, but in spite of this precaution he developed 
symptoms of blood-poisoning, and for many weeks was 
in an extremely critical condition. It was not until long 
after this unfortuate woman's death that it was known 
that quietly and unostentatiously, in spite of the hard 
work which the post of house physician involves, Mr. 
Coltart had devoted all his spare time to looking after 
this patient. It is difficult in adequate terms to express 
our admiration of his conduct, which reflects credit 
not only on his hospital, but indirectly on every member 
of the medical profession. 


^vansattions of giorittiee. 


BRITISH GYNAECOLOGICAL SOCIETY. 

Meeting held Thursday, March 23rd, 1899. 

The President, Dr. H. Macnauqhton-Jones, in 
the Chair. 

Specimens 

Mr. Charles Ryall showed three specimens of 
“ Uterine Myoma Removed by Abdominal Hysterec¬ 
tomy,” notes of which we hope to publish in our next. 
In the discussion that followed, 

Dr. F. A. Purcell commented on the accident in Mr 
Ryall’s first case: intestinal obstruction might occur 
from traction on the mesoBigmoid when there was any 
difficulty in securing the uterine artery, leading to kinking 
of the bowel. The same complication might occur from 
intestinal adhesions. The second case showed the value 
of transfusion ; until lately this measure was not resorted 
to as often as it deserved; it gave very good results. 
Rupture of the abdominal wound was a rare occurrence -, 
the triple method of suturing the abdominal wound was 
usually a safeguard. In Mr. Ryall’s case the accident 
was probably due to the vomiting from which the patient 
had Buffered. 

Dr. Hey wood Smith thought that Mr. Ryall had set 
an example worthy of being followed in bringing forward 
accidents that had occurred in his cases. He asked Mr. 


Ryall whether in the first case the gut might have been 
separated from the stump, thus avoiding the necessity 
for a faecal fistula. Referring to the second case, he re¬ 
marked that catgut was not a good material for suturing 
the peritoneum, as it was apt to become absorbed too 
soon. For the other layers the material of the suture 
was of less importance. 

Dr. Herbert Snow considered that the plan of giving 
an aperient by the mouth on the second day was not a 
good one, for it might set up vomiting, which might be 
difficult to control. 

Dr. Hodgson asked whether the condition of the 
kidneys had been ascertained in the second case; the 
symptoms appeared to him to be more than were 
accounted for by the vomiting, and the accident to the 
abdominal wall. 

Dr. WiNSON Ramsay (Bournemouth) said he was very 
interested in the second case. He held the view that 
the middle line was the only place in which an abdomi¬ 
nal wound should not be opened. He always used an 
incision through the roctus muscle, and in over 200 cases 
of abdominal section he had never had any bad results. 
He had had only one opportunity of reopening a wound, 
and he then found that the three layers were well 
united. The only objection that was made to the 
lateral incision was that some of the parts of the 
pel vis could not be got at so easily -, but it was merely a 
theoretical objection, and in practice no difficulty was 
found. He believed that in many cases hernia of the 
wound occurred, of which the operator heard nothing. 

The President observed that there were several 
points of importance in Mr. Ryall’s specimens. The 
first was the diagnosis between intestinal obstruction 
and obstructive peritonitis, and this was often a very 
anxious point. They had to rely on the countenance of 
the patient, the position of the pain, the character of 
the vomiting, and the difference in the temperature: 
the latter was high in peritonitis; in intestinal obstruction 
it was generally low, as in Mr. Ryall’B case. The second 
point was the importance of transfusion. It should be 
resorted to not only after, but if necessary during an 
operation; and the apparatus with the saline solution 
should be in every operating theatre For the suture 
of the wound, he always used fine silk for the perito¬ 
neum, silk or silkworm gut for the fascia, and silkworm 
gut for the skin. He would like to know how far Mr. 
Ryall had proceeded by the vagina in the third case 
before opening the abdomen. He thought that such 
cases were best dealt with through the abdomen in the 
first instance. 

Mr. Ryall, in reply, said that he found in the second 
case that the peritoneum had torn, and the fascia sutures 
had torn through. As to the temperature as a means 
of diagnosis of intestinal obstruction, he did not regard 
it as reliable. In reply to Dr. Hey wood Smith’s question, 
he would remark that a faecal fistula in the sigmoid, or 
indeed in any part of the large intestine, healed readily, 
differing markedly from one in the small intestine where 
the coats were much thinner. For suturing the perito¬ 
neum he did not think that silk was necessary because 
here union took place within a few hours; and Mr. 
Greig Smith in many cases did not suture the peritoneum 
at all. The patient had had an aperient—viz., 5 grs. of 
calomel; but there was no true vomiting, only a constant 
retching. In reply to Dr. Hodgson, he could not say 
whether the kidneys were examined at the post-mortem. 
There was one objection to opening the abdomen through 
the rectus—viz., the cutting off of the nerve-supply of 
the part internal to the incision. Replying to the Presi¬ 
dent, he operated by the vagina in the third case, thinking 
it might be a polypus. 

Dr. Winson Ramsay showed the following speci¬ 
mens:— 1. Two Uteri removed through the Vagina. 2. 
A Myoma (? Sarcoma) removed by Abdominal Hysterec¬ 
tomy. 3. A Specimen of Tubal Abortion. 4. A Modified 
Broad Ligament Needle. 

Dr. Purcell referred to a case of ectopic gestation 
occurring twice in the same patient, the details of which 
he had already narrated before the Society. 

Dr. Heywood Smith asked whether the large myoma¬ 
tous tumour had been examined microscopically to deter¬ 
mine whether it was really sarcomatous. With regard to 


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April 5, 1899. 


TRANSACTIONS OF SOCIETIES. 


Thb Medical Press. 351 


the tubal abortion, the mole, having remained in the 
tube, seemed too Bmall to cause so much haemorrhage. 
He notioed that in the specimen the fimbriae were much 
thickened, and suggested whether this might not have 
been the source of the haemorrhage. 

Dr. Arthur Giles complimented Dr. Ramsay on the 
care he had shown in dealing with a difficult complica¬ 
tion—viz., the proximity of the ureter to the myoma in 
his abdominal hysterectomy case. Unless great vigil¬ 
ance were exercised, the ureter was easily wounded in 
this position. With regard to the case of tubal abor¬ 
tion, he would remark that it was strictly an instance of 
missed tubal abortion; and the presence of the mole in 
the tube was sufficient to account for the continuance of 
the haemorrhage by keeping the tube distended. A 
parallel was to De found in incomplete uterine abortion, 
where a portion of the ovum retained in the uterus was 
sufficient to keep up haemorrhage by preventing uterine 
contraction. The first two specimens shown were excel¬ 
lent examples of the kind of uterus that was best 
removed through the vagina; he thought that the 
practioe of removing very large tumours by this route 
was likely to hinder the wide adoption of vaginal 
cceliotomy. 

The President asked Dr. Ramsay whether he had 
used Deschamp’s needles; they were very similar to | 
those that Dr. Ramsay had shown. 

Dr. Ramsay, in reply, first reverted to a question pre¬ 
viously raised, viz., the paralysis of the rectus muscle 
after lateral incisions, and said that paralysis did not j 
occur unless one of the tendinous intersections of the , 
muscle were cut through. With regard to the large | 
myoma, a part of it was found at the operation to be j 
cystic, and contained blood; he did not think at the 
time that it was malignant: it was only the subsequent 
history that had sugget-ted this view. In the Case of . 
tubal abortion, he thought that the blood came from 
the mole itself. j 

Dr. James Oliver showed a photo of a fibroid of the 
ovary with extensive localised extravasation of blood 
under the capsule of the tumour. 

Dr Oliver then read a paper on 

ADENOMA UNIVER8ALE OF THE ENDOMETRIUM 

which will be found in another column under the 
heading Original Communications. In the discussion 
that followed 

The President observed that they had listened to a 
philosophical paper, whose references to comparative 
anatomy added both value and interest to the paper. 
He gathered that Dr. Oliver did not consider it to be a 
case of malignant adenoma; and that he thought that 
the first interference had made the case worse. If this 
were so, it would be an argument in favour of early 
hysterectomy rather than of repeated curetting. He had 
himself had a case of adenoma which he curetted; this ! 
was followed by a malignant condition of the uterus, ‘ 
which in the end killed the patient. Yet he thought 
that most men in dealing with such a case would proceed 
to curette the uterus, rather than at once perform 
hysterectomy. 

Dr. Herbert Snow wished to protest against the use 
of the word adenoma, which was used in many senses, ! 
and consequently led to confusion. In the photo, the 
growth certainly looked malignant, though in that case 
one would not expect it to go on for ten years. His 
view of the case would be that the patient had an endo¬ 
metritis which, on curetting, became a true malignant 
disease. He would like to ask whether the later stages 
were accompanied by any of the symptoms of malignant 
disease. 

Dr. P. Z. Hebert took objection to the suggestion of 
reversion in this case. In order to show any probability 
that such a condition was a reversion to type, it would be 
necessary to show not only that horned ruminants pre¬ 
sent such characteristics, but al«> that the ancestors 
common to both man and the horned ruminants presented 
the same characteristics before the divergence of the 
common stock into two distinct species took place; and 
this would be a rather difficult task, considering the 
remoteness of the period. Characters which might have 
developed after that period in one or other of these 
species could not be reverted to by the other. In othe 


words, man could only revert to characters that had been 
volved in the direct line of descent. The comparison 
was also imperfect, inasmuch as in one case they had a 
pathological, and, in the other, a physiological condition. 

Dr. Oliver, in reply, said that when he first saw the 
patient the size of the tumour was about the same as 
when he did the hysterectomy; but at the outset he did 
not attempt more than the removal of the polypi. These 
were found on examination to be adenomatous, but the 
patient continued quite well then for two years. She 
had no pain at any time; nor had she a watery discharge 
until after the curetting, which removed the surface 
of the glandular tissue. He did not regard the presence 
of such a discharge as any indication, by itself, of the 
existence of malignant disease. 


ROYAL ACADEMY OF MEDICINE IN IREL AND. 
Section of State Medicine. 


Meeting held Friday, February 17th, 1899. 


The President, Dr. H. C. Tweedy, in the Chair. 


Dr. Grim8haw read a paper on “ Tuberculosis in Ire¬ 
land and its Prevention,” an abstract of which we publish 
elsewhere. 

After this paper was read the following resolution 
was adopted. Proposed by Dr. John W. Moore, Presi¬ 
dent R.C.P.I., seconded by Dr. McWeeney :—“ That the 
Section of State Medicine having an accurate knowledge 
of the prevalence and mortality of pulmonary consump¬ 
tion and other forms of tuberculosis, hail with pleasure 
the movement to control this destructive group of infec¬ 
tive diseases, which has been inaugurated by the British 
Medical Association. The Section urge upon the Council 
of the Royal Academy of Medicine in Ireland, as a 
matter of public professional duty, to cooperate in every 
possible way with those who are engaged in the present 
determined effort to cope with tuberculosis, now proved 
to be the deadliest scourge of the human race.” 

ON THE DEATH-RATE FROM TUBERCULOSIS, AS EXEMPLIFIED 

IN THE MALE POPULATION OF ENGLAND, FOR THE FIVE 
YEARS 1891-5. 

Dr. Martley read a short paper on the above subject. 
After pointing out that the deaths from this cause were 
nearly as numerous as those from the whole group of zymo¬ 
tic diseases, and that they annually averaged about 240 
per 100,000 living, he drew attention to the very unequal 
mortality at different ages, tuberculous disease being most 
fatal in the first few years of life, and again, though to a 
less degree, about 40. However, on correcting the county 
rates for varying age distribution, he found that there 
was comparatively but a slight difference, and that for 
all practical purposes, sufficiently correct results could 
be obtained by using the crude rates. 

THE BACTERIOLOGICAL ASPECT OF TUBERCUL08I8. 

Dr. McWeeney read a paper on this subject, and 
demonstrated a series of illustrative microscopic prepara¬ 
tions and photographs. With regard to the morphology 
of the tubercle fungus he mentioned that he had never 
failed to detect genuinely ramified forms in sputum 
whenever he had leisure to seek them out. The type 
of ramification was that of the genus cladothrix, and 
from the researches of Firchel, Coffin Jones, Hazo Bruns, 
and Ledoux Lebard, there could be no doubt of the 
biological affinity of the tubercle fungus to streptothrix 
and actinomyces. He gave reasons for refusing to 
admit the spore-nature of the unstained bodies so often 
found imbedded in the rods, and pointed out the hygienic 
importance of that fact. He emphasised the value of 
the staining reaction long considered to be peculiar to 
the tubercle and leprosy bacilli, but now known to be 
shared by a smegma bacillus, and by the pseudo-tubercle 
bacilli isolated by Mockler and others from cow-dung— 
by Mockler from the leaves of Timothy grass near the Gree- 
bersdorff Sanatorium, and by Rabinowitsch, from butter. 
Cultures of the three last-named organisms were demon¬ 
strated, as well as slides showing their remarkable 
resemblance to the genuine tubercle organism. The 
cause of the staining reaction was the presence in the 
sheath of the bacillus of a peculiar wax, as was shown 


352 The Medical Press. 


FRANCE. 


April 5, 1899. 


last year by Aronson. This underwent gradual extrac¬ 
tion by alcohol and ether, with the result that the bacilli 
lost their specific staining reaction, a fact which may 
account for their gradual disappearance from tissues that 
have been treated for reactionary purposes with these 
substances. The relation of the bacillus of human to 
that of avian and piscine tubercle was discussed, and the 
discovery by Ledoux-Lebardof the bacillus of fish-tuber¬ 
culosis and the recently demonstrated inoculability of 
poikilathermous animals with a variety of a bacillus 
capable of thriving at ordinary temperatures were pointed 
out as important recent additions to our knowledge. He 
concluded by earnestly depreoating over-zeal in the adop¬ 
tion of measures intended to be preventive, but which by j 
involving irksome restriction or intolerable publicity 
would speedily be found to defeat their own purposes. 

DISTRIBUTION OF TUBERCULOSIS IN IRELAND. 

Dr. P. Letters, by statistical tables, sought to prove 
that tuberculous disease throughout Ireland—tabes 
meaenterica and tuberculous meningitis more so than 
phthisis—was regulated almost exclusively by aggrega¬ 
tion of population. Small towns and villages bred tuber¬ 
culosis largely. He controverted all theories referring 
the prevalence of Irish tuberculosis to meteorological or 
climatic causes, or to the proportionate amount of bog 
and barren mountain land, to surfaoe elevation, or to 
geological formation These did not operate as influen¬ 
tial factors, or their effects could not be measured by 
death-rates recorded over large areas. In the counties, 
death-rates per million living from (1) tabes mesenteries 
and tuberculous meningitis combined, and (2) from 
phthisis, correspond so closely with the several degrees 
of urbanisation as to leave no reasonable doubt of a 
casual relationship. This line of argument led to the 
conclusion that tuberculosis, as found in Ireland, is essen¬ 
tially a town and village bred disease, exclusively rural 
localities showing next to no mortality from tabes 
mesenterica and tuberculous meningitis, and greatly re¬ 
duced death-rate from phthisis. The most tuberculosis 
region in Ireland extended along the eastern and south¬ 
eastern seaboard, and was mapped out by the counties of 
Antrim, Down, Dublin, Wexford, and Waterford. The least 
tuberculosis was found in a compact region in the north¬ 
west comprising the five oounties of Donegal, Leitrim, 
Cavan, Fermanagh, and Longford. These two regions 
contain respectively a high and a low percentage of 
urban population. A table giving the percentage of 
inhabitants of towns over 500 to the total population in 
each of the thirty-two counties showed that, where the 
town-dwelling population was high, so also was tubercu¬ 
losis, and vice verta. Freedom from tuberculosis, or the 
reverse, in the smaller areas of Poor-law unions through¬ 
out the country, depended on the same general law of 
aggregation into town and village communities. Kerry, 
taken as a whole county, was statistically rather tubercu¬ 
lous Divided into two regions, North Kerry, including the 
unions of Tralee, Listowel and K illarney, and South Kerry, 
the remaining unions of Dingle, Cahirci veen, and Kenmare, 
twenty of the Irish counties are found to be less tuber¬ 
culous than North Kerry, while South Kerry is consider¬ 
ably freer from tuberculosis than any whole county in 
Ireland. This was explained by the fact that the per¬ 
centage of urban population in South Kerry is only nine, 
while in North Kerry it is nineteen. A point to which 
Dr Letters directed special attention was that the most 
correct test of the tuberculous character of a locality is 
when the mortality from tabes mesenterica and tuber¬ 
culous meningitis combined bears a high rate to that 
from phthisis. This high proportion of juvenile to adult 
tuberculous mortality in Ireland invariably corresponds 
with a high degree of urbanisation. 


Dr. John M'Murray, whose term of office as Mayor 
of Bootle, recently terminated, has been presented with 
a horse and brougham and an illuminated address, as 
expressing the acknowledgment by his fellow-townsfolk 
of the ability and courtesy displayed by him during his 
year of office. 


.tfranre. 

[from our own correspondent.] 

Paris, April 1st, 1899. 

Hypertrophy of the Prostate. 

At the meeting of the Surgical Society, M. Monod 
spoke on the ligature of the vessels of the spermatic cord 
for hypertrophy of the prostate. A patient suffering 
from that affection entered his ward for acute retention 
of urine. During three days, it being impossible to pass 
a catheter, the bladder was tapped, but finally a fine in¬ 
strument was passed and left in situ. At the end of a 
week M. Monod placed a ligature on the vascular 
pedicle of the testicle, and in a short time the 
patient was able to micturate freely. As to the 
spermatic gland, it diminished slightly in volume, 
without, however, presenting any tendency to sphacelus. 
M. Monod considered that the benignity of ligature of 
the spermatic vessels towards the nutrition of the organ 
could be explained by the fact that when the vas 
deferens was separated from the vessels about to be 
ligatured, the artery of that canal is so intimately 
associated with it that it escaped being tied, and 
although of exceedingly small calibre, is sufficient io 
maintain the nutrition of the gland. 

M. Regnier thought that his colleague was particularly 
fortunate in the above case, for ligature of the spermatic 
vessels provoked frequently lesions of the testicles, 
especially if the operation was not completely aseptic. 

Resection of the vas deferens exercised the favourable 
influence on the micturition trouble caused by hyper¬ 
trophy of the prostate without having any evil effect on the 
nutrition of this gland. He could cite several cases of 
his own to confirm this fact. In one case the resection 
of the def erens canal was done on both sides, and not 
only did all retention disappear, but the genital function 
persisted. 

M. Bazy said that it was a fact that resection of the 
deferens canal, as Sir Astley Cooper pointed out long 
ago, in no way interfered with the nutrition of the 
testicle, but, on the other hand, the operation had no 
effect on the hypertrophied prostate. 

Hectic Fever of Consumption. 

Arsenious acid, £ gr.; 

Salicylate of soda, 5'ias.; 

Starch and distilled water, q. s. 

Divide into 100 pills (should not be rolled in powder). 
Ten to be tak en after each of the three repasts. 

Asepsy in Operations. 

M. Quenu spoke on the above subject and said that in 
his practice he endeavoured to come as close as possible 
to the asepsy ideal. He boiled the instruments in water 
to which was added borate of soda. The region of the 
operation was washed with soap and water, alcohol or 
ether, and a solution of sublimate of mercury, in the 
order given. As to the asepsy of the hands of the surgeon, 
and those of his assistants, he considered it very difficult 
to realise. He estimated that any septic contact was sus¬ 
ceptible, even after twenty-four hours, and in spite of 
energetic disinfection to vitiate the result of the opera¬ 
tion. Consequently he abstained from opening any 
abscess for two days prior to any important operation. 

For some time he used gloves of very thin caoutchouc 
previously sterilised by boiling, and found that they 
furnished great security. For ligatures he employed 



-oogle 



Apkil 5, 1899 


AUSTRIA. 


Thb Medical Press. 353 


almost exclusively sewing thread, for he found it to 
admirably resist the high temperature. Out of 237 
important operations he had a mortality of only 5 per 
cent. 


<&ermanp. 

[from oub own correspondent.] 

Berlin, March 30th, 18 k*. 

At the Medical 8ociety Hr. Zadek showed a case of 
Echinococcus of the Lungs. 

The patient was a butcher, 40 years of age, who had 
all his life had a good deal to do with dogs, and had 
become infected by them. In February, 1897, he had 
difficulty of breathing, cough, and haemoptysis. Catarrhal 
rales were heard at the bases of both lungs, but no 
dulness. There was fever and expectoration of muco- 
purulente sputa, and emaciation from 78 to 53 kgms. 
Tubercle was diagnosed, although there were no bacilli, 
and the patient was sent to a health resort, from which 
he returned after a Btay of fifteen weeks, with a gain of 
20 lbs. in weight, cough and hemoptysis soon returned, 
however, and the patient observed skinny membranes 
in the expectoration. These appeared for a period of 
between one and two months; and their milky look and 
the microsoopic appearance showed that they were the 
coverings of ecchinococcus cysts. There were hundreds 
of them, and they were expectorated easily and without 
much haemorrhage. They ceased to make their appear¬ 
ance from Christmas, 1898, the expectoration diminished, 
and pain ceased. The patient improved in health, and 
returned to work with a weight of 180 lbs. The phy¬ 
sical signs were only slight, and after expelling quanti¬ 
ties of cysts there were no signs of cavities remaining, 
and as percussion gave no evidence the X-rays were tried. 
These showed clearly the site, size of the collection of 
echinococci. A shadow the size of an apple was seen 
clear in the centre on deep inspiration, with darkened 
edges. From the situation it was evident that an 
echinococcus of the liver had passed into the lungs. 
Adhesive pleuritis had prevented the stormy symptoms 
usually observed in such cases. There was also a shadow in 
the left lung, between the middle and lower lobes, plainly 
from a second echinococcus, and the patient in fact did 
complain of Borne disturbance in the left side of the chest. 
There being no mixed infection complicated lung disease 
had not developed. What would be the end of the 
disease on the left side could not be foretold. The 
interesting features of the case were the mild course, the 
discovery by the X-rays, which had thrown light on the 
diagnosis, aetiology, prognosis, and treatment. The rays 
were clearly of great assistance in case of echinococcus of 
the lungs. 

Hr. Levy-Dorn explained the technique of the use of 
the X-rays. The patient must be required to breathe 
deeply and then hold his breath. In this way only was 
it possible to study the relation of the tumour to 
the diaphragm, and exclude some relation to other 
objects, which moved on inspiration. The exact seat of 
the collection was determined by the fluorescent screen. 

Hr. Bosenhein showed a boy with 

Stenobing Hypertrophy of the Pylorus. 

The boy was seven years of age, up to five he had been 
perfectly healthy, and was of healthy parentage. The 
disease began after a severe attack of measleB. The 


child began to vomit, awoke in the night and brought 
up what he had eaten during the day. The appetite was 
good, and there was no other abnormality. In July, 
1897, the speaker discovered excessive dilatation of the 
stomach; it contained large quantities of decomposed 
fermenting material, and free hydrochloric acid, but no 
tumour could be felt. The stomach was washed out and 
the food carefully selected, and the patient was free from 
symptoms, but objectively became worse. The probable 
diagnosis of stenosing hypertrophy of the Btomach was 
confirmed by operation, the pylorus only permitting the 
passage of a small sound. After recovery from 1 he opera¬ 
tion fresh symptoms came on, and at last gastro¬ 
enterostomy was performed; the pylorus had become 
adherent. After this permanent improvement set in, 
the stomach became smaller and its motor function 
re-established. 


JUistria. 

[from our own correspondent.] 

Vienna. March 30th, 18W. 

Salophen in Influenza. 

In the recent epidemic of influenza this drug has been 
need with great success, judging from the evidence con¬ 
tributed by a large number of observers. Its advantages 
of being tasteless, and having no injurious effects 
are praises frequently repeated in its favour. In 
cases of influenza, one to two grammes given every 
three hours, in plenty of mineral water, is held as an 
excellent remedy for the disease, if not a specific. Smaller 
doses are recommended as prophylactic in epidemics. 

Privat Docents. 

This peculiar body of teachers have now formed them¬ 
selves into a Union with the object of increasing their 
usefulness and improving their status. 

The privat docent is a body peculiar to Austrian 
schools, and of considerable benefit to a foreigner as an 
introduction to foreign University ideas. Their avowed 
combination is to increase this utility by adding to the 
number of their classes, particularly during the periods 
of recess. The provincial Universities are invited to 
join the combination for the regulation of post-graduate 
classes for Austrian practitioners. Drs. Landsberger, 
Hartmann, Schmid, Lampa, Jellineck, Hammer, and Prof 
Finger, have been appointed to act as a representative 
committee. 

Fochier on Artificial Abscess in Py-smia. 

This novel antidote for pyasmic poisoning is still in¬ 
creasing in favour. It seems to be more effectual in 
cases arising from abscesses forming around the genitals. 
The modus operandi is to inject two drachms of oil of 
turpentine into the calf of the leg, which sets up severe 
irritation, finally resulting in a large abscess. 

From the time of injection the rigors due to pyfflmia 
cease, and the patient rapidly recovers without any sub¬ 
sequent relapses. The temperature, however, remaina 
high for a few days after the injeotion, but gradually 
descends to the normal. 

Other infectious diseases from which abscesses result, 
such as typhoid, erysipelas, osteo-myelitis, pneumonia, 
&c., have been operated on with equally favourable 
results. 

If the artificial abscess be allowed to remain unopened 
it will soon become absorbed without any bad result, but 


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354 The Medical Press. THE OPERATI NG THEAT RES. _ Apri l 5, 1899. 


Fochier recommends the abscess to be opened at the 
earliest opportunity. 

Ebb’s “Symptom Complex.” 

At the Medical Club Weiss recorded a case of a 
female, set. 37, who had been received into hospital from 
the country. Six years ago she had suffered from an 
abortion, which was followed by pain over the whole 
body, but she seems to have shortly afterwards recovered 
her normal health. Three years later she was attacked 
with severe rigors, vomiting, subsequently becoming un¬ 
conscious, and in this condition she remained for three 
weeks. On recovering, it was discovered that she had 
difficulty in swallowing associated with involuntary 
movements of the head. 

A few months later she was able to move about only 
with the greatest difficulty. About this time a discharge 
from both ears commenced. Tn the autumn of 1897 the 
limbs became stiff and movements impeded. The speech 
was also feeble and inarticulate while double vision was 
also present. Since 1898 she has been an in-patient, and 
has become very emaciated, but is quite conscious and 
understands all that is going on around her. The 
muscles are flaccid and can be passively or actively 
moved, possessing a good deal of tonus. These pheno¬ 
mena were common to all the muscles of the body. 
The movement in the eyes and vocal cords were slow. 
The internal organs were at first normal, although at 
present bronchitis, decubitus, and albuminuria were 
present. The breathing is undisturbed, sensibility is 
intact, and there is no atrophy or trophic disturbance. 
The electric stimuli are normal, but the tendon reflex is 
exalted. 

The tonus of the muscular system increases the com¬ 
plication. 

The grey substance is undoubtedly affected, although 
the original acute fever three years ago may be accepted 
as the initial point, and probably connected with the 
pvsemia derived from the aural discharge, while the 
meninges and medulla oblongata became finally affected. 


^hc Operating theatres. 

KING’S COLLEGE HOSPITAL. 

Subphrenic Abbcess. —Mr. Cabless operated on a 
girl tet. 22, who had been under observation in the 
medical wards for some weeks under the care of Dr. 
Burney Yeo ; her symptoms were ascribed to a meal of 
rabbit, and at first were supposed to be those of typhoid 
fever ; she improved somewhat as a result of rest and 
careful dieting, but for some weeks her temperature had 
been 2 or 3 degs. above the normal, and she complained 
of pain and tendernes3 in the left hypochondrium. 
During the last ten days she had had several severe 
rigors. On examination Mr. Carless stated that the 
girl looked very anaemic, with sordes on the lips, and was 
extremely apathetic. Oa stripping the abdomen and 
chest it was found that the respiratory movements 
on the left side were less marked than those on 
the right; tenderness was complained of over the 
three lowest intercostal spaces and in the left 
hypochondrium; nothing abnormal could be de¬ 
tected on palpation; there was a patch of dul- 
ness a little behind the mid-axillary line, extending 
up to about the eighth rib, corresponding fairly accu¬ 
rately to the situation of the spleen; over this area 


breath sounds were absent, although they were heard to 
be of a normal character above and behind it. An 
exploring needle had been introduced three times by the 
house physician without result; it was admitted, how¬ 
ever, that it had not been introduced sufficiently far to 
traverse the diaphragm. Before operating Mr. Carless 
stated that the nature of this case was somewhat doubt¬ 
ful, but that he thought it probable that there was an 
ulcer of the stomach and a localised sub-phrenic abscess. 
With this supposition in view he proposed to make an 
incision along the left lower costal margin and explore 
the under surface of the diaphragm. Should nothing 
be found in this direction he would examine the 
posterior surface of the stomach through the omentum, 
then the spleen and finally explore the pleural cavity. 
An incision nearly six inches long was accordingly made 
parallel to the rib margin, and, before the peritoneum 
corresponding to it was fully opened, presence of 
adhesions round the stomach was demonstrated; these 
adhesions partly involved the omentum and fixed it and 
the stomach to the under surface of the diaphragm. A 
careful packing of gauze was introduced into the lower 
part of the wound so as to protect the general peritoneal 
cavity, and then the adhesions were carefully broken 
down with the finger. To facilitate this proceeding a 
projecting costal cartilage was divided, and the costal 
margin held aside by retractors. Before this dissection 
had been carried very far a collection of foul pus wa s 
opened, and on further exploring the cavity it was 
evident that the main trouble was tuberculous in nature- 
A certain amount of caseating material was very care¬ 
fully removed with a sharp spoon, and the cavity well 
flushed out with sterilised saline solution. A large drain¬ 
age tube was then introduced and in order to make it lie 
comfortably a portion of the costal cartilage mentioned 
above was excised. Iodoform gauze was packed in 
arouud the tube, and the external wound partially 
closed Mr. Carless remarked that the result of his 
exploration had been most satisfactory, and that it fully 
confirmed his opinion as to the nature of the case. His 
diagnosis had been based on the lack of mobility of the 
chest wall, on the localised tenderness, and on the 
fact that the lung seemed to be pushed up 
and not in any way involved. There had been compara¬ 
tively but few symptoms of gastric ulcer, but it is not 
unknown, he said, for such a condition to remain passive. 
In all probability the present operation would only be 
sufficient to relieve the immediate symptoms. The pro¬ 
jection of the costal margin would be almost certain to 
prevent satisfactory drainage, and other steps would 
have to be undertaken to secure this end. 

It is satisfactory to state that, two days after the 
operation, the temperature of the patient had dropped 
to the normal, and she was evidently very much better. 

SEAMEN’S BRANCH HOSPITAL, ROYAL ALBERT 
DOCKS. 

Operation for Rupture of Urethra at Bulbous 
Portion. —Mr. William Turner operated on a coloured 
man (a Lascar), a stoker on board ship, set. about 45, who 
had been admitted about four hours before with hsemor. 
rhage from the urethra appearing at the end of the 
penis. He had slipped and fallen against an iron bar (a 
lever), the end of which gave him a slight blow at the 
anterior part of the perinaeum. This was followed by 
pain and severe haemorrhage -, there were no symptoms 
of shock, and on examination no tenderness in the peri- 


Digitized by 


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April 5, 1899 


LEADING ARTICLES. 


Thr Medical Press. 355 


nseum. He once passed water before admission which 
was comparatively clear, showing that there was no 
rupture of the bladder. A soft instrument was passed 
down the urethra, and an obstruction met with about 
4i inches down, t'.e, at the bulbous part, and the 
instrument could not be passed on into the bladder. 
There was no swelling in the perina>um three 
hours after the accident; there was some slight 
tenderness, and the haemorrhage was continuous and 
pretty severe. Under an anaesthetic an instrument 
(a bulbous staff) was passed down to the obstruction, 
which again could not be overcome, so the perinaeum 
having been purified and the patient put in the litho¬ 
tomy position the point of the instrument was cut down 
upon; it was then found that the catheter passed 
through a rupture in the bulbous part of the urethra, 
and its point was in the cellular tissue impinging 
against Colles’s fascia, that is to say, against the deep 
perinaeal fascia. It was then attempted, after putting 
back the instrument into the urethra, to pass it on into 
the bladder, but this failed (the rupture of the urethra 
was almost transverse and about three-eighths of an 
inch long, occupying the centre and left side of corpus 
spongiosum); a linear incision was now made in corpus 
spongiosum about half an inch long into the urethra 
posteriorly to the rupture and a fold of mucous mem¬ 
brane was found, which had obstructed the passage of 
the instrument. A Lister's bougie was then passed 
readily into the bladder ; a No. 8 silver catheter 
was substituted for the bougie and the slit and the 
rupture of the urethra were stitched completely up with 
fine silk (partly by continuous suture, partly with some 
interrupted sutures). The haemorrhage was from the 
corpus spongiosum, and the stitching up completely 
stopped it. Numerous Bmall vessels were ligatured in 
the superficial part of the wound, which was dusted with 
iodoform, a piece of iodoform gauze being left in. The 
catheter was then tied in and rubber tubing attached. 
Mr. Turner remarked that it was essential to cut down 
in all these cases, as there was great prospect of com¬ 
plete healing, and the operation absolutely prevented any 
extravasation ; in this case the indications for an opera¬ 
tion were specially the hemorrhage, and the fact that 
an instrument could not [be passed into the bladder. 
The patient, Mr. Turner ^thought, must have lost at 
least a pint of blood, and the rupture was evidently 
caused by direct contact and not by tearing away 
the bulbous portion of the urethra from the 
triangular ligament. From cases he had seen, Mr. 
Turner considered it was always safer to cut down on 
all cases of rupture of the urethra in whatever position, 
which, he said, agreed with the teaching definitely laid 
down by Hurry Fenwick and H. Mon is. Ab to after 
treatment, if all goes well, the catheter would be removed 
in from three to four days. It is better treatment, he 
pointed out, not to stitch up the perineal wound 
superficially in case of any slight leakage of urine from 
the urethra, or any trouble with the silk stitches, 
which may entail their removal. These two complica¬ 
tions are, unfortunately, rather common in these cases, 
but the final results of the operation and treatment are 
admirable. __ 

Dr. Robert Lucas, of Dalkeith, was the recipient a 
few days ago of a very substantial testimonial in the 
shape of a bank draft for £350, together with a hand¬ 
some timepiece and ornaments. 


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“ SALTS POPl'LI SUPREMA LEX.” 


WEDNESDAY, APRIL 5, 1899. 


THE ENGLISH REGISTRAR-GENERAL S 
ANNUAL SUMMARY. 

The annual summary in which the Registrar- 
General for England so admirably reviews and connotes 
the statistics of the preceding year is always interest¬ 
ing, because it directs attention to concrete results 
gleaned from an arid mass of statistics which must 
remain terra incognita for those among us who are 
not statisticians by constitution and temperament. 
From it we learn our position as compared with pre¬ 
vious years and with other countries; we can see at a 
glance whether our national vitality is up to the 
standard, and whether sanitary science continues to 
justify its existence by a further reduction in the pre- 
veutible death-rate. It enables us to detect the un¬ 
sanitary and ill-governed areas by reason of their 
huge death-rates, and to gauge the value of pre¬ 
ventive and therapeutical measures when applied 
on a large scale. The summary is useful 
in that it rubs in the much-needed lesson 
that, in spite of the much-vaunted progress 
already accomplished, much more still remains to be 
done. We find that the wane in the mairiage rate 
which characterised the returns of the last thirty 
years has experienced a check, that of last year being 
the highest recorded since 1877, with a corresponding 
augmentation in the birth-rate, showing that 
Malthusiasn ideas have not yet gained a firm hold on 
our young married people. That, we suppose, is 
matter for congratulation, at any rate from a pro¬ 
fessional point of view. The returns under the head 
of infantile mortality continue to afford ground for 
profound dissatisfaction. The rate for the thirty- 
three large towns of the kingdom is 178 per 1,000, 
being eleven per 1,000 above the average proportion 


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356 The Medical Pbess. 


LEADING ARTICLES. 


April-5, 1899. 


during the last ten years. The eminently preventive 
nature of this wasteful mortality is rendered 
evident by the extraordinary differences in the 
figures for the different towns and the difference 
is even more striking when particular districts of 
certain towns are considered separately. The deaths 
from small-pox were less than some years past, number¬ 
ing in all only 13, and this figure may prove interest¬ 
ing reading in years to come in view of certain con¬ 
tingencies. While the scarlet fever mortality was 
distinctly less, that of diphtheria was equal to the 
decennial average, a somewhat discouraging fact 
considering the general use of the serum treatment, 
though, of course, the results of treatment must be 
judged by case mortality and not by total returns. 
The deaths from enteric fever were up to the average, 
but the most marked increase perhaps is that under 
diarrhoea, which is essentially an infantile complaint. 
The returns for the metropolis present some points of 
contrast with those of the large towns in the aggregate. 
In London, for example, the mortality from diphtheria 
was markedly less than that of the proceeding 
years, and the deaths from phthisis showed a slight 
reduction. Although the deaths ascribed to influenza 
in 1898 were nearly double the number for 1897 they 
were below the average for the eight preceding years. 
The returns under this head show a curious oscilla¬ 
tion of a rhythmic kind, and we are now apparently on 
the crest of a rising wave. In conclusion, we find 
that the death-rate for the total population of the 
thirty-three large towns stands at 22 2 per thousand 
living, a rate which compares unfavourably with that 
of thirty European and American cities with a death-. 
rate estimated at 20T per thousand. In Paris the 
rate was 19*7; in Berlin, 17 - 3; and New York, 19‘I 
London, one is pleased to see, still holds her own as 
the healthiest of. the very large cities, with a death- 
rate of only 18’7. 


LEAD POISONING. 

The report of the Special Committee of investiga¬ 
tion into the condition of the workers in the Potteries 
has been at length published, and furnishes a crushing 
indictment of the present system. Without going 
into details, its most pithy conclusion may be set 
forth in the simple statement that an enormous 
sacrifice of human life is going on daily in this dan¬ 
gerous pottery trade, owing to the more or less 
unrestricted use of lead in the process of glazing. 
The scientific evidence with regard to the ill effects 
of the poison is overwhelming, in spite of the fact, 
familiar to medical readers, that it is often difficult 
to determine the remote and sometimes even the 
immediate symptoms of this subtle and deadly in¬ 
dustrial material. Indeed, there can be little doubt 
that our knowledge of the subject has been almost 
hopelessly obscured by the non-recognition of cause 
and effect which has filled in the death certificates of 
bygone generations with such unsatisfying sympto¬ 
matic etiology as epilepsy, rheumatic gout, convul¬ 
sions, paralysis, nephritis, anaemia, and a host of 
chronic secondary vascular, nervous and organic 


troubles, where the one key lay in the word 
“plumbum.” But the rapid and comprehensive 
advance of modern medicine has changed all 
that, and the knowledge of the various trade 
poisonings under every aspect is now an open 
book which every practitioner may run and 
read, if he be alive to his responsibilities and 
abreast of the generalities of his profession. The 
recent inquiry has gone into this part of the 
question, and established the fact that an immense 
amount of lead poisoning has been going on day by 
day in the Potteries. It will hardly be believed that 
old-fashioned factories still exist where simple 
elementary precautions for the prevention of poison¬ 
ing are wanting, yet such is the case, and we learn that 
structurally unfit premises are at this moment in use. 
After that statement, any Government which allows 
places of the kind to continue for a day is incurring a 
grave responsibility. Indeed, we understand that the 
Home Office has already issued minute and sweeping 
notices dealing with the regulation of the special 
trade processes in question. Young persons are not 
to be permitted to work in the factories, and various 
sanitary requirements are to be enforced. Although, 
no doubt, we have been anticipated in this particular 
by the departmental advisers, we venture to suggest 
the absolute necessity of frequent and systematic 
inspection both of workpeople and of premises 
by competent medical men, who should be 
appointed forthwith in sufficient number by the 
central administration. It is to be hoped that Mr. 
Balfour, who has been stated on high authority to be 
about to devote his best energies to social legislation, 
will scotch ithis potter’s poison onoe and for all. 
Curiously enough, the slowly evolving light of science 
has placed a club of Hercules within his grasp. Lead, 
that for many centuries of histone and pre-historic 
record has claimed its death toll of the potter, 
is quite unnecessary for the production of a perfect 
glaze. That simple proposition contains the germ of 
all future action; it is the logical basis of reform ; its 
application will eradicate the problem. With no 
lead in the glaze there can be no plumbism among 
the potters, and the question of healthy trade 
environment may be settled upon the lines common 
to other occupations. With a leadless glaze potting 
will sink to the level of a comparatively harmless 
pursuit, apart from the dust, which may be readily 
provided against in special ways. So far as can be 
seen no such brilliant opportunity has ever offered 
itself for an imperative reformat small cost in the 
whole history of industrial prevention as that which 
presents itself in the suggested adoption of a lead-free 
glaze. The scientific evidence in favour of such a 
step is overwhelming. The public are educated upon 
the point, and the manufacturers have not offered 
any really serious opposition to the proposed change. 
In a case of this kind, however, capitalists should 
not be allowed to stand in the way of the saving of 
human life, nor do we fora moment imagine that the 
master potters have erred hitherto from want of 
heart so much as from want of knowledge. In 


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NOTES ON CURRENT TOPICS. 


The Medical Press. 357 


future, however, their position will rest upon 
an entirely different basis. We should hardly 
have adverted to this aspect of the subject 
save that in recent bills the Government has 
seemed to give way to capital in the matter of the 
abandonment of automatic railway couplings, and of a 
reasonable standard flash-point for petroleum. It 
seems clear that immediate action must be taken by 
the Balfour Ministry with regard to lead poisoning 
in the Potteries, and in the light of past experience it 
may be devoutly trusted that all prorision against 
mischief will be made stringent and absolute, with no 
single loop-hole of permissiveness to mar the pros¬ 
pect. 


SECRET MEDICAL COMMISSIONS. 

If the very grave charges which the London 
Chamber of Commerce has brought against our pro¬ 
fession are passed by with no more repudiation than 
the milk-and-water pronouncements of our medical 
contemporaries, we fear that the public might conclude 
that there is sufficient truth in the accusations to 
reduce us to silence, and it therefore becomes neces¬ 
sary for us to return to the subject with a view to a 
more explicit refutation and disclaimer. The London 
Chamber of Commerce is a very important body, and 
its pronouncements cannot be minimised. It has 
issued an official report which constitutes a tremen¬ 
dous indictment of the commercial honesty of the 
kingdom, the medical profession being represented 
by a homoeopathic faction of the whole. In this con¬ 
nexion it aBks that “All professional and trade 
bodies, such as those representing the medical, legal, 
artistic, and other professions and trades, be recom- ' 
mended to make an emphatic declaration on the sub¬ 
ject of Becret commissions ... by inserting into 
their bye-laws a stipulation that any member guilty 
of the pernicious practice will be expelled.” To 
justify a medical authority in acceding to this sug¬ 
gestion the Chamber should be prepared with 
evidence that the practice of receiving secret 
commission exists to a material extent in 
our profession, and of this scarcely a shred of evi¬ 
dence is adduced. The witnesses called in support of 
the charge are two in number, a pharmaceutical chemist 
and an optician, jeweller, and silversmith,both of whom 
testify, in a vague way, that secret commissions on 
medicines and on instruments pass between trader and 
doctor. Additional to this is the statement of Sir 
Edward Fry in a letter to the Times that a certain 
practitioner, after the death of his patient, handed 
the business card of an undertaker to the relatives. 
If this be all the proof upon which the Chamber 
grounds its wholesale indictment of the profession, we 
say at once that we do not believe a word of the 
charge. We are aware, also, that certain practi¬ 
tioners of the better class have left themselves open 
to suspicion of this traffic by systematically writing 
their prescriptions in hieroglyphics unintelligible to 
all pharmaceutists save the one whom they patronise, 
but this very objectionable practice does not neces¬ 
sarily imply that they receive any monetary con¬ 


sideration for such patronage, and it has never been 
charged that they do. We do not for a moment 
doubt that there are a few fourpenny practitioners 
who would take and solicit commission on sticking 
plaster which they prescribe, but we absolutely deny 
that these are worthy of being spoken of as even 
a substantial fraction of the profession. This 
secret traffic has never been complained of, as it 
would have been certain to be by rival practitioners, 
and nD instance lias ever been brought to the notice 
of the General Medical Council. If it were we 
apprehend that the question would have to be 
seriously considered whether it did not constitute 
“ infamous conduct in a professional respect.” If 
such practices existed to any appreciable extent we 
should certainly know of it, and should, we hope, be 
ready to acknowledge the abuse and try to stop it, 
but we firmly believe that outside a very limited 
class no such traffic exists, and we much regret that 
the Chamber has made no attempt to substantiate 
its accusation. 


4tote0 on Current ‘Copies. 

Madame Frain—“ Fraudulent or Felonious.’’ 

For years past a thriving trade in female remedies 
has been carried on in the heart of London by one 
Madame Frain, who has flooded the metropolis with 
pamphlets and inundated the country with disgusting 
advertisements. Her position has been repeatedly 
attacked in the medical journals, but she has been 
allowed to go her own way unchecked by our Scot¬ 
land Yard authorities, who seem to think that they 
have done their duty by seizing a few abortionists 
red-handed, and that they need not interfere with 
persons who incite and abet misguided women, either 
directly or indirectly, to rid themselves of the pro¬ 
ducts of conception. At any rate, it is difficult to 
arrive at any other conclusion when we find Madame 
Frain carrying on her sordid trade openly year after 
year apparently without let or hindrance from the 
powers that be. Last week an inquest was held in 
London on the death of a young married woman after 
abortion, and it was shown, in evidence, she had 
taken Frain’s nostrum for inducing that condition. 
In the course of the inquiry several noteworthy facts 
have transpired. First, it was stated by a man who 
called himself a “ herbalist ” that the lady’s connection 
with the business had ceased for some time past. 
Secondly, that the vendor seeks to protect himself 
by making each customer sign a form to the effect 
that she is not enceinte, a precaution that would pro¬ 
bably be worthless in the face of Frain’s printed 
advertisements and circulars. Thirdly, that Frain’s 
remedies are sold by chemists, a matter that demands 
instant inquiry at the hands of the Pharmaceutical 
Society. We have little hesitation in saying that a 
chemist who deals in abortifacients, open and 
veiled, should be deprived of his licence forthwith. 
Fourthly, Frain’s manager stated that their stuff was 
perfectly harmless, an assertion that clearly bears o 
the point of false pretences. The jury gave as tbei 


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358 The Medical Press. 


NOTES ON CURRENT TOPICS. 


April 5, 1899. 


opinion that Madame Frain'a business was either 
fraudulent or felonious, and the coroner alluded to 
the fact that the proprietors of the concern had 
taken no steps to disprove the charges recently made 
against their advertisements in leading medical 
journals. Again we ask, where are the police ? 

Infection in Public Vehicles. 

From time to time a case is published of disease 
communicated by the exposure of infective patients 
in a cab. A little stir is made over the scandal at 
the time, but the storm in the teacup soon subsides, 
and no one is a penny the worse, as prosecution for 
such recklessness is rare, and conviction almost 
unknown. Yet weighed in the balance of probability, 
a factor that cannot be ignored, the percentage of the 
known to the unknown must be in this matter simply 
incalculable, for by the very circumstances of the 
case discovery of the facts is hard to detect and still 
more difficult to prove. At the present moment, 
however, the community is faced with a situation ripe 
for instant action. Two great movements are 
afoot, each of them bearing directly on the par¬ 
ticular point under discussion. First, there is 
the great national cruBade against tuberculosis, a 
movement that is gathering every day fresh strength 
and volume. Secondly, there is the social battle now 
being waged anent the regulation of street traffic, 
especially of public vehicles plying for hire. By a 
happy combination of the practical issues of these 
two subjects of current interest it seems likely that 
the cause of prevention might be materially advanced. 
The root of the matter may be placed in a nutshell. 
Tuberculosis and many other communicable diseases 
are spread by infected persons who travel freely in 
cabs, omnibuses, tramcars, and railway cars. The 
present system of prevention in such special case is 
unsatisfactory, as the state of the law is dubious, 
and practically no provision of any kind whatever is 
enforced by the local authorities. The reform is no 
doubt a difficult one to institute, but its existence 
marks a most serious flaw in the general prevention 
of communicable diseases. Here is an opening for 
some earnest worker in public health who may be 
desirous of handing down his name to posterity. 

Margarine Evasions. 

Butter is butter, all the.world over, a sentiment 
that seemingly forms the text and gospel of the 
Butter Association, an excellent body that last week, 
pregnant with sorrows, waited upon Mr. Walter Long. 
The tale unfolded by these experts furnishes sug¬ 
gestive reading for consumers in general. No one 
objects to margarine, if sold as such, and distinctly 
labelled, as the law directs, but when vended either 
pure and simple or in mixture and paid for as genuine 
butter then the public most assuredly have a right to 
grumble. The Association have successfully pro¬ 
secuted many hundreds of offenders in that direction 
during the past five years, and have thus undertaken 
work that should have been performed by the 
local authorities. They found that out of 500 
samples of butter sold at a shilling a pound 


in apparently respectable shops, over 100 were 
adulterated with margarine, the majority to the 
extent of 70 to 90 per cent. They assert that 
the practice of many retail establishments is never to 
sell margarine or mixtures across the counter as 
butter for fear of detection, but to send such stuff to 
their family customers by van or errand boy delivery. 
An even more artful trick is that which practically 
hides the word “ margarine ” on the wrapper by 
placing it in the midst of a thicket of flourishes, while 
the word “ butter ” in connection with the name of 
the vendor stands out in ovei’wlielming prominence. 
The Association propose a label which should bear in 
bold block type the name “ Margarine,” only that and 
nothing more. All this sounds reasonable, and it is 
to be hoped that the sweet persuasiveness of the 
Butter Association will prevail upon Mr. Long to 
carry out the principles clearly adopted in existing 
margarine legislation, and no less plainly evaded and 
set at naught by the trickery of tradesmen to the 
injury and loss of Her Majesty’s lieges. 

Company Doctoring. 

Our leaders are aware that the Pharmaceutical 
Societies have been making great efforts to prevent 
co-operative stores and other limited companies from 
carrying on extensive business as dispensers under 
cover of a single'qualified pharmaceutist who stands as 
trade sponsor for a whole crowd of unqualified com¬ 
pounders. So far, the societies have not succeeded, 
but more than a year ago, it occurred to Dr. Tich- 
bome, the representative of the Apothecaries Hall 
of Ireland in jthe General Council, that there is a 
serious danger that the same method may, at any 
time be applied to medical practice, and that it may 
be legally possible for a company to be started to 
supply medical advice and medicine wholesale under 
cover of some out - at - elbows practitioner. Dr. 
Tichbome brought the matter under the notice 
of the General Medical Council, and the result, after 
much legal advice and cogitation is the following 
Bill introduced to the Lords by the Chancellor last 
week 

1. It shall be unlawful for a company under the 
Companies Acts, 1862 to 1898, to carry on the profes¬ 
sion or business of a physician, surgeon,’ dentist, or 
midwife, and if any company contravenes this enact¬ 
ment it shall be liable on summary conviction to a 
fine not exceeding five pounds for every day during 
which the contravention happens. 

2. This Act may be cited as the Companies 
(Medical Profession) Act, 1899. 

Typhus in South London. 

From a recent report handed into the Vestry of 
St. George the Martyr, Southwark, it appears that 
typhus has been running a slow epidemio course in 
South London for many months. In the parish 
named a case occurred in October last and another 
in the following February. Following up the history 
of the cases the Medical Officer of Health, Dr. Waldo, 
has established a connection between them by a long 
chain of illnesses and deaths, some of the attacks 
being recognised as typhus fever, while the fatal 
cases were certified as due to pneumonia, influenza. 

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Aprii, 5, 1S99 


NOTES ON CURRENT TOPICS. 


The Medical Press. 359\ 


enteric fever, and typhus. The report is valuable from 
several points of view. It shows the difficulty or, 
indeed, the impossibility of recognising atypical cases 
of the disease, which are nevertheless infectious. It 
also proves the value of careful and systematic in¬ 
vestigation of all cases, and the need of co-operation 
by neighbouring sanitary authorities. The disease 
was spread in the first instance by the father of a 
family who refused to go to the St. George’s recep¬ 
tion house, and who carried off the infection to his 
daughter's house in another parish, and thereby 
started the long train of specific sickness which has 
led to something like sixteen cases, with four deaths. 
Many persons will be somewhat startled to hear that 
typhus fever has been abroad in the metropolis for 
the last six months, and the officers of medical 
institutions will do well to bear the fact in mind 
when dealing with obscure cases, especially where 
there are petechial or anomalous rashes. 

A Nostrum Denounced. 

Mr. Braxton Hicks took advantage of the 
opportunity afforded him by an inquest at Putney 
last week, to expose what he rightly considers to be a 
gross fraud upon the suffering poor. It had trans¬ 
pired at another inquest that the father of an 
epileptic girl had paid several shillings a bottle for a 
quack remedy called Elepizone, prepared by one 
Root, at 28, Endsleigh Gardens, N.W., which, it was 
claimed, would cure fits, epilepsy, and falling sick¬ 
ness. The coroner had this nostrum analysed by Dr. 
Womack, of St. Bartholomew’s Hospital, who testified 
that each drachm of the liquid contained three 
grains of bromide of potassium with an admixture of 
some inert colouring matter, the whole being approxi¬ 
mately of the value of twopence. The coroner and 
Dr. Womack announced their intention of defending 
any action that might result from this exposS, but 
the risk is small, for these pernicious nostrum- 
mongers know full well that they would find short 
shrift before a British jury. This nostrum, how¬ 
ever, is probably no worse and no better than a 
myriad other preparations of the same kind, and it 
would be more to the point if an anti-quack league 
were formed for the express purpose of publishing 
analyses of them all in order to educate the public. 
The thing might be worth doing in spite of the fact 
that the taking of nostrums is with many people a 
sort of religion, and the habit is consequently open to 
amendment. 

Hospital Case Books for Sale. 

If the story told in the last number of Truth be 
correct anent the sale by auction of twenty odd 
volumes of the late Dr. Alfred Meadow's hospital 
case books, we cannot but concur in the condemna¬ 
tion expressed by our contemporary of the conduct 
of those responsible for such a tactless breach of pro¬ 
fessional confidences. These case books only dated 
back to 1873, and doubtless many of the persons 
whose histories are therein recorded are still alive, 
and they would certainly resent these histories being 
made public property. The whole lot only fetched 


between three and four shillings, so that the leaves 
may serve to wrap up butter and cheese. If any 
aggrieved patient chose to take action we presume the 
responsible persons might be held liable in damages 
for their wanton disregard of professional amenities. 
It would be interesting to know the name of the 
purchaser, but this it is not in our power to give. 

The Presidency of the Royal College of 
Physicians of London. 

It is stated that the struggle for the Presidency of 
the Royal College of Physicians (London) between 
Dr. W. S. Church and Sir William Broadbent was 
really one between St. Bartholomew's Hospital and 
St. Mary's. The former being the larger school, and 
having consequently the largest number of sup¬ 
porters, it is not surprising that their nominee should 
have been successful at the poll. The last member 
of the school of St. Bartholomew’s who was President 
of the College was the late Sir George Burrows, who 
held office from 1871 to 1876. It is no doubt an 
honour to a school to have among its staff the Presi¬ 
dent of the College, and while we heartily congratulate 
Dr. Church upon the high position to which he has 
attained, we nevertheless feel bound to confess that 
so far as work done for and in the profession is con¬ 
cerned, the claims of Sir William Broadbent were not 
only higher than those of Dr. Church, but higher 
than those of any other candidate for whom votes 
were recorded. 

A. Fatal Ether Explosion. 

An extraordinary catastrophe is reported from 
Rochdale Workhouse Infirmary, where two nurses 
were fatally injured in consequence of the accidental 
breakage of a large bottle of ether in the dispensary, 
and the ignition of the contents. It seems that the 
dispensary doors were without handles on the inside, 
thus rendering prompt escape impossible. At the 
inquest the jury added a rider to the effect that ether 
bottleB should be stronger, and that the Petroleum 
Acts should apply to this highly inflammable sub¬ 
stance. It is to be feared that the strongest bottle 
made would not resist a fall from a shelf, but some 
good might be done by requiring ether to be sent out 
in bottles not containing more than one pound each. 
We must admit, however, that even one pound of 
ether would suffice to set the place in a blaze in pre¬ 
sence of a lighted gas jet. In fine, this regrettable 
accident appears to be one against which extreme 
care alone can afford even an approximate safeguard- 

A Volta Centenary. 

Volta, the electrician, and inventor of many 
electrical appliances, was bom in Como, Italy, and 
the inhabitants of that city on May 4tli next will 
celebrate the centenary of the day on which he in¬ 
vented the pile which goes by his name. On this 
occasion, also, an international exhibition of elec¬ 
tricity will be held, a section of which will be de¬ 
voted to the various medical applications of electricity. 
Perhaps in this connection it would lie worth while- 
to recall the great discoveries made by our Country- 


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360 The Medical Press. 


NOTES ON CURRENT TOPICS. 


April 6. 1899. 


man, Michael Faraday, in electrical science. He was 
the first, for example, to demonstrate the laws of 
electrolysis, a discovery which alone would entitle 
his name to be passed down to posterity. As, how¬ 
ever, he was only born in 1791, some time must 
yet elapse before a centenary celebration can be held 
in connection with his life work. As a chemist he 
was a great man, but as an electrician he was a greater, 
and, perhaps above all, he was a native of this 
country. 

Insanitary Stations in India. 

The Government of India have a work before them 
from which they should not shrink. It is that of 
carrying out wholesale sanitary reforms in regard to 
the various stations. Most of the latter, it is reported, 
are so insanitary that they have become veritable 
death-traps for the officers and men of the British 
regiments. The necessary reforms would require 
either the complete abandonment of the old sites and 
the selection of new ones, or the enforcement of 
sanitary principles by which the old stations could 
be made free from filth diseases. Under present cir¬ 
cumstances, many young officers and men who land 
in India from this country merely do so to die from 
typhoid after a brief interval. The disease is 
quite preventible, and the responsibility of the 
deaths of the young Englishmen entirely devolves 
upon the Government. No doubt an enormous 
sum of money would be requisite in order 
to carry out the necessary reforms; but the 
Government of India should not shrink from 
such an outlay in view of the terrible cost of valuable 
lives which its neglect exacts. The matter is one 
upon which some questions might with advantage 
be asked in Parliament, inasmuch as the sooner 
public opinion is brought to bear upon the urgent 
necessity for the reforms indicated the better. 


The Open-Air Treatment of Tuberculosis. 

The West London Medico-Chirurgical Society have 
arranged a discussion upon “The Open-Air Treatment 
of Tuberculosis,” which will take place at the meeting 
of the Society on the 7tli instant (Friday next). Dr. S. 
T. Pruen, of Cheltenham, will open the proceedings 
by reading a paper upon the subject, and there is no 
doubt that the theme is one upon which much can be 
said. It is true that the open-air treatment of tuber¬ 
culosis is very greatly to the fore at the present time, 
for which in some measure the “ boom ” in “ matters 
tuberculous ” is responsible. Good, therefore, is 
likely to come from the dissemination of facts and 
opinions in connection therewith, for which the 
Society above mentioned have made timely arrange¬ 
ments. 

The extremely trying east winds of the last weeks 
has i-un up the death rate in Dublin to 32’3 per 1,000 
of the population, being two per 1,000 over average. 
The deaths from respiratory diseases the week before 
last reached 59, being 11 over average. Thirty-one 
deaths were from bronchitis, and 19 from pneumonia. 


Another Poison Romance. 

This is not the big gooseberry season or we should 
experience less difficulty in explaining the curious 
plethora of sensationally ridiculous stories about 
attempts to poison whole families with a few drops of 
chloroform on a handkerchief pushed under a bed 
room door, and the more recent tragedy reported 
from Philadelphia, where a certain society lady is 
asserted to have been the victim of an attempt to 
murder by means of a poison emanating from a book¬ 
mark placed in a work which som9 disappointed lover 
or female rival had sent her. She is said to have 
held the bookmark to her nose on account of its 
delicious odour, and soon became comatose, a whole 
hour elapsing before consciousness was restored. We 
are assured that on examination the bookmark proved 
to be saturated with poison, and it has been retained 
for analysis. Let us hope that this analysis will give 
us the key to the mystery, because we are at a loss 
to imagine which, in the arsenal of poisons, might 
answer to the description. 

Epidemic of Cerebro-Spinal Meningitis. 

A 8harp outbreak of cerebro-spinal meningitis is 
reported to have broken out among the troops at 
Omdurman. The disease is one with which English 
practitioners do not have many opportunities of 
becoming familiar, and our knowledge thereof is 
limited accordingly. We know that it is very con¬ 
tagious, and its occurrence appears to stand in some 
relationship with insanitary surroundings. Epi¬ 
demics of the disease are tolerably frequent among 
French soldiers, and are characterised by a very high 
mortality, but so far the only means of dealing with 
it is by general sanitary precautions and measures, 
and no treatment seems to have any effect in checking 
its progress when once it has obtained a hold. 

Prescriptions and Chemists. 

Complaint was recently made in the public press 
of the difficulty in London of having a prescription 
made up at a chemists between the hours of nine in 
the evening and eight in the morning, and we might 
also add on Bank holidays and Sundays, through¬ 
out the day. An instance is given in which a servant 
visited eighteen different shops before he could get a 
chemist to dispense the prescription. We should have 
thought that a chemist would find it worth his while 
to leave some one always on duty, and who would, in 
any case, not be above supplying medicine whenever 
it was required. 

Dr. Stevens’s Hospital, Dublin. 

In our last issue we stated that Mr. Hamilton had 
resigned the Surgeoncy of this hospital, which he 
has held so long with such advantage to the institu¬ 
tion. and that an election to the vacancy so created 
was pending. This statement was not altogether 
correct, inasmuch as Mr. Hamilton still holds the 
position of Senior Surgeon and performs the duty 
thereof from day to day, but, as a fact, a fourth 
surgeon to the hospital was appointed on the day 


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April 5. 1899. 


CORRESPONDENCE. 


The Medical Press. 361 


when we wrote, in the person of Dr. William Steele 
Haughton, Demonstrator in the School of Physic 
and Assistant Surgeon to Sir Patrick Dun’s Hos¬ 
pital, son of the late Dr. Samuel Haughton, F.T.C.D. 
Dr. Haughton has had a very distinguished career 
in the University of Dublin. We hear that there 
were seven candidates for the position. 

The Sex Problem at Southport. 

From the report of the Medical Officer of Health 
for Southport we gather that this town is afflicted— 
or shall we say favoured ?—with an extraordinary pre¬ 
ponderance of females. In a population of rather 
less than fifty thousand the excess of females over 
males is upwards of nine thousand. The proportion 
of males to females in the rural district is only 100 to 
1033, while in the residential quarter of the town the 
proportion rises to 100 to 19fr7. the average of the 
remaining wards being about Km) to 150. Here is an 
admirable problem which awaits solution at the hands 
of some enterprising physiologist who may find therein 
the data necessary to prove that other factors lies ides 
nutrition exert an influence on the differentiation of 

sex. - 

The Doctorate in Pharmacy. 

It is satisfactory to note that the French Univer¬ 
sities which have thought to make a rich harvest by 
selling doctorates to chemists are at loggerheads 
among themselves. The University of Lille has 
entered into competition for a share of the spoil, but 
the scientists and medical faculty of the University 
are violently contesting the transaction. Why do not 
the chemists and druggists, like the spectacle 
vendors, set up an university for themselves from 
which they can buy the privilege of calling themselves 
*' doctor,” and provide themselves with an illuminated 
Graduation testimonium and a gorgeous hood and 
gown ? 

No Payment for Abortion Advertisements. 

So far as the City of London Court can decide the 
point it is ruled that a newspaper cannot recover the 
charge for inserting these pernicious advertisements. 
The Weekly Dispatch sued an advertising agency 
for £1 lOs.for publishing such announcements, and 
the agency pleaded that, as the advertisements were 
contra bonos mores the amount could not be recovered. 
Mr. Registrar Wild, who heard the case, agreed to 
this, and refused to give a decree, but also refused 
to give the agency its costs. 

Arrangements are in progress for holding, in 
Brussels, an International Congress of Medical 
Officers of Life Assurance Companies early in Sep¬ 
tember next. Many important subjects will be dis¬ 
cussed among which will probably be hereditary 
diseaee, dipsomania, and other “ habits,” and the 
practicability of a uniform medical code for use in 
life assurance. Thus does specialism progress in 
medicinfe. - 

The Italian Government has intimated its inten¬ 
tion of taking into its own hands the manufacture of 
quinine, from which certain factories in Genoa and 
Milan are making large profits. 


£fcotlanb. 

[from our own correspondent.] 


Gla8qow University.— The following are the names 
of the candidates for the vacant Chair of Pathology :— 
Dr. J. Lindsay Steven, formerly pathologist, Glasgow 
Royal Infirmary; Dr. Robt. McNeil Buchanan, professor 
Medical Jurisprudence, Anderson’s College, Glasgow; 
Dr. A. Sheridan Delepine, professor of Pathology, Owens 
College, Manchester ; Dr. Charles Workman, pathologist 
to Glasgow Royal Infirmary, professor of Pathology, St. 
Mungo’s College; Dr. J. Lorran Smith, lecturer on Patho¬ 
logy, Queen's College, Belfast; Dr. Horace Manders, 33, 
Gloucester Terrace. Hyde Park, London; Dr. Robert 
Muir, University College, Dundee; Dr. William Russell, 
3, Walker Street, Edinburgh. Dr. Sutherland, who has 
been all along senior assistant to the late professor, is 
naturally a candidate, and as previously remarked, 
if the appointment rested with the students Dr. 
Sutherland would have an easy walk-over. The success¬ 
ful candidate will be expected to enter on his duties on 
April 25th. Salary £1 100. 

Glasgow University Summer Session. —It is 
announced in the University calendar that the Senate 
have decided to begin the summer session on April 25th 
At first it was intended that the Faculty of Arts should 
not begin before the commencement of May, but as at 
present arranged, the four Faculties —viz., arts, science, 
law and medicine—will begin at the same date. 

Victoria Infirmary. —In consequence of the large 
legacies which have been recently left to the infirmary, 
the directors have decided and are shortly to extend the 
Nurses’ Home, as they have a large piece of vacant 
ground on the site on which it is proposed to utilise in 
the enlargement of the home for the nurses. 

At It Again. —There is a great deal of talk going on 
in the city in reference to a recommendation of the 
House Committee of the new Glasgow Parish Council to 
erect a hospital at a cost of £200,<J00. It is understood 
that the proposal will be fully discussed by the Council 
at its monthly meeting, which takes place on the 13th 
inst. At present there are two very large hospitals, viz , 
Barnhill and the Town's Hospital, and it is not intended 
that the new hospital should take the place of either of 
the above. The former of these will, as it is familiarly 
known, be retained for purely poor-house purposes. 
“ Barnhill Poor-House,” the town hospital, is a very large 
establishment, giving accommodation to at least 
1,200 inmates at all times. The scheme at present 
under consideration includes a small district hospital 
in the centre of the city. The cry is, “ Still they Come.” 
We have previously drawn attention to the number of 
irons which are in the charitable fires of Glasgow philan¬ 
thropists, and the likelihood of some, at least, becoming 
cold, and now seriously ask the question, Where is the 
money to come from ? If the reconstruction of the 
Royal Infirmary requires £100,000 and two years have now 
elapsed, and still there is the small sum of £20,000 still 
wanting, with the committee at variance, if not logger- 
heads, with each other, and with no immediate start 
being made, how, then, is this new establishment likely 
to succeed and be in full swing unless it is intended to 
tax the population of the city in such a way as to 
squeeze the necessary sum out of them, or unless the 
merchant princes of the second city of the empire unite 
in the spirit of charity and subscribe the sum for the 
purpose of doing good to their less favoured fellow 
men and women ? This matter will be taken to avi¬ 
zandum. 


(EomBponOcncc, 

We do not hold ourselves responsible for the oplniooa of our 
correspondent*. 


THE CHLOROFORM “BOGEY.” 

To the Editor of the Medical Press and Circclab. 

Sir, —That there should exist so much misconception 
j as to the conditions affecting the action of chloroform 
vapour is not surprising when we remember that iis 

Digitized by LjOOQ le 




362 The Medical Press. 


LITERATURE. 


April 5, 1699. 


employment in surgery is usually to an extent sufficient 
to produce complete insensibility to the pain of some 
operation. 

As to whether it can be gradually administered during 
sleep, thus producing a deeper sleep, I have lately had 
painful personal experience. That I actually did inhale 
chloroform during my sleep I know by the symptoms I 
experienced on awakening, and that those symptoms are 
characteristic of that particular drug I also know from 
having had personal experience of them after a surgical 
operation. 

I consider myself justified, therefore, in believing the 
evidence of my senses, especially so since this evidence is 
strengthened by a corresponding train of symptoms in 
the person of both the other occupants of my bedroom. 

Your remarks upon the bona Jides of my statement, 
and your imputation of an attempt on my part to adver¬ 
tise, are most unjust, and are derogatory both to my 
character as a medical man and to the profession at 
large. 

I would point out to you that chloroform—which 
you describe as “a heavy vapour”— is volatile, and 
that a handkerchief saturated with it and left exposed to 
the air of a room becomes dry in a few minutes, the air 
becoming charged with its vapour; that a person sleep¬ 
ing in this room would, provided these conditions were 
maintained, inhale with the air an amount of chloro¬ 
form sufficient to render his sleep profound, and that in 
my case I have no means of knowing the actual quantity 
that was employed since the handkerchief may have 
been withdrawn and resaturated several times. I claim 
that, however impossible it may be to chloroform a subject 
against his knowledge when awake, yet this may cer¬ 
tainly be done while he is asleep. 

To your query? “How much chloroform would be 
required to saturate a handkerchief ” (which you answer, 
“ Barely enough to induce unconsciousness in the hands 
of a skilled anesthetist ”) I would reply that two ounces 
will saturate an ordinary-sized handkerchief, and that 
half this quantity will certainly render any one insen¬ 
sible that inhales it at close quarters. 

I, like doubtless many other practitioners, have re¬ 
peatedly anasthetised patients for surgical operation with 
one ounce of chloroform. This I am prepared to do again, 
and I think, in conclusion, that it would be more fair on 
your part to convince yourself by actual experiment of 
the truth of these observations before attempting to dis¬ 
parage the bona Jides of my statement. 

Your insinuation that the burglary did not take place 
will, I trust, be disproved by the ultimate recovery of 
some of the stolen property. 

I am, Sir, yours truly, 

Naunton Meadows. 

100, Bow Common, E. 

[We have not questioned the bona Jides of our corre¬ 
spondent j we have merely contended that he must have 
been mistaken in his conclusion regarding the chloro¬ 
form and the handkerchief.—E d.] 


MEDICAL AID ASSOCIATIONS. 

To the Editor of The Medical Press and Circular. 

Sir, —I venture to thick that if we are anxious to uphold 
the dignity of the medical profession, we should by every 
means in our power endeavour to put an end to proceed¬ 
ings which are calculated to bring us into the category of 
a trade. We all know that competition is very keen, and 
we all know that advertising is rife even amongst the 
higher branches of our profession, but I do assert without 
fear of contradiction that no amount of competition 
should lead us to countenance acts which savour at all of 
“ touting ” for clients. It is of no use shutting our eyes 
to the fact that in our large towns there exists a system 
of canvassing for patients either through the agency of 
Commercial Insurance Companies or through the direct 
agents of medical men themselves. 

By what means this objectionable and unprofessional 
system is to be put an end to is a question perhaps more 
for the General Medical Council than for individual mem¬ 
bers of the profession. At the same time it is very 


desirable that the extent and scope of the evil Bhould’be 
made known through the columns of the Medical Press 
and Circular, and it is with a view of eliciting informa¬ 
tion that I have made these few remarks. 

May I say that if the profession generally are desirous 
of raising the tone and of curing a disease which is rapidly 
becoming epidemic, the members of it should lose no 
opportunity of making representations to the General 
Medical Council? 

I am. Sir, yours truly, 

A General Practitioner. 


MEDICAL FEES FOR MEDICAL MEN. 

To the Editor of The Medical Press and Circular. 

Sir, —Very recently ray wife has been seriously ill from 
chest affection. I was also myself not well at the time. 

My medical friend in attendance, fearing complications 
in my wife’s case, expressed a wish to see a certain 

Dublin consultant. Dr.-. He left Broadstone by 

the early train, and was able to be back in Dublin early 
in the evening of the same day. ‘ He charged me thirty 
guineas for the visit.” Such a monstrous fee astonished 
me. I was prepared to pay all eipenses, and to give him 
something decent beside. 

I am anxious to know what would be a fair fee under 
the circumstances. 

I am. Sir, yours truly, 

Joseph O’Kellt, M.D. 

[We cannot, of course, be expected to arbitrate as to 
the value which any practitioner may place on his ser¬ 
vices, nor as to the “ mitigation of damages ” which he 
would agree to in the case of a professional brother in 
the humble position of a Dispensary Medical Officer, but 
we do not hesitate to say that a charge of .£31 10s. for 
one day’s work under such circumstances would not be 
justified by either the custom of the profession in 
Ireland, or consistent with the esprit de corps supposed 
to prevail. In such a case we imagine that many practi¬ 
tioners would go for the expenses out of pocket and a 
nominal fee, but there may be others who do not recog¬ 
nise any distinction between a dootor and anyone else as 
regards liability.—E d.] 

literature. 


WINDYHAUGH. (a) 

The authoress of this story won her spurs, in literature 
we believe, by a medical novel, “ Mona Maclean, Medi¬ 
cal Student,” she being herself a member of the profes¬ 
sion. That work has gone through thirteen editions, 
truly an all-sufficient incentive to the most ambitious 
literary aspirant for further efforts in this direction. 
Whether “ Windyhaugh ” be destined to such an achieve¬ 
ment time alone can decide. The initial volume was 
breezy and full of sustained action from cover to cover. 
It, moreover, traversed a comparatively untrodden field, 
which none but a writer conversant with the by paths of 
medicine could have incorporated. The present novel, 
however, has nothing of a medical nature about it, if we 
except the description of a morphoraaniac, the heroine’s 
father to wit, his passions, and his inevitable end. It is the 
story of a motherless girl to whom we are introduced at the 
age of seven, perched on the top of a cask of sugar in a 
grocer’s shop, arguing with the proprietor in somewhat 
precocious fashion on the subject of religion. This child 
is under the care of her grandmother at a quaint old 
homestead called “ Windyhaugh,” which we take to be 
somewhere near, if not actually in, Scotland, from the 
names of the characters introduced, and the austerity of 
certain religious notions. The child’s father, Mr. 
Galbraith, is a mystery throughout the piece, the one 
thing certain abont him being that he is an inveterate 
gambler at Monte Carlo, and like the majority of that ilk, 

(a) “Windyhaugh.” A Novel. By Graham Travers (Mar¬ 
garet G. Todd, M.D.). Edinburgh aud London: Blackwood and 
Sons. Pp. 446. Price 6g. 


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Aphil 5, 1899. 


MEDICAL NEWS. 


The Medical Pbbss. 363 


ia very flush at times with the mammon of unrighteous¬ 
ness and spends as recklessly as he receives; whilst at 
ethers he is penniless, runs up bills he is unable to meet, 
and borrows of such friends as are foolish enough to 
yield to his importunities. 

Wilhelmina's grandmother inculcates her own very 
narrow views of religion and of the world generally into 
the child’s mind at this early period of her life, and 
throughout the remainder of it these struggle alternately 
with the broader views of womanhood, the sobering 
influence of time, and her own higher nature, in which 
the reader becomes immensely interested. In her case 
the course of love runs very smoothly, but on the day of 
her marriage she discovers a letter in returning from 
church which induces her to leave her husband straight¬ 
away, and for the next four years she battles alone with 
the world, educates herself in the classics and higher 
forms of mental culture; meets her husband occasion¬ 
ally, when the old spark of love has almost died out, and, 
finally, as is the oase in most novels, they both find 
tbemselvee madly in love with one another, and “ live 
together everlastingly happy.” How all this is brought 
about we mutt leave the reader to trace. There are some 
fine pieces of character writing in the book, and if the 
story does not prove so attractive as Mona Maclean, 
Medical Student,” it at least possesses merits above the 
common order of novels. 


More Female Health Inspectors. 

Four women health inspectors have been selected by 
the Birmingham Health Committee out of some ninety 
applicants. The new officers commence their duties on 
April 10th, and their inspection will be confined mainly 
to the poor districts in and about the centre of the city. 

Puerperal Fever. 

The Medical Officer of Health for Bristol has caused 
to be sent to all medical practitioners the following 
note:—“A Committee of the Royal College of Physicians 
of London has recently endorsed the view that the ex¬ 
pression ‘ Puerperal Fever ' should be taken to include 
‘ Septicaemia, PyBemia, Septic Peritonitis, Septio Metritis, 
and other acute Septic Inflammations in the Pelvis, 
occurring as the direct result of childbirth.” The 
Council of the Obstetrical Society of London suggests the 
following inclusive definition of the term “Puerperal 
Fever.” That is:—“ Septicaemia and Pyaemia, including 
Peritonitis, and all cases of acute Pelvic Inflammation 
occurring in connection with childbirth.” 

The School of Anatomy. 

At a meeting of the 8t. Saviour’s (Southwark) Guar¬ 
dians, last week, it was resolved to inquire of the autho¬ 
rities of the School of Anatomy how the bodies sent to 
them by the guardians were ultimately disposed of, and 
whether their use was strictly confined to medical and 
surgical research. Mr. Upfleld, who moved the resolu¬ 
tion, Baid he had it on very good authority that 
portions of human bodies were used in a disgusting 
manner by many medical students. It was their 
duty as a board to see that the bodies they sent 
were reverently treated and given a decent and a 
Christian burial when they had served their legitimate 
purpose. The Rev. G. W. Keesey said he had spent 
some time in dissecting-rooms, and was satisfied that 
bodies were not always treated as reverently as they 
should be. The Rev. J. W. Horsley said he had dis¬ 
sected every kind of body, from a worm to that of a 
human being, but he did not agree with the Rev. Mr. 
Keesey’s account of what took place in the dissecting- 
room. In reply to a member, the Rev. G. W. Keesey 
said that medical students took portions of bodies home 
with them. He was not satisfied that the present pre¬ 
cautions were adequate. 

Mortality in Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations:—Bombay 150, Madras 37, Paris 26, Brussels 
27, Amsterdam 16, Rotterdam 21, The Hague 19, Copen. 


hagen 23, Stockholm 20, Christiania 14, St. Petersburg 
26, Moscow 28, Berlin 18, Hamburg 18, Dresden 20, 
Breslau 24, Munich 25, Vienna 22, Prague 32, Buda 
Pesth 28, Trieste 30, Rome 24, Turin (10 days) 20, Venice 
30, New York (including Brooklyn) 19, Philadelphia 23. 

Vital Statistics. 

The deaths registered last week in thirty-six great 
towns of United Kingdom corresponded to an annual 
rate of 23 1 per 1,000 of their aggregate population, 
which is estimated at 12,786,832 persons in the middle 
of this year. 

Birkenhead 23, Birmingham 22, Blackburn 25, Bolton 
22, Bradford 21, Brighton 21, Bristol 18, Burnley 24, 
Cardiff 13, Croydon 19, Derby 22, Dublin 31, Edinburgh 
20, Glasgow 23, Gateshead 19, Halifax 22, Huddersfield 
16, Hull 19, Leeds 25, Leicester 19, Liverpool 
26, London 23, Manchester 33, Newcastle-on-Tyne 19, 
Norwich 20, Nottingham 20, Oldham 32, Plymouth 27, 
Portsmouth 20, Preston 19, Salford 28, Sheffield 28, 
Sunderland 21, Swansea 23, West Ham 17, Wolver¬ 
hampton 29. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
wereFrom measles, 1*7 in Manchester, and 2 3 in 
West Ham; from scarlet fever, 2 0 in Derby from 
whooping-cough, 1*4 in Cardiff, P8 in Birkenhead, and 
2‘1 in Plymouth; and from “fever,” 1‘8 in Wolverhampton. 
In none of the large towns did the death-rate from 
diarrhoea reach 10 per 1,000. The 84 deaths from 
diphtheria included 37 in London, 8 in Sheffield, 7 in 
Leeds, 6 in Leicester, and 3 in Portsmouth. No death 
from small-pox was registered in any part of the United 
Kingdom. 

A very appreciative sketch of the late Professor 
Kanthack appears in the current number of the Eagle , 
the magazine supported by members of St. John’s Col¬ 
lege, Cambridge. 


PASS LISTS. 


Victoria University, Manchester. 

The following candidates passed the respective exami¬ 
nations during the March sittings of the Court;— 
Anatomy and Physiology—Second Examination. 

John Aoomb, Yorkshire; F. H. S. Ashworth, Owens; Herbert 
Bates, University: J. L. Beddoee, University; H. M. Birkett, 
Yorkshire; J. W. H. Brown, Yorkshire; Fred Bullough, Owens ; 
W. H. Canter, Yorkshire; J. B. Cook, Owens; J. F. Corson, 
Owens; J. M. Cort, Owens; E. N. Cunliffe, Owens: Tom Eastham, 
Owens; J. E. Floyd, Owens; J. A. C. Forsyth, Yorkshire; H. E. 
Fox, Owens; Q. W. Gelderd, University; D. G. Gellatly, Owens; 
V. J. Glover, University; P. H. Green. Owens ; J. W. Greenwood, 
Owens; Frederick Griffith, University: W. 8. Holmes, Owens; W. 

L. Maccormac, 1 orkshire; Charles Mackey, Owens : C. T. Mat¬ 
thews, Yorkshire; J. S. W. Nuttatl, University; T. F. Pugh, Uni¬ 
versity; Arthur Richmond, Owens; Edwin Seville, Yorkshire; 
F. R. Sawdon, Owens; G. H. Shaw, Owens; Robert Smailes, York¬ 
shire : H. G. Tansley, Owens; H. C. Waterhouse, Owens; Alwyn 
Wharton, Owens; B. M. Wilson, Owens ; F. P. Wilson, University; 
J. G. Woolham, Owens. 

Materia Medica and Pharmacy. 

C. W. 8. Boggs, Yorkshire ; 8. B. Brentnall, Owens; J. C. Caley, 
Yorkshire; A. C.Clarke, Owens; A. M. Deane, Yorkshire; J. A. 
C. Forsyth, Yorkshire; P. T. Harding, Owens; J. L. Hawkee, 
University; F. W. Hayes, Yorkshire; G. R. Heath, Owens; Mar- 
sliall Hooper, Owens; 8. B. Mehta, Owens; J. B. O'Donoghue, 
Yorkshire; W. P. Potts, Yorkshire; S. W. Swindells, Owens; 

M. G. L. Walker, Yorkshire; F. W. B. Young, Yorkshire. 

University Scholarship. 

H. G. Tansley, Owens. 

Faculty of Medicine: Final Examination. 

Part I.—A. G. S. Broughton, Yorkshire; T. L. Fennell, Owens ; 
B. F. Ferris. Owens; A. E. Finney, Owens; E. F. Hill, Owens: 
A. E. Horsfall, Yorkshire; C. E. Horsfall, Yorkshire; 8. K. 
Hutton, Owens; F. W. Johnson, Yorkshire; L. R. Lempriere, 
Owens; B. C. Middleton, Owens; W. H. Morrison, Yorkshire; 
R. V. A. Mosley, Yorkshire; R. 8. Nichol, Owens; W. P. Noel], 
Owens ; W. H. Bussell, Owens; G. M. Sharpe, Yorkshire. 

Part II.—J. W. Aldred, Owens; T. T. Bark, University; John 
Craig, Owens; J. T. Grierson, University; T. W. Hart, Owens ; 
J. E. Healey, Owens; W. S. Henderson, University; J. E. W. 
M’Fall, University; Thomas O’Neill, Owens; J. A. Reed, York¬ 
shire; Graham Benshaw, Owens; W. H. Richardson, Owens; O. 
H. Woodcock, Owens. 

The following were awarded honours:—Seiond Class: John 
Craig, Owens; W. H. Richardson, Owens; O. H. Wojdcock. 
Owens. 


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364 Ths Medical Press. 


NOTICES TO CORRESPONDENTS. 


April 6, 1899. 


4toti«5 to 

CorreoponkntB, Short Krtttrs, -&r. 


Mr Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive eignature or 
initiate, and avoid the practice of signing themselves “ Header, ” 
“Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

BEPRINT8.— Authors of papers requiring reprints in pamphlet 
form after they have appeared in these columns can have them at 
half the usual cost, on application to the printers before the type is 
broken up. 

THE LISTEBLAN RITUAL. 

To the Editor of the Medical Press and Circular. 

Sir,—I t is amazing that Dr. Bantock’s critics cannot see his 
simple and irrefutable answer argument. The Listerian ritual 
cannot be in any way advantageous to surgical operations if he can 
do as well without it as others can do with it. To claim sulphureous 
aCid as a part of the ritual is as reasonable on the port of Mr. 
Bowreman Jessett as if he claimed the sun and the moon. 

I am, Ac., 

Lawson Tait. 

195 Newhall Street, Birmingham, March 28th, 1899. 

J. J. Smith (Hipon).— You are quite right in supposing that the 
pollution of streams goes on practically unchecked in many parts of 
the United Kingdom. The “adoptive” Part III. of the Public 
Health Amendment Act, 1890, as concerns rural authorities (in Lon¬ 
don it is compulsory; directs as to pollution of streams by solid 
refuse: “ It is forbidden to throw or place in any watercourse 
within any district in which tliis part of the Act is adopted, any 
cinders, ashes, bricks, stones, rubbish, dust, filth, or other matter 
which is likely to cause annoyance." This is fairly comprehensive, 
but the difficulty is to get rural authorities to listen to the wooing 
of the permissive siren. Let our correspondent try his hand in his 
own district. 

CANDOUR. 


Patient (who has just had his eye operated upon): “ Doctor, it 
seems to me ten guineas is a high price to charge for that job. It 
didn’t take you ten seconds." Eminent Oculist: “ Mv dear friend, 
in learning to perform that operation in ten seconds I have spoiled 
more than two bushels of such eyes as yours ” 

The Word “ Bronchitis,” according to Dr. Ramuel Gee, was in 
vented in 1814 by Dr. Charles Badham, F.R.C.P.L. It superseded 
the old phrase, “ pulmonary catarrh.’’—C. and D. 

Qu.erens.— If yon examine a shred of mucus from the urine, and 
find gonococci, the patient is suffering from chronic gonorrhoea, 
and is infective. He is therefore unfit to marry, and if he be a man 
of good principle he would not wish to contract any union under 
such ill-starred auspices. The remote results of gonorrhoea are 
disastrous in the extreme, and it is better that the question of 
gonococci should be faced in the consulting room than in the ope¬ 
rating theatre or the Divorce Court. 

Busticcs (West Country).—To treat a patient suffering from 
appendicitis in the state yon describe by purgatives, enemata, and 
sinapisms, amounts virtually to manslaughter With reasonable 
law against unqualified medical practice, an offence of the kind 
would meet with speedy retribution. You did your du y in declin¬ 
ing further treatment without operation. It would be well to send 
a full statement of the facts to Dr. Bateman, the secretary of the 
Medical Defence Union. 

Dr. Ferrars.— For an answer to your query as to erysipelas 
you may be referred to a formula recently published in the 
Medical Brief. A drachm of sulphate of iron is triturated finely 
with a pound of native pulverised chalk, and made into a soft paste 
with lard. This ointment is spread a quarter of an inch thick 
on calico, and applied to the erysipelatous surface. It is claimed 
that the application will cure any erysipelas within twenty-four 
hours, but we have no personal experience of its use. 


Jfocttngs of the gocteties ant) lectures. 

Wednesday, April Jth. 

Obstetrical Society of London.— 8 . p.m. Specimens will be 
shown by Dr. A. Routh, Dr. Lea, Dr. McKerron, and others. 
Papers : Dr. W. S. A. Griffith and Dr. T. W. Eden : Notes of a Case 
of Pueiperal Eclnmpsia, with a description of a Five Weeks’ Ovum 
removed iira Subsequent Pregnancy.—Dr. Lowers : A Case of Per¬ 
sistent Mento-posterior Position of the Face in which the Child was 
delivered alive by the Axis-tractien Forceps. 


Thursday, April 6th. 

Harveun Society of London (Stafford Rooms, Titchliorne 
Street, Edgwure Road).—8.30 p.m. Clinical Evening. 

Friday, April 7th. 

West Kent Medico-Chiruruicai. Society (Royal Kent Dispcn- 
sarv, Greenwich Road, 8.E.)-S.45 p.m. Discussion on Tubercu¬ 
losis, with special reference to Treatment (opened by Dr. G. Heron). 
Short Papers: Dr. M. Dockrell (President >■ Tuberculosis of the 
Skin.—Mr. E. Clarke : Tuberculosis of the Eye —Mr. M. Collier: 
Tuberculosis of the Nose and Throat. __ T , 

West Londox Mf.dico-Chirurgical Society (west Loudon 
Hospital, Hammersmith, W.).-8.30 p.m. Dr. S. T. Pruen: The 
Open-air Treatment of Tuberculosis.-Mr. H. J. Paterson: I he 
Use of Gas in General Surgery. 

Lartnoolooical 8ociety of London (20 Hanover Squ^e, W.). 
- p.m. Cases and specimens will be shown by Di\ St. Clair 
Thompson. Dr. Potter, Dr. Donelau. Dr. Lack. Dr. Kelson, Mr. 
Porker, Mr. Ue Sonti, Hr. Cheatle, and others. 


DfttftitrieB. 

Birmingham and Midland Ear and Throat Hospital, Edmund Street, 
Birmingham.—House Surgeon for six months. Salary at the 
rate of £42 per annum, with board, lodging, and washing. 

Birkenhead Borough Hospital.—Junior House Surgeon. Salary 
•£75 per annum, with board and lodging, but no alcoholic 
liquors. 

County Asylum, Chester.—Junior Assistant Medical Officer, un¬ 
married. Salary commencing at £120 per annum, with board 
(no liquors), lodging, and washing. Also Medical Officer to 
act principally as Pathologist. Salary £150 per annum, with 
board (no liquors), lodging, and washing. 

County Asylum, (Shrewsbury.—Junior Assistant Resident Medical 
Officer for fonr years Salary commencing at £120 per annum 
(and £8 in lieu of beer, Ac.), with board, lodging, ana washing. 
Applications to the Medical Superintendent of the Asylum. 

East Suffolk and Ipswich Hospital, Thoro’fare, Ipswich.—Second 
House Surgeon for one year. Salary £60 per annum, with board, 
lodging, and washing. 

London County Asylum, Claybury, Woodford Bridge, Essex.— 
Junior Assistant Medical Officer (male). Salary £150 per 
annum, with board, furnished apartments, and washing. Appli¬ 
cations to the Clerk of the Asylums Committee, 6, Waterloo 
Place, S.W. 

North Biding Asylum, Clifton, York.—Junior Assistant Medical 
Officer. Salary £100, rising to £150, with board, lodging, wosh- 
iog, and attendance. 

Queen Charlotte’s Lying-in Hospital, Marylebone Road, London.— 
Resident Medical Officer for four months. Salary at the rate of 
£00 per annum, with board and residence. 

Scarborough Hospital and Dispensary. - Senior and Junior Resident 
House Surgeons. The Senior for twelve months at a salary of 
£80 per annum, with board and lodging, and the Junior for six 
months at a salary at the rate of £50 per annum, with board 
and lodging. 


Appointments. 

Beale, Peyton, T. B., F.R.C S.Eng., Surgeon to in-patients of the 
Great Northern Central Hospital, Holloway. 

Burgess, A. H., M.B.. Ch.B.Vict., M.Sc., M.R.C.S., Senior Assist¬ 
ant Resident Medical Officer to the Crumpsall Workhouse of 
the Township of Manchester. 

Cargill, L. Vernon, F.R.C.S.Eng,, Assitant Ophthalmic Surgeon 
to King’s College Hospital, London. 

Jephiott, C\, M.A., M.B., B.C.Camb., M.R.C.S., L.B.C.P.Lond., 
House Physician to Guy's Hospital, London. 

Kat, J. G., M.B. C'.M.Edin., Medical Officer to the Trellech Sanitary 
Districtof the Monmouth Union. 

Kelynack, T. N., M.D.Vict., M.B.C.P.Lond., Pathological Regis¬ 
trar to the Manchester Royal Infirmary, 

Malin8, Herbert, B.A.Oxou, M.B.C.M.Edin., Second Assistant 
Medical Officer to the St. Marylebone Infirmary, North Ken¬ 
sington. 

Mathias, R., M.B.Camb., LR.C.P.Lond., M.B.C.S., Medical Officer 
for the Pentyrch Sanitary District by the Cardiff Board of 
Guardians. 

Moorhrld, R. L., M B., C.M.Edin., Medical Officer to the First 
Sanitary District and the Workhouse of the Bridge Union. 

Reynolds, Francis Mortimer, M.B., C.M.Edin., Medical Officer 
to the Nswton Popplefonl. District, Exeter. 

Rigby, Hugh • Mallinson, M.B., B.8.Lond., M.B.C.S.EDg., 
L.B.C.P.Lond., Surgical Registrar to the London Hospital, 
Whitechapel. 

Robinson, B., L.B.C.P.Lond., M.R.C S., Medical Officer to the 
Rocester Sanitary District of the Uttoxeter Union. 

Sloggett, Harry Paynter, L.R.C.P.Irel., M.R.C.S., Surgeon on 
the Unattached List of the Victorian Naval Brigade, Depart¬ 
ment of Defence, Victoria, Australia. 

Tothill, F. C..M.B., C.M.Edin., Medical Officer of Health to the 
Staines Urban District. 


girths. 

Collins. —March 28th, at the Red House, Sawbridgeworth, thowife 
of Ethelb'ert Collins, L.B.C.P.Lond., M.R.C S., of a daughter. 
Cook.—M arch 29th, nt 22, Newport Road, Cardiff, the wife of 
Herbert G. Cook, M.D , F R.C.S., of a daughter (stillborn). 
Walker.— On March 27th. at Dawson Place, Pembridge Square, 
the wife of Basil Woodd Walker, M.D., of a daughter. 


^ttarrtages. 

Abhot-Andkrson —Shaw.—M arch 29th, at St. John’s Church, 
Nottiughill, W., M. Abbot-Anderson. M.B.. B.S., of 37 Wimpole 
Street, London, W., to Maude, widow of the late Jas. Robert 
Shaw of Leeds. 

Cardale - Din-DEN.—March 28tli, at the Catholic Apestolie Church, 
Chelsea, Henry Jasper Cardale, M.B., C.M., eldest s n of Vice 
Admiral Cardale, of Stoke, to Bruce, third daughter of J. S. 
Dib-den of Toller, Dorset. 

Kemiibk— Hunt.— March 28tli,at the Cathedral, Sharghai, Arthur 
T. Keml'er, F.R C.S.E., eldest son of the Rev. T. Keinber of 
Palamcotta, to Alice, second daughter of Richard Hunt of 
Hampstead. 


garths. 

Cooke.— On March 22nd, nt his residence, Glen Lea, Southampton, 
George Richards Cooke, M.R.C.S., L.S.A., aged 61 year-. 
Wallhh,— March 30th, Surgeon-Major G. C. Wallieh M.D., 
H.M.I.A., retired list, aged 83 years. 


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April 13, 1809 


The Med lost Press and Cfrcnla? Advertiser. 



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Iftkdiral Jr m and Cirntlar. 

“ SALUS POPULI SDPREMA LEX." 


Vol. CXVIII. WEDNESDAY, 


(Drigitral (Etrmntmticatimts. 

SOME OASES OF 
PERFORATING GASTRIC ULCER 
By THOMAS MYLES, M.D., F.R.C.S.I., 

Vice-President Hoyal College of Surgeons, Ireland; Surgeon 
to the Richmond Hospital. 

In no branch of abdominal surgery has the depar¬ 
ture from old traditions been more pronounced, and 
in none have the successes been more brilliant than 
in that to which I shall refer to-night. 

So many points of interest spring before one’s mind 
in connection with this subject that there is a diffi¬ 
culty in making a selection, without omitting what 
may be vitally important. I will first refer briefly to 
the cases that have oome under my notice, and then 
discuss necessarily in a very cursory manner a few of 
the more important points that are still controver¬ 
sial. Some months ago I was asked by my friends, 
Sir Francis Cruise and Dr. Moran, to see with them 
a gentleman with the following history. 

^Early on that day, when at his offioe, he had been 
seized with violent abdominal pain and vomiting. 
My friend, Dr. Moran, saw him, and on examination 
found him suffering from an umbilical hernia—tense, 
hard and tender. This hernia Dr. Moran reduoed, 
and the patient expressed himself as feeling some¬ 
what relieved. He was then put in a cab ana driven 
home. 

Some little time later on the same day the vomiting 
recommenced, and the patient complained of unen¬ 
durable pain above the umbilicus intne middle line of 
abdomen. 

Sir Francis Cruise who had previously treated him 
for goutv affections, was called into consultation, and 
during his examination the patient began to vomit 
black tarry matter, evidently blood acted on by the 
gastric juice. At this stage it was resolved surgical 
advice should be had, and I was sent for as detailed 
above. 

I saw the patient at 8 p.m., he was a thin, spare, 
man of ascitic type, set. 70, with an expression of great 
suffering in his features. 

His legs were drawn up, his abdomen slightly dis¬ 
tended, was rigid as a board, his breathing shallow 
and hurried, the slightest touch in the abdomen caused 
great suffering, and on percussion the area of liver 
dulne8s was replaced by one of resonance. 

At the umbilicus was still felt a decided fulness, a3 
if the hernia had perhaps partially recurred. He had 
all the aspect of a man rapidly sinking in a state of 
collapse, and it was evident that if any surgical 
measures were to be undertaken, there was no time 
for delay. I may add here that though, of course, we 
all diagnosed perforation of the stomach, we were 
rather inclined to attribute it to sloughing of portion 
of the stomach wall previously involved in the nemia, 
rather than to a perforating uloer of the ordinary 
type. 

The patient's relatives seeing his collapsed condi¬ 
tion, and being told frankly that the operation held 
out no great hopes of saving him, were unwilling to 
subject him to what seemed useless and additional 


APRIL 12, 1899. No. 15 


suffering, and I confess with this feeling I largely 
sympathised. On laying the case fairly and squarely 
before the patient, to our great surprise, he at once 
elected to be operated on, saying with both wisdom 
and resolution that he would rather die at once on the 
table than prolong his present agony till the inevit¬ 
able end came. 

As the accommodation in his present quarters was 
totally inadequate for such a grave operation, it was 
decided to remove him to the Richmond Hospital 
close by and operate there. This was done, ana all 
preparations being duly completed, ether was ad¬ 
ministered by our then house surgeon, Dr. Louis 
Robinson. Dr. Harvey, assistant surgeon to the 
hospital, assisted me at the operation, which was 
witnessed by Sir Francis Cruise and Dr. Moran, and 
the resident staff. 

An incision was made in the middle line so as to 
expose the umbilical hernia, exploration of this 
showed that the hernia was reduced, but the 
sac was very thick, and contained some fatty 
masses in its outer surface which gave me the 
impression that the hernia had partially recurred, or 
had been incompletely reduced. Coils of intestine 
now flaked with lymph came into view, and a little 
later fluid, evidently from within the bowel somewhere, 
trickled down from above. The wound was therefore 
enlarged upwards, and a very slight search brought 
the perforation into view. It was in the anterior 
stomach wall some two inches from pvlorus, and was 
about 1 inch long extending vertically from above 
down. There was no evidence of any constriction 
around it to indicate that it had been involved in a 
hernia, so this hypothesis had to be abandoned. 
Further examination showed a good deal of thickness 
and hardness about the pylorus, and I at once sus¬ 
pected the possibility of malignant disease. A probe 
was passed into the opening and thence through the 
pylorus. It undoubtedly gave me the impression 
that the case was complicated by a pyloric stricture, 
and I at once proposed to establish a gastro-jejunal 
anastomosis. Sir Francis Cruise, however, in answer 
to my inquiry as to the patient’s strength being suffi¬ 
cient to stand this additional procedure, informed me 
that if the operation was not promptly completed the 
patient would die on the table. I resolved, therefore, 
to close the wound in the stomach, and postponed any 
further measures until the patient had rallied. The 
edges of the little wound were therefore carefully 
resected, and closed with a double row of silk sutures, 
the first continuous, the second interrupted. As the 
patient was now practically pulseless and very 
cold thorough cleansing of the peritoneum 
was impossible, and it was resolved to douche the 
abdominal cavity with a hot saline solution. This 
was done while the sutures were being passed in the 
abdominal wall, and had a very stimulating effect, 
the patient at onoe rallying. A small gauze drain 
was carried down to the line of sutures in stomach 
as it was felt that the rapidity with which the opera¬ 
tion details had been carried out, prevented us placing 
absolute confidence in the completeness and perman- 
ance of the suturing. The patient having been 
carried back to bed, vigorous methods were adopted 
to rouse his dormant energies. His limbs were com- 

Digitized by CjOO^Ic 



366 The Medical Pbbss. ORIGINAL COMMUNICATIONS. Apbil 12, 1899. 


pletely enveloped in cotton wool, hot blankets were 
wrapped around him, hypodermics of strychnine and 
atropine, and rectal injections were administered, the 
end of the bed raised about a foot above the level 
of the head, to encourage the central blood supply, 
and hot saline solutions with a transfusion outfit were 
kept handy, to be available in case of emergency. 

For several hours he hovered between life and 
death, but gradually his latent energy began to 
manifest itself, the pulse at the wrist again became 
perceptible, the sufferer became warmer, and he 
gradually recovered consciousness. From that 
moment until the fourteenth day, he never looked 
back. Nursed with the most assiduous care under 
the directions of Miss McDonnell, our Lady 
Superintendent, he recovered with a rapidity that I 
have never seen equalled by one of his age before. 
On the fourteenth day, when I visited him, a 
serious change had taken place. He was cold and 
blanched, pulse very rapid and fluttering, breathing 
hurried, complained of great thirst, and said he felt 
himself dying. Inquiry elicited the fact that during 
the act of defecation copious haemorrhage had taken 
lace from the bowels, and two pans filled with fluid 
lood bore testimony to tbe statement. While 
speaking to bim be complained of again wanting to 
stool, and then and there he passed another panful 
of blood. Needless to say, this was a terrible blow 
to us, just as we had piloted him, as we thought, 
through all his dangers, was his barque foundering 
within sight of land P A hurried consultation with 
my friends, Sir Francis Cruise and Dr. Moran, was 
held, and though it was obvious that to administer 
an anaesthetic and thoroughly explore the rectum 
was out of the question, we thought it might be 
possible without undue shock to find the bleeding 
spot and control it. 

A large soap and water enema was given at once, the 
rectum well emptied, and then just inside the anal 
margin a ring of swollen, deeply congested piles were 
seen. A little cocaine solution was swabbed over 
them, and then a tampon of cotton wool soaked in 
Friar’s balsam was inserted and kept in place with a 
pad and bandage. 

This had the desired effect, no more bleeding 
occurred, and though convalescence was seriously 
retarded by this untoward complication the patient 
some six weeks after the operation was driven in a 
pneumatic-tyred carriage to Kingstown, where the 
fresh air and sea breezes soon restored him to his 
pristine vigour. He is now, I am glad to say, back 
again at his business as a director of one of the 
largest commercial enterprises in the City. I have 
given the details of this case at some length, partly 
because it was far the most interesting of all those I 
have met, but also because it was the most recent, 
and, therefore, the impressions derived from it were 
the strongest. The total number of cases I have 
operated on up to the present, in which the diagnosis 
of perforating gastric ulcer was made before and 
verified at the operation, is four. 

Of these, three occurred in females and one in a 
male. Of the three in women two died, one some 
twelve hours after the operation, and the other 
exhausted by prolonged suppuration and leakage 
through a gastric fistula. 

A few brief notes of these I will lay before the 
meeting. 

Mary A., set. 19, a servant in the Young Women’s 
Christian Association, Harcourt Street, was attacked 
suddenly with violent abdominal pain, vomiting, and 
collapse. No hsemorrhage;, called to see her, I at 
once diagnosed perforation, and had her removed to 
the Richmond Hospital, She was seen by my col¬ 
leagues in consultation, and an operation urged upon 
her—this she declined. Two days later she was much 
better, and felt convinced she had been wiser than 


her medical advisers. She was seen from time to 
time by my colleagues and complained only of a feel¬ 
ing of fulness in the epigastric area, and some tender¬ 
ness on pressure. She was living on a fluid diet, and 
had no vomiting. Some six weeks after her admis¬ 
sion to hospital she suddenly developed acute pain 
in the abdomen, a swelling formed in the left side 
of epigastrium, dull on percussion, with oedema of 
skin over it. It was obvious an abscess was form¬ 
ing. At the urgent solicitation of her friends she 
consented to the abscess being opened, but no 
further operation was to be attempted. As a 
matter of fact nothing else could be done. A large 
abscess was evacuated, but the thick layer of lymph 
which covered everything made it impossible to 
recognise any of the viscera, or to find the opening 
of the stomach. 

The cavity was douched out and drained, and for a 
time we hoped she would recover, but she gradually 
sank and died of exhaustion. 

Had this girl consented to the operation proposed 
within a few hours of the onset of her illness, in all 
probability her life would have been saved. 

The other two cases may be dealt with briefly. One 
was a woman, set. about 30, in whom perforation had 
taken place some days before admission to hospital. 
She was emaciated to an extreme degree, and a large 
collection of fluid could be easily recognised in the 
abdomen. In cutting into this quantities of half 
digested potatoes and the liquid contents of the 
stomach were discovered, but she never rallied, and 
died very soon after the operation. 

The fourth case was more interesting. Patient, a 
married lady, set. 32, was seized with violent pains in 
the abdomen, vomiting and collapse; no bleeding. 
When I saw her the collapse was so pronounced that 
operation was out of the question. Heat was applied 
to the epigastrium, rectal injections of alcohol, and a 
small hypodermic of morphia given later. Twenty- 
four hours later pain had subsided, but there was one 
spot very tender, exactly in the middle line. Opera¬ 
tion proposed and declined, patient alleging, with a 
certain amount of justification for her belief, that 
she felt certain she would die on the table. Five days 
later a small abscess had formed. This was explored 
with a hypodermic syringe, and the diagnosis being 
thus verified, local anaesthesia was produced with the 
ether spray, and the abscess opened with a tenotome. 
About an ounce or so of thick pus evacuated and a 
small drainage tube inserted. Though I naturally 
gave a very unfavourable prognosis, the patient 
recovered rapidly, and is alive and well to-day. 

So far for the cases in which the diagnosis of per¬ 
foration was made and verified by operation. 

But in common with all surgeons of any experi¬ 
ence, I have diagnosed perforation of the stomach 
which did not exist. In one case in which I was mis¬ 
taken, a remarkably accurate diagnosis had been 
made by a much younger man, Dr. Grundy, at one 
time house surgeon at the Mater Hospital. He sent 
a patient into the Richmond Hospital in whom he 
had diagnosed perforation of the bile duct, but which 
I confess I believed to be a perforation of the stomach. 
Laparotomy was performed. A biliary abscess was 
opened and drained, but it was found impossible to 
discover the seat of perforation. The patient 
gradually sank and died of exhaustion. The autopsy 
was made by my friend Dr. Woods, who discovered 
a perforation of the cystic duct. 

In another case in which perforation of the 
stomach was diagnosed, I found that organ appa- 
rently perfectly healthy, and nothing but a localised 
collection of peritoneal fluid. 

My friend Dr. Chance some time ago operated on 
a similar case, in which also nothing abnormal could 
be discovered. 

Quite recently, Dr. Conway Dwyer exhibited a 


Apbil 12, .1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Fbbss. 367 


another scientific gathering a patient .on. whom he 
had operated for perforation, of the stomach, but 
-exploration showed that the lesion was an . acute 
strangulation of a coil of the jejunum, which he 
resected with the most brilliant success. I mention 
these cases because in these, as in all other abdominal 
cases, the liability to error in diagnosis is ever pre¬ 
sent. It is because of this inherent weakness in 
the power of diagnosis that one is compelled to 
question the accuracy of the statement so often made 
at the last meeting of the British Medical Association 
that recovery frequently takes place spontaneously 
after perforation. 

I confess myself unable to accept such a result 
as probable, or even possible, except in a very minute 
proportion of cases. 

Should a perforation occur, of the pinhole type, in 
an absolutely empty stomach, no extravasation of the 
contents need take place, and the little opening may 
soon be shut off by exudation. 

The experience of physicians, pathologists, and 
operators is' entirely opposed to the belief in the fre¬ 
quency of such a fortunate combination of circum¬ 
stances. In this connection, Hume’s theory of 
miracles seems to be applicable. 

Is it not more probable that the diagnosis was 
-erroneous than that phenomena opposed to all patho¬ 
logical experience have occurred ? Forgive me if 
I. appeal* to labour this point, but it is vital and 
•essential. 

If spontaneous recovery is at all within the limits 
of probability, operation might very well be at least 
delayed. I venture to say, however, that very few 
men, even of those with the most profound belief in 
the efficacy of drugs and the powers of human resist¬ 
ance, would take the responsibility on themselves of 
recommending a patient in a case of. supposed per¬ 
foration not to submit to operation, but to trust to 
the vis medicatrix uaturaa. Surgical experience, now 
fairly extensive in this subject, has shown that the 
earlier the operation is undertaken, other factors 
being appropriate, the better the chance of success. 

If the abdomen is opened before exudation of 
lymph has taken place, the opening is generally 
easily found. If twenty-four hours have elapsed in 
an average patient, the matting together of all the 
organs, and their envelopment in a thick layer of 
lymph, renders it practically impossible. In such a 
• case death from exhaustion is almost, though not 
absolutely, inevitable. 

Again, in approaching a case of perforation the 
surgeon must remember that the operation may be 
very easy or very difficult. If the opening is in front 
and the operation is promptly undertaken, the work 
will not be difficult. If the opening is behind, or the 
operation delayed, it may tax all the surgeon’s 
resources and end in failure and disappointment. 
Two points in the technique I would like to refer to. 
1st. The use of the douche, and 2ndly, the use of 
a drain. It is urged against the use of the douche 
that it may convey infecting particles to areas as yet 
uninfected, and thus prove the cause of a general 
septic peritonitis. Per contra, it is urged tnat no 
amount of mopping can ever completely cleanse the 
peritoneum, and Mr. Treves, quite recently, has drawn 
attention to the fatal injuir that may be done to its 
smooth, glossy and absorbent surface by violence 
applied to it under a mistaken idea of its function and 
limitations. 

I must confess I am rather against the mopping 
plan, and favour the thorough douching. If the 
nozzle of the douche is carried low down into the 
pelvis first and later into the flanks the stream of 
warm water rushing out through the wound under 
pressure will carry practically everything with it. It 
may be necessary here and there to assist this process, 
by wiping away all adherent particles, but it is only 


the stomach contents that need to be wiped away, 
the lymph exudation may well be left alone unless 
there is reason to believe that it is already a centre 
of decomposition and infection. 

. Lastly, I believe these cases ought to be drained 
until the temperature is normal, and until the seat of 
perforation is shut off from the general cavity of the 
peritoneum. The tissues around the seat of ulcera¬ 
tion are generally unhealthy, even the most expert 
operator may have his doubts as to the durability of 
his suturing under such circumstances. 

I fear I can hardlv claim to have laid anything 
new before you, but the subject though not 
novel is not without interest; it deals with a fairly 
common condition, and therefore appeals to physi¬ 
cians and surgeons alike. 

When we remember that even 20 years ago such 
operations as those I have outlined to you if suggested 
by an operator would have been regarded as the dream 
of a lunatic, one cannot help feeling both proud and 
hopeful of our art. 

The modem operation of laparotomy, simple as it 
8eom8 to-day, has only reached its present position 
through the combined labours, trials, experiments, 
and disappointments of the greatest minds of our age. 
Though it is not given to all of us to be originators of 
great ideas we can, all alike at least, help in the good 
work by repeating and verifying the work done by 
the pioneers of science, and so contribute even an 
imperceptible mite to that beneficent knowledge 
which our profession, to its credit be it said, has ever 
held to be the common heritage of humanity. 


Jparis Clinical ‘JCcciures. 

PYO-PNEUMOTHOPcAX from NECESSITY. 

By Prof. GALLIARD. 

Look attentively at the chest of this patient; the 
peculiar character it presents is one which you will 
not perhaps see again. It is the first time I have 
met with it myself, though I have been on the look 
out for such a chest for several years. You will 
observe on the left of the sternum and over the 
three first intercostal spaces a hemispherical swelling 
about an inch in diameter at the base, which increases 
in size at every effort of the patient. 

This tumouv is indolent, soft, and compressible to 
the touch. On applying the ear a kind of splashing 
sound is heard, derived doubtless from the collision 
of gas and liquids. The tumour, further, is pulsa¬ 
tile, the beating being synchronous with the pulse. 
It is also reducible, as can be observed when com¬ 
pressed with the hand, giving the sensation of 
hernia of the lung. Consequently at this point there 
exists a cavity, for the time being circumscribed, 
which communicates with the thoracic cavity by a 
narrow orifice and contains a mixture of liquid and 
gas. This liquid is necessarily purulent. You can 
easily ascertain after reducing the size of the tumour 
that the narrow orifice is seated in the second in¬ 
tercostal space near the sternum. Change the 
position of the patient. Instead of examining her in 
the dorsal decubitus, place her in the sitting position, 
and you will remark tnat the tumour is more resisting, 
and gives the sensation of simple crepitation. Put 
her on her face and hands—the crepitation disappears, 
fluctuation alone is felt. The explanation of the 
phenomena is easy. In the first case the liquid 
gravitated out of the tumour, the gases alone occupying 
the tumour, while the reverse obtained in the second 

f isition. Thus examined, the diagnosis becomes easy. 

will not lose time in discussing the hypothesis of a 
hernia of the lung, for the case is one of gaseous 
abscess. 




ORIGINAL COMMUNICATIONS. 


Apbil 12, 1899-. 


368 Th* Mxdical Press. 


What was the origin of this cold abscess ? Was 
the point of departure a tuberculous vomica of the 
lung ? An unwary observer would naturally answer 
in the affirmative, for he would be influenced by the 
recent publications of Barie, Louligoux, and R. Meslay. 
But I hasten to state that the signs of pulmonary ex¬ 
cavation behind the gaseous abscess are wanting in 
this case. The hypothesis of a gangrenous cavity 
should not be entertained either, as there is no foetid 
expeotoration. We are thus, by way of elimination, 
brought to locate in the pleura itself the origin of tbe 
abscess ; it is a case of pyo-pnevmothorax from 
necessity. 

The case is a rare one, I admit, and I would not 
have brought myself to form this diagnosis if the 
arguments had not been furnished by the signs you 
have witnessed yourselves and by the olinicaJ evolu¬ 
tion of which I shall now give you the essential 
details. 

The case is that of a woman, set. 45, who, while 
walking on the footpath at the beginning of last 
December, was knocked down by a milk cart and 
severely hurt by the feet of the horse and by the 
wheel of the vehicle. She was picked up more dead 
than alive, and brought direct to the hospital St. 
Antoine, where my colleague found several wounds on 
the bead, a fracture of the left clavicle, several 
fractures of the ribs and subcutaneous emphysema of 
the thoracic wall, indicating laceration of the pul< 
monary tissue. The prognosis was bad. However, 
under appropriate treatment, the frail organism sur¬ 
mounted more or less these troubles, respiration 
became easier, the traumatic emphysema subsided to 
a certain extent, and matters were improving. But a 
few days afterwards, the temperature went up, 
the respiratory troubles became aggravated, and the 
following day my colleague showed me the patient, 
declaring that the pleuro-pulmonary complications 
belonged to the domain of medicine. According to 
him the subcutaneous emphysema was accompanied 
by a partial pneumothorax on the left side. The 
coincidence of subcutaneous emphysema and pneumo¬ 
thorax is not an everyday occurrence, because the 
conditions which favour the passage of air into 
the cellular tissue of the wall are, as you know, those 
which are opposed to penetration in the pleural 
cavity. For subcutaneous emphysema, it is neces¬ 
sary that the lung should be fixed to the wall 
by the fractured ribs, whereas, for pneumothorax, 
an open wound of the pulmonary parenchyma, 
a lung free from adhesions, moreover, a retracted 
lung, are necessary. However, the coincidence 
is possible, especially when several ribs have been 
fractured. A minute examination of the patient 
permitted me to affirm one thing, namely, that the 

neumothorax if it existed was not situated at the 

ase of the lung. Under the clavicle, on the other 
hand, I found that the vesicular murmur was 
abolished, so that I was inclined to admit the exist¬ 
ence of a partial pneumothorax as suggested by my 
colleague. In any case the patient was handed over 
to my care and a few days afterwards traumatic 
pleuro-pneumonia manifested itself, and on December 
29th I tapped the side, withdrawing only twelve ounces 
of sero-sanguineou8 liquid; the pleurisy was evidently 
encysted. The following days the temperature 
oscillated, while the dyspnoea was considerable and 
the general condition bad, without doubt. The liquid 
was increasing in quantity and rapidly becoming 
purulent. Examination of the base of the lung 
revealed nothing beyond the presence of empyema, 
no metallic sound nor signs of Hippocratic succussion, 
yet the heart was displaced towards the right side 
and showed signs of dry pericarditis. Why this dis¬ 
placement with such a small amount of liquid 
in the left base ? It was because the empyema 
did not constitute the only lesion; there was a pneu¬ 


mothorax beneath the clavicle, which was demon¬ 
strated by increased resonance of that region, by a 
complete absence of the vesicular murmur, by an am¬ 
phoric souffle peroeived in the third intercostal space, 
and by the presence of an intermittent metallic tink¬ 
ling. Was I not right to insist on the encysted nature- 
of the pleurisy? Thus only can be explained the- 
singular phenomenon of the cohabitation of pneu¬ 
mothorax and empyema under the same roof, in the 
same house, in two distinct stories of the left pleura. 
It was not necessary to be a great prophet to foresee 
that by reason of the dose contact of the empyema, 
the pneumothorax would not be slow to trans¬ 
form itself into pyo-pneumothorax. I was waiting 
for the succussion sound, but probably the cavity 
was too small and the liquid not abundant enougn 
to produce it. But in its place here is the gaseoua 
absoess which fully demonstrates the suppurative 
prooess. 

The prognosis being very grave we must not wait 
for the spontaneous rupture of the abscess; to-morrow 
morning we will incise freely the second intercostal 
space and treat the empyema in the usual manner. 


^hc (Soutetonian Jccturc© 

ON THE 

PATHOLOGY OF THE THYROID 
GLAND. 

Abstract of Lecture II, delivered before the Royal 
College of Physicians of London. 

By GEORGE R. MURRAY, M.A., M.D.Camb., F.R.C.P., 

Heath Professor of Comparative Pathology in the University o£ 

Durham; Physician to the Royal Infirmary, Newoastle- 
upon-Tyne. 

Referring to the result of loss of thyroid secre¬ 
tion in the young, the lecturer quoted evidence to 
show that in young animals and children, in addition 
to other symptoms, there was arrest of development. 
If the arrest of development or destructive disease ©£ 
the thyroid occurred early in life, symptoms of pri¬ 
mary cretinism, which are the same in the sporadic 
as in the endemic form, soon began to appear. 

In myxcedema in the adult as in cretinism different 
degrees of severity were found. As the success of 
treatment depended so much upon an early start, he- 
urged the importance of carefully considering the 
possibility of cretinism in all cases where some- 
arrest or development was noticed early in life. 
The older the child at the time of the onset the less- 
marked the want of development, and the more nearly 
the disease resembles the adult type. 

When the supply of the secretion was renewed,, 
metabolism was once more completed in a normal 
manner, and in cretins was so markedly reawakened 
that general growth again progressed even after it 
had been arrested for ten or twenty years. 8chifE 
and Von Eiselsberg had shown that a portion of 
thyroid gland successfully transplanted into the 
subcutaneous tissues of a dog or cat could maintain 
a sufficient supply of secretion to avert the acute- 
symptoms of athyroidism, and Mr. Victor Horsley- 
made a great step in advance when be suggested 
that a similar procedure should be adopted in man. 
The procedure had been followed in certain cases by 
marked improvement, but unfortunately the grafted 
gland appeared not to be able to maintain an inde¬ 
pendent- existence for long, and the symptoms re¬ 
turned. The excellence of the temporary results 
obtained, however, had led Dr. Murray to suggest 
that a simpler method of maintaining the necessary 
supply of thyroid secretion would be the continued 
internal administration of the secretion itself. With. 


Digitized by GoOglC 



April 12, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 369 


this view he had prepared a glycerine extract, and 
euch an extract was now official in the British Phar¬ 
macopoeia. At first he had administered the extract 
by hypodermic injection, but it was shown indepen¬ 
dently by Howitz, E. L. Fox, and Mackenzie that it 
was quite efficient when given by the mouth. The 
administration of thyroid extracts in animals de¬ 
prived of their thyroid glands rendered it possible 
to distinguish between the symptoms due to loss of 
the thyroid. It seemed probable that the acute 
nervous symptoms in the monkey, such as the 
fibrillary twitchings, the spastic rigidity, and perhaps 
also the tremors and convulsions were largely due to 
loss of the parathyroid, while the subcutaneous swell¬ 
ing, dryness of skin, loss of hair, subnormal tempera¬ 
ture, and changes in the blood were due to loss of 
the thyroid secretion. That conclusion received 
further support from the close resemblance of the 
latter symptoms to those of primary myxoedema in 
man, which they knew to be the result of disease of 
the thyroid gland, there being no evidence as yet to 
show that the parathyroids were affected in this 
disease. If that be the correct explanation, it was 
not surprising that these particular symptoms were 
not influenced by the thyroid extract. 

In primary and secondary myxcedema in man 
were seen tne results of loss of thyroid secretion 
pure and simple, and consequently they were able 
to remove the symptoms entirely by giving a suffi¬ 
cient supply of the secretion. The treatment was 
divided into two stages. During the first stage the 
tissues were gradually brought back to a normal 
condition. That might, according to the severity 
of the symptoms, require from one to three months. 
As soon as the symptoms had entirely disappeared, 
the first stage was completed. The condition of the 
atrophied thyroid gland was not influenced by the 
treatment, so that if the artificial supply of secretion 
were discontinued all the symptoms of myxcedema 
would gradually return, as he had found by actual 
experience. Tne second stage of the treatment of 
necessity thus lasts as long as the patient lives. It 
is therefore necessary to make the permanent daily 
dose as nearly as possible equivalent to the normal 
amount of secretion. If the dose fell below that 
slight symptoms of myxcedema would reappear, 
while if excessive a condition of thyroidism would 
be produced. 

Ill out-of-the-way places, and where expense was a 
consideration, the actual gland itself containing the 
secretion might be administered. One-eighth to one 
uarter of a lobe of the sheep’s gland was a suitable 
aily dose, one quarter being equivalent to about 
10 minims of liquor thyroidei. It should be minced 
and taken in glycerine or some similar vehicle, or 
lightly cooked on the outside by frying or boiling. 
As a rule, however, it was better to employ one of the 
preparations of the thyroid gland. The liquor 
thyroidei was the most convenient preparation for 
general use, and in his experience the most efficient 
and uniform in strength. Not more than a sufficient 
supply for a fortnight should be obtained at one time, 
and the patient should measure out the dose and mix 
with a dessertspoonful of water at the time of taking. 
The dry thyroid of the Pharmacopceia might be 
given as a powder, or made up into a pill or tablet. 
Dampness rendered the dried preparation liable to 
decompose and unfit for use. 

In advanced cases the first stage of the treatment 
must be carried out with great caution, especially in 
presence of symptoms of degeneration of the cardiac 
muscle. Under these circumstances the patient 
should be confined to bed at first, and only small 
doses of three to five minims of liquor thyroidei given 
each night. This dose, if well borne, might be gradu¬ 
ally increased up to ten minims. If not confined to 
bed these patients are apt to make use of their 


returning vigour too soon, before the heart has time 
to recover, and to adapt itself to the altered condi¬ 
tions brought about by the treatment. Now, however, 
most of these patients were seen in the early stages 
before any cardiac symptoms developed. Such 
patients were able to go about, but unusual exertion 
should be avoided during the first stage of the treat¬ 
ment. Undue acceleration of the pulse to 90 or 100, 
or rapid loss of weight were indications for reducing 
the dose. 

Symptoms of gastro-intestinal catarrh were some¬ 
times seen when a raw gland was used, but seldom 
after a suitable preparation. When they arose the 
treatment should be stopped until they had passed 
away, and when the treatment was recommended 
smaller doses should be given. When there was well- 
marked anaemia it waB as well to give iron as well as 
thyroid extract, and for this purpose five grains of 
dried sulphate of iron in a pill two or three times 
daily would answer the purpose. 

Tne second stage of treatment began after all the 
symptoms of myxoedema had disappeared. During 
this stage, which lasted whilst the patient lived, he 
must continue to take a daily dose equivalent to the 
daily output of the gland before it became diseased. 
An occasional intermission of a week or so had little 
or no effect, but if it lasted three or four weeks the 
temperature fell one or two degrees, and the myx- 
cedematous swelling of the face began again to 
develop. 

When the treatment of a well-marked case of 
myxcedema was carried out on the lines just indi¬ 
cated, very definite and interesting results were soon 
obtained. One of the earliest signs of improvement 
was the return of the temperature to the normal 
level. This was illustrated by the chart shown, by 
which it would be seen that the temperature before 
treatment ranged from 95 degs. to 96 aegs. F., whereas 
during the second, third, and fourth weeks of treat¬ 
ment it varied between 96 degs. and 98 degs. As the 
temperature rises to normal the former sensitiveness 
to cold was lost, and the frequency of the pulse was 
increased. The most striking changes wei*e those 
which took place in the skin with its appendages and 
in the subcutaneous tissues. The myxcedematous 
swelling gradually disappeared from all parts of the 
body, so that the face and hands once more assumed 
their natural appearance, and the free movement of 
the limbs, which had been considerably hampered by 
the swelling, was regained. The reduction of the 
swelling was accompanied by a loss of weight, which 
might amount to as much as two or even four stones. 
Not infrequently there was some desquamation which 
might occur in fine scales or in large flakes from the 
alms of the hands and soles of the feet, as observed 
y Byrom Bramwell. The hair follicles resumed their 
proper function, so that even where there had been 
complete baldness a good growth of hair was 
developed in the course of six or twelve months. 

In addition to these very obvious signs of improve¬ 
ment, the feeling of lassitude passed away and normal 
muscular strength and activity were regained. 
Mental proce?ses became more active, the memory 
improved, and hallucinations disappeared. In some 
cases in which actual insanity had occurred it also 
had been cured. If albuminuria without actual renal 
disease had been present it disappeared, while the 
amount of urine was increased. The observations of 
Ord and White showed that the total amount of 
nitrogen eliminated was increased, and that the in¬ 
crease was almost entirely due to the increase of urea 
in the urine. At first the amount of urea excreted 
might not only equal but actually exceed the normal 
average quantity. The number of red corpuscles in 
the blood was increased. In patients who had not 
reached the menopause menstruation returned, and 
took place regularly, even where there had been 

D 


370 The Medical Press. ORIGINAL COMMUNICATIONS. 


Apbil 12, 1809-. 


amenorrhcea for several years. In fact, the myxoedema 
was entirely cured, though the fibrosis of the thyroid 
gland remained unaffected. 

Treatment op Cretinism. 

The lecturer insisted on the importance of care¬ 
fully considering the possibility of the presence of 
disease or lack of development of the thyroid gland 
in every case of arrest or delay of development in 
children. In all such cases it was important to look 
for slight signs of cretinism. The importance of early 
diagnosis in such cases lay in the fact that the earlier 
the treatment was commenced the better prospect 
there was of normal development of the central 
nervous system. Experience had already shown that 
in cretinism of some years’ duration rapid as the 
improvement in the physical condition may be, the 
intellectual development was much slower, so that 
when treatment was commenced late it was doubtful 
if the latter would ever advance nearly as far as 
when treatment was started early. If any doubt 
existed as to the diagnosis, it was a good plan to 
carry out the treatment for one or even two months. 
If no distinct improvement took place the want of 
development was not due to cretinism, for in otherforms 
of arrested growth the treatment had comparatively 
little effect, though it is worthy of trial. The treat¬ 
ment of early cretinism should be carried out on the 
same lines as the treatment of myxoedema in the 
adult, 

In the treatment of cretinism which had lasted for 
some years they had a much more difficult task to 
perform, but very good results could be obtained. 
Even whei’e the disease had already lasted ten or 
twelve years, provided the patient was not more than 
eighteen or twenty years old, a remarkable amount of 
growth could still take place. In those cases three to 
five minims of thyroid extract might be given at the 
commencement, and increased according to the pro¬ 
gress observed. Even in cases in which the sym¬ 
ptoms had lasted for twenty or twenty-five yeara some 
growth and marked improvement in all the symptoms 
took place, In cases of long duration attacks of 
syncope were not uncommon. In such the earlier 
part of the treatment was more safely accomplished 
by keeping the patient in bed, and giving small doses 
of one or two minims only at first. 

When the necessary stimulus to the normal meta¬ 
bolism of growth was thus supplied to a cretin in the 
early stages of the disease the symptoms soon dis¬ 
appeared. The swelling gradually diminished in all 
arte of the body; the tongue, lips, and nose 
iminished in size, so that the appearance became 
natural; the skin became soft and moist and the tem¬ 
perature rose to normal. Growth, which at this early 
stage would only have been partially arrested, started 
afresh. If the treatment was continuously carried on 
in such a case from the earliest time at which the 
disease was recognisable, there seemed no reason to 
doubt that ultimately the child would grow up into a 
fully developed, healthy adult, who, however, would, 
of course, at any time develop symptoms of myxoedema 
if his supply of the extract was discontinued. 

The intellectual development was always much 
slower than the bodily growth and general improve¬ 
ment in all other respects. The shorter the duration 
of symptoms had been at the commencement of the 
treatment the more rapid the improvement in the 
mental condition, and Dr. Murray thought it was 
only in cases in which the treatment was started 
early that they could expect normal intellectual 
development to take place. In cases of some duration 
it was important that a special education should be 
carried on at the same time as the treatment in order 
that the patient might be able to make the most of 
hi 3 renewed cerebral activity. 


CASES OF 

ABDOMINAL HYSTERECTOMY FOR 
FIBRO-MYOMATA UTERI, (a) 

By CHARLES RYALL, F.R.C.S., 

Surgeon to the Cancer Hospital, Brompton; Surgeon to Out- 
Patients, London Lock Hospital. 

Case I.—M. R., ®t. 54, consulted me on September 
27th, 1898, and gave the following history:— 

For thirteen years she had noticed a tumour in the 
abdomen, but it has only troubled her during the past 
two years, during which time it has been gradually en¬ 
larging, but more rapidly bo daring the last few months. 
There has been much pain in the abdomen and lumbarand 
sacral regions, which is aggravated by walking too much, 
so that the patient is unable to get about and attend to 
her household duties. There has been a great loss of 
flesh. The bowels are constantly constipated, and mictu¬ 
rition is both frequent and painful. Catamenia began, 
at age of 13. Regular, no excessive loss. Always 
severe dysmenorrhoea. Menopause at age of 45. Children 
two; youngest 32 yeara old. No miscarriages. 

On examination a hard nodular and irregular mass 
about the size of a cocoa-nut can be felt in tto hypogas- 
trium. Dull on percussion and extremely mobile. 

Per Vaginam .—The oervix is pushed over to the right 
side, and a freely movable nodular mass can be felt in the 
left and posterior fomioes, and is found to be part of the 
abdominal tumour, and is incorporated with the uterus. 

Operation, October 6th, 1868.—Abdominal hysterec¬ 
tomy by the subperitoneal method was performed, 
which also included removal of the left ovary, 
and the abdominal wound was sutured in three layers. 
The patient went on very well on the first and second 
day following operation, and a little ffecea and some 
flatus were passed after administering 3 grains of calomel 
and an enema. A little flatns was also passed on the 
morning of the third day, but about noon on the same 
day the patient was seized with sudden acute pain in the 
left iliao fossa, followed by a little sickness. On examina¬ 
tion there was a great deal of tenderness limited to the 
left iliac fossa, and the colon was greatly distended, and 
in a few hours the distension spread to the small intes¬ 
tines. Repeated 5 grain doses of calomel were given, 
and every attempt was made to open the bowels by 
enemata and the long rectal tube, but neither faeces nor 
flatus was passed. The abdomen was reopened six hoars 
after the onset of the symptoms, and it was then found 
that the sigmoid loop was kinked and bound by reeent 
adhesions to the remains of the left broad ligament. The 
bowel was easily freed, but on palling it up it was 
noticed that there was a good deal of tension on the 
ligature embracing the upper part of the left broad liga¬ 
ment, and owing to the proximity of this ligature to the 
meso-eigmoid, it was thought that it might possibly cause 
a continuance of the symptoms. As the patient was in a 
very feeble condition, and as there was a great deal of 
liquid faeces in the colon, the sigmoid was sutured to 
the abdominal wound and drained by means of a Paul's 
tube. The tube was removed on the fifth day, after 
which the bowels acted naturally, and the fistula 
gradually contracted and eventually closed in a month’s 
time. 

There is no doubt that the kinking and adhesion 
cansed the obstruction, but a ligature close to the meso- 
sigmoid, and thus interfering with the blood supply or 
nervous innervation of the part, may cause similar- 
symptoms. 

Case II .—Abdominal Hysterectomy for Fibro-Myoma 

Uteri, followed by Rapture of the Abdominal Wound. 

F. H., set. 32. unmarried, consulted me on November 
28th, 1898. Menstruation began at the age of 13, and ever 
since then she has suffered great pain at the periods. 
The pain now commences after the first day of the flow, 
and is usually at its worst on the third and fourth day, and 
is so severe in character that it frequently makes her cry 
out. Moreover, she is quite incapacitated from work at 

in) Notes of cases read before the British Gynaecological Society 
| (March 23rd, 1899) and specknons shown. See “ Transactions of 
Societies," April 5tli,pnge 350. 


Digitized by VjL 



le 


Apbil 12, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Mbdical PrE8S. 371 


the time. The duration of the period is five to six days, 
during which there is a great loss, with occasional pass¬ 
ing of clots. For the last six months the symptoms 
have become worse, and she has also suffered from severe 
sacral pain in the inter-menstrual period. Medicinal 
treatment and rest have given her very little relief. 

Family History .—Her sister has also consulted me, and 
is suffering from flbro-myomata uteri, causing similar 
symptoms. 

On examination, a hard, smooth, solid tumour can be 
felt in the abdomen, and rising for about two inches 
above the pubis. Per vaginam, this tumour was found 
to completely fill the pelvis, where it was fixed, and was 
bulging down the vaginal fomioes. 

Operation, December 9th, 1898.—Abdominal hyste¬ 
rectomy by the sub-peritoneal method was performed, 
both ovaries being left behind. The operation was both 
difficult and tedious, owing to being unable to lift the 
tumour out of the pelvis or to get the hand below the 
tumour so as to reach the cervix and secure the uterine 
vessels. After securing the upper part of the broad 
ligament on each side, the peritoneum was incised over 
the tumour and peeled off, and then enucleation of the 
tumour was performed, after which it was lifted out of 
the pelvis, the uterine vessels secured, and the mass 
severed. The peritoneum was sewn over the stump with 
catgut. The parietal peritoneum was closed with a con¬ 
tinuous catgut suture, the musculo-aponeurotic layer 
with interrupted silk sutures, every care being taken to 
bring the fascia into careful apposition, and finally the 
skin was brought together with a continuous silk 
suture. 

The patient bore the operation well and made good 
progress after operation until the fifth day. The bowels 
had acted several times, but there was occasional 
retching. 

On the afternoon of the fifth day I was called suddenly 
to see the patient, and found her practically moribund. 
She was unconscious, the faoe was a dusky grey oolour, 
the breathing was rapid and shallow, and the pulse 137 
and almost imperceptible. The onset of these symptoms 
was sudden, but I was at a loss to understand the cause 
of this collapse. Hypodermio injections of ether and 
stryohnia were given immediately, followed by intra¬ 
venous injection of five pints of normal saline solution. 
The effect was immediate and most satisfactory, for the 
patient suddenly woke to consciousness, and the pulse 
and respirations improved. She then told me 
that she had some retching, when she was seized 
with pain in the epigastrium, after which she could 
remember no more. This made me think that possibly 
there might have been some intra-peritoneal extravasa¬ 
tion, and that the shock caused the sudden collapse, but 
on examining the abdomen the edges of the wound 
seemed in apposition, there was slight tenderness, but I 
oould find no reason to re-open the abdomen. Three 
hours after this she collapsed again, and intravenous 
injection of saline fluid had only a very temporary effect. 
The abdomen was again examined, and it was then found 
that the edges of the skin in one portion of the wound 
were gaping, through whioh came a quantity of serous 
fluid on pressing the abdomen. I therefore removed 
the cutaneous suture and found that the two deeper 
layers of sutures had completely given way, the sutures 
having torn through the tissues. The wound was now 
reclosed with sutures, including the whole thickness of 
the abdominal wound, but the patient gradually sank 
and died in a few hours. The necropsy revealed nothing 
of note, except that there appeared to have been no 
attempt at union in the abdominal wound. 

The case is of interest showing as it does that, even 
after taking every precaution, accidents may happen. 
The sudden cause of the collapse was at first a mystery 
to me, but now one knows that it was due to the shock 
of the rupture of the deeper layers of the wound, and 
thus simulated the perforation of a gastric ulcer. The 
superficial suture for a time kept the skin in apposition, 
and thus prevented me from immediately detecting the 
nature of the accident. 

Cask III.— Cate of Abdominal Hysterectomy for Myoma 
Uteri causing severe Hsemorrhage. 

M. S., aet. 35, married, no children, has suffered from 


menorrhagia during the last four years, and the loss i» 
so severe that the patient became almost completely 
blanched, and frequently faints. There is also a slight? 
irregular loss between the periods ; slight dysmenorrhcea. 
Catamenia began at age of 13, and were regular up to 
four years ago. 

On admission the patient was thin and feeble, and 
suffering from severe anaemia. 

On examination a soft smooth swelling could be felt 
in the hypogastrium, and reaching to within two inches 
of the umbilicus. Per vaginam the os was patulous, and 
a soft round swelling oould be felt within, and impli¬ 
cating the right side of the uterus could be felt a 
tumour which was continuous with that felt in the 
abdomen. The whole mass was quite movable. 

Operation in the Cancer Hospital, Jan. 25th, 1899.— 
The uterus was first explored per vaginam, and a myoma 
about .the size of a cocoa-nut could be found bulging" 
into the uterine cavity, and standing.out prominently on 
the peritoneal surface of the uterus. 

Abdominal hysterectomy by the intra - peritoneal 
method was then performed, and it presented no diffi¬ 
culties. The patient bore the operation well, and made 
a rapid recovery. 


^ranjeactions of gactetUB. 

OBSTETRICAL SOCIETY OF LONDON. 

Meeting held Wednesday, April 5th, 1899. 

Mr. Alban Doban, President in the Chair. 

MENSTRTTATION IN A MONKEY. 

Dr. Addinsell showed a section through the uterus, 
cervix and vagina of a monkey calling attention to the 
enormous size of the cervix. It was removed from a. 
“Bonnet” monkey, and it formed one of a series of 
abdominal hysterectomies performed on monkeys during- 
menstruation, the object being to decide the question of 
the shedding and denudation of epithelium during 
menstruation. He pointed out that in monkeys the 
menstrual discharge did not usually contain blood, but 
was glairy mucus. He mentioned that in Bamum’s 
Show there was a monkey, a chimpanzee, 14 years of age, 
which had begun to menstruate at 12. Since that time 
menstruation had taken place with great regularity 
every 28 or 30 days. He said this was the first instance 
of a well authenticated case of an animal high up in the 
scale, other than woman, in which menstruation had been 
observed to take place with regularity. 

ANTERO-POSTBRIOR POSITIONS OF THE HEAD AS A CAUSE 
OF DIFFICULT LABOUR. 

Dr. R. G. McKerron read a paper on difficult labour 
as the result of the antero-poBterior position of the head, 
probably the most uncommon of malpresentations. He 
related two cases to illustrate his contention. Case 1.— 
Mrs. B., set. 41, the mother of ten full-term children, all 
save two delivered by the aid of forceps. Labour set in 
on the evening of November 30th, and when seen at 
midnight on December 1st, the os was fairly dilated, 
but the head was above the brim, with the occiput 
anteriorly. The posterior fontanelle could be felt If 
inch from the symphysis, the sagittal suture running 
almost directly backwards. Traction with forceps 
proved fruitless, and the blades tended to slip. On 
further examination the anterior fontanelle could be felt 
just above the promontory to the right of the middle. 
He cautiously rotated the occiput backwards so as to 
bring the long diameter of the head into the oblique of 
the pelvis whereupon labour was promptly terminated 
with moderate traction. The mother made a good 
recovery, but the child, which was well formed, 
died three days later. Measurements of the pelvis 
gave as follows: —interspinous 8"75 inches; inter- 
cristal 1025 inches; external conjugate 71 inches. 
Case 2. —J. C., set. 38, one child delivered with forceps, 
was admitted at 10 p.m. on December 15th, labour 
having just started. The cervix was drawn up, and the- 
os admitted one finger. The pains were strong until 


Digit 



LV~ 




372 The Msdical Press. TRANSACTIONS OF SOCIETIES. 


3 a.m., when they suddenly ceased but returned the fol¬ 
lowing afternoon. On external examination the child 
was found dorso-anterior with the head free above the 
brim. The posterior fontanelle could be felt in front of 
the centre of the os an inch or more from the symphysis, 
and the sagittal suture was found to run backwards in 
the conjugate of the brim. The diagonal conjugate was 
made out to be barely 4£ inches. Guided by the previous 
case he forthwith proceeded to rotate the head backwards 
and labour was promptly terminated by the aid of the 
forceps. The child weighed 8£ pounds, there was no 
great caput succedaneum and no marked elongation of 
the occipito-mental diameter. The child died on the 
third day, and post-mortem the subdural space was found 
filled with blood and the ventricles contained sero-san- 
guineous fluid. After labour the hand was passed up 
to the pelvic brim which was found to be rounded in 
outline, and the conjugate was estimated at just 
over 3£ inches. The external measurements were: inter- 
spinous 9 inches, intercristal 10 6 inches, external con¬ 
jugate 7‘5 inches. He observed that these positions were 
often overlooked, probably because without anaesthesia 
their recognition was difficult owing to the high position 
of the head. The diagnosis rests on the antero-posterior 
position of the sagittal suture. In such cases the head, 
prematurely arrested, fails to accommodate itself to the 
brim and to the lower segment so that dilatation is slow. 
If diagnosed before rupture of the membranes an 
attempt should be made to correct the condition by ex¬ 
ternal manipulation; after rupture the head should be 
inclined laterally as advised by Ramsbotham. Manual 
alteration of the head above the brim is useless unless 
the body can at the same time be rotated by abdominal 
manipulation, otherwise the head reverts to ite old posi¬ 
tion. When the os is sufficiently dilated the forceps 
should at once be applied, and the position rectified in 
the manner described above. In these two cases cranio¬ 
tomy would have been the only alternative, but earlier 
recourse to the forceps to effect rotation would pro¬ 
bably have saved the lives of the children. 

A CA8E OF PUERPERAL ECLAMPSIA WITH A DESCRIPTION 

OF A FIVE WEEKS* OVUM REMOVED IN A SUBSEQUENT 

PREGNANCY. 

Dr. W. S. A. Griffith related the case of a married 
lady, ret. 32, who suffered from eclampsia at about the 
seventh or eighth month of her third pregnancy. Labour 
was induced by Dr. Griffith, with the intra-uterine 
bougie, and she recovered. About eighteen months 
afterwards Bhe again became pregnant, and severe 
symptoms ensued as early as the fifth week. Dr. Archi¬ 
bald Garrod reported that there was evidence in the 
urine of chronic nephritis, and the uterus was therefore 
dilated by the rapid method, and the ovum removed. 
The symptoms thereupon rapidly disappeared, but a 
trace of albumen persisted in the urine for some time. 
The ovum removed was in naked-eye appearances 
healthy. It measured 3 by 2 75 cm., and the foetus 
measured 11 mm. in length. The cephalic end could be 
made out, but the limbs were barely perceptible. The 
outer wall of the ovum was thickly beset with villi over 
seven-eighths of its total area, the remaining eighth 
consisting of a white membrane of very delicate consist¬ 
ence. The detachment of the villi from the maternal 
structures was complete in every part, no trace being 
seen of serotina or reflexa. Hardened and examined 
under the microscope the superficial plasmodial layer of 
the chorionic epithelium showed marked and widespread 
changes, clearly of pathological origin. In parts the 
layer was practically destroyed by vacuolation, the larger 
vacuoles having been formed by the fusion of adjacent 
smaller vacuoles, it being easy to follow the process of 
coalescence. The number of nuclei was below the normal, 
and their distribution was irregular, they being gathered 
together in (dusters in the least affected parts. The 
same changes were seen not only in the villi, but also 
in the plasmodial buds and processes. Where vacuola¬ 
tion was marked the deep or cellular layer of the 
chorionic epithelium had disappeared. The blood vessels 
in the chorionic stroma were normal in number and dis¬ 
tribution and were packed with blood corpuscles. The 
fcetal blood had undergone slight changes, the corpuscles ' 


April 12, 1899. - 

having lost their sharp outline, and many being in a 
state of disintegration. Almost all the cells were 
nucleated. The connective tissue stroma supporting 
the vessels and the deep or cellular layer of the epithe¬ 
lium were much altered in all parte. The meshes were 
greatly widened, the reticulum in many villi broken up and 
irregular, and the nuclei greatly reduced in number, 
and even absent altogether. Such as remained were 
shrivelled and distorted but not vacuolated. The cells 
of the deep epithelial layer had disappeared pari passu 
with these changes in the stroma. Specimens hardened 
in oemic acid showed a large deposit of fat in the proto¬ 
plasm of the plasmodic layer, most marked in the villi 
which showed least vacuolation. Whether this excess 
of fat is pathological is open to question. In the inter¬ 
villous spaces there was a good deal of fresh unaltered 
blood (maternal) and a small deposit of fibrin upon some 
of the villi. In the serotina the decidual cells were 
comparatively healthy, but in the sera and reflexa they 
show marked changes. They had no cell envelope, and 
the cell bodies were practically destroyed. Extensive 
fatty degeneration was present in all the altered 
decidual oells. In this case it is certain that the ovum 
was in situ up to the moment of its removal, though it 
cannot be affirmed that the fcetus was living at the time 
of interference. It seems probable that the changes 
described in the foetal and maternal structures occurred 
during the life of the foetus, and in all probability 
rapidly led to its death. With regard to the etiology, it 
is possible that the ovum was grafted upon an unhealthy 
endometrium, and the chronic nephritis from which the 
mother suffered may possibly be the ultimate patho¬ 
logical factor, but this conclusion cannot safely be 
deduced from a single case. 

The President raised the question as to the relative 
pathological responsibility of the mother and the fcetus 
respectively. He himself inclined to the view that 
eclampsia was always the fault of the mother, but he 
recalled the theory that eclampsia was a toxremia set up 
by the fcetus which subsides when the offending fcetus 
was removed. 

Dr. A. Routh asked the author why he had not adopted 
a more expeditious method of determining pregnancy, 
suggesting that it would have been better to have rup¬ 
tured the membranes. He asked whether the albumen 
in the mother’s urine comprised globulin. He thought 
the appearances were in favour of a fcetal or placental 
biological change. 

Dr. Griffith, in reply, said the case was of interest 
as belonging to a small group of cases of albuminuria 
with chronic kidney disease. It was a case in which the 
changes in the decidua were so marked that they formed 
a fresh point de depart for degenerative changes, but 
what relation they bore to the whole subject he was 
unable to state. 


ROYAL ACADEMY OF MEDICINE IN IRELAND 
Section of Surgery. 


Meeting held Friday, March 3rd, 1899. 


The President, Mr. R. L. Swan, in the Chair. 


DISEASES OF THE FOOT. 

Mr. W. I. De Courcy Wheeler related five cases of 
complete excision of the os calcis, followed by the most 
satisfactory results; one case of excision of the os calcis 
and astragalus, with portions of the tibia and fibula; 
thirteen cases of medio-tarsal operation, or Chopart’s 
operation, all showing as favourable results as the patient 
(exhibited at the Society) on whom he performed this 
operation twenty years ago; also three cases of complete 
excision of the astragalus for disease, besides others for 
compound dislocation. There was a brief record of thirty- 
nine cases after Symes’ operation, also results after 
Tripier’s operation, which he was of opinion had as 
many advantages over the subastragaloid operation as 
Chopart’s had, but had not the advantages claimed over 
the medio-tarsal operation, except with those who believe 
that in Chopart’s operation the astragalus is thrown 



April 12, 18#9. 


TRANSACTIONS OF SOCIETIES. 


The Medical Press. 373 


forwards against the Bear, which is quite preventible in 
a properly executed medio-tarsal operation, and does not 
occur when the plantar flap is made sufficiently long. 
After a record of the excisions of various bones of the 
foot, and six resections of the first metatarso-phalangeal 
articulation, the paper concluded by a description of 
metatarsalgia Madura foot and two cases of podal coma, 
so graphically described by Professor Miller. One case 
completely recovered, the second had a recurrence of the 
disease. There was no history of any constitutional or 
predisposing cause why the patient's foot— a male about 
thirty-two years of age—should be attacked by this 
painful disease, exoept in Miller's words, his “ system was 
weak and miserable." His parents were both alive, and 
remarkably healthy. 

Mr. Croly said that he was not in favour of excision 
of the os calcis, because in a patient with tuberculous 
os calcis the disease was rarely confined to that spot. 
If touched at all, he approved of its entire removal, the 
bone being removed in such a way that the incision 
should not be under the heel, but rather behind it. 
Excision of the os calcis was a good operation in case of 
accident. He considered Chopart's operation very good, 
because if the disease was confined to all the bones in 
front of the medio-tarsal line, a sound ast ragalus and os 
calcis were left. Podal coma required amputation of 
the foot. Xelaton’s perforating ulcer of the foot was a 
rare uffection, and was connected with certain forms of 
neuritis, and sometimes in connection with diabetic con¬ 
dition of urine. 

Mr. T. Myles related a very remarkable case 
of tuberculosis of the foot after injury. A small 
abscess formed, which was opened, and probing 
showed some bare bone apparently over the cuboid. 
The bone was dissected out, and the girl apparently 
got well. Bits of bone had, nevertheless, to be scraped 
away from time to time. Two months ago a consulta¬ 
tion was held, when it was decided to amputate the foot, 
but from that moment, to his astonishment, the young 
lady recovered rapidly, and is now perfectly well ana 
going about. 

The President considered that any tuberculous 
disease of the metatarsal bone at least should not be 
submitted to any operation except upon the bone itself, 
and many cases of tuberculous disease were confined to 
the metatarsal bones. The literature of the subject 
seemed to show that tuberculous disease of the os calcis is 
in reality the tuberculous disease of the foot which can be 
most frequently attacked with success. He related a 
case of tuberculous disease of the ankle-joint which, after 
a time, got practically well. Subsequently the patient 
developed tuberculous disease of the elbow, and a little 
later a tuberculous abscess in the iliac fossa. 

Dr. Henry Fitzoibbon said that in cases of disease 
of the boneB of the foot he approved of minor surgical 
methods before resorting to amputation. He related a 
case of a young girl whose middle cuneiform bone he 
removed for tuberculous disease. Recovery took place. 

Mr. Chance said the case related by Mr. Myles was 
very exceptional. He thought that too muoh attention 
was given to the mapping out of the bones, as tuberculous 
disease travels pretty much by the tendons and other 
structures. While he agreed that certain bones which 
are affected in small part of their bsft should be entirely 
removed, he thought that excision of such bones rarely 
gave room for free removal of the soft structures. 

Sir F. Cruise had seen the partial operations done 
successfully fifty years ago, so that the subject was not 
at all new. He observed that in a fairly healthy patient 
complete removal gave a good result, but that if th» 
patient’s constitution was decidedly tuberculous, even 
amputation did not save him. 

Mr. Wheeler, in reply, said that excision of the os 
calcis was favourable, because the synovial sac is limited, 
thus preventing rapid extension. The sooner the bone is 
removed the better, and he did not a^jprove of the gougo 
in removal, because it was difficult to say whether one 
was in healthy or unhealthy tissue, and still more, in 
strumous patients the use of the gouge might set up 
inflammatory action which would produce more carious 
disease. The podal coma he had seen was the same as 
hat described by Miller. 


PlRFORATINO GASTRIC ULCER. 

Mr. T. Myles related a number of cases of perforating 
gastric u cere on which he had operated, which we 
publish in extenso in another column. 

Among the cases narrated was that of a gentleman, 
set. 72, who, after the reduction of an umbilical hernia, 
developed symptoms of perforation. When he was 
called in the patient was sinking rapidly, with great 
pain and tenderness, persistent vomiting of black tarry 
matter, evidently altered blood, complete absence of 
liver dulness, tympany, <Scc. Operation seemed hopeless, 
but was undertaken in consequence of the agony the 
patient was suffering. The perforation was easily found, 
sutured, and abdomen freely douched with hot saline 
Patient made a complete recovery. Mr. Myles contrasted 
the ease with which an anterior perforation was found 
and handled, with what happened in posterior perforation. 

Sir F. Cruise insisted on the maxim nil desperandum. 
The patient who had been under his care was almost 
pulseless at the commencement of the administration of 
the chloroform; the pulse became much better when the 
chloroform was changed to ether. 

Mr. Wheeler congratulated Mr. MyleB on the excel¬ 
lent result, which showed that early operation offers 
better chances of recovery than delayed operation. He 
preferred swabbing out the abdomen to douching. He 
had seen saline solution revive a patient on whom he 
operated for tuberculous peritonitis. It depended on the 
position of the perforation of the stomach whether the 
operation could be rapidly done or even done at all. 

Mr. Chance mentioned the case of a young woman 
with gastric ulcer who suddenly became collapsed with 
symptoms of perforation. Laparotomy was at once per¬ 
formed, but thorough examination of the stomach re¬ 
vealed nothing. The abdomen was closed, and recovery 
followed. In another case, that of a woman, he opened 
the abdominal cavity, and found in an abscess a 
small cavity, a good deal of flocculent material, and a 
considerable quantity of undigested food. He drained 
the abscess, and recovery followed. The mortality of 
stomach operations seemed very high according to 
statistics, because the operation was so often done for 
malignant disease. 

Mr. Myles replied, and the Section then adjourned. 


WEST LONDON MEDICO-CHIRURGICAL 
SOCIETY. 

An ordinary meeting of this Society was held on 
April 7th in the Society’s Rooms at the West London 
Hospital, 

The President, Dr. S. D. Clippingdale, in the Chair. 

Dr. S. T. Pbuen, of Cheltenham, read a paper on 

RECENT ADVANCES IN THE TREATMENT OF 
TUBERCULOSIS. 

Dr. Pruen commenced his paper by giving the sta¬ 
tistics of tuberculosis. Of every eight deaths one was 
from tuberculosis; of every ten deaths one was from 
phthisis. He then dismissed the transmissibility from 
man to the lower animals and vice versa, and gave in¬ 
stances to show that tuberculous infection could pass 
not only between man and animals but also between 
man and birds, or even fishes; and showed what a 
great reduction of the mortality among infants 
could be brought about by the sterilisation of their 
food. Turning next to pulmonary tuberculosis in adults, 
he described his visits to the women’s sanatoria in 
England and on the Continent, and especially described 
the cure at Nordrach, in the Black Forest, where great 
attention was paid, not only to the question of a 
proper supply of air night and day, but to over-feeding, 
to regulated exercise, to proper rest, and to isolation 
from the cares and pleasures of the outside world. Dr. 
Pruen then showed a book written in 1840 by an English¬ 
man named Bodington, of Sutton-Coldfield, near Bir¬ 
mingham, who carried out in practice a cure for phthisis 
very like that at Nordrach. This cure was very success¬ 
ful, and one of the patients, who, when she came under 
his care was in the third stage of phthisis, he described 


Google 


FRANCE . 


April 12, 1866. 


_374 The Medical Pbsss. 

as being quite cured three years later, and who. Dr. 
Pruen added, was still quite well, although it is now 
sixty-three years sinoe she underwent the cure. This 
cure, although it was successful, was known by Boding- 
ton's medical compeers as the “beefsteak and porter 
cure," and so much ridicule was thrown upon it that the 
profession, as a whole, were afraid to take it up, with the 
result that Germany had now the credit of discovering 
it, although an Englishman was really first in the field. 

The paper was discussed by Dr. Gardner (Bourne¬ 
mouth), Dr. F. R. Walters, and the President. 


BRADFORD MEDICO-CHIRTJRGICAI 4 SOCIETY. 
Meeting held March 21st. 


President, Dr. Berry, in the Chair. 


Dr. Crowley gave a demonstration of microscopical 
specimens. 

Mr. Hall showed a number of photographs and casts 
of surgical cases, and gave brief descriptions in each 
case. 

Dr. Lodge read notes on a case of “ High Myopia,” in 
which a satisfactory result had been obtained by re¬ 
moval of the lens. The patient was shown. 

Mr. Horrocks read notes on a case of 

SIMPLE 8TRICTURE OF THE RECTUM, 

which had been satisfactorily treated by a simple opera¬ 
tive measure. He remarked that the kind of stricture 
he had in mind was one within easy reach of the anus 
and varied in depth from a simple narrow band running 
round the gut, to an annular stricture an inch in depth. 
After discussing various theories as to the origin of 
this affection, Mr. Horrocks remarked that it was more 
common in women than in men, and that it frequently 
became very narrow before patients presented them¬ 
selves for treatment. Their condition in consequence 
was one of great discomfort, and in the case brought 
before the society the patient became insane. Treat¬ 
ment by the passage of bougies is very painful, 
and does not hold out the prospect of cure. Forcible 
dilatation is unscientific and dangerous in that the 
bowel may be torn up to the peritoneal reflection and 
that cavity become infected. The patient was a 
woman, eet. 55, who had suffered from rectal 
trouble for twenty years. Had had bougies passed 
fifteen years before with some temporary relief. 
Her condition gradually become worse, and her mind 
was constantly occupied with the rectal trouble. 
On examination, there was a stricture an inch within 
the anus which barely admitted the index finger. The 
stricture was about a quarter of an inoh in depth, and 
the mucous membrane was fixed at the narrowed spot, 
but above was loose and healthy. No scars were seen 
on the pudendum or around the anus. On June 
10th, 1898, put under E.C. mixture. The anus was 
thoroughly stretched, and the stricture brought into view. 
A vertical incision was made one and a half inches long 
through the posterior part of the stricture; with the 
fingers the sticture was stretched till this vertical cut 
became transverse. The mucuous membrane was then 
held in position, and stitched with chromic gut sutures. 
After the operation the narrowed part readily admitted 
three fingers. The patient did well After the operation, 
and the bowels were relieved freely and regularly, but 
she could not be persuaded that the stricture did not 
still exist. Subsequently she became an inmate of 
Mearston Asylum. 

Mr. Horrocks remarked that the operation was sug¬ 
gested by the procedure of pyloroplasty for malignant 
stricture, which is exactly similar in principle. He also 
remarked that it was necessary for the success of the 
operation that the mucous membrane above the stricture 
should be healthy, or at any rate that it should be possi¬ 
ble to free it from the subjaoent tissues. He said that 
in a second case which he had treated by this method, 
it had been necessary to thus free the mucous membrane 
before the vertical incision could be converted into a 
transverse one. 


France. 

[from our own correspondent.] 

Paris, April 8th, 1889. 

Early Diaonosis of Consumption. 

The importance of detecting phthisis in its incipient 
stage is universally admitted, for at this period the 
malady is frequently susceptible of being cured, and in 
the progress of the lesions can be checked in many cases 
by well-applied hygiene and therapeutics. 

Among the reoent discoveries facilitating the dia¬ 
gnosis at the earliest stage is that mentioned by Chuguet, 
who found that the temperature presented a difference of 
from seven to eight-tenths of a degree between the' 
morning and the evening, or between the horizontal and 
the vertical position. The tuberculin test was supposed 
to be conclusive, but it was not exempt from danger, 
while injections of artificial serum, although giving 
analogous results, required to be employed with 
prudence. 

The method that would seem to be the most practical 
was the internal administration of iodide of potassium. 
Given in daily doses for two or three days of fifteen 
grains, it provoked in subjects suffering from latent 
tuberculosis sonorous rales in the suspected regions of 
the lungs. 

Dr. Murat has recently drawn attention to another 
sign which he considers of particular importance. It 
consists in an abnormal sensation experienced by the 
patients. When they speak loudly their voice causes 
the tuberculous lung to vibrate. When the conversation 
becomes animated with loud outbursts the same sensa¬ 
tion is felt, and he observed one case where the patient 
sought to attenuate this annoying resonance of the 
infiltrated region by pressing the arm to the correspond¬ 
ing side. The sign should be sought for with care, as 
not being painful the attention of the patient is not' 
naturally drawn to it. But if the attendant questions 
the patient and makes him cough or “ ahem ” he will 
recognise that the vibrations of the voice circulate in 
the left lung, for instance, while no kind of sensation is 
felt in the healthy side. This sign is produced by a 
thickening of the parenchyma of the infiltrated lung. 
Dr. Murat says that the symptom was well marked in 
one of his tuberculous patients at a time when the most 
minute auscultation failed to distinguish any morbid 
trace. 

Symptom of Tumour of the Cerebellum. 

Dr. Schmidt, in a recent memoir, reports two cases 
of tumour of the cerebellum in which the diagnosis, 
fully confirmed by autopsy, had been established by the 
presence of vomiting when thepatients lay on a certain 
side of the body. The first case was that of a woman of 
24, who in her childhood presented symptoms of 
rickets, both her parents being tuberculous. She 
had already had two children, but when she arrived 
at the third month of another pregnancy she 
commenced to suffer from intense headache, localised 
particularly in the occipital region. Five months sub¬ 
sequently vomiting set in, which nothing could control. 
The woman became indifferent to everything passing 
around her j her memory failed her, and she fell into a 
state of complete prostration. Artificial delivery was 
practised, believing that her life was in danger, but this 
intervention did not produce any permanent result. In 


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AUSTRIA. 


Thb Medical Press. 375 


a short time opisthotonos, paresis of the facial nerves on 
the left side, divergent strabismus with lateral nystag¬ 
mus set in, and the patient succumbed from oedema of 
the lungs. Several of the above symptoms might have 
indicated the serous meningitis described by Quincke, 
but two signs pointed towards the existence of a tumour 
in the cerebellum, which were: abolition of the patellar 
reflex, and the vomiting which was constantly produced 
as soon as the patient lay on the]right side. The post¬ 
mortem confirmed the diagnosis. The second case was 
also that of a young woman who had arrived at the 
fourth month of her first pregnancy. At this point she 
■was seized with vomiting, which continued during the 
whole period of her pregnancy, and persisted even after 
delivery. The vomiting was accompanied with violent 
headache, contractions of the muscles of the neck, vertigo, 
noises in the ears, and unsteadiness of gait. All the 
symptoms persisted more or less for fifteen months. 
Finally she took to her bed and lay constantly on the 
right side, for as soon as she turned on the left side she 
was seized with vomiting, vertigo, and noises in the ear. 
After a few weeks the patient succumbed, and at the 
autopsy a tumour was found in the right hemisphere of 
the cerebellum compressing the aqueduct of Sylvius. 


(ierntaitp. 

[from our own correspondent.] 

Berlin, April 7th, 1809. 

Danger of Infection in Tuberculosis. 

In the discussion on this subject at the Medical 
Society, that followed the reading of Dr. Cornet’s 
paper. Hr. Furbringer gave details as to the prophy¬ 
lactic measures as employed at the City Hospital, 
Friedrichshain. The measures proposed by Comet were 
rigidly carried out. Since the beginning of 1887 placards 
were hung up in all the phthisis pavilions with the very 
curt direction—“ Spitting glasses are provided for ex¬ 
pectoration, and spitting on to the floor or into the 
pocket-handkerchief is strictly forbidden.” These direc¬ 
tions were rigidly followed up, and with good results. 
In the February sitting of the Society of 1890, the 
speaker had been able to assert that up to then no case 
-of transference of infection had occurred. That proved 
nothing, and did not weaken the objection that patients 
might have left the house with latent phthisis. The 
speaker then went on to report on their experience with 
their staff of nurses and attendants. In 108 nursing 
sisters, three had tuberculosis during their term 
of service. One was previously healthy, one 
had hereditary predisposition, and one was infected 
before she came. From 1884 to 1890, 708 Victoria 
sisters were employed, of whom 94 only remained from 
five to fifteen years. Nearly all had nursed phthisis 
cases, but not exclusively or always. Since April, 1887, 
in round numbers 9,000 cases of pulmonary consump¬ 
tion had oeen treated in the various pavilions. The 
daily average was at least 80, and the length of stay 
thirty days. Under these conditions thirteen sisters 
had tuberculosis. One was previously healthy, six were 
tuberculous before coming to the hospital, and six bad 
hereditary predisposition. Possibly one or more had 
later on become victims to infection. In these figures 
lay an enormous contrast to those of earlier periods, 
when the percentage of the infected reached 60 (v. 


Ziemssen) and even 63 (Comet) The conditions were 
similar in the case of the physicians and attendants 
although they did not come into such close contact with 
the patients. He did not deny that a number of other 
favourable factors came into play in connection with 
the great change. Naturally the sisters did not allow 
patients to spit in their faces, and when a patient 
coughed out they turned away, but in the speaker’ 
opinion, the favourable figures were obtained by avoicf" 
jng infection “in the dry,” without regard to moist 
infection. From this he drew the conclusion that isola¬ 
tion of phthisical cases was unnecessary. Haupt was right 
as to hereditary taint, it formed a co-operating cause. 
Moist infection was, at any rate, rare; transference by 
the dry route was the regular one, that by the moist 
exceptional. 

The Feeding of Infants. 

Dr. Emil Schlesinger, a kinderarzt in Breslau (Iherap. 
Mcnattch, 3/99), reports that undiluted cow’s milk is the 
most rational, simple, and economical substitute for 
human milk, although pseudo-scientists and pseudo¬ 
scientific manufacturers of so-called children’s foods are 
doing their level best to relegate it to the past. The 
subject is an important one, if from an economic view 
alone, and the doctor would have done well to give us 
facte on which reliable opinions could be founded. 

The Surgical Congress. 

The twenty-eighth Congress of the German Surgical 
Association was opened here yesterday. Besides Pro¬ 
fessors Gussenbauer, of Vienna; Kocher, of Bern; 
Kroenlein, of Zurich; and Barker, of London, there were 
present a large number of German surgeons, including 
Herren Trendelenburg, of Leipzic; Braman, of Halle; 
Hoffa, of Wurzburg; and Bergmann, of Berlin, as well 
as representatives of the Army Medical Staff, and a 
number of officers of high rank. Speeches were delivered 
by Professor Koenig, of Berlin, and Messrs. Kocher. 
Bergmann, and Barker. I shall keep your readers duly 
informed of the proceedings of this Congress, which is 
creating a good deal of interest here. 

At the meeting of Maroh 1st, Hr. Ratkowsky showed a 
patient (a medical man) with 

Recurring Appendicitis, 

the case being peculiar, inasmuch as the viscera were 
transposed. As a student the patient had an attack of 
circumscribed peritonitis of the left side, that lasted 
for six weeks, a year later, he suffered in a similar way 
in which the medical attendant diagnosed stenosis of 
the sigmoid flexure as a residuum. The diagnosis was 
confirmed, inasmuch as the patient during the subse¬ 
quent years had swelling and vomiting with the slightest 
oonstipation. A similar attack occurred recently, and 
examination now revealed recurring appendicitis, and at 
the same time transposition of the viscera. This had 
hitherto escaped previous examiners, as the heart sounds 
could be heard feebly on the left side, and the examiner 
had been satisfied with this. 


Austria. 


[from our own correspondent.] 


VlEEVA, April 7tfa, 1890. 
Paroxysmal Hemoglobinuria. 

At the “ Gesellschaft der Aerzte” Neumann showed a 
patient, set. 28, who was received into hospital four years 


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THE OPERATING THEATRES. 


Afbil 12, 1899. 


376 The Medi cal Press. 

ago on account of syphilis which has manifested itself on 
the mucous membrane and skin several times since 
that time. About a year ago, for the first time, he 
passed urine of a dark brown colour after a sharp febrile 
attack. In December last he came to the hospital as 
these febrile atttacks began to recur about every 
three days with the same result in respect of 
the urine. On February 27th he was admitted 
yito Neumann’s ward with a temperature of 
40'6 degs. C. or 105‘8 degs. F. The urine had the usual ! 
dark colour, and contained a large quantity of hffimo- ‘ 
globin, and its derivatives, but no red blood corpuscles. I 
Subsequent observations confirmed the history of a j 
remitting disease usually recurring within from twelve j 
to fourteen hours after a rigor, followed by a rise of 
temperature; then appeared pain in the joints with an 
ash-grey colour of the skin. About three or four hours 
after these symptoms the patient expressed himself as 
feeling quite well, and the urine resumed its normal 
character. 

The correct diagnosis of the proximate cause gave rise 
to a diversity of opinion, as paroxysmal haemo-globinuria 
may be produced by so many different agents. As a wide 
variation of temperature between heat and cold, drugs 
such as chlorate of potassium, diseases 'such as malaria, 
chronic syphilis, &c. Ehrlich, Schumacher, and others 
have demonstrated that anti-syphilitio treatment is a 
common cause of paroxysmal hsemo-globinuria, and this 
may have been the cause in the foregoing example. 

Tbkatmknt of Lupus. 

Lang showed a patient to the Society on whom he had 
first operated for lupus, and had subsequently performed 
a plastic operation to remedy the results of the first 
operation. 

The patient, set. 34, had been operated on some time 
previously, when the cartilages and alee of k the nose were 
entirely removed. To supply these defects large flaps 
had to be taken from the volar part of the right hand, 
while the volar part was in turn supplied from the side 
of the thorax. He related the history-of seven other 
cases, in which he had similarly operated with equally 
good results, but he could not vouch for their subsequent 
history. Two had recently disappeared; two others had 
a recurrence of the disease, and two still appeared quite 
healthy, though now operated on 3J years and 20 months 
respectively. Lang has tried every form of treatment 
for. this intractable disease, and concludes his disappoint¬ 
ing efforts with the consolation that operative surgery 
and cosmetic repair is the most rational and successful 
method he has yet tried. 

Jacksonian Epilepsy. 

Wemlechner exhibited a young man, set. 28, on whom 
he had operated twenty-one days previously for epileptic 
fits. 

About three years ago he received a blow from the 
shaft of a cart on the left temple which rendered him 
unconscious for some time. After recovery it was found 
that the left leg and arm were paralysed. A few months 
after the accident epileptic fits commenced, and have 
since continued up till the middle of February, when he 
was brought to Wagner’s Clinic during one of these 
attacks. 

While under observation it was found that the attacks 
oommenced with twitchings in the left facial region, ex¬ 
tending to the upper and lower extremities ; next attack¬ 
ing, first, the right lower extremity, and then the upper; 


finally, unconsciousness supervened with general con¬ 
vulsions. 

The lower end of the central convolution was diagnosed 
to be the seat of the lesion. He was transferred to 
Wemlechner*8 wards on April 2nd for operation. 

On opening the cranium at the point specified a large 
cyst about the size of a walnut, of a bluish colour, filled 
with clear fluid, was met with. After draining and clean¬ 
ing out the space the wound was closed, and the scalp 
brought together. A few slight attacks occurred since 
the operation, but they soon ceased altogether. “ Facial 
innervation ” is now perfect. 

It is presumed that this cyst was the result of a 
haemorrhage from the contre-coup, which led to cerebral 
spasm, and finally determined a disposition to epilepsy. 

Vaginal Heat Douche. 

Hirtl showed an apparatus for supplying heat to the 
vagina, its principle being a practical form of utilising 
the heat given off by fluid substances passing into 
crystallisation. A compress is steeped in liquid acetate 
of soda and thiB is placed in the vagina, where it will 
maintain a temperature of 58 degs. Cent, or 146 4 degs. 
Fahr. for five hours, this being the crystallising point of 
sodium acetate. 


^he <S)perating theatres. 

MIDDLESEX HOSPITAL. 

Excision of the Tongue fob Epithelioma.— 
Mr. John Mubrat operated on a man, set. 51, who 
had been admitted for epithelioma of the tongue. The 
patient suffered from syphilis at the age of 16, and was 
then treated for six months. Seven years before the 
present time he noticed his tongue was painful and that 
there were little white patches on the left side. This 
condition remained unchanged till about a year ago when 
the tongue became more painful. A month before 
admission he noticed a groove on the left side of the 
tongue, and a week later a swelling appeared on the left 
side of his neck. On examination the whole of the left 
side of the tongue and part of the right was covered 
with white thickened epithelium. On the left side at the 
junction of the middle with the posterior third there was 
a large irregular ulcer with hard indurated base 
and everted edges. The floor of the mouth was not 
involved and the tongue was only slightly fixed. Several 
enlarged glands could be felt lying along the anterior 
border of the stemo-mastoid, and just below the angle 
of the jaw. A preliminary laryngotomy was performed 
to facilitate the administration of the anaesthetic, and to 
prevent any trickling of blood into the larynx. An incision 
was then made commencing just below the symphysis 
menti, carried down on the left side to the great cornu 
of the hyoid bone, and then upwards along the anterior 
border of the sterno-mastoid just below the lobule of the 
left ear ; the skin, fascia, and platysma were divided, and 
the flap thus formed was raised and turned up over the 
face. Several enlarged glands lying over the carotid 
vessels were removed. The external carotid artery was 
then exposed and ligatured between the origins of the 
superior thyroid and lingual arteries. The submaxillary 
and sublingual salivary glands were next removed. A 
suture was then passed through the tip of the tongue, 
the organ drawn forwards, and a sponge, with a silk 
thread attached, passed into the back of the pharynx, a 


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April 12, 1899. 


LEADING ARTICLES. 


The Medical Press. 377 


Fergusson’s gag having been placed in the month. The 
tongue was drawn forwards, and the mucous membrane 
of the floor of the mouth divided with scissors on each 
side quite close to the lower jaw. The tongue was now 
split, and the right half was removed with the scissors 
through the mouth, the lingual artery on that side being 
secured after division. The tissues were then separated 
from the lower jaw on the left side, and the left side 
of the tongue drawn eut through the wound in 
the neck after the anterior pillar of the fauces had 
been divided, and the remainder of the tongue cut away 
with the scissors just in front of the epiglottis. A few 
small vessels only required ligature. Two sutures were 
introduced, uniting the stump of the tongue to the cut 
mucous membrane of the floor of the mouth. The skin 
flap was then replaced, united by points of interrupted 
suture, and a large drainage tube inserted at the centr® 
of the wound, passing into the mouth. Dressings were 
applied, and the surface of the stump of the tongue and 
floor of the mouth were brushed over with Whitehead’s 
varnish. Mr. Murray remarked that the case was 
evidently one of epithelioma of the tongue supervening 
on a chronic superficial glossitis, probably the result of 
syphilis. He pointed out that in such a case, where 
glands were involved, an operation such as the 
one he had just done afforded the patient the 
best chance, as it enabled the surgeon to clear 
out thoroughly all the glands likely to be affected, 
and also to remove the tongue more completely. The 
preliminary laryngotomy, he considered, facilitated the 
operation very materially. In the first place it allows 
the anaesthetic to be more easily administered, obviating 
the likelihood of the patient coming round and strug¬ 
gling during the operation; secondly, with the sponge 
in the pharynx, all anxiety with regard to blood trick¬ 
ling down into the larynx is avoided, and the surgeon 
is, therefore, enabled to perform the operation more 
deliberately. With regard to the ligature of the ex¬ 
ternal carotid, he said it was more simple than ligature 
of the lingual and facial separately, and whilst it pre¬ 
vented hemorrhage more efficiently it did not in any 
way add to the risk of the operation. He also dwelt 
on the importance of being able to perform such 
an operation in a bloodless manner, as it enabled 
the operator to see clearly the limits of the 
growth, and thus to avoid cutting too near diseased 
tissue; this he considered a most important point. With 
regard to the lingual artery on the opposite side, in the 
absence of any cancerous disease affecting the right side 
of the tongue, and there being no evidence of any en¬ 
larged glands of the neck in that side, he did not think 
ligature of the lingual artery in the neck a necessary 
procedure, as the vessel could be easily secured after 
division of the tongue. The whole tongue was removed, 
he said, not only on account of the extensive growth, but 
also because of the chronic superficial glossitis which 
affected the right side. He thought that splitting the 
tongue and removing the right half through the mouth 
was easier than removal of the whole though the wound 
in the neck as recommended by Kocher, and it also 
enables the surgeon to draw the affected side , 
further out of the wound, and thus get more 
completely behind the disease. In this case the 
tongue was removed so far back, he said, that the mucous 
membrane in front of the epiglottis could only be very 
imperfectly approximated to the mucous membrane 


attached to the lower jaw, but that the sutures so intro¬ 
duced would diminish considerably the extent of surface 
left to granulate, and also prevent any tendency to 
falling back of the stump of the tongue. The laryngo¬ 
tomy tube would be left in for 24 hours, and the subse¬ 
quent treatment would consist in irrigating the mouth 
frequently with Condy’s fluid, swabbing its floor with 
boric acid solution and painting it with Whitehead’s 
varnish. The patient would be fed by nutrient enemata 
for the first 24 hours, and after that he would feed him¬ 
self by means of a rubber tube attached to the noazle of 
a feeding-cup. 

It is satisfactory to record, five days after operation, 
that there has been no rise of temperature, that the 
external wound has healed, excepting at the site of the 
drainage tube, and that the patient got up for a few 
hours on the fifth day. 


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“ 8ALl'S POPULI SUPREMA LEX.” 


WEDNESDAY, APRIL 12, 1899. 


MEDICAL EXPERTS IN CRIMINAL CASES- 
There are two very different methods of utilising 
expert medical evidence in criminal cases, one, the 
French plan of referring the matter to an expert 
whose duty it is to advise the Court on the points 
submitted to him—a plan which, in practice but too 
often converts the expert into a prosecutor—and the 
other, which obtains in this country, where experts 
occupy no official position, but come forward at the 
behest of the prosecution or of the defence and state 
their views, leaving it to the jury, guided by the 
judge, to decide which evidence is most deserving of 
credence. Each plan has its advantages and its 
drawbacks. The French plan, theoretically at any 
rate, appears best calculated to secure an impartial 
opinion by a person of recognised eminence, but in 
practice the medico-legal expert but too often 
follows the lead of the brow-beating jujje d'instruction 


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378 Thk Medical Press. 


LEADING ARTICLES. 


April 12, 1899 


and strains every nerve to secure a conviction, with 
-the result, in certain notorious instances, of misleading 
the jury by expressing as certainties what ultimately 
proved to be little more than conjectures. Such a 
-scandal has this become that public opinion in France 
is rapidly veering in the direction of abolishing the 
official expert in favour of a plan which would prove 
less harsh towards the accused, who, under the exist¬ 
ing regime, is placed in a very disadvantageous 
position, seeing that he is not represented at the 
Autopsy and is not afforded any facility for rebutting 
the conclusions arrived at by the official experts- 
It is only when the expert displays hesitation that 
the technical evidence the accused may be able to call 
can have any weight. Our own plan, on the other 
hand, is admittedly by no means free from objection. 
To expect an untrained jury to decide between con¬ 
flicting views of a highly technical nature is obviously 
absurd, and even the judge is not much betterjoff. 
Both judge and jury in arriving at a decision* must 
be to a great extent guided by the professional status 
of this or that expert witness, so that it reduces itself 
to a question which side can secure the services of the 
most eminent expert. This makes it largely a question 
of means, and as the prosecution is naturally best pro¬ 
vided in this respect the accused person is here again 
at a disadvantage when called upon to rebut conclu¬ 
sions unfavourable to him. This feeling has led to 
the expression of a desire to see appointed a medical 
assessor who should assist the judge just as other 
experts do in matters affecting nautical questions. 
However disguised this proposal may be, however 
it really involves the substitution of the plan which 
has failed to give satisfaction in France, and it must 
be looked upon with suspicion accordingly. There iB 
a third plan which might possibly be found to unite 
the advantage of both systems with a minimum of 
their respective drawbacks, viz., the appointment by 
the Court of an expert for the defence and an expert 
for the prosecution who would carry out the investiga¬ 
tion together, and would agree as to the conclusions 
to be drawn from the results of their mutually 
conducted inquiry. In the event of a dis¬ 
agreement a third expert, also appointed by the 
Court, would be requested to adjudicate upon the 
points of difference. In this way the jury would 
not be confused by contradictory reports and infer¬ 
ences, but would merely have to register certain con¬ 
clusions unanimously arrived at, and which would, in 
any event, represent the views of the majority of the 
Court of experts. In the first place, there would 
neoessarily be complete agreement as to the data, 
since aotual observation does not lend itself to any 
great divergence of opinion. The conclusions which 
these data warrant would have been discussed, and 
the personal equation would be eliminated. We should 
then be spared the spectacle of one authority stating 
in open court that ergot, for instanoe, is an aborti- 
faoient, while another, possibly not less eminent, 
absolutely denies that ergot will bring about abor¬ 
tion in the early stages of pregnancy. Under the 
system we have described, this point would have to be 


threshed out, not on the strength of other fallible 
authorities, but by actual experiment, failing which 
the weight of opinion would be against the witness 
who advanced such a view -without being able to allege 
facts which must convince his dissenting colleague. 
The extreme indulgence which characterises the 
administration of English criminal law as towards 
the accused robs the present system of much of its 
harshness; but it is, in our opinion, fully as desirable 
to secure the conviction of the guilty as to facilitate 
the escape of the innocent. The present system 
which involves an endeavour to confuse the minds of 
the jury by pitting conflicting views against the con¬ 
clusions of the expert for the prosecution undoubtedly 
in many instances enables the guilty to escape in 
virtue of the principle that the prisoner is entitled to 
the benefit of the artificially created doubt. 


THE LORD CHANCELLOR’S NEW ACT. 

The Bill lately introduced by the Lord Chancellor 
has emerged from its first reading in the House of 
Lords, and will almost certainly pass through its 
further stages rapidly enough before being sub¬ 
mitted to the Commons. Its intention is to pro¬ 
hibit the profession of a physician, surgeon, dentist, 
or midwife being carried on by a company. The 
operative clause, to whieh we called attention a fort¬ 
night ago, runs thus:—“ It shall be unlawful for a 
company under the Companies Act, 1862 to 1898, to 
carry on the profession or business of a physician, 
surgeon, dentist, or midwife, and if any company 
contravenes this enactment it shall be liable on 
summary conviction to a fine not exceeding £5 
for every day during which the contravention 
happens.” Clearly the principle involved in this 
clause, if carried out into legislative form, must have 
an important bearing on the medical profession. 
Unfortunately the field of action is limited to com¬ 
panies, and it is not always an easy matter to say 
what is or is not a company. The first instance that 
will occur to everyone is that of the advertising 
dentist companies which carry on business on a large 
scale. When a company simply employ a qualified 
practitioner to attend to servants or passengers, and 
where no pecuniary profit is made by the employers 
out of his services, the new Act could obviously not 
be meant to apply. There is another large class of 
cases, however, where a company makes a direct 
profit upon the work of the salaried medical officer, 
and there the Act would probably interfere. In that 
event, a severe blow would be at once aimed at the 
many proprietary medicine companies that employ a 
qualified practitioner to interview and advise their 
customers. As things go, if such a man be deprived 
of his qualification he can still go on working for the 
company, but the Lord Chancellor appears to have 
shifted the attention of the Legislature from the 
wretohed tools of the patent medicine directors 
to the fountain head. But the majority of 
our readers, on hearing of the Bill, will at 
j once ask themselves how far the Medical Aid 


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LEADING ARTICLES. 


Th« Medical Press. 379 


April 12, 1899 

Societies will be affected. The question is a burning 
one in the medical world, and its solution must sooner 
or later inevitably be forced upon the community. 
If relief should come unexpectedly from the Lords so 
muoh the better, but it seems likely, judging from 
past experiences, that the triendly societies will con¬ 
trive to fall without the operation of the Act. But, 
on the other hand, if it be wrong for a company to 
carry on the business of a surgeon for gain, it can 
hardly be right for another association formed to con¬ 
fer distinct advantages upon its members to make 
profit out of a medical man. Imagine for a 
moment the proposal being made that the friendly 
■societies should be allowed to employ the services 
-of a duly qualified solicitor for the benefit of their 
members, what would the Legislature say to such a 
scheme P Yet the difference between the professions 
-of medicine and of law in relation to the friendly 
societies is very much that ’twixt tweedledum and 
tweedledee. Whatever the ultimate fate of the 
Chancellor's Bill may be, whatever the changes that 
may take place in its passage through the Lower 
Rouse, we may at least be thankful that the 
•attention of all branches of the legislature has 
been pointedly drawn to the many rank abuses 
affecting the honourable calling of medicine. In 
some respects the new Act may be said to 
eke out and to remedy defects in the existing medi- 
cal Acts. On the face of it there seems to be little 
doubt that a properly framed Medical Act would do 
away with any necessity to forbid a company from 
practising medicine in any of its branches. There is 
•one point to which public attention may perhaps be 
-drawn. Not long ago there was a discussion in the 
House of Commons as to the desirability of members 
bolding posts as directors in companies, the interests 
of which would be likely to be discussed by Parlia¬ 
ment from time to time. It will be a matter of con¬ 
siderable importance ;to ascertain how many 
members of both houses are concerned more 
or lesB directly in patent medicine companies. 
To many the mere suggestion of such a possibility 
may seem sacrilegious, but against that emotion we 
may state the fact that a well-known member of the 
House of Commons, who was for a long time a pro¬ 
minent figure in London administration, not many 
years ago held a seaton the directorate of a notorious 
-quack medicine. His voting on the subject of the 
regulation of medical training by companies will 
naturally be followed with interest by those 
acquainted with the facts of the case. At the same 
-time, it would be more reassuring for the future of 
medical legislation if such interested members could 
meantime be excluded from voting when such 
measures are submitted to the Legislature. 


LEGISLATION AGAINST TUBERCULOSIS. 

In view of the movement now on foot regarding 
'tuberculosis, the time seems to have come for con¬ 
sidering whether or not it would be expedient to 
bring forward some legislative measure with a view 
to the prevention of the dissemination of the disease 


In this connection doubt may be expressed concern¬ 
ing the present methods of protecting the publio 
from the disease being sufficiently comprehensive 
to attain the object in view without the assist¬ 
ance of direct legislative interference. In other 
words, under present circumstances any measure^ 
undertaken for the prevention of tuberculosis are 
only carried out voluntarily; they do not belong 
to that category of compulsory injunctions provided 
for by law, and all, therefore, that public health 
authorities can do in the^matter is simply to warn 
the public that tuberculosis is an infective disease, 
against which it is essential to adopt certain precau¬ 
tions. No doubt, in time, the good sense of the people 
will lead themto adopt the advice proffered, thus 
dispensing with the need for compulsion. In 
time, too, the knowledge of tuberculosis as an infective 
disease will probably become generally disseminated, 
and by this means less difficulty will be experienced in 
making persons understand the necessity of observing 
the precautions brought under theirnotice. Meanwhile, 
however, certain impatient sanitarian enthusiasts 
are busily advocating a Tuberculosis Bill dealing 
with all the points concerning the prevention of the 
disease upon which authorities are agreed. There 
cannot be two opinions concerning the urgency of 
taking measures to prevent the dissemination of the 
disease ; but we are hardly, as yet, in a position 
to affirm that, if such measures are to be successful, 
they must necessarily be compulsory. A matter of 
such importance, it may be.urged, should not be left 
to the free will of the community, and it must be 
conceded that if the latter policy had been adopted 
in regard to small-pox, and vaccination had not 
been made compulsory, it is impossible to doubt 
that the freedom which this country has enjoyed for 
many years past from small-pox would never have 
been attained. So far as legislation against tubercu¬ 
losis is concerned, there are, of course, many points 
which would have to claim attention. In the first 
place, the opinion seems to be gaining ground that, 
as an infectious disease, it ought to be made 
notifiable. Again, as an infectious disease, legis¬ 
lation would have to provide for the free disinfection 
of dwellings occupied by persons who have succumbed 
to the disease. Recognition, too, would be necessary 
of the evil of expectorating in public streets, convey¬ 
ances, or places, and prohibition of the habit, if 
possible, enforced. Lastly, we are asked to considerthe 
necessity for public sanatoria throughout the country 
for the treatment and care of tuberculous patients, for 
this complementary measure would, of course, come 
within the purview of the Bill. Just in the same way 
as lunatics are provided for in public asylums, so, 
according to the advanced school of sanitation, accom¬ 
modation would have to be forthcoming for tubercu¬ 
lous persons, and thus the system of the prevention of 
the disease would be under legislative control, to the 
benefit, we are.assured, of the community generally 
The above suggestions upon the subject, however, are 
a mere outline of the direction in which, it is sug¬ 
gested that legislation would be useful. One main 
point in these remarks has been to draw attention to 


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380 The Medical Press. 


NOTES ON CURRENT TOPICS. 


April 12, 1899. 


a matter which now seems to call for earnest con¬ 
sideration. Much valuable time might be gained in 
the crusade against tuberouloeis were compulsory 
measures to be introduced in the near future for 
arresting its dissemination, while, on the other hand, 
to tempoi-ise with such an evil as that under discus¬ 
sion, by failing to recognise the urgency of dealing 
with it vigorously, would be to display a singular 
want of wisdom. 


$ottB ott Current topics. 

A Hint to Nervous Candidates. 

Few probably are the candidates who at one period 
or another of their student career have not experi¬ 
enced the classic indisposition engendered by the 
imminence of a mauvaia quart d'heure to be passed 
before unsympathetic examiners. The bladder 
becomes irritable, and in this condition the bowels 
may participate. In addition to these distressing 
phenomena there is often a feeling of extreme 
abdominal malaise and tumultuous throbbing of the 
heart, which may even be associated with faintness; 
this group of symptoms we are invited to attribute 
to relaxation of the abdominal muscles consequent 
upon the diversion of nervous energy to other parts 
of the economy. This relaxation of the normally 
tense abdominal walls, we are told, favours the 
accumulation in the large abdominal veins by gravita¬ 
tion of an undue proportion of the circulating 
blood provoking local plethora and coincident cere¬ 
bral anaemia, while the heart beats loudly and forcibly 
in a mad attempt to maintain the circulation with an 
inadequate supply of the fluid. As to the existence 
of cerebral anaemia no doubt can exist, evidenced as 
it is by a tendency to incoherence of ideas and an 
inability to concentrate the mind on any given sub¬ 
ject, in addition to more or less impairment of 
memory, occasionally amounting to temporary aboli¬ 
tion of that important function. ThiB hypothesis has 
much to recommend it, even in the absence of a post¬ 
mortem examination on the body of a student who has 
succumbed to an unusually violent attack. The proper 
treatment is evidently to reinforce the abdominal 
muscles, and for this purpose nothing answers better 
than a tightly drawn belt. On reflection many of our 
readers may be able to recall an instinctive desire 
to “ gird up the loins " by drawing the trousers strap 
tighter just before undergoing the ordeal. Anyhow, 
the procedure is one worth trying by nervous candi¬ 
dates. It will not, it is true, confer a knowledge of 
the subject which has not been acquired, but it may 
enable the cerebral circulation to be carried on with 
something like physiological lines, and thus enable 
the candidate to make the best use of such knowledge 
as he has obtained. 

Last week there were 3,599 patients under treat¬ 
ment in the district hospitals of the Metropolitan 
Asylums Board, being a decrease upon the preceding 
week of 62 in the scarlet fever, 47 in the diphtheria. 
2 in the typhus fever, and 23 in the enteric fever 
admissions. 


A Medical Olub in Paris. 

Medical clubs in England, that is to say, clubs 
provided solely for medical men, have been repeatedly 
organised in the past, but have always proved dismal 
failures. The last one of the kind, we believe, which 
was started hung on to life for a time, but it died of 
inanition, and its end was rendered somewhat noto¬ 
rious by the suicide upon its premises of one of the 
members. However, apparently in ignorance of the 
unclubable characteristics of medical men towards 
each other—quite natural, we imagine, under the cir¬ 
cumstances—efforts are being made to found a “ Club 
Medical ” in Paris. The idea is by no means a new 
one, but its realisation at the present time is due to 
the approaching Universal Exhibition in Paris, and 
to the fact that besides other attractions for medical 
men, the meeting of the International Medical Con¬ 
gress will be held in Paris at the same time as the 
Exhibition. It is also pointed out that last year Dr 
Lassar founded the “ Club de M6decins ” in Berlin, 
which now numbers four hundred members, this 
being regarded as an additional reason for following 
the example in Paris The Gazette Mtdicale de Paris 
discusses the whole project in a recent issue, and has 
much to say in its favour. On paper the scheme has 
a most attractive appearance, but whether it can 
succeed in practice is open to considerable doubt- 
Medical men have abundant opportunities of meeting 
each other without resorting to the surroundings of a 
medical club, where their bete noire “ shop ” would 
always obtrude itself into discussions. 

Southwark Guardians on Dissecting. 

Guardians as a general rule display more senti¬ 
ment as regards a dead than a living pauper. In 
this curious attitude they remind one of the Chinese, 
who treat human life as a worthless trifle, but to 
whom a corpse is hallowed and sanctified, an object 
of tender care and costly solicitude. This spirit 
Beema to have possessed the Metropolitan Board of 
Guardians of St. Saviour’s, Southwark, if we may 
judge from a recent discussion which took place in 
that august assembly. The occasion was a motion 
brought forward by a member to the following effect: 
“ That the steward of the infirmary be instructed to 
cease sending the bodies of deceased inmates to ths 
School of Anatomy for the present; that inquiries 
be made of the authorities of the School of Anatomy 
as to how the bodies sent to them by the guar¬ 
dians are ultimately disposed of, and whether their 
use is strictly confined to medical and surgical re¬ 
search.” The gentleman who advanced this proposal 
professed that he had no wish to stand in the way 
of science, although, so far as can be gathered from 
the report, he failed to point out how practical 
anatomy was to be learnt without bodies. His alleged 
motive was to prevent the remains of unfortunate 
persons from being dealt with in the disgusting 
manner they were at present by many medical 
students. It would be interesting to hear further 
details of the dissecting-room stories-upon which his 
ridiculous action has been founded. In all such places 
with which we have been acquainted the practice has 


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The Medical Pribs. 381 


NOTES ON CURRENT T0PI08. 


invariably been to remove all remains in a coffin for 
bnrial; but, at the same time, it may be remarked, in 
passing, the better plan would undoubtedly be to use 
cremation. The first portion of this wiseacre motion 
was ultimately withdrawn, and the second carried 
unanimously. The deans of medical schools will be 
glad to learn that there is no immediate prospect of 
the stoppage of the supply of subjects for their dis¬ 
secting-rooms. 

Clearing a Crypt of its Bishops. 

The long-delayed Home Office Order has been 
issued forthwith to clear the crypt of St. George 
the Martyr, Southwark. This peremptory docu¬ 
ment has caused no little commotion among the 
powers that be in the locality of South London, 
chiefly, so far as can be gathered, because the cost 
of removing the two thousand coffins, more or less, 
will involve a substantial addition to the rates. 
Burials have been going on continuously in this 
crypt for some centuries, and among the bodies are 
supposed to be those of Bishops Bonner and 
Gardiner, the Duke of Suffolk, Cocker the Arithme¬ 
tician, and many distinguished debtors, if the phrase 
be permissible, from the adjoining Marshalsea 
prison. The proposal to re-bury the remains of 
the above - mentioned persons in the church¬ 
yard has raised a storm of opposition from 
the Radical element of the Vestry, who claim with 
strident voice that no distinction should be made in 
the case of the “ blue-blooded ” Bishops. For our 
own part, without going into the question of the 
desirability of maintaining social distinctions under 
such circumstances, we should be inclined to think 
that the best way of disposing of the remains on 
grounds both of efficiency and of economy would be 
by means of cremation. Some time ago the view 
was advanced that the church, which had received 
large burial fees for the disposal of bodies in this 
undesirable manner, should be called upon to bear 
a portion at least of the cost of removal, an argu¬ 
ment that appears to have hitherto remained un¬ 
answered. It is to be hoped that the good sense of 
the Vestry will lead to a satisfactory solution of this 
costly problem, which, it may confidently be asserted, 
will not be allowed to arise again in the more en¬ 
lightened sanitary times in which we are at present 
placed. 

Tattooing. 

An inquest was recently held in London on the 
body of a man who had died of blood-poisoning 
three days after being tattooed by an expert in that 
department of pictorial art, but the evidence did not 
appear to prove any connection between the opera¬ 
tion and his imtimely decease. Judging from certain 
statements that have since appeared in the Press, it 
would seem that tattooing is becoming, or has 
already become, a fad in certain sections of “society.” 
One expert declares that he has tattooed no less 
than 400 medical men in London alone, but the 
practice seems to be popular also in military circles. 
What possible object the subjects can have in view 


in getting themselves decorated in thiB fashion it is 
difficult to conceive, and it must not be forgotten 
that the practice when performed in the usual way 
is not unassociated with risk in consequence of the 
use of unclean implements and neglect of antiseptic 
precautions. There are plenty of instances on record 
in which blood-poisoning, syphilis, and other com¬ 
municable diseases have been conveyed in this way, 
even if we admit that in the particular instance re¬ 
ferred to the blood-poisoning was post hoc and not 
propter hoc. 

Proposed Extension of the Compulsory 
Notification System. 

A Bill intended to make the adoption of the 
Compulsory Notification system by sanitary authori¬ 
ties which have not voluntarily adopted it is going 
through the House of Commons and is likely to pass 
this session. The only serious opposition to it will 
come from those authorities which see no commensu¬ 
rate return for the somewhat heavy cost which the 
working of the Act incurs, and for the amount of 
squabbling which it imports into the district. Neither 
of these reasons need trouble such authorities much. 
If the system is forced upon them they must adopt it 
in name, but can ignore it in practice if they choose, 
as a majority of sanitary authorities have done. 
Whe ther they have to pay much or to endure much 
wrangling depends chiefly upon the Superintendent 
Medical Officer of Health, who, if he bean enthusiast, 
may plunge his community into outlay and all sorts 
of altercations, and, if he be not, may pass the system 
by with a distant nod. It is satisfactory to note that 
the experience of the notification system for years 
past has taken most of the edge off the zeal of the 
ultra-sanitarians. We hear little now of the carting 
off of patients, willee-nillee, to isolation hospitals. If 
they get there at all it is, as it ought to be, by per¬ 
suasion and gentle pressure, and not, as some suggest, 
by policemen and handcuffs. 

Friendly Societies and the Profession. 

At the annual conference of the Friendly Societies 
Medical Alliance the recent agitation within the pro¬ 
fession against the abuse of medical aid came up for 
discussion, and some alarm was expressed at the 
prospect of action by the General Medical Council in 
the direction of treating medical men associated with 
such associations as guilty of “ infamous conduct in 
a professional respect." There is, we imagine, little 
probability of such an extreme measure, but other 
means will certainly be found of bringing pressure to 
bear on aspirant medical officers unless the societies 
in question consent to introduce certain much needed 
reforms. One of these is certainly a wage limit, and 
in this respect we regret to see that, according to the 
President, “they would always strenuously resist 
any claim put forward by the medical profession to 
impose any wage or other limit to membership of 
such societies." If this attitude be persisted in it 
will mean war to the knife, and we have little appre¬ 
hension as to the ultimate victory of reason and 


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382 The Medical Press. 


NOTES ON CURRENT TOPICS. 


April 12, 1899. 


common sense, backed by co-operation on the part 
of members of the same profession. 

A Side Wind at the Royal College of 
Physicians, London. 

An esteemed correspondent, a prominent Fellow of 
the Royal College of Physicians, London, writes to ns 
taking exception to the comments which appeared 
last week regarding the election of the President of 
the College. As the questions raised in his letter are 
of no little importance, we deem it right to publish 
the following quotation thereof. He says : “ In the 
election of the President of our college the other day, 
there was no idea of St. Mary’s and St. Bartholomew’s. 
If Sir W. Broadbent had not lent himself to mixing 
up Royalty and the public in the question of the open- 
air treatment of tuberculosis in a manner many of us 
think unseemly and unprofessional, not to say worse* 
he would have been chosen. We have bad too much 
of the Prince of Wales and hospitals, and no good 
effect has resulted. A certain class of people in this 
great city will follow the Prince, but they are not the 
class to whom we look for much help in true charity 
or true progress. The example of the Prince has not 
been a good one in many ways, and to make use of 
His Royal Highness to boom some such schem e as 
‘ open-air treatment ’ for the benefit of a clique is not 
regarded by many of the Fellows of the College as 
creditable to our profession.” We do not give publicity 
to these expressions of opinion solely because they re¬ 
present the feeling of our correspondent, but because 
we are given to understand that they are shared by a con¬ 
siderable number of his colleagues at the college. As 
such, therefore, they undoubtedly claim attention. As we 
have more than once said in these columns, it is a 
matter of sincere regret that the Prince of Wales 
should allow himself to be so exploited in the present 
day in connection with hospital and other schemes, 
the expediency of which fails to appeal to the com¬ 
munity, but this only shows the genuine good nature 
of which His Royal Highness is the possessor. 

Dirty Railway Carriages. 

Under the new Public Health Act for Scotland 
powers are conferred upon local authorities to secure 
cleanliness in “ public conveyances plying within 
their districts,” and we are glad to see that these 
powers are about to be put in force to compel the 
railway companies to improve the sanitary condition 
of their rolling-stock for passengers. The sanitary 
inspector to the Perth County Council, for example, 
has especially called the attention of his council to 
this matter, and points out that in certain cases he 
found the carriages in a very filthy state, the 
cushions being thickly charged with dry dust, 
and the floors in an offensive condition. He also 
animadverts upon the common practice of guards 
and others in charge of passenger trains closing the 
doors and windows of carriages waiting for de¬ 
parture at stations. No doubt this practice may be 
dictated by the desire to preserve the railway pro¬ 
perty, but it is by no means conducive to the health 
of the travelling public. In the interests of the 


latter, free ventilation should be allowed through the 
carriages when not in use. There is no disputing 
the fact that the question of keeping railway car¬ 
riages dean is a very important one, especially in 
view of the long-distance journeys provided by the 
trunk lines. To pass many such hours, for example, 
in a tuberculous-laden atmosphere of a railway com¬ 
partment would be Ukely to be highly prejudicial to a 
delicate passenger. It is, however, obviously the duty 
of the various companies to see that their passenger 
rolling-stock is kept in a clean and sanitary condi¬ 
tion, even if that should involve, as has been sug¬ 
gested, the substitution of the present carpeted floors 
and cloth-cushioned seats of the oompartments for 
floors lined with linoleum, and strong leather cushions, 

“ Anomalies of English Medical Education.” 

Under this heading a curious deal of disoussion 
has of late taken place in the columns of our 
American contemporaries, and some remarkable 
opinions have been expressed upon the subject. We 
can quite believe that on the other side of the Atlantic 
the various portals by which English medical 
students can obtain their qualifications provide a 
puzzling problem to those who attempt to solve it. 
But this scarcely affords an excuse for the editor of 
a journal who falls astray in his efforts to explain 
the intricacies of the system to his readers. The editor 
of the Journal of the American Medical Association, for 
example, in replying to a correspondent, shows that 
he has not informed himself in regard to the F.R.O S. 
and F.R.C.P. He gives it as his opinion that the 
“degrees (sic) are to a oertain extent honorary, 
although not entirely so.” In the first place these 
distinction* are not degrees, but diplomas, and to 
describe them in any sense as honorary is misleading. 
The former is made most exclusive by reason of the 
stringency of the examinations by which its portal is 
guarded, and is essential to all surgeons aspiring for 
hospital appointments, and the latter is perhaps more 
jealously guarded still, and is only conferred upon 
those who has proved their worth after serving a long 
apprenticeship as members of their college. But all 
the information upon this and kindred subjects is 
concisely set forth in the Students’ Number of the 
Medical Press and Circular which appears 
every September, to which we may refer our 
American contemporaries. 

Cigarettes Banned in Arkansas. 

The American tendency towards prohibition law 
is proverbial, and is, not without some show of reason, 
attributed by some authorities to the inherited in¬ 
stincts of the parent stock of Puritans. Some of the 
latest departures have been of a remarkable nature, 
and seem calculated to try to the uttermost the 
patience of a long-suffering populace. In Maine, so 
it has been reported, the legislature have issued a 
sumptuary edict against the wearing of stays by 
women, a regulation that carries on its face the stamp 
of righteousness, bat is nevertheless calculated to 
Btir up a revolution in any society of self-respecting 
women. The Government that could frame such a 


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NOTES ON CURRENT TOPICS. The Medical Press. 383 


law must indeed be conscious of a strength even 
passing that of the average empire, which would infal¬ 
libly collapse like an eggshell under so great a strain, 
In the State of Arkansas another law has been 
enacted abolishing the selling or giving away of 
cigarettes, under a penalty of not less than £100, and 
not more than £1,000. This step has been taken on 
the ground that cigarette smoking is deleterious to 
health, and to a certain extent that assumption is 
undoubtedly true. Excessive smoking in any form 
is harmful, but less injury is done by indulgence in 
pipes than in cigars, while cigarettes stand easily at 
the head of the black list. Fortunately, for the most 
part, as men grow older and less organically strong, 
by a natural process they diminish or discontinue 
their indulgence in the weed nicotians, and so 
is brought about by easy physiologioal adjustment 
what the good folk of Arkansas seek to establish by 
the strong hand of the law. Fancy how free Eng¬ 
lishmen would receive such a statute; it is likely that 
within twenty-four hours of the passage of a Bill of 
the kind the country would be aflame from one end 
to the other. 

Physicians and Charity. 

The will of Sir William Jenner was proved last 
week, the gross estate amounting to £385,083 18s. 5d. 
Under the will the Royal College of Physicians, 
London, will benefit ultimately to the extent of 
£10,000, and thus their ex-President is likely ever 
afterwards to be held in kindly remembrance by the 
Fellows of the College. It is, however, somewhat 
strange that Sir William Jenner, out of the abun¬ 
dance of his wealth, should have left nothing to the 
hospital with which he was so closely connected for 
so many years of his life. University College Hospital 
has ever been in dire straits financially, in order to 
carry on its work, and a beq uest from its celebrated 
consulting physician would no doubt have been most 
thankfully received. A propot of this subject we are 
reminded of the absence of bequests to their respec¬ 
tive hospitals in the wills of Sir William Gull and Sir 
Andrew Clark, each of whom left a gross estate of 
upwards of half a million. But neither Guy’s nor 
the London Hospital profited financially by the death 
of these distinguished physicians, although it ib, per¬ 
haps, only true to say that the foundations of their 
immense fortunes were laid as the result of their con¬ 
nection with these institutions. 


Is Registration an Essential Precedent 
of Medical Practice ? 

It will be recollected that, in the autumn of las', 
year, Mr. Victor Horsley, one of the Direct Repre¬ 
sentatives for England in the General Medical 
Council, propounded a theory that, under the terms 
of the Medical Acts, no one could lawfully practice 
without registration as well as qualification. Mr. 
Horsley’s discovery would have been an invaluable 
“ find ” if it had turned out to be genuine, and he 
gave excellent reasons for believing that it was so. In 
such case every quack in the Kingdom could be pro¬ 
secuted for [ ractising without qualification, and with 


much more prospect of success than he can now bef 
prosecuted for representing himself to be registered- 
It now appears, however, that Mr. Horsley’s inter¬ 
pretation of the Acts cannot be substantiated, for the 
Council of the British Medical Association has 
obtained the formal opinion of Mr. Haldane, Q.C., 
and Mr. Oliver Hodges, B.L., who have agreed that 
the law cannot be so read. Probably Mr. Horsley 
will not concur in this view, but, for the present, we 
may take the question as settled. 

The Role of the Pericardium. 

It is a curious fact that treatises on physiology 
say little or nothing with regard to the function of the 
pericardium, though, as a general rule, the authors of 
such writings do not display any unbecoming heeita- 
tion in explaining and commenting upon the inten¬ 
tions of the Creator in respect of tissues and organs. 
It remained for Mr. Barnard to show that the func¬ 
tion of this much-studied but ill-understood serous 
sac is really to prevent undue dilatation of the heart 
under the strain of a sudden inrush of blood. It is 
actually part of the circulatory apparatus in con¬ 
trolling which it plays a very useful role. When 
we consider the various forces at work in carrying on 
the circulation, in which the cardiac vis a ter go is 
perhaps only of secondary importance, it is evident 
that under the accelerating influence of great muscular 
exertion, plus exaggerated respiration, the quantity of 
blood which reaches the right heart must be vastly 
increased, and Mr. Barnard has shown by actual 
experiment that if the pericardium be slit up the 
strain promptly produces a distension of the thin 
cardiac walls which bulge through the pericardial 
aperture. This throws much light on the pathology 
of pericarditis. When the membrane, usually 
tough and very resistant, is softened by the inflam¬ 
matory prooess, it is apt to yield to the pressure from 
within, created by ill-timed muscular exertion, allow¬ 
ing the walls of the heart to dilate beyond the normal 
itself undergoing a process of stretching which is 
probably never recovered from. When it becomes 
adherent, on the other hand, it hinders normal 
expansion, and the circulation of blood through 
the heart is pro tanio impeded. A dilated heart 
therefore almost necessarily infers a stretched peri¬ 
cardium, though the fact that a dilated heart can to 
some extent be recovered from under appropriate 
treatment appears to negative this assumption. In 
any case we are indebted to Mr. Barnard for a valu¬ 
able addition to our knowledge of the physiology of 
the pericardium, which will certainly prove of service 
in elucidating many moot points in the pathology 
this region. 

The American papers record as an instance of 

sympathetic contagion ” the death of a girl at St. 
Louis of cerebro-spinal meningitis, attributed to her 
having read a highly-coloured description of the sym¬ 
ptoms in a local paper. It would be difficult to recon* 
cile this hypothesis with the established fact of the 
microbial origin of this disease, but of this the writers 
recked not. 


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PERSONAL. 


April 12. 1899 


384 Ihe Medical Press. 

Is Breast Milk Sterile? 

Medical writers are apt to assume that the mam¬ 
mary secretion, as it comes from the breast, is a 
perfectly sterile fluid. Their error is founded on the 
teachings of a bygone pathology, for it is clear that 
milk can be contaminated by micro-organisms, both 
before and during its secretion, or what many would 
now prefer to term its excretion. The blood-stream 
may be at fault, and he would be a bold man who 
would assert that specific pathological microbes may 
not infect therefrom the substance of the mammary 
gland and its excretion as they might that of any 
other excretory organ of the body. Then there is 
the ever-open door of entry from the outside by way 
of skin or gland ducts. All this is apart from any 
visible gross lesion about the nipple, which we exclude 
and concede reasonably to the upholders of the sterile 
theory. On the whole, itseems likely that the milk from 
a healthy mother and a normal breast will be to all 
intents and purposes, and in the majority of in¬ 
stances, sterile, but that proposition obviously leaves 
a wide margin of possibilities in a contrary direction. 
The point iB one of great practical importance, both 
as regards the milk of human beings and of cows. 
Turn to the case of tuberculosis. "Who is to say that 
the milk of a mother affected with that disease will 
at no time be contaminated with specific organisms ? 
In not a few cows it is difficult even for a scientific 
expert to recognise the disease, but it does not follow 
that an infected beast is not giving off bacilli in the 
milk which is destined to be used as food for the 
higher animal. The position indicated is bovine 
tuberculosis, apart from new growths or ulceration 
of the udder, which anyone can recognise. The whole 
question is one of extreme importance in preventive 
medicine, and it is to be hoped that some competent 
authority will investigate the matter in its various 
physiological and pathological bearings. 

Glorioua Inconsistency. 

The mining doctors in the Newcastle district have 
combined to ask a more reasonable scale of remunera¬ 
tion than that which has been their lot for the last 
half century. While in some instances the demand 
has been cheerfully acquiesced in, in others the asso¬ 
ciations of miners are busy advertising for 
medical men willing to work on the old scale. As 
Dr. E. Jepson points out in the columns of the 
Newcastle Daily Chronicle, by resorting to this plan 
the miners are acting contrary to the principles of 
trades-unionism and are endeavouring to manufacture 
medical “ blacklegs.” Consistency, however, is not 
the most noteworthy attribute of the labouring popu¬ 
lation, and doubtless they are prepared to claim a 
monopoly of the organisation of labour. We cannot 
disguise the reluctance we feel at the introduction 
into medical practice of methods which, moreover, 
have not proved an unqualified success in the hands 
of the very persons who now resent their application 
to the amelioration of the conditions of medical 
labour. Qui vent la Jin vent les moyens, but it ought to 
be possible to discover other means than direct com¬ 


pulsion of inducing these worthy people to accede to 
demands which strike one as singularly moderate and 
reasonable. 


The Agitation against Vaccination. 

We are requested by the hon. secretary of the 
Jenner Society (Dr. Bond, of Gloucester) to ask such 
of our leaders as are practising in localities in which 
the agitation against vaccination is acute, either in 
the form of newspaper correspondence or of public 
lectures or debates, to be good enough to communi¬ 
cate with him. When newspapers containing reports 
are sent the article to which it is desired to call atten¬ 
tion should be marked. 


A private Subscription Dance, in aid of a fund to 
enlarge the out patient department of the West 
London Hospital, will take place at the Empress 
Rooms, Royal Palace Hotel, Kensington, on May 
17th, 1899. 

The death is announced of Dr. William Squire at 
the age of seventy-three. Dr. Squire's name is well 
known in connection with the introduction of the 
salicylates in the treatment of rheumatic fever, and in 
various departments of preventive medicine. 

A grand bazaar in aid of the Great Northern 
Central Hospital, London, is to be opened in the Port- 
man Rooms next month by H.R.H. the Duchess of 
Albany. Mrs. Kendal and Mrs. Beerbohm Tree 
have promised to give recitations, and well-known 
artists will provide dramatic entertainments. 

PERSONAL. 


Thb Earl of Kimberley, K.G., has been appointed by 
the Queen Chancellor of the University of London, in 
the place of the late Lord Herschell. 

8ir James Bell, Bart., was last week elected, by a 
large majority, to the assessorship in the Univeraity of 
Glasgow, vacant by the death of Dr. King. 

Professor Schafer, F.R.S., of University College, 
London, is, we understand, a candidate for the Professor¬ 
ship of Physiology in the University of Edinburgh, 
vacant by the death of Professor Rutherford. 


Dr. W. Allan Jamieson, who has been appointed to 
the newly instituted chair on skin diseases in Edinburgh 
University is a renowned archer, being the holder of the 
second largest number of trophies among living members 
of the Royal Archer Company, who form Her Majesty’s 
body guard in Scotland. 

Our congratulations are offered to Professor Robt. 
Muir on his selection out of eight candidates for the 
chair of pathology in the University of Glasgow, voided 
by the lamented death of Professor Coats. Honours 
appear to fall quickly in the path of the new professor ; 
but a few months ago he was elected to the chair of 
pathology at Dundee, which post he has now to vacate 
for the still more important one at Glasgow. 


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Apbil 12 , 1899 . 


MEDICAL SOCIETY OF LONDON. 


Db. Roox, Medical Director of the Pasteur Institute 
in Paris, states that he knows nothing of Dr. Bra, of 
that city, and does not believe in his alleged discovery of 
the canoer microbe. Meanwhile Dr. Bra is striving to 
calm the daily press, begging them to restrict their 
descriptions of his experiments to their proper pro¬ 
portions. 


Wi regret to learn that as Dr. Ring wood, of Kells, was 
recently returning home at night from visiting a patient, 
he met with a very serious aocident. His horse fell and 
flung him out of a high dogcart on to a quantity of 
broken stones. In addition to fracture of his right arm. 
Dr. Ringwood received very severe abdominal bruises, 
which gave rise to a sharp attack of local peritonitis and 
cystitis. However, under the care of Dr. Minchin, Kells, 
he is now progressing as favourably as can be expeoted. 

"Wb understand that the private asylum heretofore 
conducted by Dr. Patton, at Pinglass, near Dublin, has 
passed into the hands of Dr. W. R. Dawson, Dr. Patton 
having attained the age at which rest becomes necessary. 
The establishment has always been, if we may use the 
phrase, very popular, in consequence of its excellent 
working by Dr. Patton, and as Dr. Dawson has served 
four and a half years as assistant, having previously 
studied at Morningside Asylum, Edinburgh, it may be 
anticipated that the prestige of the institution will be 
maintained. Dr. Dawson has held the Stewart Scholar¬ 
ship in mental diseases of the Royal University, and has 
been a Travelling prizeman in the University of Dublin. 


THE UNIVERSITIES DEGREES BILL. 

It will be recollected that this Bill, which is now 
before the House, aims at compelling all persons who 
hold foreign University.degrees toappend to their name 
graduation titles, the place of origin, e.g., M.D. Brux. 
for the Brussels degree. General Laurie has placed 
against this Bill a notice of motion that it shall not 
pass as long as “graduates of universities in the 
United Kingdom are exempted from such require¬ 
ment.” We sympathise with both the promoters and 
the opponent of the measure. The purpose of the 
Bill is excellent, because it seeks to prevent the 
holders of sham degrees sailing under false colours 
in Great Britain, but we do not see why graduates of 
British universities should hesitate to attach to their 
names a similar indication of the source of origin. 
And we think that the principle of General Laurie’s 
motion deserves approval. 

THE IRISH CO iNCIL ELECTIONS. 

The election of County and District Councils under 
the new Local Government Bill took place last week, 
and here and there a doctor got a seat. Among 
them was Dr. Usher, recently retired from the Dun- 
drum Dispensary, and he was elected to the Rath- 
down District Council. It was, of course, not to be 
expected that the medical profession would make 
any decent show on the hustings on this occasion, 
inasmuch as any medical officers receiving pay were 
debarred from offering themselves to the electors by 
what we believe to be a perfectly illegal sealed order 


The Me dical Press. 385 

of the Local Government Board, respecting which 1 
we may have something to say at a future time. 


NEW FIELDS FOR TAXATION. 

The French Government rejected, last week, a 
proposed tax of Id. a bottle on mineral waters, but 
accepted the suggestion that match boxes, which, in 
France are a State monopoly, should be farmed out 
for advertising purposes. The reason given by the 
Minister for refusing the mineral water tax was that 
soda water is a medicine, but we suspect that the 
traders in effervescents are politically stronger than 
those in matches. 


TUBERCULOUS MEAT AND MILK. 

We notice with satisfaction that the Royal Agri* 
cultural Society has recognised the exigencies of the* 
anti-consumption crusade. It has issued a leaflet to - 
farmers and dairymen inculcating the necessity for 
special precaution against the sale of tuberculous milk 
or meat. This is the first step in the education of the 
public who are materially interested in the question, 
and we have no doubt that it will produce good 
results. 

The National Association for the Prevention of 
Consumption and other forms of Tuberculosis has- 
been registered as a limited company, the maximum 
number of members being 1,100, and the liability five 
guineas. The registered offices are at 20 Hanover 
Square, London, W. 


§artlatti). 

[from our own correspondent.] 

New Professors in Scotland. — The Edinburgh 
School of Medicine has good reason to be satisfied with 
the honours which have lately been bestowed on her 
alumni and former members of her teaching staff. Two 
years ago thfe Extramural School provided Professor 
Stockman for Glasgow University’s Materia Medica 
Chair; St. Andrew’s took Mr. Musgrove for Anatomy; 
Dundee elected Professor R. Muir for Pathology, only to 
be deprived of his services because of his selection last 
week by Glasgow University ; while Mr. J. A. Thomson, 
Lecturer upon Natural History and Biology in the same 
School, was last week appointed successor to the late 
Professor Alleyne Nicholson at Aberdeen. If we look 
back a few years further, we find the names of a number 
of Edinburgh Graduates or Licentiates engaged in the 
instillation of medical knowledge into students’ brains. 
For example, at least seven of the Professors of the 
Glasgow University Medical Staff were at one time under¬ 
graduates in Edinburgh. 

Glasgow University Chair of Pathology.' —At a 
meeting of the curators of the Chair of Pathology, held 
on the 6th inst., for the purpose of electing a successor 
to the late Professor Coats, Dr. Robert Muir, Professor 
of Pathology, University College, Dundee, was unani¬ 
mously elected from among the eight candidates. The 
curators present were Principal Story, Professor 
MoKendrick, Dr. H. C. Cameron, Dr. C.McVail, Dr.Ker, 
and Messrs. J. H. Dickson and James Boyd. Dr. Muir’s 
testimonials were of such excellence that the curators 
were, so to say, compelled to appoint him. Certainly, it 
may not be quite a surprise to the Glasgow candidates 
and students, yet it is a source of lamentation that an 
Edinburgh graduate should have been elected to this 
coveted post. 


Digitized by v^ooQle 



386 The Medical Preps. GORRESPiD&DENCE. April 12, 1899. 


The Resident Quarters' in the Royal Edin¬ 
burgh Infirmary. —The board has listened to the 
prayers of the staff concerning their proposed altera¬ 
tions in the residency of this hospital, and agreed to a 
compromise, by which the majority of the residents will 
still have both a sitting-room and bedroom for their 
private use, while one or two of the larger existing 
sitting-rooms will be given to two residents in place of 
one, as at present. This arrangement is understood to 
be provisional until such time the managers can see a 
way to house the resident physicians and surgeons of 
the future in a more becoming manner. As the resi¬ 
dent staff is mostly drawn from the ablest students 
graduating in the summer preceding their term of office, 
those who indulge in the common habit of regarding it 
as consisting of rowdy boys, for whom any sort of 
accommodation is good enough, and no amount of 
disciplinary government too much, or tjo derogatory, 
have hereby received a deserved rebuff. 

The last six months have produced rather over w£28,000 
in legacies and donations in favour of the Royal Edin¬ 
burgh Infirmary. At present Edinburgh students fill the 
following chairs:—Practice of medicine, anatomy, physi¬ 
ology. zoology, and natural history, materia medioa, and 
pathology. We refer, of course, exclusively to the 
medical chairs. Dr. Muir will enter on his duties on the 
2oth at a salary of .£1,100 per annum. 

New College for Women. —Sheriff Johnston, Q C., 
has presented his final report to the Second Division of 
the Court of Session on the petition of the trustees of 
the late Dr. Henry Muirhead, of Longdales and Bushy- 
mill8, Lanark, to settle a scheme for the founding and 
maintenance of an institution in Glasgow for the in¬ 
struction of women in physical and biological science. It 
is proposed to acquire a property in the immediate 
neighbourhood of the Victoria Infirmary, with a view to 
fitting it up as a residential college for tbe teaching and 
boarding of female students. The institution is to be 
known as the Muirhead College. 

Glasgow Health Department —The health com¬ 
mittee have adopted the following recommendations 
submitted by the sub-committee charged with the duty 
of considering the whole question of the administration of 
the department consequent upon the resignation of Dr. J. 
B. Russell, viz.: 1st, That Dr A. K. Chalmers be continued 
as Medical Officer of Health of the city, and that his salary 
as such be increased from £500 to .£700 per annum as 
from and after the date of Dr. Russell’s demission from 
offioe. 2nd, That in the meantime no assistant to tbe 
medical officer be appointed. 3rd, That, however, a 
person having knowledge of bacteriological and chemical 
research should be appointed to devote his time mainly 
to laboratory work. 4th. That the appointment of assis¬ 
tants to the Physican-Superintendent of the Hospitals 
should be made by the Physician-Superintendent, subject 
to the approval of the Medical Officer of Health. 5th, 
That in all other respects the administration of the 
Health Department be continued in accordance with the 
practice that has hitherto prevailed. 


MEDICAL SOCIETY OP LONDON. 

The meeting on Monday evening last, April 10th, was 
.devoted to the exhibition of living subjects. Among 
them was an interesting case exhibited by Dr. G. Herman 
of a woman who in 1894 developed a cancer of the right 
breast, which was removed, witn the axillary glands, by 
Mr. Lawson. It recurred, and was again operated upon. 
When Dr. Herman saw her in July, 1898, there was a 
large cancerous ulcer on the right side, with a tumour 
measuring three inches across in the left breast, and 
enlarged glands in the left axilla. Oophorectomy was 
performed and thyroid extract given, and by October of 
that year the ulcer had healed, the tumour in the left 
breast had disappeared, and the glands in the axilla 
could no longer be felt. He mentioned cases to show 
that oophorectomy alone had not proved very successful, 
find thyroid extract alone had given no results worth 
speaking of. 

Mr. Stanley Boyd pointed out that there were 
nodules near the scar which were suggestive of malig¬ 
nancy, and hesitated to regard the patient as cured. He 


inclined to the view that Buch improvement as took 
place was the result of the obphorectomy adding that to be 
of service it must be done before menstruation had 
ceased. He mentioned certain other cases to show that 
cancer might undergo spontaneous cure without treat¬ 
ment of any kind. 

Mr. G. R. Turner observed that even if only tempo¬ 
rary the results were none the less very remarkable. 

Dr. Herman, in reply, admitted that the canoer in 
disappearing might have left traces, but denied that 
clinically, at any rate, the nodules could be regarded as 
cancerous. He pointed out that the results of the com¬ 
bined methods were indisputably superior to those of 
either procedure separately. 

Mr. Battle showed a second patient, a woman, in 
whom he had successfully performed gastrostomy by 
Albert’s method for obstruction of the oesophagus. 

Mr. .G. R. Turner showed a man with a history of 
syphilis, a sailor, who had fractured the left humerus, 
followed by non-union, a subsequent operation to pro¬ 
mote union being equally unsuccessful. He had cut 
down and wired tbe fragments, giving at the same time 
anti-syphilitic treatment, but still union did not follow. 
Another operation proved more successful, and the man 
resumed his occupation. Later on, however, he had 
once more fractured the bone, and this time operation 
proved unsuccessful, and he discussed the possibilities of 
treatment under these circumstances. 

Mr. Jaffrey showed a young man who, after two falls, 
followed by concussion of the brain, had become unable 
to answer questions, except with difficulty. When asked 
a question he put his left hand to his mouth, and was 
apparently convulsed for some seconds before finding 
expression, not, however, losing consciousness. 

The President, who knew the patient, pointed out 
that he had been subject to epilepsy before the accidents, 
and he was inclined to attribute the symptoms to shock, 
rather than to any injury to the brain. 


Ctareepmtiintce, 

We do not hold ourselves responsible for the opinions of oar 
correspondents. 


THE LISTERIAN RITUAL. 

To the Editor of The Medical Press and Circular. 

Sir, —Mr. Lawson Tait, in his letter referring to the 
Listerian Ritual, as he is pleased to designate it, says : 
“ To claim tulphurout acid at a part of the ritual it as 
reasonable on the part of Hr. Bowreman Jeisett as if he 
claimed the tun and the moon.” 

I confess I am unable to follow Mr. Tait’s argument; 
but will he deny that sulphurous acid is a strong anti¬ 
septic? Whether the sun and moon have equally power¬ 
ful antiseptic properties, I cannot say, possibly Mr. 
Lawson Tait has ascertained, and will explain. 

The question I asked Dr. Bantock was based upon a 
practice I had seen him adopt, viz., syringing out 
abscesses in the abdominal cavity caused by stitches, 
which practice he told me he found most useful. I asked 
him, if he did not believe in Listerism, why he used this 
powerful antiseptic lotion instead of plain water ? 

I am, Sir.yours truly, 

Frederick B. Jessett. 

23 Brook Street, London, W., April 6th, 1899. 


REMARKS ON THE PRACTICABILITY OF 
STATE SANATORIA FOR TUBERCULOUS 
PATIENTS. 

To the Editor of The Medical Pbess and Circular. 

8ib, —If the principles should be established that the 
chief origin of consumption and its allied diseases is in 
the contagium of the sputum of phthisical patients, dis¬ 
seminated by the wind and finding a fructifying nidus 
in the comparatively healthy lung, and that it is the 
duty of the State to prevent that dissemination at any 
cost, it is manifest that means must be adopted by the 

Digitized oyGoOglC 


OBITUARY. 


April 12, 2899, 

authorities to detect the existence of the infective 
bacillus in the sputum at the earliest age at which dis¬ 
semination becomes possible, and to keep strict guard 
against dissemination by isolating the expectorating 
patient until he or she shall, by death or otherwise, 
have ceased to be a centre of infection. We are, 
for the present, excluding from consideration the local 
manifestations of tuberculosis such as tabes, meningitis, 
and joint disease, though it remains to be seen whether 
sufferers from these forms of tuberculosis do not also 
need isolation for the safety of their neighbours. Now 
we are not able to estimate the average pathological 
life (so to speak) of a consumption patient. He or she 
may run with headlong speed to the next world, or may 
drag existence along for half a lifetime, or may even get 
weu altogether, but we do not think that, taking one 
case with another, five years would be an unreasonably 
long period upon which to estimate that the State must 
take peremptory charge of the patient in the proposed 
sanatorium. Many cases would disappear by death 
within a few months, and, let us hope, many others 
would be restored to their families and their bread¬ 
winning before the fifth year, but, on the other hand, 
many hopeless cases, profiting from the benign influence 
of the sanatorium, would linger on for ten or twenty years 
in an uncured and infective condition, which would pre¬ 
vent their returning to association with the general 
publio. Now we find that, according to the Registrar- 
General’s returns, the deaths from phthisis throughout 
-the Kingdom (excluding other local tuberculous diseases) 
^Timber about 60,000 in the year. Assuming that each 
phthisis case would be a charge on the sanatoria for five 
years, it is obvious that provision should be made by the 
taxpayer for 300,000 patients at an initial cost (say 
300 sanatoria, eaoh to aooommodate 1,000 patients, at 
the very low estimate of .£50,000 eaoh) of .£1,500,000 
first capital expenditure. Then comes the cost of 
maintaining these establishments and their inmatee, and 
it is difficult to estimate what this would be, con¬ 
sidering that the care and cure of a consumptive 
involves precautions as to temperature and ventila- 
-tion and dietary which are not thought of in the 
case of a lunatic or an ordinary hospital patient. We 
find that, in one scientifically equipped and economi¬ 
cally, though successfully, managed Consumption Sana¬ 
torium, each patient costs, for a residence of 119 days, 
about .£14. At Ventnor, the cost is proportionately less, 
as the greatest period through which a patient is 
allowed to remain is 98 days, and the average is 53 days. 
£14 outlay for 119 days means about £43 per head annu¬ 
ally, and for maintenance alone. Let us suppose that 
one-third of the whole consumptive army of 800,000 
would be able and willing to pay for their own main¬ 
tenance, the outlay on the remaining 200,000, the interest 
and sinking fund on the original capital expenditure 
being added, would come to very nearly nine millions a 
year. We have sought to rather undercaloulate than to 
exaggerate the financial burthen involved in a whole¬ 
sale scheme of compulsory isolation of phthisical 
patients. What the amount would be if the 
other 23,000 patients who die annually from other 
local tuberculous diseases were included, we should be 
afraid to say. It is enough to say that, in our opinion, 
-to ask at this juncture Great Britain and Ireland for 
nine to twelve millions a year would suffice to extinguish 
for ever the project of State sanatoria. The other diffi¬ 
culties of compulsory isolation seem to us to be even 
more overwhelming than the financial impasse. Where 
is the Government which will dare to propose, as 
has been proposed in America, that every individual 
heard to cough shall be compulsorily inspected, and, if 
found to be infected with tubercle, carried off from his 
or her family and incarcerated, perhaps for years, per¬ 
haps for a lifetime! Suoh a proposal is a legislative 
impossibility in our country, and we hold very strongly 
that to clamour for impossibilities is, in all matters of 
-this life, a fatal mistake. The idea may be realised to a 
great extent by patient education of publio opinion, but, 
most decidedly, not by striving to force Utopian pro¬ 
posals down the throat of the nation. 

I am. Sir, yours truly, 

A. H. J. 


The Medical Prxss. 387 

(Dbituarn. 

GEORGE CHARLES WALLICH, M.D., F.R.C.S., Ed., 

Surgeon-Major, retired, Indian Army, F.I*8., P.B.3.Liege, A.. 
Dr. Wallich, whose death was announced on the 30th ult. 
at the advanced age of 83, received his medical educa¬ 
tion in Edinburgh, and there obtained his F.R.C.S. and 
M.D. with honours. Soon afterwards he entered the 
Indian Army, and joinedhis father. Dr. Nathaniel Wallich, 
in Calcutta, there well known as a distinguished man of 
science and an ardent botanist, and for many years in 
charge of the Botanical Gardens, Calcutta. His son 
inherited the scientific bent oL-his father, early display¬ 
ing a deep interest in the pursuits of natural history, 
and especially with regard to the microscopic forms of 
life. On attaining the rank of surgeon-major, he retired 
from the service and returned to England. He subse¬ 
quently obtained the appointment of naturalist to the 
expedition despatched in 1860, under the command of 
Admiral Sir E. L. McClintock, to survey the proposed 
North Atlantic telegraph route between Great Britain 
and America. The information thus obtained of the sea¬ 
bed of the Atlantic proved of great value, assisting much 
towards securing sucoess for all future works and under¬ 
takings of the kind. So much new material had been 
accumulated by Dr. Wallich, and so many important 
observations made of the geological formation as well as 
of the fauna of the ocean bottom, that “ my Lords of 
the Admiralty ” saw fit in 1862 to sanction their imme¬ 
diate preparation for publication, stopping that, how¬ 
ever, at the first volume. Luckily for science, the Chal¬ 
lenger Expedition met with more generous treatment 
from the Government of a later date, and ite accu¬ 
mulation of scientific facte and valuable mate¬ 
rial have been fully laid open to the publio. 
The work of deep-sea dredging was much facilitated 
by the improvement he made in the machine previously 
in use. and whereby he brought animal life from great 
depths to the surface without mutilation, while his 
microscopical knowledge assisted much to finally 
settle the question as to the precise nature of the slimy 
viscid mud whioh was brought to the surfaoe. Huxley, 
in 1858, attached much importance to this ooze, and 
looked upon it as entirely novel, believing it to be 
“ living protoplasm .” Carpenter, who fully studied the 
same during the laying of the Atlantic Cable ten years 
later, supported Huxley’s view, as also did Professor 
Hreokel, who even went further and believed it to be “ a 
plasmir substance of spontaneous generation.” Whereupon 
Huxley and Carpenter aooordingly named it “ Bathybius 
Hteckelii.” This, of course, Wallich proceeded to show 
was an entire mistake, that the supposed newly discovered 
substance was nothing more than chalk-ooze common 
to the Atlantic bed, liquefied by a pressure at some 
5,000 or 6,000 fathoms depth. 

The discussion for some time waxed warm, but 
eventually Huxley admitted hiB mistake. Carpenter, 
however, never forgave Wallich, and when at a sub¬ 
sequent period friends thought the Fellowship of the 
Royal Society ought to be bestowed upon one who had 
done so much good work, Carpenter.it is said, strongly 
opposed and voted against his admission. Dr. Wallich 
had undoubtedly a fair claim to the honour, and his 
rejection embittered the rest of his days. His micro¬ 
scopical work was solid and of great worth, while his 
researches in Algal forms of life, the Diatom acre in par¬ 
ticular, were of the highest value. He discovered and 
described many new forms of diatoms as well as Radio- 
laria, and was the first observer to demonstrate the 
nucleus and contractile vesicle in Gromia. It would, in 
short, require much more space than we have at com¬ 
mand even to enumerate his extensive and important 
discoveries. 


MR. JOSEPH COPE. 

The remarkable personality of Mr. Joseph Cope, clerk, 
of the Rathdown Union, near Dublin, induoes us to depar 
from usage to refer to his death on Sunday last at hi, 
residence in Rath mines from influenza. We shall no 
be doing injustice to other clerks of Union if we say tha' 


388 Ths Medical Pbbm. 


LITEBATUBE. 


Apbil 12, 1899. 


Mr. Cope was their beet representative. Not only did 
he serve the Rathdown Union for nearly fifty years, but 
for most of that period he was implicitly trusted by a 
long sncoession of Guardians of all political colours and 
all personal characteristics. He was a very able man, 
knew his business thoroughly, and did it honestly and 
industriously. Our special relation to him is the part 
which he bore for many years in the struggle for the 
interests of the Poor-law offloera in Parliament and out 
of it, in which propaganda he was both earnest and 
successful. He is deeply regretted by his masters on the 
Board of Guardians and by all who have been brought 
into association with him either personally or officially. 


Xitbamtorg Jlotcs. 

THE D C.L. MALT EXTRACT. 

The D.C.L. Malt Extract and D.C.L. Extract of Malt 
and Cod Liver Oil are prepared by the Distillers Com¬ 
pany, Limited, Edinburgh. With both we have made 
exhaustive tests in the laboratory. 

The samples of Malt Extract yielded, on analysis, the 
following results:— 

Moisture . 28'2 per cent. 

Total solid residue . 71’8 „ 

The total solid residue had the following composition 
calculated in percentages on the original sample:— 

Mineral matter . 2’1 per cent. 

Nitrogenous matter . 6'6 „ 

Malt sugar... . 00 7 „ 

Dextrin, diastase, &c. (by difference) 2 4 „ 

The diastatic power was determined by the method 
given in “ Squire’s Companion to the British Pharma¬ 
copeia,” 17th Edition, page 157. 

The result of two series of experiments was that 6 cc. 
of a 5 per cent, solution of the extract converted a solu¬ 
tion of purified potato starch containing 0*6 of a gramme 
of starch in a fraction under nine minutes. That is to 
say, this malt extract is capable of converting rather 
more than double its own weight of starch in ten 
minutes. This is a very satisfactory result. The diaa- 
tatic power of a malt extract is a matter of great im¬ 
portance, and as its value largely depends on this 
characteristic, we strongly urge physicians when pre¬ 
scribing malt extract to insist on their patients taking 
care to use only an extract of proved efficacy. 

The amount of cod-liver oil present in the sample of 
D.C.L. Malt Extract and Cod-liver Oil was found to be 
12 per cent. Both samples are free from undue 
acidity, and their flavour is exceptionally fine. 


STOWER’8 LIME JUICE CORDIAL. 

We have, on more than one occasion, had occasion to 
report on this popular product and invariably in 
favourable terms. The further sample which, after the 
lapse of some years, we have received, shows on examina¬ 
tion and analysis that it has retained to the full the 
qualities which induced us to com nend it in the first 
instance—viz., the absence of injurious impurities, its 
stability, and, geneially, its dietetic properties. Spring 
is advancing with rapid strides, and the season is close at 
band when the cordial will once again be resorted to as 
a beverage in association with ice and effervescing 
water. We can confidently recommend this “ cordial ” 
as a sound and trustworthy preparation. 


British Pharmacopoeia for 1898, with the addition of a 
few brief notes on the general therapeutic action of the 
various remedies mentioned therein. 

In order to be really a “ Pocket Pharmacopoeia,” it is 
obviously necessary that this information should be very 
brief ana condensed, and this has been judiciously done 
by the authors. 

The more essential “ pharmacy ” part of the work is 
given with much completeness, the solubility of the- 
drugs, with purity tests, being clearly and fully put 
forward. 

Thus this Pharmacopoeia is made a trustworthy guide 
for the busy practitioner, and an exoellent book for the- 
candidate preparing for examination. 

It oocurs to us that the introduction of some of the- 
popular names of certain preparations might be advan¬ 
tageous. For example, Fowler'» solution under liquor 
arsenicalis. Griffith’s green mixture under mixture ferri. 
composite, and a few more. 

In examination, it is not uncommon for a candidate 
to be asked the composition of the above when named' 
to him by their colloquial and popular names. 

The appendioes of weights and measures, and the descrip¬ 
tion of certain pharmaceutical processes as designed by 
the “New Pharmacopoeia,” add to the value of thie¬ 
very servicable manual. 

YEAR-BOOK OF PHARMACY, (a) 

This ever-welcome year-book gives the pith of all' 
scientific papers read during the year that have a bear¬ 
ing on medicines and their preparations. The present 
volume fitly opens with a summary of Dewar’s paper on 
the liquefaction of hydrogen, a result obtained by the- 
combined influence of a temperature of 205 degs. C. and 
a pressure of 180 atmospheres. The result marks an 
epoch in the annals of chemistry, disposing as it does of 
the idea of permanent gases, an idea which dominated 
chemistry for over one hundred years. 

Messrs. Wade and Panting’s observations of the- 
different effects of dilute and concentrated sulphuric 
acid on potassium cyanide are of great interest, both to 
the theoretical and analytical chemist. 

Aconitine, according to Messrs. Duns tan and Cash,, 
owes its toxicity to the presenoe of an acetyl radicle in 
the molecule, a highly important fact, for it is by suoh 
carefully conducted examinations of the active principles 
that the therapeutic properties of drugs can only be 
estimated. 

Senecio Jacabcea comes in for notice, and Dr. W. E, 
Fothergill’s paper is summarised; but we regret that no 
mention is made of Dr. William Murrell’s paper on the 
subject, which appeared in our columns and attracted 
much attention at the time. 

*• Notes and Formula ” occupy close on fifty pages, and 
well repay the reading. We need only mention the 
statement on page 248 that strontium Balicylate does not 
disturb the digestive organs, as the alkaline salicylates- 
too often do The papers read at the Conference are 
very unequal. Some of them, as Mr. Stanford’s on 
“ Thyroglandin ” and “ Alginoids,” Mr. Druce’s paper on 
“ Irish Flora,” Mr. Howard’s on the “ Basicity of 
Quinine,” are really valuable. But we cannot say as 
much for all that appear in this section of the volume. 
It is no kindness to an author to prolong the existence 
of a weakly offspring—that cannot command admiration 
and only gives rise to oommiseration. 

Taken altogether the Year-Book is one of our most 
valued and valuable annuals, very helpful to the physi¬ 
cian and invaluable to the pharmaceutical ohemist. 


literature. 


THE POCKET PHARMACOP1EIA. (o) 

This book, the work of an experienced chemist, assisted 
by a highly qualified physician, is an epitome of the 


(a) “ The Pocket Pharmacopa-la, Including the Therapeutical 
Action of the Drugs, with the Natural Orders and Active Prin¬ 
ciples of those of vegetable Origin." By Frederic Hudson-Cox. 
F.f.O., F. r .M., Member of the Pharmaceutical Society of Great 
Britatn, and John Stokes. M.D., B.8., L 8.8c. Durham, M.R.0.8. 
London: BallUerie, Tindall, and Cox, 20-81 King William Street, f 
Strand. 1898. Pp. 206. Price 2a 6d. 


INDEX-CATALOGUE. (6) 

We have rec eived the third volume of the second eerier 
of the Index-Catalogue of the Library of the Surgeon- 


la) “ Tear-Book of Pharmacy ” comprising Abstracts of Papers 
relating to Pharmacy, Materia Medira, ana Chemistry, contri¬ 
buted to British and Foreign journals from July 1st. 1*>7, to June 
80th, 1888, with the Transactions rf the British Pharmaceutical 
Conference at the thirty-fifth Annual Meeting, held at Belfast, 
August, 1888. London: J. and A. Churchill. 1888. 

(b) “ Index-Catalogue of the Library of the 8urgeon-GeneraT» 
Office, United States Army." Authors and Subject*. Second 
f Series, Vol. III. C. Czygan. Washington: Government Printing 
Office. 1898. 


Digitized by 


oogle 



APBIL 12, 1899, 


LITERATURE. 


The Medical Press. 389 


-General's office, United States, America. It contains 
11,112 author-titles, representing 4,873 volumes, and 
10,090 pamphlets. It also contains 10,630 subject-titles 
of separate books and pamphlets, and 34,314 titles of 
articles in periodicals. 

The Index - Catalogue, of which the first volume 
appeared in 1880, contains, as far as published, 209,654 
author-titles, 192,861 book-titles, ana 697.535 titles of 
articles in periodicals. The new series alone contains 
38,190 author-titles, 24^94 book-titles, and 80,423 titles 
of articles in periodicals. 

The word *• chloroform ” occupies twenty-two closely 
printed columns in the present volume, two columns less 
than it did in the second volume of the first series. 
Anesthetics occupy twenty-eight and thirty-two columns 
of the first and seoond series respectively. 

So far as the seoond series has gone, a volume is given 
to each letter of the alphabet, an arrangement that 
facilitates reference. 

The present volume is much more than an index of 
books and papers; it is a most readable volume, giving, 
in the titles of many of the older volumes which the 
industry of the librarian and the generosity of the United 
States Government have secured, a vivid picture of 
medical science in the fifteenth, sixteenth, and seven¬ 
teenth centuries, and also of the system of quackery 
then rampant, and pursuing lines of mendacity which 
to the quacks of to-day are bo familiar. 

Under the headings “Cases,” “ Controversy,” '* Corre¬ 
spondence,” we £et a sidelight on the social condition of 
the past that is highly interesting. It is a strange 
commentary on life that of the disputants whose names 
oooupy columns, the great majority have passed away; 
the subject of the controversy forgotten—even their 
very names have become so unknown as hardly to excite 
a passing moment’s interest to the reader. 

We and the whole medical profession are indebted to 
the Surgeon-General of the United States of America 
and the enlightened liberality of his Government for 
-this gre»t work the Index-Catalogue. 


LAHMANN’S NATURAL HYGIENE, (a) 

The author in his preface says :—“ Those who have not 
studied phyiiology and pathology will not be able to run 
through the book on a Sunday afternoon, but will have 
to study it. - ’ Whether those who have studied physio¬ 
logy and pathology could not make a better use of their 
Sunday afternoons is at least open to question. 

The author contends the " dystemia ” is the principal 
origin of all predisposition to disease-, the term 
“dyssemia” is variously defined, perhaps the fullest 
definition being “ used to denote an abnormal proportion 
of the food-salts in the blood, and especially a deficiency 
of those salts which are absolutely necessary to maintain 
us in good health.” The author also maintains the 
limited vitality of the so-called inorganic constituents 
of the animal organism and their participation in the 
same metabolism that takes place in the tissues. 

To get enough of the proper salts, two courses are 
recommended ; first, vegetarianism, which is “ proved ” 
as followsCarnivorous animals have atrophied, inactive 
-sweat-glands, whilst man and herbivorous animals 
possess well-developed sweat-glands. There is no doubt, 
therefore, that the herbivora must have preceded the 
•carnivora in point of time, the carrion-feeders being the 
connecting link between them.” It is refreshing to 
find a mind that can sketch out in a few words such a 
profound theory, and can introduce the non sequitur con¬ 
clusion by “ There is no doubt, therefore ! ” It is sad to 
think that the author may yet have to realise the caution 
of the bishop to the curate—“ None of ub are 
infallible, not even the youngest.” 

The author holds, as so many fin^de-aiecle vegetarians 
do, that starchy foods should be very little used, green 
vegetables, green salads, juicy fruits, and the author’s 
food-salts and sugar syrup being substituted; ordinary 
table salt should be severely left alone. 

(o) “Natural Hygiene ; or, Healthy Blood the Essential Con¬ 
dition of Good Health and How to Attain It. A Treatise for 
Physicians and their Patients on the Predisposition to and Pre¬ 
vention of Disease.” By H. Lahmann, M.J. London: Swan, 
fionnenscheln and Co., Limited. 1898. Pp. 253. 


The results of the author’s system are striking The 
pains of childbirth are nearly abolished, as the infants 
of mothers so fed are so small that they easily glide into 
the world. It may also be expected that, the ovarioto- 
mist will cease to trouble, and spectacles disappear from 
the Vaterland, for we read:—“ The cause of goitre and 
ovarian cyst is a local “ hgdramia (t eatery condition of 
otmotic processes)’* just as is the case with short sight. 
The only difference is that, owing to anatomical condi¬ 
tions the osmotic enlargements of the goitre cyst or of 
the ovarian cyst may increase to any extent, for neither 
the thyroid gland nor the ovary have any system to 
allow of the escape of superfluous fluid. The pathology 
of this is not to be grasped in a Sunday afternoon ! 

Daily bathing of the body to some does not do any 
visible harm, but when the Bkin is constantly rubbed it 
is deprived of the natural oil which renders it soft, and 
which is of greater importance in helping it to perform 
its functions than the cleansing effects of the bath. 

The following testimonial is rather amusing and shows 
how little some grateful natures we thankful for— 

“ Dear Doctor, I have read your highly praiseworthy 
work, “ Dietetic dys»mia,” and have accordingly changed 
my vegetarian mode of living. The effect has been 
remarkable. Since the beginning of December, when I 
commenced the new regime, my urine has shown a 
deposit of gravel every morning (t e., uric acid, brought 
into solution owing to the greater abundance of soda in 
this food), and the same thing occurs to my wife.” 

A number of photographs of the author’s children are 
introduced to illustrate the advantage of being brought 
up on their father's system. The only one of interest 
faces page 204, and if not “ faked ” is an apotheosis of the 
mashed strawberry and raspberry (page 207) feeding of 
infants; it shows a four months old infant standing 
erect on its father’s hand, the fingers of which grasp 
the feet. The mother does not occur in the picture, so 
her feelings can only be guessed. The want of an index 
prevents some other amusing points noticed in glancing 
over the book from being recaptured and related. 

A considerable amount of ignorance of physiology and 
pathology will assist the enjoyment of this book on 
Sundays and weekdays. 


BROUARDEL AND GILBERT’S MEDICINE AND 
THERAPEUTICS, (a) 

This bulky volume is the fifth of a very imposing and 
valuable series. It deals with diseases of the salivary 
glands, pancreas, liver, spleen, kidneys, and genito¬ 
urinary tract. Prom a scientific point of view it is fully 
up to the standard of its predecessors for each chapter is 
a monograph written by one or more acknowledged 
authorities, giving the most recent and complete infor¬ 
mation on the subject. The chapter on diseases of the 
liver, by Drs. Gilbert, Fournier, Garnier, and Surwont 
is a monument of research and careful observation. No 
point is left untouched in the 450 pages allotted to this 
one subject We note with satisfaction that due credit 
is accorded to foreign investigators whose claims to 
recognition are too often subordinated to misguided 
patriotic zeaL Not less remarkable is the chapter on 
kidney disease by Dr. Chauffard whose researches in this 
direction have secured him a world-wide reputation. As 
in the preceding volumes semiology and general 
pathology have been accorded an amount of atten¬ 
tion not usually allotted to them in works of the 
kind, and this fact gives a special value to the 
articles. The claims of general pathology to recognition 
are now generally conceded, for its study enables us to 
co-ordinate and generalise the multitudinous array of 
facte and observations which must otherwise lie idle. 
General pathology indeed may be described as the philo¬ 
sophy of medicine whereby the physican is enabled to 
group his facte and to deduce therefrom the general laws 
which underlie all morbid manifestations. To those for 
whom the French language has no terrors it cannot but be 
of exceeding interest and benefit to study disease through 
French spectacles. French writers have for the most 

(a) “Traite de Medecine et de Therapeutique.” Edited by Pro¬ 
fessors Brouardel and Gilbert. Vol. V. Pp. 1,090. Price 12 frs. 
Paris : J. B. Bailliere et fils. London : Baillii-re, Tindall and Cox. 



390 The Medical Pubs. 


MEDICAL NEWS. 


April 12. 1899. 


part a singularly lucid way of expressing their ideas, and 
although the fond must obviously be the same, the 
manner of regarding and discussing the subjects presents 
marked points of contrast. We realise that it is possible 
to be comprehensive without being prolix. This series 
constitutes a medical library replete with information, 
etiological, clinical, pathological, and epidemiological. 
Criticism is disarmed by work of this calibre and we can 
<5nly congratulate the editors and their collaborators on 
the success of their combined efforts in the production 
of such a magnificent work of reference. 


^IctDs. 

The Remuneration of Vaccination Officers. 

The Vaccination Officer of one of the rural districts 
of Daventry Union has just resigned his post On the 
ground that his total income from this source for the 
hist three months had been only 6s. 7d.. out of which he 
hlad to pay postages and Superannuation Fund instal¬ 
ments. His total income Jor the preceding year had not 
exceeded 30s. The guardians accepted his resignation, 
and decided to advertise for a successor at the same re¬ 
muneration. Don’t they wish they may get him! 

The London and Counties Medical Protection Society. 

The ahnual report of this society testifies to much 
useful work during the past year in the protection of 
members againRt false accusations, inspired by ignor¬ 
ance, malice, or Bimply with blackmailing intent. The 
cash deficit of the earlier years has been converted into 
a cash balance of nearly .£900, and this, it is to be sup¬ 
posed, though it is not specifically intimated, corres¬ 
ponds to a steady increase in the number of members. 
While we cannot but regret that there should be more 
than one such society, it is evident that each of them 
finds a field of useful activity. It is a matter for sur¬ 
prise that so many practitioners still neglect to avail 
themselves of the facilities offered by these associations 
to protect themselves against certain contingencies. As 
the knowledge of the extreme value of membership 
beoomes more generally recognised, no doubt they will 
all come into the fold, and when this is the case the 
organisations will oommand more respect and carry 
more weight with the general public. 

The Medical Sickness and Accident Society. 

The usual monthly meeting of the Executive Com¬ 
mittee of the Medical Sickness, Annuity, and Life 
Assurance Society was held on March 24th, at 429, 
Strand, London, W.C. There were present the chairman, 
Dr. de Havilland Hall, Dr. J. B. Ball. Mr. J. Brindley 
James, Mr. F. Swinford Edwards, Dr. J. W. Hunt, Dr. 
Francis J. Allan, and Dr. W. Knowsley Sibley. The 
influenza epidemic is in full evidence in the records of 
the Society, and, indeed, about half the sickness claims 
which have been received this year have arisen from this 
cause. They are, however, almost without exception of short 
duration, and, so far, the influenza record of the Medical 
Sickness and Accident Society for 1899 compares favour- j 
ably with that of other years. The Society’s business 
is now being valued, and there is little doubt that when 
the members meet together in May next there will be 
found to be at their disposal a substantial amount of 
surplus. The business is valued on a very stringent 
basis, and, in addition to this, special reserves are made 
for those chronic sickness cases in which the members 
are entitled to draw from fifty to one hundred and 
fifty guineas a year till aged 65. Nevertheless, out of 
the £126,000 of reserves now possessed by the Society 
there will be found a margin, and the members may 
hope to receive a substantial cash bonus as in 1894. 
Prospectuses, &c., on application to Mr. F. Addiscott, 
Secretary Medical Sickness and Accident Society, 33, 
Chancery Lane, London, W.C. 

The Corporate and Medical Reform Association. 

We have received from the indefatigable secretaries 
of this Association a report of the proceedings at a meet¬ 
ing of the Executive Committee, which took place on the 
4th inst., at which a number of resolutions were adopted, 
urging combined and individual protest against the 
practice of issuing partial diplomas to unqualified per¬ 


sons in special departments of medical practice, notably 
in midwifery and sight-testing. We have nlso been 
favoured with a copy of the memorial on this subject 
addressed to the General Medical Council, signatures to- 
which are urgently solicited. 

Vital Statistics. 

The deaths registered last week in thirty-six great 
towns' of United Kingdom corresponded to ail annual 
rate of 231 per 1,000 of their aggregate population, 
whioh. is estimated at 11,404,408 persons in the middle* 
of this- year. , 

Birkenhead 24, Birmingham 28, Blackburn 26, Bolton 
23, Bradford 21, Brighton 21, Bristol 21, Burnley 24, 
Cardiff 13, Croydon 17, Derby 19, Dublin 31, Edinburgh 
22, Glasgow 22, Gateshead 20, Halifax 26, Huddersfield 

20, Hull 20, Leeds 22, ‘ Leicester 18, Liverpool 
28, London 22, Manchester 31, Newcaatle-on-Tyne 22 r 
Norwich 23, Nottingham 22, Oldham 30, Plymouth 28, 
Portsmouth 21, Preston 21, Salford 22, Sheffield 26, 
Sunderland 28, Swansea 21, West Ham 17, Wolver¬ 
hampton 19. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were:—From measles, 2 3 in Bolton, and 2*4 in Man¬ 
chester; from whooping-cough, 1*0 in Bristol, 1*8 in 
Hull, 1*6 in Plymouth, 2*3 in Birkenhead, and 2*8 in 
Burnley. In none of the large towns did the death- 
rate from Bcarlet fever, from “fever/' or from diarrhoea 
reach 1*0 per 1,000. The 71 deaths from diphtheria 
included 31 in London, 10 in Swansea, 4 in Sheffield, 3 in 
Birmingham, and 3 in Liverpool No death from small' 
pox was registered in any part of the United Kingdom. 

Mortality in Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death rate per 1,000 of the several 
populationsMadras 36, Paris 27, Brussels 26, Amster¬ 
dam 16, Rotterdam 20, The Hague 17, Copenhagen 18, 
Stockholm 21, Christiania 18, St. Petersburg 27, Moscow- 
26, Berlin 21;Hamburg 19, Dresden 17, Breslau 24, Munich 

21, Vienna 24, Prague 29, Buda-Pesth 26, Trieste 80, 
Rome 19, Turin (10 days) 20, Venice 28, New York (in¬ 
cluding Brooklyn) 19, Philadelphia 21. 

Royal College of Burgeons in Ireland. 

The following is the prize list for the winter session 
1898-99. Descriptive Anatomy: Junior—Mr. J. Cock- 
burn, first prize (£3) and medal; and Mr. R. G. Allen, 
second prize (£1) and certificate. Senior—Mr. A. Charles, 
first prize (£3) and medal; and Mr. T. A. Dillon, second 
prize (£1) and certificate. Practical Anatomy: First 
year —Mr. R. G. Allen, first prize (£8) and medal; and 
Mr. R W. Burkitt, second prize (£1) and certificate. 
Second year—Mr. A. Charles, first prize (£3) and medal; 
and Mr. C. W. Ewing, second prize (£1) and certificate. 
Third year—Mr. C. R. Boyce, first prize (£3) and medal y 
and Mr. J. F. Peart, second prize (£1) and certificate. 
Practice of Medicine: Mr. J. P. Byrne, first prize (£3) 
and medal; and Mr. T. J. Tallon, second prize (£1) and 
certificate. Surgery: Mr. J. S. P. Stewart, first prize 
(£3) and medal; and Mr. J. P. Byrne and Mr. W. R. 
Meredith (equal), second prize (£1) and ceatificate. 
Midwifery: Mrs. H L. Hennessy, first prize (£3) and 
medal; and Mr. J. S. P. Stewart, second prize (£1) and 
certificate. Physiology: Miss M. J. Shire, first prize (£3) 
and medal; and Mr. A. Charles, second prize (£1) and. 
cortificate. Chemistry : Mr. T. Keogh, first prize (£3) 
and medal; and Mr. G. G. Tabuteau, second prize (£1 > 
and certificate. Pathology: Mr. J. F. Peart, first prize 
(£3) and medal; and Mr. H. Grabb, second prize (£1) 
and certificate. Physics: Mr. W. Ormsby, first prize 
(£3) and medal; and Mr. A. Ellenbogen, second prize 
(£1) and certificate. 

University of Glasgow. 

The following have passed the first professional ex¬ 
amination for the Degrees of Bachelor of Medicine- 
(M.B.) and Bachelor of Surgery (Ch.B ) in the subjects 
indicated (B., botany; Z., zoology; P., physics; C., 
chemistry) :— 

Robert Adam, Z., C.; J. R. S. Anderson, B., Z., C.: George 
Beattie, Z., C.; A. G. Bisset, C.: J. S. M. Bogle, Z.: W. T. Bolton, 
Z., C.; R. G. Bradford, Z.; J. C. Bringan, P.; Thomas Brodie, B.; 
John Br-)Wn, B.,Z.; C. H. Browning, Z., C.: Robert Bruce, C. : 
B. H. Campbell, Z.: T. M. Campbell, M.A., Z.: A. A. Cnrruthers, 
B., Z. ; R. P. Cartwright, B., C.; Andrew Connal, Z.; T G. Cope- 


itized by GoOgIC 





April 12, 1899. 


PASS LISTS. 


The Medical Press. 391 


■take, B„Z.,P. ; J. C. Crawford, Z., C.: John Cross, B., Z.: W. B. 
Cunningham, Z., C.; H. C. Davies, B.. Z.. P., C : M, L Dick, P.,C; 
David Dickie, Z., C.; D. Q. Dykes, Z., C.; James Eadie, Z., C.j 
James Ferguson, BJ, C .; C. C. isolator, Z., C.; W. M. Giimour, Z.; 
George Gordon, C.; Alexander Greig. Z-, C.; John Hanson, M.A., 
Z., C.; S. H. Harris, B. : William Harvey, Z , C.; J. M. Huey, 

B. , P.; J. G. Hume, B., Z., C.; Alexander Hunter, B-, Z.; J. T. 
Kelly, B., C. ; J. M. Kelly, Z., C.; John Kerr, Z., C.; Robert 
Laurie, B„ C.; Alexander Leggatt, P„- B. T. Leiper, Z., C.; 
Bichard Making, B., P. ; Peter Millar, Z.. C.; W. A. Milne, P.; A. 
J. Mitchell, Z., P.; D. B. Mitchell, Z., C.: Spencer Mort, Z., C.: 
J. B. Morton, Z., C.; Gavin Muir, Z.; G. D. Muir, Z.; A. H. 
Munro, Z.; J. B. M'Cabe; C.: J. D. M'Culloch, Z., C.: J. G. M'Gut- 
cheon, Z.; D. D. F. Macintyje, Z., C.: C. G. Mackay, Z.; J. M. 
M'Kellar, P., C.: J. C. M’Kenzie, C.; A. 8. M’Millan, Z.; N. T. 
M‘Murdo, Z. ; N. 8. Maonapghtan, B., Z.; J., B. M‘Vail. C.; J. A. 
Macvea, Z., P.; A. A. Wwfijui. JB.; David Penman. B., P.: W. M. 
Bae, B-, P.: George Bahbifrn.’KvC.; William Bankin, B., Z.,P.,C-; 
George Richmond, B.. Z., P.. C.: P. H. Robertson, Z., C.; W. B. 
Robertson, B., P..C.; Campbell Boss, Z .; James Bussell, P.; B. C. 
J. Schlomka, B„ P. ; W. <5. Shand, Z., C.: J. M Smith, Z., C.; 
J. A. Somerville, B., P.; John Stevenson, B., Z.; J. B. Stevenson, 
Z., C.; W. D. H. Stevenson, Z., C.; N B. Stewart, Z.; A. W. 
Sutherland, Z., P.: J. W. Sutherland, Z , C ; P. L. Sutherland, 
Z.,C.; J. A. Thom, B. j Joseph Walker, M.A., Z., P.; George 
Wallace, C.: A. M. Watson, Z.; W. N. W. Watson, Z.; A. B. Watt, 

C. ; B. T. Wells, B.. C.; 5. F. Weston,'B.: *' James Wilson, Z., C.; 
Eldred Wright, Z., C.; Hfigh Young, Z., P.;' John 1 oung (Mount 
Vernon), Z., C. 

WOMEB. Jeanie Auld.P., C.; A. M. Black, P., C.: A. W. 
Cameron, P., C.; M. C. Cameron, C.; J. G. Duncan, P., C.; J. B. 
F. Giimour. C.; Margaret Hardy, P., C.; A. P, Martin. P., C. ; E. 
J. Miller, P., C.; I. D. Mitchell, P.; J. H. M‘Ilroy, M.A., Z , C.; 
A. W. Maclean, C.; E. J. M. Pryce, C. : M. H. Smart, B., P.; J. 
M. Stewart, P. ; E. T. Talbert, B., C.; J. G. WaddeU, B. 

The following have passed the Second Professional 
Examination for the Degrees of Bachelor of Medicine 
(M.B.) and Bachelor of Surgery (Ch.B.) in the subjects 
indicated (A , anatomy ; P., physiology ; 'M., materia 
medica and therapeutics) 

John Anderson, A. ; Thomas Anderson, A., P.; William Archi¬ 
bald, P.; B. W. Auld, A., P.; J. S. Barr, A., P. j Alexander Birch, 
A. ; W. M. Brown, A., P., M.; P. T. Cairns, A.; S. J. Cameron, A., 
P.; J. J. Y. Campbell, M.; B. D. Campbell, A., P.: E. 8. * hap- 
man, A.; G. H. Clark, P.; J. B. W. Cook, A., P.; James Craig, 
A., M.; Andrew Currie, A.- P.; D. B. Davidson, A., P.; James 
Davidson, M.A., M • F. L. Dickson, A.: B. N. Dunlop, A , P.; W, 
W. Farrar, A., P. ; George Ferguson, A., P. ; D. J. Fletcher, A. ; 

D. G. S. Gartshore, A.; James Gemmell, P.; J. B. Giimour, P.; 
William Girvan, A., P.; J. D. Gout lay. M. : Archibald Gow, A., P. • 
John Gracie, M.; A. P. Granger, A., M.; John Gregor, A., P.; G. 
P. Harlan, A., P. ; L. C. B. Head, A., P.; F J. Henry, A., 
P.; C. M. Hope, M.; D. W. Hunter, A, P., M. ; Matthew Hunter, 
A., P.; W. J. Isbister, A., P.; Pierce Jones, P.; W. B. Kerr, A., 
P.; D. D. Kilpatrick, A., P.; Alexander King, P., M. -, J. D. Laid- 
law, M ; John Lambie, M.; J. F. Lambie, A.. P.; Alexander Leitch, 
M. ; F. J. Locbrane, A., P. M., ; David Longwill, M.; Edward 
Magovbny.A., P..M. : W. A Masson, A., P.; W. A. Mills, A., M.; 
W. A. Milne, A., P.,M.; A. B. Moir, A, P.; Alan Howie-Muir, A , 
P.; W. J. M Feat, M.; W. F. M’Glashan, A., P.; Thomaa M'Laren, 
M. ; G. W. M'Millan, P.; James M'Phereou, M.A., M.; Robert 
Orr, A ; Robert Paterson, M.; John Piton, A., P.; J. N. Prentice, 
A., P.; Robert Ramsey, A., P.; T. H. Bankin, M.: Andrew Beid, P.; 
William Robertson, A., P. j T. B. Rodger, A, P ; W. G. Rodger, 
A., P.; N. C. Rogers, A ; A. T. Boss, A.; C. J. Boss, B.A., A., P., 
M. j E. H. Boss, M.; A..J. Smith, P.: James Smith, P.; David 
Spence, M.; Donald Steel, A., P.; Andrew Stewart, A.; John 
Stewart, M.A., P. ; B. B. Swan, P.; B. B. Thom, A,; J. N. Todd, 
A., P.: J. G. Tomkinson, A., P.; John Turnbull. A., M.; W. D. 
Walker, M.; G. 8. Wallace, A., P.; P. M. Waugh M. ; B. G. 
White, A., P.; M. W. Williams, A.; D. A. Wilson, A.; James 
Wilson, M. ; W. W. W. Wilson, M.; Robert Wylie, A.; W. B. 
Wylie, A., P„ M. 

WouES.-Martha Adams, A., P., M.; D. A. M. Clark, B.Sc., 
M.; H. M. Gordon, A.; C. S. Howden, M. ; J. T. Miller, M.; Alice 
Moorhouse, A., P.; M. J. Pirrett, A., P., M.; M. E. Potter, M. j 
M. M. Ritchie, M.; M. A. T. Bitchings, A.; A. B. Sloan, P„ M.; 

E. M. Sloan, P., M.; E. H. Smith, M.; H. F. Young, A. P. 

The following have passed the Third Professional 
Examination for the Degrees of Bachelor of Medicine 
(M.B.) and Bachelor of Surgery (Ch.B.) in the subjects 
indicated (P., pathology; M.,medical jurisprudence and 
publio health): — 

Matthew Aikman, M.A., P.; George Arthur, P„ M.; Gavin Bar¬ 
bour, P., M.; J. O. Barclay, P.. M.: T. T. Bathgate, P.: Alexander 
Binning, P.; H. E. Brown, P., M.; W. H. Brown, P.; J. D. Brown¬ 
lie, P.; W. A. Burns, P., M.; Thomas Carruthers, M.A., P., M.: E. 
P. Cathcart, P.; J. T. Clark, P., M.; Robert Clark, P.; C. P. G. 
Crichton, P., M.: C. C. Cnthbert, M.A., P-, M. ; A. W. W. David¬ 
son, P., M.; D. C. Douglas, M. ; John Downie, P.: Leonard Find¬ 
lay, P.; Alexander Fraaer, M.A., P.; M. W. Fraser, P-, M.; Gilbert 
Garrey, P., M.; Edward Gillespie, P., M.; Hyam Goodman, M.A., 
P., M.; C. A. Gourlay, M.A., P.: C. H. Gunson, P.; A. W. Harring- 

r . P., M. : J. M. Henry, P.; I. M. Huey, P., M.: N. M. Leys, P., 
; J. D. Lickley, P.: D. M. Livingston, P.; John Lockhart, P., 
M.; Alexander Logan, P.; D. D. Logan, P., M.; Robert Lunan, P., 
M.. Jacob Mains, P.; Andrew M&ir, P.: B. M. Marshall, P.; Allan 
Martin, M.A., B.Sc., P.; James Miliar, M.A., P., M.; N. M. Miller, 
P., M.; Peter Moir, P., M ; Daniel Morrison, M. ; Alexandc r 
Monro, P.; A. G. M’Kendrick, M.; G. S. M'Kinnou, P.; James 
Mackmnon, P.; A. B. Maclurkin, P., M. ; Burgess M'Phee, P., M.; 
D. M. MucBae, M.A., P., M.; Thomas Neill, P, M,; W. B. I. 
Pollock, P.: P. M. Reid, P.; J. D Richmond, P., M.; David Bussell, 
P.; James Scott, M. A , M ; E. W. Sharp, P., M.; James Shearer, 
P., M.; David Ap-Simon, P. ; John Scrathearn, P., M.; Robert 


Taylor, P., M.; J. C. Turnbull, P.; George White, P.; Alexander 
Wilson, M. : T. W. Wilson, P., M.j H. P. Wright, P. : John 
Young, P. 

Worn—Auguste Boyes, P., M.; G. J. Campbell. P.. M.; Lila 
S. Greig, P.; M. F. Liston, P. M.: J. M. F. Marshall, P., M.; K. M. 
Myhre, P.; C. C. W. Smith, T., M. 

The following have passed the Second Professional 
Examination for the Degree* of Bachelor of Medicine 
(M.B.) and Master in Surgery (C.M.) Robert Cumi¬ 
ming, B.D.; Geo. W. Milne, A M'Donald Nevin. 

The following have passed the Third Professional 
Examination (Regional Anatomy and Materia Medica) 
for the Degrees of Bachelor of Medicine (M B.) and 
Master in Surgery (C.M.)Thomas Holmes, James 
Duncan Wilson' 

Examinations for the Degrees of M,B. and Ch.B., tfce 
following candidates passed with distinction in the sub¬ 
jects indicated:— 

First examination.—In zoology and in chemistry—Spencer Mort; 
in botany—Andrew Alexander M’Whaa; in xoology—Weir B. Cun¬ 
ningham, James Eadie. Peter Millar, Charles G. Mackay, James A. 
Macvea, William G. Shand, John M. Smith, William D. H. Steven* 
son; in physic*—Arthur W. Sutherland; in chemistry—John G. 
Hume, Peter L. Sutherland. Second examination.—On anatomy 
and in Materia Medica and therapeutics—William M. Brown; in 
anatomy—Samuel J. Cameron; in physiology—Bobsrt W. Auld, 
Donald Steel; in Materia Medica and therapeutics—Daisy Anns* 
be 11a M. Clark, B.Sc., Charles M. Hope, David Longwill, Edward 
Magoveny, William A. Milne, James M'Pherson M.A , Mary Janet 
Pimt, Agnes B. Sloan, Elizabeth M. Sloan, William D. Walker, 
Third examination. — In pathology — George Arthur, John D. 
Brownlie, John T. Clark, Charles C. Cuthbert, M.A., Archibald 
W. W. Davidson, Leonard Findlay. Alexander Fraser, M.A., Llln 
Stevenson Greig, James Dunlop Liekely, Mary Forbes Liston, 
Donald M. Livingston, Andrew Hair, William B. I. Pollock, George 
White, John Young; in medical Jurisprudence and public health— 
John D. Richmond, Alexander Wilson. 

Examining Board In England by the Royal Colleges of 
PbyaiofctfH and burgeons. ■ 

The following candidates passed the Second Examina¬ 
tion (anatomy and physiology) of the Board in the 
subjects indicated on Monday, April 3rd:— 

Arnold Gregory, Yorkshire College, Leeds: M. J. Rowlands, D. 
H. Evans, aim Trevor Howell, University Collage, South Woles j 
A. H. Norris and Frank Forrest, Owens College. 1 ' M anc h ester; John 
Welsh and Harry Pierpoint, University College, Liverpool ; J. G. 
Higgins and J. L. 8tepbenaon, St. Mungo's College, Glasgow; J, H. 
Reford and J. A. D. Badclitfe, Queen's College, Belfast; V- C. 
Bower, Medical College, Madras; A. E. Hentoo, Edinburgh Uni¬ 
versity and St. Mary’s Hosp.; Li W. Hucltn, St. Mary’s Hosp.; C. 
C. Dhibble, Firth College, Sheffield; J. E. Adams and M. W. E, 
Widegren, St. Thomas's Hosp. 

Anatomy only.—Bobert A. Fitter. Yorkshire College, Leeds; and 
Rowland W. HlU, Owens College, Manchester. 

Physiology only.—John M. 8. Duncan, London Hosp.; and John 
P. E. Henery, St. George’s Hosp. 

The following passed on Tuesday, April 4th :— 

Arthur Ashmore, Yorkshire College: John M. Pooley, John L, 
Martin, and John H. Wells, St. Mary's Hosp.; Thomas W. Scott 
andEvett G. Allport, Melbourne University; Stanley Child, Cam¬ 
bridge University and Gov's Hosp.: Otto C. H. L. Moll, Durham 
University and Guy's Hosp.; John Braithwaito, Gerald W. C. 
HoWst, and Harold Tipping, Guy's Hosp.; Creswell Burrows, 
Walter M. Strong, and Robert D. Browne, Cambridge University 
and St. Thomas's Hosp.; Herbert M. Churohill, London 
Hosp.; Charles B. H. Ball, Cambridge University and St. Bar¬ 
tholomew s Hosp.: Gerald 8. Ewen, St. Bartholomew’s Hosp.: 
James E. Turle, University Coll. London; Matthew B. C. Mac- 
Watters, King’s Coll.,London; Lionel F. Lovell-Keoys and Gerald 
C.Cross, Middlesex Hoep.; Harold B. P.Baker, St. George's Hosp.; 
and Eugene C. Whitehead, Westminster Hosp. 

The following passed on Wednesday, April 5th :— 

Bichard E. H. Leach, Thomas Gibson, Harry W. Sexton, and 
Tom Jays, St. Thomas's Hosp.; Richard C. Lawry, Percival P. 
Cole, William W. C. Jones, Norris N. A. Houghton, Santiago L, 
Pollant. and Charles H. Bubb, Guy's Hosp.; Horace A. Cutler, 
Cambridge University and Guy's Horn).; John Corbin, St. Bartho¬ 
lomew's Hosp.; Frank P. Connor, Calcutta and St. Barthlomew's 
Hosp.; George F Gill, Otago University and St. Bartholomew’s 
Hoep.; Hugh B. W. Smith, London Hosp.; Percy G. Beilly. 
London Hosp. ; Reginald H. B. E. Hughes, George J. Evans, and 
Francis H. Smith, St. Mary’s Hosp.; Thomas M. Neatby, Lawrence 
C. Hunt, and Stanley P. Mummery, 8t George’s Hosp.; Wilfrid B. 
Blandy, Eric Baylev.-and Faustin M. Boclet, Charing Cross Hosp.; 
John A. Drake, king’s Coil., London ; John P. Ellerington and 
Harold B. FitzNettle, University Colh, London. 

Victoria University. 

At the degree ceremony, held March 29th, the 
following candidates were presented, and received their 
degrees:— 

Bachelor of Medicine and of Surgery. - Second-class honours; 
John Craig, Wilfrid Henry Richardson, and Oswald Himpson 
Woodcock, Owen* "ollege; John White Aldred, Owens College; 
Thomas Taylor Bark and John Turner Grierson, University College; 
Thomas Wheeler Hart and John Edridge Healey, Owens College; 
William Seville Henderson and Jo bn Edward Whitlev Me rail, 
University College; Thomas O’Neill, Owens College ; John Arthur 
Reed, Yorkshire CoHege ; and Grahnm Eenshnw, Owcds College. 





392 The Medical Pees*. 


N0TI0E8 TO CORRESPONDENTS. 


4t<rtia0 to 

Correg ponbetttg, Short filt ers, &c. 

•^T 1 Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive eignaturt or 
initials, and avoid the practice of signing themselves “ Header,’ ’ 
■ 11 Subscriber,” “ Old Subscriber,” Ac. Much confusion will be 
■pared by attention to this rule. 

FORM C OF NEW VACCINATION ACT. 

To the Editor of the Medical Press and Circular. 

8lR,—I wish to draw the attention of the profession to Form C of 
the vaccination paper given to parents, Ac., at the registration of 
birth. The Local Government Board refuse private practitioners 
to All it up. This is unjust. Surelv a private practitioner is as 
capable of diagnosing "condition of house.” and to have a know¬ 
ledge of disease being rife in the neighbourhood os the Public 
Vaccinator is. It seems preposterous that if I haven private patient 
in an unsanitary dwelling I must wait for the Public Vaccinator to 
grant postponement. If a public official is needed it surely should 
be the M.O.H. Trusting that your powerful paper will consider this 
subject worthy of ventilating and taking action in, probably best by 
bringing out a petition for sigaature and forwarding same in due 
. course to the Local Government Board. 

I am, Sir, yours truly, 

B. F. Tomlin, M.E.C.S., Ac. 

Wood Green, N. 

J. Ward.— Your postcard is illegible. 

Dr. C. Dcmas.—I t is asserted by Dr. Phelps, of New York, that 
alcohol is a safe and sure specific against the escharotic action of 
pure carbolic acid. He suggests, moreover, that if, immediately 
after the administration of the poison, aloohol were given the poison¬ 
ous effect of the acid would be neutralised. We have not, however, so 
far met with any confirmation of these statements. 

THE PROFESSION IN BERLIN. 

Berlin and its suburbs are the happy hunting ground of some 2,233 
doctors, being 37 in excess of the number for 1897. In 1825 there 
were only 191. The proportion to the population has risen from 1 
per 1,153 inhabitants in 1825, 1 to 1,191 in 1887 to 1 per 754 in 1898. 
The total number of medical practitioners in the German Empire is 
put at 25,757, but Prussia alone claims 15,961 of these. Berlin alone 
maintains more doctors than the whole of Bavaria. 

R. P. S.-We regret the delay which has been due to the difficulty 
of finding room for the articles. We hope, however, to be in a posi¬ 
tion to fulfil our promise in the near future. 

Messrs. D. and B.—We have the matter in hand, and the result 
of our inquiry will be made public without unnecessary delay. 

*' CAN THE ETHIOPIAN CHANGE HI8 SKIN ? " 

This Scriptural queiy is said to be attracting a good deal of atten¬ 
tion in Vienna medical circles just now, by reason of its alleged 
elucidation in that city lately. The case is reported of a negro 
named Lacho, who was brought from the Sondan by on Austrian 
traveller, to whom he acted as valet. Seized with a nervous disease, 
Lacho was treated by a celebrated neuropathist by electricity, with 
the result that in four months he was cured of the disease, but had 
quite lost his natural colour. He is now said to be os white as a 
normal European, and, with his bushy hair and negroid features, to 
present a very remarkable appearance. We may be pardoned for 
not placing implicit reliance on the many strange cases reported; 
meanwhile we have asked our Vienna correspondent to kindly in¬ 
vestigate and report should there be anything worth reporting. 

Jtteettngg of the Satieties aitb JCectureg. 

Wednesday, April 12th. 

Dermatological Society of London (11 Chandos Street, Caven¬ 
dish Square, W.).—5.15 p.m. Demonstration of Clinical Cases. 

Hunterian Society.— 8.30 p.m. Clinical evening. Coses will be 
shown by Dr. F. J. Smith, Dr. D. Boss, Dr. Herman, and other 
Fellows. 

The Sanitary Institute (Parkes Museum, Margaret Street, W.). 
—8 p.m. Discussion on Practical Hygiene Teaching in Elementary 
Schools fopened by Miss Alice Ravenhill). 

Northern and Midland Division of the Medico-Psychological 
Association (Count* Asylum. Hatton, Warwick).—4 p.m. Spring 
Meeting. Discussion on the Nursing 8taff in Public Asylums 
(opened by Dr. Macpliail). Paper:—Dr. Wilcox: Some Cases of 
Insanity treated by various Animal Extract*. 

Thursday, April 13th. 

Royal Institution op Great Britain.—3 p.m. Prof. Dewar: 
The Atmosphere. 

British Gynecological Society (20 Hanover Square, W.).— 
8.30 p.m. Discussion on the Abdominal Causes of Death after 
Cceliotomy (introduced by Dr. W. J. Smyly, of Dublin). 

Friday, April 14th. 

Epidemiological Society or London (11 Chandos Street, Caven¬ 
dish Square, W.).-8 p.m. Council Meeting. 8.30 p.m. Ordinary 
Meeting. 

Clinical Society of London (20 Hanover Square, W.).-8.30p.m. 

Papers :—Mr. W. G. Spencer: Wound of a large superficial Inguinal 
Artery in which the Blood was flowing from the Trunk to the 
Thigh.—Dr. Rolleston and Dr. C. Ogle: Syphilitic Stenosis of the 
Bronchi.—Mr. C. Lucas: Two Cases of Ununited Fracture of the 
Humerus caused by the Interposition of the Muscular Spiral Nerve 
between the Fragments.—Dr. S. West: The Skin Affections in 
Renal Disease. 

Royal Academy of Medicine in Ireland.— Medical Section.— 
Papers:—(1) Dr. Coleman: Notes on a Case of Addison’s 
Disease.— (2) Dr. Parsons 


April 12, 1899. 

Co^grave: A Case of Poisoning by Primula Obconica.-<5) Dr. 
Lumsden: Notes on a Case of Diabetes Insipidus.—(6) Dr. Little- 
dahs : Clinical Investigations on Widal’s Reaction as a Diagnostic in 
v 71 p' Fl , rm , y: Tachycardia, ending fatally by 
Thrombosis of both Femoral Artenee. — (8) Dr. Conolly Norman i 
Senile Dementia.-(9) Dr. O’Carroll: The Pulmonary Second 


ftecaitties. 

Aston Union.- Resident Assistant Medical Officer at the Workhouse, 
Oravelly Hill, near Birmingham. Salary £100 per annum, with 
furnished apartments, rations, washing, Ac. Apply to the Clerk 
to the Guardians. 

Bath SMt«> Dispensary.—Resident Medical Practitioner. Salary 
*.100 a year, with furnished apartments, cpal, gas, and attend¬ 
ance. Applications to Col. F. V; * Eyre, Hon. Sec. Rockville, 

Darlington Hospital and Dispensary.—House Surgeon, unmarried. 
Salary £140 per annum, with rooms in the institution, but 
applicant to board himself. 

Knighton Union.—Medical Officer and Public Vaccinator for the 
Llanbister District. Salary £80 per annum, with the usual 
extra medical fees. Apply to the Clerk Knighton, Radnorshire. 

Rotherham Hospital and Dispensary.—House Surgeon for three 
years. Salary 100 guineas, with rooms, oommons, and washing. 
Also Assistant House Surgeon. Salary £30 per annum, with 
rooms and washing. 

Roxburgh District Asylum.—Assistant Medical Officer. Salary £100 
per annum, with furnished quarters, board, washing and 
attendance. 

Stamford, Rutland, and General Infirmary, 8tamford.—House Sur¬ 
geon, unmarried. Salary £100 per annum, with board, lodging, 
and washing. —o—e. 


^ppointmente. 


Barrett, E. t L.B.C.P.Lond., M.B.C.8., Medical Officer for the 
Maxey Sanitary District o t the Peterborough Union. 

Brownlee. John, M.A.. M.D.Glasg., D.P.H.Camb., Medical Officer 
of Health for the Island of Guernsey, 

Boutflower, Andbew, M.R.C.S., Honorary Surgeon to the 
Chetham Hospital, Manchester. 

Cad ** a *» F R.C.S., Lecturer on Applied Anatomy in King’s 

College, London. 

Hoare, Mobley, L.R.O.P., L.B.C.S., Clinical Assistant to the 
Birmingham and Midland Hospital for Skin and Urinary 
Diseases. 

Horn, Arthur E., B.Sc.Lond., M.R.C.S., L.B.C.P., Assistant 
Medical Officer to the Chelsea Infirmary. 

Hosegood .Samuel, M.B.C.S., L.S.A., Medical Officer to the Swinton 
and Clifton District of the Barton-upon-Irwell Union. 

Liversidoe, William, M.B.Lond., M.B.C.S., L.R.C.P. Senior House 
Surgeon at the Blackburn and East Lancashire Infirmary 

Macme Fredrr!Ce Perctval, L.R.C.P.Lond., M.R.C.S., Resident 
Medical Officer to the Ham Green Fever Hospitals and the 
Bristol City Hospitals. 

McClean John F., M.R.C.S., L.R.C.P., Surgeon Superintendent 
of the British Hospital, Constantinople. 




Barker.— On April 6fo, at fc7, Warrington Crescent, London, W. t 
the wife of Francis J. Barker, of a daughter. 

Hamer. - On April 7th, at 22, Walpole Bond, Twickenham, the wife 
of W. H. Hamer, M.D., of a Son. 

How8e. —On April 7th, at 50, Brook Street, Grosvenor Square. 

London, W., the wife of H. G. Howse, M.S., of a son. 

Kbohn.- On April 4th, at Funchal, Madeira, the wife of R. E. 8. 
Krohn, M D.Lond., of a son. 

Skivner.— On April 7th, at Bank House, Rye, the wife of Ernest W. 
Skinner, M.D., of a daughter. 


ittarrtages. 


Burns —Bains. —On April 8th, at Christ Charch, Emerydown, 
Hants, Theodore G. A. Burns, If .A.Oxon, M.R.C.S., of Dublin, 
to Rosamund, daughter of E. Talbot Boms, of Emerydown. 

Chambers—Wood —On April 8th, at St. Mary Abbot’s Church, 
Kensington, Wm. Francis Chambers, L.R.C.P., M.B.C.S., of 
Folkestone, to Edith, daughter of the late Prof. John Wood, 
F.R.C.S., F.R.S., of King’s College Hospital. 

Menzies—Green.— On April 6th, at the Parish Church, Watford. 
William Francis Menzies, M.D., B.8c., M.R.C.P., Superinten¬ 
dent of the Staffordshire County Asylum, Cheddleton, to Jessie 
(Daisy), second daughter of George Green, of Watford. 

Wise-Hunter.-O n April 5th, at St. Margaret’s Church, Plum- 
stead, Harry Mortimer Wise, M.B., to Flora, younger daughter 
of G. R. Hunter, of the War Office, and of Plumstead, 


Scathe. 


Barnes.— On April 5th, at Perth, West Australia, John S. Barnes, 
B.A., M.D., aged 31, son of John M. Barnes, of Morningthorpe, 
Norfolk. 

Duncan.—O n April 5th, at 8, Henrietta 8treet, Covent Garden, 
London, James Andrew Duncan. M.B.Lond., in his 80th year. 
Gibbings.- On April 9th. at his residence, Dalston, London. N.E., 
Alfred Tlios. Gibbings, M.D.. aged 50. 

Haweins.— On March 3lst, at 3, Northernhay Place. Exeter, 
Thomas Hawkins, M.R.C.8., aged 68. 

8quire.— On April 2nd, at Danescombe, Ealing Common, William 


rw „ , _ , . _ . Squire, M.D., F.R.C.P., aged 73years. 

Disease.-(2) Dr. Parsons: Cases of Pylonc Obstruction.- 1 ToMKYNs.-On March 24th, nt Green Bank, West Hill, St. Leonards 

(3) Dr. R. H. Woods: Chronic Pharyngitis.—(4) Dr. Mac Dowel 1 William Fancourt Tomkyns, M.R.C.S., aged 74. 


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April 19, 1899 


The Medioal Press and Circular Advertiser. 











A few Facts in favour of 

Scott’s Emulsion. 


Patients readily take and retain Scott’s Emulsion 
when their stomachs and palates rebel against the 
plain cod-liver oil. A minute and uniform division 
of the oil is unquestionably an advantage, both in 
digestion and absorption. And in Scott’s Emulsion 
this division is MAINTAINED INDEFINITELY, and 
the oil REMAINS FREE FROM RANCIDITY. 

Glycerine is an important factor in Scott’s 
Emulsion also, and should not be lost sight of. In 
the digestion of fat Nature makes glycerine; makes 
it for a purpose and uses it, thus showing the need 
of it. We add glycerine especially because it 
prevents fermentation, because it sweetens without 
aggravating uricacidsemia or glycosuria as sugar 
does, and because it assists absorption and aids 
nutrition. We owe much to the glycerine. 

To the Hypophosphites of Lime and Soda we look 
for a necessary constituent of brain, nerve, and bone 
structure. 

Is not the above combination better than plain 
cod-liver oil? And is it not a further advantage 
that the physician can absolutely rely upon Scott’s 
Emulsion as being a PERMANENT EMULSION, FREE 
FROM RANCIDITY? 

SCOTT <& BOWNE, LTD., MANUFACTURING CHEMISTS, LONDON, E.C. 




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The Medloal Frees and Circular Advertiser. 


April 19, 1899 


ariv 



LONDON, 1884. ADELAIDE, 1887. MELBOURNE, 1888. 


BENGERS 


GOLD MEDAL AWARDED 
Health Exhibition, London. 


FOR INFANTS, INVALIDS, 
AND THE AGED. 


FOOD. 


This delicious highly nutritive and most easily digested Food is 
specially prepared for Infants, and for those whose digestive 
powers have been weakened by illness or age. 


The following letter addressed to F. B. BENGER <k CO., Ltd., is published by special permission 

of the Russian Court. 

“Balmoral Castle, 

“ Scotland, 25th Sept., 1896. 

“ Sirs,—Please forward to Balmoral Castle one 
dozen 2/6 Tins of BENGER’S FOOD for H.I.M. THE 
EMPRESS OF RUSSIA, addressed to Miss Coster. We 
have received the box ordered from Peterhoff. 

“ Yours truly, F. COSTER. 99 


The Lancet describes it as “ Mr. Benger’s admirable preparation.” 

The Medical Press says:—“ Few modern improvements in Pharmacy have done bo much as 
Benger’s Preparations to assist the Physician in his treatment of the sick.” 

The British Medical Journal says:—“ Benger’s Food has by its excellence established a reputation 
®f its own.” 

The Illustrated Medical News says :—“ Infants do remarkably well on it. There is certainly a 
great future before it.” 

A Government Medical Officer writes :—“ I began using your Food when my son was only a fort¬ 
night old, and now (five months) he is as fine a boy as you could wish to see.” 

From an eminent Surgeon :—“ After a lengthened experience of Foods, both at home and in India, 
I consider Benger’s Food incomparably superior to any I have ever prescribed.” 

A Lady writes:—“ Really I consider that, humanly speaking, Benger’s Food entirely saved baby’s 
life. I had tried four other well-known Foods, but he could digest nothing until we began the ‘ Benger.’ 
He is now rosy and fattening rapidly.” 

BENGER’S FOOD is sold in Tins at 1/6, 2/6, and 6/-, by Chemists, &c., everywhere. 

Wholesale of all Wholesale Mouses and Shippers, or of the Manufacturers , 

F. B. BENGER & CO., Ltd., Otter Works, Manchester. 

TKLKJRAPHIO Address : •* Banker's, Manoheatev.” 


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April 19, 1889 


The Medioal Press and Circular Advertiser. 


Bynin 


Perfection of Ciquid extract of malt 



Clrtllifl BYNIN possesses the same diastasic 
_ power as the ordinary thick Extract. 

BYNIN mixes readily with milk, helping 

Being Liquid, complete digestion, and preventing the 

:=: formation of large clots of casein. 

, BYNIN is far more pleasant to take, more 
LlUUlUt easily mixed with other food, and more quickly 
assimilated than the thick Extract. 


Bpnin 


is a boon to nursing mothers, 

replacing Alcoholic drinks. 


DIASTASIC ACTIVITY.—“We find that at a temperature of 100°F. 
one ounce will digest perfectly one poilnd of starch. This is a most satisfactory 
result, and, coupled with the fluidity and pleasant flavour, renders this 
preparation a most valuable one."—The Lancet. 


Allen & Hanburys Ltd., 


Lombard Street, London. 


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The Medioal Press and Ciroular Advertiser. 


April 19. 1899 


Johannia 


NATURAL MINERAL WATER. 

LITHIATEH 


Contains one grain of added Lithium Bicarbonate to each small bottle. 


So much importance is attached to the action of Lithium Salts as solvents and 
eJiminants of uric acid, in the numerous maladies referable to the uric acid diathesis, 
that it is of the greatest consequence the Lithium Waters in use should contain a 
definite and suitable quantity of a Salt of Lithium, and that thisshould be authoritatively 
guaranteed . 

The Johannis Springs Company, acting under eminent medical direction, have 
undertaken to supply precisely the kind of Lithium Water needed for continued 
consumption as a table water. The amount of Lithium is constant, and the quantity, 
while adequate to produce the best effects of this valuable uric acid solvent on the 
organism, is strictly limited to such a dose as cannot possibly cause any cardiac 
debility , or increase it where it exists. 

They have taken the natural mineral water of the JohaHHlS Springs—containing 
as it does, in admirable proportions, Sodium Bicarbonate, small quantities of Sodium 
Chloride, as well as other valuable constituents, impregnated also, as it is, with its own 
absolutely natural and pure Carbonic Acid Gas — and to this water they have added 
a definite and constant quantity of Lithium Bicarbonate, so that each bottle shall 
contain one grain of this Salt of Lithium. 

' The Medical Profession, by prescribing for those suffering from or apprehensive of 
uric acid maladies, say, 2 to 5 bottles of Lithiated Johannis water per day, will 
administer regularly from 2 to 5 grains of Lithium Bicarbonate, combined with the 
other alkaline constituents of this valuable natural water, and their patients will have 
the great advantage of drinking a perfectly pure natural mineral water containing 
just as much of this uric acid solvent as is needed, and no more ; while the additional 
eliminative and purifying properties of the Natural Johannis Water greatly enhance its 
value for the gouty constitution. 


Per Case, 100 Small Glass Bottles 


... 35 /- 


The APOLLINARIS COMPANY, Ltd., 4 Stratford Place, London, W. 


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ike SBMtral Wxm and Circular. 

O to 


“SALUS POPULI SUPREMA LEX." 


Vol. CXYIII. 


WEDNESDAY, APRIL 19, 1899. 


No. 16. 


^Ehc Cioulfitonian lectures 

ON THE 

PATHOLOGY OF THE THYROID 
GLAND. 

Abstract of Lecture III, delivered before the Royal 
College of Physicians of London. 

By GEORGE R. MURRAY, M.A., M.D.Camb., F.R.C.P., 

Heath Professor of Comparative Pathology in the University of 
Durham; Physician to the Royal Infirmary, Newcastle- 

upon-Tyne. 

Owing to the special anatomical position and 
physiological properties of the thyroid gland itaffords 
unusual facilities for observing some of the 
phenomena of compensatory hypertrophy. It is now 
a well known fact, owing to the work of Horsley, 
Halsted, and Edmunds, that when a portion of the 
gland is removed the remainder undergoes compen¬ 
satory changes, in virtue of which it is enablea to 
supply enough secretion to prevent the appearance 
of the symptoms of athyroidism. The portion 
removed at one time may be one-half or even three- 
quarters of the whole gland, and Halsted has shown 
in the dog that sucsessive portions, if removed on 
three or four separate occasions, may be excised 
until only one-eignth, or even one-sixteenth, of the 
original gland is left without symptoms of athyroidism 
being developed. Although these changes are accom¬ 
panied by an increase in size, the hypertrophied 
remainder does not attain the size of the original 
gland, so that, weight for weight, it has to do more 
work than the original glandular tissues. Under 
these circumstances it is not so surprising that the 
structure of a piece of the gland which has under¬ 
gone compensatory hypertrophy should differ some¬ 
what from that of the normal gland. When sufficient 
hypertrophy has developed to supply as much 
secretion as is necessary, we do not find a simple 
hyperplasia of the original glandular tissue, but con¬ 
siderable change in the structure throughout. The 
alveoli, instead of being nearly circular, become 
irregular in outline. This change is due to the fold¬ 
ing of the wall, which projects at different points 
into the lumen of the alveolus. In advanced hyper¬ 
trophy the lumen may appear to be star-shaped, or it 
may be almost obliterated by neighbouring folds of 
epithelium coming into contact. The appearance in 
places may thus closely resemble that of a racemose 
gland. The epithelial cells themselves are also 
altered. They are considerably increased in size, 
the ordinary low cubical epithelial cells being con¬ 
verted into tall columnar cells. The result of these 
two changes is that in equal areas the secretory cells 
are greatly increased both in numbers and size in the 
hypertrophied, as compared with the normal, gland. 
The colloid lying in the gland is diminished in amount, 
and appears to be more watery in consistence than 
normal. This change in consistence cannot, how¬ 
ever, be accompanied by any deficiency in the active 
ingredients of the secretion, as it is able to prevent 
the onset of any symptoms of athyroidism. The 
appearances just described are evidently those of glan¬ 
dular tissue working at high pressure, and just able 


to supply the necessary amount of secretion without 
storing any in reserve in the alveoli as is usual in the 
normal gland. 

In illustration of these changes he referred to an 
experiment in which the whole of the left lobe and 
the greater part of the right was removed from a 
monkey. After the operation there was slight hebe¬ 
tude and harshness of the voice. No other symptoms 
developed, although the animal was kept under obser¬ 
vation for fourteen months, and then was killed as it 
had contracted general tuberculosis. A piece of 
glandular tissue which had developed from the small 
portion of the right lobe left at the operation was 
round weighing 0 42 gram., showed the changes in 
structure which had taken place. The folding of 
the epithelium giving a larger secretory surface is 
clearly seen, and in some of the smaller alveoli near 
the centre the consequent irregular shape of the lumen 
is evident. The epithelial cells had become columnar 
in type, while the colloid was scanty, and seemed to 
be of watery consistence. 

The remarkable results shown by Dr. Rose Brad¬ 
ford to follow the excision of a portion of the kidney, 
described by him in his Goulstonian Lectures last year, 
raise the question as to whether these changes in the 
structure of the thyroid are due entirely to the want 
of that body acting as a stimulus to the compensatory 
rowth of the gland, or whether they are in any way 
ue to some other local or general effect of the opera¬ 
tion itself. If the compensating growth of the one 
lobe takes place simply in response to a call for more 
secretion to make good the loss of the other lobe, no 
hypertrophy should take place if this want is fully 
supplied from other sources. This point may be 
tested by removing one lobe of the gland and giving 
thyroid secretion continuously for some time, and 
then removing the other lobe for examination. If 
no changes indicating compulsory hypertrophy are 
found in the second lobe, it goes far to show that the 
hypertrophy develops simply as the result of an 
insufficient amount of thyroid secretion being pre¬ 
sent in the blood. 

Similar appearances were found by Halsted in the 
thyroid gland of several healthy dogs. The occa¬ 
sional occurrence of such changes in apparently 
healthy animals is at present difficult to explain. The 
interesting point in this case is that after the pro¬ 
longed interval of sixteen weeks, during which the 
extract was given, the left lobe was found to be 
paler in colour, and weighed 0'25 gram. The micro¬ 
scopical structure was normal, and showed no signs 
of commencing compensatory hypertrophy. If this 
lobe was originally in the same condition as the right 
the treatment seems to have restored it to a normal 
. condition, and if not it at any rate showed no signs of 
compensating hypertrophy. As far as they go these 
experiments tend to show that if the proper amount 
of secretion is supplied after removal of one lobe 
compensating changes do not take place in the other. 

In connection with this part of the subject he had 
tried the effect of prolonged administration of thyroid 
extract upon the nealtby thyroid gland. It is well 
known that parenchymatous goitres often decrease 
in size when treated by thyroid extract. One expla¬ 
nation of this result is that a partial atrophy from 


roogle 


Digitizi 



394 The Medical Press. ORIGINAL COMMUNICATIONS. April 19, 1899. 


disuse is established when the full amount of secre¬ 
tion is supplied from an external source. Two 
experiments have been made to ascertain if any 
atrophic changes could be induced in the healthy 
thyroid gland by supplying secretion ready made as 
it were and so doing away with the normal stimulus 
to secretion. The thymus atrophies after the first 
year of life from disuse, and,the thyroid does so itself 
in old age, possibly for the same reason. 

In the treatment of goitre it is advisable to begin 
with 10 minims of liquor thyroidei each night; in 
the course of a few days, if the pulse is not accele¬ 
rated beyond 90 or 100, this dose may be given twice, 
and at the end of a week thrice daily. If well borne, 
the dose may be still further increased. The treat¬ 
ment should be continued for three or four weeks to 
give it a fair trial, and longer if the goitre continues 
to decrease in size. In several cases in which the 
general enlargement of the gland hae been sufficient 
to cause dyspnoea by compressing the trachea, so 
that an operation had to be considered, the gland 
has been reduced to two-thirds, or even one-half, of 
its former size, and all the symptoms of pressure 
removed, and with them the necessity for an opera¬ 
tion. 

The beneficial effects of this treatment may be due 
to the iodine which is present in combination with a 
proteid in thyroid extract, for iodine has long been 
used with good results in the treatment of goitre. It 
has been seen that the healthy thyroid of the monkey 
showed some signs of diminution in size under the 
same treatment, and this suggests that the decrease 
in size in goitre may be due to part of the enlarged 
gland passing into a resting condition, and conse¬ 
quent diminution in size if there is not an actual 
disuse-atrophy as a result of the treatment. 

Exophthalmic goitre, with its many varying 
phrases, is a disease of great interest from several 
points of view. Its various clinical types, and the 
great difficulties in treatment it often presents, render 
a true solution of the problem of its pathology of the 
greatest importance. 

The circulatory and nervous systems have each in 
turn been considered to be at fault, and it is only 
recently that attention has been drawn to the 
important part which is played by the thyroid 
gland in the pathology of tne disease. The central 
and sympathetic nervous systems have been carefully 
examined in a considerable number of cases; in some 
they have been found quite normal, in others various 
lesions have been described, but these have varied 
in different cases, and on the whole appear to be 
rather secondary than primary in origin. The lesions 
found in the thyroid gland are far more constant in 
character than any yet described in the nervous 
system, and it is the most obviously diseased organ 
to be found in a case of exophthalmic goitre. 

In nearly all cases of exophthalmic goitre there is 
a palpable enlargement of the thyroid gland. On 
looking through his casebooks he had found notes 
on 70 cases of exophthalmic goitre which he had 
seen during the last nine years in the North of Eng¬ 
land, where the disease is not uncommon. Of these 
8 were men and 62 women. All the 8 men had 
enlargement of the thyroid; of the 62 women all 
except 3 had enlarged thyroid glands. Taking both 
sexes together, only 4'3 per cent, of these cases had 
no goitre. It has been shown by Maude that in 
some cases enlargement of the gland may be present 
at one time and not at another, so that even in these 
three cases, which were only seen a few times, there 
may have been some enlargement at some other time 
during the course of the disease which had escaped 
observation. In any case, in 95 per cent, of my 
cases, there was either enlargement of the gland at 
the time the case was seen, or there was a distinct 
history of enlargement at an earlier stage. 


The enlargement of the thyroid gland in exoph¬ 
thalmic goitre is as a rule uniform. In cases of long 
duration it may be irregular in shape and consistence 
owing to the development of fibrosis leading to the 
formation of irregular strands and masses of hard 
fibrous tissue in some parts of the gland. The veins 
on the surface are large and their walls are thin. In 
well-developed cases tne goitre is very vascular, and 
the arteries are dilated and tortuous, indicating that 
there was a liberal supply of blood during life. On 
section the cut surface presents a uniform appear¬ 
ance ; it is lighter in colour and exudes less colloid 
than a normal gland. The general appearance is 
that of a gland in a state of great secretory activity, 
and has been aptly compared by Greenfield to that 
of the mammary gland during lactation. The number 
of alveoli is not only increased by the total increase 
in size of the gland, but in equal areas more alveoli 
are seen than in the normal gland. In many places 
the lumen of the alveolus is irregular in outline 
owing to the folds of the alveolar wall covered with 
epithelium projecting into it, so that, even when the 
gland is but slightly enlarged, there is a marked 
increase in the amount of the secretory epithelium. 
The lumen of the alveolus is in consequence dimi¬ 
nished in size, in some cases to a considerable extent. 
The actively secreting part of the gland is thus in¬ 
creased at the expense of the storage room, which 
is so ample in the normal gland. The epithelium 
which lines the alveoli and covers these folds is 
changed in type, for the cells, instead of being flat or 
cubical, are tall and columnar. There is less secre¬ 
tion to be seen lying in the alveoli than in health. 
This diminution in quantity is partly due to the 
decrease in the amount of storage room. In addition 
to this, however, the alveoli are only partially filled, 
an appearance which suggests that there is a more 
rapid removal of the secretion from the gland than 
in health. The colloid is also more watery in con¬ 
sistence, and it stains less deeply than normal. 
Eosin does not stain it at all, and Renant considers 
that it resembles foetal colloid more nearly than that 
found in the healthy adult. 

It will be seen that the structure of the gland in 
exophthalmic goitre resembles that in compensatory 
hypertrophy in a remarkable manner. In both there 
is the increase in the secreting structures as shown 
by the plication of the alveolar wall, in both the 
epithelium is changed from a cubical into a columnar 
type, while the secretion stored in the alveoli is less 
in quantity and more watery in consistence. The 
changes in compensatory hypertrophy are known to 
afford an indication of increased activity, so that it is 
fair to infer that the changes found in exophthalmic 
goitre show that hypersecretion is going on. For other 
reasons the most rational explanation of the complex 
symptoms of this disease appears to be that they are 
due to an excessive formation and absorption of the 
secretion of the thyroid gland, which may or may not 
be altered in composition, and to the constant presence 
of this excess in the blood, and to its action upon the 
metabolism of the tissues generally, but more espe¬ 
cially of the nerve centres in the medulla. 

According to this view exophthalmic goitre is the 
opposite condition to myxoeaema, the former being 
the result of excess as the latter undoubtedly is of 
lack of thyroid secretion in the blood. This is sup¬ 
ported by the strong contrast which is presented by 
the symptoms of the two diseases, a contrast which 
is nearly as marked as that between the small fibrous 
and atrophied gland of myxoedema and the enlarged 
hypertrophied gland of exophthalmic goitre. Asso¬ 
ciated with the former there is increase of weight, 
stolidity, subnormal temperature, dryness of the 
skin due to diminution of cutaneous secretion, with 
increase of electrical resistance and slowing of the 
pulse, while with the latter we find emaciation, ner- 


d by Google 



April 19, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 395 


vousness, normal or raised temperature, moist skin 
due to increase of secretion, with diminished electrical 
resistance and acceleration of the pulse. One may 
conveniently express the relationship of myxcedema 
to exophthalmic goitre in their various degree of 
severity in the following diagramatic manner. Taking 
100 as representing the normal amount of thyroid 
secretion in health, then 75 per cent, is probably about 
the amount of secretion tormed in those cases of 
earlv thyroidal fibrosis with slight myxcedema. If 
half the glandular tissue is destroyed and only 50 

G r cent, of secretion is formed, the symptoms will 
moderate. If 25 per cent, the symptoms will be 
well marked, and if none at all is found they will be 
severe. In the reverse way, in exophthalmic goitre 
125 per cent, of secretion would be present in a 
slight case, 150 per cent, in a moderate one, 175 per 
cent, in a well-marked one, and 200 per cent, in a 
severe case. 

In myxcedema these percentages are in probability 
approximately correct. In exophthalmic goitre, how¬ 
ever, there are no means of ascertaining how much 
secretion is actually formed. It may amount to much 
more than double the normal quantity in a severe 
case, so that these percentages are purely relative, 
and must not be taken to indicate the actual amount 
of secretion present in the blood. 

Another interesting point in the relationship 
between the two diseases is the repeatedly observed 
fact that recovery from exophthalmic goitre may be 
followed by myxcedema, while, as far as is known, 
exophthalmic goitre has never been observed to 
develop in a patient already suffering from myx- 
oedema. In some cases the symptoms of exophthalmic 
goitre diminish as those of myxcedema develop, in 
others there is an interval of good health between 
the disappearance of the exophthalmic goitre and 
the onset of the myxcedema. In a case recorded by 
Baldwin exophthalmic goitre developed in 1887 and 
recovery took place the following year, Two years 
after, in 1890, myxcedema developed, which three 
years later was successfully dealt with by the thyroid 
treatment. In a similar case recorded by Jeffrey 
and Achard, and quoted by Moebius, the exoph¬ 
thalmic goitre existed for twenty-three years and 
then subsided, to be followed by myxcedema. After 
death the nervous system was found to be quite 
normal, and the thyroid gland in an advanced 
stage of atrophy. It thus seems evident that the 
development of thyroid fibrosis in exophthalmic 
goitre, by lessening the over activity of the 
gland, leads to a subsidence of the symptoms, 
which, if the fibrosis and atrophy progress far enough, 
are replaced by those of myxcedema. While these 
changes are taking place in the gland, the symptoms 
may pass from those of severe exophthalmic goitre 
through all the stages mentioned in the table to those 
of severe myxcedema. 

One or two cases have been recorded in which the 
symptoms of myxcedema are said to have coexisted 
with those of exophthalmic goitre. The reasons for 
asserting the coexistence of the two diseases in these 
cases seem to be rather slender, and to be largely 
founded on the presence of an irregular brawny 
swelling together with the symptoms of exophthalmic 
exgoitre. A firm subcutaneous swelling is sometimes 
met with in some parte of the body in exophthalmic 
goitre, but it certainly was not myxcedematous. It 
is important to have such cases carefully reported, so 
that more information may be obtained on this point. 
The persistence for a time of a few symptoms of 
exophthalmic goitre in a case of long duration which 
was passing into myxcedema is not unlikely, for the 
effects of the long continued action of an excess of 
secretion on the nerve centres in the medulla, may 
easily remain for a time even after the thyroid had 
begun to atrophy, just as the effects of the action of 


lead or the toxins of diphtheria on the nervous system 
persist long after they have ceased to act. 

The physiological effects of thyroid secretion in 
large doses are of special interest in this connection. 
Exophthalmic goitre, though rare in the lower 
animals, has been observed in the horse, the cow, and 
the dog, so that if the right cause is brought into 
operation there should be no great difficulty in pro¬ 
ducing the disease in one of these animals. As we 
are ignorant of the causes of the change in structure 
and activity of the thyroid gland in exophthalmic 
goitre, attempts can only be made to reproduce the 
symptoms we believe to be secondary to the excessive 
activity of the thyroid. This can lie done either by 
grafting an excess of thyroid gland tissue into an 
animal, or more certainly by feeding it with large 
quantities of thyroid secretion, or by injecting it 
beneath the skin. Ballet and Enriquez, by feeding 
dogs with the thyroid glands of sheep, produced dis¬ 
tinctive symptoms in three out of six cases. These 
symptoms were elevation of temperature, tachy¬ 
cardia, tremore, conjunctivitis, emaciation, and in one 
animal quite distinct exophthalmos. 

Still more important are the results which have 
been observed and follow large doses of thyroid 
extract in man. A condition of thyroidism seems to 
be more easily produced in those who have recovered 
from myxcedema than in those who have normal 
thyroid glands. It may develop rapidly if large doses 
are given, or more slowly if smaller, but still excessive 
doses are given for a long period. The earliest and most 
common symptom is increased frequency of the pulse. 
The patient complains of palpitation, and the heart¬ 
beats violently 100, 120, or 130 times a minute. A 
fine tremor of the hands is often present, and the 
skin is flushed and moist. If the large doses are 
continued for some time emaciation also takes place. 

In addition to these symptoms, elevation of 
temperature, restlessness, loss of sleep, polyuria, 
albuminuria, glycosuria, partial paraplegia, sensation 
of heat, and diarrhoea, all of which are occasional 
symptoms of exophthalmic goitre, have been recorded. 
In one remarkable case B^clere observed exoph¬ 
thalmos and rapid respiration in addition to other 
symptoms among those already mentioned in a 
woman who had Buffered from myxcedema, and had 
taken 92 grams of thyroid gland in eleven days. 

Some remarkable toxic symptoms have been 
observed in some cases by Horsley and Rodocanachi, 
Paul, and other surgeons, to follow partial removal 
of the enlarged thyroid gland. The most common 
symptoms which have been observed are fever, great 
frequency of the pulse (amounting to 150 or even 180 
beats in the minute), rapid respiration, and great 
restlessness. In some of the cases the termination 
has been fatal at the end of a few days. Such 
symptoms have not been observed after a total thy¬ 
roidectomy, so that they are not a result of the opera¬ 
tion itself. The symptoms have occurred in cases of 
exophthalmic or soft parenchymatous goitre after 
removal of one lobe of the enlarged gland, and 
especially when it had been so much handled or 
squeezed during the operation. In several cases a 
profuse flow of thyroid secretion has been observed 
to take place after the operation from the divided 
isthmus into the wound. The symptoms are similar 
to those in acute cases of exophthalmic goitre, and in 
thyroidism artificially produced in the manner 
already described, ana are evidently due to absorption 
from the wound of thyroid secretion poured out from 
the cut surface of the gland, or a large quantity of it 
being squeezed during the operation into the 
lymphatics, and so into the blood stream. 

This absorption of the secretion is a source of real 
I danger in operations for goitre, and especially in 
I cases of exophthalmic goitre. If, however, the gland 
be handled as little as possible during the operation, 



LV^ 


396 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


April 19, 1899. 


the cut surface is sealed by the cautery, and a free 
exit is provided for any secretion which may find its 
way into the wound, such symptoms will in all pro¬ 
bability but seldom arise. 

It is now well known that thyroid extract has a 
bad effect on patients with exophthalmic goitre. 
Under its influence the pulse lie comes more frequent 
and the other symptoms are increased. In some 
instances where other treatment had been followed 
by a marked improvement the administration of 
thyroid extract had been followed by a relapse into 
the former condition. In short it should never be 
given in exophthalmic goitre, as it is only adding fuel 
to the fire. 

The results of surgical treatment of exophthalmic 
goitre, undertaken with the object of reducing the 
amount of secreting tissue by removal of one lobe, 
or of inducing atrophy by ligature of some of the 
arteries which supply the gland, are of great interest. 
Unfortunately the operation itself, though sound in 
principle, is at present by no means free from risk. 
The steady improvement, however, which has resulted 
in many cases in which it has been successfully per¬ 
formed affords still further evidence that the sym¬ 
ptoms of exophthalmic goitre are due to the over¬ 
activity of the thyroid gland. 

It is a fact of considerable interest that along with 
the enlargement of the thyroid gland in exoph¬ 
thalmic goitre other ductless glands may be increased 
in size. The thymus gland is very often enlarged ; in 
all the cases recently examined at St. Thomas’s Hos¬ 
pital Dr. H. Mackenzie has found the thymus per¬ 
sistent and enlarged, the microscopical structure 
being normal. Exophthalmic goitre and acromegaly 
xre sometimes found to occur together. He himself 
had recorded two examples of this and collected 1 
records of three others, In acromegaly the pituitary 
gland is enlarged, and the enlargement seems to be 
analogous to that of the thyroid in exophthalmic 
goitre, so that there is the remarkable fact that all 
these three ductless glands may be simultaneously 
enlarged. No explanation of this is forthcoming, 
but it suggests that possibly some common factor 
may be the cause of the enlargement. That some 
association exists between the thyroid and pituitary 
glands is further shown by the enlargement which 
takes place in the latter when the former is removed 
or disabled by disease. 

These facts all indicate that in the treatment of 
exophthalmic goitre attention should be directed to 
the thyroid gland. Time will not allow the discus¬ 
sion of the question of operative treatment, but 
there can be little doubt that removal of part of the 
enlarged gland is a rational method of treatment, 
and when the risks of the operation are diminished 
it should be more frequently employed in severe cases 
in which medical treatment has failed to do good. 
Of medical treatment much ha3 been written. In¬ 
unction of red iodide of mercury ointment over the 
goitre and belladonna given in large doses internally, 
so as to check the hypersecretion of the gland, have 
proved most serviceable. If the palpitation is exces¬ 
sive, convallaria has proved more useful than any 
other member of the same group of drugs. If there 
is great nervousness the bromides have done good. 
In only one case have decidedly good effects followed 
taking thymus. In this case three tablets of dried 
thymus were taken each day for nine months, for the 
last six and a-half of which the red iodide of mer¬ 
cury was used as well. As a result of this treat¬ 
ment the pulse-rate, whioh varied from 132 and 148, 
fell to 84, the thyroid gland, which had been con¬ 
siderably enlarged, returned to its normal size, the 
tremor became much less, and the exophthalmos was 
diminished. 


NOTES ON THE PLAGUE, (a) 

Collated 

By Sir CHARLES A. GORDON, K.C.B., M.D., 

Surgeon-General (retired), Hon. Physician to Her Majesty 
the Queen. 

(<Concluded from page 317.) 

In further considering evidence brought before the 
Committee on Plague, and otherwise published, the 
same mode of arrangement as that adopted in the 
former articles is observed in the remarks which 
follow, bringing the whole down to the end of 
March, 1899. As in the former articles so now par¬ 
ticular items of evidence are recorded in the order in 
which they appear in papers quoted from, namely:— 
1. Diagnosis. 

At Barisal the type of plague was purely pneu¬ 
monic, and very virulent. In Calcutta deaths by it 
were registered under other names. Dr. Hossack had 
experience of a modified form of the disease at 
Poonah ; he had seen mild cases of fever with enlarged 
glands, which he did not believe were of plague. So 
had Dr. Bannerjee. Although direct evidence was 
wanting that native doctors returned plague deaths 
as something else, suspicious deaths were so returned 
by friends of patients. 

Surgeon-General Harvey was of opinion that the 
records of causes of deaths were incorrect; that a 
system of death certificates, though possible, would 
be unpopular; Dr. Ferras that there never had been 
plague cases in Calcutta, but simply cases of 
malignant fever. He had seen similar cases which 
were indistinguishable from plague except bacterio- 
logically. 

Dr. Hankin considered that, as a rule, plague was 
easily diagnosed by means of the microscope, but 
that in certain cases diagnosis was extremely diffi¬ 
cult, revealing only a few isolated and faintly stained 
bacilli; in others microbes, degenerated in form, 
variable in size and shape. There was no doubt 
that in some no microbes were visible at the time of 
death, as proved by the German and Austrian Com¬ 
missions. 

Colonel Thomson looked upon the suggestion that 
mahamari and plague were identical as being a pure 
assumption. At Jawalpore, according to Dr. 
Elphick, of 116 cases of plague there were buboes in 
81; no external buboes in 35. Of the former 22 re¬ 
covered and 59 died; of the latter all but one died. 
Of the 35 cases 19 were of pneumonic plague, 1 of 
internal hemorrhage and bubo, 15 believed to be of 
septicemic type. He believed that the incubation 
period was about five days. In the Agra district 
Captain Grant reported that the early cases were 
pneumonic, and invariably fatal; afterwards they 
were bubonic, and then some recoveries took place. 
Captain James, of Lahore, had seen mild cases of 
pestis ambulane, principally at the end of the epidemic, 
and among boys. 

Captain Wilkinson had not seen any pneumonic 
cases in the Punjab. Major Ross said the informa¬ 
tion given of cases was insufficient. Not more than 
30 per cent, were reported. Major Skinner disagreed 
witn Dr. Cobb and Dr. Simpson in their diagnosis of 
cases of fever with buboes in the Shropshire regiment. 
The cases in that regiment resembled malarial 
cachexy; the patients were anaemic, and had buboes ; 
six deaths occurred. Some had aoute intermittent 
or remittent fever, and developed buboes while under 
treatment. There was generally no fever until the 
bubo suppurated. 

At Kurrachee the native doctors did not conceal 
cases, nor did they report the causes of deaths in¬ 
correctly. 

(a) From Reports principally in the Timet and Indian papers. 


Digi 


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April 19, 1899. 


ORIGINAL COMM CJNICATIONS. 


The Medical Press. 397 


Colonel Maconachie, of Poonah, said the noticeable 
features of plague were the patient’s staggering gait 
and whispering voice. There was no difference in 
the symptoms of Europeans and natives. 

Dr. Mackenzie said that in Kurrachee malarial 
fever declined when the plague raged. When buboes 
were confined to the femoral region the chances of 
recovery were favourable. 

At Lahore, Muhamed Nawaz Shah said that there 
was a disease much like plague, which passed off of 
itself in children and youths of 20 or 22 with fever at 
the end of December and in January. Timid and 
nervous people were most liable to that disease. 

2. Indemnity. 


Mr. Griesbach gave evidence pointing to the trap 
and crystalline area as being specially adapted to the 
spread of plague. Bombay and the Deccan are 
situated on the trap formation. Epidemics cling to 
localities in a manner influenced by geological forma¬ 
tion. 

At Calcutta several cases of suspected plague 
occurred sporadically. At Nasik and Malagon, 
endemic as well as imported plague was mentioned 
by Mr. Silcock. At Bombay, evidence went to show 
that the disease had been endemic for centuries. In 
the district of Satara the majority of villages affected 
were situated on the banks of rivers. 

3. Liability. 


Dr. Bose, of Calcutta, noticed that his patients 
were young or middle-aged. He believed that old 
age was immune from plague. In Agra district 
Captain Grant found all nis cases were among grain 
dealers (bunnyas) in the first epidemic of November, 
1897; but in its recrudescence in January, 1898, 

S lague was not confined to that class. At Kurrachee 
[r. Kaka found that the disease had a tendency to 
persist in certain sects of the people. Dr. Niblock 
found that its incidence was the same in both sexes. 
At Lahore Dr. Clark was of opinion that all races 
were equally liable to it. At Daman the greatest 
mortality was among the Mahomedans. At Bombay, 
according to Professor Gajjar, attacks by'plague 
were most frequent during night. 


4. Season. 

In the district of Barisal the first case of plague 
occurred on September 4th, 1898. In Calcutta, 
according to Dr. Bose, in the first week of April in 
that year; at Hurdwar, according to Colonel Thom¬ 
son, it was discovered in April, 1897; it continued to 
prevail till June, when it ceased, but in that month 
spread to Kurnal, where it continued till the end of 
the year. According to Mr. Winter, however, the 
epidemic at Hurdwar continued till May, 1898. At 
Kurrachee the first case of plague occurred in 
December, 1896, the epidemic ceasing in July, 1897. 
A second epidemic appeared in March, 1898, and in 
January, 1899, was still prevailing. At Sukkur 
seasonal heat had no effect in reducing the disease, 
the temperature being 115 degs. F. in the shade. 

According to the evidence of Mr. Sladen the 
epidemic at Kurrachee was on the decline from 
September, 1898. In the state of Palampore the first 
epidemic began in February, 1897 ; it continued till 
May of that year, then ceased; in the following 
August a second epidemic appeared. At Mandvi it 
prevailed from March till August. 1897. At Ahmed-, 
abad it occurred in October, 1896; at Umrath in 
September, 1898; Baroda in February, 1897, occurring 
as a second epidemic in Octolier, and continuing till 
the following April. In Surat it occurred in Decem¬ 
ber, 1896. At Bel gaum it began in July and ceased 
in September. At Ahmedabad a second epidemic 
appeared in October, 1897, and continued till March, 
1898, when it ceased. 


5. Plague Bacillus. 

Surgeon-General Harvey stated that the plague 
germ had sprung from a pre-existing germ. It would 
not flourish except in a suitable environment of dirt 
and poverty. 

Dr. Cook at Calcutta had examined twenty cases 
of plague, and found the plague bacillus in nearly all. 

Colonel Adams, of Rijpootana, stated that the 
germs of plague were carried great distances in 
persons’ clothes. 

Dr. Cobb and Dr. Simpson had declared that in 
the blood of cases of plague in the Shropshire regi¬ 
ment, bacilli were found. Major Skinner had 
examined all the specimens and found no bacillus. 
Other evidence bearing upon this subject in relation 
to diagnosis is quoted under that heading. 

6. How Communicated. 

In Barisal, two aged women who were in constant 
attendance on patients in the same house, were not 
attacked. Many who left Calcutta were not ill while 
travelling, but fell ill the day after arrival (at Bari- 
sal). Dr. Rose said that plague was brought to 
Calcutta by six men from an infected district in 
Bombay, they carried the infection in their clothes 
and bundles. There was no specific instance of men 
coming from Bombay with the plague, but only sus¬ 
picion. He traced the infection from street to 
street by human agency. He did not believe that 
grain or articles of food carried infection. Dr. 
Hossack was of opinion that it was impossible to 
trace the connection of infected cases. Colonel 
Fullerton said that there were three imported cases 
of plague among railway passengers, but no others 
in Baluchistan. 

Captain White was of opinion that accidental 
inoculation by abrasion of the skin or mucous mem¬ 
brane was the exception rather than the rule. He 
doubted whether such abrasions were sufficient to 
account for the large number of femoral, inguinal, 
and axillary bnbos which amounted to 75 per cent, 
of total cases. Colonel Adams believed that plague 
spread in a limited way by rats. Captain Grant, of 
Lahore, that cases treated in hospital seldom or never 
communicated the disease. Captain Wilkinson, that 
it was conveyed by human agency, there was no 
evidence that it was conveyed by rats or clothing ; 
attendants in hospital were not attacked. Major 
Ross, that in Poonah it was transmitted by human 
beings, clothes, and rats. In the case of the Shrop¬ 
shire Regiment, Major Skinner considered that there 
was no infection. 

At Kurrachee, Dr. Mackenzie was of opinion that 
infection entered by means of cargo, or by rats. The 
second epidemic at that place spread rapidly, owing, 
it was said, to evacuation of the houses causing the 
rata to scatter. Mr. Kaka was of opinion that rats 
spread the disease. Colonel Maconachie that Poona 
was infected by railway passengers. 

In the city of Ahmedabad, of the first three cases, 
one occurred in a person arriving from Bombay, two 
in residents employed in the goods yard. In one 
village of that district the infection was said to be 
wind borne. At Umrath, in September, 1898, that it 
was imported from other villages, the infection 
possibly conveyed by fleas. Persons employed in wash¬ 
ing disinfecting houses with lime were attacked. Most 
of the cases spread by human agency. In Baroda and 
Nasik it was said to be conveyed by human agency. 
At Surat, to have been imported from Bombay. 
Human agency was thought necessary for importa¬ 
tion of the disease. Grain was not a factor in its dis¬ 
semination. At Daman, believed that it had been 
imported from Kurrachee by the crew of a native 
craft. 

Lieutenant-Colonel Waters was of opinion that in 
Bombay the origin of plague was associated with the 

D 



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398 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


April 19, 1899. 


protracted storage of grain prevalent in India ; that 

^ germs were mainly disseminated by the wind. 

Bor J. Gajar, of that city, attributed the disease 
to air germs, foul gases from decomposing animal 
matter in the soil. Dr. Kristina, that it was infected 
direct from Horn? Kong by means of Chinese goods. 
Evidence next went to show that it had not been im¬ 
ported, but was indigenous, and had been so for 
centuries. At Poonan contagion was said to be 
rare except in the pneumonic form of the disease. 

7. Water, Milk, &c. 

No reference to either vehicle of zymotic affection 
occura in the evidence available for the purpose of 
the present notes. 

8. In Relation to Animals. 


AtBarisal, Dr. Justice attributed epidemic plague 
to the presence of dead rats. In Calcutta a heavy 
mortality of rate was noticed in March and April, 
plague having appeared in the latter month, but, ac¬ 
cording to Dr. Bose, there was no evidence that those 
animals had died of plague. Captain Bingley believed 
that the epidemic was due to rats from the river 
landing places. At Poonah, Dr. Hossack had a 
suspicion that rats diffused the plague, although at 
the commencement of the epidemic there no rats were 
seen. At Hurdwar, while plague prevailed, there was 
a concurrent mortality of monkeys. In the Agra 
district, plague was by the villagers called “ the rats.” 
No rats were met with however. At the beginning 
of the second epidemic at Kurrachee an extraordinary 
number of dead rat3 and others dying were found in 
the Jeryia Bazaar. At Lahore, according to Captain 
Wilkinson, the victims in one village were rats, while 
no human being was attacked. In his opinion, there 
was no positive proof that rats communicated the 
disease to people. At Vinsol, dead rats were seen a 
fortnight prior to the first case of the plague; during 
the epidemic fleas swarmed. In Broach, Mr 
Pettigara had known squirrels and cats to die of 
he cited a case of infection from a cat. At 
ly, Dr. Mahomed suggested that plague 
might have been brought from Hong Kong by 
ships carrying fomitea or dead rats. At Ahmednug- 
gur there was no great mortality among the rats. 

9. Anti-Plague Serum. 

Surgeon-General Harvey was of opinion that it 
would be advisable to standardise Haffkine's fluid. 
Of that fluid Dr. Cook examined twenty five bottles, 
in seven of which he found impurities, including 
aarcina and meaentericus. He did not think that 
organisms which might be mistaken for those of 
plague could live in Haffkine's fluid, but of six bottles 
sent from Hyderabad, one contained impurity. Cap¬ 
tain Johnstone tested seven different “ brews ” of 
Haffkine's serum, and found all contaminated, some 
with pathogenic organisms. At Surat that serum 
was considered valuable, apart from its prophylactic 
properties, because it gave the people a sense of 
security. At Bombay, Dr. Mayrs described the 
treatment by means of Lustig's curative serum; in 
two cases of plague three injections resulted in 
recovery of the patients. 

Dr. Haffkine stated that though this prophylactic 
was generally sterile, it was impossible to avoid 
occasional impurities, but the danger therefrom was 
insignificant. 

Dr. Fraser and liis colleagues have decided to put 
under special observation a certain number of cases 
as they arrive in hospital, to treat one half of them 
with Professor Lustig's serum, and give the other 
half such assistance as the hospital affords without 
the serum. They thus hope to arrive at a just and 
reliable estimate of the efficacy of the serum in 
plague cases, as compared with the usual hospital 
treatment. 

Our knowledge of the nature of the material of 


serums is so limited, and the conditions of their 
preparations so manifold, vaiying. and uncontrollable 
that it is well nigh impossible to manufacture them 
twice with identical properties. In addition, the 
experience gained by their use upon the lower 
animals is not always verified in man. The action 
of a body of bacterial origin is confined to one 
disease, and influenced by a variety of conditions 
including predisposition and resistance. Hence, the 
oft repeated experience that cases looked upon as 
favourable for bacterio-therapy have frequently had 
a fatal termination, the Plague Commission has, 
therefore, proposed to mix and average the serums 
obtained from different horses at the Parel labora¬ 
tory—for everything is not yet know of the possi¬ 
bilities of the Lnstig serum. 

10. Inoculation. 

At Calcutta Dr. Bose was converted to the 
principle of inoculation because he was unable to 
resist the evidence of facts. Dr. Hossack mentioned 
three cases of plague among Europeans, of whom one, 
a nurse, had not been inoculated. Dr. Cook made 
cultures from heart's blood, lung stuff, sputum, and 
other things. He inoculated animals from his cul¬ 
tures, and killed them with unmistakable plague. 
Captain Clark said that in the Hushiarpore district 
1,467 inoculations were performed; some of those 
inoculated took the plague, but in other villages 
there were cases of that disease. Captain Jenny at 
Kurrachee used Dr. Simon’s curative serum with a 
slightly favourable i-esult, Colonel Maconachie was 
inoculated with Haffkine'B prophylactic, the dose 
being three centimetres. On the following morning 
he had slight fever, but the temperature did not 
exceed 103° F., no vomiting or diarrhoea. He had 
never seen dangerous symptoms resulting from 
inoculation. Dr. Nazareth inoculated forty-seven 
patients with Professor Roux's serum, the dose forty 
cubic centimetres each; of these twenty-five 
recovered. The effect of the inoculation was 
generally marked. It almost invariably failed in 
pneumonic cases, where the glands were suppurated. 
The treatment was supplemented by stimulants. 

At Lahore Captain Clark said that inoculation gave 
very beneficial results. Many hundreds were inocu¬ 
lated, and there were no cases among them, whilst 
there were several among the uninoculated. More 
notable results were in connection with the disinfect¬ 
ing gangs which were partially inoculated. Among 
the smaller number of the nninoculated there were 
many rases, In other instances, from among nine 
men inoculated there was do case, whilst from fifty 
men not inoculated there was one case. Among sixty 
inoculated elsewhere there was no rase; among twenty 
not inoculated, but one case. At Baroda, of 51.3 
persons inoculated there were three deaths ; of 437 
uninoculated, nine deaths. At Kylee, of 1.159 inocu¬ 
lated, nine deaths ; of 2,162 uninoculated, 110 deaths 
In some cases evil results followed inoculation, but 
it was doubtful whether they were due to that opera¬ 
tion. Among the patients who recovered, the disease 
was milder in the cases of the inoculated than the 
uninoculated, At Surat 121 persons were inoculated, 
none of whom became attacked by plague; there the 
usual measures were adopted. At Nasik and Bombay 
Mr. Stewart had no expex'ience of inoculation, but 
he strongly advo-ated evacuation and disinfection. 
In Mazagon and Tarwadi districts, of 7,000 persons 
inoculated there was only one death from plague. 
Mazagon was totally evacuated, and 12,000 persons 
removed into camp. 

At Poonah Lieutenant-colonel Fawcett reported 
that inoculation was but a makeshift; useful per¬ 
haps, in times of trouble, but cannot take its place 
among the great sanitary laws. At Satara people 
refused to be inoculated. 


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April 19, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 399 


M. Haffkine considered that the general low 
mortality among inoculated people was due to the 
fact that the inoculation of pathogenic microbes 
influenced the course of diseases by other infections 
as well as plague. 

Elsewhere the remark occurs that the existing 
methods of administering both the preventive and 
curative serums has involved an enormous amount 
of waste, and failed to do the amount of good they 
might otherwise have effected. The faith of the 
public in the Lustig serum depends upon its judi¬ 
cious employment in competent hands, and at 
present, in spite of its success in many grave cases, 
it has not gained general confidence. 

(To be continued .) 


Xccturc on 

RACHITIC DEFORMITIES. 

Delivered at the Citt Orthopaedic Hospital. 
By CHISHOLM WILLIAMS. F.R.C.S., Ed., &c„ 

Assistant Surgeon, City Orthopaedic Hospital, E.C. 

Gentlemen, —Before proceeding to the con¬ 
sideration of “ RacbitioDeformities,” it will lie well for 
us to briefly consider the disease itself. Rickets is a 
general disease, affecting the nutrition of the whole 
body in infancy and childhood. It is characterised 
by an arrest of natural growth and development, 
with a perverted and delayed calcification of the 
whole osseous system and enlargement of the glan¬ 
dular, more especially such abdominal glands as the 
liver, spleen, and lymphatics. 

Etiology .—The aisease is most commonly developed 
about the end of the first year. It is said to be 
somewhat rare before the sixth month (I have recorded 
eleven cases, of well-marked rickets, between the 
third and sixth month). It may occur at any later 
age up to about eight years, and a few cases 
have been reported at 12 or 14 yeare, at these later 
years it is termed “ recrudescence of rickets,” and it 
is very difficult to say if the disease has only just 
been developed, or whether it has remained dormant 
from early infancy. This disease is never congenital, 
and the term “ foetal rickets ” is misleading, as it 
refers not to true rickets, but to early cases of 
sporadic cretinism. The most frequent causes are 
undoubtedly improper food and feeding, both as 
regards quality and quantity Starch and starchy 
foods are powerful agents in its development. Regard¬ 
ing “ patent foods,” according to a series of cases 
reported by Dr. Baxter, as many as 92 per cent, of 
Lis patients had used patent food, but tnis I think 
comewhat high. I have only been able to obtain a 
history of this kind of feeding, wholly or partially, 
in 66 per cent. Bad hygienic surroundings, as 
dampness, w-ant of fresh air and sunlight, and defi¬ 
cient accommodation, debility on the part of the 
mother, whether caused by disease, excessive child¬ 
bearing or over-suckling. 

Pathology .—In the bones any natural curve is ex¬ 
aggerated, but later secondary curves may develop. 
The epiphyseal junctions are enlarged, owing to 
their bulging from pressure between the epiphysis on 
the one hand, and the diaphysis on the other, the 
intermediate cartilage very slowly and imperfectly 
calcifying. In a rachitic bone, on section, one sees 
that the epiphyseal cartilage is much in excess of 
normal, ana although calcification is progressing it is 
irregular and incomplete, and the line of ossification, 
irregular and jagged, also islands of calcareous 
material are found in the enlarged epiphyseal carti¬ 
lages, and portions of unaltered cartilage are to be 
seen in the most recently newly-formed bone. Micro¬ 
scopically, there is great irregularity in the rows of 


cartilage cells and much imperfectly formed bone. 
Under the periosteum similar changes take place, 
instead of new normal bone being formed, there is 
layer on layer of soft animal matter, very imperfectly 
ossified. These layers have been termed ‘‘osteoid 
tissue.” Deformities occur most frequently in the 
following order:—Extremities, thorax,spine (kyphosis, 
scoliosis, and lordosis), skull, pelvis. Parchment¬ 
like crackling on pressure on the bones of the vault, 
more especially in the occipital region, has been 
named by Elsasser “ craniotabes,” and is said to be 
observed also in congenital syphilis. The fontanelles 
remain unclosed long after the second year. The 
urine contains more phosphates, less urea and uric 
acid, than normal. 

Prognosis —Depends entirely upon the duration of 
the disease, if short, easily arrested, and pulmonary 
complications warded off, it is favourable. After¬ 
growth is never perfect except in the mildest of cases. 
Regarding bony deformities, the younger the case 
the easier the rectification, the more extreme cases 
are due to imperfect general treatment at an early 
age, and allowing the bones to take care of them¬ 
selves, which may cause a dense, buttress-like mass 
to form on the concavity of the bones, which will 
perpetuate the deformity and require the more severe 
measures for their relief. 

Coviplications .—Rachitic children are extremely 
sensitive to cold, and are especially prone to catarrh, 
both pulmonary and intestinal broncho-pneumonia 
being the most common cause of death in this dis¬ 
ease. Laryngismus stridulus is particularly frequent. 
Tetanic convulsions may occur in a few cases. 

Symptoms. The earliest noted by the parent are 
usually vomiting and diarrhoea, and bending of limbs, 
but long before the latter have developed we find 
sweating of the forehead, mostly at night, kicking 
off bed-clothes, and general restlessness, the hair on 
occipital region being often worn off; excessive and 
unnatural tenderness on handling, with general 
lassitude. The abdomen is enlarged over the whole 
of its area, due to flatulence from the gastric and 
intestinal catarrh, and this increase in size may be 
partly due to enlargement of both liver and spleen ; 
most frequently there is diarrhoea, but in a few cases 
there may be constipation, or alternating diar¬ 
rhoea and constipation, the motions being pale and 
of putty-like consistence and extremely offen¬ 
sive. Urine is often increased in quantity, and 
loaded with phosphates. The head is unduly large 
and the forehead square, with prominent frontal 
eminences, the teeth late in appearing, deficient in 
enamel, and more or less rotten, the chest yielding to 
atmospheric pressure, presents two grooves, running 
downwards and outwards, just inside the nipple lines, 
and another groove transversely across lower part 
of thorax, the liver keeping the lower ribs and carti¬ 
lages from falling inwards, thus producing the 
deformity known as “ pigeon breast.” The clavicles 
present a well marked bow near their inner extremi¬ 
ties. At the junction of ribs and cartilages the 
swollen epiphyses can be felt and often seen, pro¬ 
ducing the so-called “ Ricketty Rosary.” The long 
bones give way in the direction of their normal 
curves, other curves being produced later, giving rise 
to knoek-knees, bow-legs, and other deformities. 
The swelling of the epiphyses and the thickening of 
the cranial sutures are found in the vast majority of 
cases. The spine in the younger patients presents a 
long even convex curve, from the cervical to the 
sacral regions, which disappears almost entirely on 
raising the child up by the axillje. Scoliosis is not 
very common, and lordosis is somewhat rare in early 
years. The pelvis may be affected, either being tri¬ 
angular or hour-glass shaped. Most rachitic patients 
are of stunted growth witn weak and flabby muscles, 
in general condition they may be either very thin, or 


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CLINICAL RECORDS. 


April 19, 1899. 


very fat, but when the latter, the fat has not the 
usual firmness of health. Muscular action can have 
but little to do in producing deformity, the chief 
causes being pressure and force of gravity. 

Treatment. 

Resolves itself into five component parts—the 
hygienic, dietetic, medicinal, mechanical, and opera¬ 
tive. 

Hygienic .—Advice should be given as to general 
hygiene, and the child should at all times be 
thoroughly and warmly clad, abundance of fresh or 
freshly-prepared food, fresh air, with particular stress 
laid on the avoidance of chills ana cold. Daily 
baths, tepid in winter to nearly cold in summer, 
night ana morning, preferably sea-water, or its excel¬ 
lent substitute, sea-salt water, being used, to be 
followed by plenty of good friction, or, if possible, 
systematic massage, this seems to be of greatest 
value in the “ tenderness ” stage, causing it to dis¬ 
appear very quickly. In very young and severe cases, 
particularly in females, the child should be kept 
lying down, but never long in the same position, so 
tnat the pressure on the pelvis may be varied, this 
will tend to prevent any severe deformity. 

Diet .—Under seven months, mother's milk, sup¬ 
plemented, or substituted if necessary, by fresh cow s 
milk diluted with at least one-third boiled water, and 
slightly sweetened with white sugar, with the addi¬ 
tion of a teaspoonful of lime water to each bottle, 
afterwards a little rusks, yolk of egg, broth, or a 
small quantity of beef tea or gravy daily. Later the 
milk may be thickened with well-baked wheaten 
flour. After twelve months strong beef-tea may be 
added, and meat juice or pounded warm mutton or 
beef, a few teaspoonfuls daily. Freshly gathered 
stewed stone fruit is of great benefit in tne later 
feeding of a case, and in older children. 

Drugs .—As a preliminary step, and almost as a 
matter of routine, one or more teaspoonfuls of castor 
oil or rhubarb and soda should be given. Cod-liver 
oil, either alone or combined with steel wine, is a 
specific in doses from one teaspoonfnl and upwards, 
three times daily, half an hour after food. If it 
seems to disagree, it should be still persisted in, and 
increased at tne earliest possible moment, finding the 
unaltered oil in the faeces is an indication to lessen 
the dose for a time. In extreme cases when 
practically nothing will “stay down,” it should be 
rubbed in freely and lint soaked in the oil wrapped 
round the child’s abdomen. Some patients can take 
cod-liver oil far easier, if to each dose is added a few 
grains of ordinary table salt. The various cod-liver 
oil emulsions in my hands have not had the same 
success as the crude oil. The phosphorus in cod-liver 
oil treatment (introduced by Kassowitz) has been 
extensively tried and found to be no better than the 
oil without the phosphorus, it consists of one part 
phosphorus in 10,000 cod-liver oil. A veiy efficient 
mixture largely used in this hospital consists of tinct. 
fem mur. 10 minims ; liq. calcis chlor. B.P. 30 
minirnB; aqua camph. 3 as., to be given three times 
daily. 

Mechanical .—Generally speaking, all cases of bony 
deformity below the age of five years can be effectu¬ 
ally treated with light, well-padded, wooden splints 
fixed to the concavity of the limb by broad, soft, 
inelastic, cotton-web straps. The spine may have to 
be supported by a well-padded leather back splint. 
Above the ages of five years, and up to ten, light 
steel supports will be needed, acting in exactly the 
same way as the light wooden ones. The spine at 
this period may require a “ stoop-splint ” if growth is 
progressing rapidly, or possibly a light steel support. 

Operative Treatment .—The limbs may be unbent or 
even “green stick” fractures produced by the surgeon’s 
hands, and afterwards restrained in plaster of Paris 


or other convenient media. This, of course, should 
only be done when the child has been relieved of all 
its symptoms, exoept the deformities. At or above 
the age of ten years one of the many forms of oste¬ 
otomy will be required. Should the patient be 
unsuitable or refuse operation, a great deal may be 
accomplished in relieving deformity and giving 
comfort to the patient, by the use of light steel 
supports as mentioned under mechanical treatment. 

[During the latter part of the lecture a practical 
demonstration was given of the various mechanical 
means adopted for the rectification of rachitic de¬ 
formities, also photographs, and may plaster of Paris 
casts from the nospital museum were shown.] 


Clinical JUarrbs. 

ST. GEORGE’S HOSPITAL. 

Extensive Calcification of an Adherent Pericardium with in¬ 
veterate Ascites (tapped 52 times) which was attributed 
to Hepatic Cirrhosis and ineffectually treated by 
Laparotomy and artificial production of adhesions. 
Unusual condition of the Peritoneum, (a) 

Under the care of Dr. Wm. Ewart. 

The patient, set. 49, died from the exhausting effects 
of frequent and repeated tappings, and of increasing 
anasarca and dyspnoea. The abdomen had begun to 
swell five years ago, and the legs also slightly. When 
admitted into St. George’s Hospital in July, 1896, the 
diagnosis of nodular cirrhosis was made on the strength 
of the predominance of ascites, the enlargement of the 
liver, the absence of albuminuria, and of any apparent 
heart failure, the pulse being always good and strong, 
though at that time pericardial friotion and an apical 
systolic murmur were heard, which subsequently were 
not again discovered. There was no history of alco¬ 
holism, but for some years as a young girl she drank 
vinegar from the bottle in large quantities habitually. 
She had had rheumatic fever at the age of 18, and twice 
since. She was admitted into the hospital again and 
again merely for paracentesis, after which the liver could 
be felt below the costal margin. In August, 1897, Mr. 
Warrington Ha ward carried out the operation devised by 
Drummond and Moriaon. The patient recovered, though 
peritonitis was set up which was almost fatal. The 
relief as regards the ascites was purely temporary, and 
the patient continued to be tapped at intervals until too 
weak to leave the hospital, where she died on August 
17th, 1898. 

The post-mortem examination showed that the peri¬ 
cardium was universally adherent to the heart, and was 
stiffened by a layer of calcareous salts to an extent 
which must have precluded the contraction of the 
ventricles. This carapace extended upwards as far as 
the auriculo-ventricular groove, but not over the auri¬ 
cles, which were not rigid, and their contraction may not 
have been much interfered with. The ventricular 
cavities were only slightly dilated, the membranes 
normal, the orifices slightly dilated. The myocardium 
rather thin and soft. There was no great hypertrophy 
of the walls of the auricles. The liver was not cirrhotic 
but slightly enlarged from chronic congestion, and its 
tissue soft and greasy without fibrosis. The other abdo¬ 
minal viscera formed together with it an adherent mass, 
from which the abdominal walls could with difficulty 
be detached, occupying the upper half of the abdomen. 
The lower half of the abdomen presented an unusual 
condition. No bowel was visible except the descending 
colon, which came into view when the large accumula¬ 
tion of fluid which exclusively occupied this part of the 
abdomen had been emptied. Into the fluid projected 
from above a large, spherical mass, the smooth peritoneal 
lining of which was continuous with that of the asdtio 
cavity, and almost suggested the idea of a second peri¬ 
toneal sac. The spherical mass contained the bowel 
gathered together into a large ball. The investing 

(a) Specimens shown at the H&rvetan Society of London, March 


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TRANSACTIONS OF SOCIETIES. 


Thr Medical Press. 401 


membrane was of soft consistency, and was partly torn 
daring examination. The adherent viscera, the adhe¬ 
sions between which entirely obliterated the upper part 
of the abdominal cavity, were fairly healthy. The re¬ 
current ascites is of interest in connection with its cause, 
which was not cirrhosis as suspected but cardiac 
obstruction. Drummond and Morison have recorded a 
case in which at the operation the liver was found not 
to be cirrhosed, but the cause of the recurrent ascites 
was not made out, no post-mortem examination having 
been obtained. This case was similar to the one here 
described, for the patient survived the operation nine¬ 
teen months and was tapped sixty-nine times. 


SIB PATRICK DUN’S HOSPITAL. 

8arcoma of the Suprarenal*, nnd Secondarilu of the 
Lung, (a) 

Under the care of J. Magew Finny, M.D.Dub., 
F.B.C.P.I., L.R.C.S.L, &c. 

I am enabled to exhibit the left lung and the right 
and left suprarenale, which were the seat of sarcoma, 
with microscopical sections of the lung made and 
explained by Dr. O’Sullivan, lecturer in pathology. 
Trinity College, Dublin. The patient was a man of 
sixty-six years, who was admitted to Sir Patrick Dim’s 
Hospital, October 1898, suffering from great prostration 
and cough, and pain in the left side. The only well- 
marked signs he possessed were those of encysted left 
pleural effusion, without displacement of the heart, 
and on exploration the diagnosis was confirmed, and the 
fluid found to be bloody. This character, and his consti¬ 
tutional cachexia made the diagnosis to be cancerous 
pleurisy. The patient’s colour was very dark, but with¬ 
out the characteristics of Addison’s melasma, while the 
sputum was free from tubercle bacilli, and the urine 
from albumen. Death from exhaustion took place March 
2oth, 1899. The morbid specimens showed the left supra¬ 
renal to be converted into a mass of bloody sarcoma' the 
size of a goose egg—the natural tissue of the gland was 
obliterated, and the sarooma, which was unencapsuled, 
rested on and partly invaded the top of the left kidney, 
and was in intimate relation to the renal vein; from 
this vein a branch passed directly into the sarcoma. The 
right suprarenal was also converted into a sarcoma of 
similar character, but it was the size of a small hen’s 
egg. The left pleura was greatly thickened and 
rough, and contained a quantity of bloody exuda¬ 
tion which was strictly encysted, as had been 
mapped out during life; the layer of pleura 
pulmonalis was equally thick, and completely separated 
the effusion from the pulmonary tissue. The oentre of 
the lower lobe of the left lung was a mass of soft broken 
down sarcoma which seemed to pass at different depths 
into the surrounding healthy lung tissue. The micro¬ 
scopical character of sections of the left kidney and of 
the lung showed sarcoma of a mixed character, and what 
was most remarkable and strange—a number of giant, 
polynuclear, or myeloid cells—containing as many as 
twelve or fourteen nuolei, and resembled exactly those 
found in sarcoma springing from the periosteum or ends 
of bone. The case presented, therefore, the rare 
peculiarity— not unknown in the life history of sarcoma 
—of reproducing cells of connective tissue type, which is 
not that of the matrix from which it grew, inasmuch as 
there was a complete absence of any bone disease. The 
other point of interest lay in the sequence of the 
diseased organs. From the rarity of sarcoma being a 
primary disease of the lungs and the frequency of the 
suprarenals being the first affected, it is not improbable, 
as Dr. O’Sullivan suggested, that the disease originated 
in the connective tissue or vessels of the left adrenal, 
that by the open vein it passed through the left renal 
vein into the circulation, and directly affected the right 
adrenal, and by embolic infarction it found its final rest¬ 
ing place in the substance of the left lung. The most 
careful examination failed to show any extension from 
the adrenals to, or through, the diaphragm. 

(a) Exhibited at the meeting of the B jyal Academy of Medicine 
in In land, February 24th, 1899. 


^raitsuctimte of gocuties. 

CLINICAL SOCIETY OF LONDON. 
Meeting held Friday, April 14th, 1899. 

The President, Mr. Langton, F.E.C.S., in the Chair. 


WOUND OF A LARGS SUPERFICIAL INGUINAL ARTERY IN 

WHICH THE BLOOD WA8 FLOWING FROM THE TRUNK 

TO THE THIGH. 

Mr. Spencer described an unusual case in which, 
whilst laying open a tuberculous sinus in the groin an 
artery the size of the brachial was wounded. The bleed¬ 
ing was at once controlled, no complication occurred 
during the healing of the disease, nor was the circula¬ 
tion in the limb disturbed. The point at which the 
artery was wounded was just in front of Poupart’s liga¬ 
ment where the skin and subcutaneous tissue was much 
infiltrated by tuberculous disease. When the two ends 
had been tied and the artery divided between the upper 
end iretracted and pulsated strongly, it was then 
situated immediately beneath the skin, one inch above 
and a little internal to the middle of Poupart’s ligament, 
and resembled the brachial artery in an amputation 
stump. The lower end neither retracted nor pulsated. 
No accompanying vein was seen. The common 
femoral could be felt behind. On the opposite side 
an artery could be felt crossing Poupart’s ligament close 
beneath the skin, distinct from the common femoral 
artery. Professor Thane had not been able to throw any 
light upon this anomalous vessel. The artery was 
clearly given off somewhere from one of the iliac arteries, 
and after reaching the abdominal wall, crossed in front 
of Poupart’s ligament, to be distributed to the inner side 
of the thigh. The only likely explanation was that it 
was a superficial obturator artery. To this there was the 
obvious objection that the obturator artery was essen¬ 
tially a deep one, and that its aberrations had been 
closely studied in connection with femoral hernia. The 
provisional name, “ superficial inguinal,” was, therefore, 
employed in the absence of any information as to the 
origin of the vessel. 

Mr. Clement Lucas suggested that the artery which 
Mr. Spencer met with might have been an aberrant 
branch of the deep epigastric artery. He had seen 
branches of considerable size perforating the superficial 
muscles over that artery. 

The President also thought that the vessel might 
have sprung from the deep epigastric artery, and asked 
from what direction it appeared to come ? 

Mr. Spencer said that on the side operated on the 
tissues were so much thickened that nothing could be 
made out as to the course of the vessel. On the healthy 
side a small artery could be made out distinct from the 
common femoral in which blood was flowing from the 
trunk into the thigh. He thought that Mr. Lucas’s 
explanation was probably the correct one. 

Dr. Rolleston and Dr. Cyril Ogle read the notes of 

THREE CA8EB OF SYPHILITIC STEN08IS OF BOTH BRONCHI. 

Case 1.—A woman, sat. 25, who came to St. George’s 
Hospital, January 3rd, 1899, complaining of cough and 
loss of weight. There was stridor, but no alteration of 
voice. Air entered both lungs equally. Septic pneu¬ 
monia developed and terminated fatally. There was 
fibrosis of the lungs snd thickening of pleura, the 
bronchial glands were acutely swollen. There was a 
localised narrowing of the bronchi and dilatation, pro¬ 
bably from retention of secretion, of bronchial tubes 
beyond. There was extensive syphilitic disease of the 
liver. Ca se 2.—A man, set. 29, has admitted under the 
care [of Dr. Whiphan in November, 1896, for increas¬ 
ing difficulty in breathing. There was stridor, and 
air did not enter the left side as well as the 
right. The larynx was normal. Both testicles were 
enlarged. He was given iodide of potassium, but the 
dyspnoea increased, and death ensued from septic pneu¬ 
monia. There was narrowing in.) of both main 
bronchi, due to thickening of the bionchial wall. There 
was sign of recent ulceration. The tubes beyond were 
distended with yellow mucus. The testes contained 


Digitized by boogie 




402 The Medical Press. TRANSACTIONS OP SOCIETIES. 


April 19, 1899. 


gummata. Case 3.—A man, set. 29, was admitted to St. 
George’s Hospital, under the care of Dr. Cavafy, on 
September 24th, 1897, for increasing shortness of breath 
and stridor. There was syphilitic perforation of hard 
palate. Tracheotomy gave no relief. At the necropsy, 
both bronchi were found much stenosed. There was no 
syphilitic disease of the other viscera. Examination of 
published cases showed that syphilitic stenosis of the 
bionchi were usually combined with a similar lesion in 
the trachea, and that syphilitic stenosis of the bronchi 
alone was rare; reference was made to four other cases 
of stenosis of both bronchi, and three of one bronchus, 
making with the three cases described that evening, ten 
in all. The average age of these ten cases was 361 years, 
only two being above 40 years, the sexes were almost 
equally affected. In the cases brought forward by Dr. 
Kolleston and Dr. Ogle, it seemed probable that adminis¬ 
tration of iodide of potash had done harm, inasmuch as 
it increased the secretion in the obstructed bronchial 
tubes. This secretion accumulated, and by undergoing 
decomposition changes, set up septic bronchitis, broncho¬ 
pneumonia, and fever, from septic absorption. In order 
to avoid this, it was recommended that full doses of 
belladonna should be combined with the iodide so as to 
prevent the secretion of mucus from the bronchial 
mucous membrane. 

Mr. Lucas thought that little could be hoped for from 
treatment in such cases, as the lesions were of a cicatri¬ 
cial nature like leucoplasia of the tongue and fibrosis of 
the testis. He had met with two cases of syphilitic 
stenosis of the trachea, in which the lumen was so 
diminished that a tracheotomy tube could not be passed 
down. 

Dr. West said that the cases must be very rare, as he 
had never seen one during many years as pathologist to 
two hospitals. He remarked that stenosis might be due 
in some cases to the result of inflammation extending 
from the lymphatic glands. 

Dr. Rolleston, in reply, said that he thought that 
the cases might be more frequent than was supposed. 
Out of all the cases recorded half came from Guy’s Hos¬ 
pital, probably because attention had been drawn to 
their occurrence and a look-out kept. He mentioned 
one case in which thi3 condition was diagnosed, and in 
which recovery followed treatment. 

TWO CASES OF UNUNITED FRACTURE OF THE HUMERUS 

CAUSED BY THE INTERPOSITION OF THE MU8CULO-8PIRAL 

NERVE BETWEEN THE FRAGMENTS. 

Mr. Clement Lucas read a paper on this subject. The 
first case related occurred in a man, tet. 41, and the 
fracture, which was compound, was caused by the kick 
of a horse on November 12th, 1895. He was taken 
to a local infirmary and put up in a rectangular 
splint. Some sloughing of skin occurred. On Februray 
2nd, 1896, an operation was performed, and a wire 
applied, as union had not taken place. On April 11th, 
1896, he was discharged, union having still failed to take 
place, while musculo-spiral paralysis was established. 
He was admitted into Guy’s Hospital on May 12th, 
1896. There was a false joint at the junction of the 
upper two-thirds with the lower third of the left humerus 
and scars due to the injury and operation. The elbow 
was fixed in a semi-flexed condition, finger and wrist also 
flexed and fixed. Loss of sensation existed over the 
distribution of the radial nerve. The splint was re¬ 
moved, massage, passive movements, and electricity 
were applied till the movements of the elbow were 
restored, and some pronation and supination and 
partial movement of fingers and wrist were ren¬ 
dered possible, but musculo-spiral paralysis remained. 
On June 12th, 1896, an incision was made on the 
back part of the arm, and the musculo-spiral nerve 
was traced up to where it was found engaged between 
the fragments. The wire encircling the fragments was 
found to include the fibrous extension of the nerve. The 
bone was again resected and wired, and the nerve being 
cleared for about two inches above and below was also 
resected, about an inch of the fibrous part being cut 
away and the ends united by means of sterilised 
silk. Primary union of the skin wound took place, 
and he left the hospital soon after with the 


arm in a plaster case. Three months later it 
was found that union was still incomplete, and 
the bone was again exposed, and a screw as well as a 
wire applied to the fractured ends, and the nerve again 
resected. A sinus remained as a result of this operation 
till November, when it closed. The bone was then 
firmly united, but the paralysis remained. Electricity 
and massage were used, and a useful arm for carrying 
was obtained, but the nerve had not recovered when last 
3een. The second case was that of a man, set. 30, who 
was admitted into Guy’s Hospital under Mr. Clement 
Lucas’s care on October 9th, 1896, suffering from an 
ununited fracture of the right humerus and musculo- 
spiral paralysis. Five months before admission, when 
riding a bicycle, he was run into by a cart, the shaft of 
which struck his right arm, causing the fracture. It was 
put up in splints about an hour later, and these remained 
on seven weeks. Afterwards for three weeks he had 
a poroplastic case. At the time of the accident and 
afterwards the patient suffered severe pain down the 
back of his forearm, on the outer side, extending to the 
thumb and forefinger. On November 15th, 1896, Mr. 
Lucas made an incision between the triceps and 
brachialis anticus four and a half inches in length on the 
antero-external aspect of the arm, and finding the 
musculo-spiral nerve, traced it up to where it was 
engaged between the fragments. The nerve was 
detached, resected, and united by silk, and the fragments 
of bone were resected and united by a screw and an 
encircling wire, primary union following, and he left the 
hospital in a plaster of Paris case on December 6th, 
1896. He returned in a month, when it was found that 
good bony union had taken place, and when last seen, 
however, though he had a useful limb, the power of 
extension at the wrist had not been recovered. 

The President related the case of an elderly woman 
under his care at St. Bartholomew’s Hospital, with 
fracture of the humerus which had led to musculo- 
spiral paralysis and severe neuralgic pain. He exposed 
the bone and found that there was an oblique fracture, 
the nerve lying behind the end of the upper fragment. 
The nerve was nearly divided, and there was a bulbous 
swelling on its distal as well as its proximal extremity, a 
condition that he had seen in other cases of the kind. 
The fracture was so oblique that he had to resect a con¬ 
siderable portion of the bone. He sutured the nerve and 
wired the bone. The state of the bone was satisfactory, 
but little improvement had taken place in the paralysis, 
and he thought that less improvement usually took place 
in the musculo-spiral nerve after suture than in other 
nerves. 

Dr. Samuel West read a paper on 

SKIN AFFECTIONS IN GRANULAR KIDNEY. 

Rashes associated with oedema were for the most part 
erythematous in character, transitory in duration, pro¬ 
duced few symptoms, and unless general, have but little 
clinical importance. If the skin was broken, as after 
puncture or when blebs have formed and burst, secondary 
infection might occur, and rashes of an erysipelatous 
character might arise, or phlegmonous inflammation or 
even gangrene might develop, but these were accidental 
events. Rashes without oedema occurred almost exclu¬ 
sively in the course of “ granular kidney.” They are 
generally wide-spread and often universal, of great 
obstinacy, and of grave significance, taking the form of 
erythema, pityriasis rubra, dermatitis exfoliativa, general 
eczema, and lichen. They were rarely haemorrhagic. 
The following cases were described. 1. General Erythema: 
In a man, tet. 42, under treatment for uncontrollable 
diarrhoea. A general erythema developed which itched 
greatly and persisted until death. Post-mortem, no 
lesion was found except granular kidney. 2. Pityriasis 
rubra ; two cases.—A man, tet. 47, admitted for the rash 
and most extreme asthenia. The signs of granular 
kidney were well marked. He improved in the hospital 
but shortly after, having lost ground again, died of 
ursemic coma. A woman of 41 admitted also for the 
skin eruption, and extreme asthenia. The rash in the 
course of time disappeared, but the asthenia continued, 
and she ultimately died of exhaustion. 3. Dermatitis 
exfoliativa.—A man of 48 admitted for the rash. He 


April 19, 1899. 


TRANSACTIONS OP SOCIETIES. 


The Medical Press. 403 


presented clear signs of granular kidney. The rash im¬ 
proved, but did not entirely disappear, and the patient 
died shortly after reaching home. A woman of about 
44 was in the hospital for a surgical affection. The rash 
developed ; signs of granular kidney were discovered, and 
she died shortly afterwards of asthenia. 4. A papular 
lichenous eruption. One case occurred in a man of 40, 
which was attended with a rise of temperature, and as 
there was small-pox about, the question was raised as to 
its being one of variola to the papular stage of which it 
bore some resemblance. The man died soon after, and 
granular kidneys were found. The second case was that 
a woman of 52, whose chief symptoms were vomiting, 
diarrhoea, and asthenia, and who died in uraemic coma. 
The rash appeared fourteen days before death. It rapidly 
spread over the whole body. The papules were in Borne 
parts as large as a split pea, and resembled urticaria. 
In a third case, a girl, aet. 20, the papules were of 
small size, and developed twelve days before her death. 
In this case also the chief symptoms were vomiting, 
diarrhoea, and asthenia, and she also died comatose. 
He remarked that the cases in which these rashes 
appeared almost invariably ended fatally, and that usually 
soon. The rashes occur only late in the disease, and when 
the signs of granular kidney are well marked, though 
its existence is not infrequently overlooked. The asso¬ 
ciation of a generalised skin-eruption with albuminuria 
is of great importance, and if the cause of the albu¬ 
minuria be granular kidney, it is of the gravest signifi¬ 
cance. for the patient will soon die, not of the skin 
affection, but of the granular kidney. 

Dr. H. D. Rolleston said that he had seen some of 
the cases published by Dr. Le Cronier Lancaster, quoted 
by Dr. West, and had made examinations of the kidneys. 
In the production of these eruptions there appeared to be 
some toxic factor, which was not uraemic, or the rashes 
would not be so rare. Possibly in some cases drugs 
might be the exciting cause, and in others some intes¬ 
tinal poison, and in this connection it was of interest to 
note that several of Dr. West's cases suffered from diar- 
roea. Possibly in the cases of extensive dermatitis there 
was a secondary constitutional infection, such as occurred 
in connection with the pleural and pericardial serous 
membranes in advanced cases of Bright’s disease. He 
asked whether there was any connection between this 
condition and the epidemic skin disease which was attri¬ 
buted by Dr. Savill to an organism. Flexner had observed 
that persona suffering from chronic diseases seldom died 
from their direct effects, but usually from secondary in¬ 
fections, and had further found that the blood of men 
dying from some chronic disease had a much weaker 
germicidal action than that of a healthy man. 

Dr. Colman mentioned a oase of a papular lichenous 
eruption occurring in a tabetic patient, which closely 
resembled that in one of Dr, West’s cases, and which was 
also suspected to be one of small-pox in its early stage. 
There was intense itching, and the patient died from 
asthenia after a few days’ illness, and as the necropsy 
advanced granular change was found in the kidneys. 
Like albuminuric retinitis the occurrence of those erup¬ 
tions appeared to be of very grave significance. 

Dr. Long hurst mentioned a case under his care in 
which purpura had occurred in the legs of a patient 
suffering from advanced Bright’s disease. 

Dr. Toooood said that the epidemic skin disease men¬ 
tioned had been prevalent in many of the infirmaries, 
but that the majority of superintendents held that it was 
not due to an organism, but to some toxin taken with 
the milk, as all the affected infirmaries were supplied by 
the same firm, and when the milk supply was changed 
there were no more cases. 

Dr. West, in reply, said that the object of his paper 
was to draw attention to the occurrence of these erup¬ 
tions, and not to explain the mode of production. But 
in the present defective state of our knowledge of what 
uraemia was, he thought that it would be rash to say 
that they were not due to some of the conditions at pre¬ 
sent grouped under that term. He had no doubt that 
the acute and chronic forms of uraemia, for instance, 
were due to different poisons, and that these eruptions 
belonged to the more chronic forms. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Pathology. 

Meeting of Friday, February 24th, 1899. 

The President, J. M. Purser, M.D., in the Chair. 


pneumococcal septicemia with ulcerative endo¬ 
carditis CONSECUTIVE TO CROUPOU8 PNEUMONIA. 

Dr. McWeeney communicated an observation bearing 
on a man, ®t. 37, who was admitted on Dec. 5th, 1898, 
to the Mater Hospital, under the care of Dr. Murphy, 
with right apical pneumonia. Crisis occurred on the 
ninth day, and was attended with a good deal of collapse. 
Ten days afterwards patient was allowed up one evening 
and got very weak. On January 1st, an aortic systolio 
murmur developed which became very loud, patient be¬ 
came prostrate and delirious, the temperature curve 
assumed a pyremic type, and death ensued on January 
5th. On the 2nd blood was taken, with strict precautions, 
from the finger, and inoculated by means of a pipette on 
several tubes of oblique glycerine agar. After twenty- 
four hours incubation at 37°, one of these tubes presented 
a few extremely minute dewdrop-like colonies which 
proved to consist of Frankel’s pneumococcus. The other 
tubes remained sterile. At the autopsy (forty-eight 
hours after) blood was aspirated from the right auricle 
into a sterile bulbed pipette, and inoculated on agar 
tubes. Owing to the solid coagulation, but little liquid 
could be obtained. The incubated tubes showed 
numerous large circular colonies, like discs of porcelain 
(probably the Bacillus coli ) but also very many minute 
whitish, very delicately fringed colonies, which proved 
to; be the pneumococcus. ^ broth culture from one of 
them, after twenty-four hours at 37°, was scarcely turbid, 
yet 1 c.c. injected intraperitoneally into a rabbit caused 
death in seventeen hours. Pneumococci with typical 
capsules were in the blood of every organ examined. The 
other post-mortem results weie briefly: pericardium 
universally obliterated by recent adhesions, parietal 
layer being readily stripped off; myocardium of auricles 
soft and friable like wet blotting paper. Right posterior 
cusp of aortic valve presented a mass of vegetations as 
big as a cherry—colour, greyish green where not covered 
with clot; behind this the cusp perforated, hole would 
admit an ordinary pen handle. Grey hepatisation of 
most of the right lung. Spleen twice the natural size, 
infarcted throughout. Embolus in primary branch of 
splenio artery, fibrinous, crammed with pneumococci. 

case of hodgkins’ disease. 

Dr. J. B. Coleman read notes of a case of Hodgkins’ 
disease, which was remarkable for the acute clinical 
course, and for the widespread distribution of the lesions. 
The patient, a labourer, cet. 50, had enjoyed good health 
up to eleven weeks before his death. He gave no history 
of alcoholism or syphilis. Glandular enlargements first 
appeared in the left cervical and axillary regions. On 
admission to hospital, three weeks before his death, he 
was somewhat emaciated, but not antemic; skin dry and 
scurfy; pulse and temperature normal; all the super¬ 
ficial glands were considerably enlarged, and there was 
evidence of enlargement of the thoracic and abdominal 
glandB also; the glands were soft, freely movable, and 
painless ; spleen was easily palpable and liver dulness 
increased. Examination of the blood showed hsemoglobin 
and red cells normal, the white cells 11,200 cubic m.m.; 
40 per cent, of the white cells being lymphocytes; the 
blood contained no micro-organisms. The patient 
rapidly became more and more prostrate, temperature 
wa9 usually normal or subnormal, but on three occasions 
in three weeks it mounted to 100‘5; his appetite failed, 
he became delirious, and died with symptoms of toxaemia 
eleven weeks from the onset of the disease. The 
necropsy disclosed universal enlargement of the super¬ 
ficial lymphatic glands, as well as of the mediastinal, 
retroperitoneal and mesenteric glands ; adenoid nodules 
were present in kidneys, spleen, liver, and intestines; the 
spleen was greatly enlarged, and growing from its 
capsule, as well as from that of the liver, were large 
masses of adenoid material ; below the liver the retro- 




404 iha iHBDiCA.1 Pass*. TRANSACTIONS OF SOCIETIES. 


April 19, 1899. 


peritoneal glands were enlarged and massed into a 
tumour, which surrounded the aorta and involved the 
adrenals. Cultural and inoculation experiments were 
carried out with the assistance of Dr. McWeeney with 
negative results. Dr. Coleman mentioned the arguments 
in favour of Hodgkin's disease being cf an infective 
nature, and pointed out that numerous observers had 
found micro-organisms in the diseased glands. He also 
contrasted the disease with leucocythsemia, and said 
that Cohnheim regarded Hodgkin’s disease as an 
aleukeemic vorttadium of leukiemia, whilst numerous 
observers had noted the transition of the one disease 
into the other. 

Dr. E. J. McWeeney confirmed the negative results 
of bacteriological culture and asked if there was any 
history of suppuration, syphilis, or tuberculesis to 
account for the lardaceous disease. 

Brigade-Surgeon Lieut.-Col. Burke said when at 
Gibraltar and Malta he had seen many specimens of 
amyloid degeneration, and the liver specimens now ex¬ 
hibited were very like those he had seen due to syphilitio 
disease. 

Dr. Coleman, in reply, said that there was no history 
of syphilis or long-continued suppuration. Regarding 
the cardinal symptom of ansemia, he said that antenna 
is not necessarily a part of Hodgkin’s disease, and only 
becomes marked as the case progresses. Anaemia has 
been absent in undoubted cases of the disease. 

EPITHELIOMA OF LIP FROM YOUTH EIGHTEEN YEARS OLD. 

Mr.G. Jameson Johnston read the notes and exhibited 
microscopical sections of a case of epithelioma of the lip 
in a youth eighteen years of age. 

BREAST CONTAINING NEW GROWTH REMOVED FROM YOUTH 

SEVENTEEN YEARS OLD, WITH MICROSCOPIC 8ECTION8. 

Mr. Johnston also exhibited the left breast of a 
male patient, containing a new growth in the left upper 
quadrant, about the size of a large walnut, radiating 
processes of the growth extended in every direction into 
the gland substance; the consistence of the mass was 
quite firm, and to naked-eye examination very like 
scirrhus. It had been steadily growing for three 
months in spite of medical treatment, causing some 
slight discomfort, not actual pain; there was no retrac¬ 
tion of the nipple or dimpling of the skin; the glands 
along the leaser pectoral were palpable before operation. 
No history of injury could be obtained. The whole 
breast and connective tissues and glands along the pec- 
toralis minor were removed. The wound healed by first 
intention. At the present time (twelve hours after opera¬ 
tion). No recurrence can be seen nor any enlarged 
glands felt. Microscopical examination showed the 
growth to be mainly fibrous tissues, with what appears 
to be a few short columns of gland cells here and there. 

Dr. A. C. O’Sullivan thought that no one could 
doubt that the first section was a squamous cancer. 

Dr. E. H. Bennett said that there was a similar case 
of epithelioma of lip in youth of 18, described in Pott’s 
works. 

Dr. E. J. McWeeney considered the epitheliomatous 
nature of the lip tumour most typical. 

Mr. G. J. Johnston, in reply, doubted if the tumour of 
the lip recorded by Pott as epitheliomatous was really 
such in the absence of precise pathological investigation. 

Mr. J. Magee Finney showed specimens from a case 
of “ Sarcoma of the Suprarenals,” which will be found 
under “ Clinical Records.” 

Dr. E. J. McWeeney said that some of the sections 
showed a very marked resemblance to tissue which he 
found in the kidney as the result of an aberrant supra¬ 
renal growth originating from an aberrant fragment of 
suprarenal. The curious thing seen in the section was 
the presence of enormous giant cells, entirely like the 
myeloid cells of bone. 

Dr. E. J. McWeeney (for Dr. Cole Baker) showed a 
melanotic sarcoma of choroid. 

Dr. Knott demonstrated an extensive series of patho¬ 
logical fibulae and patella?. 


Dr. Arthur P. Luff has been elected a vice-president 
and member of Counoil of the Medical Defence Union 


HARVEIAN SOCIETY OF LONDON. 
Meeting held Thursday, April 6th, 1899. 

H. A. Caley, M.D., in the Chair. 


Clinical Evening. 

EXCISION OF MALIGNANT GROWTH8 OF LARGE 
INTESTINE. 

Mr. W. H. Battle showed two female patients on 
whom he had operated for distension due to malignant 
growth of the large intestine. The first was a case of 
growth in the splenic flexure with the gradual onset of 
symptoms for four weeks. She was twenty years old, and 
as there was extreme distension so that it was impos¬ 
sible to bring the growth to the surface, and inadvisable 
to prolong the operation, a temporary colotomy was done 
under the left lower ribs. At operation, five weeks later, 
exoision of growth, and artificial anus, with lateral 
anastomosis, was done. This was in September, 1898. 
The second was a woman, set. 46, for whom operation 
for distension was done in August, 1898, and a columnar- 
celled carcinoma of sigmoid flexure treated by Paul’s 
method. Subsequent attempts to get rid of the spur 
were painful and tedious. Ultimately a lateral anasto¬ 
mosis was done, and the artificial anus closed Both 
patients had now a regular action of the bowels, and 
looked remarkably well, whilst the scars were firm with¬ 
out any tendency to weakness or hernial protrusion. 

In answer to Mr. Raymond Johnson, Mr. Battle said 
that in his experience the best results in excising portions 
of intestine were obtained by completely closing the ends 
of the bowel, and then establishing a lateral anasto¬ 
mosis. 

SYRINGOMYELIA WITH PHARYNGEAL AND LARYNGEAL 
LE8ION8. 

Dr. Herbert Tilley showed a case of syringomyelia 
in a girl, set. 15, in which there was paresis of the right 
half of the palate, pharynx and right vocal cord. Other 
points of interest in the case were the blunting of 
painful, and the complete loss of thermal, impressions all 
over both superior extremities and certain well-defined 
areas of the neck and trunk, atrophy of the small 
muscles of the hands, the latter exhibiting the main en 
griffe position, moderate wasting of the flexors and 
extensors of the wrist and slight nystagmical jerks of 
both eyes (for fuller details vide Proceedings Laryngolog. 
Society of London, December, 1898). A painless but 
severe burn on the hand and a gruffness of the voioe 
with some difficulty in swallowing first led the patient 
to seek advice. The pharyngeal and laryngeal condi¬ 
tion have muoli improved during the past two months, 
during which time the patient has been taking strychnia. 

COMPLETE PARALYSIS OF LEFT SPINAL ACCESSORY 
NERVE. 

Dr. Herbert Tilley showed a man, jet. 65, who, in 
October, caught cold and became hoarse, and at the same 
time experienced an accumulation of, and difficulty in 
expectorating, saliva. He managed, however, to fulfil his 
engagement as a preacher. There was slight difficulty 
in swallowing. No history of gout, syphilis, or rheuma¬ 
tism. Examination showed the left side of the palate, 
pharynx, and left vocal cord, the left stemo-mastoid, 
and upper part of the left trapezius to be completely 
paralysed. At the onset of his trouble the patient had 
had no pain, giddiness, or general symptoms beyond 
those due to the cold, and the exhibitor agreed with the 
President that the case was probably one of pachy¬ 
meningitis involving the trunk of the spinal accessory 
nerve after the cervical and spinal portions had united, 
within the skull. 

PARESI8 OF LEFT 8IDE OF PALATE, PHARYNX, LEFT VOCAL 
CORD, AND RIGHT 8IDE OF TONGUE. 

Dr. Herbert Tilley showed a female, set. 31, exhi¬ 
biting these conditions. In October, 1898, she Buffered 
for two to three weeks from very severe pain over the 
back of the head and neck terminating in “ fits,” details 
of which are not obtainable. In the first she fell down, 
but did not lose consciousness; in a second fit, three 
days later, she lost consciousness, was hoarse on recovery 
and paralysed in the left arm and leg, with some weak- 


Digitized by 


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April 19, 1899. 


FRANCE. 


ness of the left side of the face. She was in bed for fire 
weeks, and at first was sustained by nutrient enemata 
as swallowing was impossible, fluids being ejected 
through the nose. Food was then administered by 
stomach pump, her condition improved, the arm and 
leg recovering power, but the throat condition remains 
the same. When first seen by the exhibitor there was, 
in addition to the above throat lesions, slight paresis of 
the left lower facial muscles, protrusion of the tongue to 
the right (slight), contraction of the left pupil, and a 
small warty growth on the mucous membrane of the 
right arytasnoid cartilage. It is difficult to conceive of 
any single lesion which would explain the various con¬ 
ditions found in the case. Dr. Tilley remarked on the 
rarity of laryngeal or pharyngeal paralyses in syringo¬ 
myelia, the slight effect on the voice of paralysis of one 
vocal cord, and the way such cases as these tended to 
support experimental evidence that the spinal accessory 
supplies the muscles of the palate, pharynx (partial) and 
larynx. 

SPASMODIC TORTICOLLI8. 

Mr. Noble Smith showed a patient, tet. 21, upon whom 
he had operated for spasmodic torticollis by excising a 
piece of the spinal-accessory nerve just above its entry 
into the stemo-mastoid muscle. This was on the right 
side. He had previously operated upon the left side four 
years ago. Both operations had been successful, and it 
was remarkable that on the left side (the first operation) 
the function of the nerve had been restored six months 
subsequent to its division. It had been necessary on 
that occasion also to divide the external branches of the 
second, third, and fourth cervical nerves on the right 
side. The patient had gradually improved in health and 
strength, but recently some spasms had developed in the 
right stemo-mastoid. He had subjected the patient to a 
course of special exercises and massage which had still 
further strengthened her, but this treatment had not 
relieved the spasm, so he had recently operated on the 
right spinal accessory. The patient had been able to be 
up and about six days after the operation. She was ex¬ 
hibited at the meeting, and it was found that the right 
sterno-mastoid and the upper portion of the trapezius 
were completely paralysed, but that the patient was in 
no way inconvenienced by this loss of power. 

In discussing the above cases, Dr. Leonard Guthrie 
referred to the regression of symptoms which had 
occurred in Dr. Tilley’s case of syringomyelia. In 1896 
he ( Dr. Guthrie) had shown before the society a woman, 
set. 28, who had nystagmus, complete analgesia, and 
thermo-ansesthesia with bloated tactile sensation of the 
whole of the left upper extremity and left side of the 
head, fore neck and chest to level of third rib. She had 
also paralysis of the left side of the soft palate, and of 
the left vocal cord. The analgesia, Ac., had followed 
immediately a violent attack of sneezing, three months’ 
previously, whilst paralysis of the spinal accessory 
occurred immediately after an attack of coughing two 
months later. In the course of about a year these 
symptoms had to a great extent disappeared. He attri¬ 
buted the sudden onset of symptoms to hremorrhage in 
or near a syringomyelio cavity and their subsidence to 
it3 absorption. 

The cases were also discussed by Mr. Jackson Clarke 
and the Chairman. 

calcification of adherent pericardium with 

INVETERATE ASCITES. 

Mr. W. Ewart showed specimens from a case, and 
gave details thereof which will be found under “ Clinical 
Records." 


SHEFFIELD MEDICO-CHI ETJRGICAL SOCIETY. 
Meeting held Thursday, March 16th, 1899. 

The President, Dr. Alfred Robinson, in the Chair. 


Mr. Simeon Snell exhibited the following patients:— 
1. Coloboma of iris, two cases, one extending through 
choroid, one confined to iris. 2. Tumour of each orbit, 
probably extending across the septum; a stereoscopic 
photograph was shown. 3. Optic atrophy (post-neuritic) 
after influenza. 


The Medical Press. 405 7) 

Mr. Snell also showed the following nine sections of 
eyes, with tumours.-—Three of gleniea, one an instance 
in which the first affected had been removed two years 
previous to the appearance of the disease in the second 
eye. A case of concurrence of globi, apparently com¬ 
mencing in the cornea. Five instances of sarcoma of the 
choroid, one a leuco-sarcoma, in an old man, two in young 
men, one a middle-aged man, one in a middle-aged 
woman. 

Mr. Sinclair White exhibited and made remarks on 
1. A woman from whose bladder he had excised a can¬ 
cerous tumour nine months ago. The growth was about 
one inch in diameter, and grew around the entrance of 
the right ureter. It was removed through a supra¬ 
pubic wound, together with the entire thickness of the 
bladder wall. To prevent urinary extravasation a 
dependent opening was made into the vagina. The 
resulting vesico-vaginal fistula was closed three months 
later. The patient was now free from recurrence, per¬ 
formed her vesical functions perfectly, and was much 
improved in health. 2. A case of paralytic talipes equino- 
varus treated by transferring the tendon of the tibialis 
posticus and the outer third of the tendo-Achillis to the 
tendons of the common extensor and the peroneus 
anticus muscles. The result achieved was remarkably 
good. The patient was a boy, set. 10. 3. Four cases 
operated on for undescended testicle, In each case 
after free division of the cremaster muscle and 
incision of the tunica vaginalis a silkworm 
ligature was passed through the tunica albuginea at the 
lower end of the testicle, and both ends of the ligature 
passed through the base of the corresponding side of 
the scrotum, and fastened to the thigh by means of 
strapping. 4. A woman cured of a suppurating pelvic 
cyst which had discharged into the bladder for four 
years. The cyst was in the first instance opened and 
drained suprapubically ; but as the sinus did not close it 
was subsequently successfully dealt with by draining it 
into the roof of the vagina. 5. Cases of excision of the 
knee and ankle. 6. Cases illustrative of diseases of the 
nose. 

Mr. Pte Smith read notes of a case of “ Traumatic 
Dislocation of the Hip” on to the dorsum ilii in a boy, 
sat 5. It had been produced by a fall during a scuffle 
with another boy, and was easily reduced by manipula¬ 
tion under chloroform. 

Mr. Pte Smith also showed a sequestrum of bone 
forming the nucleus of a vesical calculus removed by 
median lithotomy from a man who had sustained fracture 
of the pelvis from a crush in a coal mine two years pre¬ 
viously. The sequestrum had probably entered the 
bladder about a month before its removal. 

The President, Dr. Keeling, Dr. Wilkinson, Mr. Pye 
Smith, Dr. Sinclair White, Dr. AddiBon, Mr. Dale James, 
and Dr. Hargreaves made remarks, 


efraucc. 

[from our own correspondent.] 


Paris, April 16th, 1899. 

Ossificating Role of the Dura Mater. 

At the Academie de M^decine M. Chipault spoke on the 
role of the dura mater in repairing the osseous tissue of 
the cranium. He said that he was always opposed to 
cranial operations leaving intact the dura mater sub¬ 
jacent to the osse jus orifice. He had the conviction that 
those of his patients he had trephined, and in whom he 
had removed this membrane, gave him results much 
superior to those in whom he had left it intact or 
sutured after incision. He was glad to be able to state 
clinical facts confirmed his opinion, for they showed that 
in those operations where the dura mater had been pre¬ 
served intact the osseous obliteration of the loss of sub¬ 
stance was produced over the entire surface, whereas it 
was not produced where it had been destroyed. Of nine 
cases of old traumatism, three patients suffering from 

Google 


Digitized by 



406 Thb Medical Pees?. _ G E R1 

lesions of the cranium of an apparently alight 
character, were not operated on; two of theae were at 
present the subjects of Jacksonian epilepsy, while the 
third presented mental trouble. The other six were 
trephined, as they all presented before the opera¬ 
tion epileptic symptoms; in three the dura mater was 
untouched; the occlusion of the loss of substance was 
effected by a hardened and probably osseous plate. In 
the three remainder, the dura mater was removed, re- 
OBsification did not take place, and the epilepsy was 
cured; two of these were children, one of which pre¬ 
sented an interesting history. It was a girl, tet. 10, in 
whom, after a fracture of the left side of the head, pro¬ 
duced by a fall from a one-storey window, hemiplegia of 
the right side had developed, as well as a cephalo-hydro- 
cele. This latter was opened, and the rent in the dura 
mater sutured. Some time after this operation, the 
child was seized with epileptic fits, which continued for 
a year at more or less long intervals. Another opera¬ 
tion was advised and accepted ; this time the cranium 
was resected in the region already repaired, after the 
first intervention, and a portion of the dura mater re¬ 
moved. Since that moment (a year and a half ago) the 
epileptic fits had ceased. 

M. Chipault communicated six other cases of essential 
epilepsy, in all of which the dura mater was preserved, 
with the result that when ossification was completed* 
the primary affection returned, and concluded, in 
the great majority of operations for recent or ancient 
traumatisms, followed by Jacksonian epilepsy, in inter¬ 
ventions for essential epilepsy for microcephalos or 
intracranial neoplasms, that, first, the ablation of the 
bone should be complete, and, secondly, the removal of 
the dura mater subjacent to the orifice should be defin¬ 
itely removed. Only by such means could a permanently 
favourable result be obtained. 

Dr. Bra, of this city, is the most recent claimant for 
the distinction of having discovered the elusive organism 
of cancer. lie even entertains hopes of elaborating a 
curative serum. He states in the La Prcsse Medicate 
that he has succeeded in isolating and cultivating a 
parasite from cancerous tumour. On inoculating animals 
with these cultures he has produced cancer. He adds 
that the parasite belongs to the family of actinomycetes 
fungi. Pending more precise details it would obviously 
be idle to speculate on the value of the alleged discovery. 
We have seen so many generations of alleged “cancer 
microbes ” bite the dust that while we admit a hope we 
must refuse credence. Even if we were satisfied that the 
incriminated funguB was the causa causa res it it still a 
far cry to prophylactic or curative measures. 


(Germany. 

[from our own correspondent.] 

Berlin, April 14th, 18 S«I. 

The Prophylaxis ok Cancer ok the Uterus. 

Proke8sor Duhr8sen has a paper on the subject in 
the D. -If. Wochensch, 4 99. He agrees with other authors 
that cancer is rapidly increasing in Germany as well as 
in other countries, and this in spite of improved sur¬ 
roundings of the people. Out of 25 millions of females 
in the German Empire 25,000 die annually of cancer of 
the uterus. Of women between the age of 40 and 50 2 
per cent, die of the disease—a mortality equalling that 


I_A_N Y. ___April 19, 1899. 

of the whole German army in the war of 1870 and 71, 
and removal of the disease by operation does not 
materially lessen this mortality. Only from 10 to 30 
per cent, of all cases are fit for operation when first seen* 
and of the small number operated on only a third or a 
fourth part remain free from recurrence of the disease. 

A meanB of improving this condition of affairs would 
be afforded by early diagnosis, but this is scarcely 
possible under present circumstances of public educa¬ 
tion, Ac.. Some means of preventing the onset of cancer 
would be more desirable still, some means of acting 
on the uterine mucous surface in such a way that cancer 
would not develop, and the author thinks there is such 
a means, and that the destruction of the mucous 
membrane by means of Sneguireff’s vaporisation. By 
means of this procedure, which is not painful and abso¬ 
lutely free from danger, necrosis of the mucous 
membrane is effected. The same object pan be attained 
in another way. This is to open the abdominal cavity, 
through the anterior vaginal arch, and draw down the 
body of the uterus; the anterior uterine wall has then 
to be split, and the mucous surface removed. The portion 
can also be removed at the same time. The operation 
he does not consider likely to be dangerous He considers 
that great security against the occurrence of cancer 
would be afforded by Schroder’s high amputation of the 
cervix, and this is a more reasonable proposal, as the 
operation is practically free from danger, and it would 
effect the removal of that part of the uterus in which the 
disease commences in nine cases out of ten. The pro¬ 
posal will, no doubt have the effect of leading the gyne¬ 
cologist to consider favourably the removal of the cervix 
when it can be no longer of service, and when a possible 
danger may lie in its retention. 

At the Society for Innere Medizin Hr. A. Fraenkel 
related a case of 

Gangrene of the Lung treated by Operation. 

The patient, a labourer, tet. 33, was attacked with 
febrile lung symptoms in October of last year. In 
November his breath became offensive, and on December 
8th sudden acute symptoms came on, a stitch in the 
right side and fever. In hospital the expectoration of 
stinking sputa reached about 300 ccm., and even to the 
naked eyo it plainly contained lung constituents in large 
quantities There was great emaciation and loss of 
strength, and the case had a very unpromising appear¬ 
ance. Operation was decided on between the speaker 
and the surgeon Korte, as both agreed that an extensive 
destructive process was going on in the right chest- 
Two circumstances favoured operation: one was that 
the disease was in the upper lobe and easily accessible, 
and the other, the large quantity of expectorated material 
which implied a large cavity which would be easier to 
find than a small one. He pointed out the happy results 
that had followed surgical interference in some lung 
diseases, especially in acute and solitary abscesses. 
In cases of multiple abscesses the prognosis was 
more unfavourable in such as followed influenza 
pneumonias. In gangrene of the lung also a dis¬ 
tinction must be drawn between acute and chronic 
cases, the first starting from abscesses giving the best 
results. In the case before them, the clinical history 
showed that the disease began in an acute abscess. The 
original disease was influenza, but the multiple patches 
of disease were limited to the upper lobe, aud they had 
probably coalesced. The speaker had not made an ex- 


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Apgll 19, 1899. 


AUSTRIA. 


The Medical Press. 407 


ploratory puncture, first on account of the danger of in¬ 
fecting the pleural cavity, aad, second, because in such 
oases with large cavities there was danger of fatal 
haemorrhage from puncture of large vessels. 

Hr Korte said that even after making several examina¬ 
tions of the patient he could not satisfy himself as to the 
existence of a cavity, but on account of the large quantity 
of expectorated material, he determined to operate 
Operation January 10th. The first, second, and third 
ribs were extensively resected. The pleura was found 
adherent. The lung was opened by a large transverse 
suture with the cautery, and a large cavity was laid open 
from which, however, no air was expelled. A spouting 
vessel was ligatured. A large quantity of fcetid pus 
escapedifrom the cavity, a sequestrum of lung was removed, 
establishing a communication with the large bronchi. A 
large branching vessel running across the cavity was 
ligatured in two places and removed. The cavity was 
now packed with iodoform gauze previously dipped in 
balsam of Peru. The course was favourable, cicatrisa¬ 
tion went on well, and the opening now remaining was 
small. The cavity reached from over the clavicle to the 
3rd rib, so that happily the opening was made in the 
lower part, whereby drainage was facilitated. In an 
earlier case in which the speaker only had charge of the 
after treatment, the cavity became covered inwardly 
with epithelium continuous with that of the skin, a 
fistulous track remaining. On admission the patient 
had large drumstick-like swellings on the finger-tips, 
but those had now become a good deal smaller. He had 
only had one other case in which he had operated, one 
in which there were multiple cavities, a proof consider¬ 
ing the great material of the hospital, that cases suitable 
for operation were rare. 


JUtstria. 

[from OCR OWN CORRESPONDENT.] 

Vienna, April 14th, 18t*». 

BALNEOLOGICAL CONGRK88. 

Under the auspices of Professor Winternitz, the 
Balneo-Klimito-and Hydro-Therapeutic Association met 
in Vienna this year, and passed off with great success. 
At the plenary meeting Winternitz heartily greeted the 
Association on behalf of the medical faculty of Vienna, 
while Von Kusy welcomed them in the name of the 
Austrian Government. 

Winternitz read a long paper on the benefits of 
Hydrology, which he described as one of the most 
important branches of medicine. At the various con¬ 
gresses held in Russia, Germany, Italy, and France, the 
subject had been sub divided into balneology, clima¬ 
tology* and hydrology, which was a literary convenience 
in discussing and estimating the value of hydrology. 
Under the protection of the Austrian Emperor he was 
confident this branch of medicine would soon flourish as 
a department of scientific therapeutics. 

The Influence of Balneotherapy on the 
Circulation. 

Prof. Kisch next introduced the subject of the influ¬ 
ence of balneology on the circulation. The various 
results, he said, of warm baths on the circulation have 
been the subject of criticism since the days of Galen. 
It is only within the last ten years that anything like 
scientific methods of research had been brought to bear 


on the beneficent or injurious effects of baths on the 
system. The classic names associated with this progress 
are O. Naumann, M. Schuller, and Kolman Miiller. 

In enumerating the results of these investigations, he 
observed that warm baths dilated the peripheral vessels, 
and then action in this respect persisted longer than that of 
other causes of relaxation, the frequency of the pulse is 
augmented, and the temperature of the body conse¬ 
quently raised. After the bath a compensatory recession 
in the circulation occurs, and if the bath be not too warm 
the tonus of the cardiac muscle is increased. 

Mineral baths, warm or cold, had other advantages, 
both local and general. The gases and chemical sub¬ 
stances contained in the waters had a useful local effect 
on the skin, which reacted on the reflex movements, and 
thereby exerted a regulating influence on the heart. The 
absorption of carbonic acid had a stimulating action on 
the nervous system and cardiac movement, and this, of 
course, influenced the circulation. Both these actions 
could be demonstrated by temperate mineral water. As 
the peripheral stimulus gave rise to a flow of blood to the 
surfaoe, the blood pressure was raised, the systole full 
and prolonged, while the tonus of the cardiac muscle was 
greatly accentuated. He showed that this was the prin¬ 
ciple on which the action of the acid, iron, and mud 
baths could be explained. 

The value of the internal use of these waters was in¬ 
disputable in cardiac affections and diuresis was in¬ 
creased. Similar advantages could be obtained by 
immersions in medicated waters. 

Climatology. 

Clar gave an extensive review of the effects of climate 
on the human organism. It had the effect of removing 
water from the blood by means of perspiration, increas¬ 
ing diuresis, w.hile rarefaction of the air modified the 
blood pressure and pulsation. Mountain residence was 
an effectual method of curing antemia dependent upon 
the circulatory system. For this purpose the height 
should not be too great. 

The Action of HydbotherApy on Blood and 

Circulation. 

Strasser contributed a long paper on the clinical 
aspects of hydrotherapy, its applications and effects. 
He dwelt at great length on the effects of heat and 
cold as stimuli on the quality of the pulse and the 
corpuscular elements of the blood. He had repeated 
Wintemitz’8 experiments, and was enabled to confirm his 
results by showing patients in whom the specific gravity 
of the blood, colouring matter, and corpuscular elements 
were all increased by hydrotherapy alone. He reviewed 
Wintemitz's theory, according to which the change is 
simply due to the change in the constituents, he himself 
holding that the action of increased distribution was 
largely responsible for this beneficent alteration in the 
component constituents of the blood. The ebb and flow 
in the various organs brought about spontaneous changes 
in pathological fimctions, whether depending on humoral, 
solid, or cellular pathology. 

Katatonia. 

Haveroch exhibited two cases of katatonia, which, 
according to Kahlbaum, is a disease of the central ner¬ 
vous system of a cyclical nature. The symptoms were 
usually melancholia, stupor, mental confusion, and 
idiocy. Haveroch preferred to describe the symptoms 
as “ verbigeratio, mutacismus, and negativismns.” He 
was convinced that katatonia was a distinct disease, and 


Digitized by 


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408 The Medical Pbks s._THE OPERATING THEATRES. April 19, 1899. 


belonged to dementia precox in the following order:— 
1st, Dementia simplex; 2nd, hebephrenia; 3rd, kata- 
tonia; 4th, dementia paranordes, and dementia epilep- 
ti corum. 

Josef Enoel. 

Another of the Vienna landmarks haa passed from this 
life in the person of Prof. Engel. He had reached his 
eighty-fourth year, and though long ago retired from 
active practice, he took a deep interest in all things 
medical up to the last. 

^hc (Operating theatres. 

ST. 'THOMAS’S HOSPITAL. 

Successful Operation in a Case of Pyemia.— The 
following case shows the advantage of the method of 
operation in a case of commencing pyaemia due to absorp¬ 
tion of material from a septic focus in the extremity. 
The principle of treatment is the same as that which 
guides the surgeon in operation for septic thrombosis of 
the lateral sinus due to disease of the ear. The patient 
a boy, set. about 10, had been operated on for disease of 
the foot on account of severe talipes; the wound had 
become septic, and at the time of operation the lad 
had passed into a very serious condition. There had 
been high and irregular temperature for some days, he 
had been emaciating rapidly, was constantly calling out 
and was very restless. On two occasions, at a short in¬ 
terval, he had had severe rigors with a rise of tempera¬ 
ture to above 106 degs. F. The pulse was very rapid and 
small, the tongue was furred and dry, he was rapidly 
going downhill, and it was evident that he could not 
live long unless something of a radical nature was done. 
Mr. Battle, who was in temporary charge of the case, 
advised that the leg should be amputated (it was ex¬ 
tremely atrophied from results of congenital talipes), and 
it was not possible to say how high a purulent 
thrombus was extending up the limb; he also 
advised that the common femoral vein should be 
ligatured at the same time. Mr. Wallace, the 
resident assistant surgeon, applied two ligatures to the 
vein in the groin, after which Mr. Bingham, the house 
surgeon, amputated the leg in the middle third. It was 
not evident that there was a thrombosis in the veina of 
the stump, but it was not improbable that it was so, as 
the stump suppurated, although the wound in the groin 
healed satisfactorily ; both had been treated with strict 
aseptic precautions. The ultimate result was very satis¬ 
factory, and the patient left for a convalescent home about 
three weeks afterwards. The case illustrates the method 
referred to above, and is of special interest, as this method 
has seldom, if ever, been carried out. It has doubtless 
suggested itself to many surgeons, but opportunities of 
trying it are almost nil. Whether it should be tried more 
frequently in cases of pyiemia associated with acute bone 
mischief or not is a question for consideration. Many 
cases of acute osteomyelitis of the tibia are brought 
into hospitals suffering from pyaemia, and it is possible 
that a ligature of the main vein of the limb conjoined 
with amputation would give better results than those 
obtained by amputation alone. In cephalic cases the 
results of ligature of the main highway from the head, 
with removal of the mischief, havo been in some cases 
almost startling in their success, and in instances 
similar to that above recorded similar measures may 
prove of equal value. 


ST. MARK’S HOSPITAL FOR RECTAL DISEASE. 

Proctorrhaphy for Procidentia Recti. — Mr. 
Swinford Edwards operated on a married woman, 
rot. about thirty, who was the mother of several 
children. For years she had been the subject of pro¬ 
lapse of the rectum, for the cure of which she had 
undergone no less than three operations in various 
London hospitals. On examination, after the adminis¬ 
tration of an enema, it was found that she was suffer¬ 
ing with true procidentia, that is to say, there was pro¬ 
lapse not only of the mucous coat but also of the 
muscular. The gut protruded for about three inches. 
There was practically no sphincter, for on separating 
the buttocks before prolapsus had taken place, one could 
with ease see some inches up the rectum. Of course 
she suffered at times with incontinence of flatus and 
motion. The patient having been placed under 
the influence of an anaesthetic in the left lateral decu¬ 
bitus, a posterior median incision was made as though for 
excision of the coccyx, but prolonged down to within an 
inch of the anus. The posterior wall of the rectum was now 
freed, which manoeuvre was greatly facilitated by a finger 
in the gut, which not only brought the muscular coat of 
the bowel wall up into the wound but also was effectual 
in restraining prolapse. A straight needle, armed with 
a fairly stout silk ligature was now inserted transversely 
through the muscular coat of the bowel, taking up about 
an inch of muscular tissue and being passed as near the 
lower part of the exposed gut as possible. The needle 
was then passed through the ligamentous structures 
lying to the left side and back of the coccyx. 
The other end of the thread, which had been 
left long at the point of original entry was 
now threaded in another needle and passed in 
the same manner through the ligamentous struc¬ 
tures on the right side and back of the coccyx. 
On traction being made on both ends of the liga¬ 
ture it was found that the bowel was drawn up, or 
in other words anchored, to the coccyx. Before tying the 
ligatures and with the bowel held in this position Mr. 
Edwards found that ordinary efforts to produce a pro¬ 
cidentia by artificial means failed. The ligature having 
then been securely tied, the wound was washed with sub¬ 
limate solution, sutured without drainage, and the usual 
antiseptic dressings applied, instructions being given to 
remove these on the following day, and in their place to 
apply a collodion dressing in order to prevent, if possible* 
contamination of a wound so close to the anus. Mr. Edwards 
remarked that this was the first time this operation had 
been performed at St. Mark’s, and, as far as he knew, in 
Great Britain, and therefore he could give nodefinite pro¬ 
gnosis, although from the effects shown before closure of 
the wound he anticipated the best results, at all events, 
as far as the muscular coat was concerned If there 
should be a subsequent prolapse of the mucous coat this 
might be treated either by the cautery or by excision. 
The points in the steps of the operation on which he laid 
special stress were: First, sufficient freeing of the 
posterior rectal wall; secondly, the application of the 
suture to the lowest possible point of the rectum, so that 
the subsequent bracing of the part may be more effec¬ 
tual. He also said that in order to get a good hold for his 
ligature he took care to pass the needle not only 
through what ligamentous structures he could find on 
the dorsal end lateral aspects of the coccyx, but also he 
made it include the periosteum—that is to say, all tissues 


Digitized by LaOOQle 



April 19, 1899 


LEADING ARTICLES. 


Th* Medical Press. 409 


down to the bone itself. The reason he selected a 
straight needle in passing the suture through the rectum 
was that with it he thought it would be easier to take up 
a greater width of the muscular wall of the gut than he 
oould have done with a curved instrument. A curved 
needle, however, was more handy for passing the ends of 
the ligature through the plaoe of anchorage. 

It is satisfactory to record that two days after the 
operation all was going well. 


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“ 8ALDS POPULI SUPREMA LEX.” 


WEDNESDAY, APRIL 19, 1899. 


OOPHORECTOMY AND THYROID 
TREATMENT IN CANCER. 

The effects of the menopause on the generative 
apparatus, and on the breasts in particular, suggested 
to certain enterprising surgeons some time since that 
malignant growths of the breast might be favourably- 
influenced by an artificially induced menopause, as 
for instance, by ablation of the ovaries. On the whole 
the results of the operation, though not devoid of 
interest, have not proved quite as successful as 
had been hoped. Subsequent observations by a 
method in which the administration of thyroid extract 
was associated with removal of the ovaries have given 
much more promising results, though one is quite at 
a loss to explain the modus operandi of the combined 
treatment or to apportion the relative merits of the 
two factors. At a recent meeting of the Medical 
Society of London, as reported in our last issue, Dr. 
G. Herman recorded a second case in which this 
operation, 'plus the administration of thyroid gland, 
had given results so successful as to be remarkable. 
In this particular case the treatment had brought 
about the healing of a large carcinomatous ulcer 
of the right breast which had recurred after two 
operations for removal by surgical means, and 
had determined the disappearance of a large tumour 
in the other breast, the nature whereof was suffi¬ 


ciently indicated by the enlargement of the cor¬ 
responding axillary glands, which glands also 
had ceased to be perceptible to the touch. These 
results are sufficiently remarkable to merit attention 
especially in view of the unsatisfactory results of 
purely surgical measures which are at best but pallia¬ 
tive. Mr. Stanley Boyd inclines to the view that the im¬ 
provement is really due to the oophorectomy, but 
statistics hardly bear out his contention, for Dr. 
Herman had no trouble in showing that the results 
after oophorectomy alone were not nearly as good as 
when the thyroid treatment is superadded. Further 
experience will show which of the two factors plays 
the most important role in producing these results. 
It seems, however, that oophorectomy, if it is to be 
of service, must be done before the cessation of men¬ 
struation for, in several recorded instances, no effect 
has followed their removal after the menopause. 
This is what one might have anticipated, though 
from another point of view it seems odd if the 
artificially-induced menopause exerts such a marked 
effect the natural process should not confer 
similar quasi - immunity against cancer. This 
fact tends to support the view that oophorectomy 
alone is not sufficient to determine a constitu¬ 
tional change capable of inhibiting malignant 
growths. Dr. Herman suggests that the withdrawal 
of the ovarian secretion and the presence of an excess 
of thyroid secretion'render' the tissues less amenable 
to the ravages of the hypothetical parasite of cancer, 
and this explanation is in accordance with the results 
so far obtained. Has excessive thyroid secretion any 
direct influence in conferring immunity against 
canoer P This question ought not to be difficult to 
answer, for we have only to ask ourselves whether on 
the one hand women who suffer from exophthalmic 
goitre ever develop cancer, and whether, on the other 
hand, myxoedematous patients display any marked 
predisposition thereto. We must not forget, how¬ 
ever, that cancer has its vagaries. There is the well- 
known case of Mr. Gould’s, in which a patient appa¬ 
rently dying from cancer, and regarded as past 
treatment, suddenly took a turn for the better, and 
ultimately made a perfect recovery without 
treatment of any kind. * There are, indeed, plenty 
of cases on record of the spontaneous subsi¬ 
dence of cancer, and it is hardly in accord¬ 
ance with scientific methods to dismiss all such 
instances as examples of faulty diagnosis. That is 
merely begging the question at issue. We must not 
allow our judgment to be warped by preconceived 
pathological notions. It is possible, and indeed prob¬ 
able, that the microscope alone does not enable us to 
establish absolutely {he malignancy of a tumour^ 
Malignancy, moreover, is essentially a clinical term t 
it characterises growths in which from microscopical 
data one would not have expected it, while it is some¬ 
times absent in growths which, as far as microscopical 
evidence goes, are doomed to rapidly fatal develop¬ 
ment. These facts should teach us not to be too 
dogmatic, and not to pin our faith to such a kalei¬ 
doscopic science as pathology which, useful when 


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410 The Medical Peess. 


LEADING ARTICLES. 


April 19, 1899. 


taken in conjunction with clinical observation, is apt 
to prove misleading when erected into a scientific 
dogma. We shall probably not have long to wait for 
further and more extensive observations on the lines 
which we have sketched, and these will serve to teach 
us the limits of the treatment and possibly, later on, 
the precise method of its action. 


THE MEDICAL DEFENCE UNION. 

The annual report for the year 1898, recently issued 
by the Medical Defence Union, is an interesting docu¬ 
ment. It marks the progress of the remarkable 
spirit of self-help that, in spite of its youth, has 
sprung up into sturdy and fruitful life within the 
four walls of the profession. Tear by year the roll 
of members has steadily grown, with a proportionate 
increase both of income and of the amount of work 
accomplished. At the end of the year the guarantee 
fund for emergencies, that is to say available if called 
up under the articles of association, fell little short 
of £6,091). At the same time, there was an 
Accumulated Fund of £755, which represented 
the surplus of assets over liabilities. Several 
important changes have been made in the financial 
statement of th9 Honorary Treasurer. Thus, in the 
balance-sheet, the item “ assets ” included subscrip¬ 
tions in arrears for the currant and preceding 
years only. At the same time the names of all sub¬ 
scribers more than two years in default have been 
struck off the register. By adopting this amended 
form of balance-sheet the Council have been enabled 
to present figures free of the inflation of worthless 
arrears. The only feature with regard to the finan¬ 
cial side of the work of the union upon which 
we have any suggestion to make is that 

the accumulation of a reserve fund would 
greatly strengthen the hands of the executive. 
The younger days of hand-to-mouth existence have 
now gone by, and the difficulty of saving money 
should every year be lessened. By the exercise of 
increased watchfulness and economy an actual 
reserve fund equal to that now guaranteed might be 
established, a result that would redound to the credit 
of the society. In offering this suggestion there is 
no intention whatever to criticise the management of 
the Union, which we believe to be carried out with 
unceasing devotion, integrity and earnest ability. 
The present membership of the Union amounts 
to something over four thousand, a small pro¬ 
portion when compared with the qualified prac¬ 
titioners of the United Kingdom, and one that 
must be greatly increased as the coming genera¬ 
tion of medical men wakes up to the necessity 
and value of professional organisation. Turning to 
the actual work of the past year we find the usual 
record of what may be called routine cases, such as 
those associated with the suppression of unqualified 
practice and the prosecution of unqualified persons. 
At the same time there are many cases which have 
points of special interest. As invariably happens, 
one result of the prosecutions has been to show the 
lamentable vagueness of the penal sections of the ' 


Medical Acts. The decision of the magistrates in 
the case of the unqualified man Mitthe ws, who carried 
on an extensive practice at Norwich, was that in using 
the title “ Doctor ” he had not wilfully and falsely 
represented himself as a medical practitioner, but for 
using the description “Surgeon” he was convicted 
and fined a small penalty. As there can be no appeal 
against such obviously unfair decisions, it may well 
be said that the reformer’s path is indeed beset with 
thorns. So again, a jury at Greenwich acquitted a 
woman who was proved to have dispensed physic 
and to have advertised a diploma, and in that case as 
usual leave to appeal was refused. Much more might 
be said, especially with reference to the purely defen¬ 
sive side of the organisation, but for the present that 
partof the matter, important as it undoubtedly is, may 
be passed over with the remark that blackmailing 
actions for alleged malpraxis, negligence, or other 
misconduct have materially lessened in numbers 
since the Defenoe Union has appeared upon the 
scene in the character of legal champion. The Union 
has made a determined effort to bridge over a gap in 
the Medical Act of 1886 by attempting to enforce a 
reading of Section 6 to the effect that registered 
practitioners alone possess the right of carrying on 
medical practice in its various branches, and to make 
any trespass upon such right an illegal act. That 
view was advanced by Mr. Victor Horsley last year, 
and has since been submitted to expert legal opinion, 
which has pronounced adversely to Mr. Horsley's 
contention. For all that, it is to be hoped that a test 
case may be brought before the Courts, for if the 
point could be established, it would go far at one step 
towards doing away with the present deadlock. One 
important function of the Union has been the collec¬ 
tion and recording of evidence of the utmost value to 
the future regulation of the General Medical Council, 
and of medical legislation generally. This fact has 
been emphasised in the case of the conviction during 
the year of a personator, whose name had been com¬ 
municated to the General Medical Council by the 
Union in 1895, but who was. nevertheless, allowed 
subsequently to go upon the Medical Register. It is 
imperative that the whole of that set of circum¬ 
stances be fully and openly investigated at the next 
meeting of the General Medical Council. In conclu¬ 
sion, a word of praise may be bestowed on the Council 
of the Medical Defence Union, for by their self- 
sacrificing labours the Association has been advanced 
to its present sound and vigorous position. 


AN OBJECT LESSON IN MUNICIPAL 
EXTRAVAGANCE. 

It cannot be consolatory for the Dublin tax-paying 
citizens to note that the first act of the newly-con¬ 
structed Council of their city is to perpetrate one of 
the most atrocious building jobs of which a munici¬ 
pality ever was guilty. It is right to say that the 
job was prepared and made safe and snug by the old 
Coiporation. and is simply adopted, in globo, by the 
new one, which might and should have cast it out¬ 
wit!) ignominy if it desired to recommend its own zeal 


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Apbil 19, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Pbess. 411 


for economy of administration to the citizens. The job 
consists in the buying up of a filthy slum in the worst 
part of the city and the building thereon of artisans’ 
dwellings. The slum, itself, is covered mostly with 
squalid tenement houses, the intrinsic valne of which 
x s the rotten bricks and slates of which 
they are composed, and, if the Corporation 
had, long ago, done its duty the area would have 
been declared insanitary, and these houses deten- 
anted, in which case the owners would never have 
thought the premises worthy of rebuilding or repara¬ 
tion and the whole area would have fallen to the 
Corporation, as many similar areas in Dublin have 
done, with insignificant cost. As the matter stands, 
the citizens are called upon to pay £35,000 
for a few hundred cartloads of rubbish, this sum 
being the amount at which the imagination of an 
arbitrator and the rapacity of some scores of 
attorneys assessed the value against the ratepayers. 
Then come the items of £9,000 for clearing the area, 
and £47,000 for erecting the artisans’ dwellings. 
That total sum required already exceeds the estimate 
by £28,000, and we know enough of architects and 
builders to be confident that, before the transaction 
is closed, another £10,000 will be added for extras. 
The whole cost (omitting the last contingent item) 
is £91,000. 

Now, what are the citizens to get in return for 
this enormous outlay ? First, they profit by the 
extinction of a disgusting slum and the substitution 
of decent dwellings, but we apprehend that, with 
a little patience and judgment, this advantage 
might have been attained without paying any such 
amount as £35,000 for it. Second, they get 29 
houses, each costing £3,137, and the whole contain¬ 
ing 210 separate tenements—i.e., £133 per tene¬ 
ment ! ! ! Four hundred and thirty-three pounds 
for a bricklayer’s or a carpenter’s lodging—as much 
as would enable a professional man to accommodate \ 
a numerous family in a respectable villa in a fashion¬ 
able suburb —as much as would build two, if not 
three, cosy houses for commercial clerks and their 
belongings in the less popular neighbourhoods ! Was 
there ever such atrocious waste ? The Tammany 
proceedings of the London Metropolitan Board of 
Works in presence of this job “pale their ineffectual 
fire.” 

It will, no doubt, be said that the guardianship of 
the money of the Dublin citizens is no part of the duty 
of the Medical Press, but there is a consideration 
which brings this transaction within the purview of 
anyone interested in the welfare of the poor. There 
is a vast population in Dublin of the very poor. 
in6rm, miserable, squalid, and starved who live in 
cellars and in the worst burrows of the tenement 
houses and can pay no more for the rent of their lodg¬ 
ing than lOd. to Is. 6d. per week. Obviously it is here 
that the function of a beneficent Corporation should 
come in not only out of simple humanity and decency, 
but to protect the citizens against the dissemination 
of disease from such holes, and for this the Superin¬ 
tendent Medical Officer of Health and liis co¬ 
philanthropists have never ceased to clamour. 


•But thfese poor creatures have no friends, no' 
votes, and no influence, and. are, in fact, not 
worth a thought from the Corporation, and, as a con¬ 
sequence the Corporation has refused to grant a 
single shilling for providing them with decent lodg¬ 
ing, which could be done for less, per tenement, than 
one-fourth of the money now being spent on the dwell¬ 
ings of artisans who have votes, friends, and money. 
Already Dublin is well provided with comfortable 
dwellings for this artisan class, who can, and do, pay 
3s. 6d. to 4s. 6d. per tenement, a rent which returns 
a decent dividend of 4 per cent, to the speculators 
in that form of house property. We ask, why 
should the Dublin Corporation spend the citizens' 
money in catering for comparatively well-to-do 
people at a rate of investment greatly below the cur¬ 
rent in the open market, while it absolutely repu¬ 
diates its duty to the more necessitous poor which 
are its natural charge. 


ts on Current topics. 

School Nominations for the Army Medical 
Service. 

WE understand that the gentleman recommended 
on the last occasion by the Royal College of 
Surgeons, Ireland, at the request of the Director 
General, has been returned on its hands, having been 
found physically ineligible, this not being the first 
time that the College has found itself in the same 
position. While we earnestly sympathise with the 
gentleman who, from no fault of his own, ha9 been 
deprived of what he seems to have regarded as a prize 
within his grasp, we cannot hesitate to express our 
satisfaction that, as far as the Irish College is con¬ 
cerned the nomination system has again broken 
down. We have pointed out that the selection of an 
Army Medical Officer under such circumstances is 
humiliating to the service, to the officer himself, and 
to the recommending college, and is injurious to the 
interests of the Army Medical Officers at large. If 
the gentleman recommended is satisfied to enter the 
Service with the record against him of having got in 
by the back stairs we have nothing to say. We urge 
upon the Director-General, however, thatliis going into 
the highways and byways to gather in the maimed, the 
halt, the lame, and the blind, is a humiliating con¬ 
fession of the failure of the authorities to attract 
the best men, and we again urge upon the Universi¬ 
ties and Colleges that it is, also, humiliating for them 
to mix themselves in the personal jobbery which these 
nominations involve. In our experience the appoint¬ 
ment of a Medical Officer to take charge of the 
soldier has come to be a simple question of the fight¬ 
ing capacity of rival schools and hospitals, and of 
the personal canvass in the interest of individual 
candidates. The moment it becomes known that 
there is a nomination vacancy every tentacle is put 
out by the rival schools and hospitals to secure the 
appointment of one of their own students, and every 
relative of the candidate is put in motion for the 
canvass. Letters flood the tables of the electors and 


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412 The Medical Press. 


NOTES ON CURRENT TOPICS. 


April 19, 1899. 


touts await them in the streets. No doubt the elect¬ 
ing bodies elect a man who will pass muster with the 
authorities, but, beyond this, the merits of the 
candidates or the needs of the soldier have little effect 
on the selection. We insist that such a method of 
obtaining a Medical Officer is discreditable to all con¬ 
cerned, and, as it seems that the authorities intend 
to adhere to it, we suggest that the interference of 
Parliament has become necessary. 

Malthusiasism in Ontario. 

The Deputy Registrar-General for Ontario, in 
calling attention to the low birth-rate of the Province, 
states that it is due to the practice of Malthusianism. 
In the year 1897, the birth rate was only 20 9 per 
1,000, as compared with a similar rate of 29 2 in the 
United Kingdon; 38'57 in Quebec; 36 3 in the 
German Empire ; 35'0 in Italy; 38 0 in Austria; and 
22 - 7 in France. In commenting upon these facts, 
a Canadian contemporary points out that the practice 
of Malthus among the people of Ontario is no secret 
to the medical practitioners of tbe Province, and 
to have a large family is considered by the Ontario 
materfamilias as most undesirable. Hence the de¬ 
clension in the birth-rate. The definite assertion, 
however, by a public official like the Deputy Regis¬ 
trar-General aforesaid, to the effect that the evil of 
Malthusianism is prevalent in the province, is a most 
important matter. It draws public attention to a 
debased practice which reflects seriously upon those ! 
accused of practising it. Here is an official who has ; 
the boldness to positively point to the evil to which 
the practice leads, and thus every married woman in 
the province of Ontario is placed under suspicion of 
conspiring to avoid her maternal duties by resorting 
to means to prevent conception. Have the women of 
Ontario no self-respect, and are they regardless of 
their moral reputation too P 

The Consumption of Tobacco. 

The Chanoellor of the Exchequer, to the surprise 
of the tobacco trade, did not deal with their com¬ 
modity in his Budget address, save to refer to the 
satisfactory revenue which the consumption of 
tobacco yielded to the countiy. A few facts, how¬ 
ever, upon this subject are not without interest. In 
1840 tobacco furnished duty to the imperial ex¬ 
chequer to the amount of £3,500,000 per annum, when 
22,876,641 lbs. were consumed, as compared with 
73,794,197 lbs. last year. The population of the United 
Kingdom in 1840 was 26,487,026, while now it is roughly 
40,000,000. Again, the consumption of tobacco at 
the earlier date was 0 86 lb. per head, as compared 
with 184 lb. per head now, of the whole population. 
Thus there is abundant evidenoe in these figures to 
show how greatly the consumption of tobacco has 
increased, per head, in this country, and the question 
which cannot fail to arise in this connection is, Can 
such high consumption be regarded as tending to the 
public good? Within the last few years immense 
facilities have arisen for the development of the habit 
of smoking. In London especially large firms have 
competed with eaoh other to offer tobacco at cheap 


rates to the public, and so tempting many to smoke 
and indulge more freely in the habit than doubtless, 
in former days, their prudence and means allowed 
them. This greater cheapness in tobacco has also in 
a measure been brought about by the reduction in 
duty of sixpence a pound, introduced by the Chan¬ 
cellor of the Exchequer last year—and possibly this 
fiscal enterprise was dictated by the idea that in 
the end it would lead to a greater revenue from 
one of the most lucrative sources of taxation in 
the country. However, it is impossible to overlook 
the contingency that in the course of years the nation 
will physically not be the gainers by the universal 
growth in the habit of smoking. Medical men are 
frequently called upon to treat oases of tobacco 
toxeemia; and “ tobacco hearts ” are quite a recognised 
source of illness in the present day. The worst 
effects of over-smoking are seen in those who lead 
sedentary lives, and in such even a moderate indul¬ 
gence in the habit is often productive of baneful 
results. But the whole subject affords food for curious 
reflection. The Chancellor of the Exchequer does 
what he can to make the nation smoke in order that 
he may have money with which to build warships, 
while, at the same time, he forgets that he is thus 
doing a good deal to destroy the “ nerves ” of those 
who will be called upon to fight them. 

A Lord Chancellor Druggist. 

Lord Halsbury, Lord Chancellor of England, 
has manifested a determined hostility to the inclusion 
of chemists in the Companies Act, which, if agreed to 
by Parliament, would make it impossible for co¬ 
operative stores and other such traders to carry on 
business as dispensers, unless every man behind their 
counter were a registered chemist. The Chemist and 
Druggist retorts upon the Lord Chancellor by quoting 
from the register of shareholders of Lewis and 
Burrows, Limited, drug stores, the name of 
“ Halsbury, Lord, Peer,” as an investor in the com¬ 
pany for 100 preference shares. Of course, no one 
will imagine that his monetary relation to the ques¬ 
tion could influence Lord Halsbury in the faintest 
degree, but, perhaps, it would have been wise to 
silence cavillers by selling his co-operative shares 
before supporting their system in Parliament. 


The Value of High Altitudes in the Treat¬ 
ment of Tuberculosis. 

The value of high altitudes in the treatment of 
tuberculous disorders has been repeatedly shown in 
the case of human beings, but up to a short time 
ago no observations had been made or lecorded 
regarding the influence of this treatment upon the 
lower animals. A work, however, has recently been 
published in Mexico, giving the results of some in¬ 
quiries into this point, which are distinctly note¬ 
worthy. The authors find that in the lower animals 
tuberculosis is decreased in high regions. For 
example, in 1885, out of 73,000 cattle slaughtered in 
the general abattoir of the City of Mexico, only 45 
were tuberculous. Thus it would seem that cattle and 
men benefit to the same degree when suffering from 


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April 19, 1899. 


NOTES ON CURRENT TOPICS. 


tuberculosis by living at a high altitude. The 
tubercle bacillus cannot flourish in a dry, cool atmo¬ 
sphere, such as high altitudes afford. 

Object Lessons in Ophthalmia. 

After many years of suffering beneath the scourge 
of ophthalmia the Hanwell Schools of the Central 
London School District have been released from a 
burden that at one time was as rife as, say, measles 
or scarlet fever in an ordinary community. At a 
board meeting last week the Medical Officer of the 
Ophthalmic Isolation Schools, Mr. Sydney Stephen¬ 
son, was able to report that he had not a single case 
of ophthalmia from the Hanwell School under his 
-care. Everyone concerned in this desirable result 
may be congratulated on having furnished a valuable 
object lesson to the world at large upon the possibility 
of stamping out ophthalmia. The isolation school is at 
this moment full of children drawn from other unions, 
so that there is abundant opportunity for other Boards 
to go and do likewise. Perhaps these facts may serve to 
stir up Mr. Chaplin, who promised so much a few 
years ago. His scheme was handed over to the Metro¬ 
politan Asylums Board, and a plot of ground has been 
bought, but we still await the schools, and an army 
of Poor-law children in the Metropolis is being inade¬ 
quately treated and improperly housed. Mr. Stephen¬ 
son has shown that by isolation and systematic 
inspection the disease can be rooted out. What 
more is wanted? or does Mr. Chaplin think his 
responsibility at an end now that the matter is with 
the over-worked Asylums Board ? One fact brought 
out in relief in the medical officer’s report was that 
some cases of trachoma, under the most favour¬ 
able conditions, take four years or more to cure, while 
the average is two years. 

The Lord Chief Justice on Secret Commis¬ 
sions and the Medical Profession. 

In a speech at the London Chamber of Commerce, 
last week, the Lord Chief Justice drew pointed 
attention to secret commissions in reference to 
medical practitioners. “Is it not intolerable to be 
told,” he said, “ that medical practitioners—I am 
not attacking the profession as a whole, for 
these cases are the exceptions—would write a 
prescription and have a secret arrangement that 
the chemist shall give them 25 per cent, on the 
amount of the drugs. Again is it not disgusting 
to be told as a fact that if a doctor recommends 
a particular undertaker he gets a slice of the under¬ 
taker's business. Anyone who has taken the trouble 
to look into the matter will know that these are facts. 
They are the exceptions—I hope rare exceptions— 
but where this moral corruption exists it blunts the 
sense of honour and honesty.” Lord Russell, of 
Killowen, is not one given to making statements of 
this nature without being sure of his information. 
But, however this may be, we should still feel 
doubtful as to his “ facts ” unless their authen¬ 
ticity was brought under our personal verification. 
It is so easy to be led into error in regard thereto. 
So far as the arrangement with chemists is concerned, 


The Mrpical Press. 413 

we altogether question whether anything of the kind 
related exists. Medical men, it is true, are apt to 
have an understanding with chemists, but this only 
consists in asking the latter to send them patients, 
in return for which the chemists have the dis¬ 
pensing of their prescriptions. Again, with regard 
to the undertakers, Lord Russell’s remarks seem 
more like the revival of a popular erroneous 
notion than the record of actual “ fact.” The 
papers devoted to comical matters are disposed 
occasionally to make laboured attempts to amuse 
their readers by referring to the supposed liaison 
between doctors and undertakers. But we have no 
hesitation in asserting that even Lord Russell would 
find it impossible to produce a single instance in 
which such a working arrangement as he suggests 
between an undertaker and doctor, exists. We are 
sorry, therefore, that Lord Russell, whose friendly 
feeling towards the profession is well known, should 
have expressed himself in the manner which he has 
done in this matter. He only refers to these cases as 
exceptions, it is true, but, as will be gathered above, 
we take exception to the truth even of his exceptions, 
and, undoubtedly the enunciation of such opinions 
by the Lord Chief Justice and the London Chamber 
of Commerce is calculated to convince the publio 
that the secret commission traffic is not exceptional— 
persons of such authority should not make such 
charges without supporting them by cases. 

The Registration of Midwives. 

This perennial source of controversy lias cropped 
up again, with disgusting regularity, and although, 
as a legislative measure, the immediate future is not 
very menacing, the same old arguments are being 
brought forward orbi et urbe in its favour. It is 
absolutely necessary that it should be made perfectly 
clear to the public that the opposition on the part of 
the medical profession is not based, as alleged, on 
purely interested motives. It is incontrovertible, on 
the one hand, that there is great need for a supply of 
properly trained nurses to attend, it may be, normal 
labour, and to co-operate with medical practitioners 
all over the country. Of midwives proper, that is to 
say, female obstetric practitioners, there is no publio 
need whatsoever, for they could not possibly underbid 
the fees at which duly qualified medical men are 
willing to offer their services, while in the matter 
of skill they must necessarily be hopelessly handi¬ 
capped. Moreover, if it be deemed that there 
is really an opening for female obstetricians, 
the London School of Medicine for Women may 
be looked to to provide them. It is waste of time to 
prove that three or six months’ perfunctory training 
cannot convey a trustworthy knowledge of the sub¬ 
ject, not even to the extent of recognising an abnormal 
labour, at any rate until matters have reached a point 
at which skilled assistance is deprived of much of its 
value. The gist of the controversy lies in the inop¬ 
portuneness of the term “ midwife.” The use of this 
title implies a diploma which in its turn implies, or 
should imply, a special training, which is conspicuous 
by its absence. No one objects to monthly nurses 

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414 The Medical Press. 


NOTES ON CURRENT TOPICS. 


April 19, 1899. 


being trained to their duties, and, if thought desir¬ 
able, to their being registered, but it is above all 
things desirable that women with but a smattering of 
technical knowledge should not be foisted on to the 
pnblio as capable of replacing qualified medical prac¬ 
titioners. 

Cardiac Failure in Medical Men. 

How frequently it happens that death overtakes 
medical men suddenly, generally without warning. 
Sometimes such deaths are more than tragic. For 
example, nothing could exceed the tragedy and 
pathos of the last scene of a man’s life, than that of 
a doctor dying in the sick room of a patient. A case 
of this nature was recently recorded. The medical 
man had called to see his patient, and even while 
feeling her pulse he suddenly fell forward upon her 
bed, and in .a moment he was dead. Within the past 
few months other instances of similar sudden deaths 
of medical men have also been published in the Press. 
There is no doubt that the weakest organ in a 
medical man’s animal economy in the majority of 
instances is his heart. The wear and tear and strain 
to which in the course of a busy active practice 
extending over many years it is subjected, is enormous. 
At first it may be the strongest organ, but as years 
pass, it cannot help but fail in strength. With 
oftentimes incessant night work undertaken by the 
practitioner, what chances has this long-suffering 
organ of recouping itself with much needed rest? 
And so the time comes when it has simply to admit 
that it is worn out, and then its brave struggle ceases, 
and the practitioner dies generally where he stands. 
With many medical men, perhaps, there is an ardent 
desire to die in full harness. How could such a wish 
be moi*e closely gratified than when death overtakes a 
practitioner at the bedside of a patient ? 

The Treatment of Neurasthenia. 

What is known as the “ rest cure ” is greatly in 
vogue in the present day for neurasthenic persons. 
When life has become a burden from the excessive 
turmoil of its modern requirements the rest and peace 
obtained by going to bed and keeping there for a 
long interval has oftentimes proved to be the best, if 
not the only treatment for those whose physical 
oupital has all been spent. The “rest cure" is also 
sometimes applied to horses, that is to say, 
they are put into pastures for a time and 
taken from all work with the best possible results. 
The speed of life in certain occupations to 
which men devote themselves is far too high to be 
maintained for any length of time; such is the 
experience of many in the present day, and it is not 
until they become the subjects of advanced neuras¬ 
thenia that they will see the wisdom of curtailing 
the output of their physical power. Meanwhile 
the “break-up” of their health is the debt which 
Nature exacts under such circumstances, and lucky 
should those consider themselves to be who, by careful 
treatment, are able to recover from its effects. 


Church Bells and Invalids. 

The ringing of the church bell often becomes an 
intolerable nuisance to the invalid, however readily 
use may bring tolerance of its noisy jangling to the 
man who is whole. There is a certain leading hotel 
in the West-end of London that was separated by the 
width of a single thoroughfare from a particularly 
strident church clock. After repeated applications 
had been made, the local authorities took action and 
the clock was silenced during the night. Why not P 
The church clock is not needed in these days of cheap 
and univeral watches. So with the church bells; it is 
a useless relic of barbaric ages, when the congregation 
was scattered and had no clocks and watches, 
or when danger threatened and the bell summoned 
folk from far and wide to the shelter of the church. 
The noisy belfry of to-day is a survival, not only 
useless, but further, an active offenoe to the neigh¬ 
bourhood and a danger to the sick. It is only on the 
rarest occasions that a clergyman has been known to 
8top the bell-ringing in response to the request of the 
friends of a sick, or, it may be, a dying man. In the 
ordinary church the discordant noise is kept within 
more or less reasonable bounds, but in some sectarian 
buildings it may be heard intermittently from day¬ 
break to darkness. Why should so useless and, in 
many ways, objectionable a custom be retained ? In 
some towns, be it remembered, there are half a dozen 
churches in a single street. Lastly, the bells are 
often harsh, and jangle out of tune in a way that must 
spell torture to any invalid within earshot who has the 
least idea of music. 


Another Cancer Organism. 

Dr. Plimmer, of St. Mary's Hospital, has come 
in for a considerable amount of popularity during 
the last few days in connection with his work on the 
parasite of cancer, brought before a recent meeting 
of the Royal Society. He states that he has suc¬ 
ceeded in isolating organisms which, he believes, 
stand in actual relationship to the disease. These 
organisms possess great vitality, and multiply under 
conditions which prove fatal to most other patho¬ 
genic organisms. They are capable of cultivation 
by the means in general use in bacteriological work. 
Inoculated in animals these cultures are followed by 
the production of cancei-ous tumours. Judging from 
the description at our disposal Dr. Plimmer’s 
organisms differ in every essential particular from 
those of Dr. Bra, whose discovery is now receiving 
attention on the other side of the Channel, as an¬ 
nounced by our French correspondent, the latter 
being of the nature of a fungus. In spite of many 
deceptions in respect of this elusive organism, dum 
spiro apero. 


International Congress of Women. 

An assembly of those interested in the social and 
intellectual progress of women is to be held in London 
from June 26th to July 4th. The discussions in the 
Congress will be largely devoted to woman's education 
and work in the medical profession and in musing. 


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April 19, 1899. NOTES ON CLTHH/ENT TOPICS. The Medical Press. 415 


The Limits of Counter-Prescribing. 

The case of Coleman versus Coldwell and Co. 
directs attention to the inconvenience and dangers 
attending counter-prescribing when powerful drugs 
are dispensed. In this case the mother of the infant 
plaintiff went to the chemist for a remedy for ring¬ 
worm, and was given nitrate of mercury ointment. 
There may have been some misunderstanding as to 
the way in which this highly caustic pomade was to 
be used, but in the event violent irritation was set up 
and permanent disfigurement caused. The jury gave 
a verdict in favour of the plaintiff for £5, and in so 
doing they certainly erred on the side of indulgence. 
It is difficult to deny the chemist the liberty, though 
not the right, to respond to a request for a cough 
medicine by prescribing a bottle of some non- 
poisonous remedy ; but for a chemist to dispense, on 
his own responsibility, such a powerful escharotic as 
nitrate of mercury, with or without verbal directions 
for its U8e, is a gross abuse; one, moreover, which we 
should like to see treated with condign punishment. 
They might as well give atropine or morphia, possibly 
with less risks of disaster. We trust the lesson will 
not be thrown away on ph armaceutists whose incur¬ 
sions into the medical domain are likely in future to 
prove more unremunerative than in the past. 

Some Healthy Health Resorts. 

The mortality statistics of certain health resorts 
forthe past year - are both interesting and instructive. 
They show how much can be done for the public health 
by the adoption by the local authorities of an 
enlightened policy in regard to sanitation and the 
enforcement of hygienic principles. The people of 
Bournemouth will be interested to see that their town 
heads the list for lowness of mortality. In this 
popular resort the death-rate last year was only 9 8 
per 1,000; Eastbourne comes next, a very close 
second, with 9 9; Hyde, third, with 10’0. Hove is 
sixth on the list with 124, and Harrogate, 
eighth with 12’8. Congratulation is justly deserved 
by such towns which can maintain their 
reputation as health resorts in this fashion. 
Moreover, an example is thus set which the authori¬ 
ties of other localities favoured by Nature should 
seek to emulate. Capital which is spent in making 
a health resort above suspicion as to drainage and 
water supply is money well invested, for visitors in 
their thousands are largely by this means attracted to 
the town, and prosperity to the townspeople follows 
as a matter of course. 

A Judicial Farce. 

An inquest was held a few days since at Sunder¬ 
land on the body of a man of 25, who came home 
feeling ill, and died an hour or two later. A doctor 
who saw the patient only when he was already mori¬ 
bund, and who said that he had never known that the 
deceased had anything the matter with him, stated 
in his evidence that, “ taking all things together, he 
was of opinion that death had resulted from natural 
causes, most probably phthisis,” and the jury said, 

“ Hear, hear.” Could there be a more lamentable 


judicial farce P No history of illness, and death in a 
few hours. A doctor, called in to the dying man, 
without any post-mortem examination declares, 
“ taking all things together,” that death is due ta 
phthisis. It is difficult to know on which party to 
shower one’s disapprobation, the doctor who gives 
that evidence or the coroner who accepts it! 

The Promotion of Midwives’ Registration. 

The tactics and good taste of the neck-or-nothing 
promoters of Midwife Registration may be judged 
from perusal of the following advertisement which 
they have published in the agony columns of several 
of the London papers 

VV7"ANTED.—The British Public to know 
’ * that this beneficent measure will have 
the effect of reinstating registered women 
exclusively, and with perfect safety in all 
cases, Si c., Ac. 

The statement in this advertisement is not true, but, 
if it were, the publication of it would be equally dis¬ 
creditable. If the opponents of the measure con¬ 
descend to fight with similar weapons, they could 
open the eyes of the “ British Public ” to the spirit 
which animates the Midwives’ Registration 
enthusiasts. 

A Medical Blackleg. 

The union movement promoted by the medical 
practitioners of county Durham is stated by a local 
contemporary to have proved “ successful beyond the 
most sanguine hopes of its members,” but the Ravens- 
worth Collieries have decided against the claim, and 
are stated to have secured the services of an experi¬ 
enced medical practitioner, “ M.D., L.R.C.P. 
L.R.C.S.,” for the usual sixpence per fortnigh 
We regret not being able to give the name of thi 
gentleman whose “ gentlemanly deportment ” seems 
to have enacted such a favourable impression. 

Notification of Mercurial Poisoning. $ 
There will come into force on May 1st next 
under the Factory and Workshops Acts, an order to 
all medical practitioners attending, or called in to 
visit, any person whom he believes to be suffering 
from mercurial poisoning contracted in a factory or 
workshop, to notify the case forthwith, under penalty 
to the Home Office, and for which he is entitled to a 
fee of half-a-crown for each such notification. Forms 
of application will be supplied gratuitously, full par¬ 
ticulars of which will be found in our advertising 
columns. 


Ball ia Aid of the National Consumption 
Hospital of Ireland. 

An aristocratic and exclusive Ball to provide funds 
for this hospital will be held on this (Wednesday) 
evening in the Rotundo, Dublin. Their Excellencies 
the Lord Lieutenant and Countess Cadogan will be 
present, and the patronesses include all the aristocracy 
of Ireland. As the tickets are a guinea each, and the 
applicants will be narrowly scrutinised, it is not 
1 likely that many every-day people will attend. 


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416 The Medical Press. 


SCOTLAND. 


April 19, 1899. 


The Disputed Dundrum (Co. Dublin) Dis* 
pensary Election. 

We learn that the Local Government Board for 
Ireland has intimated its decision that the recent 
election of Dr. Mackey, of Kilgobbin, to the Dundrum 
district, vacated by Dr. Usher, is invalid, and that a 
new election must be held on May 3rd next. It will 
be recollected that a prolonged inquiry was held 
respecting the absence of a voter who, it is alleged, 
was kept away by a bogus telegram. As the full 
report of the Local Government Board on the sub¬ 
ject is not extant, we are unable to judge of the 
grounds upon which the election has been annulled. 

The Royal College of Surgeons, England, 
and its Assessment Appeal. 

The Court of Appeal has dismissed the appeal 
action brought by the Royal College of Surgeons 
against the assessment made upon the Lincoln a Inn 
property of the College, under the Customs and 
Inland Revenue Act, 1885. The Court held that the 
Library, like the other buildings of the College, ought 
not to be exempted from assessment. The sum claimed 
under the Act is £160 per annum. 

Election of Examiners in the Royal College 
of Surgeons, Ireland. 

The College has issued its notices for the election 
of Examiner on the first Tuesday in May in all sub¬ 
jects and for all the several Courts. With the excep¬ 
tion of the Court in Preliminary Education, which 
acts in co-operation with the College of Physicians, 
all examiners must be Fellows of the College. 

The New Inebriates’ Act. 

The first case in which a jury has dealt with an 
habitual inebriate has occurred at Blackburn. A 
drunken prisoner, having been convicted for larceny 
and duly sentenced was then tried as an habitual 
drunkard and, being again convicted, was sent for 
three years to an Inebriate asylum. 

'Several children at Douglas (Isle of Man) were 
poisoned last week by eating hemlock in mistake for 
watercress, and one, at any rate, has died in con¬ 
sequence. When will our Board School authorities 
make rural botany a subject of instruction for the 
young ? It is much more desirable that they should 
be able to distinguish hemlock from watercress than 
Fiji from Van Diemen’s Land. 

A death under chloroform was recently inquired 
into at Liverpool. The victim was a woman, seventy- 
two years of age, who was undergoing an operation 
on the eye. The jury agreed to a verdict of “ Death 
from cardiac failure,” but we should have liked to 
know how much, and by what method, chloroform 
was given. The chances are great that the so-called 
“ open method ” has claimed another victim. 

PERSONAL. 

We understand that Mr. Mackenzie, recently house 
surgeon to the Rathdown Hospital, Dublin, has been 
nominated by the Royal College of Surgeons in Ireland 
for a Commission in the Army Medical Corps. 


Dr. W. Milligan has been appointed honorary aural 
surgeon to the Royal Manchester Infirmary. Mr. 
Joseph Collier, F.RC.S., has been elected honorary 
assistant surgeon to that institution. 

Mr. Jukes de Sttrap. one of the best-known .prac¬ 
titioners in Shrewsbury and the West, has died at his 
residence. The College, Shrewsbury, in his eighty- 
fourth year. He was author of “ Medical Etiquette." 

We regret to learn, while at preso, of the death of Sir 
William Roberts, M.D., F.R.S. He had been suffering 
for some time from an internal affection. We hope to 
publish details of his life and work in our next. 

His Excellency Sir William MacGregor, K.C.M.G. 
C.B., M.D., is about to leave England to take up his 
new position as Governor of Lagos. To-morrow (Thursday) 
he will address the members of the London Chamber 
of Commerce on the subject of “ British New Guinea." 


JSartlattii. 

[from our own correspondent.] 

The Inebriates Act in Scotland. —The Secretary 
for Scotland has sent an intimation to the magistrates 
with reference to the administration of the Inebriates 
Act, that the Treasury wiil make a contribution of 
168. weekly in respect of any person convicted of an 
offence punishable with imprisonment or penal servi¬ 
tude, provided that drunkenness was the cause, or a 
contributory cause, and the offender is found to be an 
habitual drunkard, and is accordingly ordered to be 
detained in a reformatory for inebriates for a period of 
three years, in addition to or in substitution for, any 
other offence. A weekly grant of 10s. 6d. will be made 
in respect of ordinary habitual drunkards ordered to be 
detained in a reformatory for three years, and a weekly 
! grant of not more than 6d. per diem, at the discretion of 
the Secretary for Scotland, will be made in respect of 
each inmate, while out on license for not more than 
three months. The Treasury will also bear the expenses 
of the removal of an inmate from one reformatory to 
another. This scheme of contribution will be in force 
for three years, dating from April 1st of the present 
year, and after that date no Treasury grant will be made 
unless a contribution of not less than 3s. Gd. per week 
per inmate is made by the local authority. Since receiv¬ 
ing the above intimation the Lord Provost has had an 
interview with the Under Secretary for Scotland regard¬ 
ing the Act, and the Magistrates’ Committee have 
resolved to recommend an inebriate reformatory of 
moderate size should in the meantime be established, 
either by the Corporation alone or in conjunction with 
other authorities. 

Town Refuse.—Glasgow Experiment. —Lord Kelvin, 
j and Professor Archibald Barr, of the Glasgow Uni¬ 
versity, have been making experiments on the subject of 
the profitable destruction of town refuse. One experi¬ 
ment dealt with damp ash-pit refuse, containing a large 
proportion of night soil .and vegetable matter from 
markets and shops. This, we understand, was con¬ 
sumed without the slightest trace of smoke, and in 
addition to the solving of the smoke difficulty, the 
residual products proved to be of great commercial 
value. In another experiment the steam produced by 
the process of destruction was utilised for the driving 
of electric-lighting machinery, and also for other pur¬ 
poses. Neither coal nor coke was used in the experi¬ 
ments. Lord Kelvin in his report shows that public 
bodies have no longer any excuse for referring to “ waste 
products,” but have within their reach the means of 
turning the most unpromising kinds of refuse to a 
highly profitable account. 

Glasgow Ophthalmic Institution. —The annual 

eport of this institution, lately issued, shows th at the 


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CORRESPONDENCE. 


April 19, 1899. 


Thb Medical Press. 417 


establishment is in a very flourishing condition, and 
doing a lot of very useful work. During the year 1898 
the out or dispensary patients numbered 12,530, and of 
this number 692 required special treatment as in¬ 
patients, and of these 512 were cured, 168 improved, and 
12 were found incapable of further benefit. The average 
period of residence was 13T days, as against 14 79 days 
in 1897. The number of operations performed on indoor 
patients was 423, showing an increase of 170 over the 
previous year. Many valuable and necessary alterations 
and additions have recently been made in this institu¬ 
tion. A new dispensing department has been com¬ 
pleted, and through the generosity of Mrs. Elder the 
large female ward has been provided with new beds and 
all the necessary furniture and adornments, as also with 
cots for juvenile patients. At present everything is in 
a most satisfactory condition, a ad it is to be hoped that 
such will continue; but when one institution begins to 
vie with another and grand displays are made, we 
become a little anxious, and as onlookers advise caution. 


ittitnch ester. 

FROM OUR OWN CORRESPONDENT.! 


Royal Infirmary. —Much interest has been excited 
by the recent election to the honorary staff. As was ex¬ 
pected, Dr. Milligan and Mr. Joseph Collier have been 
appointed, the former as aural surgeon, the latter as 
assistant surgeon. These gentlemen will be strong addi¬ 
tions to the teaching staff. Both hold lectureships at 
the Owens College. Dr. Fothergill has been appointed 
to take charge of the new Clinical Laboratory in connec¬ 
tion with the hospital. It is probable that further 
changes in the constitution of the honorary and teaching 
staff are not far distant 

A Biological Aspect of Cancer. —Mr. Faraday, at 
the Manchester Literary and Philosophical Society, sug¬ 
gested that cancer growth might be considered as due to 
arrested development at what might be termed the 
crvtogamic as distinct from the phanerogramic stage. 
From analogy it was argued that deficient oxygenation 
of the blood generally, or deficient local blood-irrigation 
might account for cancerous proliferation. It was shown 
that there has been too great a tendency to regard cancer 
as a case for the surgeon rather than for the physician, 
and to give attention to the isolation of a pathogenic 
organism rather than the changes in the environment. 

Lamp Explosions. —Mr. William Thomson has pre¬ 
pared a valuable report upon the lamp explosions which 
have occurred in Manchester and Salford during the last 
few years. He shows the urgent necessity of raising the 
legal flash point of petroleum oil, as distinguished from 
petroleum spirit, to 100 degs. Fahr. 


(EomspmtAence 

We do not hold ourselves responsible for the opinions of our 
correspondents. 


THE LISTERIAN RITUAL. 

To the Editor of The Medical Press and Circular. 

Sir, —In answer to Mr. Bowreman Jessett, I have to 
say first of all, that it was not I who invented the 
phrase, “ Listerian Ritual,” but I adopt it with 
avidity, it so well describes the whole ridiculous business. 
It is after the fashion of the ritualists to claim anything 
and everything that is of use in the treatment of wounds. 
For Mr Jessott to claim Bantock as a ritualist because 
he uses sulphurous acid in treating wounds would be as 
absurd as to claim Lord Lister’s own father-in-law, 
James Syme, as another, because he used sulphate of 
zinc before Lister was born Dewar, of Kirkaldy, int'O- 
duced sulphurous acid for the treatment of wounds long 
before the ritualistic mummery was ever heard of. It is 
not essential that a man shonld be branded as a ritualist 
(in matters ecclesiastic) because he wears a decent white 
surplice. But the constant changes in the ritualism ot 
Lister makes it certain we can never guess what the next 


of their claims will be. “ Heads I win, tails you lose,” 
is their double-headed war-cry. 

I am, Sir. yours truly, 

Lawson Tait. 

195, Newhall Street, Birmingham. 

April 13 th, 1899. 


To the Editor of The Medical Press and Circular. 

Sib,—M r. Jessett seems to have a peculiar faculty for 
misunderstanding both my acts and words. I don’t know 
what he means when he says he has seen me syringing 
out “ abscesses in the abdominal cavity caused by stitches.” 
I have never seen such a case. I have had to syringe a 
suture track, but I have never known one of these com¬ 
municating with the “ abdominal cavity.” The reason 
why I use sulphurous acid in cases of suppuration, is 
that it is the most efficient cleanser I know, because of 
its solvent property. If he will try the effect of carbolio 
acid and sulphurous acid respectively on a mixtuie - 
of blood and water, he will see that the former 
turns it milky from coagulation of the fibrin and 
albumen, while the latter makes a clear solution. This 
is the reason why I use sulphurous acid and not because 
of its supposed antiseptic property. Mr. Jessett ought 
to know by this time that carbolic acid of a strength to 
kill bacteria will destroy the vitality of the tissues. But 
I presume it will be impossible to disabuse his mind of 
an idea which, with him as with so many others, is of the 
nature of a religion or creed. 

I have just received from the Clinical Research 
Association a report upon a sample of fluid obtained from 
a drainage tube in a case of ovariotomy with recent 
parietal adhesions and free ooziog. It is as follows :— 
“ This fluid contains the streptococcus in very small 
numbers, and the bacillus coli communis.” Now, this 
drainage tube was in for four days and ten hours; it 
was emptied exactly fifty times, air entering freely with 
each drawing ; the fluid removed (for the most part very 
bloody) amounted to twenty-three ounces, and at the 
time of the withdrawal of the tube the temperature was 
98'6 degs, and the pulse 86. At the ti me of operation 
they were respectively 99 and 104. Does not this show 
that the presence of these organisms was of no conse¬ 
quence from a pathological point of view ? 

I am. Sir, yours truly. 

Geo. Granville Bantock. 

12, Granville Place, April 15, 1899. 


MEDICAL EXPERTS IN CRIMINAL CASES. 

To the Editor of The Medical Press and Circular. 

Sir, —The writer of the editorial in your last issue 
contrasts the French system or medical testimony in 
Courts of Law with the system adopted in Great Britain. 
In England each litigant employs his own corps of 
doctors to swear whatever is likely to prove his own case, 
while in France the Court employs an expert specialist 
who is supposed to advise the Court independently of the 
interests of either litigant. You say the French plan, 
theoretically at any rate, appears best calculated to 
secure an impartial opinion by a person of recognised 
eminence but, in practice, the medico-legal expert but 
too often follows the lead of the brow-beating juge 
d'instruction, and strains every nerve to secure a convic¬ 
tion. 

My object in writing is to point out that, at the worst, 
the French system is better than oure, and that it could 
readily be made more perfect by paying the expert a3 a 
judge is paid in our country, not by fees, but by a fixed 
salary, amply sufficient to mike him quite independent 
of the ;'uy« d’instruction or anyone else. In our country 
nothing can be more calculated to mislead justioe or to 
discredit our profession than the system of medical tes¬ 
timony. When a suit for damages—say, for personal 
injury—commences, each of the rival solicitors looks out 
for two or three doctors with sufficient repute to “ go 
down ” with a jury, sufficient effrontery and readiness to 
confront a cross-examining counsel, and with consciences 
of good, leathery, durable quality. The next step is to 
ensure a partisan opinion on the part of these doctors by 
putting the desired aspect of the case in the strongest 


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MEDICAL NEWS. 


JLphil 19, 1899. 


418 Ihe Medical Press. 

way, concealing all the facts favourable to the other! 
side, exaggerating all those favourable to their own side, 
and, without saying it, making the witness understand 
that if his testimony is not satisfactory to his employer, 
that he need never expect another retainer for a future 
suit from the same source. Needless to say that a medi¬ 
cal witness, under such circumstances, enters on the case 
with a preconceived judgment, examinee the patient with 
the disposition to find out all symptoms conformable to 
that opinion, and to pass by those antagonistic thereto. 
One of the worst features of this system is that the re¬ 
sult of the suit usually depends on two factors— a, the 
capacity of the litigant or his speculating attorney 
to pay a good “ bar ” of swearing doctors; and, b, j 
the amount of credit which the jury may accord I 
to the opposed medical witnesses. The first of these 
influences ought not to exist in any court of 
law, and iB supposed not to exist under the French 
system ; the second can have full effect only under our 
system, and it is it which places the medical profession in 
the humiliating position whioh it commonly occupies when 
shown up in the witness-box. The jury, dazed with the 
mass of totally contrary medical opinion delivered by 
experts of apparently equal authority, believes neither 
side, and, after delivering a verdict which is but slightly 
influenced by the doctor’s swearing, goes home and out 
into society abusing the doctors and discrediting their 
honesty. 

In my opinion justice will never be done in such cases 
until the opinion of an expert, who is not coached by 
any side, and who may be regarded as a thoroughly 
reliable expert adviser, is available for the assistance of 
the court. If such an expert witness were employed the 
ruck of swearers and counter-swearers would soon find 
their occupation gone. 

I am. Sir, yours truly, 

A. Juryman. 

MEDICAL AID ASSOCIATIONS. 

To the Editor of The Medical Pbbss and Circular. 

Sib, —The tone of your correspondent’s letter in the 
issue of April oth is both dignified and reasonable. He 
protests against the “ touting ” for clients in general, 
and against the Medical Aid Societies as representing 
the forefront of that ethical offence. 

How is the evil to be scotched ? We may well ask 
that question, for it cannot and will not be effected by 
the efforts of those who have to fight the traitor at their 
own gates. However straightforward, manly and united 
the general practitioners of a district, they dare not 
fight the great political and social organisations directly 
or indirectly connected with the medical aid move¬ 
ments. The friendly societies, again, have thrown down 
the gauge of cynical defiance to the medical profession. 
To whom are we to turn for help ? Will the General 
Medical Council come to our aid ? I trow not, until we 
ourselves elect the representatives of our colleges and 
universities, and get a governing body in sympathy with 
our wants, wishes and aspirations. 

Perhaps your correspondent will tell us who is to 
k« bell the cat.” He will find nine-tenths of the profes¬ 
sion at his back if he can give us a lead in this important 
matter. 

I am, Sir, yours truly. 
Another General Practitioner. 


0bitumrt}. 


DE. WILLIAM FEAZEE, OF DUBLIN. 

Although the long illness of Dr. Frazer had prepared 
the public for his demise, yet his death, which oc¬ 
curred on Sunday morning, came as something of a 
shock to the profession in Dublin. Being bom in 1824 
he was 75 years of age at his desth, and, during his mas¬ 
culine life of nearly 50 years, he developed many sides to 
his intellectuality. He was a reliable practising physi¬ 
cian, a clear teacher of the subjects upon which he 
undertook to give instruction, a discreet administrator 
of the institutions with which he associated himself, and, 
in addition, one of the most cultured antiquarians. 


numismatists, and picture connoiseurs in Ireland. Dr. 
Frizer died, as many of his cogeners have done, of the 
sequelae of influenza. He had served his profession not 
only as the author of works on the skin and on Materia 
Medica, and of papers on various subjects which have 
appeared in The Medical Press amd Circular, but 
as a lecturer on Materia Medica in the Carmichael 
School, and on Forensic Medicine in the Old Park Street 
School. He also filled the positions of Fellow, Coun¬ 
cillor, and Examiner in the Irish College of Surgeons, 
besides many other honourable places in other similar 
bodies. 

As an antiquarian Dr. Frazer acquired equal distinc¬ 
tion. He had been a Fellow of the Boyal Irish Academy 
for more than thirty years, a member of its Council, and 
afterwards its Honorary Librarian, in which office he 
succeeded Sir John Gilbert. He was also a Fellow of 
the Societies of Antiquaries, both of Ireland and of 
Scotland. Apart from his scientific pursuits. Dr. Frazer 
enjoyed respect and friendship for his personal qualities, 
having always manifested a genial and conciliatory tem¬ 
perament and a suave manner. 


Jkdiamentitrn ^etos. 


The Midwives Bill. —Mr. Fulton Egerton moved the 
second reading of the Midwives Bill, which, he said, was 
the result of a Select Committee, which sat in 1894 and 
reported favourably on the subject. It was a subject of 
immense interest throughout the whole country. The 
Bill had, he believed, received the acceptance of the 
medical profession through both the Boyal College of 
Surgeons and the Boyal College of Physicians, ana had 
also been favourably received by the United County 
Councils Corporation. Mr. T. P. O’Connor deprecated 
discusaion at such a late hour, and criticised the pro¬ 
vision of the Bill in respect of the training of the pro¬ 
posed midwives. He concluded by moving the adjourn¬ 
ment of the debate, but this was rendered unnecessary 
by the rules of the House, according to which the debate 
stood adjourned at 5 p.m„ after Sir Wm. Priestley had 
spoken in its favour. 

Glycerinated Calf Ltmph.— In reply to Sir B. 
Simeon, the President of the Local Government Board 
said that the Department was not prepared to supply 
glycerinated lymph to all qualified medical men on 
application, though a sufficient quantity was always 
kept on hand. 

Lead Poisoning. —In answer to Sir C. Dilke, Mr. 
Jesse Collings admitted the death of a man at Hanley 
from chronic lead poisoning, but added that the non¬ 
holding of an inquest was a matter within the discre¬ 
tion of the coroner. He admitted, however, that the 
fact of an inquiry by the Home Office was not per se a 
sufficient reason for refusing an inquest, and he 
reiterated the view that an inquest should be held in all 
such cases. He explained the oircumstances under 
which the death in question had taken place—delay in 
precuring and fixing a fan, but gave no hint of any 
measures against the firm for their negligence. 


^tebical ^letos. 

Royal College of Burgeons of England Exaxnlnershtps. 

In our advertising columns will be found the official 
announcements of forthcoming elections to Examiner- 
ships at this college in June next: — 

Four examiners in elementary biology, four in ana¬ 
tomy, three in physiology, four in midwifery, and two in 
public health under the Conjoint Board. 

The Council will also elect four examiners in anatomy 
and four examiners in physiology for the fellowship of 
the Eoyal College of Surgeons ; and on May 11th next 
they will proceed to the election from the Fellows of the 
College of a member of the Court of Examiners in the 
vacancy occasioned by the expiration of the period of 
office of Mr. J. McCarthy, who is not a candidate for 
re-election. 


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PASS LISTS. 


The Medical Press. 419 


April 19, 1899 

Bt. Thomas's Hospital Medical School. I ptoms coincided with excessive doses of bromide. D 


The following scholarships, medals, and prizes have 
been awarded:—Fifth year’s students: Mr. James Gaff, 
the Treasurer’s Gold Medal; Mr. H. J. Horton Smith, 
the Wainwright Prize; Mr. H. T. D. Acland. the 
Cheselden Medal. Third year’s students: Mr. C. N. 
Sears, the first College Prize (.£20) and the Peacock 
Scholarships (.£38 10s.), seoond tenure: Mr. A. F. 
Miskin, the second College Prize (£15). Second year’s 
students: Mr. C. U. Ind, the Mnsgrove Scholarship 
(£38 10s.) ; Mr. W. H. Harwood Jarred, the first College 
Prize (£20); Mr. J. E. Adams, the second College Prize 
(£10). First year’s students: Mr. G. C. Adeney, the 
Tite Scholarships (£27 10s.); Mr. C. M. Roberts, the 
first College Prize (£20) ; Mr. C. H. Latham, the second 
College Prize (£10). 

Tropical Medicine. 

The King of the Belgians, as Sovereign of the Congo 
Free State, has contributed £200 towards the establish 
ment of the London Sohool of Tropical Medicine and the 
enlargement of the Branch Hospital of the Seamen’s 
Hospital Society. The Archbishop of Canterbury has 
also*contributed £50 to the same object. Lord Lister, 
president of the Royal 8ociety, is to be the principal 
guest on the occasion of the inaugural dinner in con¬ 
nection with the Liverpool 8chool for the study of 
tropical diseases on the 22nd inst. Altogether a sum of 
£1,700 has been promised towards the expenses of the 
Liverpool school. 

Society for Belief of Widows and Orphan b of Medical Men 

At a quarterly court of this Society, held on Wednes¬ 
day last, Mr. Christopher Heath, vice-president, in the 
chair, three new members were elected, and the deaths 
of two reported. The deaths of two widows were 
announced; one had been in receipt of grants since 
January, 1870. and had received £1,847 18s., the other 
since July, 1874, and had received £1,429 10s. A first 
application was read from a widow for herself and two 
children, and a grant was made. It was resolved to dis¬ 
tribute £1,201 10s. at the next court to the forty-eight 
widows, twelve orphans, and five recipients from Cope¬ 
land Fund, now on the funds. Sir Thomas Smith, Bart., 
was nominated for election as vice-president at the 
annual general meeting, and the following gentlemen as 
directors:—Mr. Morley, Mr. King, Mr. Leigh, Mr. Gim- 
son, Dr. Samuel West, and Dr. Whipham. It was 
decided to hold the annual general meeting on Wed¬ 
nesday, May 31st at 5 p.m. The expenses of the quarter 
were £58 10s. 

Sent to Prison. 

Mr. Robert Herbert Foot, of North Brixton, was 
last week sentenced to three months' imprisonment for 
gross indecency towards females. The defence was that 
he was suffering from an infirmity “ which often placed 
him in an embarrassing position,” a remark which cer¬ 
tainly covered his then position. 

Mr. Allinson A gain . 

“ Dr.” Allinson appeared at the Marylebone Police 
Court on the 13th inst. to answer charges preferred by 
the General Medical Council of “ wilfully and falsely 
pretending to be a doctor of medicine and licentiate in 
medicine and surgery; and, secondly, of using titles and 
descriptions thereby implying that he was recognised by 
law as a physician.” The magistrate held that the use of 
the prefix " Dr.” conveyed the idea that the defendant 
was a dootor of medicine and fined him £5, with five 
guineas costs, but dismissed the second summons. 

A Dangerous Nostrum. 

On the 11th inst. the adjourned inquest concerning 
the death of Charles Ellis, who died while undergoing a 
so-called course of treatment by the Fanyau remedies 
for epilepsy was resumed. The inquest, as will be re¬ 
membered, was adjourned for the purpose of having' the 
so-called remedies analysed. The analysis was made by 
Dr. Campbell Brown, the public analyst, who stated that 
the medicine was essentially a strong solution of potas¬ 
sium bromide. It appeared that the deceased had taken 
150 or more grains of bromide in a day. That was very 
excessive. There were other substances of no conse¬ 
quence, the proportions being very trifling. The sym- 


Maule said his opinion was that the bromide had a great 
deal to do with the cause of death. This opinion was 
concurred in by Dr. Stanley Bruce Smith, of Liverpool. 
The jury returned a verdict that deceased came by his death 
from coma, accelerated by an overdose of bromide of potas¬ 
sium sold and administered by Oscar Fanyau and Com¬ 
pany, and they made a presentment that Oscar Fanyau 
and Company ought not to be permitted to sell that drug 
under the guise of a fit remedy, and strongly condemned 
them for the false statements contained in their pam¬ 
phlets and letters. They considered that the Legislature 
ought to interfere for the protection of the public against 
the publication of such false statements, and to prevent 
the sale of that drug under conditions so dangerous to 
life. The Coroner added that until the jury was in¬ 
formed by him of the legal difficulties in the way they 
wished to return a verdict of manslaughter against 
Oscar Fanyau and Co., and if they came before him 
again it was probable they would be sent for trial. 


PASS LISTS. 

Royal College of Physicians, Edinburgh; Royal 
College of Surgeons, Edinburgh, and Faculty of Physi¬ 
cians and Surgeons, Glasgow. 

The quarterly examinations in Edinburgh, were con¬ 
cluded on 11th inst., with the following results: — 

First Examination, Four Years' Course.—Of 8 candidates the 
following 4 passedBooert E. Turner, Nigel Oliphant, Ernest 
Saxton, and Frederick C. H. Dady. 

First Examination, Five Years' Course.—Of 20 candidates the fol¬ 
lowing 9 passed Edward H. Knowles, Gideon H. van Zyl. Herbert 
F. Walker. Charles S. Macaskie(with distinction), George L. Baker, 
Albert H. Griffith, Henry Carlaw, Reginald N. Macdonald, and James 

H. Stewart(with distinction). 

Second Ex imination. Four Years’Course.—Of nine candidates, 
the following three passed: —Robert B. Sandiford, James C. Frank¬ 
lin, and Arthur J. Morkill. 

Second Examination. Five Years' Course.—Of twenty-seven can¬ 
didates. the following seventeen passed:—Catharine F. M. Leach 
(with distinction), William S. Cowen (with distinction), John B. 
Mason, Lewis ’Beesly. Topal C. Ghose (with distinction), Basanta 
K. Chatterjee, Jeanie Newton, Arthur T. Hoskins (with distinction), 
Harry F. Wilkin (with distinction), Philip G. Marshall, Herbert 
E. J. Batty, John D. J. Bruce, Alexander W. Frew, William E. 
Graves, Alfred L. White (with distinction), Robert H. Cromble, 
and Henry E. Staniforth. 

Third Examination. Five Years' Course.—Of twenty-two candi¬ 
dates, the following fifteen passed:—Henry E. C. K. Murray; 
(with distinction), David Mitchell (with distinction'. Alexander 
Brownlee, George H.Usmar, William A. O.lCole, David L. Williams, 
Ernest Hill, William M. Browne, Lionel R. Popham, Ernest F. Cox, 
Ewen MacKenzie, Gerald S. Coghlan, Thomas R. Leo hard, Ezra 
Khamis, and Dudley Jeaffreson. 

Final Examination.—Of 65 candidates the following30 passed, and 
were admitted L.R.C.P., L.R.C.S.E. and L.F.P. and S.G.:—W illiam 
C. Carnegie, Herbert H. E. Russell, Elie P. Marett, George W. 
Paule, James E. Ratcbfle, William Carey, Reginald F. N. Overton, 
William M. Paul, Katharine C. Sampson. William A. Pitt. Isaac 
Daniels, Lawrence W. Cock, Cuthbert L. Dunn, Frederick C. Ack. 
land, diaries A. Festins, William L. Cockcreft, Robert M. Quin 
Richard N. Woodley, Robert W. Jubb, Reynold Tarbuck, Robert S. 
Muir, Richard C. Morris. Robert D. C. Rose, .Tnmes W. Barber, 
George Young, George E. A. Thomas, Daniel P. G. O’Sullivan 
William Campbell, Rajabali R. Lakhadhir, and Charles G. Etches. 

Aberdeen University. 

At the Graduation Ceremony on April 7th, the follow¬ 
ing degrees were conferred :— 

Degree of Doctor of Medicine (M.D.):- •William Findlay, M.A., 
M.B., of Aberdeen; George Alex. Reid, M.B., Royal Victoria Hob- 

S ital, Bournemouth ; George Savage, M.B., Beverley, Yorks: Aaron 

I. Sims, M.B., of Sparkbrook, Birmingham; and Robert B. Tydd 
Stephenson, M.B., Berbice, British Guiana. ’Thesis considered 
worthy of “ Commendation." 

Degrees of Bachelor of Medicine (M.B.) and Master in Surgery 
(C.M.) (Old'Ordinanoes)Robert Batchan, A. Rutliwell; Leonard 
Cotterill, Weybridge: Alexander B. Cruikshank, Aberdeen; John 
Halley, Aberdeen; Donald F. Mackenzie, Muir of Ord, Boss; 
Richard N. Petrie, Alford, Aberdeen ; Alex. C. Profeit, Dinnet; and 

J. Sebastian de Silva, Moratuwa, Ceylon. 

Degrees of Bachelor of Medicine, M.B., and Bachelor of Surgery, 
Ch.B.,New Ordinances. Alex. H. Cran, M.A., Nigg. Boss; James 
M. Duncan, M.A., Aberdeen; Cecil V. M. E. Fanu, Cassel, 
Germany; aGeorge A. Finlayson, Aberdeen ; John C. Galloway. 
Oyne, Aberdeen; Arthur N. Haig, Ahmednagar. India; Cliarlea 
Hunter. Badenscoth, Aberdeen ; Francis A. Innes, Skene, Aberdeen; 
John W. Lindsay. Peterculter, Aberdeen; James H. Mackay. 
Aberdeen ; John McPherson, Aberdeen : George A. Mavor, Aber¬ 
deen ; Alex. M. Mitchell, Insch, Aberdeen ; Charles Murray, 
Aberdeen; Alex. Bruce Simpson, Alford, Aberdeen; James A. 
Stephen, Lhanbryd, Elgin -. Lessel P. Stephen, Cong la se, Inverurie; 
William E. Taylor. Aberdeen; James A. Tolmie. Glenglassaugh 
Banffs;and John H. Wilson, Aberdeen. “With Credit.' 


420 The Medical Pbbbs.' 


NOTICES TO CORRESPONDENTS. 


April 19, 1899. 


Notices to 

GLtrrresponbents, §hort ICettero, &r. 


Relations of Bacteriology to Epidemiology. (The date Aprii 14tlr 
wae inadvertently printed on the Sessional Card.) 


ttecancieB. 


Correspondents requiring a reply in this column are par¬ 
ticularly requested to make nse of a distinctive tig nature or 
initial*, and avoid the practice of signing themselves" Reader," 
"Subscriber," “Old Subscriber,” Ac. Much confusion will be 
■pared by attention to this rule. 

Reprints.— Authors of papers requiring reprints in pamphlet 
form after they have appeared in these columns can have them at 
half the usual cost, on application to the printers before the type is 
broken up. 

HOMCEOPATHY. 

Take a little rum, the less you take the better; 

Pour it in the lakes of Wener or of Wetter. 

Dip a spoonful out, and mind you don't get groggy; 

Pour it in the lake of Winipisiogee. 

Stir the mixture well lest it prove it inferior; 

Then put a half drop into Lake Superior. 

Every other day take a drop in water; 

You'll be better soon -or at least you oughter. 

Tri-State Medical Journal. 

Aggrieved. —We cannot insert the communication forwarded by 
our correspondent. The matter is entirely and solely a personal 
one, and as such its publication could not serve any useful purpose. 

THE TREATMENT OF ACNE -A QUERY. 

L. E. M. writes: “ I have a poor patient suffering from acne 
rosacea. He is a bootmaker, and cannot afford the time to attend 
& hospital. I have tried all the usual remedies without avail, and 
I would be much indebted if some specialist in dermatology would 
suggest some means of cure." 

Dr. J. L.—Apply to the Secretary of the College, Lincoln's Inn 
Fields, W.C. 

Student.— The facts are of considerable interest. At the present 
time nearly 200,000 species of plants are known to science. Hippo¬ 
crates was only able to enumerate 234 specimens, but then, of 
course, he lived as long as 500-400 B.C., which is something more 
than a “ mere detail.” 

“Qcjebitor.”— The appointment of additional inspectors under 
the Irish Local Government Board, to undertake the supervision 
of workhouses under the new system, lias been long talked of and 
is much needed, but nothing has yet been done, and we have no 
reason to suppose that there is any immediate intention of making 
such appointments. We are, however, aware that vigorous wire¬ 
pulling nas been going on for months past in favour of certain 
candidates, and it is quite possible that the business is being kept 
close, and that appointments may be made at a moment's notice at 
any time. 

Absit Omen.— Wo believe the risk of live burial to be chimerical, 
but the dread thereof sometimes assumes the dimensions of a 
malady. It is unnecessary to insist on a post-mortem examination 
which, effectual enough, to be sure, in its purpose, is in many 
respects objectionable, It would suffice to leave instructions for 
the electro-contractility of the muscles to be tested before' proceed¬ 
ing to interment. An absolute lack of response to electrical 
stimulation is a thoroughly trustworthy sign of death. 

A Word to the Wish.— Apropos of our present agitation regard¬ 
ing the teaching of physiology in the schools, the following from 
the Medical tinea is worthy of note“ A school teacher at Port 
Allegheny, N.Y., the other day received the following note : 'My 
boy tells me that when I trink beer der overcoat vrom my stum- 
mack gets too thick. Please be so kind and don't interfere in my 
family affairs.’ ” 


Jfteetmgs of the gociettee anb lectures. 

Wednesday, April 19th. 

Royal Microscopical Society (20 Hanover Square, W.).-8p.m. 
Paper:—Prof. L. S. Beale : The Bioplasm of Man and the Higher 
Animal, and its Influence in Tissne Formation, Action, and Meta¬ 
bolism. . _ 

Thursday, April 20th. 

Harveian Society of London (Stafford Booms, Titchborne 
Street, Edgwure Road).—8.30 p.m. Clinical Evening. 

Friday, April 21st. 

Royal Academy op Medicine in Ireland.— Obstetric Section.— 
Papers :—(1) Dr. John Campbell: Two Years' Work in the Samari¬ 
tan Hospital, Belfast.—(2) Dr. More Madden : Treatment of U terine 
Carcinoma.—(3) Dr. Kidd: Notes on a Case of Csesarean Section. 
—(4) Prof. Kinhead, Galway: Polycystic Tumour of the Ovary.— 
Specimens:—Dr. John Campbell: (1) Dermoid Cyst of Ovary 
Removed by Abdominal 8ectiou ; (2) Ovarian Cyst Removed by 
Abdominal Section; (3) Fibroid Tumour of Uterus, Showing De¬ 
generative Changes, Removed by Abdominal Hysterectomy (Inter- 
Peritoneal Method) ; (4) Fibroid Uterus Removed by Extra Peri¬ 
toneal Hysterectomy ; (5) Carcinomatous Uterus Removed by 
Vaginal Hysterectomy : (0) Carcinoma of the Anterior Wall of the 
Rectum Removed by Kraske’s method.—Dr. Smyly: (1) Myoma¬ 
tous Uterus Removed by Doyen's Method ; (2) Tuberculous Ovary 
Removed by Abdominal Section.-Dr. Glum: (1) Microscopical 
Section of Secondary Carcinomatous Nodule from the Lung with 
Carcinomatous Uterus in Inoperable Case; (2) Ovarian Cyst Re¬ 
moved by Abdominal Section. 

Society of Anesthetists (20 Hanover Square, W.).—Papers by 
Dr. G. H. Savage and Dr. H. G. Turney. 

Epidemiological Society of London (11 Chandos Street, Caven¬ 
dish Square, W.).-8.30 p.m. PaperDr. F. B. Blaxall: The 


County Asylum, Bainhill, near Liverpool,— Assistant Medical 
Officer, unmarried. Salary commences at £100 per annum, 
with prospect of increase to £250, with furnished apartments, 
board, attendance, and washing. 

Darlington Hospital and Dispensary.—House Surgeon, unmarried. 
Salary £140 per annum, with rooms in the institution, but 
applicant to board himself. 

Fisherton Asylum.—Assistant Medical Officer. Salary commencing 
at £100per annum, with board, lodging, and washing. Apply 
to Dr. Finch, The Asylum, Salisbury. 

Lewes Dispensary and Infirmary and Victoria Hospital, Lewes. — 
Resident Medical Officer. Salary £90 per annum , furnished 
apartments, board, coals, gas, and attendance. 

Liverpool Dispensaries, 34, Moorflelds, Liverpool.—Assistant Sur¬ 
geon, unmarried. Salary £80 for the first year, and £90 after¬ 
wards, with board and residence. 

Manchester, Chorlton-upon-Medlock Dispensary.—Resident House 
Surgeon. Salary £120 a year, with furnished rooms and attend¬ 
ance. 

Rotherham Hospital and Dispensary.—House Surgeon for three 
years. Salary 100 guineas, with rooms, commons, and washing. 
Also Assistant House Surgeon. Salary £30 per annum, with 
rooms and washing. 

Royal College of Surgeons of England, London.—Various Exa- 
minerships on the Court (see Advt.). 

Stockport Infirmary.—Assistant House and Visiting Surgeon. 
Salary £70 per annum, with board, washing, and residence. 
Also Junior Assistant House Surgeon. Salary £2 per mensem, 
with board, washing, and residence. 

Victoria Hospital for Children, Queen's Road, Chelsea, S W., and 
the Victoria Convalescent Home, Broadstairs.—House Physi¬ 
cian for six months. Honorarium at the rate of £50 per annum, 
with board and lodging in the Hospital. 


JLppomtmento. 

Chalmers, A. K., M.D.Glasg., D.P.H Camb., Medical Officer of 
Health by the Glasgow Town Council. 

Collier, Jobbph, M.B., B.S.Lond., F.R.C.S., Honorary Assistant 
Surgeon to the Royal Infirmary. Manchester. 

Gaylor, Edward, L.B.C.P.Edin., L.F.P.S.Glasg., Medical Super¬ 
intendent at the Belper Joint District Isolation Hospital. 

Hill, Charles A., M.B., B.C., B.A.Cantab., M.B.C.S., Assistant 
Bacteriologist to the Royal Commission on Sewage Disposal. 

Jones, Hugh Edward, M.B.C.8., L.B.C.P., Honorary Surgeon to 
the Liverpool Eye and Ear Infirmary. 

McElligott, Maurice G., D.P.H., L.B.O.P., and S., Deputy 
Medical Superintendent at the Belper Joint District Isolation 
Hospital. 

MacGregor, P., L.R.C.P., F.R.C.S.Edin., Honorary Surgeon to 
the Huddersfield Infirmary. 

McMahon, F. D. Sutherland, L.R.C.P. and S.Ed, Medical Officer of 
the St. Columb Major Rural District Council. 

Martin, R. C., M.B.C.S., L.R.C.P., Junior House Surgeon to the 
Great Northern Central Hospital, Holloway, London. 

Milligan, William, M.D., Honorary Aural Surgeon to the Royal 
Infirmary, Manchester. 

Mon8arrat, Keith W., F.B.C.S.Eng., Assistant Surgeon to the 
Children's Infirmary, Liverpool. 

Moore, H. C., M.R.C.S., Medical Officer of Health by the Hereford 
Town Council. 

Parker, George, M.A., M.D.Cantab., M.B.C S., Joint Lecturer on 
Medical Jurisprud ence at University College, Bristol. 

Rust, Montague, L.R.C.P., L.R.C.S Edin., Assistant House Sur¬ 
geon to the Glasgow Eye Infirmary. 

Willoughby, W.G..M D.Lond., D.P.H.Camb., M.B.C.S,, L.R.C. P. r 
Medical Officer of Health to the Borough of Eastbourne. 


girths. 

Bowie.— April 13th, at 40, Hertford Street, M lyfair, London, W. F 
the wife of Dr. Alex. Bowie, of a daughter (premature). 
Newbolt.— On April 12th, at 42, Catharine Street. Liverpool, the 
wife of George P. Newbolt, M.B.Durh., F.B.C.S., of a daughter. 


^ftarriagce. 


of F. M. Corner, J.P., Poplar, to r-isie lacnam, omy uuuguier 
of Thomas Watson Mackwood, and grand-daughter of the late 
Christopher Tatham, M.R C.S. 

Griffith—Jones.— On April 12th, at St. Mary s Church, Dolgelley, 
Harry Rathbone Griffith, M.D., Portmadoc, to Marv Elizabeth 
Amoyl, youngest daughter of Dr. John E. Jones, J.P. and D.L., 
of Bryn y-Fynon, Dolgelley. . 

Milles—Wills.— On April 13th, at the Parish Church of St. 
Michael, Sittingbourne, Seymour A. Millen, M.R.C.S.Eng., 
L.R.C.P.Lond., eldest son of Alfred MUlen, of Sittingoourne, to 
Mary R. Wills, only daughter of Daniel Wills, of Sittingbourne. 


>RNER -MACKWOOD.-On April 12th, at St. Martin's, Trafalgar 
o __ T. Fnnb IViniDr M R OS. L.R.C.P.. F.G.S.. son 


geaths. 


UANPHIER —On April 12th, at Alford, Lincolnshire, Charles William 
Lanphier, M.R.C.S., L.R.C.S., aged 28. . „ 

Jobekts. On April 16th, at his residence, 8, Manchester Square, 
London, Sir Wm. Koberts, M.D.. F.R S., in the 70th year of 

Howlanda— On April 10th, at King Street, Carmarthen, James 
Rowlands, F.R.C.S., in bis fe5th year. 


oogle 



April 28, 1399 


The MpH 1 ''**! Pros* nnri Olnrufan Advertiser. 


xiii 



* * * * 


PEPSENCIA is an ever-ready digestive fluid, containing all the soluble 
constituents of the gastric juice, preserved in an agreeable 
aromatic menstruum. It represents both the peptic and milk 
curdling ferments obtained directly from the fresh peptic glands. 

PEPSENCIA is acceptable to the most delicate and fastidious patient, 
while it excels all other allied preparations in activity and utility. 

One teaspoonful before or after a meal will be found of service 
in all cases where pepsin is indicated. 

Supplied to the Medical Profession in 4 oz. and 8 oz. bottles, at is. 9d. 

and 3s. each. 

vf* VK Vf* 4* Vf* 4* 4* 

Peptogenic Milk Powder. 

^ ^ 

Cows’ milk prepared with PEPTOGENIC MILK POWDER becomes 
. remarkably like mothers’ milk t in all particulars: in physical 
properties, in colour and taste, and in the percentage of nutritive 
constituents: in its digestibility, its behaviour with acid, with 
rennet, and in the infant’s stomach. 

Milk prepared with the PEPTOGENIC POWDER has simply the 
normal digestibility of mothers’ milk: is not too easily or unnaturally 
digestible, and contains no aid to digestion. It affords a complete 
substitute for mothers’ milk during the entire nursing period. 

Supplied to the Medical Profession in two sizes, at is. 9d. and 3s. 4d. each. 

Specimens and literature will be forwarded on request. 

Originated and Manufactured by 

Fairchild Bros. & Foster, 

NEW YORK. 


Agents for turope, Asia, Africa, and Australasia: 

Burroughs, Wellcome & Co., 

LONDON and SYDNEY. 

c 

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Th« MortUwl Pr*88 and CIroular Advertiser. 


April 26, 1899 



■I.Kill;.IE ■: I fFI "K .11 I'll:' 1 . 1 . IE 11 111 

AN AXIOM IN 

FAT PRODUCTION. 


“ Properly Purified Petroleum is a 
Stimulant and Regulator of the 
Digestive Processes and Incident¬ 
ally a Fat Producer.” 

ANGIER’S PETROLEUM EMULSION 

possesses what animal and vegetable oils lack, namely, 
—a marked antifermentative power whereby bacterial 
action is inhibited and the absorption of toxic pro¬ 
ducts is stopped. The anaemia resulting from the 
toxaemic condition disappears, the red corpuscles accu¬ 
mulate a new store of haemoglobin, the quiescent cells, 
supplied with an abundance of oxygen., revive, and 
the whole system, stimulated into healthy activity, 
carries on with normal vigour the complicated pro¬ 
cesses of metabolism. 

Gain in flesh and Strength 
follows as a natural 
sequence. 


FREE SAMPLES TO THE MEDICAL PROFESSION. 


fgr OAUTION 1 .—When prescribing be careful to specify ANGIES’S Emulsion; otheririse 
some disappointing imitations made with ordinary petroleum may be substituted. 

THE ANGIER CHEMICAL GO., Ltd., 

31 & 32 SNOW HILL, LONDON, E.G. 

MmjmmJMiM .■ Bt^l^Il 1.ftftHftft ft 

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Throat and Lungs, 

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foa D«am o» tn* 

Digestive Apparatus. 



Anficr Chemical Company. 

O«*lon. 1 . S. A. 




























April 26, 1899 


The Medloal Press and Circular Advertiser. 



Ip 

Mmimms. <$>* j 


A A A A A 


‘Lanoline’ 


The most natural, stable and elegant 
base for all medicated ointments. 
Its absorbent qualities are unique. 
Supplied in tins, at 2s. 8d. per lb.; 
anhydrous, 3s. 4d. per lb. J* J* 


Toilet 

‘Lanoline* 

A delightful and effective natural 
<Hn emollient possessing great soothing 
properties. In collapsable tubes, at 
4s. 6d. and %. per dozen. J* 




‘Lanoline’ 

Toilet Soap 

Is carefully superfatted with 'Lanoline.' 

It is soothing to the most delicate or 
sensitive skin, and renders the hands 
beautifully smooth and supple. In 
boxes containing 3 tablets, at 4s. 6d. 
per dozen tablets. j * 

Sole Licensees— 

Burroughs Wellcome & Co , 

LONDON and SYDNEY. 


IcopKmamJ 


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Google 












XVI 


The .Medical Press and Circular Advertiser. 


April 26, 1809 


NEPENTHE- 


The Safest and Best Preparation of Opium. 

PRODUCES NEITHER HEADACHE, SICKNESS, NOR CONSTIPATION. 

PREPARED EXCLUSIVELY FROM OPIUM. 


THE BEST 
FIFTY YEARS AGO. 

“ 7 GH08VKN0B StBKBT, 

“ Gbosvenob Sqcabe, 

“ October, 1847. 

“ Sir— 

“ Having for the last eight or nine 
year’s prescribed your * Anodyne Tinc¬ 
ture’ in all oases requiring Buch a 
remedy I am induced to speak of its 
effects both as a Sedative and an 
Anodyne in the highest terms The 
sleep produced by it is more refreshing 
and more allied to natural sleep than 
that arising from the use of any other 
narcotic with which I am acquainted. 

“ One of its greatest advantages, how¬ 
ever, is that it does not act as an astrin¬ 
gent aooording to my experience, nor 
does it produce any of the unpleasant 
effects whioh usually accompany the 
use of this class of medicine. 

“ I remain, 8ir, 

“Your obedient servant, 

“ 8. Mubchison, M.R.C.8." 

[Certificate.] 

“ Nepenthe or Anodyne Tincture. 

“ I have had many opportunities of 
witnessing the very excellent effects of 
4 Anodyne Tincture ’ in the numerous 
affections where an opiate is deemed 
advisable. It gives no headache, does 
not interfere with the proper action of 
the bowels, it rather promotes than 
diminishes appetite, and gives tranquil- 
ising and refreshing sleep in many very 
painful nervous affections. 

“ With such strong recommendations 
I consider it an invaluable preparation 
of opium. 

“ CHABLE8 GbEVIIXE, M.D., 
"Physician to Bath Institution for 
Diseases'of the Chest, &c. 

Bath, Sept. 24th, 1848." 



ANODYNE tincture 

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'ress and Circular. 


“SALUS POPULI SUPREMA LEX.” 


Vol. CXVIII. WEDNESDAY, APRIL 26, 1899. No. 17. 


(Original Commumtaiume. 


DEATHS AFTER ABDOMINAL 
CCELIOTOMY. (a) 

By W. J. SMYLY, M.D., 

Gynaecologist to the Adelaide Hospital, Dublin. 

Though the views I hold are shared by the majority 
of operators at the present time, and may, therefore, 
seem trite and lacking in originality, yet so rapid have 
been the advances in abdominal surgery in recent 
years that I think the Council of the British 
Gynaecological Sooiety have acted wisely on this 
occasion in calling a halt in order that we may see 
how far it is possible to fall into line, and that we 
may count the cost of our operative procedures. And 
as regards the causes of death after abdominal opera¬ 
tions, I know that there is among the Fellows of this 
Society a sufficient divergency of views to render the 
discussion of the subject both interesting and 
instructive. To some, fatalities after cceliotomy are 
attributed almost exclusively to the invasion of the 
peritoneum by micro-organisms; whilst to others this 
is of secondary importance, and to others again of no 
importance at all; so that the subject cannot be 
regarded as closed to discussion, and, remembering 
that a majority, however great, is not necessarily in 
the right, we should put aside partisan feeling, and 
approach the discussion with a simple desire to know 
the truth. 

Among the causes of death after cceliotomy more 
or less due to abdominal conditions are :— 

1. Shock. 2. Hemorrhage. 3. Ileus. 4. Uraemia. 
6. Inanition. 6. Tetanus. 7. Embolism. 8. Sepsis. 

Shock .—Though weave familiar with the symptoms 
it is difficult to define the nature of this condition, to say 
that it is “ a profound impression made on the nerve 
centres and indicating extreme depression of the 
putient’s vital forces ’ 7 is rather vague, whilst the 
statement that “ it is due to exhaustion of the medulla 
oblongata and spinal cord leading to a great reduction 
in the vital activity generally, and resulting from 
severe irritation of the peripheral ends of the sensory 
and sympathetic nerves,” is in the present state of our 
knowledge too precise, nor does it include all the 
cases which present a common group of symptoms, 
but in some of which there has been no marked or 
prolonged nerve irritation, as, for example, those 
resulting from anaesthesia, haemorrhage; or one 
recorded by Fritsch, where an ovary was removed in 
five minutes, and yet for hours afterwards the patient 
remained in an alarming condition of the profoundest 
shock. It appears then that the term shock applies to 
a group of symptoms which may be due to a variety 
of causes, but is generally in direct proportion to the 
magnitude and duration of the operation, especially 
when associated with long exposure and manipula¬ 
tion of the intestines, to the amount of blood lost, and 


a Paper read before the British Gynaecological Society, 
1 13th. 1899. 


the cooling of the body generally. Patients already 
debilitated by disease, such as canoer, bleeding 
myomata, and granular kidneys, bear operations 
badly, and also those with “ weak hearts.” Not so 
much valvular disease as what is commonly under¬ 
stood by this term, namely, hearts with rapid and 
weak action, whether this be due to imperfect 
development, degeneration of tissue, previous illness, 
or nervous excitement. Failure of the heart is one 
of the most prominent features in shock, and it is 
a matter of common experience that women who ac¬ 
cept their position with quiet resignation are less 
affected by it than those of a nervous temperament, and 
that where anxious days and sleepless nights have pre¬ 
ceded an operation, the heart, worn out by nervous 
palpitation, fails to meet the extra demand which 
may be made upon it. Not only may this cardiac 
insufficiency prove directly fatal, but it may, as 
pointed out by Fritsch, do so indii-ectly; for not the 
circulation of the blood only but also the movement 
of all the fluids in the body, depends upon the heart’s 
action. If the heart be strong, or if it soon recovers 
after operation, the circulation of the blood and the 
flow of lymph continue normal; as also the currents 
in the peritoneal cavity, where absorption takes 
place with extraordinary rapidity; lymph, blood, and 
micro-organisms are canned away through the lym¬ 
phatics into the circulation, where the latter are 
rapidly destroyed or rendered harmless by the blood, 
Nature's great antiseptic. But for this to occur 
three things are necessary: first, there must not 
be too many cocci; secondly, there must lie a 
sound heart; and an undisturbed circulation; and, 
thirdly, the functions of the peritoneum must be 
normal. Where the beai^t is weak, and continues so, 
the flow of lymph is impeded, peritoneal absorption 
is diminished, or ceases altogether, and a fluid 
collects in its cavity forming a stagnant culture 
medium eminently suitable for the development of 
germs, which are seldom altogether absent even after 
the most aseptically conducted operation. There 
exist, then, a number of peripheral dangers which a 
strong heart could overcome, out which with a weak 
heart may prove fatal. Not only do the causes 
already mentioned cause depression of the heart’s 
action, sluggish circulation, diminished absorption, 
and suppression of urine, but exposure and manipu¬ 
lation of the intestines is followed by derangement 
of the physiological functions of tne peritoneum. 
These injurious effects are observable in the con¬ 
gested and disordered circulation, the dilated 
blood vessels and the reddened and lustreless 
peritoneum. The muscular and mucous coats par¬ 
ticipating, peristalsis becomes weak, or ceases alto¬ 
gether ; the mucous membrane swells, and ceases to 
absorb; much flatus forms and is not expelled ; there 
is excessive tension in the intestines, and under such 
circumstances a passage of their contents into the 
peritoneal cavity is possible. We know that white 
Dlood cells can escape, and in them, with them, and 
apart from them doubtless intestinal bacteria also. 

Fritsch, who has drawn especial attention to this 
subject, attributes these changes to air contact and 
pressure changes, rather than to cooling and mechani¬ 
cal injury ; though he says they are doubtless aggra- 


Digitized by v^ooQle 






422 The Mbdicai Pbefs. 


ORIGINAL COMMUNICATIONS. 


Apbil 28, 1899. 


vated by rough treatment of the peritoneum with 
unsuitable materials when the intestines are rubbed 
and dragged about in performing the peritoneal 
toilette, or where chemicals are introduced into the 
peritoneal cavity. 

Walthard. of Bern, however, from a series of 
experiments on animals, came to the conclusion that 
the injury was due to the drying qualities of the 
atmosphere; though he did not deny that it might in 
some measure be due to its coldness causing contrac¬ 
tion of the blood-vessels and imperfect nourishment 
of the serosa. He, therefore, warned operators against 
drying the peritoneum, and recommended the use of 
moist compresses wrung out of sterilised salt solution. 
Sanger, of Leipzig, adopted these views, and Schiffer, 
his assistant, reported much better results, especially 
the earlier return of peristaltic action and expulsion 
of flatus since the introduction of moist asepsis. 
Uhlmann, however—assistant to Professor Zweifel in 
the same city—states in a recent publication that no 
apparent benefit has resulted from moist asepsis, 
which is inferior to the dry in other matters, especi¬ 
ally as a hemostatic. With these latter views I am 
inclined to agree and prefer the dry compresses taken 
directly from the can in which they have been steri¬ 
lised, excepting only those which directly cover the 
intestines, since the latter are liable to adhere to the 
dry cloths. 

These cases present, according to Fritsch, peculiar 
clinical and post-mortem appearances. The patient 
awakes from the anaesthetic with a peculiar anxious 
feeling, embarrassed respiration, and a feeble heart. 
She complains that the binder is too tight. The 
intestine is paralysed, tympanites occurs without 
fever, the tongue is dry, and the pulse is fast, and 
grows faster and faster. The sensorium remains 
clear, but the weakness and anxiety increase. On the 
evening of the second day, or later, fever sets in, the 
tympany increases, the pulse grows thready, and the 
patient dies. 

This, he contends, differs from sepsis, because as 
acute septic condition could not develop within an 
hour of the operation. Fever sets in early in sepsis, 
late in these cases, and the fact that one patient may 
die in this way, whilst others operated upon the same 
day make good recoveries, proves that no serious 
error in asepsis has been made. There are peritoneal 
symptoms no doubt, but not peritonitis, since there 
is neither fever nor tenderness, and these cases often 
recover, whereas the acutely septic invariably die. 
Such patients become septic towards the end, but 
cardiac weakness is the prominent symptom through¬ 
out ; and they die not because they are septic, but 
they become septic because they are dying. 

The better results obtained by vaginal methods 
he believes to be due to the peritoneum retaining its 
physiological functions, which are not altered by con¬ 
tact with the air, cooling, or pressure changes; and 
he holds that the excellent results obtained by Lawson 
Tait, Bantock, Koeberle, and others are due to rapid 
and careful operating, whereby central and peri pheral 
injuries are so slight that the functions of the heart 
and peritoneum are little interfered with. 

It may, perhaps, be wrong to consider haemorrhage 
in connection with shock, but there can be no doubt 
that a large number, if not the larger number, of 
cases reported as deaths from shock have been due 
to loss of blood during or subsequent to operation. 
Haemorrhage after operation may be due to the 
slipping of a ligature which has been improperly 
applied, from denuded surfaces, or torn adhesions, 
omental vessels, or from puncture of an epigastric 
artery, when inserting the abdominal sutures. The 
spouting of a large vessel soon gives rise to symptoms 
easily recognised, but a small oozing is more easily 
overlooked. It occasionally happens that owing to 


heart failure the bleeding ceases altogether, or appears 
so insignificant that the abdomen is closed ; but after 
the patient has been put to bed and warmth and 
stimulants employed, with the recovery of the circu¬ 
lation the haemorrhage returns, and its symptoms 
may be confounded with those of shock. 

Zweifel has laid particular emphasis upon the im¬ 
portance of absolutely checking all oozing before 
closing the abdomen, especially where much loss has 
occurred during an operation. After severe haemor¬ 
rhage, he says, the heart works with half-filled 
vessels, the demands upon it are increased, and it 
works with great rapidity. If the bleeding point has 
been secured and the circulation enclosed within 
itself it gradually refills; all the organs and tissues 
pouring serum into it. The functions are gradually 
restored, the patient comes round by degrees and 
climbs step by step back to life. 

But if, on the other hand, even a small haemorrhage 
goes on it works against the heart’s action both 
dynamically and reflexly. When the latter improves 
the hemorrhage increases ; as more serum flows into 
the circulation the blood becomes more watery, less 
cosgulable, and thus less adapted to the spontaneous 
closure of the bleeding vessels. The heart working 
with a half-filled circulation aggravated by even a 
small continued loss he likens to a steam engine 
working a ship's propeller, which lifts out of the 
water, or a locomotive when t^e wheels slip upon the 
railB. The mechanism is imperfect paving lost its 
accustomed grip, it resembles a pump insufficiently 
supplied with water. It is, in fact an empty pump¬ 
ing heart which authors term shock. 

Late or secondary shock has been described, but 
I have never met with an example, and am inclined 
to attribute the fatal issue in cases that I have seen 
recorded to secondary haemorrhage, sepsis, or the 
giving way of sutured viscera, especially intestine. 

Preventive Treatment of Shock .—In weak and 
debilitated patients with weak hearts and rapid pulse 
operation should be if possible postponed or aban¬ 
doned. The operation room should be heated to 75 
or 80 degs. F., prolonged exposure of the surfaoe of the 
body but especially of the intestines, should be care¬ 
fully guarded against. The loss of blood should be 
reduced to a minimum, and the first symptoms 
of depression carefully watched for and actively 
treated. 

Treatment of Shock —I think we are pretty well 
agreed as to the main lines of treatment in these cases 
Hemorrhage should at once be controlled, and where 
the loss has been considerable, sterilised salt solution 
infused either into the subcutaneous connective tissue 
or directly into a vein. In my practice in the Rotunda 
Hospital I formed an unfavourable opinion of the 
former, and abandoned it in favour of intravenous 
infusion, but the apparatus of Munch meyer, which I 
employed, was imperfect compared with that used 
by Dr. Howard Kelly in the Jonns Hopkins Hospital, 
by which a large quantitv of solution can be more 
rapidly infused witn a fall of six feet, and it is so 
strongly recommended by him that I am inclined to 
have recourse to it should the occasion occur. In all 
cases of shock, whether due to loss of blood or other 
causes, the patient should be placed in a warm bed 
between blankets with her head low, heat should 
i be applied by means of hot water bottles, 
enemata of hot saline solution and stimulants 
administered. The best enema in such a case 
is, according to Dr. Kelly, one containing two ounces 
of brandy, twenty grains of carbonate of ammonia, 
and hot water or beef tea to eight ounces. At the 
same time brandy, ether, and strychnine are ad¬ 
ministered hypodermically. Opinions differ with 
regard to morphia, but I think its use should be 
restricted to cases in which pain is an important 


Diqi- 



LV~ 




April 26, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press, 423 


factor in the nervous depression. Excepting in cases 
where loss of blood has been considerable, saline in¬ 
fusion is of little value, though in some cases of pro¬ 
tracted shock, it might, as Mr. Watson Cheyne has 
pointed out, prevent coagulation of blood in the 
pulmonary vessels, a recognised cause of death under 
such circumstances. 

Ileus is one of the greatest disappointments that 
an abdominal surgeon encounters. I have lost two 
patients from this cause during the past year, one 
twelve months and the other six years after opera¬ 
tion. The former occurred in England and nothing 
was done; the other came into hospital on the 
sixth day after obstruction, too late to save her 
life. Excluding cases of paralysis due to peritonitis, 
ileus is generally due to adhesion of intestine to raw 
surfaces, either the abdominal wound, the stump or 
pedicle, omentum, or surfaces denuded in enucleating 
tumours or breaking down adhesions, constriction of 
bowel by bands or from a coil of intestine slipping 
through a hole in the omentum, kinking of intestine 
or volvulus. Cauterised surfaces and those deprived 
of epithelium by abrasion have been blamed for this 
accident, but this has been denied by others and it is 
doubtful whether such injuries would cause adhesion 
unless deeper structures were destroyed. It has also 
b**en stated that septic infection is necessary, but 
experiments haye shown that this is not the case, 
and that with the moBt rigid asepsis adhesions as a 
rule take place. When intestines are long exposed 
and mucn manipulated, they undergo changes to 
which I have already alluded, and adhere together. 
Walthard found that where the peritoneum 
had been long exposed the superficial epithelium 
perished, and an inflammatory demarcation formed 
between the dead and living tissues. If two surfaces 
thus affected remained in quiet contact they adhered. 
If they were not so left fibrous changes only occurred, 
nor would a surface so affected adhere to a normal 
one. Siinger, as I have already mentioned, adopted 
these views, and attributed some cases of fatal ileus to 
the use of dry asepsis ; but Uhlmann states that in a 
number of cases in which the abdomen had to b9 
opened a second time in Zweifel’s clinic they always 
found adhesions to the wound, to £h? stump, or to 
places denuded of peritoneum, but never between coils 
of intestine that had been exposed to tbe air, and I 
think that this will be found to coincide with the 
experience of most operators. The early diagnosis of 
this complication is of the utmost importance, but 
unfortunately this is often impossible. Where the sym¬ 
ptoms set in suddenly with violent paroxysmal pain 
in a localised position, where the peristaltic action of 
the intestine can be seen and felt through the abdo¬ 
minal wall, and the patient lies prostrated between 
the attacks bathed in cold perspiration. Where 
neither flatus nor faeces are expelled after energetic 
efforts to procure evacuation, where vomiting sets 
in after the second or third day, and the abdomen 
becomes distended, an error is scarcely possible, but 
such a stormy onset is exceptional, and most of these 
symptoms are simulated by other conditions. The 
obstruction may even be incomplete, and the bowels 
may be evacuated at intervals, and yet the patient 
may be lost. In any case, active measures should be 
at once' employed to induce the bowels to act, the 
stomacn should be washed out, and copious enemata 
administered with a long tube, and where the stomach 
can tolerate it calomel, Glauber’s, or Epsom 
salts administered. Should these measures 
fail, the abdomen should be reopened with¬ 
out further loss of time. The earlier the gut is 
freed the better is the prognosis. As to prophylactic 
measures, Trendelenburg’s position is one of the 
most important, since the bowels are out of the way 
and are not disturbed, but especial care must be 


taken when the patient is restored to the horizontal 
in arranging the intestines in their normal position, 
and seeing that they preserve their natural relation 
to the omentum. Coating raw surfaces with collo- 
dium has been recommended, and Martin of Berlin 
introduces a sponge soaked in sterilised oil, but most 
operators attach more importance to drawing down 
the omentum between the abdominal wound and the 
intestines, and as far as possible covering all raw 
surfaces with peritoneum. 

Thrombosis occurs from septic infection, or 
from prolonged pressure of pelvic tumours upon 
veins, or sluggisn circulation due to the quiet 
recumbent posture or the change in the intra¬ 
abdominal pressure due to the removal of large 
tumours. As thrombus is a potential embolism, and 
as it may be set free even at a late period, patients 
should be cautioned against violent efforts or strain¬ 
ing for some time after an abdominal operation. I 
lost a patient from this accident during the third 
week after operation; she had been sitting by the 
fire talking to the other patients, and was in the act 
of pulling off her boots when Bhe suddenly was 
seized with a feeling of suffocation, precordial anxiety, 
gasping respiration, cyanosis, and died in a few 
minutes. 

Of Tetanus I have had no personal experience. 

Peritonitis. —A question of much importance is 
whether peritonitis is always septic. Many would 
answer this question in the affirmative, but there is much 
to be said on the other side. There is a condition called 
traumatic or plastic peritonitis, it is best marked in 
cases where the intestines have been long exposed 
and much manipulated, and where wide areas of 
adhesion have been separated. In the worst forms 
of this affection there is vomiting, severe pain in the 
lower abdomen, tympanites, tenderness on pressure, 
accelerated pulse, and elevation of temperature. 
Death may resalt in such cases from pressure of the 
distended intestines on the diaphragm or from ileus. 
The treatment of this condition recommended some 
years ago by Mr. Lawson Tait, namely, free purga¬ 
tion, is, I believe, at the present time the recognised 
method. The non-infective character of many of 
these inflammations has been proved by Dr. Howard 
Kelly, who, when obliged to reopen the abdomen to 
relieve obstructed bowel, found extensive union 
between adjacent peritoneal surfaces, but these cases 
failed to show any kind of micro-organisms in the 
peritoneal cavity, and yet tbe evidences of the pour¬ 
ing out of a plastic lymph with the subsequent 
formation of adhesions were abundant. 

Septic Infection. —I now come to septic in¬ 
fection, the most important part of our subject, 
including the germ theory of disease, yet how 
can I deal with it in such an assembly as 
this p What can I add to all that has been 
already said and written upon the subject P The 
art played by living organisms in the production of 
isease has been most firmly established by “ many 
infallible proofs,” and appears to me as certain as the 
law of gravitation or the shape of the earth. I shall 
not therefore try your patience by repeating the 
arguments now upon whicn the germ theory is based, 
nor shall I describe in detail the various conditions 
to which the introduction of such organisms to the 
human body during abdominal operations may give 
rise. I would rather devote the few remaining 
moments allowed to me in considering how best their 
entrance may be prevented, and the effects of such 
contamination treated. 

Some who place their faith in procuring absolutely 
aseptic conditions spare no pains in attaining this 
object, whilst others regard such extreme precautions 
as superfluous, and laugh at those who practioe them 


boogie 


ORIGINAL COMMUNICATIONS. 


424 The Medical Press. 


April 26, 1899. 


as extreme ritualists; Borne even discarding all pre¬ 
cautions excepting cleanliness, and attributing their 
success to perfect technique and skill in operating. 
For myself, I must confess that I am a ritualist. 
Since deaths from infection still occasionally occur, 
we cannot flatter ourselves that we have reached per¬ 
fection, though even at present such fatalities are 
more often due to imperfection in carrying 
out alreadv aoquired knowledge than in the 
lack of reliable information. Most of us have, 
I imagine, passed from antiseptic to aseptic 
methods in tne treatment of wounds; the former 
method went too far, in that fresh wounds and 
healthy peritoneum were treated as if they were 
septic,’ whilst on the other hand chemical agents 
were not absolutely efficient in the prevention of 
infection. The present aseptic treatment consists 
essentially in perfect cleanliness, and whatever others 
may say I have no hesitation in stating that the 
doctrine of cleanliness originated with and has been 
based upon the teaching and practice of Lawson Tait 
and Bantock. Years ago, whilst most of us were 
practising antiseptic methods, they, in the face of 
bitter opposition, insisted upon the importance of 
perfect cleanliness, and pointed out the injurious 
effects of chemical substances in irritating and 
poisoning the tissues. And at the present time we 
differ from them only in the meaning of the word 
perfect, for, whilst they are satisfied with ordinary 
cleanliness, we strive after and in a great measure 
obtain not only macro, but also microscopic, cleanliness. 
By perfect asepsis, then, we understand that every¬ 
thing which comes in contact with the field of 
operation must be absolutely pure. Everything 
includes not only the operator and his assistants, his 
instruments and dressings, but also the air and water. 
An operation may be carried out aseptically in any 
ordinary room, but this is achieved with great diffi¬ 
culty and risk, so that in my opinion so serious a 
proceeding as cceliotomy should, except under peculiar 
circumstances of emergency, always be performed in 
a special apartment so constructed that absolute 
cleanliness can bo insured with pure air free from 
draughts, ample supplies of pure water and good 
light, and heated to about 80 degs. F. The operating 
theatre in the Rotunda Hospital is divided into two 
parts by a glass screen, in the first of which are 
placed the basins, sinks, instrument cases, sterilisers, 
and platform for spectators, all of which are indis¬ 
pensable, but would be difficult to clean with sufficient 
ease and rapidity, especially where several operations 
have to be performed in succession. Their absence 
from the inner compartment enables its furniture to 
be so simple that it can be thoroughly hosed out in a 
few minutes. 

A pure atmosphere, free from draughts and dust, 
and uncontaminated by spectators, is obtained by 
its complete isolation, its simplicity of construction, 
and the cleanliness and dampness of its walls. Whilst 
the high temperature of the inner compartment 
enables us to dispense with blankets, maintains the 
patient's vitality, lessens shock, and dissipates mist, 
the outer compartment is so cool that the spectators, 
though dressed in their ordinary clothing, suffer no 
inconvenience. 

Lastly, it enables the spectators to approach close 
to the operation without any risk of disturbing the 
operator or meddling with his arrangements. 

Where an operation has been carried out with 
thorough aseptic detail and hemorrhage completely 
arrested, drainage, one of the most important aids to 
success in former times, is now but rarely needed, 
but can never, I fear, be entirely abandoned. 

With regard to the after-treatment of septic cases, 
I shall only state that I place most reliance upon 
alcohol; of antistreptococcic serum I have had but 
little experience, and that of a not very favourable 


kind. The reopening of the abdomen and thorough 
washing of the cavity I view in a pessimistic manner, 
though Howard Kelly speaks of it with approbation. 
The chief difficulty is diagnosis, for when this is clear 
it is generally too late to interfere. 

In conclusion, I may epitomise these somewhat 
fragmentary remarks with the advice of Doyen, 
Operer vite et bien. 

NOTES ON 

FOUR CASES OF INTUSSUSCEPTION. 

By ALBERT E. MORISON, M.B., F.R.C.S., 

Hon. Surgeon Hartlepool® Hospital. 

Case I.—M. R., ait. 3 months. First seen January 
21st, on account of intermittent attacks of crying, 
accompanied by diarrhoea. Duration, four hours. 

History .—The patient had been apparently per¬ 
fectly well all day. Immediately after her evening 
bath she began to screech as if in pain, and to draw 
her legs up. These symptoms continued more or less 
constant for two hours, when diarrhcBa set in. The 
stools, at first natural, soon became mucoid and 
tinged with blood. I was sent for about 11 p.m. 
The child had always been difficult to feed, owing to 
gastric catarrh, and its mother’s milk was so scanty 
that artificial substitutes had to be resorted to. The 
bowels had been constipated since birth. I foimd the 
infant lying in a restless sleep on its mother’s knee. 
It was roused at intervals of ten or fifteen minutes 
apparently by griping pain in the bowels. The par¬ 
oxysm was ushered in by a shriek. The legs were 
drawn up and the child writhed about in agony. At 
the same time the bowels acted. Sickness was also 
frequent. There was nothing abnormal to be seen 
on inspecting the abdomen. On palpation the abdo¬ 
minal walls were tense, and there seemed to be some 
tenderness on pressure, but nothing abnormal could 
be detected. Per rectum nothing could be felt. As 
the symptoms all pointed to intussusception the usual 
method of large injections was tried, but without any 
apparent good result. Although warned of the 
serious nature of the case, the parents would not 
listen to my suggestion that an operation was neces¬ 
sary. Small doses of morphia were accordingly given 
to allay the pain. 

The child continued in much the same condition 
during the next week. Though the morphia, which 
had been given regularly, somewhat masked its 
symptoms. Sickness continued; diarrhoea was not 
so frequent as at first, nor the evacuations so profuse, 
and the blood had disappeared from them. The 
condition of the child steadily deteriorated, and it 
grew manifestly thinner. On the fifth day a sausage- 
shaped mass could be felt along the course of the 
ascending colon. During the second week the 
symptoms remained much the same, except that the 
sickness was less frequent. Emaciation still pro¬ 
gressed, and it seemed hardly possible that the child 
could live much longer. 

On February 6th the child passed per rectum a 
mass of intestine twelve inches long. From this 
date improvement commenced, and the child began to 
regain >ts former condition of nutrition. Now, some 
years after, she is a strong and healthy girl. 

• Case II.—F. D., set. 11 months. According to the 
mother’s statement, she had been vomiting con¬ 
stantly for ten days. 

History .—On June 27th, the patient was being 
carried by her sister, who let her fall. On the follow¬ 
ing morning (28th) the present illness began with 
violent vomiting and screeching. In a short time she 
passed per rectum a large quantity of blood. She 


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ORIGINAL COMMUNICATIONS. 


The Medical Press. 425 


had been under medical care, but the sickness had 
still continued, and there was a constant discharge 
from the rectum of dark treacly fluid. 

On July 8th I saw the child. She was very much 
wasted, with pinched face, distended and tympanitic 
abdomen. The vomiting was incessant, and a dark 
thick fluid was constantly passing from the bowels. 
On palpation a sausage-shaped swelling could be felt 
in the area of the descending colon, and per rectum a 
mass could be felt extending down to within an inch 
of the anus. The child was so ill that any operative 
rocedure was out of the question and it died in a few 
ours. 

Post-mortem Examination. —On opening the abdo¬ 
men gas escaped. The peritoneal cavity was flooded 
with intestinal contents and the swelling, previously 
felt, was seen. It consisted of an intussusception of 
the ileum through the ileo-csecal valve. This had 
been forced in through the ascending into the trans¬ 
verse and descending portion of the colon, sigmoid 
flexure and rectum. At the splenic flexure the mtns- 
suscipiens had been perforated and the mucous 
membrane of the ascending colon projected through 
the opening. The invaginated small intestine reached 
to within an inch of the anal orifice. 

Case III.— C. R., set. 3. First seen March 12th, 
1895, complaining of severe intermittent pain in 
the abdomen, and diarrhoea of twenty-four hours’ 
duration. 

History. —Up to the evening of the 10th, the patient 
was perfectly well, when his mother, thinking ne had 
a commencing cold, gave him a dose of castor oil 
(3ij)- On the morning of the 11th, he was seized with 
very severe pains in the abdomen, accompanied by 
diarrhoea and sickness. These symptoms continued 
during the day and until the following morning. The 
motions then became mucoid and contained a con¬ 
siderable quantity of blood. He had always been a 
healthy child with entire freedom from digestive 
troubles. 

When I saw him on the 12th, he was looking very 
careworn. He lay in bed, passing from him every 
few minutes mucus tinged with blood. The evacua¬ 
tion was preceded by slight pain, and followed by 
tenesmus. He had not been sick for twelve hours. 

Inspection. - The abdomen was to all appearances 
normal. It was quite flaccid on palpation, and along 
the left side in the line of the descending colon 
could be felt a mass of an elongated sausage-shape, 
extending from the costal margin to the left iliac 
fossa. The swelling was slightly tender to touch. 
On rectal examination the anus was patulous, and 
my finger introduced high up could feel the tip of 
something i-esembling a soft cervix and os uteri, 
round which it could be freely passed. Chloroform 
was at once given, and a large enemata employed with 
the object of reducing the intussuscepted bowel. 
These failed, and the colon was next dilated with air, 
but this also produced no improvement. Immediate 
surgical interference was then advised, but before 
deciding tbe parents requested a consultation, which 
was held the same evening. A continuance of large 
enemata administered under chloroform was advised 
by the consultant. These were repeatedly tried the 
same night and following day, but without any satis¬ 
factory result. Tenesmus and diarrhoea still con¬ 
tinued, and though the child was taking and retaining 
a large quantity of nourishment, it was manifestly 
getting weaker. The tip of the intussusception 
could now be felt within an inch of the anus. Not 
till the morning of the 14th did the parents consent 
to operation, which was performed at 11 a.m. 

Operation. —An incision, three inches long, was 
made in the left linea semilunaris, directly over the 
thickened colon. On opening the abdomen the 
descending colon was at once found, and on tracing 
it upwards it was seen that the splenic flexure had 


become invaginated into it. Bv grasping the intus- 
suscipiens close to tbe neck and kneading the lower 
portion of the intussusception upwards the former 
was easily dislodged. There were no adhesions, The 
abdominal wound was rapidly closed, and the little 
patient put back to bed in twenty minutes, having 
suffered very little from the operation. 

During tbe day the patient was wonderfully well. 
It took nourishment freely. No diarrhoea, had passed 
flatus, and had very little pain. A gr. morphia 
suppository was given. 

10 p.m.—Patient rather drowsy. Temp. 100 - 2. 
Pulse 120. No sickness or diarrhoea. Taking nourish¬ 
ment well. 

15th, 4 a.m.—Called up to find patient dying. Has 
had no obstructive symptoms, and is evidently dying 
of some form of toxaemia. Temp. 1026. Pulse 
almost absent. Died half an hour later. 

Case IV.— D. S., set. 5. First seen April 28th, at 
10.30 a.m. Complains of severe paroxysmal pains in 
the bowels, accompanied by diarrhoea, of 2£ hours’ 
duration. 

History.— Patient went to bed on the evening of 
the 27th, apparently perfectly well, after having par¬ 
taken rather freely of oranges during the afternoon. 
He slept well till 6 a.m., when he awoke, and was very 
restless. At 8 a.m. his bowels were abundantly 
moved, the stool being well formed, but containing 
much undigested food. He was immediately after¬ 
wards seized with a very severe pain in the bowels, 
which made him writhe about in bed. He vomited, 
and at the same time his bowels were again moved, 
the second motion consisting only of mucus tinged 
with blood. Abdominal pains came on in paroxysms 
about every ten minutes, causing him to cry out, and 
each time accompanied by tbe passage of mucus and 
blood. 

10.30 a.m.—I saw him. He was very pale, with a 
pinched appearance. Pulse rapid and weak. Between 
the intervals of pain he lay exhausted. As soon as a 
pain came on he cried out and rolled about the bed. 
Each paroxysm of pain was followed by an evacua¬ 
tion of mucus and a little blood. On examining the 
abdomen it was quite flaccid. There was no disten¬ 
sion. Palpation of the whole abdomen was allowed 
without any complaints until the hand came to the 
right iliac fossa, where a small elongated mass, appa¬ 
rently about three inches in length, could be felt. 
This was very tender to the touch. 

Patient was immediately put under chloroform, and 
the mass previously discovered could be still more 
distinctly palpated. Per rectum nothing could be 
felt. 

Insufflation and massage were first tried, but with¬ 
out effect. Large enemata of hot water were next 
administered, but the tumour remained unaltered. The 
following operation was then performed: — 

An incision three inches long was made over the 
seat of the swelling, and as soon as the abdomen 
was opened the c»cum was drawn out, and an intus¬ 
susception discovered of the ileo-ceelic variety. Dr. 
McGregor, who assisted me, held the small intestine 
close to the intussusception to steady it, and grasp¬ 
ing the colon beyond the intussuscepted portion, I 
was able, by manipulation, with comparative ease to 
release about one foot of gut. To prevent recur¬ 
rence, the mesentery of the intussusception was 
shortened by inserting a few fine silk sutures parallel 
with the gut, as advised by Senn. The abdominal 
incision was closed with three layers of silk sutures, 
and the patient put back to bed in twenty-five 
minutes, apparently little the worse for the operation. 

After-progress and Treatment. —Patient was kept 
for the first twenty-four hours on raw beef juice and 
white wine whey. Small doses (H\_ iij) of liq. morph, 
mur. were given every four hours. There was no 
sickness or diarrhoea after the operation. The bowels 

D 




426 The Medical Prxbs. ORIGINAL COMMUNICATIONS. 


April 26, 1899. 


acted naturally twice on the fourth day, and morphia 
was given to check a tendency to diarrhcea. 

The subsequent history was uneventful. The 
highest temperature was 99 6 degs. on the evening of 
the operation. The dressings were first removed and 
the wound found healed on the tenth day. 

Remarks. 

The four cases recorded illustrate four possible 
terminations of intussusception. 

Case I. is an example of recovery without opera¬ 
tion, a result which statistics say occurs in 3 per cent, 
of cases, and one consequently as rare as it is for¬ 
tunate. 

Case II. may be regarded as a typical example of 
the disease allowed to run its natural course, with 
the usual result—an agonising death. The patho¬ 
logical interest of the case lies in a point which, per¬ 
haps, does not appear sufficiently clear in the record. 
An invagination of the ileum into the cajcum at the 
ileo-ceecal valve had been the primary leison. Then 
the intussusception and the ascending colon were 
invaginated into the transverse and descending colon, 
sigmoid flexure, and rectum, so that a section 
through the mass at the rectum would have shown: — 
First, the wall of the rectum; Becond, a layer of 
ascending colon; third, another layer of ascending 
colon near the caecum; and fourth, the ileum. In 
other words, it was an intussusception of an intussus¬ 
ception. 

Cases III. and IV. both illustrate the failure of 
injections. Case III. the disadvantages of postponed, 
and Case IV. the advantages of early, operation. 

So far as I have had opportunities of judging of 
such cases, they should be regarded as more related 
to strangulated hernia than to intestinal obstruction. 
In both, intestinal obstruction, due to a mechanical 
cause, exists; in either, delay in the removal of the 
cause is equally serious. Both can only be treated 
properly by mechanical measures, and in both an 
accurate and early diagnosis is possible. The sur¬ 
gical rule for the treatment of irreducible and stran¬ 
gulated hernia is to give the patient chloroform at 
the earliest possible moment, to try gentle taxis, and, 
if this fails, to operate at once—without allowing the 
patient to recover from the an aesthetic This rule, it 
cannot be doubted, has been the means of saving 
many lives. A similar rule should have as beneficial 
results when applied to the treatment of intussuscep¬ 
tion. 

In Case IV. chloroform was administered with the 
understanding that injections were first to be tried, 
and, these failing, operation was to be at once pro¬ 
ceeded with. 

I believe that the mortality of cases operated upon 
for intussusception has been greater than that of 
cases operated upon for strangulated hernia, only 
because in the former, operation has been delayed, in 
the latter has been promptly performed. Why should 
the operation for intussusception be delayed ? I can 
find no reason. When the symptoms are such as have 
been described—vomiting, paroxysmal pain, passage 
of blood-stained mucus, and tenesmus—careful 
examination of the abdomen and rectum are likely 
to lead to a correct diagnosis, and this should evolve 
definite action. Probably the bad reputation acquired 
by ordinary operations for intestinal obstruction, and 
the uncertainty of prognosis without operation in such 
cases, has had some influence in delaying the accept¬ 
ance of prompt operative treatment for intussuscep¬ 
tion ; but in an ordinary intestinal obstruction case the 
diagnosis of intestinal obstruction may not be arrived 
at for some days: the prognosis may remain uncertain; 
and thencome8 the difficulty of ascertaining andlocut- 
ing its cause; in the majority of cases operated upon 
a large opening has to \n made in the middle line of 
the abdomen ; a considers!/ j amount of troublesome 1 


and dangerous work has to be done to find the cause, 
and, if that is found, there is frequently no possibility 
of dealing with it. 

In intussusception, as in hernia, a tumour is felt. 
A small incision can be made over it, the lesion can 
be discovered without difficulty and reduced—in the 
early stages readily—without serious disturbance to 
the patient's condition. 

Without drawing further conclusions in parallel 
lines, as could easily be done, I would again emphasise 
the comparison between strangulated hernia and 
intussusceptiou, to express my belief that, as in the 
treatment of hernia, taxis is gradually losing ground; 
so in intussusception, injections and such-like 
measures will in the future be less employed, for 
early operation in both I believe to be the safest and 
mon satisfactory treatment. 


NOTES ON THE PLAGUE, (a) 

Collated 

By Sir CHARLES A. GORDON, K.C.B., M.D., 

Sargeon-General (retired), Hon. Physician to Her Majesty 
the Queen. 

(Continued from page 399). 

11. Other Methods. 

Mr. J. V. Ramasamy Naidu, of Madras, 
treated plague on the old successful plan by neem 
and olive oils. The “ Baroda plague pills,” largely 
believed in by the natives, consistof quinine 2 grs., cam¬ 
phor gr. 1, ipecacuanha gr. 1, carbolic acid minim 
They were used by thousands as a preventive ; from 
the date of their being so the disease began to 
decline and speedily disappeared Captain Wilkinson 
believed that patients treated did better than those 
untreated. Dr. Seymour used the following prescrip¬ 
tion which had effected 75 per cent, of recoveries 
against 21 where the patients were not so treated :— 
Acid carbolic liquid, 3 minims ; quin, sulph. 5 grains ; 
acid Rulph dil., 10 minims; glycerine (P) minims; 
aqua to one ounce every four hours. Colonel Maco- 
nachie said that no treatment stopped the course of 
the disease. As already observed, inoculation was in 
certain instances supplemented by the administration 
of stimulants. 

12. Segregation. 

Dr. Hossack stated that segregation was aban¬ 
doned. The forcible removal of patients to hospital 
had practically ceased. He had not found cases recur¬ 
ring in one room, and thought that the abandonment 
of segregation had not produced bad results. Dr. 
Banerje said that the natives were opposed to isola¬ 
tion and segregation. Women would object to leave 
their homes for the short time nece«sary for disinfec¬ 
tion, but they would prefer that to segregation. Mr. 
Winter that in the segregation camp for the Hurd- 
war Union very few cases of plague occurred, and the 
disease soon ceased. Colonel Crofts stated that mea¬ 
sures of segregation and evacuation in the village of 
Khandraoni were successful. Mr. Giles : that during 
the epidemic at Kurrachee evacuation was the mo6t 
effective measure; universal segregation was dan¬ 
gerous and unnecessary. At Bombay Major Roughton 
recommended the adoption of the system employed 
in London during the plague of 1665 as related by 
Defoe, of locking up the houses and confining the 
inhabitants inside unless the natives underwent 
segregation. 

13. Disinfectants. 

The rules at inspection camps were elastic, and 
disinfection of goods was evaded. At Calcutta it 
was said that plague cultures had been found in the 
clothes supposed to have l>een rendered sterile by 


(a) From reports principally in the Timet nnd other poj>er8. 


Apbil 26, 1899. 


CLINICAL RECORDS. 


Tub Medical Press. 427 


disinfection. The natives were educated up to disin¬ 
fection, and carried it out themselves. The disinfec¬ 
tion measures of the authorities were insufficient in 
face of the opposition of the people. Dr. Banerjee 
said that disinfection was impossible owing to the 
nature of the dwellings. The inhabitants mixed 
indiscriminately. Only the highest classes disin¬ 
fected their dwellings; the poorer were not used to 
taking proper steps for disinfection. A buatee could 
be disinfected as a whole, but not partially. The 
people objected to disinfection because they thought 
their goods would be destroyed. 

Surgeon-General Harvey said that wholesale dis¬ 
infection was not thorough because of the lack of 
European supervision; the natives shirked it. Cap¬ 
tain Clark advocated the use of disinfectants, and 
suggested that steam disinfectors should be pro¬ 
vided. Captain Jenny, at Kurrachee said that disin¬ 
fection of ships' cargoes had proved unsuccessful. 

At Baroda, nitric peroxide was deemed the best 
disinfectant, as it destroyed both the smell and the 
infusoria of sewage. At Satana evidence went to 
Bhow that chemical disinfectants had not proved 
successful. 

14. Sanitary Measures. 

At Calcutta Dr. Justice believed that plague did 
not spread because the native huts were better venti¬ 
lated and lighted than those of Bombay. Dr. Bose 
considered that persons cooped up in ill-ventilated 
houses were generally infected; those living in the 
open air escaped. Dr. Hossack disagreed with Dr. 
Justice as the cause of plague not spreading being 
the better description of native huts. They were 
being gradually removed. Surgeon-General Harvey 
considered that evacuation was theoretically excellent, 
but in large towns impossible. Colonel Fullerton 
said that passengers and crews were subjected to 
observation before landing on the Baluchistan coast. 
Passengers by railway underwent medical inspection 
only at first. When plague spread to other localities 
besides Kurrachee a segregation camp was estab¬ 
lished at Sibi, and passengers were detained ten days. 
Captain Bingley said that municipal camps had been 
tried at Bombay but were not successful. A camp 
in his own district at Calcutta was very successful. 

Colonel Thomson said that medical inspection of 
railway passengers, segregation and disinfection gave 
to Agra a remarkable immunity from epidemic 
diseases generally. At Hurdwar evacuation was the 
chief measure adopted. Mr. Winter, that the 
measures taken were evacuation of infected blocks, 
segregation, burning of houses, disinfection of houses 
and property. These measures were completely suc¬ 
cessful. Colonel Adams, that cordons were placed 
in the infected area in Sirohi, the result astisfactorv. 
Captain Grant said that in the Agra district the 
infected were sent into camps, and the epidemic 
stopped. Infected huts were burned ; houses un¬ 
roofed, floors burnt, walls limewashed. Captain 
James, of Lahore, had known a case where the people 
had returned to a house after the lapse of thirty-four 
days. before the house was disinfected, and a 
number of the family were attacked. The most 
satisfactory measure was evacuation. 

Captain Wilkinson said that in the Punjaub the 
measures adopted were segregation of patients and 
their friends, evacuation, disinfection of holes and 
roofs, and whitewashing; removal of floors, of huts, 
and burning them. Mr. Giles, that during the first 
epidemic at Kurrachee only the ordinary measures 
were taken. It ceased in July, 1897. During the 
second epidemic the measures adopted were segrega¬ 
tion, hospital treatment, and voluntary camps. 
Colonel McCloghry said that at Kurrachee the whole 
town proper was evacuated, and the result was suc¬ 
cessful. Mr. Kaka, that after voluntary camps were 


formed the plague declined. Mr. Giles believed the 
continuance of cases among people who fled to the date 
plantations to be due to the insanitary nature of the 
ground. In January, 1897, the inhabitants of 
Kurrachee were encouraged to leave. Seventy-five 
thousand went from the city then badly infected, but 
the people in the afflicted area were restricted from 
leaving. 

In the Cutcli district evacuation, disinfection of 
clothes with carbolic acid, of houses with quick¬ 
lime were the measures employed. At Nasik and 
Melegaon evacuation took place, and the epidemic 
stopped. Partial evacuation was inefficient when the 
plague was indigenous, but successful when the 
disease was imported. At Ahmedabad the houses 
were fumigated with sulphur; the walls washed 
with lime. In Baroda registration of deaths, removal 
of sick to hospitals, isolation of contacts, disinfection, 
proper disposal of dead bodies, voluntary inoculation, 
and evacuation. Nasik town was successfully evacu¬ 
ated. At Daman the salt frontier force was success¬ 
fully used as a cordon, and kept infection from 
British territory. The epidemic was of short dura¬ 
tion, owing to evacuation measures. At Mazagon, 
after the population were removed into camp, few 
cases of plague occurred. In Kolalba district European 
supervision overcame the disease, t.e., its second 
epidemic. At Poonah and Kirkee, the measures 
adopted were the removal of the sick, the segrega¬ 
tion of contacts, evacuation, disinfection, the estab¬ 
lishment of a sanitary cordon, and inoculation. In 
Satara there was immunity among those living in the 
open air, and among Europeans. Fresh air prevented 
the disease. There also the unroofing of infected 
houses was found to be the best measure. Kiln burn¬ 
ing was neither theoretically nor practically sound. 
After evacuation no houses were re-occupied in less 
than four months. At Asbmednuggur, plague and 
cholera ceased after disinfection of the city. 

To be concluded in our next. 


Clinical JRccorbs. 

ROYAL HOSPITAL, BELFAST. 

Ulcer of the (Esophagus, (a) 

By Dr. J. A. Lindsay, 
of Belfast. 

I wish to bring before you a case of ulcer of the 
oesophagus, resulting in abscess of the posterior medias¬ 
tinum, rupture into the lung, emphysema of the face and 
neck, and death. The patient, a male, set. 59, was ad¬ 
mitted to the Royal Hospital, Belfast, suffering from 
abdominal pain, distension, and collapse. A few hours 
before admission, as the result of drinking a bottle of 
stout, he had been seized with severe pain in the epigas¬ 
trium, and haa vomited. There was a history that the 
patient had suffered for some weeks from pains in the 
abdomen, to which he had not paid much attention. On 
admission to hospital he complained of pain in the epi¬ 
gastrium, and weakness. The abdomen was moderately 
distended, and tender on palpation in the epigastric 
and in both lumbar regions. There were signs of a large 
effusion into the right pleura. The temperature was 
100 degs., the respirations hurried, and the urine con¬ 
tained much sugar and a little albumen. Towards mid¬ 
night of the day of admission the patient's state began 
to change for the worse. For the first time a puffiness of 
the left eyelid was observed, which rapidly extended 
over the left side of the face and neck, and the upper 
portion of the left chest. This was found to be superfi¬ 
cial emphysema. The pulse was now 120, weak and irre¬ 
gular, the respirations 56, and the patient much collapsed. 
The diagnosis presented great difficulties. The possibility 
of a gastric ulcer which had ruptured through the dia- 

(«) Read before the Royal Academy of Medicine in Ireland 
March In, 


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428 The Medical Pbkss. TRANSACTIONS OF SOCIETIES. 


Apbil 26, 1899. 


phragm into the long was considered, bnt the history 
was, on the whole, against gastric nicer. The abdominal 
pains had been vague, shifting in position and not 
severe, and there had been neither haematemesis nor 
melsena. The indications were held to be too obscure to 
justify operative interference. The patient gradually 
sank on the following day and died at 11 o'clock p.m., 
thirty - seven hours after drinking the bottle of 
stout, and twenty- three hours after the first 
appearance of emphysema of the face and neck. An 
autopsy was made twenty-two hours after death. Em¬ 
physema was found to be well marked in both media- 
stina, especially the left. The right pleural cavity con¬ 
tained 50 ozs. of serum, rather flocculent in character. 
There were also a few ounces in the left pleural cavity. 
Signs of acute pleurisy were well marked on both sides. 
Two inches above the cardiac orifice of the stomach 
there was an elongated. ulcer, 11 inches long, in the 
cesophageal wall. In the lower part of its extent it in¬ 
volved only the mucous membrane. The edges of the 
ulcer were thickened but not indurated. There was no 
evidence of any malignant deposit around the ulcer or 
elsewhere in the oesophagus, and no secondary deposits 
in any of the viscera. A sinus connected the ulcer with 
an abscess in the posterior mediastinum between the 
oesophagus and the aorta. This abscess had ruptured 
into the lung at its root, and air had extravasated along 
the deep fascia, and also along the superficial fasoia of 
the neck. There was no communication between the 
abscess and the pleural cavity. The aorta was athero¬ 
matous, as were the arteries of the base of the brain. 
There was chronic thickening of the pia and arachnoid, 
general congestion of the meninges, and oedema of the 
brain substance. The punota cruenta were well marked. 
The kidneys were much congested and the liver fatty. 
The pancreas was normal. The view taken was that the 
ulcer in the oesophagus was probably of syphilitic origin. 
The patient had suffered some years before from what 
he called “blood poisoning”—which may have been 
syphilis. No definitely syphilitic lesions were found at 
the autopsy, but the state of the brain lent some support 
to the theory of syphilis. 


‘tomsactirntB of gocutics. 


BRITISH GYNAECOLOGICAL SOCIETY. 
Meeting held Thursday, April 13th, 1899. 

H. Macnauohton-Jones, M.D., President, in the Chair. 


ABDOMINAL CAUSES OF DEATH AFTER 
CCELIOTOMY. 

Dr. W. J. Smyly read a paper, which will be found in 
another column, introducing a discussion on this sub¬ 
ject. 

The President observed that the paper was one of 
great practical importance and interest. It touched on 
all those vital points in the post-operative period which 
made even the most experienced operator anxious, and 
the interest in them was universal, because no surgeon 
knew beforehand whether he might not have to face one 
or other of the complications mentioned. There were 
other accidents, to which Dr. Smyly had not referred, 
but which would, no doubt, be mentioned in the course 
of the discussion. 

Professor Japp Sinclair (Manchester) said that he 
had not heard a paper dealing better or more concisely 
with its subject than that of Dr. Smyly; and on all 
essential points he found himself in entire accord with 
the author. With regard to shock he had nothing to 
say to its nervous origin, as to whioh he did not feel 
very convinced; he took the view that haemorrhage 
played a predominant part in its causation. All the 
cases of shock which he had seen had been due to 
haemorrhage, the result in some cases of accident, in 
others of blundering. He therefore looked on shock and 
haemorrhage as equivalent, with a very few exceptions 
snch as cases of heart disease. One cause of death was 
a want of tone in the bowel, which in some cases was 
chronic, the result of chronic constipation; and he 


always operated on such cases with great anxiety. These 
patients might go on all right for a few days, then 
symptoms of intestinal paresis came on and the patient 
succumbed. Examination after death showed nothing 
to indicate ileus, pressure on the bowel, or any other 
form of intestinal obstruction; and before death there 
was no indication for re-opening. In one case he was 
told by the nurse that almost the whole of the contents 
of the bowel came away half-an-hour after death. 
Another cause of bowel trouble was pressure, such as that 
of a hsematoma in the broad ligament. He had a case 
of this kind, and it was only by the exercise of great 
foroe, such as only extreme necessity would justify, that 
he was able to get a rectal tube past the swelling, and 
the symptoms then subsided, and the patient got quite 
well. He agreed with Dr. Smyly's remarks about ileus, 
but would add that as regards prophylaxis, he thought 
they were often too late in giving aperients. When there 
was any doubt, peristaltic action could almost always be 
set up by calomel, which he gave on the day after opera¬ 
tion, in hourly grain doses. In cases where raw surfaces 
had to be left, through the separation of adhesions or 
removal of portions of peritoneum, he always liked to 
leave some saline solution in the peritoneal cavity; this 
allowed the bowel to float and diminished the risk of 
bowel adhesions. Of course, in this case they must not 
drain. With regard to peritonitis, he believed that 
there was a non-septic form, and in these cases purga¬ 
tion was successful; but he did not believe that purga¬ 
tion succeeded when the peritonitis was septic ; on the 
contrary, it might make matters worse. As far as he 
knew, no micro-organism except the streptococcus 
led necessarily to a fatal result. His experience 
of anti-streptocoocic serum coincided with that of 
Dr. Smyly; the serum might reduce temperature, 
but he had not seen a case where it had saved the patient’s 
life. He thought that Dr. Smyly gave undue credit to 
Tait and Bantock in the advocacy of cleanliness; he 
remembered being very shocked at a description of the 
way in which Tait flushed out the peritoneum, teaching 
that it would do no harm to flush out with Birmingham 
tap-water. Judging from the agitation to secure purer 
water in that city, he thought the tap-water there was 
not above suspicion. Such teaching was not one of 
cleanliness, and was likely to encourage carelessness 
among young operators. He had just received a pamphlet 
advocating the flushing of the peritoneum with saline 
solution, as if it were a new thing; his impression was 
that he had recommended this some twenty years ago. 

Dr. William Walter (Manchester) thought Dr. 
Smyly was right in drawing attention to shock as in 
itself a cause of death. When he was a student, a sur¬ 
geon never did an ovariotomy without first asking a 
physician to test the condition of heart and kidneys ; 
he thought this precaution was neglected now-a-days. 
Too often a patient came in one day and was operated 
upon on the next. Delay was especially necessary when 
a patient had been badly fed and came from unhealthy 
surroundings. He must confess to making a mistake 
sometimes in this matter, owing to the exigenciee of 
hospital practice. The best way to prepare against the 
tendency to shock was to fortify the heart’s action with 
strychnine, and to operate in a warm room, guarding 
against cooling of the intestines with warm compresses, 
&c. Perhaps the best thing of all was the Tren¬ 
delenburg position; since this had been introduced 
patients seemed to bear difficult operations much better. 
It was often difficult to diagnose shock from internal 
haemorrhage. In guarding against the latter, he thought 
they were sometimes not quite careful enough. For 
instance, if the pedicle had been cut too near the liga¬ 
ture, the surgeon was apt to think it might do, even if he 
did not feel quite satisfied about it; whereas he ought 
not to be above tying it again. He would remark in thiB 
connection that the Staffordshire knot tended, in his 
opinion, to cause haemorrhage, for it often cut through 
the tissues almost like a knife. Proper attention to the 
pedicle was one of the most important safeguards 
against haemorrhage. Another mistake was in having a 
transfixion needle with too large a point. This might 
lead to tearing of a vein and fatal haemorrhage. He 
had lost one patient in this way. He believed that 



April 28, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Medical Press. 429 


death might be due to violent emotion. Thus he had 
a case in which the patient had recovered so far as to be 
sitting up. She was told some bad news, and haemor¬ 
rhage coming on suddenly led to a fatal result. 
Haemorrhage from adhesion sites was always difficult to 
deal with, especially as at the time of operation there 
might be no sign of it, and on the return of conscious¬ 
ness it might come on. When secondary haemorrhage 
occurred he thought that, unless one were actually on 
the spot, it was almost impossible to save the patient. 
If it were necessary to reopen for haemorrhage, he advo¬ 
cated the plan of opening the vagina instead of the 
abdomen, washing out with very hot water and packing 
with gauze. This procedure saved time, and was 
attended with less shock. In any case, the less 
one could do the better. By trying too much 
they might lose the patient. For septic peritonitis, 
reopening the abdomen did not answer, for the patient 
was seldom able to stand a second operation. He did 
not believe in opium and morphia in the treatment of 
peritonitis, for they only tended to increase the intestinal 
paralysis. He preferred calomel and salines given early. 

Dr. George Elder (Nottingham) observed that any 
one experienced in abdominal work must always approach 
a case with some anxiety. He agreed with Dr. Walter 
that in some cases bad results might have been due to 
too great hurry in operating before the patient was fit to 
stand it. It was well to wait three or four days, and to 
employ the time in learning the patient’s habits, in getting 
her accustomed to her surroundings, and in seeing to the 
condition of bowels and kidneys; he regarded the 
latter as most important. To illustrate the value of the 
patient’s history, he might mention a case he saw 15 
or 20 years ago. He performed ovariotomy, and after 
doing well for a few days the patient collapsed. The 
matron, a most competent woman, discovered that the 
patient had been in the habit of taking large doses of 
laudanum ; whereupon the gave her a drachm at once, 
and the patient rallied and eventually got well, the 
laudanum being continued for several days. Shock was 
not so often seen at the present time because operations 
were done more quickly and under better conditions. He 
did not like to operate on any woman who had made up 
her mind that she was going to die. No doubt many 
deaths formerly put down to shock were really due to 
htemorrhage. There was one symptom which he had not 
seen described, but which he believed to be pathogno¬ 
monic of haemorrhage — viz., intense pain, of a 
shooting character, uncontrolled by morphia. Dr. 
Walter had said that his experience of reopening the 
abdomen had been unfavourable, and he had compared 
the results with those of reopening for peritonitis. But 
he did not think that the cases were comparable ; he had 
rarely seen a case in which the abdomen had been re¬ 
opened for hsemorrhage, where the patient did not 
recover. As regards peritonitis, he believed that fatal ; 
cases were due to sepsis. He was surprised to hear Dr. ! 
Smyly give the credit of aseptic surgery to Bantock and 
Tait. He was himself an old pupil of Lister, and he felt 
sure that what they knew of asepsis was due entirely to 
the untiring efforts of Lister during the last twenty-five 
years. There was one kind of sepsiH which no antiseptic 
precautions could get rid of, and which only time could 
render harmless, and that was the sepsis arising from 
operations for puerperal peritonitis or for the clearing 
out of a putrid placenta. He had lost two patients 
through operating too soon after such cases: one was an 
ovariotomy which he did four days after an operation for 
puerperal fever. 

Mr. J. W. Taylor (Birmingham) Baid that they might 
gather from Dr. Smyly’s paper that the cause of death 
after cceliotomy was in many cases shock; but he did 
not think that he had ever seen a death due directly to 
shock, though he had seen cases where death was due to 
sepsis, predisposed to by hsemorrhage and shock. As 
regards ileus, he thought the use of dry sponges might 
lead to it; for he had had more difficulty in getting the 
bowels open after the use of dry than after moist 
asepsis. The discussion seemed to have centred round 
the question of asepsis; he believed that the three 
chief factors in the production of sepsis were 
sponges, hands, and the breath of the operator. He 


had had the opportunity of seeing work in 
Birmingham under conditions that could not be 
considered aseptic; and this experience had helped 
him to see which details were of more and which 
were of less value. He had not seen a death due to the 
use of tap-water ; nor bad he seen one attributable to 
clean instruments, even when these had not been boiled; 
but in the three factors he had mentioned he believed the 
chief danger lay. With regard to treatment, he agreed 
with what had been said as to the value of calomel; he 
always tried to get the bowels open by six o’clock on 
the morning following the day of operation ; if they 
were not open then, he gave small doses of calomel. 
There was another way to combat sepsis in cases where 
the kidneys were acting badly, and that was by means 
of the hot air-bath ; he believed he had seen this 
treatment save several cases. In watching two or 
three outbreaks of peritonitis, he had seen that the 
characters of the outbreaks varied ; probably there were 
several kinds of peritonitis due to different kinds of 
micro-organisms ; and they might hope for further light 
on the subject when they were able to distinguish not 
only between the clinical types, but also between the 
micro-organisms concerned. In conclusion, he ex¬ 
pressed his thanks to Dr. Smyly for his valuable and 
interesting paper. 

Dr. Heywood Smith said that a point which Dr. 
Smyly had omitted was the question of the idiosyncracy 
of the patient. There were some patients who were 
described as slow healers, and who tended to go to the 
bad; and it was well to keep such cases some days in 
hospital before operation. With regard to sepsis, he 
would observe that there were many different practices 
with regard to ligature material; he was sure catgut 
had caused inflammation in some cases. He agreed 
with Dr. Doyen’s dictum, operer vite et bieti, and as every 
time-saving detail was of importance, he thought that 
Greig Smith’s forceps-needle was a useful thing; it was 
a fine forceps, passed through the tissues as a pedicle- 
needle ; it was then opened, and the ligature could be 
rapidly Beized and drawn through. 

Dr. Dudley Buxton said that there was one aspect of 
anEBsthetics which bore upon the discussion, viz., the 
relation of chloroform to shock. The shock of operation 
was, to a great extent, caused or enhanced by the physical 
effect of chloroform, which was most marked in aneemic 
persons, and in those who had lost much blood during 
operation ; and the explanation of the action of chloro¬ 
form under these conditions was to be found in the 
alteration of pressure of the abdominal contents after 
the abdomen had been opened. For the maintenance of 
intra-abdominal pressure the action of the recti and of 
the diaphragm was needed; and during cceliotomy this 
action could not be exerted. When, in addition, the 
action of the nerve centres was weakened by anaemia the 
effect of chloroform in lowering blood pressure through 
the filling of the “ abdominal pool ” was greatly enhanced. 
Consequently, the mere opening of the abdomen made 
the patient more liable to shock from chloroform 
than was the case in any other kind of operation. 
The Trendelenburg position minimised shock by assist¬ 
ing gravity in the prevention of cerebral anaemia. 
Another important point about chloroform was its 
liability to cause post-operative hsemorrhage. Some 
operators preferred chloroform because they got less 
bleeding during the operation, but the lesser hsemorrhage 
was due simply to the depressed state of the circulation, 
and as soon as the anaesthetic was eliminated from the 
system hsemorrhage was liable to come on. These two 
points came fitly within the scope of the discussion, 
but the general question of the choice of an anaesthetic 
was too large to enter into then. 

Dr. T. Eastes (Folkestone) mentioned two cases of 
pseudo-ileus. The first was a patient suffering from 
myoma and ovarian cyst. The latter was removed by 
ovariotomy, the myoma being left. After a few days 
symptoms of ileus came on. He opened the 
abdomen and put a tube into the colon, but she died, 
and he thought the death was due to the myoma acting 
as a ball-valve, and keeping up the obstruction. In the 
other case the obstructive symptoms were due to hsema- 
tocele, and he carried out a much more active treat- 


430 The Medical Press. TRANSACTIONS OF SOCIETIES. 


ment; thus, he stopped all feeding by the mouth, gave 
nutrient and aperient enemata, and small doses of 
calomel. The result was satisfactory, and he believed 
that in such cases a similar plan should be adopted. 

Dr. R. T. Smith believed that patients might die of 
simple shock. Thus he had a case of double ovariotomy; 
the operation presented no difficulty, but an hour after 
the patient's pulse was 160, and she died in two days. 
The autopsy showed no haemorrhage nor other cause of 
death, and he believed that it was due to vasomotor 
paralysis. But she had also had a good deal of nervous 
disturbance. For the prevention of ileus calomel was 
good, begun early, but he thought it was even better to 
give it three or four days before operation. 

Mr. Charles Rtall said that there were cases where 
the shock was quite out of proportion to the time taken 
by the operation, especially operations involving the 
mesentery, and hysterectomy. There was always shock 
at the moment when the uterus was being severed. In 
the preventive treatment of shock, flushing the abdomi¬ 
nal cavity was a good thing. For acute obstruction he 
held that the proper treatment was to open the bowel 
and relieve it of its contents, in just the same way as 
tracheotomy was done for respiratory obstruction. He 
was in the habit of giving calomel in the evening of the 
day of operation and an enema next morning. If septic 
peritonitis came on, the treatment was that of an abscess: 
drugs were useless. 

Dr. Smyly observed that he had no idea of detracting 
from Lord Lister’s fame: antisepsis came first, asepsis 
later, and in consequence of antisepsis. But Mr. Tait 
first showed that antiseptics were not only useless, but 
injurious to fresh wounds ; he also emphasised the im¬ 
portance of avoiding contamination of the operator’s 
hands, and this teaching had led to the modern aseptic 
methods. 

The President Baid that he did not know when Mr. 
Tait first laid stress on the importance of clean hands, or 
showed that antiseptics might be toxic ; but he was sure 
that when Lister first introduced the antiseptic treat¬ 
ment, 25 years ago, cleanliness was laid down as one of 
the most important points. Moreover, every modern 
aseptic operation included antisepsis at some time before 
or during the operation. He believed that death from 
shock was almost always due either to haemorrhage or to 
operation on a patient whose condition was not good 
enough for operation. One of the most important points 
in an operation was the arrangement of the peritoneum 
and omentum. He had recently had a case of death after 
hysterectomy from peritonitis arising in the track of the 
wound, although every possible care was exercised: and 
so it was important that the possibility of this should be 
borne in mind. The possibility of auto-infection also 
should be remembered. Dr. Sinclair’s remark that the 
streptococcus was the only harmful micro-organism was 
not in harmony with the views of bacteriologists, and he 
thought Mr. Taylor was right in saying that there were 
several kinds of pyogenic organisms. The question of the 
operator's breath was an important one; in Vienna, 
Chrobak and his assistants operated with a kind of facial 
mask on. The kind of case that he most dreaded operating 
on was not the patient who thought she was going to die, 
but rather the nervous woman who threw herself about 
after operation ; to tie her down and to give her freedom 
both had drawbacks ; in the former case the patient got 
worse, in the latter she might break open the wound. 
Kelly thought that the lesser evil was to give her 
freedom. In conclusion, he thanked Dr. Smyly for his 
valuable paper. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section or Medicine. 


Meeting held Friday, March 10th, 1899. 


The President, Dr. J. W. Moore, in the Chair. 


ULCER OF THE (ESOPHAGUS. 

Dr J. A. Lindsay, of Belfast, read notes of a case of 
ulcer of the oesophagus, which will be found under 
“Clinical Records.” 


April 26, 1899. 

Dr. Finny said he could not understand how medias¬ 
tinal emphysema could reach the eyelids, though, of 
course, there were records of emphysema of the eyelids 
from rupture of the air passages. 

Dr. Hayes related the case of a young man dying of 
rapid general tuberculosis, who two days before death 
complained, after drinking some milk, of intense painB 
over the sternum. An autopsy showed the extravasa¬ 
tion of milk surrounding the cesophagus, which had two 
ruptures about half-way down. ' 

Dr. Coleman referred to the case of a boy who, after 
swallowing a large fish bone, developed not only pus, but 
also air in pericardium, due, no doubt, to the fish bone, 
ulcerating through the cesophagus. He believed that the 
gas in the pericardium was due to decomposition, and 
this was also a possible explanation of the emphysema 
which was present iu Dr. Lindsay's case. 

The President suggested that the lesion was 
syphilitic. 

Dr. Lindsay, in reply, said that it was the condition 
of the vessels of the brain that had suggested to him its 
possibly syphilitic origin 

tuberculous meningitis (?) 

Dr. Lindsay also read notes of a case of probable 
tuberculous meningitis which terminated in recovery. 
The patient was a young lady, fet. 19, seen in con¬ 
sultation with Dr. King Kerr, of Knock, Belfast. 
There was tubercle on both sides of the house, and 
patient’s mother and younger sister are sufferers from 
phthisis at the present time. The patient had had 
tuberculous glands excised from the neck a few years 
ago. She had suffered from periodic headaches, but had 
been otherwise healthy. In November, 1898, she took an 
attack of ill-defined pleurisy, with some effusion in the 
right side. This pursued a slow course until December 
3rd, when she first complained of headache. Next day 
the headache was more severe and vomiting set in. On 
December 5th the headache was severe and continuous, 
vomiting frequent, tongue thickly coated, temperature 
1015 degs., pulse 96, weak and regular, pupils sluggish, 
patient very restless, signs of fluid in the right pleural 
cavity. Next day the patient was delirious, tempera- 
101 degs. in tbe morning, and 102 degs. at Dight, tacke 
cerebrate well-marked, pupils dilated and almost immo¬ 
bile, continuous vomiting, double optic neuritis. Late at 
night the patient became comatose and began to pass all 
evacuations involuntarily. The pulse remained frequent, 
weak and regular. The patient could swallow her milk, 
and sometimes showed signs of slight consciousness on 
being spoken to in a loud voice. This condition lasted 
from Tuesday, December 6th, to Friday, December 9th, 
when the coma began to abate. By Sunday, December 
11th, the patient was much better, and thence¬ 
forward made an uninterrupted recovery. The treat¬ 
ment consisted in the continuous application of cold 
to the head by means of Leiter’s tubes, and the admini¬ 
stration of bromide and iodide of potash, with an occa¬ 
sional mercurial purge. The grounds for suggesting the 
possibility of the meningitis being tubeiculous were— 
(1) the fact that mother and sister were sufferers from 
phthisis; (2) the presence at an earlier stage of tuber¬ 
culous glands in the neck ; (3) the existence of an ill- 
defined pleurisy, which may have been tuberculous. 

Dr. Drury questioned the diagnosis of tuberculous 
meningitis, and gave his reasons. He suggested that it 
was a case of rheumatic pleurisy with some rheumatic 
meningitis. 

Dr. Finny also dissented from the diagnosis of tuber¬ 
culous meningitis. 

Dr. R. Travers Smith asked whether the choroid coat 
of the eye had been examined for the presence of 
tubercle. 

The President thought as cases of tuberculous peri¬ 
tonitis could recover without operation so might tuber¬ 
culous meningitis. He suggested that they should try 
the tuberculin test in these cases, and believed that 
both pleural effusion and the head symptoms were pos¬ 
sibly due to the micro-organisms of pneumonia, which 
sometimes produced a very dangerous form of menin¬ 
gitis. 

Dr. Lindsay, in reply, said that the President’s sug¬ 
gestion of pneumonia had also occurred to him. 


.ogle 



April 26, 1899. 


FRANCE. 


The Medical Press. 431 


Tubercles were not found in the choroid, but the patient 
was restless so that the examination of the eye was 
accomplished with difficulty. 

NON-FSBRILE PNEUMONIA. 

Dr. Lindsay also read notes of a case of non-febrile 
pneumonia. The patient, a gentleman, cet. 33, was seen 
in consultation with Dr. M‘Kisack, of Belfast. There 
was a history of alcoholism. The patient first sought 
advice upon October 13th, 1828, for headache, sickness, 
abdominal pain, and malaise. The temperature was 98 8°, 
pulse 80, respirations 20; no abnormal signs in the chest, 
tongue very foul. Next morning the patient felt better; 
the chest was examined with negative results; in the 
afternoon the patient sat for some time in the dining¬ 
room and talked with friends. About 9 o’clock p.m. it 
was noticed that his breathing was becoming hurried. 
He passed a restless night Next morning he was much 
worse, respirations 36, temperature in the mouth and in 
the groin 96’5°, well marked signs of consolidation of the 
right lower lobe—viz., dulnees, bronchial breathing, and 
increased vocal fremitus; at 4 o’clock p.m. the tempera¬ 
ture was 98° in the groin and 99° in the rectum, respira¬ 
tions 36, pulse 106 and very weak, patient much collapsed, 
but quite conscious. Crepitus was now audible over a 
considerable portion of the right lower lobe. The sputum 
was rusty. Towards evening the temperature for the first 
time began to rise.andat 8 o’clock p.m., it was 101°. Death 
took place at 9.30 o’clock, within twenty-four hours of 
the first advent of definite pulmonary symptoms. Alcohol, 
strychnine, carbonate of ammonia, digitalis and oxygen 
were administered, but without effect. 

The President observed that there was nothing new 
in the apyrexia. He considered that the hypodermic 
administration of strychnine was one of the best remedies 
in all the collapsed fevers. 

Dr. Cosorave mentioned a case of pneumonia in 
which the temperature remained subnormal throughout. 
He had tried hypodermics of strychnine, but they had had 
no effect. 

Dr. Lindsay, in reply, said he always gave strychnine 
in these cases. 


SHEFFIELD MEDICO-CHIRURGICAL SOCIETY. 

Meeting held Thursday, March 30th, 1899. 

Dr. Hunt, Vice-President, in the Chair. 

Da. Arthur Hall showed a case of linear ichthyosis 
hystrix. 

Dr. Sorley, a case of muscular atrophy from poly¬ 
neuritis, following influenza. 

Mr. Archibald Cuff exhibited and made remarks 
upon:—1. A case of hemi-hypertrophy. 2. A tumour 
of the cerebellum. 

Dr. Hunt, Dr. Arthur Hall, Dr. Hargreaves, Dr. 
Gwynne, Dr. Burgess, Dr. Keeling, Mr. Snell, Mr. Richard 
Favell, Dr. Martin, Mr. Sidney Barber, and Dr. Sinclair 
White made remarks. 

Mr. Simeon Snell introduced two patients. 1. Re¬ 
current third nerve palsy, associated with migraine. 
The patient was shown first before the Society 
in 1884, and the case is reported in the Tran¬ 
sactions of the Ophthal. Society, 1885. The patient, 
a woman, is set. 23. The attacks of severe pain 
and sickness have recurred every three or four 
months, but recovery from the associated third nerve 
palsy has become increasingly imperfect. 2. Embolism 
of central artery of retina in a young woman, set. 23. 

Dr. Martin gave the notes of a 

CASE OF CJ58ARIAN SECTION. 

The patient’was a primipara, aet. 23, a dwarf, and 
deformecl. Her heightn was 3 feet 10 inches. She had 
a large square head, short arms, and thickening of the 
cartilages, and the ends of the long bones, especially at 
the wrists; the tibiae were bowed. From measurements 
carefully taken before the patient left the hospital it 
was found that the distances were: between the crests 
of the ilium, 10$ inches; between anterior superior 
spines, 10 inches; ant. post, diameter, 6 inches; inf. 
conjugate (with callipers), 1 inch ; thickness of sacrum 


(with callipers), 3j inches. She was admitted into the 
Jessop Hospital for Women at 2.30 a.m., April 13th, 1898, 
and was in labour at the time, The deformed condition of 
the pelvis was at once noted by the house surgeon, Mr. 
S. Barber, and the necessity for operation recognised. 
After consultation with the other members of the staff. 
Dr. Martin did a Cesarian section successfully, the life 
of both mother and child being saved, the operation 
lasting thirty-five minutes. There was a smart dash of 
hemorrhage after the patient was put to bed; this 
seemed to be controlled by the subcutaneous injection 
of the 1-150th of a grain of citrate of ergotine. There 
was some bronchial trouble, and rise of temperature 
for four days after the operation, but both speedily sub¬ 
sided, and the patient made an excellent recovery, being 
discharged May 7th, 1898. 


$ ranee. 

[from our own correspondent.] 

Paris, April 21st, 1899. 

Diffuse Hypertrophy of the Bonks of the Face. 

At the Acad^mie de M4decine,'M. C. Dentu read a 
paper on diffuse hypertrophy of the face and of the 
cranium, which he said was generally bilateral, but could 
be also limited to one group of bones. To well under¬ 
stand the nature of the affection it should be remarked 
that its evolution was marked by subacute or acute 
phases, which had, for consequence, the exaggerated 
development of certain portions of bone already 
abnormally developed generally. His personal 
observations lead him to formulate the follow¬ 
ing propositions:—The lesions are not always sym¬ 
metrical ; generally the superior maxillary was the centre 
of unilateral hypertrophy, but he had also seen the tem¬ 
poral bone attacked. On the other hand, the symmetry 
belonged sometimes to pediculation, having no relation 
with the diffused hypertrophy. Sometimes also the 
lesions commence within the cranium. Far from being 
constituted solely by osseous substance, the tissues could 
present to histological examination, fibrous and embryo 
plastic elements. The malady lasts generally several 
years. The prognosis is usually benign, but 
the affection could abridge life by grave func¬ 
tional troubles of the mouth (difficulty in mastication 
of the nose (obstacle to respiration), the head (compres¬ 
sion of the brain and irritation of the membranes). In 
his personal cases he observed pseudo-meningitis, con¬ 
vulsions, epileptiform seizures, delirium, and dementia. 

Partial extirpation of the osseous masses gave good 
results in his hands. He considered, then, that in future 
diffused hypertrophy might be arrested by practising 
at the outset abrasion of the parts, combined with the 
application of the thermo-cautery. 

Tuberculosis of the Testicle. 

M. Berger spoke on the treatment of tuberculosis of 
the testicle, and said that where the lesi on was 
limited, castration should be performed, as frequently a 
definite cure was the result; where the tuberculosis was 
advanced, and the patient presented pulmonary 
lesions, an operation was useless. 

Peruvian Balsam and Scabies. 

At the Soci4t4 de Dermatologie, M. Hallopeau related 
two cases of death in children after the application of 
the treatment of scabies by balsam of Peru. He thought 
that these fatal results were due to impurities of the 
drug, but it was possible that the child presented as re- 


Digitized by 


Google 



GERMANY. 


Apbil 26, 1899. 


432 The Medical Press. 


garde that agent a much greater susceptibility than an 
adnlt. 

M Fournier said that he constantly employed pure 
balsam of Peru in the treatment of Bcabies in adults 
and ohildren, and never met with an accident. Another 
speaker said that he had renounced the use of pure 
balsam on account of its too adhesive properties, in 
favour of a 30 per cent, mixture with vaseline. 

Trycophyton Tonsurans. 

Ringworm of the scalp is, as the majority of skin dis¬ 
eases, difficult to treat. All kinds of anti-parasitic 
remedies have been tried with variable success; iodine 
linim ent, chrysophanic acid, acetic acid, sulphurous acid, 
corrosive sublimate, carbolio acid, &c. Recently M. Balzer, 
of the St. Louis Hospital, has employed strong solutions 
of lactic acid, and recommends it highly. After washing 
the parts with alcohol and ether, he applies a solution of 
laotio acid 3ss. t and alcohol 5j., rubbing it in until red¬ 
ness is obtained. The pain resulting is not very sharp, 
and subsides in a quarter of an hour. The solution is 
applied twioe a day. To complete the treatment, the 
patient is recommended to wash the parts with a sub¬ 
limate solution (1-2,000). Out of nineteen cases thus 
treated fifteen were cured in less than three months, 
three others were improved, while one resisted the 
treatment. 


(Hermanp. 

[from our own correspondent.] 

Berlin, April 22nd, 1899. 

At the Society for Innere Medizin Hr. Hirschlaff 
reported a 

Fatal Case of Leuosmla. 

A woman was admitted into hospital in September 
last. For some months past she had suffered from 
steadily increasing weakness. There was leucaemia, 
with enlarged deeply notched spleen. The patient had 
died the day previous to the meeting. Three weeks 
before, pleuritic exudation took place, after which her 
condition became very bad. On the day of her death 
she complained of difficulty of swallowing, from pain in 
her neck. Examination showed extreme swelling, of a 
snow white uvula, although no decoloration had been 
observed before. (The throat was examined daily in all 
cases of leucaemia.) The swelling increased rapidly, in 
an hour the left palatal arch was affected and then the 
tonsil. Two hours later extreme stridor came on and 
the patient died from suffocation. As regarded the 
blood the condition was one of myelogenous leucsemia. 
The proportion of white to red blood corpuscles was 
1 to 6, there was great increase in the polynuclear 
oells and nucleated red blood corpuscles, the mono¬ 
nuclear cells were not very numerous, and there 
was neurophile cornification. The change in the 
medulla of the bones was considerable, it was 
a reddish grey, the spleen weighed 6J lbs., the liver was 
large, and all the lymphoid organs were much swollen. 
The microscopic preparation showed only medullary 
cells. The case appeared strongly to support Ehrlich's 
theory, according to which the spleen played only a 
secondary part in the elaboration of the blood, the first 
being played by the medulla of bones. 

Hr. Litten would also draw attention to the latter 
point. The clinical features were rendered interesting 


by the rapid tumour formation leading to suffocation, 
which was so rapid that there was not time for tracheo¬ 
tomy. In an acute case he had seen an equally rapid 
formation on the hands, but in a chronic case like the 
one before them he had never observed such changes. 

Hr. Benda did not agree with the previous speaker as 
to the nature of the swelling in the throat. It was 
cedema in a mucous surface changed by leucsemia. Such 
a rapid development of a tumour did not appear to him 
to be quite possible. 

Hr. Litten agreed that there was cedema, but the 
principal change was thickening of the tissues. 

Hr. Hirschlaff added an explanation of the conditi on 
of the blood that with the advance of the disease of the 
bone marrow, at last only the unripe cells, the mono¬ 
nuclear were carried into the blood current. 

At the Surgical Congress Hr. Koing read a paper on 
the 

History of Free Bodies in Joints, 
in which he attributed them to a dissecting inflamma¬ 
tion. He was not the first to account for their origin in 
this way, but lately he had been able to study them 
both clinically and tetiologically more sharply. During 
the last twenty years he had had seventy cases of free 
bodies in the joints, three in consequence of arthritis 
deformans, sixteen after injury; there were ten cases to 
exclude as the elbow or knee-joints were not the site of 
the bodies, there were thon left thirty-six cases, to which 
the above aetiology did not apply. A number of the 
cases had had rheumatoid affections, that had also 
attacked other parts than those in which the free bodies 
were. Then there was pain and crackling in the joint, 
then certain movements could not be performed. He 
would not go further into the well-known symptoms 
peculiar to free bodies in the joints, but he would observe 
that their occurrence was generally preceded by injury. 
He then went on to describe the bodies themselves, and 
to mention various conditions that had led to their 
origination. 

Hr. Kocher, Berne, read a paper on 
The Conditions of Successful Operation in 
Epilepsy. 

He thought pessimism in regard to operation for 
epilepsy had been carried too far. From recent expe¬ 
rience he had concluded that the method of operation 
practised had not been the right one. Y. Bergmann had 
introduced an improvement by removing the cortical 
portion from which the epilepsy started. About 10 per 
cent, were cured in this way. Since the eighties the 
speaker had operated after a theory of his own, and had 
obtained six complete cures in traumatic epilepsy. He 
had collected 175 cases of operation, only calling those 
cures that remained well at the end of three years, 
although epilepsy sometimes returned even later than 
that. In this investigation he was able to determine 
that that treatment was successful that attacked the 
cause of the epilepsy direct. After extraction of foreign 
bodies from the skull, and especially from the brain, 
88 per cent, of recoveries took place. In the latter cases, 
where the dura was incised/ the results were the best. 
He assumed that an essential cause of the occurrence of 
attacks was tension, which was relieved by incision of 
the dura. Perhaps this reduction of tension was the 
factor in these cases that had been cured after incision 
of the cortical centre, and also in those cures in which 
the centre could not be determined by electricity. 


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The Medical Press. 433 


April 26, 1899. 


In his successful cases the covering over the opening more recently, those of Goltz. When the lower portion 
had remained soft, so that “ giving ” could take place on of the cervical region iB quite severed in a dog 
pressure, whilst in the unsuccessful ones, the covering the animal does not die immediately, but the 
had become bony or at least of tense connective tissue, breathing will go on for some time quite spon- 
If the principal factor of the attack was assumed to be taneously; the blood pressure gradually sioks; the 
a cicatrix or adhesions, operations should not be per- arteries of the extremities become narrower, and the 
formed, as a cicatrix was always left by them. But these pulse constantly declines till it finally disappears, finally 
need not be feared. Aseptic soft cicatrices, even when they the animal sinks into a deep coma, and will probably 
projected into the brain, almost never caused epilepsy, die within 24 hours. The clinical diagnosis in such a 
Guinea pigs could be made epileptic by a simple blow on case would be given as “ heart enfeeblement,” while the 
the head, and in these cases the blood pressure was post-mortem bears witness that the cardiac muscle is in 
increased fourfold. If the animals were then operated , good condition, though greatly contracted, and contain- 
on and a lateral ventricle opened, the epilepsy ceased, ing little or no blood, while the bowel is hypertemic. 

An {etiological connection between increased pressure Analogous conditions are met with in cases of htemor- 
and epilepsy had thus been experimentally proved. In rhage, when the central nervous system is involved and 
this way cysts and collections of fluid of all kinds within cedema occurs. Examination of the heart duri ng life 
the brain easily gave rise to epilepsy. does not reveal all changes in that organ, not with- 

According to these views, we had first of all in our i standing the presence of dangerous, morbid alterations, 
operation to remove all local irritation, such as foreign as in typhus or typhoid. Briefly stated, two conditions 
bodies, and then take measures for reducing local and are present in these vascular cases: (a) Inadequacy of 
general blood pressure within the calvarium. The dura the heart itself; or (A) insufficiency of the supply to 
when incised should not be sutured, but should rather the heart. 

be excised, and the defect should not be covered by His own experiments with phosphorus poisoning 
bone. In penetrating wounds of the head, the damage proved that in subacute poisoning cases the heart 
was not caused by the opening, but by the firm closure muscle was normal, and no degeneration present, while 
of the skull. the vascular system was paralysed. The clinical area of. 

Hr. V. Bergmann said it was yet to be determined : the heart was small, the pulse good, but apparently the 
what was the nature of epilepsy ? and then there was the return from the vessels to the heart was deficient, as 
proposition that there was no epilepsy without spasmodic proved post-mortem. 

changes in the brain. This condition was congenital, Romberg, Bruhns, and Passler have adduced similar 
and it would not be too much to say that in nine-tenths testimony from experiments on animals with bacillus 
of the cases of epilepsy, whether traumatic or not, there j pyocyaneus, pneumococcus Fnedlander, and the bacillus, 
was a hereditary tendency. If we took from the j of diphtheria. In their conclusions they Btate that the 
remaining tenth all the cases in which infective diseases j vasomotor system must be considered in conjunction 
were the cause, the remainder would be very small. I w ith the heart’s enfeeblement. 

Hereditary disposition could not be assumed when the ^*1 states that during the last two years he has had 
attacks began after the 20th year. As to the cases Beven cases of poisoning from phosphorus in his wards, 
operated on it was very difficult to determine whether The post-mortem revealed a normal empty heart in four 
they had a hereditary predisposition or not. There were °f these cases ; two were not quite, though nearly 
two categories of causes of epilepsy—1st, the supposed em pty; while one was acute poisoning, and not to be 
epileptic change in the brain, which could be treated by classed under the morbid effects of phosphorus changes 1 
operation, bromides, aud section of the sympathetic, The two chronic cases with the heart partially filled with 
and 2nd, those where the disease was caused by localised blood on post-mortem had been treated during life with 


peripheral injury, and here we must satisfy the indicatio 
causalis. If excision of the cortex did not always 
succeed, it was because general epileptic changes had 
already been set up in the brain. For fulfilment of the 
indicatio causalis operation should not be too long 
delayed. A definite judgment as to results of operation 
could only be given years after they had been performed. 

-♦- 

JUistria. 

[from our own correspondent.] 

Vienna. April 22nd, 18M>. 

Death From Vascular Deficiency. 

Under this title Pal has prepared a long article 
with experiments, to prove that death in many cases 
assigned to heart failure is principally due to vascular 
deficiency, and not to any heart impairment. The 
presence of a vascular tonus is generally admitted, 
while experiments on the vaso motor centres demonstrate 
the fact beyond dispute. To defend this argument we 
need only consult the writings of Le Gallois (1812), and 


j injections of a suprarenal extract, whioh may account 
I for the presence of the blood post-mortem. 

The results obtained from these cases prove the exist¬ 
ence of an enfeebled heart during life, out of all proportion 
to the physical Rigns; in many cases before death the 
cardiac area is decidedly less than normal, while the post¬ 
mortem reveals an empty or nearly empty heart. These 
facts are not alone in our clinical investigations, but are 
analogous in many infectious diseases, as tuberculosis, 
typhoid, Ac., as well as non-infectious, such as nephritis, 
pseudo-leucEemia, Ac., which led to a conviction that we 
have a vascular death (“ Gefastodes "), or death due to 
an impaired condition of the vessels concerned and not 
at all attributable to heart failure. This condition 
would be better described as vaso motor paralysis. 

This subject has been further demonstrated on animals 
by drugs by Passler, who first paralysed the vaso-motor 
system and subsequently by vascular stimulants stimulated 
the tonus. The suprarenal extract has the same power. 

Balneological Association. 

The members of the Association, after a few weeks 
discussion, were invited by Lantin to visit his “ Curan- 
stalt,” or hydropathic institution, which is one of ths 


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434 Thb Medical Press. _THE OPERATING THEATRE S. 


finest in the monarchy. The surprised visitors were 
sumptuously entertained at a banquet which will long 
be remembered as that of the first Balneological Con¬ 
gress in Austria. 

“Phy6icats” Examination. 

According to the recent Acts passed in January for 
the security of competent “ physicats,” the test exami¬ 
nations will commence this month in Vienna, followed 
during the year by the other universities. These ex¬ 
aminations will consist of special chemistry, * pharma- 
cognosia,” and general hygiene. 

Sanitary law is also compulsory. The examinations 
are written and oral. 

Accident Insurance 

Owing to the large number of accidents which the 
various insurance companies have dealt with since the 
Workmen’s Compensation Act has come into force the 
Minister of Education has ordered that all universities 
teaching medicine Bhall devote two to three hours every 
week during a winter or summer session to the special 
study of such accidents as come under the compensation 
law, so that no medical practitioner will be able in future 
to plead ignorance of his responsibilities in this depart¬ 
ment of medicine. These additional classes must be given 
without any extra fee from the medical student. 

©peratirtg theatres. 

WESTMINSTER HOSPITAL. 

Scpra-pubic Lithotomy. —Mr. de Santi operated on 
a boy, a‘t. 5, who had been admitted with symptoms of 
vesical calculus. On examination under chloroform with 
a sound a hard and large stone was detected free in the 
bladder. The boy had the usual symptoms of stone, but 
his mother stated he had only complained of them quite 
reoently. The urine contained a little pus and blood. 
It was decided to do a supra pubic lithotomy. The 
patient having been anaesthetised and sounded again, the 
bladder was gently washed out with warm boracic lotion; 
then three ounces of the same lotion were injected and 
r etained by a ligature round the penis. An incision two 
i nches long was next made in the mid-line well over the 
pubes, the fat covering the anterior part of the bladder 
exposed, some rather large veins hooked aside, and the 
anterior wall of the bladder defined. The peritoneal re¬ 
flection was well seen, and waB a little lower than normal 
the bladder was fixed with a sharp hook, and incised in. 
the middle line with a scalpel from above downwards. 
On introducing a finger into the bladder a pair of pres¬ 
sure forceps having been applied to each side of the 
viscus, the stone was felt quite loose at. the base of the 
bladder; the calculus was very rough and large. The 
vesical incision had to be enlarged downwards for some 
distance, in order to allow of the extraction of the stone 
with a small pair of lithotomy forceps. The bladder 
was then explored to see if there were [any other stones, 
and then gently irrigated with boracic lotion. The wound 
in the viscus was sutured with fine silk by Lambert’s 
method, it was found impossible, however, to suture the 
lowermost part of the opening into it without unduly 
dragging on the bladder, so an india-rubber flanged 
tube was .inserted into that part of the wound in the 
viscus, being brought out at the lowermost part of the 
skin wound. The upper part of the skin wound was 


Abril 26, 1899. 

closed with silkworm gut, and collodion gauze dressin g 
applied with a peat pad over it. The stone removed 
weighed 500 grains, was slightly oval in shape, and 
measured 41 inches in its greatest circumference ; it was 
extremely hard and tuberculated on its surface. Mr. de 
Santi said that th9 size of the stone, if for no other 
reason, contra-indicated such an operation as lateral 
lithotomy, it therefore became necessary to consider the 
operations of litholopaxy and supra-pubic lithotomy; 
he decided on the latter being the better method of 
operating in this case for three reasons: first, the age 
of the patient; secondly, the size of the stone; and 
thirdly, its extreme hardness. If litholopaxy had been 
the operation chosen, only a very small lithotrite could 
have been employed, and there would have been extreme 
difficulty with so small an instrument in crush¬ 
ing so hard a stone; moreover, there would have 
been considerable more risk of inflicting injury on 
the vesical mucous membrane. The operation of supra¬ 
pubic lithotomy in such cases had given, he pointed out, 
in experienced hands extremely good results, and, with 
ordinary care there should be no risk of wounding the 
peritoneum. Where the condition of the bladder and urine 
permit of it complete closure, by Lembert’s method, of 
the wound in the bladder was, he thought, the soundest 
treatment. In this case, on account of the rather low 
reflection of the peritoneum and the size of the stone, the 
incision into the bladder had to be prolonged downwards 
and the lower part of it could not well be sutured; in all 
cases, even when the bladder wound is completely closed 
with sutures, it is safer, he considered, to leave the lower 
angle of the skin wound open, and to keep a drainage 
tube in for three or four days. 

WEST LONDON HOSPITAL. 

Intra-cerebral Injection for Tetanus. — Mr. 
Bidwell operated on a man, set. 35, who had been ad¬ 
mitted suffering from acute tetanus. A fortnight before 
the patient had run a nail into his right foot. He had 
been under treatment outside the hospital, and the 
wound had healed. On the day before operation he 
oonld not open his mouth, and had twitchings of the 
right leg; he was, therefore, immediately brought up 
to the hospital. After admission 10 c.c. of anti-tetanio 
serum were injected hypodermically under the Bkin of 
the abdomen. On the morning of operation, however, the 
tetanus had increased, with marked opisthotonos, and 
the abdominal muscles were quite rigid, breathing bein g 
thoracic ; it was therefore decided to inject the antitoxic 
serum into the cerebral hemispheres. The patient was 
put under chloroform, and the area of the wound in the 
foot freely dissected away, the scalp was then shaved 
and purified. The points at which the skull should be 
drilled were defined in the following way:—An imaginary 
line was taken over the head from one auditory meatus 
to the other, another line was taken from the base of the 
nose to the top of the head, crossing the first line at 
right angles, and a third line was carried from the outer 
angle of the orbit to where the first two lines crossed 
each other; the centre of this last line is the point where 
the skull should be drilled. This point was marked on 
the skin, and a small curved incision made just external 
to it, the pericranium elevated, and a hole drilled with 
an ordinary bradawl ; the needle of the antitoxin syringe 
was then plunged downwards and backwards into the 
substance of the cerebrum, and 5 c.c. of antitoxic serum 
very slowly injected. This injection took about 


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April 26, 1899. 


LEADING ARTICLES. 


Th* Medical Prk86. 435 


15 minutes. The syringe was then withdrawn, and 
the skin flap fixed with a oouple of horsehair sutures. 
An incision was next made at the same point on the 
opposite side, the bone drilled, and the antitoxin (5 c.c.) 
injected as before, this second injection taking 10 minutes. 
This wound was also closed and dressings applied. Mr. 
Bidwell said that when tetanus has once developed the 
toxin has already been fixed in the central nerve 
cells ; these cells are not influenced by antitoxin injected 
hypodermically; but it has been proved that animals can 
be cured by interoerebral injections of antitoxin. It iB well 
known he pointed out that hypodermic injections of anti¬ 
toxin are quite satisfactory in early cases, but have proved 
very disappointing in more advanced ones. This method, 
he said, had been advocated by M M. Roux and Borrel, 
and about twenty cases had been treated in the neigh¬ 
bourhood of Paris by it with encouraging results. The 
first case treated in this country was by Major Semple, 
B.A.M.C., whose directions both for point of injection 
and slow method of injecting the fluid were followed in 
the case he (Mr. Bidwell) had just done. The reason for 
this slowness is to avoid breaking up the brain tissue, the 
object of the surgeon being to allow the antitoxin to soak 
in drop by drop. The object of the measurements is to 
select a spot where no injury can be done to any part of 
the motor area. He commented on the necessity of 
freely removing the area of the original wound, as at 
this point there is a colony of bacilli, from which freBh 
doses of toxin will be absorbed. He should continue the 
hypodermic injection of antitoxin daily until the stiff¬ 
ness had gone. 

It is very satisfactory to state that the patient made 
an uninterrupted recovery, and left the hospital three 
weeks after operation. 


Vital Statistics. 

The deaths registered last week in thirty-six great 
towns of United Kingdom corresponded to an annual 
rate of 19o per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of this year. 

Birkenhead 17, Birmingham 24, Blackburn 18, Bolton 
19, Bradford 17, Brighton 27, Bristol 17, Burnley 20, 
Cardiff 11, Croydon 14, Derby 19, Gateshead 21, Halifax 
19, Huddersfield 21, Hull 19, Leeds 16, Leicester 17, Liver¬ 
pool 24, London 18, Manchester 28, Newcastle-on-Tyne 17, 
Norwich 18, Nottingham 18, Oldham 24, Plymouth 19, 
Portsmouth 18, Preston 18, Salford 21, Sheffield 17, 
Sunderland 22, Swansea 18, West Ham 13, Wolver¬ 
hampton 26. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were : —From measles, in Manchester; from scarlet 
fever, l'l in Halifax and in Bradford; from whooping- 
cough, 2’1 in Plymouth, and 2 3 in Birkenhead and in 
Burnley ; and from diarrhcea, 14 in Salford. In none of 
the large towns did the death rate from “fever,” reach 
1-0 per 1,000. The 59 deaths from diphtheria included 
20 in London, 7 in Sheffield, 4 in West Ham, 4 in Liver¬ 
pool, 3 in Portsmouth, and 3 in Leeds. Two deaths from 
small-pox were registered in Hull, but not one in any 
other town. 


Mortality in Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations:—Bombay 149, Madras 36, Paris27, Brussels 
17, Amsterdam 17, Rotterdam 24, The Hague 21, Copen¬ 
hagen 20, Stockholm 23, Christiania 24, St. Petersburg 
26, Moscow 25, Berlin 18, Hamburg 18, Dresden 21, Breslau 
24, Munich 26, Vienna 25, Prague 29, Buda-Pesth 25, 
Trieste 30, Rome 20, Venice 37, Cairo 32, Alexandria 35, 
New York (including Brooklyn) 19, Philadelphia 21. 


Registered roR Transmission Abroad. 


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^he .ittelrical {kess anb Circular. 


SALUS POPDLI SUPREMA LEX.” 


WEDNESDAY, APRIL 26, 1899. 


THE RADICAL CURE OF HERNIA. 

The habitual use of the term “radical cure of 
hernia” is probably largely responsible for the very 
prevalent belief that surgeons can be trusted to 
obviate a very disabling condition with but trifling risk 
to life; but, judging from a paper recently read before 
the Medical Society of London by Mr. Langton, the 
ultimate results are by no means aU that could be 
desired or expected. The surgeon is but too apt 
here, as elsewhere, to consider his responsibility at an 
end when the wound has healed and the patient has 
been authorised to resume his ordinary avocation, 
but in such a matter as the cure of hernia it is obvious 
that the experiment has only begun when the patient 
leaves the surgeon’s hands. It is of vital importance 
that we should know whether the permanence of the 
cure is such as to render it worth the patient’s 
while to undergo the inconvenience of such 
an operation and the risks inseparable from 
a surgical intervention of this magnitude. The 
mortality attending the operation has steadily im¬ 
proved since 1880, until at the present time it is 
almost nil, though it must not be forgotton that the 
results are not equally good at all hospitals and in the 
hands of all surgeons. But the very freedom from 
danger effected by modem improvements in surgical 
technique may have created in the minds of practi¬ 
tioners a certain recklessness in advising recourse 
thereto, hence the importance of rendering available 
statistics which will show whether or not it is really a 
radical cure or merely an operation for the radical 
cure, two very different things. Unfortunately, such 
statistics are very difficult to obtain. Two years have 
been laid down as the minimum period at which it is 
possible to form a trustworthy opinion as to the 
permanence of the expected cure, and, in hospital 


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436 The Medical Pbess. 


LEADING ARTICLES. 


practice at any rate, it is almost impossible to keep 
one’s patients under observation for this, and 
a fortiori for a longer, period. It appears, however, 
that during the last six years no less than 242 
operated patients have applied to the City of 
London Truss Society for relief, from which it 
may be inferred that the total number of instances 
of the hernia recurring after operation in the metro¬ 
polis must be considerable. It would be an interesting 
object lesson for surgeons to scan the list of patients 
thus applying for relief for this would enable them to 
form some idea of the success attending their inter¬ 
vention, and, incidentally, of the value of the par¬ 
ticular procedure adopted by them Each surgeon 
has his own pet way of operating, and each, no doubt, 
flatters himself that his results leave little to bedesired 
This is a delusion which it might be well to destroy, 
but we will not be cruel enough to advocate the publi¬ 
cation, even among medical readers, of the list which 
Mr. Langton holds over them in terrorem. The paper 
gave rise to a very interesting debate in the course 
whereof various technical points were discussed, 
notably the frequency with which suppuration 
occurred in the wound and the age limits within 
which the operation might safely be advised. While 
some surgeons seldom or never witness suppuration 
as a complication it appears to be tolerably frequent 
in the hands of others. Doubtless, the age of 
the patients had something to do with this, for it 
must be vastly more difficult to obtain asepsis in the 
very young than in older patients. This, indeed, iB 
a cogent argument against operation in very young 
subjects in the absence of urgent indications. Apart 
from this, suppuration is probably due in many 
instances to inadequate cleansing of the skin, a point, 
which the modern surgeon might reasonably be 
expected to attend to. The operation, moreover, 
appears to be attended by small success in cases 
where the hernia is so large that it cannot be con¬ 
trolled by moderate pressure, a state which implies 
a large and patulous opening in the abdominal wall 
Lastly the ultimate results appear to be greatly 
influenced by the condition of the peritoneum after 
operation. The existence of any fossse or depres¬ 
sions must necessarily favour a recurrence of the 
infirmity, and surgeons understand this well enough 
to make every endeavour to leave the peritoneum 
tense and smooth, so much so indeed that the torsion 
of the sac resorted to for the purpose of obliterating 
any tendency to pouch-formation is occasionally 
carried so far as to drag in the bladder, a very dis¬ 
concerting accident in truth. The outcome of the 
discussion is to leave a doubt in one’s mind as to the 
permanent value of the so-called radical cure of 
hernia. The operation has, however, a recognised 
place in surgical therapeutics, and it cannot well be 
abandoned, but it behoves surgeons jealous of their 
reputation to study how best to obviate the insuffi¬ 
ciencies of the procedures at present in vogue, so that 
practitioners may conscientiously recommend their 
patients to seek relief from an infirmity which 
entails very tangible risks and much discomfort. 


Apbil 26, 1899 

MILITARY AND NAVAL SURGERY OF THE 
FUTURE. 

The civilised world has lately witnessed a move¬ 
ment in favour of peace that may well be regarded 
not only as the shadow of a coming event, but as one 
of the most notable occurrences of a notable century. 
The great cause of universal peace espoused by the 
Czar of Russia was prompted in the first place by M. 
Johann von Bloch, a Russian Councillor of State. In 
a ponderous treatise of six volumes von Bloch argue a 
that the development of war will one day render the 
arbitration of the sword impossible, owing to the vast 
armaments, the enormous destruction of life, and 
the damage to commerce that must be involved. 
The main thesis of this epoch-making book 
is worked out with an elaborate detail that 
beare the stamp of indefatigable energy and 
thoroughness,'and to no small extent accounts for the 
way in which the author has stirred up the mind of 
the nations. So far ar the medical profession is con¬ 
cerned the statements are full of interest. In the 
battle of the future there will be a terrific hail of 
artillery fire at a distance of 6,000 metres; while at 
2,000 metres the bullets of the infantry will sweep 
the field. Already within the last thirty years the 
efficacy of rifles has been increased fourteen-fold, and 
there is no sign that the limit of destructiveness 
has yet been approached by the ingenuity of 
inventors. It seems clear that with modern 
arms there must be an area of at least a thousand 
metres between the opposing armies so swept by 
missiles that no man could live therein. Beyond that 
would come zone after zone of diminishing danger, 
with corresponding effects upon the human targets. 
The effect of the new nickel-coated, small-bore pro¬ 
jectile is described as frightful, resembling that of an 
explosive bullet. It splits up bone3 into a mass of 
fragments, which tear through the body. It has a 
small wound of entry, and a great gaping wound of 
exit. It pierces three human bodies, and is stopped 
only by afourth. Itpulverises heart, liver, kidneys, and 
other internal organs, and tears muscles to shreds. At a 
distance of over 1,000 metres, it causes a radiated 
wound of entry. At 1,600 metres, it has still the 
power of causing dangerous, and sometimes com¬ 
minuted, fractures. The natural result of all this 
terrific and deadly fire is that a great many more 
soldiers must be killed outright on the spot. Another 
inevitable rider is that it will be impossible for non- 
combatants to venture within the fatal zones, so that 
the wounded must lie untended during the time that 
the battle is waging. Delay of that kind in attending 
to casualties must mean a vast increase in the death- 
roll. Another point is that, in coming warfare, 
an enormously increased number of men will have to 
to be put in the field, which will mean that the 
present ambulance corps will have to be multiplied 
by at least tenfold. From an English reviewer’s 
translation of Von Bloch's views we gather that 
“ Owing to the longer range of modern weapons, 
ambulances must remain at a greater distance than 
I ever from the field, and as future battles on a large 


Digitized by v^ooQle 


NOTES ON CURRENT TOPICS. 


The Medical Press. 437 


April 26, 1899. __ 

scale will certainly last longer, the wounded and 
dying may be obliged to remain for two or three 
days in the open without a drop of water or morsel of 
bread.” In naval warfare, even under present con¬ 
ditions, it is impossible for the wounded to be imme¬ 
diately removed when a ship is engaged at close 
quarters, so terrific is the storm of missiles that 
sweep her decks. Out of all this sad desolation of 
human savagery issues the fixed idea of universal 
peace, one of the greatest conceptions that has ever 
seized upon the mind of man. Those who are the 
friends of peace have long preached an unpopular 
doctrine, but Yon Bloch has suddenly opened to 
them a road to salvation. He has shown the absolute 
unwisdom of the nations of the earth devoting their 
accumulated cunning to the task of mutual extermi¬ 
nation. He has done more for the advancement of 
the principle of international arbitration than any 
one man whose lot has been cast in this universe of 
unceasing upward stress and struggle towards the 
ideal perfection not less of the individual than of the 
community. 


33 control cases there was but one genuinely 
positive reaction. In seven active syphilitic 
cases the loss of haemoglobin after one inunction 
averaged 21 per cent. In brief, the experiments 
of these two observers tended to confirm the conclu¬ 
sions at which Justus had arrived, with two excep 
tions. One was the case of a girl suffering from 
chlorosis. Despite the fact of the complete absence 
of syphilis in her, a typical positive reaction was 
obtained with a loss of 13 per cent, of haemoglobin. 
The other was in a case of tertian ague, where 
a loss of 10 per cent, of haemoglobin was 
noted. The latter condition, the authors believe, 
could be accounted for by the agueish attack 
occurring just after the administration of the mercury. 
With regard to the first case, however, the authors 
offer no explanation as to the cause of the loss of the 
haemoglobin, nevertheless they express the opinion 
that so far as it goes the case certainly tends to 
diminish the value of the test which Justus has 
introduced. These experiments, however, are un¬ 
doubtedly valuable, showing as they do that further 
investigation in the same direction might establish 


THE JUSTUS TEST FOR SYPHILIS. 

To decide whether an ulceration of a given part of 
the body is syphilitic, tuberculous, or malignant is in 
some cases extremely difficult. An ulcer affecting 
the tongue, for example, may be either cancerous or 
syphilitic, and the external appearances of each 
disease being nearly similar in the early stages, 
the surgeon cannot at first be absolutely cer¬ 
tain as to the differential diagnosis. Justus, 
however, an assistant in Schwimmer’s clinique 
at Budapest, two or three years ago, designed 
a test which he claims will determine the 
diagnosis in doubtful cases of syphilis. The test 
depends upon the sensitiveness of the red blood cor¬ 
puscles in syphilitic persons to the action of mercury 
administered by inunction, or by subcutaneous or 
intravenous injection. Justus holds that this sensi¬ 
tiveness is greater in syphilis than in any other 
disease, so much so that the administration of the 
drug is followed a few hours afterwards by a sudden 
fall in the percentage of haemoglobin. In 300 
cases of syphilis observed by Justus in which 
mercury was given, a sharp fall of 10 to 20 per cent, 
was recorded in the haemoglobin, while among control 
cases, in which syphilis was not present, no such fall 
was noticed. The subject is fully discussed in an 
interesting paper by Drs. Cabot and Mertins, 
published in the Boston Medical and Surgical 
Journal for April 6th last, in which they 
record their own experience of the test. The 
authors state that in the summer of 1898 they 
tried the test in the out-patient department of the 
Massachusetts General Hospital in 98 cases of un¬ 
doubted syphilis, 4 cases suspected of being syphi¬ 
litic, and 33 control cases of various other diseases, a 
total of 44 cases. From fifteen to forty grains of the 
unguentum hydrargyri were “ inuncted ” into each 
patient, with the result that all the syphilitic cases 
reacted strongly and characteristically, while in 


greater certainty as to the usefulness of the new test. 
That some test of the kind is needed goes without 
saying. If subsequent observers can prove that the 
Justus test is to be depended on, a distinct advance 
will have been made in the subject of syphilis. 


$otts oti Current topics. 

Increase of Lunacy in Norfolk. 

Hebe as elsewhere, we hear of a steady increase 
of lunacy and a growing demand for additional 
accommodation. In Norfolk the demand seems to 
be more for female patients, and the County Council 
following the recommendations of the Committee of 
Visitors of the county asylum have decided to build 
new accommodation for males at the auxiliary 
asylum. The Committee of Visitors were guided to 
a decision by a report furnished by the medical 
superintendent, Dr. Thompson, who has gone into 
the question most thoroughly and considered not 
only causes of increase, but means of meeting the 
difficulties of the situation. He observes that the 
yearly increase is produced in several ways, but 
speaking generally it is the annual increase difference 
between the admissions on one hand and the deaths 
and discharges on the other. It is curious how unani¬ 
mously superintendents of asylums write regarding 
causes of increase. Here again we have repeated an 
old tale of accumulation of senile and workhouse 
cases in asylums. There can be no question that 
patients are much too readily sent to asylums, and 
that their friends shunt them off whenever they be¬ 
come the least troublesome. Moreover, recovery 
rates cannot be so high when such flotsam and jetsam 
as senile cases, congenitally paralytics, and other in¬ 
curable forms are accumulating and being sent to 
asylums. Moreover, as others have pointed out, the 
death-rate tends to diminish, owing to sanitary and 
other improved conditions of treatment, and here we 


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433 The Medical Press. 


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April 26, 1899. 


have another element in the increase of lunacy. Dr. 
Thompson suggests five ways of meeting the 
difficulty; two of these need only be considered, as 
the others are merely of a temporising character, 
One of them is to board out quiet and harmless 
patients. This, although successfully carried 
out in Scotland, for some unknown reason has never 
succeeded in England. It would be interesting to 
know what the views of the Commissioners in Lunacy 
in England are with regard to boarding-out. Certainly, 
if they showed one quarter of the energy and zeal 
which the Scotch Commissioners have shown, board¬ 
ing-out would not have been an unknown quantity in 
England, and much money would have been saved- 
Dr. Thompson’s other proposal, the one which has 
been adopted, is to build new accommodation for 
males at the auxiliary asylum, making the latter a 
separate institution for males only. Dr. Thompson 
gives details of how he would carry this out, and 
these details seem very satisfactory. He mentions 
several advantages likely to arise by such a depar¬ 
ture from an administrative point of view. With 
some of these we are quite in accord, though it may 
be matter of discussion regarding some of the others. 

Essentiality of “ Sanction ” for an Irish 
Dispensary Election. 

The curious deadlock of the election of a Medical 
Officer of the Dundrum (Dublin) district has unex¬ 
pectedly raised a question of vital interest to the 
Poor-law Medical Officers of Ireland. It will be 
recollected that, after a fierce contest between the 
only two possible competitors, one, who had held the 
neighbouring district for about twenty years, was 
elected by a majority of one vote. It then became 
known that such majority was secured by the sending 
of a bogus telegram to one of the voters hostile to 
the elected competitor, which telegram kept the voter 
away and turned the scale. A sworn investigation 
was held by the inspector of the L.G.B., and the facts 
were established beyond question, except that no 
serious attempt was made or evidence presented, 
to show that the elected officer had anything what¬ 
ever to do with the telegram transaction or any 
privity to it at any time, which he indignantly denies* 
Under these circumstances the Local Government 
Board ordered a new election, but it departed from 
precedent inasmuch as it did not supply the 
guardians, as has always been done, with a precis of 
the facts or a statement of the reasons for invalidating 
the election, but confined itself to declaring that 
“ irregularities ” had occurred. The effect of this 
decision may be to deprive the Medical Officer of the 
position to which he was elected by a majority, 
because the constituency who are to elect on the 
next occasion are quite different in religion, politics, 
and personality from those who elected the last time, 
and we say that it is very hard on him that he 
should lose his appointment because of the 
offence of a third party with which it has not 
been shown that he was, in any way, cognizant of 
or responsible. The question thus arises whether the 


Local Government Board has power to invalidate 
an election by the simple process of omitting to give 
its sanction thereto. Assuming that it has such 
power under ordinary circumstances, we do not see 
how it can justify the proceeding under the circum¬ 
stances of this case, because, as a matter of fact, the 
gentleman elected has served the neighbouring dis¬ 
trict for about twenty years sans reproche. We do 
not, for a moment, dispute the moral right of the 
Local Government Board to bar the entrance into 
the service of a man who has disqualified himself by 
misconduct, but it is entirely another matter whether 
it can exclude a man admittedly suitable in all 
respects. Needless to say that we speak in the 
interests of justice, not having the faintest interest 
in either competitor. 

Proposed Inquiry as to the Prevalence of 
Venereal Diseases. 

Some time since we mentioned that a movement 
was being organised by a number of influential ladies 
who are devoted to philanthropic and rescue work 
among women, in the hope of inducing the Govern¬ 
ment to investigate by Royal Commission the preva¬ 
lence of venereal diseases in the civil as well as the 
military population. Among other public bodies 
the organisation asked the help of the Irish College 
of Surgeons, and that College has responded by for¬ 
warding the following Memorial for presentation to 
Parliament, or to the Government authorities, as 
may seem best: — 

The Memorial of the President and Council of 
the Royal College of Surgeons, sheweth—That your 
memorialists, having been brought into intimate 
relation to the treatment of venereal diseases not only 
in this country but elsewhere, and, being thus enabled 
to form a judgment as to the frequency of occur¬ 
rence of such diseases in both the military and civil 
populations, feel it their duty to urge upon the 
Government the necessity for a thorough examina¬ 
tion of the question by Royal Commission or other¬ 
wise, as may be thought best. 

That your memorialists would find it difficult to 
exaggerate the prevalence of these forms of disease 
in one or other form, and they testify from prolonged 
experience of both hospital and private practice that 
primary venereal disease is wide spread among the 
community, and that the dissemination of the 
secondary forms of the disease by these primary 
sources of infection is calamitous and is undermining 
the constitution of the nation and weakening the 
working capacity of thousands of innocent indi¬ 
viduals. 

That your memorialists, for these reasons, urge 
upon the Government the necessity for a thorough 
investigation of the subject, being fully confident 
that evidence can be produced by the medical pro¬ 
fession which will convince the Government of the 
necessity of seeking a remedy. 

We are quite certain that the great majority of our 
readers will sympathise with the purpose of this 
organisation, and with the view expressed by the 
Irish College, and will desire every success for the 
effort which these humane ladies are making. 

The Marchioness of Zetland opened, last week, the 
Victoria Hospital, in commemoration of the Diamond 
Jubilee, at Richmond, Yorkshire. 


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April 26, 1899. 


NOTES ON CURRENT TOPICS. 


Thb Medical Press- 439 


Nurses and Nostrums. 

From time to time the fact is brought forcibly 
home to medical men that nurses have it in their 
power to work an almost endless amount of mischief 
among patients. With the ordinary indiscreet 
woman who would never learn her craft from a 
hundred years of training and experience we are all 
familiar. She tells the languid invalid with ghastly 
detail of all the fatal cases she has attended, she 
pours forth the history of her own woes, or she laughs, 
weeps, is lively, restless, active, still, present, absent, 
assertive, elusive, colourless, sharp, abrupt, decisive, 
inquisitive, reticent, all in the wrong places. The 
particularly michievous minister in mind was rather 
she who poses as an authority on physic and matters 
medical, she who always knows more than the 
medical attendant, and is ready with an opinion upon 
any surgical or medical treatment, no matter how 
complicated or technical. Like all half-trained 
minds, she yearns for the specific cure, and not in¬ 
frequently surrenders her belief to the blandishments 
of the quack medicine vendors' smoothly-worded 
assurances. That would not so much matter if 
things rested there, but, unhappily, as often as not 
she goes on to recommend her favourite nostrums to 
patients under her charge, who naturally place more 
trust in the advice of a trained nurse than they 
would in that of an ordinary layman. This evil is no 
shadowy one; but it may happily be believed that it 
is confined to a comparatively small section of a 
sisterhood that in its higher aspects both deserves 
and earns the thanks of mankind. This much may 
be said for their excuse, namely, that patent medi¬ 
cines are not unknown within the walls of our great 

hospitals. - 

Tbe Doctor in the Witness Box. 

An action was tried last week in the County Fer¬ 
managh Assizes before Chief Baron Palles, which 
turns a good deal on a matter of medical evidence- 
Mr. Thompson, a Fellow of the Irish College of Sur¬ 
geons and Surgeon to the Omagh Infirmary, sued a 
solicitor for defamation by words spoken at an 
Orange meeting. The defamatory speech repre¬ 
sented that Mr. Thompson, having offered himself 
as a Unionist candidate for the representation of the 
county, and having failed, tried to “ hedge ” with tbe 
Nationalists, for the next election, by the evidence he 
gave at the trial of certain persons for the murder of 
a man named Funston. It seemed to be admitted that 
this simple murder issuewas,by the religious rancourof 
the locality, converted into a politico-religious wrangle 
all the Orangemen being for the conviction of the 
accused and all the Nationalists for their acquittal. 
Be this as it may, the evidence of two or three 
medical practitioners who had made post-mortem 
examination being that the man was undoubtedly 
beaten to death, and that of Dr. Thompson, that he 
lay down and died on the roadside from natural causes, 
the accused were acquitted, and the defendant in this 
suit appears to have suggested that Mr. Thompson's 
evidence was influenced by his anxiety to please the 
Nationalist party upon whom he was supposed to be 
dependendent at the next election. The trial resulted 


in a verdict for Dr. Thompson for two separate sums 
of £25. Wherever the merits of this case may be, it 
is, manifestly, a fact disgraceful for all concerned- 
that a murder should be made the subject of political 
wire-pulling, either to convict innocent men or to 
protect murderers. 


The Prevalence of Tuberculosis among 
Cattle. 

The announcement made some time since that 
thirty-six out of forty cows belonging to the Royal 
herd at Windsor proved to be suffering from tuber¬ 
culosis on the application of the tuberculin test, the 
results being subsequently confirmed by post-mortem 
examination, is very startling, and brings us face to 
face with some very grave problems. It is evident 
that sanitation alone cannot be trusted to avert con¬ 
tamination, and we are told that the only effectual 
way of keeping herds free from this disease is to 
rigorously test each animal before allowing it to 
associate with its fellows. It has been computed 
that probably a third of all the adult animals in the 
country are more or less affected with tuberculosis, a 
proportion which must for the time being paralyse 
any effort to eradicate it from our midst. Fortu¬ 
nately there is no reason to suppose that the milk 
and flesh of cows suffering from localised tuberculosis 
are necessarily infective, but as it is a progressive 
disease it is obviously impossible to lay down any 
hard and fast limit, for the localised tuberculosis 
of to-day may become generalised to-morrow, or the 
disease may spread to parts, such as the udders, 
under circumstances which would confer infective 
properties on the milk and, later, on the flesh of 
such animals. Now that we are in possession of a 
means of ascertaining for certain whether an animal 
has latent tuberculosis it will be possible to exercise 
more effectual control in the matter of segregation 
or isolation, but in the meantime it becomes impera¬ 
tive to warn the public of the ever present danger of 
consuming uncooked milk. 

Magisterial View of the New Inebriates' Act. 

A homeless woman, of ill repute, was last week 
brought up at the North London Police Court on a 
charge of being drunk and disorderly. It was given 
in evidence that she had been convicted of drunken¬ 
ness five times already during the present year, and 
an application was made by the Court Missionary 
that the prisoner's consent should be asked to her 
being placed in a home under the provisions of the 
recently-enacted Act of Parliament. Mr. Fordham, the 
magistrate, however, held that the prisoner was not the 
sort of habitual drunkard contemplated by the Act. In 
va in the missionary pointed out that she was compara¬ 
tively young and might, after a suitable period of 
detention, stand a chance of reformation. The magis¬ 
trate laid it down that, in his opinion, the Act only 
applied to respectable women who had fallen victims to 
theer aving for drink. But these so-called respectable 
women who are chronic inebriates, usually indulge their 
craving in the privacy of their homes. The}’ do not 
blazon forth their ignominy by getting drunk in 


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440 Tub Medical Press. 


NOTES ON CURRENT TOPICS. 


April 26. 1699. 


public-houses and proclaiming the fact in the puhlio 
•thoroughfare, hence they are not likely to incur the 
repeated conviction which an over-scrupulous legisla¬ 
ture has made an indispensable condition of com¬ 
pulsory treatment. Mr. Fordham’s view, if generally 
acted upon, would inevitably stultify an Act which is 
generally recognised to be of a most beneficent 
character. So serious is this decision that, either by 
question in Parliament or by appeal to a higher 
court, immediate steps should be taken to have it 
rectified, or otherwise all the labour which this Act 
entailed will have been wasted, and no progress will 
have been accomplished in the reform of this large 
and distressing olass of social delinquents. 

No Pees. 

Our legislators have not yet consented to remedy 
the anomaly of refusing fees to medical men for 
-giving evidence at inquests when the subject 
of the inquiry has died in hospital. We have fre¬ 
quently insisted on the unreasonableness of this pro¬ 
vision, which is as unjust as it is contrary to public 
policy, but at an inquest held last week by the 
Coroner for East Middlesex, the absurdity of the 
rule was made even more glaring. Dr. Tomlin was 
called in to attend an epileptic girl who had been 
seriously burned, and, in view of the gravity of the 
injuries he had her removed to the neighbouring 
cottage hospital, where she died in spite of every 
care. Dr. Tomlin was, of course, called upon 
to give evidence at the inquest, yet, on the ground 
that the patient had died in the hospital, his fee was 
disallowed. We should not have supposed that the 
rule would have applied in such a case, the witness 
not being the resident medical officer of the insti¬ 
tution, but the coroner held that it did, and so Dr. 
Tomlin had to go without his fee. Why medical men, 
alone among members of the learned professions, 
should be constrained to render so many gratuitous 
services to Society and to the State, it would be a 
difficult task to explain, and it behoves them as a 
body to take steps to have all such anomalies 
redressed. 

“ Trailing Skirts.” 

A correspondent to a morning contemporary 
resuscitates the objections to the fashionable “ cling¬ 
ing and trailing skirts.” Nothing, of course, could 
be conceived more unhygienic and uncleanly than 
this form of apparel. Not only do women thu6 
become the means by which much gratuitous street 
sweeping is done, but worse than all their clothing 
gathers up, during the process, a large and varied 
assortment of infective abominations, which are 
ultimately conveyed into houses and distributed in 
the form of dust. From this point of view a visitor 
with a trailing skirt is a distinct source of danger to 
a household ; quite possibly the infection of measles, 
for example, and other zymotic diseases, has thus fre¬ 
quently been conveyed. In this connection mention 
may be made of the fact that it is so usual to think 
only of the apparent channels of the transmission of 
such infection that other possible means are quite 


overlooked or ignored. To suppose, however, that 
the fashion-mongers will ever pay any attention to 
what is hygienic and what is not, in their designs for 
dresses, is contrary to the experience of centuries. 
Unfortunately a “ fashion ” is only designed with 
a view to its commercial success, and this explains 
how it is that women have to take everything as it 
comes in this regard, however much they may have to 
suffer in consequence. 


Failure of a Manchester Malpraxis Aotion. 

The Medical Defence Union has to add another to 
its long list of distinguished successes in the protec¬ 
tion of members. The plaintifE in the action, heard 
last week in Manchester, was a coachman past middle 
age. In the course of his work he was thrown from 
the box of a carnage, and sustained a bad compound 
comminuted fracture of the forearm. His injury was 
treated at the Stockport Infirmary, where the house 
surgeon described it as the worst fractured forearm 
he had ever seen. Shortly afterwards he pas Bed 
under the care of Dr. Gunn, of Droylsden, from whom 
he ultimately claimed damages for improper treatment. 
According to the evidence of well-known hospital 
surgeons who had seen the arm in question, the issue 
of the injury was doubtful from the first, while the 
normal plastic operations could not be attempted from 
the nature of the case, and on account of the age of 
the patient. A radiogram figured prominently in the 
course of the evidence. Without hearing the address 
of counsel for the defence, the jury at once gave a 
verdict for the defendant, Dr. Gunn. As the plaintiff 
was unable to pay the costs of the trial, the whole of 
the large outlay involved in the defence would have 
fallen upon Dr. Gunn had he not belonged to the 
Defence Union. As unjustifiable “speculative” 
actions of this kind hang potentially over the head 
of every practitioner, the moral is clear, namely, to 
join the Association that will help them in the hour 
of need. 


A Stupid Canard. 

Some really astonishing “ facts ” find their way 
into the newspapers, and, perhaps, the most absurd 
thing of the kind which has come under our notice 
is the statement that the late Mr. Gladstone pos¬ 
sessed a membrana nictitans in each eye, which he 
frequently made use of to paralyse his opponents in 
argument. It would be just as true to say that the 
present Prime Minister is able to make his oppo¬ 
nents 6quirm by the aid of his vermiform appendix. 
H ow any editor could have allowed himself to be gulled 
by such nonsense entirely surpasses our comprehension. 
Every educated person should know that the mem¬ 
brana nictitans is only found in birds and certain 
mammalia. At all events, we should have imagined 
that, to any one of ordinary intelligence, the impossi¬ 
bility of any such anatomical peculiarity as that 
claimed for Mr. Gladstone would have been apparent 
at once. However, such is the gullibility of many 
persons that, although the statement has been 
absolutely contradicted, quite possibly in years to 


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April 26, 1899. 


.NOTES ON CURRENT TOPICS. Thb Medical Press. 441 


come the public will again be told that the late Mr- 
Gladstone had remarkable eyes, which were espe¬ 
cially distinguished by having a nictitating membrane' 

Retribution. 

Mbs. Longshore Potts the soi-disant Yankee 
M.D. who has been touring this country as a lecturer 
on indecent subjects to women who call themselves 
ladies, and who has practised extensively on the vile 
bodies of such persons, has, we are gratified to note, 
been mulcted in £175 and full costs, at a trial last 
week in Manchester, for damage inflicted by her on 
a foolish, young unmarried woman. This person not 
only went to the lecture, but brought her sister with 
her, and visited the quack next day at her own 
house, where she was examined and frightened out 
of her life by being threatened with nameless evils 
if she did not submit to the adaptation of one of Mrs. 
Potts’ pessaries for which, though valued at 2s. 9d., she 
was charged £5 10s. From it she suffered so much 
injury that she had to go to several doctors, all of 
whom concurred that she had never suffered from 
the alleged disease, and she then brought this action 
We do not suppose that quacks can be prevented 
from trading on the erotic sensibilities of certain 
women, but the worst of this woman's trade is that 
she has been enabled to carry it on successfully 
because a considerable number of well-known public 
men, including the Bishops of Manchester, Landaff, 
and other places, the Lord Mayor of Manchester, an 
ex-Lord Mayor of Dublin, and many others lent her 
their names. Her ruse is an extremely clever one. 
Before she opens her camp aign in a certain district, 
her agent makes a tour with her sham diploma 
iwe have ascertained that it is not recognisable 
by any official authority even in America) and other 
documents. He calls on Bishops and other leading 
people, most of whom never heard of this woman in 
their lives, but he does not ask them to testify any¬ 
thing but the fact that they have seen the said docu¬ 
ments, which statement Mrs. Longshore Potts cir¬ 
culates in such form as to lead the public to believe 
that these important individuals know her and 
guarantee her honesty and respectability. It is 
astounding that responsible public officials should 
allow themselves and their public status to be dragged 
through the mire at the tail of a female whose lack of 
medical qualification is the least of her disabilities. 

The Public and Lock Hospitals. 

Theoretically, no doubt, the object which con¬ 
tributors to hospital maintenance funds have in view, 
is the relief of the deserving and suffering poor, 
though, in truth, the latter quality is the only recog- | 
nised claim to medical relief. In practice, however, 
the great charitable public holds aloof from institu¬ 
tions which are, of their nature, destined to the treat¬ 
ment of persons guilty of the heinous offence of 
incontinence. It follows that hospitals for the 
treatment of venereal cases have always re¬ 
ceived niggardly and altogether inadequate support; 
and, in respect of lying-in charities, their benefits are 
largely restricted to women duly provided with 


* marriage lines.” This inopportune intrusion of 
Mrs. Grundy into the domain of medical charity is 
much to be regretted in view of the wide-spread 
misery and disease accruing to innocent persons from 
the prevalence of contagious diseases conveyed by 
sexual infection. The idea, no doubt, is that this very 
prevalence acts as a deterrent to the weak* 
kneed and potentially incontinent, and if only 
the guilty suffered we should be content to leave 
them to their fate. Everyday experience, however' 
shows but too painfully to what a great extent the 
innocent suffers not for, but with, the guilty. When 
we consider the important part which marital gonor* 
rhoea plays in the production of tubal mischief, and 
the wholesale damage to generations as yet unborn 
caused by parental syphilis, we cannot but feel that 
the innocent are unjustly and unwisely made to pay 
the penalty for the misdeeds of others. If the public 
cannot be persuaded to support Lock Hospitals, the 
duty of providing treatment should be discharged, as 
in other countries, by the municipalities, especially 
as our general hospitals are not accessible to patients 
suffering from the primary disease, however grievously 
affected. Why sexual misconduct should be so 
severely dealt with while the victims of alcoholic 
abuse, for example, are treated with indulgence, it is 
not easy to explain. 


Reading in Bed. 

Should the average man read in bed ? is a query 
that is certain to be put from time to time to the 
medical adviser. A little inquiry shows that, as 
usual, there is something to be said on both sides of 
the question. Some medical men advocate the 
practice as a treatment for insomnia, while others 
condemn it. Life is so rapid nowadays that many 
folk have no opportunity of seeking solace from 
books in their hurried passage through the hours of 
the working day. In Buch a case it is not unthink¬ 
able that a short course of some standard author 
taken in bed might act as a composing sedative, and 
lead up through easy stages of drowsiness to the deeper 
and fuller calm of sleep. But the book must be well 
chosen, avoiding all extremes of wit, melodrama, 
corned y, tragedy, or philosophy. It must be like a 
good supper, neither too heavy nor too stimulating. 
What, is the other side of the question ? Many 
worthy people condemn utterly and outerly the 
practice of reading in bed, and we think that on the 
whole most physicians will be found on their side. 
Bed was made for sleep, and healthy persons should 
as far as possible keep ordinary pursuits and recrea¬ 
tions away from the bedroom, just as they take their 
meals elsewhere. Under conditions of moderate 
healthfulness a man should fall asleep soon after he 
assumes the horizontal posture, with a view 
of knitting up “ the ravelled sleeve of care.” 


The Council of the British Medical Association 
has voted, for the third time, a sum of £100 to the 
Jenner Society towards the expenses of the work of 
that society. 


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442 The Medical Press. 


NOTES OS CURRENT TOPICS. 


April 26, 1899. 


The Centenary of the Royal College of 
' Surgeons, England. 

The committee appointed by the Council of the 
Royal College of Surgeons of England to consider 
the advisability of commemorating the centenary of 
the College have recommended that the occasion 
should be celebrated upon some date between March 
22nd and June 30th next year. They also re¬ 
gard it as of cardinal importance to the 
success of the undertaking that power should 
be granted the Council to confer diplomas 
of honorary fellowship. The Council, however, 
have been advised that before this can be done a 
supplemental charter will have to be obtained, and 
accordingly the legal advisers of the college have been 
instructed to draft the necessary petition and charter- 
It has been determined to call a meeting of the “ body 
corporate ” for the purpose of submitting the question 
of applying for power to confer honorary diplomas 
to their consideration. But no date for this meeting 
has yet been fixed. If the charter be subsequently 
agreed to and obtained, we presume that the first 
Honorary Fellow who will be elected will be the 
Prince of Wales. 

The Election of Examiners in the Royal 
College of Surgeons, Ireland. 

These elections will take place on next Tuesday, 
May 2nd, and the list of competitors has closed. The 
chief contest will arise in connection with the sur¬ 
gical subject. Professor Stoker and Mr. Glasgow 
Patteson, the outgoing examiners, offer themselves 
again, and in addition, Mr. Conway Dwyer, Burgeon 
to JerviB Street Hospital; Mr. MacFeely, Mr. Pratt, 
also of Jervis Street; and Mr. Edward Taylor, sur¬ 
geon to Sir Patrick Dun’s. For the anatomy 
examinerships Professors Bermingham and Fraser 
seek re-election, and Mr. MacFeely also offers himself. 1 
For the physiology and pathology subjects there will 
be practically no change in the court. For the Mid¬ 
wifery examinerBhip, held by Mr. Alfred Smith, 
there will be three additional candidates—Professor 
Kidd, Mr. Hearn, and Mr. Stevens, of Jervis Street 
Hospital. For the ophthalmology subject Mr. Benson 
will take, as the colleague of Mr. Maxwell, the place 
vacated by Mr. Story. For the courts in sanitary 
science and in dentistry and in preliminary educa¬ 
tion there will be no material change. 

Dublin Appointments. 

We understand that, upon the resignation by Mr. 
Harrison Scott, surgeon to the Adelaide Hospital, 
Dublin, of his position as chief medical officer to 
Guinness’s brewery, Mr. Lumsden, visiting physician 
to Mercer’s Hospital, who has heretofore served as 
Dr. Scott’s assistant, has succeeded to the full 
responsibility of the department. We learn, also, 
that Dr. Scott has resigned the office of medical 
officer to the Bank of Ireland, but no day has yet 
been fixed for the election. There are about ten com¬ 
petitors in the field, the names of Dr. Gordon, who 
has been acting as locum tenens, Dr. Lennon, Dr. 
Bmnskill, and Dr. Henry Oulton being prominently 


mentioned. These appointments are both of them 
rather attractive, for, though they entail a good deal 
of work and punctual attendance to business, they 
are fairly well paid, and they afford young men an 
excellent lead into private practice. 


The Health of the City of London. 

It is a bitter irony that in the city of London 
where wealth is accumulated beyond the dreams of 
avarice the death-rate for the last month was equal to 
29 3 per 1,000 of the population, a population so 
small morever that there were only forty-one births 
which were more than counterbalanced by sixty-three 
deaths. The rookeries of this limited territory will 
hold their own with any, and however well the city 
may be administered in other respects the sanitation 
of the dwellings of the poor is evidently not a subject 
which commends itself to the serious consideration 
of its pampered corporation. 

The daily press, in discussing Dr. Bra’s alleged 
discovery of the parasite of cancer, has, with few 
exceptions, made a hopeless mess of the technical 
terms employed by this observer. We are told, for 
instance, that the parasite in question is a “ fungas,” 
an “ assomycus,” and “ alga,” and much of the same 
kind. The result in respect of the education of the 
public is not perhaps all that might be desired, 
though even if the terms had been given correctly 
the average reader would probably not have been 
much “forrarder.” 

An outbreak of small-pox has occurred at Hull, 
some fifteen cases having so far been admitted to 
hospital. There have only been three serious cases, all 
in unvaccinated persons. The inhabitants are hasten¬ 
ing to avail themselves of the protection afforded by 
revaccination. It is “ hoped ” that the measures taken 
to circumscribe the spread of the disease will save 
the town from the loss which even a mild epidemic 
necessarily entails. 


PERSONAL. 

Mb. Lawson Tait will be one of the speakers at the 
meeting of the London Anti-Vivisection Society at the 
Sc. James’s Hall on the 26th inst. 

Mb. H. G. How8e, F.R.C.S. of Guy’s Hospital, has 
been chosen the Bradshawe Lecturer for the ensuing 
collegiate year at the Royal College of Surgeons, Eng¬ 
land. 

Madahx Term oe hoff, a medical graduate of the 
University of St. Petersburg, has taken up her abode at 
the Court of the Ameer in order to attend the inmates 
of his harem at the special request of his Majesty. 

Mb. Frederic H. Madden, who for the last ten 
years has held the Secretaryship of the Medical School 
at St. Mary*8 Hospital, Paddington, has been appointed 
Secretary to the Asylum for the Education of Deaf and 
Dumb Children. 


Mb.Thos. F. Chavasse, of Birmingham, and Mr. F. S 


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April 23, 1899. 


MEDICAL SOCIETY OF LONDON. The Medical Press. 443 


Dennis, of New York, both members of the Royal College 
of Surgeons, England, were elected last week Fellows of 
the College under Section 5 of the Charter of 15 Victoria 
relating to members of twenty years’ standing. 

Lord Lister was among the large number of friends 
assembled in the Mersey, on Saturday, to bid adieu to 
the new Governor-General of Lagos, Sir Wm Macgregor, 
M.D. It may be mentioned in connection with this 
event that His Excellency was a former pupil of Lord 
Lister. 

Surgeon-General J. A. Maes ton, MD., C.B., has 
been selected to fill the vacancy of Honorary Surgeon to 
the Queen, in succession to Deputy Inspector-General 
Lee, deceased. Dr. Mars ton entered the Army as 
Assistant Surgeon in 1854 during the Crimean War; 
was present at the battle of Tel-el-Kebir in 1882, was 
mentioned in de-patches, and promoted Deputy 8urgeon 
General. 


gcotlartb. 

[from our own correspondent.] 

Glasgow University —Last week the Graduation 
Ceremony took place before a very large audience. The 
Earl of Stair, Chancellor of the University, presided, 
who referred in very feeling language to the loss the 
University has sustained in the death of the late Prin¬ 
cipal Caird, Professor Coats, and Dr. King, remarking 
that the University was fortunate in having secured 
such able successors in Professor Muir and Sir James 
Bell. The students on this occasion, in response to the 
request of their representatives, acted like reasonable 
bemgs, giving vent to their exuberance in a rational 
manner, so that the ceremony passed off most pleasantly 
for all concerned. It is needless to say that when Dr. 
James Finlayson came up for his honorary degree the 
applause was of the heartiest description. We wish him 
many years in the enjoyment of his distinction. It is 
pleasing to state that the Principal was listened to 
during nis address with marked attention and decorum, 
which differed so markedly from the treatment accorded 
to him when he made his first appearance, when, on 
account of the turbulence and childishness of the 
students, he left the hall with his lecture undelivered. 
Legacies to the University of .£450, £1,650, £3,064, 
£1,000, £500, and £18,000, for the foundation of scholar¬ 
ships and bursaries, were announced, and the proceed¬ 
ings closed with a hearty vote of thanks. 

Glasgow University Lord Rectorship. —The Uni¬ 
versity Court has decided that the election of the Lord 
Rector shall take place on October 28th ensuing. By 
this arrangement, namely, the first Saturday of the 
winter session, the authorities hope that the shouting 
and excitement consequent on the election will have 
ceased, and are anxious that the classes should be dis¬ 
turbed as little as possible. Up to the present there are 
no rumours of retirement on either side, and both parties 
have settled down with the determination to work for 
their side, each convinced that their candidate will be 
returned. 

^Ciberpool. 

[from our own correspondent.] 

OPENING OP THE NEW WARD AND LABORA¬ 
TORIES FOR TROPICAL DISEASES IN 
LIVERPOOL. 

This new development of an important department of 
medicine reached a further stage on Saturday last, when 
the new ward for the reoeptionof patients suffering from 
malarial and other tropical diseases, and the laboratory 
fitted up for scientific inquiry into their aetiology and 


pathology were formally opened by Lord Lister in the 
presence of the Lord Mayor and a large number of dis¬ 
tinguished visitors and leading citizens of Liverpool. 
Among the guests invited for the occasion there were 
present, inter alia, Professor Michael Foster, Professor 
Haffkine, Sir J. Crichton Browne, Sir Charles Cameron 
(Dublin), and Dr. Moore (Dublin). The ward for the 
reception of the cases contains twelve beds, which were 
already filled by patients from almost every quarter of the 
globe, including China, India, United States of America, 
Russian Finland, and Ireland. The ward, which is a 
handsome one, is on the top floor of the hospital build¬ 
ing, and has a large window looking to the west, a view 
from it which is very extensive, and equally attractive, 
embraoes the magnificent river Mersey, the pride 
of Liverpool, and naturally of all Liverpudlians, 
carrying as it does on its bosom the vessels of all nations ; 
beyond the beautiful Wirral peninsula with its crowning 
wooded ridge of Bidston and Stourton, and beyond this 
again the mountains of Wales with old Moelfama over¬ 
topping all. By the bye, a low raised platform at the 
west end of the ward would enable those patients who 
are able to sit up to lounge in their easy seats, and with 
their eyes take in all the beauty of the landscape before 
them. 

The proceedings, which were very brief, were commenced 
by a short speech by Mr. Adamson, the President of the 
Hospital, in which he sketched the inception of the 
scheme and its unfolding. He said that within the past 
few years 460 cases of tropical disease had passed 
through the hospital, as many as 19 having been admitted 
in one day in the year 1877. He alluded to the great 
service rendered to the cause by Mr. A. L. Jones, who had 
taken the subject to heart, and done much to bring 
about the present issues. 

He then introduced Lord Lister, asking him to declare 
the ward now open. 

Lord Lister said he held it to be a peculiar privilege 
to be invited to open the ward and laboratory. It was a 
distinct advantage to patients to be treated in teaohing 
institutions There was better supervision, and when a 
number of eyes were looking on, and when criticism was 
abundant, there was less likelihood of the work being of 
a slipshod character than when there was no school 
attached. He bestowed a high eulogium on Major Ross, 
of the Indian Medical Service, whose services have been 
acquired in connection with the new school. He said 
his work in that special department of medioine had 
been of the highest importance, and had received pro¬ 
fessional recognition in France, Germany, and every¬ 
where. He then declared the ward and laboratory open, 
with the wish expressed that the widest hopes of the 
founders would be amply fulfilled, one in whioh every 
friend of humanity will join. 

MEDICAL SOCIETY OF LONDON. 

At the meeting of the Society on Monday evening last, 
Mr. Betham Robinson read a paper on some complicated 
cases of appendicitis in which the abscess in relation to 
the appendix was attended later by suppuration in the 
neighbourhood of the liver. He remarked that this 
infection of the peritoneum was very liable to spread 
along the ascending colon when the adhesions were 
defective, aided possibly by the recumbent position and 
the natural curve of the lumbar region. He showed that 
the pus collected in the right hypochondrium in the 
space between the inferior space of the liver, the upper 
part of the right kidney, and the hepatic flexure of the 
colon, with a possible extension over the anterior and 
superior surfaces to form a sub-diaphragmatic collection, 
aqd he related four cases illustrating this sequence of 
events. 

Mr. Battle referred to three cases of supposed sub- 
diaphragmatic suppuration, remarking that these collec¬ 
tions tracked up along the surface of the bowel an d not 
in the cellular tissue. 

Dr. Hanley mentioned a case of localised peritonitis 
in the upper part of the abdomen, which ultimately 
proved to have started from a c®cal abscess. 

Mr. Macadam Eccles related a case of suppuration in 
the right iliac fossa, which was opened, but a subsequent 


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OBITUARY. 


April 26, 1899. 


444 Tub Medical Press. 

incision had to be made in the loin to evacuate another 
(intra-peritoneal) collection, a complication which he 
suggested might be forestalled by making a counter¬ 
incision in the loin in the first instance. 

Mr. W. Armstrong (Buxton) read a paper on the 
effects of the free nitrogen contained in the Buxton 
water on the excretion of uric acid and urea, and on the 
flow of urine. 

Dr. Bain read a paper on “ The Relative Excretion of 
the Nitrogenous Waste Products in a Case of Liver 
Abscess.” 

Dr. Luff confirmed the statement as to the diminished 
excretion of urio acid early in gout, and agreed that 
under certain circumstances free nitrogen might produce 
active effects. 


flarliamentitTB ,iUtos. 


The UniversityDegrees Bill has been “blocked" 
by General Laurie, who announces his intention, on the 
second reading, of moving an amendment to the effect 
that the House declines to place a stigma on foreign or 
colonial universities by enacting that any graduate or 
holder of a degree of such university shall be required 
to add to his name the derivation thereof, while 
graduates in the United Kingdom are exempted from 
such requirements. This seems likely to prevent any 
further progress being made with the Bill during the 
present session. 

The Midwives Bill, after several postponements, 
was adjourned till yesterday (Tuesday) when Mr. Weir 
was announced to move the following motion : “ That no 
measure dealing with the question of midwifery can be 
considered as satisfactory which does not provide for 
female medical practitioners to have equal representa¬ 
tion with men on the General Midwives Board which it 
is proposed to appoint under the Bill." 

The Public Heath Acts Amendment Bill was read 
a second time on Wednesday, and was referred to a 
Select Committee. 

The Lunacy Bill, introduced by the L^rd Chancellor 
in the House of Lords, was read a Becond time early last 
week without discussion. It embodies the clause for the 
temporary treatment of insanity suggested by the 
Medico-Psychological Association. It has since been 
discussed in a committee of the House, and Clauses 1 to 
20 were agreed to. In reference to Clause 21 enjoining 
on County Councils the duty of granting superannuation 
allowances to officers and servants having charge of 
lunatics, the Marquis of Ripon announced his intention 
of opposing the clause whereupon the Lord Chancellor 
agreed to omit it. Clause 22 (grant of allowance or 
gratuity in case of injury) was also omitted. The re¬ 
mainder of the Clauses passed through committee, and 
the Bill was reported to the House. 

The Aldershot Sewage Farm. - In the course of the 
discussion on the Army Estimates, Mr. Jeffreys moved 
to reduce the vote by .£100 as a protest against the con¬ 
version of the sewage farm at Aldorshot into a dairy farm 
for the supply of milk to the troops. A number of well- 
known Service members took part in the discussion, and, 
after a little pressure by Sir H. Campbell-Bannerman, 
Mr. Powell Williams stated that if the report of the 
expert advisers of the War Office should cast any sus¬ 
picion or doubt upon this milk supply it would be dis¬ 
continued and the farm would be put to some other use. 
The inquiry, he added, would take place at once. 

Army Medical Service. On the vote of .£305,800 
for the medical establishment of the Army, Dr. Clark 
asked whether sufficient candidates for the Army Medi¬ 
cal Service were now forthcoming, and Mr. Powell Wil¬ 
liams replied that there were now two candidates 
for every vacancy. Colonel Welby urged the War Office 
to consider the expediency of attaching a senior medical 
officer to every regiment in the country, and other mem- 
beis raised once again the question of the nursing 
arrangements for the troops at Cairo and Alexandria 
after the battle of Omdurman. Captain Norton, being 
dissatisfied with the Ministerial explanation on this sub¬ 
ject, moved to reduce this vote, but this amendment 
was negatived on a division. 


(Dbituarij. 


SIR WILLIAM ROBERTS, M.D., F.R.C.P., F.R.S. 

The profession has sustained a great loss in the death 
of Sir William Roberts, which took place last week at 
hiB residence in Manchester Square. This distinguished 
physician was born at Mynddygop, Anglesey, on March 
18th, 1830; he was, therefore, at the time of his death in 
his sixty-ninth year. Having received his education at 
Mill Hill School, he entered at University College 
Hospital where he passed through the ordinary 
medical course, becoming a member of the Roval 
College of Surgeons and a Licentiate of the Apotne- 
caries Society in 1853. In the following year he 
graduated at the University of London, taking the 
degree of M.D. Shortly afterwards he was elected 
to the post of house-surgeon at the Manchester Royal 
Infirmary, and lesB than two years later, at the age of 
twenty-five, he was appointed a physician to the infir¬ 
mary. This post he held for thirty years, during which 
period he made for himself a great reputation as a sound, 
practical teacher of clinical medicine. In the Victoria 
University he was the first to hold the post of Professor 
of Medicine. In 1885 the honour of knighthood was 
conferred upon him in recognition of the posi¬ 
tion to which he had attained as a distinguished 
provincial physician. Sir William’s connection with 
the Royal College of Physicians was especially 
noteworthy. He obtained his Fellowship thereof 
in 1866, and soon afterwards he was selected to 
deliver the Goulstonian lectures; again, in 1880, he 
delivered the Lumleian lectures before the college, on 
the subject of “ The Digestive FermentB and Artificially 
Digested Food ; ” and in 1892 he was appointed Croonian 
lecturer, giving a course of three lectures on the 
" Chemistry and Therapeutics of Uric Acid, Gravel, and 
Gout.” Furthemore, in 1897, he was invited by the 
College to give the Harveian oration, in which he dis¬ 
cussed “ Science and Modern Civilisation.” From the 
subject matter of the former lectures the profession soon 
gathered that Sir William bad made himself a specialist 
in dietetics, and there is no doubt that the good 
work which he did in this direction added greatly to his 
reputation. But his college, in addition to conferring 
upon him the honour of the various lectureships, also 
recognised his worth in other ways. He was appointed 
to the Council of the College in 1882, and in 1889-1890 
he was elected one of the censors. In 1877 Sir William 
received the honour of election to the Fellowship of the 
Royal Society, while in 1879 the University of Edin¬ 
burgh awarded him the Cameron Prize in recognition 
of his work upon the subject of digestion. In addition 
to other public posts he was elected the representative of 
the University of London on the General Medical Council, 
in succession to Sir Samuel Wilks, who retired on being 
appointed President of the Royal College of Physicians. 
Up to 1889 Sir William enjoyed a large and lucrative 
practice as a consulting physician in Manchester; in 
the course of that year, however, he decided to leave 
that city and come to London. Socially his genuine 
geniality made him many friends, both within the 
profession and outside of it. As a hobby he was ex¬ 
ceedingly fond of botany, and in the pursuit of this 
he made interesting collections of various plants. 
Again, one of his pastimes was angling, and thi9 he had 
great facilities for enjoying at his country seat in North 
Wales. In his long and busy life Sir William found 
time not only to enrich his profession with original 
work, but also to break away from his professional labours 
and indulge in pursuits which some of the wisest and 
best of men have made famous by the passion which 
they evinced for them. 


MR. JABEZ HOGG, M.R.C S , F.R M.S. 

The death of this distinguished member of our profes¬ 
sion was so sudden and unexpected that not many hours 
previously a member of our staff, who was an old and 
intimate friend, received a letter from him, written in 
his usual cheerful strain. Now he is no more. A 
painless death has closed a laborious and useful life at 


April 26, 1899 


CORRESPONDENCE. 


The Medical Press. 445 


the ripe age of 82, and we who hare been fellow workers 
with him, and the readers of this journal likewise, who 
have from time to time perused his thoughtful and 
painstaking articles, both signed and editorial, will join 
with that wider circle of microscopists all over the 
English-speaking world in the pious ejaculation, 
“ Requiescat in pace.” Mr. Hogg, before he retired 
some few years, was engaged chiefly in ophthalmic prac¬ 
tice, and several books and papers on the subject 
emanated from his pen. For many years he occupied 
the post of surgeon to the Royal Westminster Ophthal¬ 
mic Hospital, of which he was consulting surgeon at the 
time of his death. He was a vice-president of the 
Medical Society of London, and corresponding member 
of many foreign learned societies. But it iB principally 
in connection with microscopy that his name was known ; 
he was one of the founders of the Medical Microscopical 
Society, its first president, and a Fellow of the Royal 
Microscopical Society. But a few months since he had 
the privilege of passing through the Press the 15th 
revised edition of his work on “ The Microscope: ita 
History, Construction, and Application,” a work of 
upwards of 700 pages with 900 illustrations. No work on 
the subject has we believe ever attained to such popu¬ 
larity, and we received a letter from him at the time 
testifying to the great pleasure it had given him. On 
Saturday last, we understand, he was busily occupied 
with his autographs, of which he was a well-known col¬ 
lector. On Sunday, without apparently anything ailing, 
heart failure took him quietly away to his eternal rest. 

DR. WM. ALEX. CARTE. 

News reaches us while at press of the sudden death 
of Dr. Wm. A. Carte, Medical Superintendent of the 
Royal Hospital, Kilmainham. Previous to the occupa¬ 
tion of his present post he was Surgeon-Major in the 
Grenadier Guards, Surgeon to the Coldstream Guards, 
and Surgeon to the Royal Hibernian Military School. 
He was exceedingly popular in medical circles, and will 
be much missed. 


dorrespmtOence 

We do not hold ouraelvee responsible for the opinions of our 
correspondents. 


MEDICAL AID ASSOCIATION. 

To the Editor\of The Medical Press and Circular. 

8ir, —I may be allowed to say, in answer to the query 
of “ Another General Practitioner,” that I am prepared to 
do my best to convince the General Medical Council, the 
British Medical Association, and other medical bodies of 
the necessity for taking effective steps to put an end 
to the medical aid work of the industrial insurance 
companies. I would suggest that any practitioner who 
possesses accurate information respecting the mode of 
working of these association should write either to the 
Registrar of the General Medical Council or to one of 
the direct representatives of that body. It may be of 
interest to “Another General Practitioner” t ■> know 
that the following resolution will be proposed at the 
next quarterly meeting of the Manchester Medical 
Guild:— 

“The attention of the Medical Guild having been 
called to the methods pursued by certain industrial 
insurance companies, which combine medical aid work 
with ordinary life insurances, hereby expresses the 
opinion that it is inimical alike to the public weal and 
to the interest of the medical profession for practi¬ 
tioners to give their services to such companies in the 
furtherance of medical aid. The Guild is of opinion 
that the serious attention of the General Medical 
Council should be given to the matter.” 

As a committee of the General Medical Council is now 
sitting to discuss the question at issue, members may 
rest assured that these communications will receive 
full consideration. 

• I am, Sir, yours truly, 

T. Garrett Horder. 

Cardiff, April 22, 1899. 


CONSUMPTIVE PATIENT3 IN SOUTH AFRICA— 
A PAUTION 

To the Editor of The Medical Press and Circular- 

Sir —There is a growing practice among medical men 
in this country of recommending consumptive patients 
to go to Natal and other parts of South Africa, and under 
certain conditions the advice is good, but there have been 
cases in which that advioe has been followed by lament¬ 
able consequences. 

In those cases where the disease is only threatened, or 
has become but slightly developed, and there is a reason¬ 
able prospect of recovery, provided that the patients 
have sufficient means of their own for their support, 
let them go to South Africa by all means but not other¬ 
wise. 

The facts should be known that, as legards Natal (and 
the same may be said of other parts of South Africa) 
there i« no provision for the treatment of consumptives 
otherwise than in the hospitals; that the expenses in 
cases of sickness are greatly in excess of the expenses 
in Great Britain, and that the private benevolence of 
the small European community is apt to be over¬ 
strained. 

It is, therefore, extremely undesirable that invalids in 
the last stage of consumption should be sent out there to 
die, or to be sent back in a dying condition. 

I write this letter by desire of the Government of 
Natal, in the hope that by its publication in your columns 
medical men in this country may realise the position 
more clearly. 

I have the honour to be, Sir, 

Your obedient servant, 

Walter Peace, 
Agent-General for Natal. 

Natal Government Agency, 

26, Victoria Street, London, S.W., 

April 20th, 1899. 


“ REMODELLING OF POOR-LAW DISTRICTS.” 

To the Editor of The Medical Press and Circular. 

Sir,— Kindly permit me through the medium of your 
paper to advise all medical officers, from whose districts 
one or more divisions are being taken in regulating the 
county boundaries, to at once write to the Local Govern¬ 
ment Board impressing on them the justice of so arrang¬ 
ing the compensation that the present holders of such 
districts shall not suffer any diminution of salary. It 
seems only fair that" such reduced salary for reduced 
work should commence with the successors of the present 
occupants of these posts. 

I am. Sir, yours truly, 

F. C. Fitzgerald. 

Newtownbutter, April 17th, 1899. 


REGISTRATION OF COLONIAL DEGREES. 

To the Editor of The Medical Press and Circul ar. 

Sir,—A paragraph, in the report of the proceedings 
of the Executive Committee of the General Medical 
Council on February 27th last, under the heading 
“ Colonial Degrees,” deserves the attention of all colonial 
practitioners and also of all those interested in the higher 
education of women. 

In 1897 Calcutta University conferred its M.B. 
Degree on a woman graduate, who was then awarded 
the “ Elgin ” Scholarship, on condition that she obtained 
a registerable British qualification. Finding that 
women are not yet admitted to the Fellowship of the 
Royal Colleges of England and Scotland, she passed the 
examination of the Royal College of Surgeons. Ireland, 
and received the Diploma of Fellow in May, 1898. 
Application was made to the Registrar of the General 
Medical Council, who registered the M.B. Degree, but 
refused to register the Fellowship Diploma on the 
grounds that “ A colonial qualification, can be added to 
a name on the General Register, as an additional quali¬ 
fication, but British qualifications cannot be so added 


Dig 


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The Medical Press. LTTERA.RY NOTES AND GOSSIP. April 26, 1899. 


^Literarg Jtotes aitb Gossip. 


to names on the Colonial List,” this is the opinion of Mr. 
Muir Mackenzie. 

Part 2, section 14, of the 1886 Act states that the pro¬ 
visions of the Medical Act, 1858, shall apply in the case 
of colonial practitioners when registered under the Act 
of 1886. 

This lady wis registered under the Act of 1886, and 
therefore appears entitled to have an additional qualifi¬ 
cation added to her name on the Colonial Register under 
section 30 of the 1858 Act. As the Don-registration of 
this Fellowship diploma debars the holder from appoint¬ 
ments to which she legitimately aspires, and the Regis¬ 
trar informs me that similar applications have been 
refused on previous occasions, I have applied to the Privy 
Council for a direction to the General Medical Council, so 
that the question may be definitely decided, though, as 
it affects many colonial students, I should have preferred 
the application to have been made by the Irish College 
of Surgeons or the Scottish Association for the Medical 
Education of Women. 

I am. Sir, yours truly, 

Charles Frederick Knight, M.D. 

Edinburgh, April 20th, 1899. 


Xabaratorg Jlotes. 


BELLADONNA PLASTERS, B.P. 

We have received from Messrs. William Mather, 
Limited, of Manchester, several samples of Belladonna 
Plasters prepared by this firm, which we have examined, 
in all cases with satisfactory results. The method 
employed for estimating the alkaloids (which according 
to the B.P. 1898, must be -5 per 6ent. of the plaster mass), 
was that of C. E. Smith, as given in the Analyst of 
August, 1898, page 214. The plasters were found to 
contain '48 per cent, of alkaloid, which corresponds 
closely to the B.P. requirement. 

There have lately been a number of prosecutions under 
the Food and Drugs Acts, and as there are undoubtedly 
many plasters offered which do not come up to the re¬ 
quirements of the Brit. Phorm., physicians would be 
wise in warning their patients to insist on purchasing 
only such plasters as are guaranteed to be of B.P. 
Strength. 


EUCALYPTUS GLOBULUS OIL. 

We have duly examined the sample of eucalyptus 
globulus oil, '‘Platypus Brand,” prepared by the Tas¬ 
manian Eucalyptus Oil Company, 138, Leadenhall Street, 
London. It possesses a pleasing aromatic odour, and is 
of a slight yellow colour, and on examination gave the 
following figures:— 

Sp. gr. at 15'5 per cent., ’9194; 

Optical rotation (100 mm, tube) +1*6® ; 

Eucalyptol, 63 8 per cent.; 

Phetlandrene, absent; 

Alcohol solubility number, 410; 

Residue, 0 - 2 per cent.; 

Acidity, none. 

The eucalyptol was estimated by the phosphoric acid 
method, and the residue by heating 10 grams, over a 
water bath until the weight was constant. These figures 
show that this oil more than satisfies the require¬ 
ments of the tests given for eucalyptus oil in the latest 
edition of the British Pharmacopoeia. 

It will be probably within the knowledge of our 
readers that a large quantity of the eucalyptus oil of 
commerce does not come up to the requirements of the 
B.P., which, though they may be too stringent in the 
case of oils sold for other than medicinal purposes, should 
certainly be fulfilled by all oils offered for sale for such 
use, and the various prosecutions that have recently 
taken place under the Food and Drugs Act show that 
the question of the purity of this oil is attracting the 
general notice of public analysts. 


A vert handy little book is published by Messrs. John 
Wright and Co., of Bristol, labelled “Private Formul© 
with Posological Tables.” It comprises a number of 
blank pages with thumb index, wherein the practitioner 
can jot down such formul© as he considers worthy of 
that distinction. A posological index, antidote chart, 
Ac., serve to complete this “ waistcoat pocket remem¬ 
brancer.” 

• • 

“The Health Resorts of Europe,” by Dr. Th. Linn, is 
described as a medical guide to the mineral springs, Ac., 
of the Continent, but if so it was hardly necessary for 
the author to explain that amenorrhoea signifies “ stop¬ 
page of menses,” or dysmenorrhoea “ difficult and painful 
menstruation.” It gives useful information as to the 
therapeutic properties of the various waters, Ac., and on 
the means and cost of travelling thither. 

V 

The “ Medical Officers’ of Sohools Association ” has 
been well advised in reissuing, in book form, their valu¬ 
able “ Code of Rules for the Prevention of Infectious 
and Contagious Diseases in Schools ” (J and A. Churchill), 
a copy whereof should be in the hands of everyone in 
any way responsible for the sanitary supervision of 
schools and similar institutions. The present is the 
fourth edition, and advantage has been taken of the 
opportunity to revise and oomplete the already ornate 
but practical instructions, the outcome of collective 
expert experience. 

*•* 

The “Year-book of Treatment” for 1899 (London: 
Cassell and Company, Limited) is characterised by Dr. 
Barton Fanning’s article on the Open-air Treatment of 
Phthisis. Of the remaining articles we can only say that 
they are fully equal to those which for the past fourteen 
years have been familiar to the medical profession ; and 
have built up the reputation of the Year-book as a con¬ 
venient, useful, and trustworthy summary of the year’s 
work in medicine and surgery. 

The hon. sec. of the forthcoming International 
Otological Congress, to be held in London in August, 
asks us to announce that Baron L6on de Lenval, of 
Nioe, has given 8,000 francs to found a “ Lenval 
Prize,” the interest on which sum will be awarded at 
each meeting of the Congress to the author, who evinces 
the most marked progress on the practical treat¬ 
ment of deafness. Prospective essayists are requested 
to apply to Mr. Cress well Baber, F.R.C.S., 46 Brunswick 
Square, Brighton. 

• • 

• 

Volume IV. of the Bdinbwgh Medical Journal, edited 
by G. A. Gibson, M.D., F.R.C.P.Ed. (Edinburgh: Young 
J. Pentland) is now before us. The new series of our 
contemporary is fairly on its way, and from the excel¬ 
lence of the material in this, the fourth volume, the large 
staff of able writers associated with it, the many ex¬ 
cellent illustrations, we have no doubt of the success 
that awaits it. Of the thirty-seven original articles 
in the journal there is not one whioh may not be read 
with interest and profit. We are glad to see the Scotch 
Medical School so worthily represented. 

V 

The first number of the Manchester Medical Chronicle 
of the new series has just appeared. New editors, new 
publishers, and new dross have not, however, modernised 
the general substance. The current number is particu¬ 
larly noteworthy for its numerous topographical errors. 
It is reassuring to read that “ no attempt will be made 
to deal with medical politics or subjects of ephemeral 
or merely local interest; the journal will be conducted 
from a scientific standpoint.” We hope that the standard 
of this journal will not be lowered, but that it will con¬ 
tinue to be a trustworthy chronicle of medical progress. 

V 

The latest issue of the “ Archives Internationales de la 
Pharmacodynamic ” is devoted to a very valuable and 
interesting article by Prof. T. R. Fraser and Dr. Joseph 


Digitized 


-oogle 


April 26, 1899. 


MEDICAL NEWS. 


1h» Medical Press. 447 


Tillie, late lecturer on Experimental Pharmaoology in 
the University of Edinburgh, on acokanthera Schimperi, 
a new heart tonio, allied in action to digitalis and stro- 
phanthus. Dr. Fraser, u is well known, has for some 
months past been away in India in connection with the 
Plague Commission, but he has certainly not neglected 
his pharmacological work, for the present paper is quite 
up to his old standard, and is a credit to the Edinburgh 
school. We do not know whether Dr. Tillie at present 
holds any official appointment, but he ought to be heard 
of again. 

%• 

Part II. of “ Aids to Materia-Medica,” by Dr. W. 
Murrell, is devoted to drugs of vegetable origin. It, to 
quote the preface, consists of a considerable basis of 
matoria-medica with a certain amount of pharmacology, 
as an adjuvant or auxiliary, and a dash of therapeutics 
as a corrective. This little volume contains all that the 
student could possibly be expected to know of the sub¬ 
ject, and the information is conveyed in an agreeable 
and convincing manner. As the subject is one that calls 
for much “ grinding," the student can carry it about 
in his pocket, and dip into it as and when an opportunity 
presents itself. 

%• 

“ The Nursing Profession : How and Where to Train " 
Edited by Sir Henry Burdett, K.C B. (London: The 
Scientific Press, Limited.) This is an encyclopaedic 
guide-book for all those who are ambitious to become 
trained nurses, and a directory for those who have passed 
through that tedious ordeal. Home and foreign train¬ 
ing hospitals and infirmaries are gazetted, described 
and indexed, and much useful information is given con¬ 
cerning preliminary training, monthly, fever, village, 
mental, and private nursing wbioh will be appreciated 
by those for whom the book is designed. 

V 

•'Notk8 on Surgery for Nurses,” by Joseph Bell, 
M.D., F.R.C.S.Edin. (Edinburgh: Oliver and Boyd), ■ 
as a convenient little volume is already too well known 
to require any exunination at our hands. The rapid sale 
of previous editions is the best possible proof that the 
author has supplied a want by its preparation. In the 
present issue “ the author has again thoroughly revised 
the work and added an appendix treating of the impor¬ 
tant and interesting question raised as to the Relation 
of the Trained Nurse to the Profession and the Public.” 
We have no doubt whatever that it will maintain the 
well-deserved popularity of its predecessors. 

Da. Edward Blake has done a literary tour do forct 
in writing dose upon forty pages on “ The Study of 
the Hand for Indications of Local and General Disease ” 
(Glaisher, London). We learn that “ artistic persons 
usually have slender and mobile fingers,” and, further, 
that “ musical people have sensitive hands.” If so, then 
the exceptions we have come across must be regarded as 
proving the rule. It must be useful to know what 
etiological indications we may draw from particular 
appearances, but when carried to the bitter end 
tne utility is less obvious. For instance, we 
are told that petechisB on the dorsum of the hand might 
be due “ to the bite of a flea, to senility, scurvy, rickets, 
gonorrhoea, syphilis, small-pox, scarlatina, septicaemia, 
malignant endocarditis, pyaemia, jaundice, cancer, 
typhus, measles, albuminuria, and Hodgkins’ disease, a j 
well as many toxic agents.” If a practitioner comes 
across petechee on the back of the hand, we should advise 
him to consult a specialist, who will proceed to the 
diagnosis by elimination. On the whole, the monograph 
is disappointing, for it gives either too muoh or too little. 
It falls short of a scientific treatise, and it is too diffuse 
for practical clinical purposes. 


Jftcbical ^CtDB. 

French Hospital and Dispensary. 

The thirtyfirst anniversary dinner in aid of the funds 
of this institution is announced to take place at the Hotel 
Cecil on May 6th, when the chair will be taken by his 


Excellency the French Ambassador supported by the 
Lord Mayor and the Sherifis of London. 

Charitable Indulgence. 

Some misguided testator not long since bequeathed 
his fortune, amounting to .£11,000, to the London Homceo- 
pathic Hospital, leaving a near relative totally unpro- 
vided for. Under the circumstances the managers of 
this institution have decided, as an act of grace, to 
pay this relative JLoO yearly so long as it is duly 
applied for, and is needed, though care is taken to 
repudiate any legal claims on the part of the disinherited 
one. 

The Proposed Manchester Asylum for Epileptics. 

A deputation from the Corporation of Liverpool 
recently waited upon Mr. Chaplin at the Local Govern¬ 
ment Board, to protest against the sale of the Anderton 
Park Estate to the Corporation of Manchester for the 
purpose of an asylum for epileptics, on the ground that 
the water supply from the Rivington watershed might 
thereby be contaminated. The Liverpool people are 
willing to take over the bargain at a reasonable price in 
order to obviate this contingency. The matter is to 
receive due consideration. 


PASS LISTS. 


University of Durham.—Faculty of Medicine. 

At the examination held during April, for the degree 
of Bachelor in Medicine (first examination), the following 
candidates have satisfied the examiners 


Chemistry with Chemioal Physics (Old Regulations). 
Herbert Loris Noel-Cox, St. Thomas’s Hospital. 

1.—Elementary Anatomy and Biology, Chemistry, and 
Physics (New Regulations). 

Honours—First-Class. 

Charles Harold Crass, College of Medicine, Newcastle-npon-Tyn , 


Pass List. 


John Frederic Dover 
Charles William M. Hope 
Janet Lane-Claypon 
Lucy Selina Molony 
Thomasina Georgina Prosser 
Thomas Bo well 
Frederick William Bitson 


Briton Smailman Robson 
Andrew Smith 
Frank Tomisman Simpson 
William Clayton Smoles 
Otho Boyle Travers 
Marmaduke C. Wetherell 
Hugo Wolfenden 


2.—Chemistry and Physics. 


S. C. Claphatn.M.R.C.S.,L.B.C.P. 
Harold Linton Currie 
John James Grant 
Alfred Herbert Heslop 
Lizzie Evelyn Kendal 
Wharram H. Lamplough 
John Herbert Me Do wall 


Harry Tudor Newling 

Thomas Eben Pemberton 

John Malcolm Shaw 

Francis Bupert Snell 

Basil Edward Spurgin 

S. D. Turner, M.B.U.S., L.B.C.P. 

Thomas Nicholson Wilthew 


3.—Elementary Anatomy and Biology. 


Arthur Budd 

Walter Donald Carruthers 
John Cooper. B.Sc., F.C.S. 
Wilfred K. L Drawbridge 
Margaret Douglas French 
Arthur Henry Fullerton 
Bryden Glendinning 


Charles Robert Lease 
George Ed. Victor Morris 
Flora Murray 

Christie Mutnuswamy-Anthony 
John Robert Wylie 
Herbert Hoyle Whaite 
Auburn Lawrence Wilkinson 


4.—Elementary Anatomy, Chemistry, and Physics. 


Ernest John Manning. 

Douglas Montague Brooking Snell 


5.—Elementary Anatomy. 


Lietitia Norah Ede. 


At the second examination during April for the 
degree of Bachelor in Medicine, the following candidates 
have satisfied the examiners :— 


Anatomy, Physiology, Materia Medica. 
Honours—Second-Class. 


Vincent Blumhardt Nea field | William Greenwell Hobson 

Pass List. 


Anthony B. Bradford 
Mary Evelyn De Rusett 
Alice Maud Dodd 
Mary Jane D'Vaz 
Lretitia Nora Ede 
Henry Wallace Furnivall 
James Alfred Giles 
Chel'n Mary Hankin 
Katharine M. H. Hawkins 
W. C. Hayward, M.R.C.S. 
L.B.C.P. 

Guy Hannah Kirby 


Leonard Montgomery Markh 
Leonard Clark Newton 
Ernest Edward Norman 
Hermann Heinrich Rnffmann 
David Rees Roberts 
Carl Anders Ryman 
Hugh Widdas 
Frederick George Wilson 
Thomas Wilson 


! Hngh Robert Kendal 
Ken red Manson 


Digitized by 




448 The Medical Pees 8. 


NOTICES TO CORRESPONDENTS 


Apbil 26, 1899. 


^loticee to 

CorrespoTtbertts, Short JCettrro, -Sec. 

•V Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive signature or 
initials, and avoid the practice of signing themselves" Reader," 
*’ Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

"Here’s some pills, Murty, that Mrs. Hogan was afther sindin 
over for yez. 8he says dey'll aither kill or cure yez." “ Begorra, 
didish e say which dey would do foorst ? "—Puck. 

S.'S. Esq.—A ccidents will sometimes happen in the best regu¬ 
lated families, especially when authors write illegibly and proof 
readers are careless We are obliged to yon for calling attention to 
the vagaries of the printer’s imp, the wliich we deprecate. 

M. R-—You should join the Medical Defence Union and then you 
would have little to fear from threats of this kind, assuming, of 
course, that the allegations are inspired by mere malevolence and 
have no serious basis. 

THE MEDICAL PRESS IN AUSTRIA. 

One of the vexatious restrictions on the circulation of class 

J ournals in Austria has been the sur-tax levied on each copy 
lelivered to subscribers in any part of that Empire. Our‘own 
journal, as well as our contemporaries, has suffered for years past 
in this connection, the reason for wliich, with our ideas of a free 
press, seems past comprehension Fortunately, we have “ a friend 
At Court" who has taken a kindly interest in this journal, and 
through his intervention we had the pleasure of receiving an official 
announcement last week from Vienna, stating that in future The 
Medical Press and Circular would pass as a privileged jouranl 
throughout the Empire, without any tax or restriction of any kind. 
We beg to tender our correspondent our most sincere thanks for 
his efforts on our behalf. 

Dr. S. J J.—We thank you for the marked copy of the local 
paper you have sent. We have dealt with the matter in the current 
issue. 

Perplexed. - When in doubt as to the propriety of a certain step 
it is safer to abstain. Your plan, without being absolutely objection¬ 
able, lies on the border land. It is not enough to conform to the 
letter of the code which requires to be construed conscientiously, 
in other words, your object should be how to apply it, and not how 
best tp evade it. 

Matron.—A medical man is not liable under such circumstances. 
Pace.—S mall lumps of charcoal placed inside a coffin by the side 
of the body will effectually prevent any unpleasantness arising from 
the decomposition processes. 

Omega. —There can be no possible objection to the course which 
our correspondent proposes to take. 


Jfteetinge at the godettes mb JCedum*. 

Wednesday, April 26th. 

Hunterian Society.— 8.30 p.m. Paper :—Dr. B. Harris: On the 
Influence of Ozone on certain Micro-organisms. Dr. T. G. Lyon 
will show a New Method of Ventilation by a working model. 

Thursday, April 27th. 

Dermatological Societt op Great Britain and Ireland (20 
Hanover Square, W.).—4.30 p.m. Informal Exhibition of Coses. 
5 p.m. Ordinary Meeting. 

British Balneological and Climatological Society (20 Hanover 
Square, W J.—9 p.m. Sir Hermann Weber: The Climates of 
England Compared with those of the Continent. Followed by a 
Conversazione. 

Friday, April 28th. 

Clinical Society op London (20 Hanover Square, W.).— 8.30p.m. 
Clinical Evening. The following cases will be shown:—Mr. W-. 
Turner: A Cose of Achondroplasia. Mr, S. Boyd : Solution of Con¬ 
tinuity of both Femora. Mr. A. E. Barker: Revolver Shot of the 
Brain through the Hard Palate, Discovery of the Bullet on the 
Corpus Callosum by Roentgen Rays, Removal on 69th day through 
the Vertex, Recovery. (To be illustrated by demonstration of 
lantern slidesj. Mr. E. W. Roughton : Tumour of the Upper Jaw. 
Mr. Pearce Gould: Spontaneous Cure of Recurrent Carcinoma of 
the Breast. Dr. A. Mormon: (1) A Case of Unilateral Hypertrophy 
of the Accessory Muscles of Respiration ; (2) A Case of False 
Accentuation of the Second Sound of the Heart. Mr. M. Biggs : A 
New Splint for Fractured Clavicle. Mr. S. Boyd and Dr. Bond : A 
Cose after Excision of the Posterior Half of the Tongue and Epi¬ 
glottis. Dr. Batty 81iaw: Injury to the Roots of both Brachial. 
Plexuses in an Infant. Dr. N. Dalton: Pulsus Paradoxus. Dr. B. 
Thorne: A Case of Aortic Disease with a Musical Bruit to which 
“Competence” has been restored by Baths and Exercise. Mr. W. 
G. Spencer: A Patient after Excision of a Meningo-Myelocele, with 
a Skiagraph of the Condition before Operation. Mr. Battle: A 
Cose ufter Removal of a Tumour of the Frontal Bone (read at meet¬ 
ing in March). Patients will be in attendance at 8 p.m. 

British Lartnuological, Rhinological, and Otological 
Society (11 Chandos Street, Cavendish Square.).—3 p.m. Cases 
will be shown by Dr. Dundas Grant, Dr. Milligan, Mr. Lennox 
Browne, Mr. Wyatt Wingrave, and others. 

Monday, May 1st. 

Odontological Society op Great Britain. — 8 p.m. Mr. C. B. 
Keetley, F.R.C.S., on " Limitation of the Gape after Operations on 
the Cheek and Jaws." Mr. Mayo Collier, M.S., F.B.C.S., on 
" Deformities of the Upper Jaw, Teeth and Palate, due to Nasal 
Obstruction. 


- Bacmtcus. 

Birmingham.—Assistant Resident-liedieal 0 Alter at the Workhouse 
Infirmary. Salary £100 per: annum, with apartments, rations 
(no alcoholio liquors), and aJteqBance. Apply to the Clerk to 
the Guardians, Edmund Street.. 

Cheltenham General Hospital.- Assistant House Surgeon, un¬ 
married. Salary £80 per annum, with board, lodging, and 
washing. 

Chorlton Union.—Senior and Junior Resident Medical Officers for 
the Workhouse Hospitals. Salary, senior appointment, £130 
per annum, junior, £120 per : annum, with apartments and 
attendance (bnt not rations) in the Workhouse. Applications 
to the Clerk, Chorlton Union Ofljces, Manchester. 

County Asylum, Shrewsbury.—Juhior Assistant Medical Officer, 
Salary commencing at £130 per annum, with board, lodging, and 
washing (no liquors). 

Fisherton Asylum, Salisbury.—Assistant Medical Officer. Salary 
commencing at £100 per annum, with board, lodging, and wash¬ 
ing. Apply to Dr. Finch, The Asylum, Salisbury. 

Lewes Dispensary and Infirmary and Victoria Hospital.— 
Resident Medical Officer. Salary £90 per annum, furnished 
apartments, board, coals, gas, and attendance. 

Royal Mineral Water Hospital, Bath.—Resident Medical Officer, 
unmarried. Salary £100 per annum, with board and apartments 
in the hospital. 

Victoria Hospital for Children, Chelsea. House Physician for six 
months. Honorarium at the rate of £50 per annum, with board 
and lodging in the Hospital. 


.appointments. 

Arnold, E. G. E. M.B., B.S.Durh., M.R.C.P.Lond., Senior Assis¬ 
tant Medical Officer to the Workhouse, Toxeth Park, Liverpool. 

Eyre, J. W. H., M.D.Durh., D.P.H.Camb., Bacteriologist to the 
Charing Cross Hospital, London, and Lecturer on Bacteriology- 
in the Medical School. 

Johnston, T. L., L.R.C.P.. L.R.C.S.Edin., L.F.P.S.GIosg., Senior 
Medical Officer for the Bracebridge Asylum, Lincoln. 

Morgan, D. N„ L.R.C.P.Lond., M.R.C.S., Medical Officer to the 
Tonyrefail and Gilfach Sanitary District of the Pontypridd 
Union. 

New8HOlmf, A., M.D.Lond., F.R.C.P., M.R.C.S., President of the 
Incorporated Society of Medical Officers of Health. 

Norman, F., M.D.Brux., L.R.C.P.Lond., M.R.C.S., Medical Officer 
to the Eighth District of the Parish of St. Mary, Lambeth. 

Norwell, J. S., B.Sc.Ediu., M.B.Edin., Assistant Surgeon to the 
Perth Royal Infirmary. 

Peaiicr, G. H., L.R.C.P., L.R.C.S Ed., Medical Officer and Public 
Vaccinator to the Fourth District of the Barnsley L : nion. 

Reed, J. Arthur, M.B., Ch.B.Vict., Assistant House and Visiting 
Surgeon to the Stockport Infirmary. 

Shaplanp John, M.A., M.B., B.S.Durh., Medical Officer to the 
Exmouth Dispensary. 

Spencer, E. M., M.D.Toronto, L.B.C.P., L-R.C.S.Ed., Medical 
Officer to the Penarth Sanitary District of the Cardiff Union. 


girths. 

Burnett.— On April 19th, at 20 The Drive, Hove, Brighton, the wife 
of James Compton Burnett, M.D., of a daughter. 

Johnston.- On April 19th, at 95 London Bond, Reading, the wife of 
David Richmond Johnston, B.A., L.R.C.P., of a daughter. 
PeaRse. On April 17th, at Ripley, Surrey, the wife of F. Edward 
Pearse, M.R.C.S., L.R.C.P., of a daughter. 

Waller.— On April 16th, at London Road, Stroud, the wife of A. 

W. Waller, M.R.C.S., L.B.C.P., of a daughter. 

White.— On April 22ud, at Westlands, 280 Upper Richmond Road, 
Putney, the wife of E. F. White, F.B.C.S., of a son. 


Carriages. 

Colby—Mandell.— On April 19th, at St. Cuthbert’s Church, 
Huydon Bridge, Carlisle, J. G Ernest Colby, M.A., M.B.Oxon, 
F.K.C.S-Eng„ °f Malton, Yorkshire, eldest son of Wm. Tnylor 
Colby, M.D , of Malton, to Grace Adela, third daughter of the 
Rev. J. H. Mandell, M.A.. vicar of the parish. 

Hancock— SwKEt EScott.— On April 19th, at the Parish Church, 
Leigh, Worcester, William Ilbert Hancock, F.B.C.S.Eng., of 
Wiveliscombfij Somerset, to Margaret Hay Sweet-Escott, 
daughter of the Jtev. W. Sweet-Escott, rector of the parish. 

Pauli— WiLtUMS.—On April 18th, at Kilsby, E. H. Churton Pauli, 
M.B.C.S., of the’ Albyns, Bristol, to Clara Penelope Turville, 
second daughter of Dr. Williams, Guilsboro’, Northampton. 

Pearce—Sutcliffe.— On April 20th, at St. John’s Church, Barnsley, 
George Harper Pearce, L.B.C.P., L.B.C S.Edin., L.F.P.S.Glasg., 
to Nora, third daughter of the late H. S. Sutcliffe, Esq., of 
Barnsley. 

Reith—Machin.— On April 20th, at the Parish Church, Erdingtou, 
Williamson Rust Reith, M.A. M.D., Erdington, second son of 
Alexander Reith, M.D., Aberdeen, lo Helen Constance, elder 
daughter of Edmund Spooner Machin, M.R.C.S., Erdington. 


gsaths. 

Cotton.- On April 18th. at 7 Rupert Street, Hampstead, Wm. 
Mitchell Cotton, M.R.C.S., L.R.C.P., aged 38. 

Frazer.— On April 16th, at his residence, 20 Harcourt Street, 
William Frazer, F.R.C.S.I., M.R.I.A., after a long illness. 

Hogg.- On April 23rd, at his reaidence, 102 Palace Gardens Terrace, 
Kensington, Jabez Hogg, M.B.C.S., in the 83rd year of his age. 

Kidd.— On March 20th, at Dinapore, India, Henry Alexander Kidd, 
M.D., late Civil Surgeon of Mandla, C.P.,aged70, of pneumonia. 

Medcalf.— On April 15th, at Church Road, Hove. Ernest Sexton 
Medcalf, M.R.C.8., Medical Officer of Health, Borough of Hove, 
aged 48. 


by Google 



May 3, 1899 


The Medioal Press and Circular Advertiser. 


> iii 



PHARMACEUTICAL SPECIALITIES. 


A n iw intestinal Astringent contain¬ 
ing 87 per cent. Tannin and 18 per 
cent. Hexamethylene Tetnunin. A 
brown non-hygroscopic powder, insolu¬ 
ble in water weak acids, and aloohol, 
but dissolves slowly in diluted solution 
of soda and alkali. It passes through 
the stomach entirely unchanged, de¬ 
composition commencing only in the 
intestines. 


TANNOPINE 

(Hexamethylene Tetramin 
Tannin). 


Has an excellent effect, without 
secondary phenomena, in all the 
various kinds of enteritis when given 
in doses of to 8 gr ains for obildren, 
and 16 grains, 2 to 4 times daily, for 
adults. 

Has given especially good results in 
oases of tuberculous inflammation 
of the bowels, in oases of non- 
tuberculous, subacute, and 
chronic intestinal inflammation, and 
also in oases of typhoid. 


The active principle of the Thyroid 
Gland, combined with sugar of milk in 
suoh proportions that one part of 
Iodothyrine is equivalent to one part of 
the fresh gland. Iodothyrine contains 
an exactly known quantity of Iodine 
and always produces uniform results. 
Is permanent and not liable to de¬ 
composition. In this it is distinguished 
from all Thyroid preparations at 
present on the market. 


Has been used wibh marked suooessin 
Myxcedema, Goitre, Caohexia, follow¬ 
ing extirpation of the Thyroid, 
Tetanus, Obesity, Aoromegaly, some 
| ^ ^ I Jk I ■■ skin diseases—suoh as Psoriasis and 

1 1 1 It I i I I H I ii I la | Eczema—and some forms of mental 

I kS W ■ II I I I I ■ ■ ks affections. The commencing dose is 

5 grains daily, to be gradually 
increased, aooording to results obtained. 
Prepared also in Tablets, each con¬ 
taining 5 grains. 


The new silver compound for the treat¬ 
ment of Gonorrhoea. Most strongly 
recommended as an antiseptic wound- 
healer. and as a general substitute for 
Nitrate of Silver. Contains 8 per cent, 
of silver; is easily soluble in hot or 
cold water; absolutely non-irritating, 
and possesses a better penetrating effect 
than any other silver preparation. 


A perfect substitute for Iodo¬ 
form. Odourless and non-toxic. Five 
times lighter than iodoform. Non¬ 
irritating, and does not produce a rash. 
Adheres closely to mucous surfaces. Of 
great value in burns, its soothing and 
antieeptio action rendering it specially 
serviceable in suoh oases. A 3 per cent, 
ointment is recommended. 


PROTARGOL 

(Proteinate of Silver.) 

EUROPHEN 

(Isobutylorthocresoliodide). 


Pbopessob Nbisshb declares that 
Protargol is the best, the safest, and 
the quiokest remedy he has yet em¬ 
ployed in ths treatment of Gonorrhoea. 
Protargol possesses high baoterioidal 
properties, and is therefore excellent 
for the treatment of wounds. Has 
been used with the greatest possible 
success in Ooular Therapeutics. The 
usual strength of the solution for 
injeotions is ± to 2 per oent. 

Put up in bougie form by Messrs. 
R. Sumner & Co., Lord Street, Liver¬ 
pool, and R. Manson, 76, Fortess Road, 
London, N.W. 

Pbincipaxly useful in venereal 
diseases; in this direction it accom¬ 
plishes more than any remedy hitherto 
tried. In oases of scrofulous, syphilitio, 
and varioose ulcerations a 6 per oent. 
ointment will be found most advantage¬ 
ous. May be used either pure or com¬ 
bined with equal parts of boric acid. 


Trional, Tannigen, Salophen, Lycetol, Creosotal, Duotal, Heroin, Aristol, Tetronal, 
Analgen, Losophan, Somatose, Iron Somatose. Milk Somatose, Phenacetine- 
Bayer, Sulfonal-Bayer, Piperazine-Payer, Salol-Bayer. 

Samples and Literature may be had on application to the Wholesale Depot for all Bayer's Pharmaceutical Specialities. 

THE BAYER CO., Ltd., 19 ST. DUNSTAN’S HILL, LONDON, E.C. 

Also at MANCHESTER GLASGOW, and BRADFORD. 


Digitized by v^ooQle 



xiv 


TH® Medical Pr®as and Circular Advertiser. 


May 8, 1899 


IN THE NEURALGIAS AND NERVOUS HEADACHES, resulting from over-work 
and prolonged mental strain, paroxysmal attacks of sciatica, brow-ague, painful menstruation, 
la grippe, and allied conditions, ten-grain doses of Antikamnia in an ounce of sherry wine, 
taken every two to four hours, will carry the patient through these painful periods with great 
satisfaction. 


Antikamnia & Codeine. 

AK., 4} gr. Sulphate Codeine, i gr. 



Exhibited in the pains which precede and follow 
labour, in the uterine contractions which often 
lead to abortion, as well as in the nocturnal pains 
of syphilis, in all neuroses due to irregulari¬ 
ties of menstruation this combination affords 
immediate relief. Dose : 1 or 2 tablets as indicated. 
Instruct that tablets be crushed. 


Anfrikamnift. powder and tablets(6-gr. A3 gr.) 
Antikamnia combinations ,5-gr. tablets only) 


1-oz. packages, prioe to the Profession 3/10 post free. 

Antikamnia Chemical Co. (St. Louis), 46 Holborn Viaduct, E.C. 


Digitized by 


Google 




















She fgMiral iPress and ffiirailat. 


“SALUB POPDXJ SUPREMA LEX.” 


Vol. CXVIII. WEDNESDAY, MAY 3, 189 9. • No. 18. 


(Original Communications. 


MALFORMATIONS OF THE 
KIDNEY AND DISPLACEMENTS 
WITHOUT MOBILITY, 

WITH ILLUSTRATIVE CASES AND 
SPECIMENS. 

By DAVID NEWMAN, M.D., F.F.P.S., 

Surgeon, Boyal Infirmary, Glasgow. 

Anomalies of the kidney have until recently been 
looked upon simply as pathological or anatomical 
curiosities ; but now that many of the diseases of the 
kidney come to be placed under the surgeon for 
treatment by operation, all departures from the 
normal, whether in respect of number, form, size, or 
situation, must be considered of moment to those 
who have frequently to operate upon the renal organs. 
The amount of literature on the subject published 
within the last ten years is a testimony to this. 

Since early times anomalies in size, situation, and 
form of the kidney have been recorded, but very often 
only as curiosities, and little attention was given by 
the authors to points of detail. Recently, however, 
the records of cases have been carefully given, and 
much interest has been shown in the subject from the 
surgical, as well as from the pathological, standpoint. 

Vesalius, Spigelius, Duretus, Valsalva, and Sylva- 
ticus were about the earliest authors to describe the 
anomalies we are about to consider ; since their time 
many hundreds of cases have been recorded, so that 
now we have a considerable basis to work upon. 

We shall not endeavour to reconcile the various 
classifications of malpositions and malformations of 
the kidney which have been advanced from time to 
time. 

If we simply study the cases recorded it will be 
found that they group themselves together, and may 
be naturally classified under the following heads: — 

A. Displacements without Mobility : I. Con¬ 

genital displacement without deformity ; 

II. Congenital displacement with deformity; 

III. Acquired displacements. 

B. Malformations of the Kidney: I. Varia¬ 

tions in number : (1) Supernumerary Kid- 
Dey; (2) Single Kidney, <,a) Congenital 
absence of one Kidney, (6) Atrophy of one 
Kidney ; (3) Absence of both Kidneys. 11. 
Variations in form and size : (1) General 
variations in form, lobulation, Ac.; (2) Hyper¬ 
trophy of one Kidney; (3) Fusion of two 
Kidneys ; (a) Horte-shoe Kidney, (6) Sig¬ 
moid Kidney, (c) Disc-shaped Kidney. 

C. Variations in Pelvis, Ureters, and Blood¬ 

vessels. 


A. Displacements without Mobility : I. Con¬ 
genital displacement without deformity of the 
organ is by no means uncommon. 

Perhaps no organs in the body vary more in their 
position than do the kidneys. Their relative dis- 
from the spine, and their position in relation to 


other organs, is observed to vary considerably. For 
instance, without any evident cause one kidney may 
be found close up to the spleen, almost touching the 
diaphragm and the vertebral column, while the other 
organ is situated considerably below the crest of the 
ilium, and removed some distance from the spine. 
From observations which I made regarding this 
point, it seems clear that malposition of the kidney 
within certain limits is of frequent occurrence, and 
may exist without causing any disturbance. In 1,000 
post-mortem examinations, 24 instances occurred 
where the position of one or both kidneys might be 
described as abnormal. In nine of these cases there 
was also malposition of the suprarenal capsule. Mal¬ 
position of the kidney does not therefore necessarily 



Fig. 1. 

involve an alteration in the position of the supra¬ 
renal capsule, although the intimate anatomical rela¬ 
tionship which exists between them might lead one to 
expect that any condition causing the kidney to 
occupy an anomalous position would also cause a dis¬ 
turbance of the corresponding suprarenal body. 

Case 1. —Fixed displacement of the right kidney 
above Pcntpart's ligament simulating a perityphlitic 
abscess. — Operation, fa) 

The patient was admitted to the Glasgow Royal 
Infirmary on November 2nd, 1894, complaining of 
ain in the right iliac region. In September, 1890, 
e began to complain of pain in the lower dorsal 
region, but although the pain continued with more 
or less persistence, he continued at his work till the 
winter of 1893. It then became so severe that he 
went to bed and remained there for over a month. 

(a) This cose is published in detail in the Scottish Medical and 
Surgical Journal, Vol. I., No. 1, p. 53. 


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ORIGINAL COMMUNICATIONS. 


May 3, 1899. 


He first felt pain in the abdomen about this time, 
and for six months after this he could walk about 
only with the aid of two sticks ; the swelling in the 
abdomen he noticed about seven months before his 
admission. There was a slight fulness of the abdo¬ 
men in the right iliac and lower lumbar regions, and 
a rounded swelling was felt passing upwards and 




Fig. 3. 

backwards. It appeared to be fluctuant. The dul- 
ness on percussion did not exactly coincide with the 
opinion formed of the size of the swelling as made 
out by palpation ; it was obtained over an area of 
about two inches in breadth running parallel with 
Poupart’s ligament. The swelling was cut down 
upon, and as soon as the muscles were cut through 


the sense of fluctuation was lost. The incision was 
then enlarged, when the swelling was found to have a 
rounded outline with a distinct hilum towards the 
inner and upper aspect, and being semi-elastic but 
firm, immediately suggested a displaced kidney 
(Fig. 1). 

A very thick adipose capsule was dissected through 
and the kidney exposed. It was quite immobile. 
There was no enlargement or hydronephrosis. The 
condition of the ureter could not be made out. The 
wound healed in a few days, after which the sense of 
fluctuation was again as deceptive as on admission. 

Case 2. —Left kidney displaced downwards and 
forwards in a patient upon whom lumbar colotomy 
was performed. 

The patient was admitted to Sandyford Nursing 
Home early in 1897, suffering from malignant disease 
of the rectum, and it was resolved to perform a lum¬ 
bar colotomy. 

On making an incision from the lower border and 
tip of the last rib on the left side to a point half an 
inch behind the centre of the crest of the ilium, the 
upper border of the left kidney presented itself at the 
lowermost limit of the incision. When first felt by 
the finger in the wound, some doubt was entertained 
as to the nature of the hard mass ; but by drawing 
aside the surrounding adipose tissue, the renal cortex 
was easily recognised. The kidney, as far as could be 
made out, was normal in size and form, except that 
the surface was slightly lobulated (Fig. 2). 

Case 3.— Right kidney displaced downwards and 
rotated on its anteroposterior axis, shortened ureter 
entering upper aspect of bladder. 

The patient was admitted to the Glasgow Royal 
Infirmary in September, 1887, and died from severe 
abdominal injury with rupture of the liver and spleen. 

At the post-mortem examination the right kidney 
was found to be displaced and firmly fixed, the pelvis 
of the kidney looked upwards, inwards, and forwards, 
while the convex aspect of the organ rested tlpon the 
brim of the pelvis. The kidney was normal in shape 
and size, and the vessels were natural in their distri¬ 
bution, with the exception that both the renal artery 
and vein were elongated, while the right ureter was 
shortened and entered the bladder close to the upper 
aspect of that viscus. The left kidney, with its vessels 
and ureter, was strictly normal (Fig. 3). 

In the three cases above described, where the 
kidneys occupied abnormal positions, the fixed mis¬ 
placements were not associated with any deformity 
of the organs. 

II. Congenital Displacement with Deformity. 

The alteration in the form of the kidney seems in 
some instances to depend upon the situation occupied 
by it, as for example in a case described by M. Aubd 
where the left kidney was found between the common 
iliac arteries, close to their origin from the aorta. 
Pacoud narrates another, in which a kidney was 
found situated in the pelvis between the rectum and 
bladder, and somewhat similar instances have been 
described by Drouin, Bellini, Andral, Bonet, and 
others. 

In my own cases, and in those referred to by these 
observers, alteration in form of the displaced organ 
undoubtedly to some extent depended on the situation 
occupied by it. For example in M. Aube’s case the 
kidney was flattened, and its anterior surface divided 
into three parts by two depressions formed by the 
passage of the two arteries. As a general rule, mal¬ 
positions of the kidney are associated, particularly 
when the displacement is congenital, with some 
deviation from the normal in regard to the position 
of the large intestine and peritoneum, and, not un¬ 
commonly, the distribution and number of the blood¬ 
vessels, and the course and length of the ureters are 
found to be abnormal. Roberta states that in twenty- 


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r Mat 3, 1899. 


ORIGINAL COMMUNICATIONS. • The.Medical Prtcrr 451 


one cases of congenital malposition of the kidney, 
which he was able to collect and compare, the abnor¬ 
mality was in every instance confined to one kidney; 
and the left kidney was much more commonly 
affected than the right (left 15, right 6). Most fre¬ 
quently the kidney was found lying obliquely on the 
sacro-iliac synchondrosis. In some cases the organ 
was fixed beside the uterus, or transversely between 
the rectum and the bladder, or across the prominence 
of the sacrum. 

As a rule the displaced organ has its long axis 
vertical or slightly oblique, but it may also occupy, 
as illustrated by a case published by Carshaw («), a 
transverse position. In this case the left kidney 
was found lying on the fourth and fifth lumbar ver¬ 
tebra, and the long diameter was transversely 
from right to left, three inches. The kidney 



Fio. 4. 

was divided into two lobes by a fissure run¬ 
ning on the anterior surface almost verti¬ 
cally. The ureter was double, one branch coming 
from each lobe, but these united while still in the 
hilum of the kidney. Two arteries supplied the 
kidney, one from the aorta and a second from the 
right common iliac, and corresponding with each 
artery there was a vein. 

These congenital displacements will be more fully 
described under malformations of the kidney. At 
present we may give the following cases in illustra¬ 
tion of the subject:— 

Case 4. —Right kidney at the brim of the pelvis, 
anomalous distribution of bloodvessels, and deformity 
of the kidney. ( 6 ) 

The right kidney was found lying on the brim of 


the pelvis. The anterior aspect of the organ is 
convex, the posterior surface slightly concave. The 
front of the organ is marked by a deep groove 
extending from its upper to its lower extremity. 
This groove is, roughly speaking, Y-shaped, the 
right limb of the Y being longer and deeper than the 
left. At the upper limit of the former an artery 
enters the kidney directly from the aorta, and before 
entering the substance of the organ it divides into 
two branches of equal size. In the centre of the 
groove, where the two limbs of the Y join, the pelvis 
of the kidney is seen, and the ureter passes directly 
down from it. From the kidney, close to the upper¬ 
most limit of the pelvis, a large vein passes directly 
to the vena cava. The posterior aspect of the kidney 
is flat or slightly concave and is penetrated by two 
vessels, one a vein which passes from the kidney up 
its lowermost margin to tne common iliac vein, and 
the other an artery, which arises from the common 
iliac artery, and penetrates the kidney at the union 
of the lower and middle thirds. 

Case 5.— Malposition of both kidneys, one to the 
right of the jyromontory of the sacrum, the other in the 
iliac fossa. Right kidney small and with no hilum. (a) 

In this case the kidney was found to be situated 
about half an inch to the right of promontory of the 
sacrum, and the left kidney was discovered in the 
left iliac fossa two inches to the left of the sacro-iliac 
synchondrosis. The right kidney was small in size 
and so altered in shape that there was no hilum, and 
the ureter passed from the lower aspect of the organ. 
The parenchyma of the kidney was normal in appear¬ 
ance, and the arteries, two in number, came off from 
the aorta about one inch above its bifurcation. The 
left kidney was normal in every respect except its 
position. There was no evident cause for the 
abnormality; the other abdominal organs were 
practically normal, and there was no indication of 
inflammatory or other mischief within the abdomen. 

Case 6. —Right kidney fiat, oval in form and situ¬ 
ated at the brim of the pelvis, supplied with two 
arteries ; one ureter from its anterior aspect, (b) 

In this case the right kidney was situated at the 
brim of the pelvis, half in the cavity, and half out. 
The preparation was removed from the body of a 
man, set. 61, who died of erysipelas in the Royal 
Infirmary. 

The right kidney forms a flat oval body about the 
normal size. It is marked by three grooves on its 
anterior aspect which correspond to the line of the 
entrance of the blood-vessels and exit of the ureter. 
The organ is supplied by two arteries which pass off 
from the aorta in the middle line in front, just above 
the bifurcation. These vessels pass slightly io the 
right, and enter the kidney on its anterior aspect, 
about one-third from the upper border. The arteries 
lie each in a separate groove as they pass along the 
upper third of the kidney, and the grooves demarcate 
a triangular piece of the organ. The right renal vein 
passes to the vena cava about one inch above the 
level of the bifurcation of the aorta, and the vein 
passes from the kidney along the same groove as the 
arteries enter it; the ureter also arises from the 
anterior aspect and passes down in front and has a 
somewhat tortuous course to the bladder, as if it were 
too long for the distance to be traversed. The right 
suprarenal capsule is in its normal position close to 
the liver. The right kidney was firmly fixed in its 
abnormal position. No other irregularities were 
discovered in the vessels. The inferior mesenteric 
artery came off just above the bifurcation of the 
aorta (Fig. 5). 

The left kidney was normal in size and in its 
relations, but it showed a distinct tendency to lobu- 

(ni Newman, “ Surgical Diseases of the Kidneyp. 7. 

(6) Boyal Infirmary Museum, Series VII., No. 1. 


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(a) Glasgow Medical Journal, Vol. XXXI., p, 381. 

(b) Royal Infirmary Museum, Series VII., No. 2. 





452 The Medical Press. ORIGINAL COMMUNICATIONS. 


Mat 3, 1899. 


lation. The anterior aspect of the organ being marked 
by three distinct transverse grooves. 

Two specimens, very similar to the above, will be 

Museum, and they 
are described in a 
recent paper by Dr. 
L. R. Sutherland 
and Dr. G. H. 
Edington. (o) 

In the first case 
the right kidney, 
which was found 
lying at the brim 
of the pelvis, is 
greatly altered in 
form and in rela¬ 
tions. The pos¬ 
terior surface is 
flattened, showing 
a groove accommo¬ 
dating the right 
common iliac 
artery. The 
anterior surface 
shows four promi¬ 
nent lobules sur¬ 
rounding the 
liilum. from which 
the pelvis springs; 
the ureter is nor¬ 
mal. Two veins 
emerge, one on 
either side ot the 
liilum, the left 
passes upwards in 
front of the aorta 
to empty into the 
left renal vein, 
while the right 
empties directly into the inferior vena cava. The 
right kidney is supplied by two arteries which arise 
separately from the anterior aspect of the aorta, and 
pass in grooves to the upper part of the liilum (Fig. (5). 

In the second case the right kidney was found at 
the level of the bifurcation of the aorta, and to the 
right of that vessel. In this case also the liilum is 
situated anteriorly; and the bloodvessels, three in 
number, arise directly from the aorta. The veins 
unite to form a common trunk, which empties into 
the vena cava above the junction of the common iliac 
veins. 

The pelvis is bifid, and the two limbs pass from the 
kidney at different levels, the left one being the 
higher. The ureter comes from the lowermost limit 
of the united pelvis. It passes downwards and in¬ 
wards. lying in a shallow groove on the anterior sur¬ 
face of the lower lobe (Fig. 7). 

These remarkable cases of malposition of the kid¬ 
ney seldom give rise to serious symptoms, and gene¬ 
rally escape observation during life. 

Cases, however, have been recorded where the mis¬ 
placed kidney lias been mistaken for an abdominal 
tumour,, or, in the female, has from its position in 
the pelvis become a serious obstacle to parturition. 

HI.— Acquired Displacement of the Kidney. 

Besides being liable to congenital malposition the 
kidney may be displaced upwards, downwards, or 
laterally from the enlargement of other organs, such 
as the liver, spleen, suprarenal capsule, or pancreas, 
or from the pressure of tumours near them. When 
the right kidney is depressed by an enlarged liver— 
not an uncommon accident—it is most usually rotated 
on its short axis, the hilum is turned downwards, and 
the upper portion of the kidney is more depressed. 


(a) Glasgoic Medical Journal, February, 181*8. 


found m the Western Infirmary 



Fio. 5. 


Rayer mentions an instance where the right kidney 
was forced down by an enlarged suprarenal body, 
and cites a case of Hold's where the kidney, situated 
deeply to the inner side of the psoas muscle, offered 
an obstruction to parturition by retarding the passage 
of the child’s head ; Laennec also describes a case in 
which the right kidney was pressed downwards to 
the opposite iliac crest by a greatly enlarged liver, 
and Morris mentions an instance where the left 
kidney was depressed on to the brim of the pelvis 
by a large cyst in its lower part, which contained a 
pint of yellow fluid. The cyst had dragged the 
kidney down, and itself occupied the greater part of 
the pelvic cavity. 



Case 7 .—Acquired displacement of the right kidney 
by a perinephric abscess. 

In a case of perinephric abscess upon which 
I operated in 1890, on opening the abscess by 
a lumbar incision, after the pus was evacuated, 

f reat difficulty was experienced in finding the 
idney. By enlarging the incision upwards, the 
kidney was discovered with its convexity looking 
upwards, and lying close to the diaphragm, while the 

S elvis was turned downwards. The kidney was quite 
enuded of adipose tissue, so that its contour could 
be easily made out, the organ was firmly fixed in its 
abnormal position, probably by inflammatory 



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TRANSACTIONS OF SOCIETIES. 


May 3, 1899. 

adhesions, and, as far as could be discovered by 
examination with the finger, the upper border of the 
kidney was resting on the vertebrae, while the renal 
bloodvessels and ureters must have been elongated. 

Many similar cases have been recorded where the 
kidneys have been displaced in one direction or 
another and anchored by their vessels and ureter. 
The displacements naturally cause rotation of the 
organ in its short axis. 

Probably the most important fixed displacements, 
either congenital or acquired are those where the kid¬ 
ney comes to occupy the cavity of the pelvis, or where 
the organ is placed in such a position as readily to be 
mistaken for an abdominal tumour. 

When the kidney had been displaced and occupies 
the cavity of the pelvis, the swelling may possibly be 
made out by a rectal or vaginal examination, but in 



Fig. 7. 

all cases the diagnosis is extremely difficult, as in 
many instances the organ is not only displaced but 
also malformed, so that the normal reniform outline is 
lost as a guide in diagnosis. When, however, the 
normal shape is maintained it is an important aid to 
the diagnostician, and when superadded to the pre¬ 
sence of a reniform swelling in an abnormal situation 
there is a loss of the usual fulness and resistance in 
the loin, a suspicion of misplacement of the kidney 
may be aroused. 

r |Fixed malpositions of the kidney have seldom been 
diagnosed, as they almost never give rise to sym¬ 
ptoms or even to inconvenience during life. Up to 
the present time most of these anomalies have been 
discovered after death, but now that operations upon 
the kidney are of frequent occurrence, the clinical 
aspect of the subject io likely to be more fully 
recognised. 

(To be continued.) 


Dr. Vidal, of Perigeux, has been awarded, by the 
Paris Society of Biology, its annual prize, for essay 
on the influence of chloroform on nutrition. 


The Medical Press. 453 


NOTES ON 1 HE PLAGUE. 

Collated 

By Sir CHARLES A. GORDON, K.C.B., M.D., 

Surgeon-General (retireil), Hon. Physician to Her Majesty 
the Queen. 

(Concluded.) 

15. Stamping Out. 

Although there was no epidemic. Dr. Hossack 
denied the inference that the measures adopted were 
sufficient. He believed that there was a factor in 
the environment of Calcutta inimical to the spread 
of the plague. The form of the factor was unknown. 
At Bombay, Major Boughton was of opinion that 60 
long as overcrowding increased, and subsoil water 
and bad drains existed, the disease would never be 
exterminated. At Belgaum plague died out 
spontaneously in September, although the place was 
neither disinfected nor evacuated. In the latter days 
of March, 1899, the statement was made with refer¬ 
ence to the Indian epidemic that as yet the efforts to 
stamp out the plague have not met with the success 
due to the devotion of the officials. 

16. Native Opinion. 

Dr. Bose stated that in the northern portion of 
Calcutta only could disinfection be carried out, else¬ 
where it was impossible, being repugnant to the 

? eople, who looked upon it as injurious to health. 

'lie natives objected to inoculation. He induced a 
few men to be inoculated; they were looked down 
upon by members of their caste. Both Mahomedans 
and Hindoos objected to corpse inspection, even in 
the case of males. 

Dr. Hossack said that the people gave false informa¬ 
tion regarding plague, or refused it. The people had 
the greatest abhorrence of the plague measures and 
officials. This sentiment was mixed with a consider¬ 
able amount of political feeling. The native doctors 
with Indian degrees rendered no assistance, but 
resisted the action of officials and concealed cases. 
Dr. Banerjee thought that native doctors did render 
assistance. But he admitted that there was some 
difficulty in getting information. 

Surgeon-General Harvey said that the natives 
objected to inoculation because mutton was used in 
the preparation of the fluid. The principal necessity 
in inoculation was to overcome the prejudices of the 
natives with regard to European medicines. Mr. 
Winter said that in the Hurdwar towns the natives 
preferred corpse inspection to segregation. Colonel 
Adams stilted that segregation and detention were 
less objectionable to natives than disinfection by 
chemicals or house visitation. Captain Grant said 
that in the Agra district all treatment was refused 
by the natives who feared poison, the people con¬ 
cealing cases owing to their aversion to going into 
camp. Lieutenant Niblock, at Kurrachee, said the 
removing of patients to hospital frightened them, 
and sometimes reduced their chances of recovery 
50 per cent. 

At Kolaba there was some resistance to the plague 
measures in the first epidemic ; there was none during 
the second. No objection was made to corpse inspec¬ 
tion. 

Summary and Conclusions. 

In the preceding articles an endeavour has been 
made to collect and arrange such information regard¬ 
ing the plague in India as appears in the columns of 
the Times and other newspapers. From the summary 
so presented the following conclusions appear to be 
justified, namely:— 

1. Plague in India, 1896-99, is said by some 
reporters to be a recurrence of Mahamari or Pati 
plague, by others not to be so. The forms and degrees 
of the present epidemic vary, in some instances mani- 



ORIGINAL COMMUNICATIONS. 


464 The Medical Press. 


Mat 3, 1899. 


festing characters of malignant endemic fevers ; in 
others, of influenza. Cases of plague are stated to 
have been, in certain instances, recorded under other 
headings, statistics being thus vitiated. 

2. On the one hand, the disease is described as 
being endemic; on the other, as imported. 
Endeavours were made by some reporters to connect 
the disease with particular geological formations and 
with the vicinity of rivers. 

3. Attacks of plague are said to oc ur 
most frequently at night. By some reporters 
males are said to be more liable to them 
than females; the most general age from twenty 
to forty; by others that sex and age make no dif¬ 
ference. In certain instances herdsmen are said to 
have been relatively exempt; Hindoos to have 
suffered more than Mahomedans; in others, 
Mahomedans more than Hindoos, and native Chris¬ 
tians to a great extent. According to other reports, 
the incidence of the disease is equal among all races. 

4. Outbreaks of plague occur at different places in 
each month of the year; thus there is no relative 
seasonal difference in that respect. 

5. A recognised expert gave his opinion that a 
patient does not die oi plague because lie has bacilli 
in his blood, or recover because of their absence. 
Thus the presence or absence of such organisms 
becomes without value for purposes of prognosis. The 
germ said to be special to the malady is declared to 
be incapable of living in sewers ; light to be unfavour¬ 
able to it. Certain observers found bacilli in all 
cases examined; certain others failed to find them in 
any. In some instances where they existed they 
were variable and degenerate in Bize and shape. 

6. The spread of plague was assigned respectively 
to clothes, goods, human agency, including travellers 
by road, rail, and sea; to windbome germs, to germs 
entering by abrasions, to grain, to animals, including 
fleas. Other reporters were unable to find the original 
source of infection, or relation of infected cases to 
each other. In Calcutta some native men employed 
in post-mortem rooms became affected, but neither 
nurses nor other ward attendants, nor friends visiting 
patients. Of persons living in the same house some 
remained exempt, while others were affected. 

7. The possible transmission of plague by means 
of water or milk is not alluded to. 

8. Diffusion of the epidemic was by some reporters 
assigned to rats; they observed also that in certain 
places monkeys and squirrels, in addition to those 
animals were contemporaneously affected. In one 
instance, dead rats were absent during an epidemic, 
their influence was accordingly doubted. In another, 
rats were the only victims, human beings not being 
affected. At one place mentioned, squirrels and cats 
suffered, the latter animal believed to have transmitted 

lague to man. Fleas, as transmitters of infection, 
ave been already mentioned. 

9. Several kinds of anti-plague liquids are said to 
have been used, the mode of preparing one only is 
given so far. In various examples of that liquid im¬ 
purities, including pathogenic organisms were found. 
Another such liquid is described as useless. Ex¬ 
perience gained on animals was not always verified 
on man. It was proposed to treat cases in hospitals 
by means of Berum, and by ordinary methods 
respectively, also, to mix and average serums from 
different houses. So far, then, mistrust in the utility 
of the several liquids in use is implied. 

10. Opinions of reporters differ in respect to the 
protective and curative properties respectively, 
assigned to inoculation against plague. Adverting 
to success claimed for that method the statement 
occurs that no one can say whether persons inocu¬ 
lated would otherwise have been attacked. Some 
reporters stated that the method reduced mortality by 
plague. Others that it did not confer immunity to 


the extent supposed, that the results from it were 
negative, that in pneumonic cases it failed, that in 
some instances plague occurred in persons inoculated, 
while tho-e uninoculated remained unaffected. In 
certain places inoculation was supplemented by 
stimulants and by other means. In certain other 
places other means were found satisfactory to the 
exclusion of inoculation. The practice was but a 
makeshift, it could not take its place among the great 
Banitary laws. 

11. Among methods of treatment mentioned were 
neem (melia azadarichta) and olive oils, red iodide ot 
mercury, Baroda pills, and alcoholic stimulants, Ac. 
On the one hand, the statement occurs that patients 
treated did better than those untreated. On the 
other, that no curative agents were beneficial, that no 
treatment stopped the disease. 

12. In some instances segregation of patients was 
said to lie successful. In others it was described as 
a mistake, and had to be abandoned. 

13. Disinfection by various means was used. In 
some instances they were reported on favourably. In 
others they were impossible, or were evaded. When 
employed, they were 3aid to be inefficient, to have 
been opposed by the people. In some instances 
inhabitants of houses disinfected were attacked with 
plague on returning to them. The practice is stated 
to have been abandoned. 

14 It is said that in combating plague, measures 
of sanitation should be placed before inoculation. 
Superior sanitary conditions of Europeans are said to 
have preserved them from attack. Evacuation of 
infected places where practicable resulted in decrease 
of the disease in those places (by reason of diminished 
numbers to be attacked). In large cities the measure 
was impracticable. Municipal camps had varying 
degrees of success. In Bombay, and certain other 
places, epidemic plague recurred on several occasions 
after all sanitary measures had been applied. A 
British regiment became affected, notwithstanding its 
superior advantages in that respect. In various in¬ 
stances the sanitary methods employed resulted in 
the people concerned being left houseless for the 
time being. In others, the epidemic ceased, irre¬ 
spective of such measures. 

15. All efforts to stamp out the plague by the 
several methods described are considered to have been 
ineffectual for the purpose. 

16. Protests against methods employed were made 
by the people concerned, in the Press, and otherwise; 
armed demonstrations occurred in certain places; in 
others, the people left infected towns, their object to 
avoid those methods. Some of the demonstrations 
thus alluded to were, in the first instance, connected 
with the bearing of measures in question on usages 
of religion and caste; there is reason to believe that 
to these political opinions became superadded. 

NOTE ON PROTARGOL IN URETHRITIS. 

By JAMES MAOMUNN, M.R.O.S., L.R.C.P.Lond. 

In reading the criticisms of other surgeons on the 
employment of this drug I find that although they 
often particularise their mode of treatment they fail 
to dwell on some important Considerations, and on 
accessories to treatment by injection, without which 
no drug can have fair play. 

Chief among these are the stage and degree of 
inflammation present, and the mode of injecting. 
Guided by this recent literature a novice would have 
no qualms in applying this new remedy in the 
presence of the most severe inflammation attacking 
any part of the urethra. This would be a great mis¬ 
take, even with protargol. Inflammation and irrita¬ 
tion, must as in the past, be subdued before or pari 
passu, whilst we attack the bacterial cause of them 


Digitized by VjOOQ 1C 



May 3, 1809. ORIGINAL COMMUNICATIONS._ The Medical Press. 455 


by rest, aperients, and certain internal means and 
external applications. I cannot help alluding to the 
good effects of lead lotion constantly applied in penile 
urethritis and rectal douches in deep urethritis. 

Then, as to injections, these are best carried out 
by a special aseptic syringe made for me years ago 
by Messrs. Arnold and Sons. With it the patient 
cannot hurt himself, and its peculiarly-shaped nozzle 
allows of the prolonged retention of the solution, 
owing to the way it plugs the meatus. 

I have found protargol most excellent, not only in 
anterior, but also in deep urethritis. Nitrate of silver 
was, up till lately, the almost indispensable salt for 
the latter, but its property of combining with albu¬ 
men, and in this way actually forming protection 
shields for the deep-seated gonococcus, greatly 
detracted from its value. Now happily we possess 
a drug of superlative value devoid of such effects. 

In urethritis I begin with I per cent, solution. In 
deep chronic urethritis I often instil a 5 per cent, 
solution. 


THE ATTENUATION OF SYPHILIS IN 
PORTUGAL IN 1812. 

By GEORGE OGILVIE, B.Sc., MB.Edin., M.R.C.P. 

Lond., 

Physician to the Hospital for Epilepsy and Paralysis. Regent's 
Park, Loudon. 

Dr. John A. Shaw-Mackenzie's peace of mind has 
of late been repeatedly disturbed by several of my papers 
having been—to use his own words—“ prominently 
noticed,” and having received “considerable support” 
in the leading medical journals of this country. Much 
as I regret the discomfort which this has caused him, I 
cannot but feel gratified by the fact which has given 
rise to it. 

A notice in the Lancet of January, 1898, on a paper of 
mine drew forth his first letter ; a leading article in the 
British Medu'al Journal for November, 1898, on “Syphilis 
in the Army,” was promptly followed by a lengthy letter 
from Dr. Shaw-Mackenzie’s pen; and now the short 
notice which appeared last January in the Medical 
Press and Circular on the same subject has again 
aroused him to action. This time his reply (vide 
Medical Press and Circular, February 22, March 1) 
occupies not less than eleven columns. Of course, it is 
impossible to fully answer an attack so formidable 
by its length, within the space which could be 
allotted to me for the purpose ; but I would 
like to draw attention to a few inconsistencies in his 
remarks. I should have done so before had I not had to 
ask Professor Neumann, of Vienna, for some information 
on a certain point which I shall have to refer to later on. 
Hence the delay. 

Di. Shaw-Mackenzie’s attempt to “ represent the work 
of Fergusson in its proper light’’ is a Quixotic adventure 
He is fighting for a chimera, viz., the attenuation of 
syphilis in Portugal in 1812, which cannot be substan¬ 
tiated by a single fact, which is not sustained by a Bingle 
writer of competence, and which has been repudiated by 
Fergusson himself. Among the numerous surgeons, the 
evidence of whom I have collected, there is not 
one who, from his own personal experience, reports 
attenuation. Dr. Shaw-Mackenzie. with an air of pro¬ 
found erudition, says:—“ But he (Dr. Ogilvie) does not 
mention Hennen, an equally prominent Peninsular sur¬ 
geon, who, while subscribing to the non-mercurial treat¬ 
ment, thinks it * proper to direct attention to the opinion 
of those who held,’ like Fergusson and others 
previously, that syphilis has ‘ undergone great 
changes in its nature since the end of the 
fifteenth century.’ ” What is there in this quotation 
worth mentioning ? Hennen does not report his own expe¬ 
rience. he only directs attention to the opiaion* of others, 
and these opinions only refer to changes in the nature 
of syphilis as compared with the disease at the end of 
the fifteenth oentury. But the question with Fergusson 
was not whether syphilis in Portugal in 1812 was milder 


than syphilis in the fifteenth century, but whether Por¬ 
tuguese syphilis in 1812 was milder than English syphilis 
in 1812. As a result of Fergusson’s. personal experience 
in Portugal it certainly appeared to be so, but his 
experience was not of a kind to decide the question. 
Later on, when he thoroughly realised that the severe 
character of English syphilis was due to aggravation 
by “ murderous and unnecessary courses of mercury,” 
then the inevitable conclusion he arrived at was that 
the comparatively milder character of Portuguese 
syphilis could not be attributed to attenuation. This is 
the reason why Fergusson’s later paper “ makes no 
mention of attenuation.” Dr.* Shaw-Mackenzie’s pro¬ 
phetic suggestion that “six years later, even had he 
lived, Fergusson again might have had reason to revert 
to his original opinion ” can hardly be taken seriously. 
But the fact remains that Fergusson, whom Dr. Shaw- 
Mackenzie so gallantly defends against himself, totally 
abandoned his self-attenuation theory of syphilis, finding 
that there was not a tittle of evidence to support it. 

It has been somewhat of a surprise to me to read that 
“ in proof of the truth of Fergusson’s views the simi¬ 
larity of the aggravated form of disease among British 
troops invalided home from India was originally ad¬ 
duced ” by Dr. Shaw-Mackenzie. Until he quotes 
chapter and verse I am bound to consider this statement 
the production of a daring imagination, a fiction, ’‘all 
carved from the carver's brain.” I have only to add 
that when this “ similarity ” teas first pointed out by me 
it was not done in “ proof of the truth of Fergusson’s 
views.” This could not have been done seriously and 
reasonably by any one. 

Of Dr. Shaw-Mackenzie’s exegetical abilities I will 
give only one example, which is at the same time 
amusing and characteristic. In his text-book on 
syphilis Professor Neumann on two occasions states 
that he is not in a position to corroborate Fer¬ 
gusson’s statement about the particularly benign 
character of syphilis in Portugal, while in his historical 
introduction to the same book he declares, that syphilis 
is particularly benign in Portugal, and that therefore 
he is in opposition to Fergusson who “ pointed out the 
malignancy of syphilis in Portugal.” This latter state¬ 
ment, I said, was evidently a slip of the memory on 
Neumann’s part. On this point Dr. Shaw-Mackenzie, 
however, becomes very suggestive and deep, or rather 
abstruse. He says: “Among ‘the well-known facts of 
Fergusson,’ his notice of the ‘very severe’ disease in 
Lisbon among the Portuguese is referred to. Pro¬ 
fessor Neumann's later opposition to the ‘ malignancy!?) 
of syphilis in Portugal’ is, probably, not ‘evidently 
a slip of the memory excusable in so bulky a work,’ as 
Dr. Ogilvie thinks, but founded on the statements of 
Fergusson, corroborated by Guthrie.” I therefore wrote 
to ProfessorNeumann and asked him for an explanation. 
He has kindly replied that the statement in the historical 
introduction to his book is due to a misprint, which at 
the time my letter arrived had already been corrected 
for the second edition of his work. Bisum teneatie, 
amici ? — Rideret Fergusson. What a curious malady it 
must have been that he observed in 1812, this “ very 
mild,” “ very severe,” “ attenuated,” “ malignant ” 
syphilis “ among the Portuguese." 

If Dr. Shaw-Mackenzie is not altogether successful in 
the interpretation of the authors he quotes, he is still 
more unfortunate in the choice of his authorities. 
Formerly it was Aitkin’s misstatements which were pro¬ 
duced as final and crushing “testimony.” Of late Dr. 
Shaw-Mackenzie’s piece de resistance has been a com¬ 
munication made by Professor Tamowsky, of St. Peters¬ 
burg, at the last International Congress of Dermatology, 
relating to thirty cases of syphilis, in the “ majority ” of 
which both parents and children had acquired syphilis. 
Elsewhere I have shown that these observations do not 
in the least prove the attenuating influence of syphilis. 
Perhaps Dr. Shaw-Mackenzie would have hesitated to 
place himself under Professor Tamowsky’s protection if 
he had known the, by no means flattering opinion in 
which this author holds the adherents of the attenuation 
theory of syphilis. In his book, “ Prostitution and 
Abolitionismus,” he thus expresses himself: “ Only those 
who form their opinions in a most perfunctory manner 


456 The Medical Press. 


CLINICAL RECORDS. 


May 3, 1899. 


or who are utterly ignorant of medicine, can at the pre¬ 
sent day speak of attenuation of syphilis as a patho¬ 
logical process.” Herbert Spencer once said that, 
“without going the length of Mr. Carlyle, and defining 
the people as twenty-seven millions mostly fools, one 
will yet confess that they are but very sparely 
gifted with wisdom ” In the same way, “ without 
going the length” of Professor Tarowsky, “one will 
yet confess ” that those who, like Dr. Shaw-Mackenzie, 
proclaim that “ the question of hereditary immunity and 
attenuation is absolute fact” are “but very sparely 
gifted ” with discernment and knowledge. 

Sed hive hactenus ! In conclusion, I have one practical 
suggestion to make to Dr. Shaw-Mackenzie in exchange 
for the many theoretical ones contained in his paper. 
In my first paper I had by mistake spelt Fergusson’B 
name with one “ s ” only. Heu misero mihi ! But : 
so/amen mi verts sorios habuisse ma/orum. The same mis¬ 
take is made by Dr. Aitken, Mr. Hutchinson, and, not last 
but first, by Mr. Henry Lee. Whenever Dr. Shaw- 
Mackenzie quotes from my first paper he makes it a 
point to place an alarming “sic!” in brackets after 
“ Ferguson ” while he does nothing of the kind when he 
has to quote the same mistake from other writers If 
this mode of procedure is not exactly fair, there is a 
certain air of juvenility about it which renders it quite 
pardonable. 

Dr. Shaw-Mackenzie tells us that “ not long before his 
lamented decease ” Mr. Lee “ gave him permission to 
make use of or even alter any of his writings.” This is 
certainly a most extraordinary testamentary deposition 
on the part of an author of original thought and per¬ 
sonal experience. Should Dr. Mackenzie ever make use 
of this right it would be advisable not only to correct 
the spelling of “ Ferguson’s ” name, but also to “ alter ” 
the conclusions drawn by Mr. Lee—and religiously 
espoused by Dr. Shaw-Mackenzie — for they were 
“ obviously founded upon imperfect knowledge ’’ of Fer- 
gusson s work. 


Clinical JK-ccovIjs. 

WESTMINSTER HOSPITAL. 

Hysteria or Hemiplegia ? 

Under the care of Dr. Murrell. 

Amelia B., let. 22, unmarried, was sent up from the 
country as a case of supposed hysteria, for which she 
had been extensively blistered in the ovarian regions. 
Three months ago, whilst in her usual health, she sud¬ 
denly lost power all down the right side, and was in¬ 
sensible for several da) 8. On regaining consciousness 
she spoke indistinctly, and was unable to move the 
right arm or leg. She gradually improved, and little 
by little the power of movement in the limbs returned. 
On admission it was noted that she presented none of 
the ordinary indications of hysteria. The right arm 
and leg were distinctly weaker than the left, although 
the paralysis was nowhere absolute. Her gait was hemi¬ 
plegic, and she dragged her right foot slightly in walking. 
Her right arm and foot weie warmer and moister than 
on the healthy side. The right knee-jerk was more 
marked than the left, there was ankle clonus on the right 
side only, and the right plantar reflex was exaggerated. 
There was right-sided hemi-ana'sthesia of the face, 
trunk, and limbs. The patient had no idea that her 
sight was affected, but she was blind in the right half of 
both visual fields, the hemiopia being absolute. The 
optic discs, the pupils, and the external ocular move¬ 
ments were normal. There was no heart mischief, and 
there was no albumen in the urine. Menstruation had 
entirely ceased since the attack. The family history 
was good, with the exception that one brother and one 
sister were deaf and dumb. The patient had had no 
previous attack or seizure of any kind. 

Remarks by Dr. Murrell. —To overlook a gross lesion 
of the nervous system and to attribute the symptoms to 
hysteria, is as bad a mistake as can be made. Tn this 
case there is not a single symptom pointing to the 
existence of hysteria. The disease is organic and not 
functional. In every case of organic brain disease 


there are two questions which have to be discussed — 
1. What is its situation ? 2. What is its nature ? 

The position of the lesion is determined by the objective 
symptoms, and all that is required for its localisation is 
a practical acquaintance with the anatomy and 
physiology of the nervous system. The nervous system 
is a combination of an immense number of units called 
“neurones,” each composed of a cell-body, of proto¬ 
plasmic processes or “dendrites,” and of the axis- 
cylinder process or “ axone.” A voluntary motor impulse 
starting from the brain cortex must pass through at 
least two neurones before it can reach the muscles, and 
we accordingly speak of the motor tract as being com¬ 
posed of two segments, an upper and a lower. The upper 
neuron extends from the motor cortex down through the 
corona radiata, internal capsule, and pyramidal tract to 
the dendrons in the anterior horns of the spinal cord on 
the opposite side. The lower neuron commences at the 
anterior cornual cells, and extends through the anterior 
nerve root along the motor ner7e into the motor end 
organ and the muscles. The upper neuron exerts a 
restraining influence on the lower, and checks the over¬ 
flow of nerve energy which proceeds from the lower neuron 
and produces their “ tone.” If one part of a neuron is 
injured the whole Deuron suffers. If, for example, the 
cortical cell is injured the axis-cylinder process or axon 
also suffers and undergoes degeneration. In the same 
way if a motor nerve is injured the functions of the 
cortical nerve cell are impaired. If the upper neuron is 
damaged it can no longer exert its restraining influence 
on the lower neuron, so that the tone of the muscles is 
raised and we have exaggeration of the deep reflexes. 
If the lower neuron is injured the corresponding muscle 
fibres lose their tone and undergo degeneration. 

Lesions of the motor tract may be divided into two 
great groups, those of the upper neuron and those of 
the lower neuron. A lesion of the motor tract, whether 
of the upper or the lower neuron, will produce motor 
paralysis, but the type of the paralysis differs in the two 
cases. 

Motor paralysis due to a lesion in the upper neuron 
is characterised by:—1. Motor rigidity. 2. Increased 
deep reflexes. 3. Absence of muscular atrophy. 4. Normal 
electrical reactions. 

Motor paralysis, due to a lesion in the lower neuron, 
is characterised by:—1. Flaccidity of the muscles. 2. 
Diminished deep reflexes 3. Muscular atrophy. 4. 
Electrical phenomena of degeneration. 

Applying these considerations to the case now before 
ub we have no difficulty in determining the site of the 
lesion. Absolute hemianopia, slight hemiamesthesia, 
and slight hemiplegia, all on the right side, point to a 
lesion of the left internal capsule, the knee-shaped band 
of white matter which is bounded on its outer side by 
the lenticular nucleus, and on its inner side by the optic 
thalamus and caudate nucleus. The lesion is probably 
far back where the fihres of the optic radiation are found 
behind the sensory tract. 

The determination of the pathological nature of the 
lesion is a much more difficult matter, and in the eluci¬ 
dation of this problem we must be guided to a very great 
extent by the Liistory of the case. A sudden onset indi¬ 
cates a vascular lesion, while a gradual onset points 
to an inflammatory condition or to a new growth. Our 
patient was attacked quite suddenly so that we have no 
hesitation in paying that the lesion was connected with 
some disturbance of the blood supply. The common 
vascular lesions are (1) Embolism. (2) Thrombosis, and 
(3) Haemorrhage. 

In embolism we have:—1. An absolutely sudden 
onset. 2. No unconsciousness. 3. A mitral murmur. 

In this case there was the sudden oneet, but the other 
indications were absent, to that we may put embolism 
out of court. 

In thrombosis we have:-l. A gradual onset. 2. 
Unconsciousness rare. 3. Arterial disease such as 
atheroma or endarteritis of syphilitic origin. 4. Blood 
pressure at time of seizure low ; may occur during sleep. 

In this case the onset was sudden, and unconsciousness 
was of profound duration, so that this cause may be 
eliminated. 

In cerebral hcemorrhage we have:—1. Onset les3 


Digitized by GoOgle 



May 3, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Medical Press. 457 


sadden than in embolism. 2. Unconsciousness. 3. 
Arterial degeneration probably associated with Bright's 
disease. 4. Blood pressure at the time of seizure, high ; 
often following excitement or exertion. 

This fits in closely with our case. The onset was 
certainly sudden, how sudden we do not know. There 
was prolonged unconsciousness, and there was probably 
high arterial tension due to the absence of the menstrual 
function. Cerebral haemorrhage, it is true, is not very 
common in young women, but many such cases are 
recorded, and it has even been noted in children. From 
a consideration of all these circumstances I think we are 
justified in concluding that the patient was suffering not 
from hysteria, but from hsemorrhage into the left 
internal capsule. 

She has continued to improve during her short stay in 
the hospital, but as she was sent in simply for diagnosis 
and not for treatment we do not think it necessary to 
keep her long. 


‘(Transactions of §ocietics. 

CLINICAL SOCIETY OF LONDON. 
Meeting held Friday, April 28th, 1899. 

The President, Mr. Langton, F.R.C.S., in the Chair. 

Clinical Evening. 


CASE OF ACHONDROPLA8IA. 

Mr. Turner showed a girl, a;t. 10, who looked consider¬ 
ably younger, with no history of syphilis, born of young 
parents, with two sisters, aged respectively seven and 
three, in good health, she was only three feet high. 
The diaphyses of the bones were very short, and had not 
increased in length pari passu with the increase of 
growth of the epiphyses. The three year old sister was 
three inches taller than the patient. The clavicle, for 
instance, was as long as the humerus. 

Dr. A. Garrod observed that the case was similar to 
one which he had shown to the Society last year. 

Mr. Barwell said the lordosis was analogous to that 
occurring in congenital dislocation (so-called) of the hip, 
and the result was probably due to an affection of the 
upper part of the femur, which caused the patient to 
throw the buttock and tuber ischii backwards. 

SOLUTION OF CONTINUITY OF BOTH FEMORA. 

Mr. Stanley Boyd showed a patient, let. 18, in whom 
two years ago, after much difficulty in walking, both 
femora gave way and who had become unable to walk or 
Btand. When admitted to hospital there was a remark¬ 
able deformity of both thighs which persisted. Since 
shown at the last meeting he had applied extension with 
marked improvement, especially in respect of the left 
limb. He showed on the screen skiagrams of the lad, 
which showed the characteristic deformities of rickets, 
but the shadow of the solution of continuity in the bones 
was almost as dark as. that of the bones themselves. 

Mr. W. G. Spencer thought this was an example of 
one of the general diseases of the skeleton which did not 
fall into any definite category, and which might be de¬ 
scribed as intermediate between rickets and osteomalacia. 

Mr. Charters Symons referred to a case by Mr. Davies- 
Colley, reported in the “Transactions” of the Patho¬ 
logical Society, Vol. 35, which he said was almost exactly 
similar. Both femora and both tibia; were broken, and 
the child also developed large masses of soft bony tissuo 
in connection with the jaw, ribs, and pelvis. The child 
died at the age of 15 from paraplegia caused by yielding 
of the Bpine and pressure on the cord. It was diagnosed 
as osteomalacia. 

Mr. Barwell suggested that there was something 
inflammatory about the lesions. There was great pain 
on the slightest movement of the limbs, and he com¬ 
mented on the fact that the substance uniting the frag¬ 
ments was as dark in the skiagram as the bone itself. He 
did not consider that the case referred to by Mr. Symons 
was at all comparable. 


REVOLVER SHOT OF THE BRAIN THROUGH THE HARD 
PALATE. OPERATION. 

Mr. A. Bab her Bhowed a man who had fired two 
shots of a revolver into the mouth and then, despairing, 
had given himself up to the police. There was free 
haemorrhage but no loss of consciousness. Twelve hours 
after there was no trace of any nerve lesion except a 
slight drooping of the right eyelid. Eighteen days later 
he began to vomit frequently, and on the twenty-eighth 
day it was noted that the left side was growing weak, 
which by the thirty-second day had become complete. 
There was marked optic neuritis moat pronounced on the 
right side. Some improvement occurred and in a few 
weeks he was able to walk about. A skiagram was ob¬ 
tained which showed the position of the two balls. He 
had several epileptic attacks, and after experiments on 
brains in the post-mortem room he localised one of the 
bullets, and trephined over the region, and ultimately 
succeeded in removing it on the sixty-ninth day. On 
recovering from the operation the patient was completely 
paralysed, but motion returned first in the leg and then 
in the arm, feet, and hands. Then it was noticed that his 
trunk muscles were quite paralysed on one side as shown 
in screen projections. He had since steadily improved, 
but as there was optic neuritis Mr. Barker pointed out 
that the prognosis was doubtful. 

The President agreed that surgeons were well ad¬ 
vised not to interfere in these cases, seeing that very 
often the bullet gave rise to no symptoms at all, and he 
referred to three cases in which no operation had been 
found necessary. 

Mr. Gould asked whether the author thought it was 
the removal of the bullet or the relief of tension that 
had brought about the amelioration in this case. 

Mr. Barker admitted that there was considerable 
tension, but thought that as the symptoms were on the 
mend the existence of optic neuritis rendered it 
likely that the bullet was causing irritation. He 
asked whether in the cases referred to by the Presi¬ 
dent skiagraphic or other evidence had been forthcoming 
of the presence of the bullets in the brain. 

The President said that in one case a skiagram had 
been made. His three cases were all in Germans. 

Mr. Barker added that his patient was a Russian. 

TUMOUR OF THE UPPER JAW. 

Mr. E. W. Roughton showed a man, Eet. 39, who two 
years ago first noticed a swelling on the upper jaw just 
below the left eye, which had since gradually increased 
in size. There was a swelling of uniform hardness 
mainly occupying the left superior maxillary bone, also 
the nasal bone, and the malar bone. The alveolar process 
was much thickened, and the arch of the hard palate 
was much depressed. From the nose it was seen that 
the floor of the nose was depressed on one side showing 
that it was a bony growth infiltrating not only the 
superior maxilla, but also the adjacent bones. He 
had removed a portion of the growth, which on section 
pnved to consist of delicate trabeculae of bone with 
spindle and round cells, and some multinucleated giant 
cells. It might, he said, be leontiasis or a soft growing 
sarcoma. 

SPONTANEOUS CURE OF RECURRENT CARCINOMA OF THE 
BREAST. 

Mr. A. Pearce Gould showed a woman who had 
already been shown to the Society in November, 1897. 
She was single, and set. 49. In 1888 she received a blow 
on the left breast which was followed by a lump, which, 
in 1890 was removed, and on microscopical examination 
was diagnosed asscirrhus. In 1892 she returned with recur¬ 
rence in the left axilla which was excised, and in 1894 
recurrence had again taken place, and on this occasion 
there was a lump in the right breast. These were excised 
in December. In 1895 she returned with another recur¬ 
rence in the scar and also the lump in the other breast, 
and enlarged glands in the corresponding axilla. She 
also complained of shortness of breath, and her condition 
was looked upon as incurable, and she was admitted to 
the Cancer Ward of the Middlesex Hospital. There were 
then numerous nodules around the scar and elsewhere, 
and dulness at the base of the right lung. In March, 
1896, she was unable to lie down in bed and there was a 


joogle 


458 The Medical Pbiss. 


TRANSACTIONS OF SOCIETIES. 


May 3, 1899. 


large lump in the right thigh bone. Nothing was done, 
but in June, 1896, she had lost her dyspnoea and the 
nodules had disappeared. The swelling in the thigh had 
diminished and was no longer painful. He had shown 
her in November, 1897, when the scars alone were visible, 
and he showed her again to prove that the improvement 
was not ephemeral. Mr. Gould mentioned that the 
patient had menstruated the last time in January, 1895, 
and the improvement had been manifested many months 
later, viz., between March and June, 1896. He com¬ 
mented on the fact that no credit could be given to any 
treatment, for she had had none, and the improvement 
had taken place in the cancer wards of the hospital 
devoted to cancerous patients for the last fifty years. 

Mr. Clement Lucas asked whether Mr. Gould himself 
bad made any microscopical examination of the growths. 
He mentioned that he had tried oophorectomy in one 
case, but the growth in the breast had doubled in size 
within the six weeks following the operation, and he had 
subsequently removed it. 

Mr. Gould said he had not made any sections while 
the patient was under his care, and he had no explana¬ 
tion to suggest of the subsidence of the growths. 

UNILATERAL HYPERTROPHY OF THE ACCESSORY MUSCLES 
OF RESPIRATION. 

Dr. A. Morison showed a woman, art. 35, with uni¬ 
lateral hypertrophy of the accessory muscles of respira¬ 
tion viz. the trapezius, 6temo cleido-mastoid, and scaleni. 

A NEW SPLINT FOR FRACTURED CLAVICLE. 

I)r. Mouat-Biogs showed a man wearing his splint for 
fractured clavicle, which he had had in use for this 
injury for the last fifteen years. He claimed for it that 
it afforded complete immobility of the fractured bone, 
with much less discomfort than the usual appliance. 

EXCISION OF THE POSTERIOR HALF OF THE TONGUE 
AND EPIGLOTTI8. 

Mr. Stanley Boyd showed a patient (with specimen) 
who, when seen, presented an epitheliomatous tumour, 
involving the posterior half of the tongue and the epi¬ 
glottis. The growth reached nearly back to the spine. 
He removed it by opening the pharynx and removing a 
portion of the hyoid bone, the tumour reaching down to 
the thyroid cartilage. The removal of the tumour left 
a cavity which he closed by a purse-string suture, and 
the patient was able to swallow on the fifteenth day. 
Some recurrence had taken place low down in the neck 
where the glands were not readily accessible, and this 
he had removed. The patient had since gained in 
weight, and the tongue looked fairly normal, but there 
was some narrowing of the pharynx. 

INJURY TO THE ROOTS OF THE BRACHIAL FLEXUS IN 
AN INFANT. 

Dr. Batty-Shaw showed an infant, 13 months of age, 
in whom, consequent on violence exerted at birth on the 
left arm, impairment of motion had resulted in the 
corresponding limb. Sensation was not affected. 

PULSUS PARADOXUS. 

Dr. Norman Dalton showed a man, age 48, with no 
history of rheumatic fever, syphilis or alcohol, who had 
rales and coarse friction over the lower two-thirds of the 
left lung, but no dulness. There was marked retraction 
of the apex beat, which extended from the ensiform 
cartilage to two inches below the nipple. There was 
also typical pulsus paradoxus, but no other signs of 
adherent pericardium, or of chronic mediastinal cellu¬ 
litis. The heart sounds were normal, and the heart 
action strong. As no tuberculous bacilli could be found, 
he suggested that there was probably chronic intersti¬ 
tial pneumonia, with pleuritic adhesions in the lower 
part of the left lung, with probably much fibrous tissue 
between the heart muscle and the chest wall and dia¬ 
phragm, and a certain amount of pericardial adhesion, 
though not enough to embarrass the heart. 

A CASE OF AORTIC DISEA8E WITH MUSICAL BRUIT 
REMEDIED BY BATHS AND EXERCISE. 

Dr. Bezlet Thorne skowed a man, art. 45, without 
marked hypertrophy of the heart and no increase of 
cardiac impulse. After an effort he had become breath¬ 
less, and had developed a musical bruit and he had become 


incapacitated for work. Under treatment by baths and 
graduated exercise be had gained in health, though the 
exaggerated cardiac dulness remained unaltered, and he 
was about to resume work as a timekeeper. 

EXCISION OF A MENINGOCELE (w’ITH 8KIAGRAM). 

Mr. W. G. Spencer show’ed an infant who, when seven 
months old, was operated upon for spinal bifida, and he 
showed a skiagram of the cavity. Previous to the opera¬ 
tion the child had never been seen to use its lower limbs 
at all, but since, it kicked about like a normal child. 
He bad opened the sac and dissected out the cauda 
equina, &c , bringing together the walls of the sac by a 
double row of sutures, and keeping the child in such a 
position that the wound was the highest part. No 
untoward symptoms had followed and no cerebro-spinal 
fluid had escaped through the wound. 

OSSIFICATION OF THE TENDO-ACHILLIB. 

Mr. Wilmott Evans showed an elderly man who pre¬ 
sented a hard tumour in the left tendo-Achillis, which 
in skiagram appeared to be calcified if not ossified. 
There was a history of two injuries twelve and eight 
years ago, but the condition was not noticed until twelve 
months ago. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Obstetrics. 

Meeting held Friday, March 17th, 1899. 


Dr. W. J. Smyly, in the Chair. 


Drs. Pukefoy, Glenn, and A. Skith inaugurated a 
discussion on the action of the General Council of the 
Academy in refusing the recommendation of the Obste¬ 
trical Section to print and circulate among the members 
the reports of the Rotunda Hospital, and after some 
further discussion it was resolved “ That the Council be 
asked to reconsider their decision, and that in future 
hospital reports of sufficient interest be printed and cir¬ 
culated among the Fellows of the Academy.” 

SPECIMENS OF MYOMA UTERI. 

Dr. Alfred Smith exhibited three myomatous uteri 
removed by retro-peritoneal hysterectomy. 1. The first 
specimen was a large soft myoma which had been re¬ 
moved five days previously. The patient had given 
birth to two children, and after the birth of the younger 
child, who was now three years old, the uterus in repose 
came down to the size of a three months’ uterus. The 
tumour, which was considerably a>dematous, and blocked 
up the pelvis completely, extended well into the broad 
ligament. 2. The second specimen was a small fibroid, 
which he removed on account of the constant trouble 
which it gave to the patient during micturition. On 
cutting through the pedicle there was no haemorrhage, 
and he found that there was only one uterine artery 
developed to any extent, and that was on the left aide. 
The absence of an uterine artery on the right side was the 
chief point of interest in this specimen. 3. The third 
specimen which he had removed a fortnight ago was 
large, and appeared to him before operation as sub- 
peritoneal and pedunculated. On operating, however, 
he found a second pedicle intimately adherent to the 
promontory of the Eacrum, and this gave him consider¬ 
able trouble until he found out the condition. He then 
attempted to perform a myomectomy. He put a clamp 
round the cervix in the ordinary way in order to sup¬ 
press haemorrhage from it, and then proceeded to ampu¬ 
tate the large tumour which he exhibited. On loosening 
the ligature,however, there was haemorrhage everywhere. 
He tied several arteries, but notwithstanding this he 
could not arrest the htemorrhage, so that he was obliged 
to perform hysterectomy. The patient did remarkably 
well. 

Dr. Porefoy said that Dr. Smith’s failure to find the 
uterine artery on one side was another illustration of the 
variations in size which one oiten observed in different 
cases in the uterine vessels. It was very difficult to 
forecast what the behaviour of a fibroid would be. There 
were some harder than others, and the rate of growth 


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The Medical Press. 459 


in these cases was comparatively slow. The difficulty 
Dr. Smith had in controlling the haemorrhage in the 
case of myomectomy showed that one ought to be prepared 
for an emergency, even in the case of a tumour with a 
small pedicle. He suggested that tying the ovarian 
arteries might have had some effect in checking the 
haemorrhage in this case. 

Dr. Shyly suggested that the small tumour might 
have been removed per vaginam. 

Dr. Smith, replying, said there seemed to be a growing 
opinion that operation should be the treatment in the 
case of fibromata. He looked upon these cases as strong 
arguments in favour of operative treatment. The un¬ 
certainty of the prognosis was another point in favour 
of operation. As regards the shock of removal of the 
uterus by the retro-peritoneal method, his experience 
was that patients suffered more pain and distress after 
removal of the tubes and ovaries only, than when they 
removed the tumour and the uterus down to the level of 
the cervix. With reference to Dr. Smyly’s suggestion, 
the reason he removed the tumour from above was on 
account of the long pedicle attached to it making this 
easy. 

The Section then adjourned. 


LIVERPOOL MEDICAL SOCIETY. 

Meeting held Thursday, April 13th, 1899. 

Dr. Magpie Campbell, President, in the Chair. 

Dr. Frank H. Barendt showed a patient, male, u;t. 13, 
with prurigo erox. The history, general appearance, and 
the distribution of the eruption agreed with Hebra’s 
account of tbe disease in every particular. The 
“ eczematisation ” of the skin due to incessant scratching 
with prurigo efflorescences glimmering through, and in 
the vicinity of this 6econdry eruption, was most 
marked on the shins and forearms. The thighs, 
buttocks, and arms, with the exception of the 
internal aspects displayed red ridges and configured 
area of thickened integument decked with fine 
asbestos-like powder. The “prurigo buboes” were well 
marked in the inguinal and axillary regions, and the 
integument when free from rash, was harsh to the touch. 
The expression of the patient was miserable, ho rarely 
passed a night without scratching, and owing to the 
disease which began in infancy, had been unable to 
attend school or associate with other children. The 
father had recently died of phthisis, and the patient 
constantly suffered from pulmonary trouble. The family 
history shed no light on this incurable affection. Treat¬ 
ment was only palliative, and at present he was using 
B. naphthol (gr. v. benzoated lard 5) ointment, a dusting 
powder of equal parts of talc, starch, and oxide of zinc, 
and olive oil to bo used in the place of soap and water. 

Mr. Rushton Parker showed a man, jet. 48, upon 
whom he had performed pylorectomy on January 16th, 
1899. Stomach troubles had existed five or six years, 
and recently pain after food, and vomiting had reduced 
him to emaciation. No tumour was to be felt, but a 
c’iagnoBis of carcinoma was assumed provisionally. At 
the operation a hard tumour was found in the posterior 
wall near the pylorus. The mucous membrane was 
thickened, but not ulcerated, and although the growth 
was doubtful, and not strongly suggestive of carcinoma, 
excision seemed the only practical way of dealing 
with it, especially as the local circumstances were 
favourable; accessibility, and absence of lymph or glan¬ 
dular infection. The duodenum was attached to 
the stomach by continuous silk stitches, one set for 
the mucous membrane and the other for the peritoneum, 
and the remaining gap in the stomach was closed by 
attaching its sides in the same position. The patient 
made a good recovery, and in a few weeks’ time was able 
to eat ordinary food. The growth showed no evidence 
of carcinoma, but was evidently of syphilitic origin, as 
evinced by small gummata and arteritis and cellular 
i nfil tration. On April 13th he was in good health and 
free from stomach affection, but had not yet returned to 
his heavy work of boiler-making. 

Mr. Rushton Parker also showed a young man, set. 


21, upon whom he had performed pyloroplasty on 
January 23rd, 1899. There had been a history of 
dyspepsia for five years and a condition of dilated 
stomach, but no symptom suggesting gastric ulcer. At 
the operation the pylorus was narrowed to j in. diameter 
outside. This was laid open, and a small circular ulcer 
found just inside the stomach. Pyloroplasty was per¬ 
formed over a Mayo Robson’s decalcified bone bobbin, 
and the diameter of the pylorus increased to li inches 
outside ; he made a simple, uneventful recovery. For 
three weeks the patient was fed on milk as in the treat¬ 
ment of gastric ulcer ; after that he ate fish, and in a 
month or five weeks’ time ordinary meat diet ; and later 
resumed his occupation as carter on a farm. On April 13th 
he was in good health, plump and well, but still a little 
weak, he said, on his legs. 

Dr. Grossman described a method which he has em¬ 
ployed for localising foreign bodies in the eye by means 
of X-rays. In contradistinction to Mr. N. Davidson’s 
stereoscopic method (British Medical Journal, Jan 1st, 
1898), he utilises the movements of the eye for obtaining 
the parallax of the shadow of the foreign body, the 
Crookes’ tube, the patient’s head, and the sensitive plate 
retaining the same position in two successive exposures. 
It may be necessary, under certain circumstances, to 
make two pairs of exposures in order to obtain both the 
vertical and horizontal parallax. The author claims for 
this method that it is simpler than the stereoscopic 
method, and that a path can be chosen for the X-rays 
which offers the least amount of bony opacity. 

Mr. R. W. Murray exhibited a child upon whom he 
had operated for general suppurative peritonitis 
associated with a gangrenous appendix. The patient, a 
boy of nine years, was first seen by Mr. Murray during 
last September. He had been seriously ill for five days 
with abdominal pain, constipation and continuous 
vomiting. The abdomen was much distended, tender, 
and tympanitic. On opening the abdomen the intestines 
were found bathed in pus, and bubbles of gas came 
from the right iliac fossa. The median incision was 
enlarged, the intestines turned out of the abdominal 
cavity, and the appendix, which was seen to be gangre¬ 
nous and perforated, excised. The abdomen was then 
well washed with warm boracic lotion, the distended 
intestines, after being cleansed, were with some difficulty 
returned, and the wound closed, except the lower part, 
where a drain was inserted leading to the stump of the 
appendix. After an anxious convalescence the child 
ultimately made a good recovery. 

Drs. and Messrs. Humphreys, Parker, N. T. Thomas, 
Raw, Barr, Griinbaum, and E. T. Davies took part in the 
discussion. 

Mr. Murray replied. 


(Hermann. 


[from our own correspondent.] 


Berlin, April 28th, 1899. 

Following Dr. Kocher’s paper on epilepsy, at the 
Surgical Congress, was one by von BergmanD, on 
Porencephaly, 

at which the patient was shown, and whicli the speaker 
said bore out Kocher’s theory as to epilepsy. There was 
a cyst formation in the head which often led to epilepsy. 
This was the traumatic form of the disease, but not all 
cases were of that nature. The clinical features of the 
disease were quite typical, there were localised paralyses 
with contractions, and arrest of growth in the paralysed 
extremities in childhood, there were epileptiform 
attacks; the patients were imbecile, or at least their 
intelligence was defective. The case shown was one of 
traumatic porencephaly, from a fracture of the skull 
caused by pressure of the forceps at birth. There was 
a cyst in the skull, but apparently no meningocele. 
During the epileptic attacks, and when the head was 

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460 Thb Medical Pbess. * AUSTRIA. Mat 3, 1899. 


sharply flexed, however, the open space became tense, 
and the skin thrust forward. According to Koning, when 
such defects were covered with bone, a cure was effected. 
This had been attempted after extirpation of the cyst, and 
as the margins of the defect was very thin, like the skull 
bone of a child, a bone flaphad been taken from the tabula 
vitreca and pushed over the defective spot. Thecover- 
ing-in was not successful, however, until after several 
operations, as the space had a length of 14 c.m. and a 
maximum width of 8 c.m. The first operation was at the 
beginning of April, 1898, and the last on July 11th. A 
small part still remained uncovered, the requirements 
of Kocher as regarded “ ventilation ” were therefore 
fulfilled. The epilepsy had ceased. The child (shown) 
displayed shortening of the left upper and lower extremi¬ 
ties, left-sided club foot, and spastic position of the 
fingers. As the cyst communicated with a lateral 
ventricle drainage had been kept up for a long time. 
The anatomical features of this porencephaly were con¬ 
stant. The speaker showed a preparation from a child of 
7 who had died of collapse after operation, but had not 
suffered either from fits or paralysis, though there was a 
very large tumour. When operation was to be under¬ 
taken, he urged that Kocher’s procedure should be 
followed, although it could not be diagnosed with 
certainty whether intracranial pressure was always 
increased or not The most important indication was 
always causal, and the treatment should always be 
carried out before an epileptic condition of the brain had 
become established. 

Gun Shot Injury of the Brain. 

Mr. Arthur Barker, of London, read a case of 
'• Gunshot Wound of the Brain, Removal of the Bullet 
by Trepanation with Recovery,” which was followed by 
Krdnlein, of Zurich, on “ Gunshot Injury of the Brain.” 
The interest of the latter case lay in the destruction that 
had been wrought, the suicide having taken his life with 
a Swiss ordnance rifle of 7'5 c.m. calibre. There were 
gaping wounds in the skull, the bone being much 
shattered, but with the dura still connected, the interior 
of the skull was perfectly empty, but the brain blown 
completely out. This was found almost uninjured, lying 
on the ground about two feet away from the body, 
almost as if it had been taken out by a skilled hand. 
No trace of the passage of a projectile could be found 
in the brain. There was only slight tearing at the 
root of the brain running along the base. The 
cerebellum was torn away from the cerebrum, and 
lay five foot farther away. How had the concentra¬ 
tion taken place? There could be only a hypo¬ 
thesis regarding it, viz., that the blowing out of 
the brain was the result of hydraulic pressure. In 
another case of shooting with the same arm, when the 
shot took effect on the margin of the left upper alveolus, 
the left eye was torn out. The shot had an external 
opening opposite in the upper part of the temple. That 
the shot passed through the brain, therefore, there could 
not be the slightest doubt, but the patient did not lose 
‘consciousness even for a moment, and he was now in a 
condition of undisturbed convalescence. 

Hr. Lauenstein, Hamburg, could confirm Kocher’s 
statements as to the useful effect of removing brain 
pressure in epilepsy. A man, set. 20, had suffered for 
seven or eight years from frequent attacks (latterly 
almost daily) of epilepsy, starting from the left motor 
cortical centre. The patient was then blind, and the lef 


arm paralysed. Operation was performed, but no tumour 
or cyst was found. The dura was now replaced and 
the periosteum lightly laid over it. After the operation 
the fits ceased and also the blindness, and the hemiplegia 
was much improved. The defect, as Kocher had recom¬ 
mended, was not completely covered in with bone, a 
space being left for relief of intracranial pressure. 

Hr. v. Bergmann showed a patient who, in 1895, was 
shot in the right temple. He remained unconscious for 
fourteen days, and then had left-sided paralysis ; two 
months later, epilepsy came on. The bullet could not be 
found on trepanning. In 1897, symptoms of abscess 
came on, and the pus was evacuated. The defect in the 
skull was covered with periosteum ; but two fistula 1 still 
remained. The epilepsy had entirely ceased. The 
bullet lay in the antrum of Highmore, and not in the 
brain. 

Hr. v. Bech, Carlsruhe, reported eight cases of 
traumatic epilepsy, partly treated by himself, and partly 
by Czerny, in the Heidelberg Klinik. Three, in which 
no care was taken to cover the defect with bone, had 
completely recovered. The others were cases that had 
suffered from epilepsy from childhood from osteophytic 
formations within the skull. In these a bony covering 
wa8 attempted So long as this covering remained a 
loose one, the epilepsy remained well, but it returned as 
soon as the covering grew firm. In one case the lateral 
ventricle was drained, and recovery took place. These 
cases were in favour of the correctness of the view taken 
by Kocher. 


Jlustria. 

[from our own correspondent.] 

Vienna. April 29th, 181W. 

Uterus Myomatosus Gravidus. 

Wertheim exhibited a preparation at the “Gesell- 
schaft der Aerzte,” which he had removed from a patient, 
a?t. 32, in her first confinement, by the Ciesarian section. 
The myoma was situated immediately behind the neck 
of the uterus, occluding the channel so completely that 
embryotomy was impossible. The fcetus weighed 
4,(580 grammes or 10 296 lbs., and 56 centimeties or 
22-047 inches in length. On opening the uterus, a pene¬ 
trating odour was intense; the decidua was purulent, 
which excluded, in Wertheim’s opinion, any conservative 
operation, and therefore extirpated the entire organ, 
which was followed with perfect recovery. 

The Kaiser operation, he said, was not uncommon in 
“ uterus myomatosus,” but the. mortality was so high 
that little or no favour had been extended to it, as thirty- 
one deaths out of thirty-eight cases operated on with 
conservative endeavours was not at all encouraging. 

By Porro’8 method the conditions are better, three 
deaths occurring in fifteen. The Kaiser operation with 
total extirpations is by far the most successful. 

Wertheim is convinced that this case would have 
decidedly died of septiccemia, had he attempted con¬ 
servative principles. 

Tuberculosis of the Penis. 

Ehrmann exhibited two men with tuberculous ulcers 
on the external surface of the urinary canal. In Decem¬ 
ber of last year the first case commenced with laryngea] 
tuberculosis in the lower commissuire, which soon healed 
with the application of iodoform vasogen. On the 13th 


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May 3, 1899. 


THE OPERATING THEATRES. 


The Medical Press. 461 


of the present month the patient returned with three 
ulcers immediately in front of the cicatrices of the 
former ulcers. In the secretion of the penal ulcer tuber- 
c lous bacilli were found, but nothing in the urine. The 
bladder and prostate were in a normally healthy con¬ 
dition. 

The second case was one suffering from tuberculous 
thickening of seminal duct, bladder, and prostate. In 
the urine and secretions the tuberculous bacilli were 
found in large numbers. Ehrmann related the history 
of'a third case fwith “ Moulaye ” of the glans penis 
which had healed up, but the examination of the sores, 
urine, prostate, and bladder revealed the tuberculous 
bacilli which led to a diagnosis of the kidneys being the 
primary source of the disease. He thought the infection 
from these sores must be very varied. The primary 
cause in these genital affections could be traced to the 
kidneys and infected as the sputa ; or it might arise in 
the blood and thence be transmitted to every organ of 
the body. It does not require much force of conception 
to perceive that ulcers of the glans penis may be a source 
of general auto-infection. The careful treatment of all 
these sores, in his opinion, should demand constant atten¬ 
tion. He instanced a case where twenty inunctions had 
a very beneficial effect. 

The Progress of Bontgen Photography. 

Kaiser referred to Siemen’s and Halske’s improved 
Hg. interrupter as a great advance in Root gen photo¬ 
graphy, as it removed the sound and the flickering of the 
light. The mode of application was to fill a cylindrical 
with dilute H 2 S0 4 , into which are fastened a plate of 
lead and two of platinum. The current decomposes the 
H 2 SOj, from which gas bubbles are evolved that stick 
to the electrode and immediately produces an inter¬ 
ruption. The bubbles soon disappear and the current 
commences anew. The other improvements were in the 
plates, which are now lighter, cheaper, and more 
sensitive than ever they were. 

He next recounted the various objects that disappeared 
or remained permanent on the photograph. In those of 
the head, the hair quite disappeared, while the bones 
remained quite distinct on the shadow. It was very 
rarely that the ethmoid bone or sulci arteriosi could be 
observed ; on the other hand metallic substances, 
fractures, pus, bony splinters, tumours in the nasal 
passage and maxilla can be noted. Tumours in the brain 
cannot be detected by means of the Rftntgen rays. In the 
neck the spinal canal, pharyngeal cavity, root of tongue, 
trachea, and even the gullet can be defined. In the 
thorax, clavical, scapula, ribs, and head of the humerus 
can be traced. The intercostal spaces can be judged by 
the respiratory movement. The heart can be clearly 
defined by lighting both behind and before when its 
movements can be readily followed, but it is impossible 
to discern any morbid changes like calcification in the 
heart or vessels. The curve of the aorta can only be 
seen in children, hence any changes like aneurysms, Ac. 
can be easily detected. The lungs appear on the photo 
clear, though tuberculous infiltration produces a cloudy 
condition. Gangrene or tunlours are sharply defined . 
exudations of the pleura are easily recognised. In the 
abdomen, duodenum, gall-bladder, stomach, and its 
contents can be observed, but the pancreas cannot be 
seen. 


^he (Operating theatres. 

GUY'S HOSPITAL. 

Operation for Complete Excision of Large 
Volvulus of Sigmoid. —Mr. Arbuthnot Lane operated 
on a case of intestinal obstruction in a middle-aged 
woman who had been admitted under Dr. Frederick 
Taylor. Her abdomen was enormously distended; the 
bulk of the swelling seemed to be due to the presence of a 
large resonant mass in its interior projecting beyond the 
adjacent coils of intestine. The patient gave an indefi¬ 
nite history of attacks of previous obstruction which 
had been both acute and chronic. Mr. Lane made an 
incision along the length of the linea alba through 
which there at once leaped out a hugely distended coil of 
bowel ; this measured 1 yd. in length and 18 ins. circum¬ 
ference ; the wall of the bowel was exceedingly thick, and 
its mesentery opaque and scarred. Further exami¬ 
nation showed that the condition was one of volvulus 
of the sigmoid. He adopted the method of excision 
which he had urged at a meeting of the Clinical Society of 
London on April 26th, 189.'), and resected the whole lump, 
using the largest size of Murphy’s button for the pur¬ 
pose of joining the divided ends, controlling the proximal 
and distinct poitions of the bowel during the process 
by his own clamps which are now used pretty univer¬ 
sally. It was the largest volvulus that Dr. Taylor or Mr. 
Lane had ever seen. Mr. Lane said that it seemed to 
him that this method of excision was the only scientific 
plan, as he had before pointed out at the Clinical 
Society, in the discussion of the paper on “Acute 
Intestinal Obstruction,” by Dr. F. L. Benham and Mr- 
Silcock. It was quite clear, he pointed out, from the 
condition seen in the case he had just operated upon 
that any other recognised form of treatment would 
not have brought about the complete restoration of 
function which he hoped might result in this patient. 
The reasons in favour of excision were, he said: 
(1) that recurrence is impossible. (2) That a loop 
which is often acutely inflamed and extensively 
ulcerated, and the source of immediate danger from per¬ 
foration, gangrene, septic absorption, Ac., is at once 
removed. (3) That no drainage is necessary, and no 
fistulous opening can remain. (4) That it is a procedure 
to which no reasonable objection can be offered. Button 
was passed on 31st day. 

The patient made an uninterrupted recovery. 

Operation for Intestinal Obstruction due to 
Intussusception.— The same surgeon operated on a 
child, six months old, who had been admitted under 
Dr. Fred. Taylor. He opened the abdomen in the 
middle line, and found an intussusception in the iliac 
fossa, which had been diagnosed before the operation 
but whose presence could not be detected on account of 
the considerable distension of the abdomen. The intus¬ 
susception was reduced by traction and firm pressure. 

Mr. Lane pointed out at the operation that the 
free exposure of the whole interior of the abdomen 
by means of a long median incision, in this, as in 
other conditions of intestinal obstruction, facilitates 
enormously the observation of the cause of the obstruc¬ 
tion and its treatment, and reduces to a minimum the 
duration of the operation and the extent of the shock to 
which the patient is exposed. The advantage of a long 
incision he thought was most conspicuous in cases in which 
the seat and cause of the obstruction were in doubt. 

The progress and recovery of the child was mono¬ 
tonously satisfactory. 


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SALUS POPULI SUPREMA LEX.” 


WEDNESDAY, MAY 3, 1899. 


AN ANTI-VIVISECTION GALA. 

At the close of the twentieth century we find our¬ 
selves living in an age of demonstrations, organised 
by every grade of society for the purpose of airing 
every kind of belief. In some instances the motives 
are worthy of a place in the great onward march of 
civilisation, in others they are simply irrational out¬ 
breaks that serve to register the stages of the social 
and scientific progress. Among the latter futilities 
may be reckoned last week's meeting of the 
London Anti-Vivisection Society. As the speakers 
were in many respects representative of the 
particular views to which they owe their com¬ 
munion, it may be well to examine the logical 
value of this official gospel. It may be premised 
that in oil the history of modern societies founded 
for protesting against commonly accepted views 
and practices, none have been more noisy, more 
assertive, more caluminous and less supported 
by facts and reasons than the sect of the anti-vivi- 
sectioni8ts. Like their first cousins, the anti¬ 
vaccinationists, they boldly run counter to the practi- 
caUy united voice of the medical profession. In 
neither case are their peculiar tenets supported by 
men of scientific standing in the medical profession, 
although each has contrived to gain a single adherent 
whose name is known in the medical world. The anti- 
vivisectionists have naturally made the most of their 
capture, and have advertised for weeks past in the 
public journals that an “ eminent surgeon ” would 
address their meeting. The propositions advanced 
by this new pillar of support, a pervert from his 
former views, were briefly that experimentation on 
living animals is crude in conception, unscientific in 
its nature, and incapable of being applied to the 


Mat 3^1899. 

benefit of humanity, and that the inspectors of vivi¬ 
section should be appointed from the legal rather than 
from the medical profession. The first three assertions 
may be taken together. Man is the issue of a stock 
common to the rest of animal life, and has been 
placed by the process of evolution at the head of the 
mammals, at least, that is the view of every modern 
biologist of note with whose writings we are 
acquainted. In a great number of instances, if not 
in the majority, the tissues of the lower animals react 
to injury and disease in a manner analogous to those 
of mankind. The morel right has been assumed by 
the higher species to make use of the lower for food, 
for forced labour, for sport, and for other purposes. 
Can it be seriously maintained that there is less 
justification in testing some pathological problem» 
say, on a guinea-pig, than in killing a heron by 
means of a trained hawk, for purposes of sport* 
nothing more and nothing less, wanton in its con¬ 
ception, brutal in its tendencies, and useless in 
its results. Yet the ancient pastime of hawking is 
undergoing a flourishing revival in our midst at the 
very moment when the anti-vivisectionists are filling 
the air of St. James's Hall with their resounding 
accusations. Let us take an example of modem 
“ vivisection.” using the word in its strictly technical 
sense. It is desired to test the action of a specific 
pathogenic micro-organism, say, that of tuberculosis, 
and for that purpose cultures can be injected, among 
others, into fowls, guinea-pigs, rabbits, cattle, and 
horses. In this way much invaluable information 
has been gained as to the life-history of the tubercle 
bacillus outside the human body, and especially in 
its relation to the communication of the malady from 
the lower animals. It must be borne in mind, more¬ 
over, that the existence of the specific bacillus was 
discovered and proved mainly by experimental 
evidence obtained from “vivisection.” We fail to 
see anything crude or unscientific in this chain of 
investigation, which is exactly reproduced in a 
hundred and one other directions. Even if the 
results upon a particular animal, say, a goat, prove 
negative, they simply set the investigator at work to 
find the reason of that immunity, and in that way the 
brilliant chapter of serum-therapy has been placed 
in the hands of the modem medical man. Such 
results will require more to upset them than loose 
assertions addi-essed to the emotions of a scientifically 
untrained audience. As to appointing the vivisection 
inspectors from the legal profession, we might as well 
entrust the latter with the control of the vaccina¬ 
tion, lunacy, and anatomy acts, and with the 
control of the General Medical Council itself. That 
the “ eminent surgeon ” carried his audience with 
him goes without saying In the absence of com¬ 
plete justification of his now position the greater 
the eminence the more disastrous is likely to 
be the fall. The value of their support, how¬ 
ever, may be gauged from the utterances of the 
worthy Bishop of Nottingham, who although he 
had no “ practical knowledge ” of vivisection was 
nevertheless convinced that it was “ a wicked and an 


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The Medical Press. 463 


May 3, 1899. 

evil thing.” Then the meeting proceeded by easy 
stages to condemn the whole medical profession for 
making experiments upon patients in hospitals. The 
ground upon which that gratuitous assumption rests 
has been thus cut away by the editor of a London news¬ 
paper. “ The fundamental fallacy,” he says, “ on which 
the agitation of the London Anti-Vivisection Society is 
based would appear, soberly, to be this : It conceives 
that vivisection is undertaken in pure wantonnese. 
for the fun of the thing as it were, and that the lust 
of sport grows on the practitioner till he prefers a 
human being to an animal subject.” It is to be re¬ 
gretted that any member of the medical profession 
should appear to sanction by his unprotesting pre* 
sence a view that Mr. Eden Phillpotts has eloquently 
described as “ a deliberate insult hurled at every great 
London hospital, where science and humanity go 
daily hand in hand for the welfare of the race.” 


PREGNANCY AND THE THYROID GLAND. 

During pregnancy, and even to a slight extent 
during menstruation, the thyroid gland undergoes 
more or less pronounced enlargement. This becomes 
noticeable towards the fifth month of gestation, and 
continues until the end of the puerperal period, and 
it is a physiological fact to which, perhaps, sufficient 
attention has not been paid for it may possibly help 
to explain a whole train of nervous symptoms of 
which, so far, no explanation has been attempted. 
The first question that suggests itself is whether the 
enlargement is due to simple hypermmia or whether 
it is a genuine hypertrophy. To determine this 
point. Dr. Lange, of Berlin, administered thyroid 
preparations to several pregnant women under his 
care, with the result that under this treatment the 
gland diminished in size, the engorgement reappear¬ 
ing as soon as the treatment was suspended. He 
infers from this fact that the enlargement 
is really of the nature of hyperplasia, such 
hypertrophy being a strictly physiological pro¬ 
cess. The only possible explanation of this 
phenomenon is that there exists in the blood of preg¬ 
nant women a substance, or substances, peculiar to 
this state, which is or are capable of acting directly 
upon the thyroid gland. It must, however, be borne in 
mind that all pregnant women do not display this 
tendency to enlargement of the thyroid. Thus, of 133 
women observed during the last three months of 
pregnancy, 25 did not exhibit any tendency to glan. 
dular enlargement, but of these 25 no less than 18 
were suffering from the albuminuria of pregnancy. 
As, on the other hand, women suffering from chronic 
nephritis exhibit this gestation goitre in the usual 
way, Dr. Lange concludes that the thyroid hyper¬ 
trophy is more likely to be absent in women who 
fall victims to one or other of the renal affections 
associated with the pregnant state. It is obvious 
that the non-existence of “ gestation goitre ” cannot 
be due merely to the existence of the albuminuria of 
pregnancy, seeing that the latter makes its appear¬ 
ance, as a rule, much later than the hypertrophy of 
the gland, and, moreover, it has been shown that i 


Bright’s disease by no means interferes with the 
development of this ephemeral variety of goitre. 
Comparative experiments on pregnant cats seem to 
show that pregnant animals require a larger volume 
of thyroid gland for the maintenance of health than 
non-pregnant animals, and when more than four- 
fifths of the gland are removed the animal develops 
tetany, which subsides under the administration of 
thyroid extract. Moreover, in a cat possessed of 
sufficient thyroid gland to maintain health under 
ordinary circumstances, the supervention of preg¬ 
nancy is soon followed by symptoms of more or less 
pronounced renal disease. Clinical experience, as far 
as it goes, seems to confirm these experimental data, 
for Dr. Lange has had under observation two women 
who, during their first pregnancies, had albuminuria 
and no goitre, whereas in subsequent pregnancies 
they presented this hypertrophy of the thyroid 
gland and no albuminuria. These facts would seem 
to warrant the inference that there is a close relation¬ 
ship between the activity of the thyroid gland and 
that of the kidneys, and it is conceivable that another 
field of usefulness may be opened out for this protean 
medication, not only in obstetrics, but also in gynae¬ 
cology, for it is-quite possible, though no clinical 
demonstration thereof is as yet available, that some 
forms of dysmenorrhcea may be dependent upon defi¬ 
cient activity of the thyroid gland, the importance of 
which in the animal economy has so recently been 
demonstrated. 


THE NEW METHOD OF TREATING 
TETANUS. 

The successful case at the West London Hospital 
of the treatment of tetanus by intra-cerebral injec¬ 
tions of antitoxin, recorded under “ The Operating 
Theatres ” last week, is, we believe, only the second 
instance published in this country in which the new 
method has been tried. Of course it is impossible 
to claim for this method that it has solved the diffi¬ 
culty under which, so far, surgeons have laboured in 
their treatment of tetanus; nevertheless, it is 
impossible to dispute that it appears to be 
founded upon a substantial, scientific basis, and 
that its trial, up to the present at least, while not 
being uniformly successful, still gives promise of 
affording more satisfactory results in the future. We 
may here recall that Roux and Borrel, from experi¬ 
ments earned out at the Pasteur Institute in Paris, 
determined that the toxin of tetanus becomes stored 
up in the nerve-cells, while the antitoxin injected 
into the blood in the treatment of the disease 
does not reach the cells in which the poison 
is contained. The authors assumed, therefore, that 
this was the explanation of the frequent failure 
of the intravenous and subcutaneous injections of 
antitoxin which had hitherto taken place. Hence 
the idea occurred to them of bringing the poison¬ 
laden nerve-cells into direct contact with the anti¬ 
toxin by means of intra-cerebral injections. For 
proof of this assumption their experiments showed 
i that of forty-five tetanised guinea-pigs treated by 


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The Medical Press. 


464 May 3, 1S99. 

these injections, no fewer than thirty-five recovered, 
while of seventeen others treated by simple sub¬ 
cutaneous injections only two survived, and of seventeen 
not treated in any way, a fatal result ensued in 
every instance. The principle, however, of the treat¬ 
ment does not exclude the continuous use of the 
subcutaneous injections; indeed, it i6 deemed to be 
highly essential that these should not be in any way 
interrupted, the idea being that the circulation of the 
fresh supplies of antitoxin in the blood will neu¬ 
tralise the poison which is secreted at the seat of 
injury before the opportunity is afforded it of reach¬ 
ing the nerve-cells. A detail of some importance, also, 
seems to be to excise the tissues in the neighbourhood 
of the wound from which the tetanic infection has 
taken place. The soundness of this practice cannot 
be disputed. As long as the infected tissues are 
allowed to remain, so long, it is reasonable to assume, 
will fresh secretions of the toxin continue to gain 
entrance to the blood. Those who are interested in 
this subject will find a resume of the recorded cases, 
up-to-date, published in the April number of the 
Annals of Surgery. So far as they go, the cases 
clearly point to the value of the new treatment, but 
time only can show, with increased experience of 
its practice, whether intra-cerebral injections of 
tetanus antitoxin will solve the problem of the treat¬ 
ment of this fatal and terrible disease. 


4lotC0 on Current ‘Copies. 


Dockrell v. Dougall. 

We regret to learn that the plaintiff in this im¬ 
portant legal case has failed on appeal. Our readers 
will remember that the action was originally brought 
by Dr. Morgan Dockrell for an injunction to pro¬ 
hibit one Dougall, the manufacturer of a certain 
nostrum, from using his (the plaintiff's) name in his 
advertisements. The jury, a common jury, from 
several points of view, held that the statements con¬ 
tained in the advertisement complained of were not 
libellous, and so the action failed. The Judges of 
Appeal held that as the finding of the jury was final 
in respect of the alleged libel, the verdict could not 
be disturbed, but Lord Justice Vaughan Williams 
took advantage of the occasion to observe that the 
verdict must not be held to mean that the 
advertiser of a quack medicine had a right to 
use the name of an eminent (or any other ?) 
physician without his authority. Such a course, 
his lordship added, would constitute an actionable 
wrong which a British jury would unquestionably 
regard as justifying exemplary damages. The cir¬ 
cumstances in this particular case which, in all 
probability, led the jury to their conclusion, were 
peculiar, in that the plaintiff admitted having 
prescribed and taken the nostrum of which apparently 
he approved, though he had given no authority for 
his name to be used in connection therewith. The 
moral is that medical men may look to the law to 
protect them against the unauthorised and damaging 


use of their names, on condition that they are careful 
to keep altogether aloof and avoid affording any 
colourable pretext for the act. Dr. DockrelTs dis¬ 
comfiture ought to prove a useful object lesson to the 
profession generally, and now that he has effectually 
cleared himself of any suspicion of connivance with 
or approval of the defendant nostrum-vendor, he 
himself will concede that it is imprudent to have any 
sort of dealings with unscrupulous persons of that 
ilk. “ The front door, and the sooner the better ! ” 


Public Analysts and Somerset House. 

We venture to submit that it is high time that 
some definite understanding should be arrived at 
between the Society of Public Analysts and the 
analytical authorities at Somei*set House by which 
the constantly recurring wrangles in the courts of 
law between them respecting the standard of purity 
of disputed articles may be avoided. It is nothing 
less than a scandal that two or three public analysts 
should appear in the witness-box to swear to the 
accuracy of a certain analysis, and that, when samples 
of the impugned article are sent forward to the 
Government tribunal, the analysts swear something 
like the opposite. This regrettable difference of 
opinion is all the worse when the defendant’s counsel 
states in court, as was recently done, that the sample 
must be sent to Somerset House because there is a 
ring among the public analysts to prevent 
any of them from differing from the find¬ 
ing of another. Now we do not believe a word 
of that statement, and we know that the contest 
of analytic opinion is only apparent, it being con¬ 
sidered by Somerset House, as in the case to which 
we now refer, that the obvious deficiency of the 
sample which the Public Analyst regarded as indis¬ 
putably the result of sophistication, might possibly 
have arisen from negligent washing, without any 
fraudulent intent. It is our suggestion that, as the 
Somerset House people have always inclined towards 
the accused, and the analysts have, perhaps, been 
disposed to be over-strict in their standards of 
purity, it would be much better for the latter to try 
to raise the Somerset House standard by conference 
and persuasion, and, failing that, to sacrifice a little 
of their scientific virtue by accepting the official 
standard. Certainly, as the result of many trials of 
strength between the rival opinions, the public is 
rapidly coming to the conclusion that analysts’ 
judgment is as little to be depended on as doctors’ 
verdicts. 

Medical Biographies. 

It is always interesting to know how the world 
wagged in medical circles in times past, but our 
knowledge of medical celebrities of bygone centuries 
is mostly of a fragmentary nature, gathered from 
many sources, and laboriously patched together. 
Thanks to the researches of a few labourers in this 
vineyard, we are enabled to follow up the career of 
the medical worthies of the last hundred years or so, 
but though it is given to no man to forecast the 
verdict of posterity in request of claims to this sort 


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NOTES ON CURRENT TOPICS. 


The Medical Press. 465 


of ephemeral immortality, there is no reason why 
measures should not be taken to hand down duly 
authenticated memoirs of celebrities of more recent 
date. We hear with pleasure that Mr. J. Y. 
W. MacAlister, the librarian of the Royal 
Medical and Chirurgical Society, is engaged upon 
a collective biography of the principal medical 
men of the nineteenth century. The biographer 
may not have much that is new to say with respect 
to those belonging to the first half of the present 
century, but Mr. MacAlister’s almost unique 
acquaintance with eminent members of the profes¬ 
sion of this end of the century promises to make the 
work one of exceptional interest. The dismal practice 
which prevails at certain societies of reading obituary 
notices of deceased fellows at stated intervals provides 
an unlimited supply of ready-made notices, not un- 
frequently rather bluntly put, which will facilitate 
the task of compilation. On the whole we would 
advise the author to act on Butler’s wise maxim to 
“ call no man happy not until he's dead,” leaving it to 
his sorrowing relatives or, failing them, to his execu¬ 
tors, to subscribe to the work when it appears. 


The Dalrymple Home for Inebriates. 

The last annual report of the Dalrymple Home for 
Inebriates at Rickmansworth is a most encouraging 
one in many ways. In the first place during the 
past year the number of patients who presented 
themselves for treatment established a record, and 
the financial position of the home was corres¬ 
pondingly good. The committee of the institution 
also express their satisfaction with the Inebriates Act 
of 1898, a point which it is of interest to emphasise, 
inasmuch as the favourable testimony of such experts 
in the treatment of inebriety must be regarded as a 
substantial proof that the Act in question was well 
conceived and has met a decided want. The new 
Act. as the committee assert, strikes the first blow 
at personal liberty when abused by drink, and so far 
is limited to those who, by their conduct as criminals 
or the subjects of petty offences, are the greatest 
nuisance to society. Hence it does not go far 
enough, since it has little application to those who 
keep themselves out of the clutches of the criminal 
law. The committee, however, trust, when suffi¬ 
cienttime has elapsed to satisfy the State as to the 
value of this extended legislation, that a further step 
will be taken so as to include, with proper safeguards, 
compulsory clauses applicable to the many thousands 
of cases which are not at present touched by the pro¬ 
visions of existing legislation. The report alludes to 
the deep loss which the Home has sustained by the 
retirement of Dr. Norman Kerr, who, from continued 
ill-health, has been compelled to sever his active 
connection with the Institution and its work. The 
resignation, also, of Dr. Branthwaitlie, who for the 
past fifteen years has filled the post of resident 
medical superintendent, is announced. Dr. Branth- 
waite lias been appointed an Inspector at the Home 
Office under the Inebriates Act. 


A Sanitary Tangle. 

A curious case, involving a judgment of an 
extraordinary nature, was settled last week in a 
London Police Court. The proprietors of the Carl¬ 
ton Hotel, a magnificent structure just erected in the 
West End at a cost of £500,000, were summoned 
for having no less than nine soil-pipes inside the 
building, instead of outside, as directed by the 
London County Council bye-law. For the defence it 
was urged that to alter the drains would mean to 
pull the building half down. The magistrate there¬ 
upon adopted what we believe to be the unparalleled 
course of imposing a fine of £2 and ten guineas costa. 
It follows that the drains are to be allowed hence¬ 
forth to remain in their present position, that is to 
say, one that iB clearly condemned by the Council 
bye-law. If there be one place in the whole world 
where advanced sanitary law should be maintained 
it is in a large hotel. Yet they are, as a 
matter of fact, often built and maintained in defiance 
of the most ordinary rules of modern hygiene. What 
about the architect who is responsible for the plans of 
the hotel ? Was he ignorant of the London County 
Council rules, or did he imagine that there would be 
no proper official inspection, or that at the worst any 
little difficulty would be got over by a complacent 
magistrate and a pliant vestry, and the payment of a 
paltry fine ? Are we to understand that for the sum of 
ten guineas the proprietors of the Carlton Hotel are to 
be empowered to expose whole generations of visitors 
to the risks arising from inside soil-pipes ? Surety, 
the magistrate's law must be wrong, and the County 
Council will not allow a salutary bye-law to be over¬ 
ridden in this fashion. Unless we mistake the 
character of the Council, further legal proceedings 
will be heard of in this matter, which has a distinct 
importance as a leading^case. 

Medical Men and Undertakers. 

The subject of the alleged commissions paid by 
undertakers to medical men for introducing custom is 
still attracting attention in the public Press, and in 
some journals has led to some correspondence. 
In the Birmingham Mail last week, for example, 
a writer signing himself “ Lex,” stated that 
in the course of winding up an estate in 
which he was interested, the executors exhausted 
most of their testator’s ready cash in paying 
death dues, so the creditors were asked to let their 
claims stand over for a few months. With the ex¬ 
ception of the undertakers all assented ; he declined 
on the plea that he had already paid the medical 
man 10 per cent, on the amount of his bill which 
came to £80, for introducing the business. Perhaps 
before inditing this epistle it would have been more 
just if the correspondent had made some inquiries 
into the case, in order to ascertain whether the state¬ 
ments made by the undertaker were true. In any 
case, however, we trust that “ Lex ” will not refuse to 
give the names of the medical man and the trades¬ 
man to whom he refers when applied to by those who 
are inquiring into the authenticity of these alleged 
commissions. However, as an example of the other 


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466 The Medical Pbkss. 


NOTES ON CURRENT TOPICS. 


May 3. 1899. 


side of the argument, a firm of undertakers wrote to 
the same newspaper last week, stating that they had 
been funeral directors for twenty-five years, during 
which period they had never once given a fee or com¬ 
mission to a medical man for introducing business. 
Owing to the publicity which this matter has received, 
it cannot be allowed to rest where it is, and in order 
to assist the inquiry all undertakers who have paid 
such commissions should not hesitate to come forward 
and say so, producing their evidence. 

Foreign Bodies in the Vermiform 
Appendix. 

Since the appendix has been treated surgically 
for its inflammatory disorders it has been found to 
contain a varied assortment of foreign bodies, 
together with fecal concretions. In a paper in a 
recent number of the Johns Hopkins Hospital 
Bulletin, Mitchell discusses this subject from a 
statistical standpoint, and refers to 1,400 cases of 
appendicitis from various sources in the last ten 
years. In about seven per cent, of these cases true 
foreign bodies were found, while in 700 of the patients 
in the notes of whom a definite statement was made 
as to the nature of the foreign body, there were 45 per 
cent, of faecal concretions. Among the assortment of 
foreign bodies which were brought to light mention is 
made of 6hot, pins, worms, gallstones, a tooth, and a 
piece of bone ; also grape seeds and an oat husk, a date 
seed, five apple pips, and a bullet Pins seem to have 
quite a predilection for the appendix. The author 
mentions thirty-five cases, of which he was able to 
obtain the record in which a pin was found in the 
appendix at the operation or the post-mortem 
examination, together with two instances in which a 
pin had perforated the caecum. Contrary to what 
might be anticipated these cages occur more frequently 
in males than females, being chiefly in children 
under ten years of age. In only a single instance of 
the recorded cases was any information obtainable 
of the means by which the pin gained entrance to 
the body. Another interesting feature in connection 
with the cases was the comparative frequency with 
which they were associated with abscess of the liver. 
In eight out of the thirty-five cases this lesion was 
present. In summing up the result of his inquiries 
the author states that foreign bodies play a much 
smaller role than was thought to be the case formerly 
in the causation of appendicitis, while the most 
frequently exciting cause is fecal concretion. Again, 
there was evidence to show that the appendix acted like 
a trap for pointed bodies or small heavy objects such 
as shot or bullets. Furthermore, the popular notion 
that foreign bodies of light weight, as for example, 
grape seeds and cherry stones, were a frequent cause 
of appendicitis was, as a matter of fact, erroneous, 
inasmuch as their presence in the appendix was 
exceptional. The author, therefore, believes that the 1 
pin is the commonest, and at the same time the most 
dangerous of all foreign bodies. Of the thirty-five 
cases in which a pin was found in the appendix, the 
notes of which are given in the paper, nine are I 
attributed to an English source. 


Stamp-lickers’ Tongue. 

Of a truth, the ways of disease are manifold, and 
it may well be said that the study of them furnishes 
to mankind one of the most ravelled as well as the 
most fascinating and comprehensive of all intellec¬ 
tual pursuits. What layman, for instance, would 
suspect that the unassuming postage stamp could 
become an active vehicle for the spread of 
deadly ailments ? Yet so it is, and the name 
of “ stamp-lickers* tongue ” has recently been 
brought to our notice by two distinguished medical 
men whose names are household words not only in 
the profession but also throughout the whole 
civilised world. It is known to the few that the 
common postage stamp owes its adhesiveness 
to the serum of the horse. It follows that the 
film drawn from such a source may, or even must, 
at times be charged with microbes of a more or less 
hurtful nature. Nor could a more direct means of 
introducing such undesirable visitors into the human 
body be conceived than that involved in the extremely 
unsesthetic operation of drawing the tongue 
across the back of a postage stamp. If a man licked 
a large number of stamps daily over a sufficiently 
long period of time the chances are he would set up 
cancer of that much-abused member. As it is, 
many mysterious invasions of the mucous mem¬ 
brane of the mouth may not unreasonably be 
ascribed to the far too familiar habit noted by our 
medical friends. By the way, would not “ stamp- 
lickers’ mouth ” be a better title ? The danger has 
long ago been recognised by the postal authorities of 
this country, who have placed dampers on the 
counters of the Post Office, and some years ago an 
ingenious little apparatus, invented by a lady, was 
much in vogue. Although not an ideal alternative, 
we would advise readers who have no choice to use 
a moistened finger in their future postal operations. 

An Epidemic of Small-Pox. 

The first epidemic of small-pox, after the passing 
of the Act last year, has begun, and Hull is the 
centre of its outbreak. The disease first appeared in 
the east part of the town, and has now spread to the 
west and north-east portions thereof. Of course, 
everything is being done by the sanitary authorities 
to isolate the patients and stem the dissemination of 
the disease, but naturally much anxiety is felt among 
those responsible for the health of the town as to the 
position of affairs. On the other hand, it is satisfac¬ 
tory to report that the vaccination officers in some dis¬ 
tricts of the town are able to announce a large increase 
of cases of vaccination in their districts. One officer 
affirms that since the Act of last year came into force, 
and the time limit had expired, he had only had about 
ten cases of conscientious objection. The working 
classes in his experience did not object to vaccina¬ 
tion, whereas the applications to the magistrates 
were principally from the middle classes. After all, 
with the glycerinated calf lymph now provided by 
the State, we cannot see that the anti-vaccinationistB 
have a single plea left for urging their stupid fad. 
Mr. Chaplain says that the public have accepted the 


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NOTES ON CURRENT TOPICS. 


The Medical Press. 467 


new lymph as the solution to the problem, and that 
the new Act is exceeding all anticipations as a vacci¬ 
nation measure. We can only trust that what Mr. 
Chaplin says is true. - 

Alcoholism and Phthisis. 

Of all the causes of chronic malnutrition which 
predispose to phthisis in adult life the abuse of 
alcohol is probably one of the most potent. The 
victims of the habit usually come under medical 
observation for dyspepsia associated with loss of 
appetite and more or less profound disturbance of 
the mechanism of nutrition. In the long run all the 
tissues of the body participate in the process of 
denutrition and their vitality is progressively im¬ 
paired until they, or some of them, fall an easy prey 
to any form of infection which chance may throw in 
their way. Dr. Jacquet, in a paper recently read 
before the Paris Hospitals’ Society on the relationship 
of alcoholism with phthisis, mentions that the 
history, in sixteen out of seventeen cases of phthisis in 
his wards, pointed to confirmed abuse of alcohol for 
yeara before the first symptoms of the pulmonary disease 
had made their appearance. He remarked, moreover 
that in alcoholic patients the second or disintegrating 
stage of the disease runs a very rapid course in spite 
of the fibroid tendency which is generally held to 
characterise the physiological effects of chronic 
alcoholism. It is more than probable that in many 
instances alcohol only intensifies an already existing 
predisposition, but this does not alter the fact that 
alcohol per se, especially when taken on an empty 
stomach or in the form of absinthe, is a potent factor 
in creating a tendency to tuberculous infection. 

CafFein and Its Dangers. 

The employment of caffein in cardiac and renal 
disease has become very general during the last few 
years, but it is well to bear in mind that though 
capable of rendering great service under certain 
circumstances, it is a drug that requires to be 
administered with caution. Several well authenticated 
cases have been recorded in which the administration 
of caffein has determined sudden death even in the 
absence of any obvious organic lesion. In three 
cases recently published by Professor Zenetz, of 
Yarsovia, the heart was found post-mortem so 
firmly contracted that it could with difficulty 
be sliced. In patients suffering from cardio¬ 
renal disease, the administration of from three 
to five grains of citrate of caffein twice or 
thrice daily, though it brought about increased 
diuresis and improved the action of the heart, ulti¬ 
mately caused a distinct change for the worse in the 
general condition, manifested by oppression, dyspncea 
and nocturnal excitement, the area of dulness of the 
heart at the same time undergoing very perceptible 
diminution. It was noted that traces of caffein 
could be found in the urine for a period of from ten 
to fifteen days after ceasing its administration. This 
shows that caffein is eliminated but slowly by the 
kidneys, and the dangerous effects to which we have 
called attention are probably due to its accumulation 
within the organism. 


The Saturday Hospital Fund. 

The Committee of the London Hospital Saturday 
Fund has issued its twenty-fifth annual report. Itsfinan- 
cial position is satisfactory, and the receipts advanced 
steadily from £4,141 in 1874, to £20,113 in 1898. The 
falling-off in the last mentioned year when compared 
with 1897 is explained by the radical and most 
desirable change that has been effected in the organ¬ 
ising methods by doing away with the street collec¬ 
tions. Notwithstanding the loss that ensued, the 
Fund may be congratulated upon the fact that the 
total amount available for grants was diminished only 
by the comparatively trifling sum of £600. In many 
ways we regard this Saturday Fund as one of the 
soundest charitable institutions in Great Britain. At 
the same time we have always felt it our duty to protest 
against some of the proceedings of the management. 
We note, for instance, in the list of institutions con¬ 
nected with the Fund, the name of a Convalescent 
Home that for years past has laboured, and is still 
labouring, under grave public charges of mismanage¬ 
ment. We also note the official connection of the 
Fund with the Metropolitan Provident Medical 
Association, a connection that always seemed to us 
to give an undue preference, to say nothing of 
money payments, to a selected number of medical 
men. The great loss of the year has been the resig¬ 
nation of Mr. R. B. D. Acland, who for nine years 
has steered a difficult course with tact and ability 
whom it will indeed be difficult to replace. It is to be 
hoped and believed, however, that the bark has 
been brought for a time into smoother water, 
notwithstanding the shoals and rocks of hospital 
reform that still lie ahead. 

The Secret Commissions Bill. 

Lord Russell of Killowen introduced his Anti¬ 
corruption Bill on the 20tli ult. into the House of 
Ljrds, and garnished his statement with a reasser¬ 
tion of the fact that the medical profession are in the 
habit of receiving secret commissions from chemists, 
opticians, and even undertakers. Speaking for the 
medical profession, we desire every success for any 
Bill which will make impossible such disreputable 
proceeding on the part of medical practitioners, but 
we protest against the Lord Chief Justice or the 
London Chamber of Commerce, or anyone else making 
a charge which they, so far, have not made any 
attempt to prove, and, we believe, cannot prove. We 
absolutely deny that the acceptance of secret com¬ 
missions from chemists or opticians exists among 
even a material fraction of the members of the pro¬ 
fession, though, of course, we assume that a few of 
the helots resort to the practice just as they descend 
to any other disreputable proceeding. We should 
like to see Lord Russell’s Bill submitted to a Select 
Committee, when the two chemists and one optician, 
upon whose hearsay testimony the charge is made, 
could be put at the witness table and thoroughly 
examined. 

[Our Edinburgh correspondent refers to this 
subject in another column, as it is supposed to affect 
Scotland.] 


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NOTES ON CURRENT TOPICS. 


Mat ?, 1899. 


An Old English Work. 

A remarkable Old English MS. on Medicine 
was sold at Messrs. Sotheby’s last week. It was the 
work of Guy de Chauliac, a great medical authority 
in the Middle Ages, who helped to fight the plague. 
Some of this physician’s prescriptions are still in 
existence. The book, which is clearly written in black 
letter, is entitled in thequaint style of the period: “ Here 
begiiney ye Inventorie or ye Collectoriie in Cirgurgicale 
part of Medicene, compiled and complete i ye zere of 
Oure Lord 1363 by Guy done I Gy de Caulviaco, Cyru- 
gien, Maistr in Medicene, doctor of Phisic, in ye ful 
clere studie of Montis Pessulani, Montpelers wt. som 
addicons of oth. doctourez necessary to ye foresaid 
Arte or Crafte.” The MS. has fourteen fine orna¬ 
mental painted and illuminated initials, with floreate 
marginal decorations and drawings of surgical 
instruments. The surgical works of Guy de Chauliac 
written in 1363 were first printed in French in 1478- 
in Latin (with other medical writers) in 1498, after¬ 
wards appearing in Italian and Spanish, but no 
English translation has apparently ever been 
printed. This important MS. was once submitted to 
the late Sir Andrew Clark, who was of opinion that 
its reproduction would be of great value to the 
medical profession. 

The Disposal of the Dead. 

The problem of how to find space for the disposal 
of the dead in the metropolitan area is one which in 
a few years more will have reached an acute stage- 
Cemeteries are not unlimited, expansible areas- 
and the limit of their expansion in London 
seems to have been reached. No further ground, 
then, being available for the burial, within the 
district, of London’s dead, it is obvious that 
the problem will have to be solved by finding burial 
accommodation elsewhere. One difficulty, however 
which will be ever present in this regard will be that 
of sentiment. Londoners will be likely to rebel 
against being called upon to take their dead kith and 
kin to be buried in districts far removed from their 
everyday surroundings, and whither pilgrimages 
would be costly and demand a large expenditure of 
time. But in the interests of the public health, 
sentiment notwithstanding, London’s burial places 
should be far away from the living, if in after years 
the salubrity of the metropolis is to be maintained. 


A Municipal Doctor for Dublin. 

The Daily Independent says that it has been de¬ 
cided that the Corporation shall appoint a Municipal 
Doctor. It speculates as to the duties which the 
official will have to discharge, and protests against a 
job to be perpetrated for the benefit of some unknown 
individual. We confess to having no information on 
the subject, but we entirely sympathise with such 
protest. 

Lunatic Asylum Discipline. 

The difficulty which medical superintendents of 
asylums suffer in their effoits to protect the patients 


from outrage and to maintain discipline among the- 
staff is illustrated by a recent prosecution in Cork of 
a warder for kicking a lunatic. In most of these 
cases there is cross-swearing, with the usual allow¬ 
ance for perjury, but, in this instance, the attendant 
was caught by the Assistant Resident not only kicking 
the patient on the floor, but kicking him in the 
presence of a crowd of inmates. The only defenoe 
was that the lunatic, who was epileptic, kicked out 
and hurt the attendant, but we might ask of what 
use is an attendant if he cannot stand the violence 
a patient without knocking him down and kicking 
him. The useful lesson to be derived from the pro¬ 
ceedings is in the fact that, after the ruffian had been 
caught in the very act, the sapient magistrates con¬ 
sidered half-a-sovereign a sufficient penalty for his 
offence. 


The London Medical Graduates' College and 
Polyclinic. 

The prospectus of the new Polyclinic College in 
London has just been issued, containing a full 
list of the post-graduate educational course for the 
first session which commenced on the 1st instant. 
The list comprises practical classes, lectures, and 
laboratory and clinical classes, and each course will 
extend over six weeks. In addition, during the 
current month, clinical consultations will be held at 
the Polyclinic on three afternoons in each week. The 
“ bill of fare,” so far, is certainly an attractive one, 
catering, as it does, for all the possible requirements 
of the post-graduate student. It may be said, there¬ 
fore, that the Polyclinic starts its career auspiciously, 
and should have a successful future. 

Nurse Training for Irish Workhouses. 

Mr. Edward Thompson, surgeon to the Tyrone 
County Infirmary, has been making a good deal of 
newspaper noise because the Local Government 
Board declines to recognise the training of nurses in 
county infirmaries as sufficient for the Poor-law ser¬ 
vice. We quite admit that there may be infirmaries 
which are able to give their nurses a good and suffi¬ 
cient training, but we know that these are the excep¬ 
tion, and we can understand that the Local Govern¬ 
ment Board can scarcely be asked to make a selection 
among these institutions. Wherefore there seems 
to l^e no course open to them but to adhere to the 
recognition of fully equipped clinical hospitals only. 


‘‘Dr. Bland,” Limited. 

The question of the right of a syndicate of un¬ 
qualified persons to carry on a joint stock doctoring 
speculation is receiving immediate illustration in 
Dublin. A company has been formed, of which the 
first subscribers are five pharmaceutical chemists, a 
clerk, and a gentleman named Whelan, who is 
described as a physician and surgeon. It proposes 
to “carry on the professions or businesses of medical 
doctora, physicians, apothecaries, pharmaceutical 


Digitized by v^.ooQle 




Mat 3, 1899. 


SCOTLAND. 


Th* Medical Press. 469 


chemists, dentists, midwives, and druggists.” The 
programme is sufficiently comprehensive and, if the 
formation of the company be proceeded with, the 
legality of its proceedings will need to be carefully 
watched. 

A man named Walter Fisher, of Sprowston, near 
Norwich, was sent to prison last week for six 
weeks, for having on March 28th last, deposited for 
sale at Smithfield Market, four quarters of beef 
which were diseased and unfit for human food. 

The following appeared in the Times of April 28th : 
—“ The results attained by the experiments with 
inoculation against enteric fever in India have been 
so satisfactory that there is every hope that the 
scourge, if not eliminated, will be so brought under 
c ontrol that the mortality caused by it in our Army 
abroad will be reduced to a minimum 

The Royal College of Physicians of London has 
been presented by the executors of the late Dr. Hare 
with a gold angel piece of the time of Charles II, 
given to persons “ touched ” by the King for the 
King’s evil. 

A cheque for £1,000, as a donation to the Princ e 
of Wales’s Hospital Fund, has been received from 
Mr. J. B. Robinson. This is the second contribution 
of one thousand pounds received last week. 

PERSONAL. | 


The services of the English nurses in the Greek hospi¬ 
tals during the Turko-Greek war have been recognised by 
the Queen of the Hellenes by the grant to them of a 
medal and special diploma. 

Sir William Turner, President of the General 
Medical Council, received the degree of Doctor of 
Science (honoris causa) at the University of Cambridge 


role of the mosquito in the dissemination of malaria, 
arrived in London a few days since to take up his 
appointment as lecturer at the School for Tropical 
Diseases at Liverpool. 

We are pleased to learn that the health of Professor 
A. M. Buchanan has so much improved that he hopes to 
resume his teaching in the anatomical classes at Ander¬ 
son’s College, Glasgow, during the winter session. In the 
interim the lectures will be carried on by Dr. Howat, 
who has so successfully conducted the classes during Dr. 
Buchanan’s prolonged illness. 

Mr. Edmund Owen, Past Master of Sancta Maria 
Lodge, and Mr. W. J. Walsham, Past Master of Rahere 
Lodge, were among those especially chosen by the Most 
Worshipful Grand Master, H.R.H. the Prince of Wales, 
to mark the twenty-fifth consecutive year of his office, 
the dignity of Past Grand Deacon having been conferred 
upon them. 

The Right Hon. Joseph Chamberlain, Secretary of State 
for the Colonies, will preside at the inauguration dinner 
of the London School of Tropical Medicine, on Friday 
the 10th inst., when a large and distinguished company 
is expected. The names of the dinner committee and 
other particulars will be found on reference to our adver¬ 
tising columns. 

We are glad to chronicle an act of gratitude on the 
part of a patient to his medical attendant. Mr. Thos. A- 
Matthieson, of Glasgow, whose will was proved last week, 
has bequeathed £500 to Dr. Samson Gemmell “ for his 
kind attention during his professional attendance.” He 
also left £500 to Anderson's College to assist the income 
of the Professor of Anatomy, and £250 each to the 
Glasgow Royal and Western Infirmaries. 


♦Scotlanb. 

[from our own correspondent.] 


on the 27th ult. 


Her Majesty the Queen has presented Dr. Allen 
Sturge, of Nice, with a silver inkstand and writing 
materials in recognition of services rendered during her 
sojourn in the Riviera. 

Dr. Dolan (Halifax) and Dr. Barr (Liverpool) have 
been appointed by the British Medical Association dele¬ 
gates to the Annual Congress of the Royal Institute of 
Public Health. 

The Laboratories Committee of the Conjoint Board 
for England has appointed Dr. Thomas Grigor Brodie 
(lecturer on physiology at St. Thomas’s Hospital) to fill 
the vacancy of director of the laboratories of the two 
colleges, void by the resignation of Dr. Sims Woodhead. 

H.R.H. the Prince of Walks has appointed Sir 
Hermann Weber, Dr. Hillier, Mr. Malcolm Morris, and 
Mr. Rube as the representatives from this country of the 
National Association for the Prevention of Consumption 
and other forms of tuberculosis at the forthcoming 
Berlin Congress. 

Major Ronald Ross, I.M.S., whose name is well- 
known in Connection with his researches bearing on the 


Secret Commissions. —Although the hands of the 
medical profession are probably somewhat cleaner in 
this respect than those of some of their neighbours, it is 
to be feared that dubious relations do sometimes exist 
between doctors and chemists. During the past week 
letters—anonymous, it is true—have appeared in the 
Scotsman newspaper, and there seems no reason to dis¬ 
pute their general accuracy. The writers, dispensing 
chemists, all tell the same tale. A “young” doctor (is 
it always the junior who wanders from virtue’s ways ?) 
calls, and proposes to the chemist that the latter is to 
dispense and to retain all the prescriptions of the 
former; that an account is to be kept of these, with the 
charges (which are to be in excess of the ordinary ones) ; 
and that the doctor is to get 30 to 40 per cent, of the 
profits of the “ deal.” From the doctor’s point of view 
this may be all very well; but the reflection that occurs 
to one is that the chemist must be very confiding who 
supposes that even the whole custom of a doctor just 
starting in practice will prove a lucrative investment. 
Of course there are all grades of this sort of thing. One 
hears, on the one hand, of the chemist from whom it is 
difficult to get a regular account of your indebtedness; 
on the other, of the doctor who never clreams of taking any 
notice of his drug bills. But, so far as our experience 
goes, it does not seem to be very prevalent; we are sure 
that the vast majority of medical men, here as elsewhere, 
can honestly disavow all knowledge of such practices. 
Possibly on account of the naked simplicity of our 
northern funeral rites, those other unholy alliances— 
between doctors and undertakers—do not appear to 


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470 The Medical Plss?. 


OBITUARY. 


Mat 3, 1899. 


exist here at all. Yet, surely we have met these under¬ 
takers somewhere. Does one’s memory not fly back to 
the pact between Mr. Mould and one Sairey Gamp, of 
whom he said “ She’s the sort of woman now one would 
almost feel inclined to bury for nothing; and do it neatly, 
too!" 

The Will of the late Sir John Struthkrs.— By a 
codicil to his will, dated February 20th, 1899, Sir John 
Struthers leaves the sum of .£500 to the Royal College of 
Surgeons of Edinburgh for the purpose of founding a 
lecture to be delivered before the college every third 
year. The subject of the lecture may be any part of 
hnman or comparative anatomy, naked eye, micro¬ 
scopical, or embryological normal anatomy understood, 
not pathological. The lecture may consist of original 
unpublished work, may be an account of the progress of 
some branch of anatomical science, or may relate to the 
history of anatomy. The choice of a lecturer is unre¬ 
stricted as to country or profession, but he muBt 
be one who “ has done and published noteworthy 
original work in one of the above-mentioned 
departments of anatomy.” To the University of Edin¬ 
burgh is bequeathed the stock of anatomical drawings to 
be exclusively under the care of the Professor of Anatomy. 
Jn this bequest the testator says, “ The making of them 
(the drawings) has been a pleasure to me over many 
years, and I cannot now render them more useful 
than by presenting them for use in the anato¬ 
mical class of Edinburgh University.” A third 
bequest runs as follows" I leave .£100 to the Royal 
Infirmary as a slight recognition of the benefit I derived 
from my connection with the old Royal Infirmary, in 
which I was dresser, non-resident surgical clerk, house 
physician, house surgeon, assistant surgeon, and junior 
ordinary surgeon from 1843 till 1863, when I went to 
Aberdeen, and in recognition of the honour and pleasure 
I have had since returning to Edinburgh in sitting on 
the board of management of the Royal Infirmary.” £500 
is bestowed on the University of Glasgow for the pur¬ 
pose of encouraging original work—not, it is expressly 
stated, for a students’ prize in the ordinary sense. The 
award is to be biennial, the decision to rest with the 
Professor of Anatomy, and competition to be open to all 
students and graduates of the University, without respect 
to sex. 

Opening of the Summer Session in Glasgow.— 
The University opened on the 25th ult., when there 
was a very large number of students present at the 
usual inaugural ceremonial. There was no introductory 
lecture here, or at any of the extra-mural schools. In 
each division the professor addressed a few remarks in 
the way of introduction to his students. Dr. Muir, the 
new Professor of Pathology, as was to be expected, 
received a warm and cordial reception from his studenta 
He told them that pathology is, of all branches of medical 
science, the most important. In this the new Professor is 
not singular, for have we not been told by every professor 
of the other branches of the science that hiB particular 
branch it the most important ? The Professors of 
chemistry, anatomy, surgery, medicine, physiology, 
materia medica, therapeutics, pharmacology, midwifery, 
medical jurisprudence, natural history, Ac., Ac., inva¬ 
riably preface their teaching with, “ Gentlemen, this is 
the most important branch of the science,” Ac - 

Anderson’s College also opened on the same day as 
the University, and the emoluments in the various 
classes give promise of totalling a considerably larger 
number than in any previous year. 

St. Mungo’s College also opened on the 25th. Here 
also, a large number of students were enrolled and a 
further great addition is expected before the complete 
list of members is made up. In these schools no loss of 
time took place, as the work of the session began 
straight away. 

Queen Margaret College for Women also com¬ 
menced on the same date, when all the classes were well 
attended. At the recent graduation ceremony the 
female students were again located in the gallery, seem¬ 
ing to cause some friction among the young ladies. We 
give them our sympathy, simply because elderly 
dowagers, who have no connection with the university, 
but simply from curiosity and love of show, are per¬ 


mitted to occupy the area of the hall, so as to prevent 
the two sexes of students from mixing together and thus 
causing commotion and excitement among them. 


(DbituarQ. 


DR. WILLIAM CARTE, OF DUBLIN. 

The lamented death of this gentleman deserves a 
much more sympathetic notice than the brief announce¬ 
ment which we published last week while our journal 
was at press. Dr. Carte took his first qualification as 
Licentiate of the Irish College of Surgeons in 1852, and 
subsequently became a Fellow in 1874, a member of its 
council, and its vice-president. Shortly after his qualifi¬ 
cation he entered the Army Medical Service, and went 
out to the Crimea, where he served with distinction 
during the greater part of the campaign, not only in the 
field but as a member of the official supervisory board. 
On his return home in 1857 he was appointed surgeon to 
the Royal Hospital for Old Soldiers at Kilmainham, 
which position he occupied at his death. He was also 
advanced to the Commission of the Peace for the county, 
and was chosen as surgeon to the County Gaol at Kii- 
mainham, in which capacity his experiences were long 
and interesting. He had medical charge not only of Mr. 
Parnell and the other “ suspects ” who were incarcerated 
with that gentleman, but afterwards of the whole of the 
“ Invincibles ” who planned and executed the murders of 
Lord Frederick Cavendish and of Mr. Burke, the Under¬ 
secretary, besides many of the local murders throughout 
the country, for which a dozen or so were hanged. Dr. 
William Carte shared with his brother. Dr. Alexander 
Carte, an ardent taste for natural history, and, possessing 
the faculty of neat manipulation and a good knowledge 
of dissecting, he assisted his brother and served for some 
time as curator of the Irish College of Surgeons. The 
most important of his published papers had reference to 
comparative anatomy, which, we regret to say, seems 
likely to become a lost science in Ireland. In 1891 he 
was appointed Physician and Surgeon on the Staff of the 
Commander of the Forces. 

Dr. Carte, of late years, went largely into public life 
as an administrator of publio enterprises, and in that 
capacity showed not only great ability, but the indis¬ 
pensable attributes of integrity, discretion, and good 
address. His chief venture was in the Dublin Tramway 
Company, which under his chairmanship flourished so 
exceedingly as to be now one of the best investments 
available, and one of the Institutions of which Dublin 
has a right to be proud. When the electric installation 
now being substituted for horse traction is completed, 
no such perfect system of domestic locomotion will be 
found in Europe. Dr. Carte was also intimately asso¬ 
ciated with the management of the Blessington Tram¬ 
way Company, the Civil Service Building Society, and 
other stable and prosperous organisations. He was a 
gentleman in mind, and therefore necessarily, in manner, 
and he dies universally regretted, not only by his pro¬ 
fessional brethren, but by a very large circle which 
knew him as a public man. 


DR. NEDLEY, OF DUBLIN. 

The death of this gentleman, which took place on the 
25th ult., at his residence in Cavendish Row, Dublin, at 
the ripe age of 79, and, after long delicacy of health, is 
worthy of special notice, as he was a personality very 
well known and characteristic for the public as well as 
the profession. 

Dr. Nedley took his first qualification as a Licentiate 
of the Edinburgh College of Surgeons in 1851, and 
became M.D. of King’s College, Aberdeen, in 1856, and, 
for some years, he, being a man of marked ability, 
acquired and enjoyed a fair share of private practice, 
but he cannot be said to have been, in any other sense, a 
member of the medical fraternity. So far as we know 
he never wrote a line for publication, or read a paper on 
a professional subject, or belonged to any medical society 
even in name, or, in fact, associated himself with medical 
organisations in any way, or subscribed a shilling to their 




May 3, 1899 


CORRESPONDENCE. 


The Medical Press. 471 


funds. It was to his gifts as a social entertainer that 
Dr. Nedley owed everything in life. He was a 
professed story-teller, and kept on hand a num¬ 
ber of amusing anecdotes which he was wont 
to retail for the delectation of his friends at 
dinner and elsewhere, and, as he possessed some ready 
wit, and the faculty of imitating a variety of Irish 
brogues, his stories were always amusing, especially to 
English visitors, who listened with speechless wonder to 
his flights of fancy. He also possessed an excellent 
tenor voice for an amateur, and a considerable know¬ 
ledge of music, which caused his songs to be as popular 
as his stories. We should be only making his memory 
as a musician ridiculous if we were to adopt the fulsome 
gush of one of the Dublin newspapers, which said—“ His 
tenor was as sweet as Guiglini’s, and far more robust. 
His knowledge of music was incomparably greater. He 
could easily have made .£10,000 a year as a singer, but 
for his unconquerable nervousness.” These special 
qualities for entertaining the public were brought to the 
notice of the Earl of Carlisle in the year 1855, when that 
nobleman assumed the Viceroyalty, Nedley was forth, 
with invited to the select Castle dinners, as a unique 
specimen of the witty, wild, Irish native, and, forthwith, 
Lord Carlisle became so enamoured of Dr. Nedley’s 
qualities that be showered upon him the first good thing 
at his disposal. He made him surgeon to the Metropo¬ 
litan police; a lucrative position, which he vacated only 
about a year ago. He was also, on the death of Dr. 
James Stannus Hughes, appointed surgeon to the Vice¬ 
regal Household, the only medical Household appoint¬ 
ment which carries with it a salary. He has recently 
been succeeded in that office by Mr. Lentaigne. He was 
also Medical Attendant on the Training School attached 
to the National Board of Education. 


jparlmmcntrtnj ilctos. 


The Midwives Bill came up for discussion on Tues¬ 
day of last week on the motion for its second reading, 
but Sir Walter Foster objected, and the discussion was 
adjourned until Monday last. 

Inebriate Reformatories. —The Home Secretary 
stated that three inebriate reformatories had been 
certified, but that no local authority had as yet estab¬ 
lished any such institution, though the matter was 
under consideration by several municipalities. There 
being no certified reformatory for men, several men have 
had to be discharged for want of such accommodation. 
With one exception the reformatories certified are 
willing to receive persons committed under Section 1 of 
the Act. Later in the week the Home Secretary in reply, 
to Mr. Hobhouse, said that he did not feel justified at 
resent in settingup a State reformatory for inebriates, 
ut substantial Government contributions had been 
secured for persons committed to certified reformatories. 
He proposes later on to call the special attention of the 
local authorities to their responsibility in the matter. 

The Teeth of Recruits.— In reply to a question, it 
was stated that in 1898 no fewer than 1,767 recruits were 
rejected on account of the unsatisfactory condition of 
their dental appendages. 


(2TorrcBporificnc£ 


We do not hold ourselves responsible for the oplnioi s of our 
correspondents. 

MEDICAL AID ASSOCIATIONS. 

To the Editor of The Medical Pre&s and Circular. 

Sir,—T here are two Bides to every question, and I beg 
herewith to advance a few considerations for the behoof 
of the two general practitioners who have lately 
trumpeted so loudly in the correspondence columns of 
your valuable journal. 

First, and foremost, if I, a properly qualified and 
registered medical practitioner, choose to accept the 
salary offered by a certain combination of individuals 


who is to say me nay ? The amount of the salary has 
nothing to do with the question. Otherwise who is to 
defend the ridiculous sums paid to house surgeons, 
qualified assistants, junior officers (and, for that matter, 
of the senior officers as well), in workhouses and in 
lunatic asylums ? Our opponents say that the medical 
aid system is radically wrong, because it makes a 
profit out of a medical man to whom a fixed salary is 
paid. 

Now, Sir, may I ask your heated correspondents in 
what respect a medical aid officer differs from a junior 
medical assistant at a private asylum, paid at, say, £100 
per annum, a sum that the average medical aid officer 
would despise. A plain answer to this point would serve 
to demonstrate to those who now cry out so loudly that 
the beam is not so far remote from their own organ of 
vision. The assistant lunacy officer is a qualified regis¬ 
tered practitioner, engaged at a peddling rate to put 
profit in the pockets of his employers, the fat private 
asylum proprietors. 

There are other points that could be raised with equal 
force and logic, but for the time being the point I have 
advanced will suffice. I challenge any of your readers 
to offer me a satisfactory way out of the above dilemma. 

As to interference by the General Medical Council, the 
idea is too absurd for discussion in the columns of a 
serious journal. 

I am, Sir, yours truly, 

April 22nd, 1899. Medical Aid Officer. 


MORTALITY UNDER ANAESTHETICS. 

To the Editor of The Medical Press and Circular 
Sir,— Some coroners are in the habit of consoling 
the relatives of the victims of maladministration of an 
ansesthetic mishap with the assurance that the mortality 
under chloroform is 1 in 4,000 cases; under A.C.E. and 
other mixtures containing chloroform, 1 in 6,000; while 
under ether, which is asserted to be an anesthetic eight 
times safer than chloroform, the proportion is only 1 in 
32,000; under nitrous oxide, said to be practically free 
from all risk, it is put at 1 in 1,000,000. 

If these statistics are based upon facts, some interest¬ 
ing results may be deduced from the returns for the 
year 1897. During this period. 96 inquests were held 
on persons who had died under anesthetics in England 
alone, viz., 63 males and 33 females. 

From pure chloroform.74 deaths. 

„ A.C.E. and other mixtures containing 

chloroform . 10 „ 

„ Pure ether . w „ 

„ Nitrous oxide followed by ether ... 5 „ 

Total . 96 „ 

If the mortality statistics under anesthetics quoted 
above are based upon facts, it follows, that in the year 
1897 the following number of surgical operations per¬ 
formed under an anesthetic in England alone must have 


been as follows:— 

Operations. 

Under chloroform . 296,000 

„ mixtures containing chloroform 60,000 

„ ether . 224,000 

„ nitrous oxide . 7,000,000 


Total 7,580,000 


Quod abturdum ett. Seriously, however, as the name 
of the anesthetist in all fatal cases is known it ought to 
be possible to obtain trustworthy information (1) on the 
total number of cases in which the particular anesthetist 
has administered either of the four principal anesthetio 
agents or combinations; (2) the number of times he has 
administered them during the year 1897. 

I may point out that the deaths under anesthetics 
reported in the daily papers probably represent but a 
fraction of the total number. Dr. Leonard Hill recently 
remarked that: “ In a certain institution in Great Britain, 
in the course of a recent year, not fewer than twelve 
deaths occurred. This is no exceptional case, the deaths 
from chloroform are not recorded in the medical journals. 


Digitized by Google 




472 The Medical Press. 


NEW INSTRUMENTS. 


Mat 3, 1899. 


for these reflect upon the reputation of the administrator 
and the institution in which they occur” (Bril. Med. 
Journal, April 17th, 1897). Professor Augustus Waller 
says in the same journal (November 10th, 1897): “A 
large proportion of the cases of death, undoubtedly 
caused by chloroform, are never published. How large a 
proportion it is impossible to say, yet almost certainly 
the largest proportion of the total number of deaths. 
At one hospital, from which two deaths from chloroform 
were reported during a year, nine deaths actually 
occurred.” And Professor Juliard, of Geneva, gives par¬ 
ticulars of twenty cases of death by chloroform that 
took place within his knowledge, but outside his own 
practice, three only of which had been published. In 
view of these facts it is fair to assume that the numbers 
given may safely be doubled. 

I am, Sir, yours truly, 

A Disciple of JortN Snow. 


of two, but absent in another from one of aged three’ 
and from a third five years of age. As a book of 
reference, Mr. Poland's exhaustive * monograph will 
be essential to the shelves of every medical 
library no less than of every scientific surgeon. The 
labour involved must have been very great, even if we 
take the simple verification of references. The editing and 
the general appearance of the book are excellent, and the- 
matter is illustrated with do less than three hundred 
and thirty - seven illustrations. The work savours 
of the German love of absolute and comprehensive 
detail, but at the same time it is tempered with an 
insular blending of the practical. The book is a credit 
to English surgery and all concerned in its production 
deserve the thanks of the medical profession. 


Instruments. 


literature. 

POLAND ON THE EPIPHTSES. (a) 

This monumental monograph affords an interesting 
illustration of the more detailed knowledge that is being 
attained as scientific surgery approaches its maturer 
growth. The main volume contains some 900 pages of 
royal octavo size, and is supplemented by a small 
skiagraphic atlas showing the development of the bones 
of the wrist and hand. The little auxiliary volume 
strikes the keynote of the author’s fresh departure in 
relation of the traumatic separation of the epiphyses. 
By the aid of the Rentgen rays he has studied recent 
and old injuries of the kind indicated, and has been thus 
enabled to ascertain definitely the condition of parts, 
whereas previously the only control over conjecture was 
the objective proof offered in comparatively rare in¬ 
stances by operation and by dissected museum speci¬ 
mens. Although the author has availed himself fully of 
the X-ray methods, he has also turned to the literature 
and the clinical aspects of the subject with an applica¬ 
tion that may be styled without any stretch of rhetoric 
as simply Gargantuan. Hitherto there has been no 
authoritative teaching of this important subject 
as a whole, and the practitioner has been left 
to a great extent to work out for himself the 
occurrence and the results of epiphyseal damage. Still, 
a knowledge of the signs of epiphysitis should now be in 
the grasp of every medical man, who would be thereby 
enabled to avoid many of the opprobria of surgery. The 
study o^ the traumatic conditions of the epiphyses has 
yielded conspicuously brilliant results in orthopaedic 
surgery, in which Mr. Polland’s monograph may be 
fairly said to mark a new era. To take an illustration 
of the bearing of this class of injury upon deformities, out 
of several instances of subsequent shortening of the 
humerus, the three following may be quoted. A 
woman, sot. 30, whose humerus was shortened 5 ins. 
from a fall on shoulder in infancy. A woman of 
seventy with 3 ins. of shortening, due to an injury when 
six months old. A third case (Tubby’s) of 3J ins. of 
shortening in a lady of twenty-five, from being lifted up 
by the arm at three years of age. Including the above, 
seven authentic cases of arrest of growth following sepa¬ 
ration of the upper epiphysis of the humerus are tabu¬ 
lated. The injuries to other long bones are treated at 
such length and minuteness as to render it out of the 
question to atten.pt any general sketch or summary of 
conclusions. The author has been fortunate in being 
able to complete his work with the luller light thrown 
upon the subject by the Rontgen methods. Indeed, 
without that aid much of the present volume could 
not have b?en written. Many of the radiograms 
have been furnished by Messrs. Webster and Thos. Moore, 
two well-known workers in this field. The wide range 
between th ? appearance of some of the centres of ossifi¬ 
cation is shown in the Atlas by the cuneiform bone of 
the carpus, which is visible in the radiogram of a child 


(a) " Traumatic Separation of the Epiphyses." By John Poland, 
F.B.C.S. London : Smith, Elder & Co. IKiis. Price Jfc2 12s. 6d. 


AN IMPROVED FORM OF AXIS-TRACTION 
FORCEPS. 


Messrs. Down Brothers, of St. Thomas’s Street, 
S E., have enabled us to make a practical test of an im¬ 
proved form of axis-traction forceps, the outcome of 
twelve months’ experiments at the hands of Dr. G. 
Porter Mathew. The advantages which axis-traction 
forceps possess over the instrument in general use are, 
even now, not as generally appreciated in this country as 
their importance merits. No one who has studied their 
use would be disposed to question the value of Pro¬ 
fessor Tarnier’s innovation. These forceps enable 
powerful traction to be applied in the axis of the pelvic 
canal without the risk of any misapplication of force and 
consequent damage to mother and child. They look a 
wee bit complicated, but this is only because to many 
practitioners they are unfamiliar, and a very small 
amount of practice effectually disposes 1 of any diffidenoe 
on this ground. 

Dr. Mathew’s forceps differ from 
other axis-traction forceps in several 
noteworthy points. They are made 
entirely of metal, and can be steril¬ 
ised by boiling. The traction rods are 
detachable, and are easily cleansed and 
the weight has been brought as low as 
is consistent with perfect rigidity. 

There are no screws or fixed joints, 
except in the parts that remain outside 
the vulva, and such screws as are 
present, few in number, are not easily 
lost. The blades have a pelvic curve 
of a seven-inch radius, and the 
cephalic curve is also more abrupt 
than usual. The blades are stout and 
rigid though somewhat narrower than 
ordinary blades. The lock is the 
close-fitting ordinary Englsh lock. 

The application handles have been 
much short¬ 
ened and light¬ 
ened, and once 
the blades C 
have been 
applied they 
become merely 
indicators. ” 

The traction 
rodB are on 
the well- 
known rect¬ 



angular model, devised by Dr. Milne Murray, and they 
are easily detachable by an aseptic joint. A special 
form of traction block has beendevised by Messrs. Down 
Brothers, which combines the qualities of lightness, 
ease of application and facility of cleansing, with an 
absence of screws which might be mislaid or lost. 

These forceps afford a good example of the perfection 
to which the manufacture of surgical instruments has 
been brought in this country. They are admirably 
finished, neat in appearance, and rigid in use. In the 


Digitized by L.OOQ le 




May 3, 1899. 


MEDICAL NEWS. 


The Medical Pbess. 473 


interests of the parturient population it is to be hoped 
that obstetricians will, in future, avail themselves more 
generally of the advantages of the form of midwifery 
forceps.for many a difficult labour would be simplified, 
and many a perineum saved from rupture. 


4fteiriral Jtctos m b {toss Xists. 


Royal College of Physicians of London. 

At the ordinary quarterly comitia of the College, held 
last week, the following members were elected Fellows 
of the College: — 

Sydney A. Monckton Copeman, M.A., M.D.Camb ; Wilfred James 
Hadley, M.D.Durh.; Henry Handford. M.D., C.M.Ed.; Percival 
Horton-mnith, II.A., M.D.Camb.; Cyril Ogle, M.A.. M.B.Oxon.; 
Arthur Ranaome, M.A., M.D.Camb.; William Halae Rivera Rivera, 
M.A. (/ion. causa), Camb., M.D. Lond. William John Ritchie 
Sim peon. M.D.Abeid.; William Yicary Snow, M.D.Lond.; Herbert 
Ritchie Spencer, M.D.Lond. 

The following gentlemen having passed the required 
examinations and conformed to the by-laws were ad¬ 
mitted Members of the College:— 

Peverell Smythe Hicliens, M.A , M.B., B.Ch.Oxf., L.R.C.P. and 
M.R.C.S.; and George Thornton, M.D., C.M.Edin., L.R.C.P. and 
M.R.C.S.; Arthur Latham Ormerod, M.A., M.B Oxf. L.R.C.P. and 
M.R.C.S. 

At this meeting various reports were received, and 
the usual routine business transacted. It was also 
decided to recognise the Royal University of Ireland as 
one of the Universities whose students are entitled to 
exemption from the first and second examinations of the 
conjoint board, and to continue during the present year, 
the recognition of the late Mr. Thos. Cooke’s School of 
Anatomy, as previously. 

Royal University of Ireland.—Second Medical Examination 

Upper Past.— Robert J. Bethune, Q. C., Belfast; Thomas A. 
Carson, Q. C., Belfast; .Walter Phillips, B.A., Q. C., 'Belfast; 
EdwardT. Tuckev, Q.C., Cork; Thomas Walsh,Q.C.,Galway,and 
John S. P. Weir, Q. C., Belfast. Above may present themselves for 
Honours. 

Pass. —Marion B. Andrews, Q. C.. Belfast: Robert Best, Q. C., 
Galway; Catharine L. Boyd, Q. C., Belfast; William H. N. Bright, 
Q. C., Belfast; James G. Campbell, Q. C., Belfast; Joseph Corker, 
Q. C., Belfast: Augustine T. Frost, Q. C., Cork; Daniel Gleeson. 
Q. C., Cork; Elizabeths. Graham, Q. C., Belfast; Rodolphus W. 
Harper, Q. C., Belfast; Patrick Hefferaan, Cath. Univ.; Michael J. 
Zaffan, B A., Cath. Univ.; John L. Lunham, Q. C., Cork ; Maurice 
J. Macauley, Q. C„ Cork ; John McClatchey, Q. C., Belfast; Samuel 
B. W. Moore, Q. C., Belfast; Andrew J. Quirk, Cath. Univ.; Jane 
E. Reynolds, Q. C., Cork; Frederick W. Stewart, Q. C., Belfast; 
and William A. Stoops, B.A., Q. C., Belfast. 

Royal Colleges of Physicians and Surgeons of Edinburgh 
and Faculty of Physicians and Surgeons of Glasgow. 

At the April sittings of the Conjoint Board held in 
Glasgow, the following candidates passed the respective 
examinations:— 

First Examination (five years’ course) ; William George Mac 
donald (with distinction), Edward Graham Taylor, Thomas Percy 
Cox, Evan Owen Roberts, William John Shorten, William Francis 
Holland, James M'Manus, Edward P. A. Richardson, D. Bernard 
William Dakers, William S. Nicholson, Samuel Robert Scott, 
Edmund Eccles. 

First Examination (four years’ course): Thomas B. Trotter, 
George A. M'Farland, Thomas Arthur Fall. 

Second Examination (five years’ course): John M'lntvre (with 
distinction), John Wm. Isbister, Sved Zumiruddin, Wm. Thomson, 
James Charles Gallowny, Adam Pox, Archibald Macmillan (with 
distinction), Archibald B. Laidlaw, William H. Duncan, James W. 
Skelly, John Stewart, Ashton N. Collier, John Raeside Smith (with 
distinction), Stuart Jackson Farries, Terence Aloysins Welch, 
Charles Henry Nash, Joseph Edwin Cooper. 

Second Examination (four years’ course): Robert Cooper, 
Hamilton Jos. Bell, B.A., Robert Dunlop, William Boyd, Joseph 
D. Begley. 

Third Examination: Alexander Scoular (with distinction); 
Percival H. Rainbird; Charles W. Sharp; Peter Mackellar Dewar; 
Alexander Fraser Jack; John Thomson Mollock; Allan Douglas 
Cameron; Timothy M. O’Driscoll: Ernest George Dryden Benson; 
Eyre William Powell; Paresh B. Roy. 

Final Examination (and admitted licentiates of the three co oper¬ 
ating colleges): James M. Inverarity; William M’Farlane; 
Alexander Johnston Wilson; Richard Steward (with honours); 
Duncan Macpherson Macgregor, William Denness: Louise Alice 
Fox; Joseph V. Usher-Summers ; George Abraham Parker; Edgar 
Hep worth Alton; Andrew Snody Omund; Ernest Hill; Samuel 
Howard Smith; Denis Murphy: Margaret Elizabeth M’Neill; 
Albert Sophron Sieger; George Phocion Barff, John Wiglesworth. 

Meath Hospital and Co. Dublin Infirmary. 

At the annual prize examinations in this institution 
senior prizes in clinical medicine and surgery, were 
awarded to Mr. Edmund Bennett (gold medal), and to 


Mr. Patrick S. O’Reilly (silver medal); the junior prize 
fell to Mr. Byrne. 

8mall-Pox Patients at HulL 

The steamer. Port Darwen, of London, arrived at Hull 
on Sunday morning having six cases of small-pox on 
board. The vessel was from Alexandria, and she had as 
passengers an English minister, his wife and sister, and 
seven children. A few days out the minister was taken 
ill, the illness developed into small-pox, and he died 
before Algiers was reached, the body being buried at sea. 
After Gibraltar had been passed five of the children 
took the disease, and also the steward who had attended 
them. On the vessel arriving at Hull the patients were 
landed and conveyed to the hospital, and the ship was 
disinfected. 

Corporate and Medical Reform Association, Limited. 

At a meeting of the Executive Committee, held on 
the 22nd ult., the following resolutions were unani¬ 
mously adopted:—1. That the letter of the President of 
Council and Honorary Secretaries to the Lord President 
of the Privy Council, with the reply received, be sent to 
the Direct Representatives, with covering resolutions 
urging them to press home the five objections to the 
present Midwives Bill taken in the letter to the Lord 
President:—(1) That the Bill confers the right to attend 
all cases of labour; (2) also the right to render all 
attendance, including use of medicine and instruments ; 
(3) that rights conferred by Statute cannot be taken away 
or diminished by a board formed to regulate the exercise 
of the rights; (4) that central licensing and a national 
roll (as provided in the Bill) override local authority 
and place the midwife beyond control; (5) that in ail 
these respects the Bill fails to comply with the recom¬ 
mendations of the General Medical Council. A commit¬ 
tee was constituted, consisting of members of the 
association, who are also members of the Ophthalmo- 
logical Society U.K., and a letter of that committee 
adopted, inviting the support of other members of the 
Ophthalmological Society in opposing the certification 
of unqualified persons as efficient in departments of 
medical practice. 

Mortality in Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations :—Bombay 142, Madras 35, Paris 23, Brussels 
17, Amsterdam 18, Rotterdam 19, The Hague 20, Copen¬ 
hagen 18, Stockholm 23, Christiania 16, St. Petersburg 

26, Mo8Cow 26, Berlin 20, Hamburg 16, Dresden 21, Breslau 

27, Munich 26, Vienna 24. Prague 30, Buda-Pesth 26, 
Trieste —, Rome 20, Venice 31, Cairo —, Alexandria —, 
New York (including Brooklyn) —, Philadelphia 20. 

The New York Assembly has passed a Bill providing 
that a witness shall in future lay his hand on the Bible, 
instead of kissing it, while the oath is being adminis¬ 
tered. If the witness be allowed to wear gloves the sole 
remaining risk of contracting scabies will have been 
obviated. 

The Governor of New York has signed the Bill passed 
by the Legislature prohibiting bicycle racing for a 
greater period than twelve hours in any period of 
twenty-four hours. 

The Boston Medical and Surgical Journal states that 
as a result of the inquest on the person who was 
poisoned by cyanide of mercury sent in a bottle of 
“ Kutnow Powder,” the firm engaged in manufacturing 
this quack medicine has been forced into bankruptcy, 
consequent upon the falling off in the sales. 

The Civil Code in force at New York has been rein¬ 
forced by a provision forbidding physicians to give any 
information concerning the mental or physical condition 
of his patient either before or after the death of the 
latter. No exception is made in favour of persons whose 
life is insured. 

A well-known American musical composer has 
undertaken, in exchange for .£1,000, to compose a march 
to bear the name of a certain proprietary medicine, and 
to be used in advertising the same. This is “ art for 
art” with a vengeance! 


Google 



474 The Medical Press. 


NOTICES TO CORRESPONDENTS. 


Mat 3 1899. 


Notices to 

(EorresponiientB, Short fetters, &c. 

t*r Cob respondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive eignature or 
4*4tiafr, and avoid the practice of signing themselves “ Reader,’’ 
“Subscriber,” "Old Subscriber," Ac. Much confusion will be 
spared by attention to this rule. 

THE ROYAL MEDICAL BENEVOLENT COLLEGE. 

Notice will be found in our advertising columns that the Annual 
General Meeting for the election or re-election of ten members of 
Council, will be held on Friday, May 26th. At the same meeting 
the result of the voting for Pensioners and Foundation Scholars 
will be announced. 

Dr. R. (London).—A medical man, delegated by an insurance com- 

C y to report on a patient, is, strictly speaking, at liberty to address 
iself directly to the subject of his investigation. In practice, 
however, it is more courteous and decidedly advantageous to enter 
first of all into communication with his medical attendant, if there 
be one. 


JfttetitiQB of the Societies aitb lectures. 

Wednesday, Mat 3rd. 

Obstetrical Society or London.— 8 p.m. Specimens a-ill be 
shown by Mr. Targett, Dr. Purslow, and others. Papers Mr. A. 
Doran: Fibroid of the Brood Ligament weighing 44J lb. (20 kilo¬ 
grammes) removed bv Enucleation, Recovery, with Table and 
Analysis of 39 Cases. Dr. C H. Roberts: Note of a Case of a Large 
Retroperitoneal Fibroid undergoing Suppuration. 

Thcbsdat, Mat 4th. 

Harveian Society op London (Stafford Rooms, Titchborne 
Street, Edgware Road).—8.30 p.m. Mr. C. B. Lockwood: A Series 
of Cases of Arthrotomy for the Relief of Pain and for the Removal 
of Synovial Fringes, Loose Bodies, and Fibro-cartilages. 

Ophthalmolooical Society or the United Kingdom. - 8.30 p.m. 
Clinical Evening. Mr. A. H. Thompson : Tumour of Iris. Mr. T. 
Collins: (1) Tumour of Iris; (2) Unusual Opacity of Cornea. Mr. 
A. Lawson : Vascular Formation in Vitreous. Dr. Lediard : Slough¬ 
ing of Cornea following Fracture of Base of Skull. Mr. Snell: (1) 
Primary Intraocular Carcinoma; (2) Traumatic Ptosis. Mr. 
Critchett: (1) Solid (Edema of Eyelids; (2) Snellen's Artificial 
Eyes. Mr. M. Davidson: Skiagram of Glass in Eyeball. Mr. 
Mackay : Skiagram of Foreign Body in Eye. Mr. Rowan : Carci¬ 
noma of Lung and Eye. Mr. Batten : Filamentary Keratitis. Cases 
in place at 8 p.m. 

Friday, Mat 5th. 

Royal Academy of Medicine in Ireland.— Section of Pathology. 
—L Dr. Knott: Pathological Clavicles. 2. The Secretary : Another 
Case of Infective Endocarditis due to Pneumococcus. 3. Prof. E. 
H. Bennett (President of the Academy): Traumatic Dislocations of 
the Intatarsus on the Tarsus. 4. Mr. W. J. de Courcy Wheeler: 
Central Sarcoma of Bones. 5. Mr. R. Chas. B. Mnunsell: Two 
Peculiar Vascular Tumours of Abdominal Wall. 6. Mr. P. J, 
Fagan : Specimens of the following Pathological Conditions of the 
Tunica Vaginal is Testis :—(a) Simple Hydrocele with the Coverings 
Displayed by Dissection; (b) Syphilitic Disease; (c) Malignant 
PapTllomatous Neoplasm. 

West Kent Medico-Chircrgical Society (Royal Kent Dispen¬ 
sary, Greenwich Road, S.E.)—8.45 p.m. Dr. M. Dockrell: 
General Health as a Factor in Skin Diseases. (Presidential 
Address.) 

Lartngological Society or London (20 Hanover Square, W.). 
—5 p.m. Special Discussion on Asthma in Relation to Disease of 
the Upper Air Passages (to be opened by Dr. P. Kidd and Dr. P. 
McBride). 

West London Medico-Chiruroical Society (West London 
Hospital, Hammersmith, W.).—8.30 p.m. Mr. H. J. Paterson : The 
Use of Gas in General and Dental Surgery, together with a demon¬ 
stration of a new Apparatus for the Prolongation of Nitrous Oxide 
Anesthesia. Dr. J. Pardoe: Some Modern Methods of Treating 
Chronic Urethritis in the Male. 

Monday, Mat 8th. 

Central London Throat and Ear Hospital.— 5 p.m. Mr. 
Lennox Browne's Lecture on Ozsena. 


Uacanriee. 

Aston Union.—Resident Assistant Medical Officer at the Workhouse, 
Erdington, near Birmingham. Salary £100 per annum, with 
furnished apartments, rations, washing, &c. 

Bornwood House Hospital for the Insane, Gloucester.—Junior 
Anistant Medical Officer. Salary £100 per unnum, rising to 
£120 after the first year, with boaid, Ac. 

Berks County Asylum, Wallingford.—Junior Assistant Medical 
Officer, unmarried. Salary commencing at £120 per annum, 
with furnished apartments, board, attendance, and washing. 

Bethlem Hospital.—Two Resident House Physicians for six months. 
.Apartments, complete board and washing provided, and an 
honorarinm at the rate of £12 12s. each per quarter will be paid. 
Applications to the Treasurer, Bridewell Hospital, New Bridge 
Street, London, E.C. (See Advert.) 

County Asylum, Shrewsbury.—Junior Assistant Medical Officer, 
Salary commencing at £130 per annum, rising £10 a year to 
£150, with board,lodging, and washing (no liquors). 

Dublin, Cork Street Fever Hospital.—Assistant Registrar and Resi¬ 
dent Medical Officer. Salary £46 per annum, with board, resi¬ 


dence, and attendance. Immediate applications to the Chair¬ 
man. (See Advt.) 

Grove Hall Asylum Bow, E.—Junior Assistant Medical Officer. 
Salary £120 per annum, with board, lodging, and washing. 
Personal application to the Medical Superintendent. 

Manchester Roval Infirmary.—Honorary Ophthalmic Surgeon and 
an Honorary Assistant Physician. Applications to W. L. 
Saunder, Esq., Secretary, on or before May 20th. (See Advt.) 

Royal Mineral Water Hospital, Bath.—Resident Medical Officer, 
unmarried. Salary £100 per annum, with board and apartments 
in the hospital. 

Rural and Urban Districts in the Counties of Leicester, Rutland, 
and Warwick.—Medical Officer of Health for the period ending 
June, 80tb, 1902. Salary £450 per annum, inclusive of travel¬ 
ling, stationery, and other expenses. Applications to the Clerk 
to the Joint Committee, Lutterworth. 

Stepney Union. Medical Officer for the Union Workhouse,’{St. 
Leonard's Street, Bromley-by-Bow, E.—Salary commencing at 
£110 per annum, with the usual midwifery and vaccination fees 
in addition. Applications to the Clerk, Offices, Barnes Street, 
Ratcliffe, E. 


Appointments. 

Adams, D. V. M., M.B., Ch.B.Edin., a Resident Surgeon to the 
Glasgow Royal Infirmary. 

Bateman, F. J. Harvey, B.A.Cantab., M.B., C.M.Edin., House 
Surgeon to the Leith Hospital. 

Baumann, E. P., M.B., Ch.B.Edin., M.B.C S., L.B.C.P.Lond., Resi¬ 
dent Physician to the Glasgow Royal Infirmary. 

Cameron, A. F., M.B., C.M.Edin., Resident Assistant Medical 
Officer for the Workhouse of the Sheffield Union. 

Christie, B. R. Craig, M.B., C.M.Edin., a Resident Physician to 
the Glasgow Royal Infirmary. 

GRirriTHS, John S., M.R.C.S., L.R.C.P., Medical Officer to the 
Bristol Jubilee Convalescent Home. 

GRIM8DALE, Harold B., M. B., B.C.Cantab., F.R.C.S.Eng., Assistant 
Surgeon to the Royal Westminster Ophthalmic Hospital. 

Hector, C. Mvnro, M.D.Edin., Demonstrator of Bacteriology, 
University College, Sheffield. 

Jellet, W. E., M.B., Ch.B.Edin., a Resident Surgeon to the 
Glasgow Royal Infirmary. 

Jordan, H. Marttn, F.R.C.S., Registrar to the Chelsea Hospital 
for Women. 

Miller, J., M.B., C.M.Aberd., a District Medical Offioer, Tyne¬ 
mouth Union. 

Nasmtth, T. G., M.D.Edin., D.Sc., D.P.H.Camb., Examiner in 
Public Health in the University of St. Andrews. 

Salmond, J. L., M.B., C.M.Aberd., Medical Officer to the Aberdeen 
Dispensary, Vaccine, and Maternity Hospital. 

Thomas, J. T., L.R.C.P.Irel., L.R.C.S.Edin., D.P.H.Irel., Medical 
Officer of Health for W iltshire. 

Wilson, A. Garrick, M.R.C.S., L.R.C.P., Junior Out-patient 
Surgical Officer to the Royal London Ophthalmic Hospital, 
Moorflelds. 


#irtho. 

Berry.- On April 26th, at South Lowestoft, the wife of Walter 
Berry, M.D., of a son. 

Stewart.- On April 30th, at Walton House, Lordship Lane, S.E., 
the wife of H. M. Stewart, M.D.Cantab., of a son. 

Walker. —On April 27th, at Hill Road, Wimbledon, the wife of 
George Walker, M.R.C.S., L.R.C.P., of a son, stillborn. 


Carriages. 

Bland Sutton—Heather Bigg.—O n April 21st, at St. Maryle- 
bone Church, London, John Bland Sutton, F.R.C.S., to 
Edith, youngest daughter of Mrs. Heather Bigg, of Radnor 
Place, W. 

Brown—North. -On April 26th, at the Church of St, John the 
Evangelist, Upper Norwood, David Brown, B.8c., M.D.Lond., 
of Taunton, to Cecilia Emily, elder daughter of George North, 
of Upper Norwood. 

Lydall—Watkin.— On April 27th, at the Parish Church, Welling¬ 
borough, Wykeham Tracy Lvdall, M.D., of Birmingham, to 
Gertrude Wat kin, eldest daughter of Charles Watkin, Esq., of 
Wellingborough. 

Mkacock—Wand.— On April 27th, at St. James's Church, West- 
bourne Terrace, London, W., Hy. Chas. Meacock, M.R.C.S., 
L.R.C.P., to Hilda Blanche, youDgest daughter of Chas. K. 
Wand, of Clapham. 

Smith— Skar.— On April 27th, at the Church of the Sacred Heart, 
Gibraltar. Peter Colin C. Smith, L.R.C.P. and S.E., L.F.P.S.G., 
son of Robert Smith, M.D., of Sedgefleld, Durham, to Dorothee 
de Sales, daughter of the late lens Bager, Pedersen Skar, of 
Sknr, Norway. 


geaths. 

Hinnell. —On April 28th, suddenly, at liis residence, Bury St. 

Edmunds, George John Hinnel, M.R.C.S., L.S.A. 

Hussey.—O n April 23rd, at 24 Winchester Road, Oxford, Edward 
Law Hussey, Esq., F.R.C.S.Eng., aged 83 years. 

Orb.—O n April 27tli, at 204 Earl's Court Road, London, S.W., 
Andrew Aylmer, M.B.Oxon, eldest sou of the late Rev. R. H. 
Orr, of Stramore, co. Down, aged 40 years. 

Prince.—O n April 22nd, at Crowbo rough, Sussex, Charles Leeson 
Prince, M.K.C.S., F.R.A.S., aged 77 years. 


Digitized by 


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JTMay 10, 1899 


The Medioal Pre 89 and Circular Advertiser. 


=‘Tabloid’ 



Hypnotics 


‘Tabloid’ 

Sulphonal, gf. 5 [0.324 gm.]. 

Readily disintegrates, and is the 
most convenient and active form 
in which this valuable hypnotic 
can be prescribed. Administered 
1 in doses of one to six it pro¬ 
duces (after three or four hours) 
sound sleep, which is followed 
by neither headache, nausea nor 
vomiting. 

Bottles of 25 and 100. 

‘Tabloid’ 

Trional, 8T- 5 [0.324 gm.]. 

Resembles Sulphonal in action, 
but is more prompt. In doses of 
three to six it induces quiet and 
refreshing sleep in fifteen to thirty 
minutes. 

• Bottles of 25 and 100. 

‘Tabloid’ 

Chloral Hydrate, 

gr. 5 [0.324 gm.], and gr. 10 [0.648 gm.] 

Hypnotic and anodyne. Accurate 
in dosage, and therefore safe in 
administration. 

Bottles of 100. 



‘Tabloid’ 

Morphine Preparations. 

These products are reliable and 
safe hypnotics: they keep per¬ 
fectly, and by their use the dangers 
of decomposition and loss of 
strength, common to solutions of 
morphine salts, are avoided. 

‘Tabloid' Morphine Sulphate, 

gr. 1/20 [0.0032 gm.], and gr. 1/8 
[0.008 gm.]. 

In bottles of 50. 


HYPODERMIC. 

‘Tabloid’ Morphine Bimeconate, 

gr. ilS [0.008 gm.], gr. 1/6 [o.oil gm.], 
gr. 1/4[0.016gm.], and gr. 1/3[0.022gm.]. 
‘Tabloid’ Morphine Hydrociilor., 

gr. 1/6 [0.011 gm.], and gr. 1/4 [0.016 gm.]. 
•‘Tabloid’ 

Morphine Hydrochlor., gr. 1/6, 
and Atropine Sulphate, gr. 1/70. 

‘Tabloid’ Morphine Sulphate, 

gr. 1/8 [0.008 gm.], gr. 1/6 [0.011 gm.], 
gr. 1/4 [0.016 gm.], gr. 1/3 [0.022 gm.], 
gr. 1/2, [0.032 gm.], and *gr. 1 [0.065 gm.] 
‘Tabloid’ 

Morphine Sulphate, gr. 1/8 gr. 1/6 \ 
and Atropine Sulphate, gr. 1/200 : gr. i/i8o : / 
/gr- i /4 . gr. 1/3 . gr. 1/3 . * gr . 1/2 
[gr. 1/150 • gr. 1/120 • gr. 1/60 * *gr. 1/100 

In tubes of 20, exbept those marked with an asterisk, 
which are In tubes of 12. 



[cOPYr.lOHT] 























The Mfldlonl Press and Circular Advertiser. 


May 10, 1899 


H 


US 


httvVJumf- 


CM 


flrtof Infant feeding 


hlES 


W* NOT iiy t&y& <£©u?tiE?u®us &4mr?iE?i$tr&tH©i3) of ttjij or t9>ai 
forrsrj of i)Ourisfi)n)ei>t for n?on?t!b>3p BUT t!h>e 

adoption? of & PROGRESSIVE OIETRRY «uit<£<dl to 
t!>e Physiological of th« growing chii<d. 

SCURVY RICKETS Is due to the misuse of sterilized 
artificial foods and to want of change in the infant*s 
diet. 

TUBERCULOSIS , TYPHOID and DIARRHCEA are 

commonly milk-borne diseases. Sterilization precludes 
infection from this source. 



j)4 aecuratc use of th«_ — 

Allenburys” Milk Food No. 1 £f£.*S3iS£.|jSl? 
‘Allenburys” Milk Food No. 2 

. i ti ■ m ll li. j r ■ %r O Adapted to, and all that can be 

Allenburys Malted Food No. 3 desired si f ° r m I 0 n n f ^ s ts 0 f fter e five or 


SAMPLES FREE ON APPLICATION 


Allen & Hanburys Ltd., lisa's* London. 

Infants’ Food Manufactory: WARE MILLS, HERTFORDSHIRE. 






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She judical l\css and (Tirmlar. 


“8ALU8 POPULI SUPREMA LEX." 

Vol. CXVIII. WEDNESDAY, MAY 10 , 1899 . No. 19 . 


©right* l (Emnmunicaihmg. 


REMOVAL OF KIDNEY FROM FRONT 
OF SACRUM; RECOVERY. 

By EDMUND OWEN, F.R.C.S., 

Surgeon to St. Mary's Hospital, W. 

In connection with the communication by Dr. 
Newman on Malformations and Displacements of the 
Kidney, which appeared in the Medi-cal Pkess and 
Circular of May 3rd, I would like to place on 
Tecord a brief account of an extraordinary case of 
nephrectomy. 

On November 13th, 1894,1 saw in consultation with 
Dr. Frampton, a foreign gentleman of an extremely 
neurotic temperament, who complained of constant 
abdominal pains. In searching for a possible 
explanation of this distress, Dr. Frampton, under 
whose care the patient was, had by digital examina¬ 
tion discovered a firm, fixed tumour in the concavity 
of the sacrum “ in front of it there seemed to be aring- 
like narrowing of the rectum.” “ On withdrawing the 
finger fasces escaped in small, narrow pieces.” Two 
well-known surgeons subsequently examined the case, 
one of whom gave it as his opinion that the tumour was a 
simple adenoma which was associated with a slight 
intussusception of the x*eetum, whilst the other re¬ 
garded it as a malignant mass. Having examined 
the patient under ether, I said that I would not ven¬ 
ture even to give a guess as to what the nature of the 
tumour might be; but that, as the abdominal distress 
seemed apparently to be caused by its presence, I 
urged its removal by abdominal section. Two 
days later, therefore, I opened the abdomen above 
the pubes, and on dividing the peritoneum as it 
passed on to the rectum, I introduced my hand into 
the pelvis and explored the tumour which had been 
detected through the rectum. Finding it quite free 
from the reetum, but firmly fixed in its bed, I 
enucleated it, and bringing it up into the abdominal 
cavity I tied its pedicle and removed it. Only then 
could we determine its nature; it was a well-shaped 
left kidney. (Tbe specimen is now in the museum of 
the Royal College of Surgeons.) 

To say that the patient was neurotic is but feebly 
to express his temperament. He was a Semitic 
gentleman who had long sought relief for abdominal 
pains by morphia, but his craze for sedatives had 
been somewhat diminished by residence in an insti¬ 
tution in America, in which the treatment of the 
morphia-habit waB earned out. A few hours after 
the operation ho became quite hysterical, arched him¬ 
self upon his head and his heels, and, straining hard, 
burst open bis wound, and forced the intestines out 
under the dressings. In less than an hour he was 
again under an anaesthetic, with the bowels replaced, 
and the abdominal wound restitched. He was a long 
■while recovering, but on February 23rd, 1895, he left 
the Home in a greatly improved condition, the bowels 
acting every day with the help of a dose of salad oil. 


MALFORMATIONS OF THE 
KIDNEY AND DISPLACEMENTS 
WITHOUT MOBILITY, 

WITH ILLUSTRATIVE CASES AND 
SPECIMENS. 

By DAVID NEWMAN, M.D., F.F.P.S., 

Surgeon, Royal Infirmary, Glasgow. 

(Continued from page 453). 

B. Malformations of th* Kidney : I. Varia¬ 
tions in number: (1) Supernumerary Kid¬ 
ney ; (2) Single Kidney, (a) Congenital 

absence of one Kidney, ( b ) Atrophy of one 
Kidney; II. Variations in form and size: 
(I) General variations in form, lobulated 
Kidney; (2) Hypertrophy of one Kidney ; (3) 
Fusion of two Kidneys; (a) Horse-shoe Kid¬ 
ney ( b ) Sigmoid Kidney, (c) Disc-shaped 
Kidney. 

B. Malformations of the Kidney : I. Variations 
in number. 

(1) Supernumerary kidney. —Supernumerary kid¬ 
ney iB extremely rare. It must be considered simply 
as an anatomical curiosity, and consequently very 
little requires to be said regarding the condition. 
Although very few instances have been met with 
where more than two kidneys exist in the human 
subject, still cases have been recorded by Rayer, and 
other writers, where a supernumerary gland has 
existed. We have only seen one instance of this 
anomaly; it was at a post-mortem examination 
which was made many years ago upon a gentleman 
who died from malignant disease of the ascending 
colon. As no record was kept beyond what was 
sent at the time to the family attendant, I am unable 
to give details: but, from a clear recollection of the 
case, I can say that ljing close to the upper margin 
of the left kidney there was a small pear-shaped 
body, supplied by a branch of the renal artery, and 
having a distinct ureter which passed into the left 
ureter half an inch below the pelvis of the left kid¬ 
ney. Sections of this mass were examined micro¬ 
scopically, and found to be healthy renal tissue. The 
mass was completely separated from the kidney 
proper, being united to it only by the little ureter. 

This anomaly may be regarded as an extreme 
variety of segmentation of one of tbe kidneys. 
Generally when a supernumerary kidney has been 
seen, it has been found to lie close to a normal kid¬ 
ney, but in order to be placed in this class of malfor¬ 
mations, the part ought to be so separated as to 
possess distinct vessels and have a ureter of its own, 
which, however, always unites with the ureter of the 
normal kidney before it reaches the bladder. 

(2) Single kidney. —The anomalies which have been 
included under this term have been so various and 
so entirely different, even in their main characteristics, 
that it is difficult to avoid confusion, and at the same 
time follow the classification at present adopted. 

The existence of so-called “single kidney” was 
known by many of the older writei-s such as Vesalius 


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May 10, 1899. 


476 The Medical Press. ORIGINAL COMMUNICATIONS. 


Duvetus, and Eustachius, but Morgagni, in 1769, was 
the first writer to classify these abnormalities of the 
kidney into two groups, namely: those instances in 
which two organs had become coalesced; and secondly, 
those where only one kidney had developed; but 
unfortunately to both of these conditions he applied 
the term “ solitary kidney.” Then, following upon 
Morgagni, Rokitansky limited “ solitary kidney ” to 
those cases in which the malformation was due to the 
fusion of two organs, of which the lowest degree is 
seen in “ horse-shoe kidney,” and the highest in 
those instances in which the two kidneys approach 
one another more and more, and form one “ disc¬ 
shaped " organ lying in the median line, and provided 
with a double ureter. To the other class of kidneys 
where there is a “right or left kidney which is 
normal in regard to position and formation, and 
occasionally rather enlarged, its fellow being 
deficient,” he applied the term “ unsym metrical 
kidney.” We do not understand why two kidneys 
fused together as in horse-shoe kidney, where the 
two organs may be united only by a narrow band 
(see Fig. 12) and having distinct sets of vessels and 
ureters, should be spoken of as a “ solitary ” or 
“ single kidney,” any more than that the double 
monsters Eng and Chang should be considered as 
one individual. So much confusion haB arisen 
regarding the use of the terms “ unsym metrical 
kidney,” and “ solitary kidney,” that it would be well 
not to employ them. For example, “ sigmoid ” 
kidney, a condition where two kidneys are fused 
together, as shown iD Fig. 16, and occupying one 
side of the body, has been described under the head¬ 
ing “ solitary kidney,” even although the mass was 
provided with a double set of vessels and two 
ureters. 

Under the term “ single kidney ” we purpose only 
to include those cases in which one active organ is 
found, either as a consequence of atrophy, or from 
congenital absence of its neighbour. The other 
abnormalities, such as “ horse-shoe kidney,” “ sigmoid 
kidney,” and,“ disc-shaped kidney,” may be considered 
under the general heading of “ fused kidney.” 

A careful distinction must be drawn between 
“ single kidney ” due to congenital defect of develop¬ 
ment of the opposite organ, and those instances m 
which a kidney has become wasted and functionally 
useless as a consequence of disease, while its neigh¬ 
bour has undergone compensatory hypertrophy. 

In the former instance no trace of the kidney or of 
its ureter, or bloodvessels is found, as shown in Fig. 8, 
while in atrophy of one kidney as a consequence of 
disease the rudimentary kidney and its vessels are as 
a rule represented. 

The following specimens illustrate (a) congenital 
absence of one kidney :— 

Case 8.— Complete absence of the left kidney, ureter, 
and vessels. Compensatory hypertrophy of right 
kidney. 

On June 23rd. 1885, we made a post-mortem 
examination on a patient, Mrs. H., set. 53, who was 
admitted to the Royal Infirmary under the care of 
the late Dr. Scott Orr, and died from tuberculous 
ulceration of the bowels and secondary tuberculous 
peritonitis (Fig. 8). 

The nght kidney was normal in its position, but 
the whole organ was greatly enlarged, weighing 12$ 
ounces, and measuring five inches in length and four 
in breadth. All the parts of the kidney were propor¬ 
tionately normal, and the kidney was supplied by 
one artery and one vein, both of which were normal 
in their course and distribution. The right supra¬ 
renal body was normal in size and situation, the left 
suprarenal body was found under the last left rib, 
and was normal in size and structure. No trace was 
found of the left kidney or of its vessels and ureter, 


and no opening into the bladder could be discovered 
corresponding to .the entrance of the ureter. 

The microscopic examination of the enlarged 
kidney was gone into very carefully, and the inquiry 
was a most interesting one, showing very clearly how 
compensatory hypertrophy takes place. 

The minute changes occurring in compensatory 
hypertrophy we have described elsewhere. They do 
not demand attention here, further than to say that 
as far as could be made out the increase in the size 





Fig. 8. 

of the kidney was due to an augmentation in the 
bulk of the glomeruli, and to an elongation and 
increased convolution of the uriniferous tubules, 
rather than to any numerical hyperplasia. 

The changes taking place in compensatory hyper¬ 
trophy have been carefully studied by Eckardt, 
Ebstein, Guttmann, Polk, and others. 

Case 9.— Congenital absence of the left kidney , 
vessels, and ureter. 

The specimen about to lie described was placed in 
the Museum of the Glasgow Royal Infirmary by Dr. 
J. Lindsay Steven, and in the catalogue is described 
by him as follows (a):— 

“ The preparation showB with the right kidney the 
bladder and the right ureter. A most careful search 
at the time of the post-mortem examination failed to 
find any trace in the body of the left kidney or 
ureter, the right suprarenal capsule was normal in 
Appearance and situation, and perhaps slightly en¬ 
larged, the right renal artery had normal character¬ 
istics ; the left was scarcely thicker than a stout 
thread, and was lost in the tissue of the left renal 
region. The right ureter was quite normal; no left 
ureter could be found after careful search. The 
patient was a boy, set. 11, who suffered from morbus 
coxarius, complicated by tuberculous disease of the 
lungs ” 

(a) Glasgow Royal Infirmary Museum, Series VII., No. 8a. 


Diqi 


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ORIGINAL COMMUNICATIONS. 


The Medical Press. 477 


The case and specimen described above illus¬ 
trate single kidney due to the congenital absence of 
one organ. 

The following cases show how (a) one kidney may 
atrophy or become functionally inactive, either as a 
consequence of want of growth, or from disease in 
early life:— 

Case 10.— Extreme atrophy of the left kidney with 
double pelvis but single ureter, (b) 

I have no details of the 
post-mortem examination 
in this case. The kidney 
tissue is almost completely 
destroyed, and the whole 
organ is about the size of a 
walnut. The pelvis is 
branched, and there is no 
hilum, the upper limb of 
the pelvis springs from the 
inner and upper aspect of 
the atrophied organ, while 
the lower limb arises from 
the lower border of the 
kidney. Both limbe unite 
about one and a half inches 
below the level of the 
kidney, each branch is of 
sufficient size to admit the 
little finger, and after 
uniting form a channel 
■ three-quarters of an inch 

in diameter. Below this 
the pelvis gradually 
narrows and forms a 
ureter which is a little 
wider in lumen than nor¬ 
mal. In the preparation 
v q the vessels have not been 

° preserved (see Fig. 9). 

Case 11 .—Atrophied kidney . the renal tissue being 
almost entirely replaced by fat. (b) 

The patient from whom this specimen was removed 
was under my care in 1887. He suffered for many 




l 


Fio. 10. 

ears from chronic cystitis, and ultimately died 

rom cardiac disease complicated with passive hyper- 
aemia of the lungs. 

At the post-mortem examination the right kidney 
■was found to be in a state of moderately advanced 
chronic interstitial nephritis, but up to the time of 
his death there were no symptoms pointing to renal 
incompetency. The kidney weighed ten ounces. 
The left kidney, as represented in Fig. 10, weighed 
half an ounce, very little renal tissue could be found 

(a) Glastrow Royal Infirmary Museum, Series vn.. No. 9. 

(b) Glasgow Royal Infirmary Museum, Peries VII , No 13. 


in the mass, and what remained was completelyJ em¬ 
bedded in firm fat. In this case the fat appeared to 
have developed outside the kidney, pushed its way 
into the interior of the organ by the hilum, and so 
spread towards the periphery of the organ. 

The following specimen was placed in the museum 
by Dr. J. Lindsay Steven, and he has allowed me to 
make use of it* « 

Case 12— Atrophy of the right kidney with com¬ 
pensatory hypertrophy of the left kidney, disease of the 
suprarenal capsules. 

The following is Dr. Steven's note in the Museum 
Catalogue:— 

“Both kidneys are preserved, the right only 
weighed one ounce, the left seven and a half ounces. 
The organs were obtained from the body of a man 
suffering from spinal caries. The small right kidney 
was embedded in a mass of adipose tissue, and at its 
upper extremity there was a small cavity with smooth 
walls the size of a hazel nut filled with pultaceous 
material. The ureter of this kidney was considerably 
thickened, and its lumen was practically obliterated. 
The urinary bladder was much hypertrophied. The 
left suprarenal capsule was enlarged and was con¬ 
verted into a cream-coloured structure, but little 
tissue of normal appearance remained. The right 
suprarenal presented similar appearance.” 

The left kidney was healthy. Fig. 11 shows the 
atrophied kidney entire and on section, also the 
healthy kidney. 

In the Royal Infirmary Museum there are many 
other specimens illustrating atrophy of the kidney as 
a consequence of disease. 

Bright’s disease and tuberculous lesions are un¬ 
doubtedly the most frequent causes of wasting of the 
kidney, and it is not uncommon in very chronic 
cases of interstitial nephritis to find both kidneys 
weigh less than two or two and a half ounces. Such 
cases are, however, beyond the scope of this paper. 

Again, renal atrophy ub a consequence of obstruc¬ 
tion to the ureter or from endarteritis, cannot be 
considered at present. It is to cases of congenital 
atrophy, or wasting of the kidney in early life, that 
we desire more especially to direct attention, and the 
cases described above appear to come under this 
category. 

We may now consider some general questions con¬ 
nected with “ single kidney ” whether due to con¬ 
genital defect or to complete atrophy of the neigh¬ 
bouring organ. It is of interest to observe that 
“ single kidney ” is not peculiar to the human sub¬ 
ject, but has been seen in the lower animals also. 
Sutton, among others, states that this condition 
occurs in such animals as hens, horses, and sheep, and 
I have observed it in one instance in a calf. In these 
animals, as in men, the single kidney has been 
observed to have undergone increase in bulk. The 
following points in connection with single kidney may 
beconsidered :— 

(a) Duration of life of the individual. 

(1>) Size of the kidney, compensatory hypertrophy. 

(c) Form, position, and side affected. 

(d) Sex and age of the individual. 

(e) Liability of a single kidney to disease. 

(f) Condition of the kidney, ureters, and vessels 

on the affected side, and on the side of the 
single kidney. 

( g ) Malformation of the other organs. 

( h) Position of adrenal body. 

fa) Duration of life of the individual. The 
absence of one kidney, especially when compensated 
for by augmentation in size, and by increased func¬ 
tional activity of its neighbour, does not seem to 
seriously influence the duration of life, so long as 
there is sufficient renal tissue left in the remaining 
organ to fulfil the function of life, as doubtless we 


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478 The Medical Press. ORIGINAL COMMUNICATIONS. May 10 , 1809. 


are endowed, in the normal state, with considerably 
more renal tissue than is necessary for even active 
and vigorous life. 

In the post-mortem room kidneys containing very 
little active secreting tissue are frequently found in 
the bodies of individuals who have, as far as is known, 
never suffered from any symptoms of renal insuffi¬ 
ciency. 

The following table shows the age at death of 17 
case6 of single kidney when death occurred after the 
age of 60 years was past:— 

8 persons died between 60-65 years. 

1 „ „ 65 70 „ 

4 „ „ 70-75 „ 

2 „ „ 75-80 „ 

2 „ „ over 80 „ 

17 



Fig. 11. 

It can be easily understood, however, that in an 
ndividual with only one kidney, if that kidney be¬ 
comes affected by any serious malady such as obstruc¬ 
tion to the ureter, thrombosis, or any local inflammatory 
infection, the risk to life is areally increased by the 
existence of only one organ. In single compensa¬ 
tory hypertrophy is the rule when the individual 
survives through the term of infancy, hut even in the 
ftetus considerable enlargement of the kidney has 
been seen. Morris mentions an instance of this in “ a 
well-informed foetus born at full time,” where “ a 
right kidney only was present, and was twice its 
natural size ; the ureter was much dilated.” 

(6) In estimating the degree of compensatory hyper¬ 
trophy in recorded cases, care must oe taken to ex¬ 
clude instances where the single kidney has become 
enlarged by disease ; for instance, Morgagni describes 
a case where one kidney was functionally inactive, 


while its neighbour was ten times the normal size, 
and he mentions another case where a single kidney 
weighed 35 pounds. Again, Rhodius (a) records a 
case in whicn a kidney was so enlarged as to give 
rise to the suspicion of pregnancy. Eustachins, 
Veealius (b), Poupart (c), Perrin ( d ), Breschet (e^,and 
other old writers have recorded similar cases, in all 
of which it is very evident that the enlargement was 
due to disease rather than to a true hypertrophy of 
the organ. It may be said that when the single 
kidney is increased to much more than twice the 
normal size the enlargement is not entirely due to 
compensatory hypertrophy. 

In true compensatory hypertrophy the kidney is 
found to be homogeneously enlarged in all its parts, 
and seldom if ever weighs more than two normal 
kidneys. Take for example other organs. Some¬ 
times hypertrophy occurs in cases of congenital non¬ 
inflation of one lung, the neighbouring organ being 
increased in bulk, so also in the liver, when one por¬ 
tion becomes atrophied another may undergo hyper¬ 
trophy. So many cases of compensatory hypertrophy 
in single kidney have been recorded that it is impos¬ 
sible to mention more than a few of them, but for the 
sake of reference I may give the following:— 
Duckworth (/), Macdonald (y), Palma (h), Bracken- 
burg (i). Northrup (j ), Davies (k). Pollock (1), 
Hewett (to), Gubbin (n). 

On the other hand, it does not always follow that 
because one kidney is undeveloped or functionally 
useless the other organ must be considerably en¬ 
larged. Instances of single kidney, normal in size, 
have lieen seen by Turner, (o) Mayor, ( p ) Hamy, (q) 
Bostrom, (r) Brown («) and many others. 

(c) Position, form, and side affected —In the absence 
of one kidney the remaining organ may (as in Fig. 8) 
occupy its normal position in the loin. This is 
usually the case in atrophy of one kidney from 
disease. Dr. P. W. Macdonald ( t ) described a case 
in which the right kidney and ureter were absent, 
while the left kidney was normal in position, and 
had a normal ureter entering the bladder in the 
ordinary situation. Similar cases have been described 
b 7 Gubbin, Peacock, Lorain, and Gruber Single 
kidnev, when due to want of development of its 
neighbour, is more likely to be misplaced and altered 
in form. 

In many cases, however, the single kidney remains 
normal in shape as well as natural in 8'ze, and, even 
in those cases where there is considerable hypertrophy, 
the renal for mis strictly maintained, the organ being 
simply increased in all its dimensions. Indeed, 
alterations in form are not common. In some cases, 
however, the organ is much elongated, in others disc¬ 
shaped, angular, or relatively thickened, and not un¬ 
commonly lobulated. Dr. M. Watson (u) described 
a case of congenital absence of one kidney, in which 
the remaining organ was normal in size but circular 


(а) Rayer's "Maladies dee Reins.” 

(б) “ De Corporis Humani fabrica,” lib. V., cap. 10. 

(c) “ Histoire de l'Academie royale dea Sciences,'' Paris, annee 
1700, p. 35. 

( d) “ Jonrn. de Med. de Chirur, et de Pharmac.,” Tom. XIII. 
Novembre 1700, p. 431. 

(») •' Medico-ChiruTfical Transations, Vol. IX., 1818, p. 437. 

( f) “ Pathological Society's Transactions.” Vol. xx., p. 232. 
la) “ Lancet,” May 30th, 1885. 

(5) “ Pra*rer Med. Woclienschr.,” 1801, xvi. “Jalirg.” No. 33, 
p. :5*>. 

(*) ” Lancet,” London, 1801, Vol. it., p. 860. 

(i) “ Medicul Record," New York, Vol. xxxii., p 608. 

(fr) “ British Medical Journal,” 1885, Vol. it., p. 397. 

(l) "Lancet,” 1863, Vol. It., p. 622. 

(m) “ Lancet,” 1863, Vol. II , p. 622. 

(n) “ British Medical Journnl,” 1883, Vol. i., p. 115. 

id) “ Edinburgh Medical Journal,” February. 1865, p. 687. 

Ip) “ Bulletins de la Societe Anatomique de Paris," 1876, p. 502. 

( q) " Joum. de l’Anatomie et dela Physiol.,” 1884. p. 103. 
lr) "BeitniKe zur Pathol. Anat. der Nieren,” Heft i., 1884, 
p. 36. 

'*) " Journal of Anatomy and Physiology,” Vol. xxvm , p. 198. 

I (tl “ Lancet." May :50th, 1885. 

(u) "Edinburgh Medical Journal,” Vol. ii., 1874, p. 13. 


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Mat 10, 1806. 


ORIGINAL COMMUNICATIONS.' The Medical .Press 479 


in form, the surface was distinctly lobulated, and the 
kidney was situated close to the brim of the pelvis. 

Polk (a) also describes a case of single kidney where 
the organ was displaced into the iliac fossa, while 
Marzolo ( b ) records an instance where the right kid¬ 
ney was found lying on the right sacro-iliac synchon¬ 
drosis. Wiesbach (c) and Lombroso (d) publish 
instances in which misplaced kidney was associated 
with other abnormalities. The side most frequently 
affected is the left, especially in male subjects; in 
the female the right and the left kidneys are equally 
liable to the malformation. 

(d) The influence of age aud sex. —The abnormality 
is found twice as often in males as in females, a cir¬ 
cumstance which may be accounted for by the fact 
that necropsies are more often procured in the former 
sex than in the latter. About 10 per cent, of the 
specimens published were met with in the body of 
the foetus, or in newly-born children, and, in most of j 
these cases, the anomalous condition of the kidney ] 
was associated with some other congenital deformity, 
such as imperforate anus, deformities of the bladder, 
uterus, ovaries, &c.‘ 

In individuals who have lived, notwithstanding the 
deformity of the kidney, there is nothing remarkable 
to note regarding their age at the time of death, the 
mortality being almost equally distributed up to 
sixty years of age; over that age, as already shown, 
seventeen cases are recorded. 

(e) Liability to disease in single kidney is marked. 
—Chronic nephritis, renal calculus, tuberculous dis¬ 
ease, hydronephrosis, pyonephrosis, and abscess being 
the most common maladies met with. Morris (c) 
says: “ Probably, as has been above stated, there is 
a tendency to chronic albuminuria in early or young 
life in persons with one kidney atrophied. When 
only one kidney exists, and t hat an “ unsymmetrical” 
organ, there would seem to be a considerable disposi¬ 
tion to renal calculus. Of the twelve cases of “ un- 
sym metrical ” kidney collected by Mosler, death was 
due more or less directly to calculus in the pelvis or 
ureter in nine of them -, in the other three, cancer of 
the bladder and rectum involved the ureter; nephritis, 
and the consequences of obstruction due to severe 
congenital phymosie, were respectively the causes of 
death. In the case of cancer (Tulpius), a calculus 
had been passed per rectum in early life, and there 
was an opening from the ureter into the rectum 
through which part of the urine escaped.” 

I have collected eight cases of “ single kidney ” in 
which calculus was present. These were published 
by Rhodius, (/) Jobi. (g) Rokitansky, (h) Rayer, ( i ) 
C. Julia Fontenelle, (j) Everard Home, (k) Sylva- 
ticus. ( l) 

Chronic tuberculous and interstitial nephritis is 
also very common, a few cases of hydronephrosis have 
been recorded, and one or two of tuberculous disease, 
pyonephrosis, and abscess. 

(f) The condition of the kidney, ureters, and blood¬ 
vessels on the affected side.— In cases of congenital 
absence of one kidney the ureters and renal vessels 
on the afEected side are absent, or only represented 
by a cord of fibrous tissue, and in all cases where a 
rudimentary ureter has been found, the opening into 
the bladder has been obliterated. Indeed, single 
kidney due to want of development may be distin¬ 
ct) “Lancet.'' Vol. I., i>. 514. 

lb) “R. Ins. Veneto di he. Elettre," 1879. 

(c) “ Wiener Medicinische Wochen, 1897. No. 2, a. 20. 

(d) “ Gazzetta Medica Italinna,'' February, 1800. 

(p) “ Diseases of the Kidney.” p. 100. 

( f) “Mantissa Anatomica, Observatio,” xxxri., 1661, p. 21. 

(p) “a Meek'ren, Observations Medico-Chirurgicee,” Amstelo- 
<lami, 1682, cap. xl., p. 169. 

iAi “Lehrb. der Pathologischen Anatomie.” Bd. in., 1861, s. 317. 

( 1 1 •* Trait* des Maladies des Reins.” Tome i., 1839, p. 4<4. 

(,') Archives Gen*rales de Medecine,” Tome n„ 1824, p. 517. 

Ik) “ Practicul Observations on the Treatment of the Diseases of 
•the Prostate Gland,” London. 1811, Vol. i., d. 68. 

(1) Cited by “ Lieutand. Historia Anat. Med.” Tome i., p. 284. 


guished from that caused by disease and atrophy by 
the condition of the ureters and the blood-vessels. 

When “ single ” kidney is the result of disease the 
condition of the diseased kidney varies very consider¬ 
ably, it may be represented only by a mass of fibrous 
tissue, small congeries of cysts, or a nodule of fat. 
Sometimes the kidney is very small and occasionally 
lobulated; there may be remnants of renal tissue 
remaining, and the ureters may be either occluded, 
atent, or even dilated. The appearance of the wasten 
idney depends upon the causes of atrophy, which are 
either sudden ana complete obstruction to the passage 
of urine from the pelvis, or obliteration of the renal 
artery at an early period of life. Frequently we meet 
with greatly wasted kidneys as a consequence of 
disease late in life, as, for example, in tuberculous 
lesions, or in chronic inflammatory affections attack¬ 
ing one kidney only. These, however, do not come 
within the scope of this paper. 

The pelvis and ureter of the “ single kidney ” are 
seldom much altered, and are never double, as has 
been described by some authors. Cases of a kidney 
provided with double pelves, double ureters, extend¬ 
ing to and entering the bladder at different points 
must be looked upon as examples of “fused kidney” 
rather than of tine “ single kidney.’’ In many con¬ 
genital cases, however, the arteries and veins are 
anomalous in their distribution, and, as might be 
expected, are collectively larger in size than normal. 

Dr. M. Wilson (a) describes a case of congenital 
absence of the right kidney where the left organ was 
1 enlarged, circular in form, and lobulated on the sur¬ 
face, and situated close to the brim of the pelvis, in 
; front of the common and external iliac arteries of 
that side, with which it was in contact. Its duct, 
which was enlarged at the hilus, so as at first sight 
, to resemble a cyst, gradually narrowed, but continued 
: to be of greater calibre than usual throughout its 
course, except at the point of entrance into the 
J bladder, where it assumed the normal size. The left 
' renal artery came ofE from the point of bifurcation of 
! the aorta, passed obliquely downwards and outwards, 
resting on the front of the left common iliac artery, 
and entered the upper extremity of the kidney, having 
previously divided into two branches. Dr. W. F. 
Menzies (b) describes a case of “ single kidney,” in 
which he states that the arterial supply was as 
, follows :— 

Just above the bifurcation of the aorta a branch 
■ was given ofF from the anterior aspect, and ran to the 
inferior internal corner of the kidney, entering it at 
; about a quarter of an inch from the edge of the 
posterior surface. From the right common iliac a 
third renal artery took its origin, and entered the 
i organ in close proximity, but inferior to the former. 

| The middle and inferior sources of supply were long 
straight vessels of similar lumen to the superior ” 

Similar anomalies of the circulation in “single 
kidney” have been noticed by Hebb (c), Strube (d) 
Macdonald Brown (e), Macdonald ( f), Duckworth (g) 
Tourtual (li). 

(g) Malformation of other organs, such as the rectum, 
the bladder, the uterus, the vagina, and the ovaries, 
frequently accompany congenital defects in the 
kidney. This is not to be wondered at when we 
remember the close embryonic relationship of these 
parts, but this is a subject which is rather beyond the 
scope of this paper. 

a) ” Edinburgh Medicnl Journal,” Vol. XX., Part i , p. 13. 

(b) “ Journal of Anatomy and Physiology,” Vol. XXXI., i>. 111. 

(c) “Transactions of the Pathological Society of London,” 1885, 
Vol. XXXVI., p. 281. 

(d) “ Uber Congenitale Lage- und Bildungsanomaliender Nieren.” 
Virchow's “ Archiv.”, Bd. 137, 1894. 

(e) “ Journal of Anatomy and Pnyxiology," Vol. XXVIII., p. 197. 

ifi “Lrncet,” 1885, Vol I.. p. 979. 

(pi •• Transactions of the Pathological Society of London,” Vol. 

, XX., 1896. 

(h) “ Zweiter Anatomischer Bericlit u. s. w.,” Munster, 1833, 8. 69 

D 

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May 10, 1800. 


480 i’hk Mbdtcal Pbms. ORIGINAL COMMUNICATIONS. 


(h) The position of the adrenal body on the affected 
side varies considerably. Sometimes where the 
kidney is small or altosrether wanting, the adrenal 
body is natural in size and normal in position; on 
the other hand, however, commonly the adrenal 
body is misplaced, and undoubtedly in a few instances 
may not be present; or again the “ single kidney ” 
may have two adrenal bodies, as in a case published 
by Liebmann (a), where a “ single kidney.” lying in 
the pelvis, had two adrenals associated with it. 
Brumer (b) states that in forty-eight cases of “ single 
kidney ” which he had collected the adrenal bodies 
were only absent in five. 

3. Absence of both kidneys is found in the lower 
grade of monstrosities only, and, according to 
Beclard, this anomaly is most frequently met with in 
acephalous monsters. Chaussier(c) showed a foetus 
in which the urinary bladder, kidneys, and uterus 
were entirely absent, and Mayer (d) also published an 
example where the same organs were wanting. These 
cases may be of great interest from the embryological 
standpoint; and from the physiological side they are 
also of interest, as illustrating that the most impor¬ 
tant functions of life may be preserved in utero, 
without the presence of any renal tissue; but they 
are of no practical value to the surgeon. 

(To be concluded in our next.) 


“ DAYMARE.” 

By TOM ROBINSON. M.D., 

Physician to the Western Skin Hrspital. 

A gentleman consulted me with the following 
somewhat curious history:—“I was coming up 
to London a fortnight since, and when we were 
passing through a tunnel a feeling came over 
me that I must get out. I was trembling, and I 
felt like a child in a dark cupboard, so strong was 
this feeling that I left the carriage at the next 
stoppage, remained all night there, and travelled up 
to London the following day by a slow train. I am not 
usually timid in a train, I have never been in a rail¬ 
way accident, and I am totally unable to account 
for this sensation; all I know is that I feel quite con¬ 
vinced that had I not got out of the carriage T 
believe that I should have jumped out of the window. 
I am ashamed to come with such a story. I don’t 
think I am what would be called a coward. As I 
ride to hounds, and I have been in some tight places 
in my life, and. honestly, I don’t think I ever showed 
the white feather.” My patient was forty years of 
age; he was, so far as clinical observation went, a 
sound man. His family history embraced several 
odd symptoms, without pointing to any definite 
proclivities either mental or physical. Physically he 
was a healthy looking man, and conducted himself 
quietly and sensibly whilst in my room. 

It would be easy to select a group of cases which 
we may designate “Daymare.” For instance, it is 
not uncommon to meet with robust and sturdy men 
who cannot go near to the edge of a cliff, look out of 
a high window, or climb a ladder, at least they assert 
that if they were to do so a strange, trembling, 
uncertain feeling creeps over them, and they think 
they must lose their balance and throw themselves 
over. Others are unable to sit in a crowded building, 
such asachurch or a theatre. Others, again, will tell us 
that they experience the same sensation if they are in 
a crowd. Many women and some men have a sensa¬ 
tion of approaching calamity if they ride in a con¬ 
veyance of any kind which is drawn by a horse. 
These very individuals will usually ride tranquilly in 

(a) •• Tenth, fur Chir.,” 1«S7. 

(hi Virchow's “Archiv.," Vol. LXXII., p. 344. 

(e) “ Bull, de la Faculty tic Med. de Pnris,” 1810, p. 35 
(d) “ Journal des Progrea," Tome IV., p. 281. 


a train. We are seldom consulted primarily for these 
troubles they usually come under our notice in 
gathering up the history of a case. 

One thing is certain, that the majority of 
such instances spring out of those who have 
what is known ub the nervous temperament. In 
other words, they are subject to cold feet, at times 
pass abundant and pale urine, and have a generally 
unstable nervous system, with tremulous upper eyelids, 
best seen when the eyes are shut. There is not any 
morbid anatomy connected with such cases, the 
changes are only fugitive and functional. The 
practical question is, can we suggest any line of treat¬ 
ment with any hope of helping our patient in these 
odd cases P I am afraid we are only able to point out 
to these people the fact that the remedy is in their own 
bands, that they must try to conquer their terror, but 
we can and we ought to impress upon them not to lean 
upon alcohol or drugs for support. These will cer¬ 
tainly give them confidence for a time, but there is 
always the force of habit to be remembered, and the 
man or woman who takes a dose of bromide or opium, 
or a stiff glass of whiskey, before commencing a jour¬ 
ney, runs a risk, and a great risk, of becoming a victim 
to habit. These patients will sometimes say, “ Give 
me something which I can take when I feel queer,” 
and if we are wise we shall do so. A little 
tincture of valerian is as good as anything; 
it will generally remain untasted in the bottle. 
It is astonishing to notice how many go about 
with a little bottle full of some medicament 
which they will be able to take “ if they are queer,” 
and it is equally astonishing to know how long a 
single dose will last con fid o conquiesco. There are 
many other terrors which profoundly affect indi¬ 
viduals besides these of space, terrors which dislocate 
the reason and produce physical effects out of all 
proportion to their origin. There is the large group of 
individuals who are always going to their doctor 
because they are afraid they are going mad, others fret 
themselves tremendously because they are afraid they 
are going to have some malady such as cancer or con¬ 
sumption. I have known a man labour for some years 
under the fixed delusion that he was the victim of 
syphilis; another will gloat day by day over an 
examination of his own faeces, which, he says, are 
never healthy. Could any of us define healthy faeces ? 
Everv internal organ meets the attention of many 
who tave time on their hands and the nervous tempera¬ 
ment, and to all these a floating kidney appeals with 
striking force. And the lives of thousands of women 
are practically spent in the contemplation of a 
sluggish liver. In all seriousness such cases 
are too often the vampires in a family. No one is so 
selfish as the self-absorbed. Give these patients what 
names we like, either neurotics, hypochondriacs, or 
hysterics, say with Shakespeare that “ their flesh is 
mad.” the fact remains that to us they look for 
assistance. With disease which has a morbid 
anatomy we experience but little difficulty, because 
we, to a large extent, know the course which the 
malady will usually run ; but these individuals whose 
whole tissues seem crazy, whose special senses do not 
appear to see the world as others see it, who, in one 
word want common sense, these constitute an enor¬ 
mous bulk of those who appeal to us. What 
we can do is to listen patiently to their complaints, 
to examine every organ carefully, and then to speak 
with absolute frankness; many of the most gifted 
men and women which the world has ever seen have 
had daymare. Martin Luther threw the ink-pot at 
the devil; Napoleon I. used to say he had|heart-disease: 
Sam Johnson was profoundly imaginative. My late 
gifted teacher, Dr. Sutton, said with so penetrating 
a truth, “ It really is a grand thing to be nervous, 
often much unpleasantness and pain are mixed with 
it, but that is owing to abuse. The world’s work is 


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CLINICAL RECORDS. 


The Medical Press. 481 


done by the nervous. We may see that the greatest 
workers are the most nervous, the most sensitive 
among men.” 


TREATMENT OF GONORRHCEA 
IN THE MALE, (a) 

By J. D. THOMAS, M.D., 

Professor of Genitourinary Diseases, Western Pennsylvania 
College, Pittsburg, &c., &c. 

“ There is no royal road to geometry ” ; neither 
is there a royal road to the cure of gonorrhoea, as 
those who have' extensive experience with the disease 
will testify. That the vast majority of cates of 
gonorrhoea are recovered from within six or eight 
weeks is true, but it is also true that a certain pro¬ 
portion is very rebellious to treatment. Some of 
these latter recover after prolonged treatment, whilst 
a few appear to be incurable. I believe that most 
urethrae that have once undergone a marked 
attack of the disease suffer some permanent impair¬ 
ment, evidenced by hyperesthesia, an urethritis of 
simple character from trivial causes, prostatic 
neurasthenia, to say nothing of the more gross 
lesions, such as stricture, &c.; therefore, an early 
cure is a very important matter, as it prevents the 
many sequels which may follow. 

With regard to treatment, I recognise three types, 
or classes, of the disease, viz.:—1. A virgin gonor¬ 
rhoea, in which the inflammation is of a severe char¬ 
acter. 2. A virgin gonorrhoea, in which the inflam¬ 
mation is of a moderate or mild character; and 3, a 
multigonorrhoea, for in this last class the inflamma¬ 
tion, as a rule, is subacute or moderate. Classes 2 
and 3 may be treated along the same lines, unless 
there are special pathological lesions left from the 
previous attacks in Class 3. 

In the first class, irrigations or injections are im¬ 
practicable. The urethra is so swollen that the uiine 
is voided in a small stream and with a great deal of 
pain. It is still more painful to attempt to inject a 
solution of any kind into such an urethra, for, in the 
first place, it will not enter, and, in the next place, 
the attempt is a source of irritation. In this class 
catharsis is indicated, together with full doses of 
sodium bicarbonate (or any of the alkalies) with hot 
water, persistently applied, locally. Quietude, with 
proper hygiene, general and sexual, is also important. 
To Keep the bowels open, a drachm of sulphate of 
magnesia may be given morning and evening. With 
the evening dose, thirty grains, or more, of bromide 
of potassium may be combined. This will tend to 
keep down erections, which are accompanied with 
chordee, and at the same time aid in securing rest. 
After the acute symptoms subside, the same line of 
treatment may be followed in Classes 2 and 3, which 
1 now outline. 

Irrigation by the Janet method is, without doubt, 
a great aid in the treatment of gonorrhoea. It is 
carried out thus: Fill a fountain syringe, placed 
six to eight feet high, with the solution hereafter 
described. The end of the rubber tube is fitted 
with a glass nozzle. The nozzle fits in the 
meatus, and the irrigation is accomplished without 
passing any instrument into the urethra. It is not a 
specific or “ sure cure,” as some would have us believe, 
but it is a good method of cleansing the urethra 
with copious quantities of antiseptic fluids. It is less 
painful than attempting to accomplish the same 
results with a catheter or retrojection tube passed to 
the bulbous portion of the urethra. After the first 
irrigation, when the patient may be somewhat nervous, 
the method is painless, agreeable, and satisfactory. 

(a) From the “ International Medical Magazine,” April, 1899. 


The best general solution to use is that of perman- 

f nate of potassium of the strength of 1—4,000 to 
-3,000. I do not vary the strength of the solution 
much, for if it is too strong, some smarting will be 
produced, and it cannot be used in sufficient strength 
to act as a germicide. Strong solutions are less 
efficient than those that produce no pain. Having 
used other solutions, as bichloride of mercury, 
formaldehyd, &c., and having found them less 
efficient than the permanganate, I now use the latter 
almost exclusively. 

To make the irrigation method successful, it must 
be given morning and evening for six day3, then once 
a day untill the case is cured. If at the end of two 
weeks it is found that no better results are being 
obtained than by methods that take up less of the 
physician's time, it is then better to resort to some of 
the other methods. 

If the patient cannot receive office treatment daily, 
the Janet method cannot be utilised, except as 
auxiliary treatment, and it becomes necessary to 
resort to the injection method. The medicines used 
for this purpose are numerous. Personally, I prefer 
the following injection, viz. 

B Zinci sulphocarb., gr. xv. 

Acidi boric, gr. xxx. 

Aq. destillat., gvj. 

Sig.—To be used as an injection every two or three 
hours, after urination. 

To prescribe an injection to be used three times a 
day is temporising and inefficient. The patient 
should also be instructed to use the injection at least 
twice during sleeping hours. By this method the pus, 
with the gonococci, is washed away, and nature is 
given a better chance in the conflict. If the patient 
is not making satisfactory progress, the physician 
himself may occasionally give an injection of nitrate 
of silver, grain I to the ounce. In addition to the 
local treatment, salol with oil of sandal-wood, or 
copaiba, may be given three times a day. 

When the deep urethra is involved, if we are using 
the irrigation method, the solution should be carried, 
after first cleansing the anterior urethra, through the 
urethra into the bladder; the patient is then per¬ 
mitted to void it. This process is repeated two or 
three times during each seance, as the bladder will 
not bear a large amount of the solution at each 
attempt. When the irrigation method is not prac¬ 
ticable, instillations may be substituted, nitrate of 
silver grain 1 or more to the ounce being used, but 
not oftener than every three or four days. Salol and 
the alkalies are here quite beneficial. Hot water, 
injected into the rectum, may also be useful. If, at 
the end of six or eight weeks, there remains some 
discharge, the passage of a fairly full-sized sound 
may lie practiced. If, after the passage of the sound, 
the case improves, the treatment may be repeated 
every fourth day, but, if not, it must be discontinued 
immediately. 


Clinical ^frccorbs. 


TWO CASES OF ECLAMPSIA SUCCESSFULLY 
TREATED BY VENESECTION AND INTRA¬ 
VENOUS INFUSION OF SALT SOLUTION, (a) 

By Charles N. Cutler, M.D., ChelBea, Mass. 

The first case was a primipara, set. 25, at full term 
of pregnancy, confined October 13th, 1898; labour 
normal, duration of second stage about one and one- 
half hours. The first convulsions came on during the 
delivery of the head, and were repeated somewhat 
regularly with fifteen or twenty minutes intervals. The 
administration of ether was immediately resorted to, and 

(a) From the *' Boston Medical and Surgical Journal,” March 
30th, 18H9. 


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482 This Medical Press. 


TRANSACTIONS OP SOCIETIES. 


May 10, 1899. 


one-eighth grain pilocarpine with one-half grain mor¬ 
phine given hypodermically. Consciousness did not 
return after the first interval. Pulse 125, temperature 
not noted. The patient hid five convulsions up to the 
time of receiving the intravenous injection. Total sup¬ 
pression of urine. 

With the assistance of Dr. George C. Hall, the median 
basilic vein was opened, and about eight ounces of blood 
allowed to escape, followed by the introduction of about 
one quart of normal saline solution. 

Ten minutes after completing the operation the pulse 
fell to 108, later to 104 ; consciousness returned in half 
an hour. 

The catheter was introduced directly after the injec¬ 
tion and two ounces of urine obtained, which became 
Bolid when subjected to the heat test. Three hours after 
the injection twelve ounces of urine were obtained by 
catheter. 

Two hours later, on introducing the catheter, but two 
or three ounces of urine were obtained, showing a return¬ 
ing suppression; this was very soon followed by a 
convulsion very much milder in form than those which 
preceded it. Three convulsions followed at hourly 
intervals. The secretion of urine then began to in¬ 
crease ; fourteen ounces were, secreted in the three hours 
following the last convulsion. Consciousness again 
returned and the patient recovered rapidly without 
incident. 

Twenty-four hours after the cessation of convulsions 
the urine showed a slight trace of albumen. 

The second case occurred in the practioe of Dr. W. G. 
Bond, of Revere. A multipara with her second child, 
eight months pregnant, was attacked with a convulsion 
at 12 a.m., January 24th, 1899. 

Premature labour was induced by Dr. Bond and com¬ 
pleted about 4 a.m. Prior to this the patient had had three 
convulsions, notwithstanding the free exhibition of 
chloral, potassium bromide, morphine, pilocarpine, and 
the administration of ether. 

After delivery the convulsions oeased for eight hours. 
From 12 o’clock January 24th until 2 o’clock a.m. 
January 25th she had eleven convulsions, increasing in 
severity, frequency, and duration, the patient not 
regaining consciousness in intervals between the last 
three convulsions. 

At 2 a.m. January 25th one-half ounce urine was drawn 
by catheter, which showed over one per cent, albumen. 

At 3 o’clock a.m. January 25th the median basilic vein 
was opened and from twelve to sixteen ounces of blood 
allowed to escape, after which the cannula was introduced 
and two quarts saline solution injected. The pulse 
rapidly fell from 130 to 88 per minute. Consciousness 
returned as soon as the patient recovered from the 
anaesthesia. 

The patient was catheterised at 4 o’clock a.m., one 
hour after the introduction of the solution, and fifteen 
ounces of urine were drawn; again at 7 o'clock six 
ounces; at 9 o’clock three ounces, at 12 o’clock twelve 
ounces. 

In the twenty-four hours following the operation forty 
ounces of urine were secured. 

At 12.30 o’clock a.m., of the 27th the second suppres¬ 
sion of urine began ; between this and 3 pm. only nine 
ounces were secured. At this time, sixty-one hours 
after the last convulsion, a partial convulsion occurred, 
followed by delirium, and it was thought best to subject 
the patient to another infusion. Accordingly the vessel 
was opened and eight ounces of blood allowed to escape, 
followed by the introduction of two quarts saline solution. 
This entirely overcame the delirium. Urinary secre¬ 
tions commenced in earnest, and sixty-four ounces were 
secreted in the following twenty-four hours, and as 
much each day until the mine became normal in 
quantity as well as quality. 

Circumstances surrounding the first case rendered it 
impossible to preserve a more detailed record. Like the 
second case, it clearly proved the tendency in these 
cases to a secondary suppression of urine, which must 
he promptly met by a second intravenous injection. 
Whether a second bleeding was indicated remains a 
question of some doubt. 


transactions of gocicties. 

ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Pathology. 

Meeting held Friday, March 24 th, 1899 . 


The President of the Academy, Prof. E. H. Bennett, 
in the Chair. 

brodie’8 abscess in tibia. 

Mr. Henry Gray Croly communicated several cases 
of Brodie’s abscess, and exhibited portions of bone 
removed by a small trephine and drawings of the cases ; 
the bones were much thiokened and diseased. Imme¬ 
diate relief followed the operation in all cases. 

Mr. E. H. Bennett noted that they were not con¬ 
fined to the epiphyses as described by Brodie. He 
believed that they had nothing to do with tuberculous 
disease of the bone, owing to their great chronicity, and 
the fact that they are relieved by emptying. 

Mr. T. Myles related the case of a boy who returned 3 
years after operation with a superficial abscess over the 
site of the original Brodie’s abscess. No new bone had 
formed in the cavity. Another case on which he operated 
was remarkable in its recovery in that the skin dipped 
down into the recess, and patient had now a pocket 
extending backwards an inch in depth into the tibia. 
He thought that the explanation of the alleged frequency 
of this condition in the tibia was that the disease was 
not recognised when occurring in other situations. 

Dr. Knott pointed out that in Brodie’s cases there 
was no external appearance to guide to a diagnosis. 

Mr. T. E. Gordon referred to the case of a patient, 
set. 45, who had fiist noticed a swelling after an injury 
received twenty or thirty years previously. About twelve 
years ago a sinus had formed and closed, and a second 
formed and closed, but a third sinus which formed per¬ 
sisted. A thick layer of dense bone was chiselled 
through with difficulty, and a large abscess found in the 
bone. 

Mr. Croly, in reply to Mr. Myles, admitted that cir¬ 
cumscribed absoess of bone was not confined to the tibia, 
though it was met much more frequently there. 

enteric fever with fatal embolic hemiplegia. 

Dr. J. W. Moore reported the case of a married 
woman, rot. 29, who died on the forty-third day of an 
attack of enterio fever. Severe intestinal haemorrhage 
occurred as early as the tenth day, persisting for three 
days. The patient, notwithstanding, progressed favour¬ 
ably until the twenty-seventh day, when a fresh rise of 
temperature, pain in the left side and a choking sensa¬ 
tion marked the occurrence of haemorrhagic infarction in 
the spleen. Eleven dayB later, a violent rigor and rapid 
rise of temperature to 105'6 dega. ushered in an attack of 
right hemiplegia with complete aphasia. The patient 
sank and died on the forty-third day. The heart was 
Boftened. An ante-mortem clot was found in the left 
auricle. The left middle cerebral artery was blocked by 
a firm embolus. The spleen was the seat of several 
hemorrhagic infarctions. The terminal few inches of 
the ileum showed frequent excavations formed by the 
previous detachment of numerous typhoid ulcers. 

Dr. E. J. McWeeney mentioned a case in which the 
pneumococcus of Fraenkel became localised in the 
meninges after the morbid process to which it gave 
rise had been successfully overcome in the lung, also 
a recent case in which the symptoms were indistinguish¬ 
able from meningitis, and the real nature of the case 
was only ascertained by Widal’s reaction. 

Dr. R. Travers Smith asked if the myocardium 
exhibited parenchymatous or fatty degeneration ? 

Dr. J. W. Moore, in reply, said that the endocardium 
was perfectly healthy, and that he could not account 
for the ante-mortem clotting. No minute examination 
of the heart muscle was made. 

Dr. D. F. Rambaut exhibited specimens of primary 
carcinoma of liver, with enormous enlargement of 
spleen. 


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TRANSACTIONS OF SOCIETIES. 


The MEDICAL J?B*88. 483 


_ May 10 , 1899 . 

GALL-STONES WITH MULTIPLE AB8CE88 OF LIVER AND 
CARCINOMA OF THE BLADDER. 

The Secretary (Prof. McWeeney) showed the liver 
of a woman, set. 70, who suffered from severe and per¬ 
sistent jaundice for several months before death, and 
was thought to have cancer of the liver. Post-mortem 
the organ was not much enlarged (weighed 60 ore ), but 
was studded on the surface end throughout with hun¬ 
dreds of small abscesses, varying in size from a pin’s 
head to a hazel nut, and containing a greenish pus, 
thick and inodorous. The larger bile ducts were greatly 
dilated and oontained inspissated bile mingled with soft 
gritty concretions. The common bile duct was large 
enough to hold the little finger, and contained several 
crumbling calculi, one of which quite blocked the passage 
into the duodenum. Of gall-bladder there was no trace, 
its position being occupied by a solid white nodule about 
the Bize of a walnut, to which the duodenum was firmly 
adherent. On microscopic examination this proved to 
have the structure of adeno-carcinoma, and a gradual 
transition from normal bile duct to carcinoma struc¬ 
ture could be distinctly traced in the sections. No 
trace of the wall of the gall-bladder could be de¬ 
tected with the microscope. The hepatic duct ran 
into this nodule, and the common bile duct ran 
from it to the duodenum. The cyBtic duct seemed 
to be represented by a solid cord about J in. in diam. 
The abscesses contained two varieties of bacillus coli, 
both highly virulent for animals. He was inclined to 
look upon the organisms as the primary setiological 
factor, then came the calculi, and finally the conversion 
of the gall-bladder into a solid mass of neoplasm. 

Dr. Littledale remarked that in the case of the 
kidney, when bacterium coli is found in the urine with 
symptoms of pain about the kidney, it was a sign of 
stone in the kidney. 

Dr. J. W. Moore commented on the fact that patients 
recovering from typhoid fever sometimes became subject 
to gall-stones, probably due to the localisation of 
Eberth’s bacillus producing a deposition of choleeterine 
and lime salts. 

Dr. Rambaut, in reply, said that there was a varicose 
condition of the gastric and oesophageal veins, and also 
the veins behind the peritoneum. He had lately made a 
post mortem examination on a woman who died of con¬ 
sumption, and found four abscesses in the liver. From 
the pus obtained he got almost a pure culture of bacterium 
coli. 

Dr. McWeeney, in reply, said that he had lately seen 
a very large kidney completely riddled with small 
abscesses containing a creamy pus which contained one 
organism only—the bacillus coli in prodigious numbers, 
and they could be seen easily filling up the urinary 
tubules. Without doubt, the process had penetrated 
from the pelvis through the papills, along the straight 
tubules, and had excited suppuration from the interior 
of the urinary tubules outwards. The same thing is 
constantly found in what are unjustly called “ surgical ” 
kidneys. In cases of typhoid fever, it was his experi¬ 
ence to find Eberth’s bacillus invariably present in the 
gall bladder. In fact, the bile seemed to be an ideal 
medium for the long preservation of the life of various 
pathogenic species of bacteria. 

Dr. Ninlan Falkinsr reported a case of peculiar clot 
from a case of ep is taxi a. 


EDINBURGH MEDICO-CHIRURGICAL SOCIETY. 
Meeting held May 3 rd, 1889 . 


Sir John Batty Tuke, President, in the Chair. 


Dr. R. Fleming showed specimens of ( 1 ) typhoid 
ulceration of intestine from a breast-fed child of ten 
months; ( 2 ) gumma of brain; ( 3 ) waxy degeneration 
of kidney and liver. 

Drs. Harvey Littlejohn and C. B. Ker read a paper 
dealing with 

the history and clinical features of the recent 
outbreak of typhus fever. 

Dr. Littlejohn said that there existed no records of 


the exact amount of typhus fever in Edinburgh prior to 
1879, when compulsory notification was enforced. There 
were, however, many hundreds of case4 annually. 
During the period 1880-98 482 cases were reported, 
with a mortality of 25 per cent. The yearly 
average of cases had diminished from 30, with 
a mortality of 28 per cent, in 1880-9, to 6, with a mor¬ 
tality of 14 per cent, in 1890-7 The epidemic of 1898-9 
began in the first week of October, reached its height 
during November, and died down in the middle of 
January. In all 82 cases were reported, but there was 
no doubt that earlier ones escaped recognition owing to 
the comparative rarity of the disease, and that those 
which proved fatal were certified as pneumonia, influ¬ 
enza, or bronchitis. The epidemic appeared to have 
originated at the wake of a man said to have died of 
pneumonia; it was kept up for two whole days amidst 
the most insanitary surroundings. Among the lessons 
taught by this epidemic, the speaker noted that 
the disease appeared to be communicated by direct 
contagion only, there being but one case in which 
this could not be demonstrated. No case was 
reported where the fever had spread in an infected 
tenement, apart, that is, from actual personal inter¬ 
course. It was also noteworthy that nearly a quarter 
of the cases occurred in children under ten—three times 
as many as in the next decade of life. There were no 
deaths below the age of fifty, and most of the fatal cases 
were in alcoholic subjects. In one instance, an old 
woman had infected twenty-two persons—her children 
and grandchildren—living in different parts of the 
town. The disease was stamped out by isolation of 
patients, disinfection of dwellings, and fifteen days’ 
quarantine of ail exposed persons. It was found that if 
some small compensation for rent, &c., were given, no 
objections were raised by persons put in quarantine. 

Speaking of the clinical featuieR of the epidemic. Dr. 
Ker said that his desire was to learn from some of the 
older members whether the type of the fever had altered 
since it was endemic in Edinburgh thirty years ago. iln 
two cases where the exact date of exposure to infection 
was known, the incubation period proved to be thirteen 
days ; in another, the disease developed two days after 
discharge from quarantine— i.e., at least seventeen days 
after exposure. Vomiting, headache, and pains in the 
limbs were the most common features of the invasion, 
and were present in thirty-seven per cent, of the cases. 
In a few cases the temperature rose suddenly ; usually, 
however, the rise was gradual, attaining its maximum 
about the fourth or fifth day. In one patient the tem¬ 
perature actually fell to normal on the morning of the 
third day—only, however, to rise again. The rash almost 
invariably appeared on the fourth day, and consisted of 
three elements:—(1) Raised rose-coloured spots, disap¬ 
pearing on pressure at first, but becoming duller and 
permanent later; the whole trunk and limbs were 
covered, but the face was spared; (2) similar spots 
beneath the skin—the subcuticular mottling—often best 
seen in the axilla; (3) haemorrhages. The second of 
these elements was the first to appear - it might be seen 
as early as the second day. In all the favourable cases 
the temperature tended to recede a little about the 
seventh day, and, as a rule, the cases terminated on the 
thirteenth or fourteenth day by a crisis lasting for two 
or three days. Most of the fatal cases died at the crisis 
—in only one case later. The urine of the fifteen con¬ 
secutive cases gave the diazo-reaction; after this the 
examination in this respect was suspended. None of 
the cases examined give Widal’s reaction. One patient 
had had an undoubted attack of typhus six years 
previously. Among the complications were two cases of 
pregnancy—in neither instance did miscarriage ensue. 
Otorrhcea occurred twice, severe diarrhoea seven times, 
hypostatic pneumonia six times, parotitis once, and 
nephritis once. Fewer females died than males; the 
prognosis was worst in alcoholics, in old people, and in 
cases whose temperature did not fall a little about the 
end of the first week. As regards the treatment adopted: 
the temperature of the wards was kept low, 55 to 
60 deg. F. by day, and about 50 deg. F. at night. In 
addition, few bed-clothes were allowed, and these two 
procedures seemed to help to keep the temperature down 


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464 Thb Medical Press. 


TRANSACTIONS OF SOCIETIES. 


Mat 10, 1609. 


a little. Insomnia’ almost always required treatment; 
for this, sulphonal, paraldehyde, and occasionally 
chloral, were the drags most relied upon. It was of 
some interest that the staff of sixteen nurses and four 
doctors engaged in looking after the cases escaped com¬ 
pletely ; Dr. Ker ascribed this to the great care taken to 
secure good ventilation, and to the frequent sponging of 
the patients with disinfectants. 

Sir John Tuke and Drs. James Carmichael, Affleck. P. 
A. Young, James, and Argyll Robertson took part in the 
discussion which followed. It was generally agreed that 
this outbreak of typhus fever seemed in no way different 
from those seen a quarter of a century ago. 


HARVEIAN SOCIETY OP LONDON. 
Clinical Evening. 

Meeting held Thursday, April 20 th, 1899 . 
H. E. Juler, F.R.C.S., President, in the Chair. 


COXA VARA. 

Mr. Jackson Clarke showed a girl, set. 3J, suffering 
from unilateral coxa vara. The patient when first 
brought to hospital, walked with a pronounced limp, the 
body lurching to the left when the foot of that side was 
placed upon the ground. On examination the left great 
trochanter was found to be nearly on a level with the 
anterior superior iliac spine. There was neither eversion 
nor inversion of the limb, and the head of the femur was 
felt to move smoothly in the acetabulum. The patient 
had severe rickets. The treatment adopted in this case 
consisted in the use of an extension apparatus which 
was worn continuously. In the earlier stages Mr. Clarke 
regarded rachitic coxa vara as curable without operation. 
congenital dislocation of the hip. 

Mr. Jackbon Clarke showed photographs of a girl, 
iet. 6, who had congenital dislocation on the left side. 
The trochanter in this case had been two inches above 
NPlaton’s line, and on manipulating the limb the head 
of the femur was felt to move about upon the surface 
of the ilium. Mr. Clarke reduced the dislocation 
by Lorenz’s method under anesthesia It was 
not until the final movement, that of abduction, was 
made that the head of the femur was felt and heard to 
slip into its socket. The thigh was then fixed in the 
completely abducted and partly everted position by 
plaster bandages reaching from the iliac crest to the 
foot. This position was maintained for ten weeks 
when it was replaced by another with a slightly 
diminished degree of abduction. The patient now 
wears a steel instrument and a oertain degree of abduc¬ 
tion is maintained, and with the limb in this position the 
head of the femur remains in the aoetabulum. The now 
extensive experience of the results of Lorenz’s method of 
bloodless reduction had proved that congenital hip dis¬ 
location up to a certain age was practically a curable 
affection. 

In answer to Mr. Rough ton, Mr. Clarke said he 
thought some cases of coxa vara were essentially akin 
to green-stick fractures of the neck of the femur. 
aneurysm. 

Dr. Robert Maguire showed a woman who presented 
the physical signs of an aneurysm involving the arch of 
the aorta and the innominate artery. Dr. Maguire had 
seen little good result from prolonged rest in bed and 
low diet in such cases. 

Dr. Harry Campbell noticed that Dr. Maguire attri¬ 
buted the arterial sclerosis in this patient to syphilis, 
and asked whether a connection between the two had 
been definitely established. He thought the patient had 
granular kidneys, as the heart was hypertrophied, and 
there was albuminuria. He suggested, by way of treat¬ 
ment, the introduction into the aneurysm, through an 
insulated trochar, of several feet of fine-drawn gold wire, 
and the employment of a mild galvanic current, the wire 
being left in situ, a method which had yielded good 
results. He did not think that patients with thoracic 
aneurysm Bhould be doomed to months of enforced rest. 

Dr. Cautlby expressed surprise at the unfavourable 


opinion Dr. Maguire had formed of the treatment by 
rest and low diet. Although hospital patients- are 
rarely suitable subjects, seeing that the aneurysm is 
commonly due to a combination of strain, aloohol, and 
Byphilis, he maintained that among the better classes 
good results can sometimes be obtained by strict Tuf- 
nell’s treatment. He referred to a very severe case of 
aneurysm of the transverse part of the arch of the aorta, 
due to strain, in a gentleman, set. 37. After a diet 
of six ounces of solid food and eight ounces of liquid 
daily, with absolute rest, for a period of ten weeks, the 
patient recovered completely, and lived for another 26 
years without any recurrence. Similar good results 
might still be obtained in suitable cases. 

The case was also discussed by the President and Mr. 
Raymond Johnson and Dr. Maguire replied. 

OBLIQUE FRACTURE OF HUMERUS TREATED BY 
WIRING. 

Mr. Roughton showed a man who, in December last, 
sustained a simple fracture of the humerus, extending 
from the deltoid insertion obliquely upwards for about 
2i inches. As it was found impossible to keep the frag¬ 
ments in apposition by the use of splints, Mr. Roughton 
cut down upon the fracture and secured the ends by 
means of two silver wires passed horizontally round the 
bone. The patient recovered with a shapely and freely 
movable arm. The position of the wires and of the frac¬ 
ture after operation was demonstrated by a skiagraph. 

EXTENSIVE LUPUS ERYTHEMATOSU8. 

Dr. Whitfield eihibited a woman, set. 56, who 
was the subject of very extensive lupus erythematosus 
of ten years’ duration. The eruption began behind the 
left ear, and had gradually spread so as to cause a large 
bald cicatricial patch reaching nearly "up to the occi¬ 
pital protuberance. The edges of the patch, where the 
disease was still active, were red and somewhat infil¬ 
trated. On the nose and both cheeks were numerous 
discoid patches showing very little tendency to involu¬ 
tion, and large areas of fine white scarring. Both ears 
were extensively affected on the inner aspect of the 
conchas. The patient presented no evidence of any 
other organic disease. 

In reply to the President, Dr. Whitfield Baid that the 
treatment of lupus erythematosus might be divided into 
palliative and active. In the first class he would include 
the use of soothing and protective lotions, powders, and 
ointments. In the second the use of such drugs as 
pyrogallio acid, chrysarobin.snd the oxydised compounds 
of these drugs, mercurial ointments and plasters, also 
operative measures, such as scarification and the appli- 
sation of the fine galvano-cautery. He proposed, in this 
case, later on to use mercurial applications, and if these 
did not succeed he should try the effect of tattooing the 
spreading edges with the galvano-cautery as he had seen 
great benefit from this line of treatment in obstinate 
cases of the disease. It was necessary to reserve all the 
active forms of treatment for use when the disease had 
been reduced to as quiescent a state as possible, other¬ 
wise one was liable to do more harm than good. 

DISSEMINATED SCLEROSIS. 

Dr. James Taylor brought forward a well marked 
case of disseminated sclerosis occurring in a young girl. 
In answer to a question by Dr. Harry Campbell it was 
stated that there was no defect of speech and no emo¬ 
tional excitability. The patient was gradually getting 
worse, and it was feared that the prognosis was hope¬ 
lessly bad. 

PARALY818 OF TRAPEZIUS MUSCLE. 

Dr. Harry Campbell showed a case of complete 
paralysis and atrophy of the scapular portion of the 
right trapezius, apparently due to the involvement of 
the spinal accessory nerve in an old cicatrix. The case 
showed the important part taken by this muscle in keep¬ 
ing the scapula in pooition. The bone was considerably 
altered in position, the glenoid cavity looking down¬ 
wards and outwards, and the inferior angle projecting 
as in ‘ winged ’’ scapula; the outer part of the clavicle 
was bent downwards by the fall of the acromion and 
coracoid process. The patient showed an occasional 


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PRANCE. 


The Medical Press. 486 


tendency to a form of wry-neck from over action of 
the oppoeite trapezius. 

In answer to Dr. Jaffe, Dr. Campbell stated that the 
lower part of the muscle showed the reaction of degene¬ 
ration. 

TREATMENT OF LOCOMOTOR ATAXY BY SXERCI8E8. 

Dr. Leonard Guthrie demonstrated upon a case of 
locomotor ataxy, the treatment of the disease by specially 
arranged exercises, as suggested by Frenkel. The 
power of co-ordination had been considerably improved. 


WEST LONDON MEDICO-CHIRURGICAL 
SOCIETY. 

Meeting held May 5 th, 1899 . 

The President, Dr. S. D. Clippingdale, in the Chair. 

Dr. Charles Chapman showed specimens of ( 1 ) Ad¬ 
herent pericardium in a child; (2) Calcifaction of the 
aortio valves. 

Mr. H. J. Paterson read a paper on the 

USE OF GAS IN GENERAL AND DENTAL SURGERY. 

After explaining that his object was to plead for a 
more extended use of nitrous oxide ansesthesia, he 
pointed out that although using the single word “ gas,” 
ne implied thereby that it was given with a suitable 
proportion of air or oxygen. The advantages of gas 
were its safety, pleasantness, and freedom from causing 
after effects. He contended that it was safe, provided 
that asphyxial symptoms were avoided to prolong nitrous 
oxide anaesthesia for one or more hours, and recorded a 
case in which anaesthesia was maintained by means of 
gas and oxygen for two hours and ten minutes. There 
was no evidence that prolonged administrations 
affected the heart injuriously, provided that asphyxia 
was guarded against, and any effect on the heart was 
due to neglect of this precaution. In giving gas the 
danger signs were readily observed and gradually deve¬ 
loped; hence he had come to the conclusion clinically that 
for operations long or short nitrous oxide gas mixed with 
air, or better with pure oxygen, was the safest anaesthetic 
we possess. The danger of passing from gas anesthesia 
to chloroform was pointed out. He expressed the opinion 
that there are few operations which cannot be performed 
under gas if desired, and many in which this anaesthetic 
is preferable to e : her or chloroform. Its use in cceliotomy 
was at present inadmissible on account of the difficulty 
of ensuring freedom from occasional retching movements. 
He Btrongly deprecated its use during the removal of 
adenoids. Mr. Paterson next dealt with the question 
of prolonged nitrous oxide anaesthesia in dental prac¬ 
tice. He showed his new design for apparatus for 
administering gas through the nose, and contended 
that this was the best way of administering gas 
in all dental cases. He proceeded to anaesthetise 
two female patients by this method, while Mr. Lloyd 
Williams performed prolonged painful operations on 
the teeth. The demonstration was a brilliant success. 

In the discussion which followed, Mr. 8winford 
Edwards, Drs. G. D. Robinson, Charles Chapman, Mark 
Starling, Richard Lloyd, Lloyd-Williams, McAdam 
Eccles, Bellamy Gardner, and Keetley took part. 


NORTH OF ENGLAND OBSTETRICAL AND 
GYNAECOLOGICAL SOCIETY. 

Meeting held in Manchester, April 21 st, 1899 . 

Dr. Donald, President, in the Chair. 


Specimens. 

Dr. W. E. Fothergill : 1. Umbilical cord with knots, 
child being born alive. 2. Two months’ fcetus, with 
well-marked umbilical vesicle. 

Dr. Lea : A fcetus, with sections and photographs. 
Dr. 8. Buckley : Blood cyst in connection with 
Fallopian tube, removed by abdominal section. 


Dr. J. S. Martin : Two ovarian cysts, with haemor¬ 
rhagic contents. 

Dr. Lloyd-Roberts : Tubal gestation, with intra- 
peritoneal rupture, removed by abdominal section. 

Dr. W. Walter : Uterus with multiple fibroids re¬ 
moved by total abdominal hysterectomy. 

Dr. W. K. Walls described the labour in the case of 
a woman who possessed a “ uterus bicornis.” The right 
horn, containing the placenta, was strongly retrofiexed 
into Douglas pouch; the os uteri was found to be high 
up behind the pubes, and a hand presented. Delivery 
was effected by version under chloroform, and after re- 

E daoement of the right uterine cornu. During the 
ying-in period the left horn became retrofiexed, and 
caused much discomfort from piles. All the symptoms 
were immediately relieved by replacing it. 

Remarks were made by Drs. Sinclair, Briggs, and the 
President, and Dr. Walls replied. 

Dr. Sinclair read a short paper on 

MALIGNANT ADENOMA OF THE BODY OF THE UTERUS, 

illustrating his remarks by specimens and microscopic 
sections from four cases. He also made incidental refer¬ 
ence to two cases of malignant adenoma of the oervix, 
from which microscopic sections were also shown. He 
mentioned several anatomical and clinical features of 
this form of malignant disease, which seemed to differ¬ 
entiate it from carcinoma. Anatomically it is not 
distinguishable by the microscope from the rough form 
of adenoma, although there is a form of adenoma 
which from microscopic appearances may be confidently 
declared malignant. In support of this opinion sections 
were shown from a case which had been observed through 
the stages considered benign until extirpation of the 
uterus had to be resorted to for a clearly malignant con¬ 
dition. Sections of the body in this case showed invasion 
of the muscle by the adenomatous growth. Clinically, 
the chief point dwelt upon was the more chronic course 
of malignant adenoma as compared with carcinoma. 
Some minor clinical differences were also said to exist. 

Remarks were made by Dr. Briggs, Dr. Fothergill, Dr. 
Lloyd Roberts, and the President. Dr. Sinclair 
replied. 


prance. 

[from our own correspondent.] 

Paris, May 7,1899. 

Appendicitis. 

At the last meeting of the Soci£t£ de Chirurgie M. 
Poirier said that, after the long discussions on appendi¬ 
citis which had taken place at previous meetings, it 
would be interesting to note the conclusions at which 
they had arrived. The cases he had observed led him to 
affirm that every case of acute appendicitis should be 
operated upon as early as possible. This opinion 
appeared too absolute at first, and provoked numerous 
protestations. 

M. Brun said that a distinction should be made 
between cases of septic appendicitis where urgency 
imposed. itself, and those where the symptoms 
allowed the adjournment of the operation to a 
more favourable moment. One of his colleagues 
(M. Routier) insisted, however, and very rightly, on the 
extieme difficulty of making that distinction at the 
outset of the affection, and added that if he had some¬ 
times regretted to have abstained from operating, he 
never, on the other hand, had to repent of having 
interfered. M. Broca advised temporising for all 
cases where neither general peritonitis nor a puru¬ 
lent collection were present. M. Jalaquier, while 
admitting that the resection of the appendix 
was indicated when the operation could be performed 


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486 Thb Medical Press. Ct E R MANY. _May _10,_1899. 

on the first symptoms, declared that in general it would | from Germany, 16 from Africa, 18 from South America, 


be well to wait until the acute phenomena had subsided 
in order to insure success. MM. Walther and Schwartz 
were of the same opinion, but M. Lejars believed that 
delay was dangerous. On the other hand, M. Guinard 
qualified the assertion of the speaker as contrary to the 
interests of the patient, and maintained that interven¬ 
tion in the acute stage was only admissible where the 
existence of pus was clearly diagnosed. M. Quenu 
recently declared that he was always disposed to operate 
in every acute appendicitis. MM. Tuffier, Nimier, 
Chaput, Pozzi, Berger, Segond, Michaux, Hartmann* 
Picque and Peyrol were all of the same opinion as the 
speaker; consequently there was a large majority for early 
interference. Even in cases where the diagnosis was not 
very clear it was preferable to operate rather than tem¬ 
porise. The operation should be as complete as 
possible, that was to say, that in all cases the appendix 
should be sought for and removed. 

Injections of Cocaine into thb Medulla. 

Professor Bier has made some interesting ex¬ 
periments on the anesthetic effects of cocaine in¬ 
jected into the spinal cord. Up to the present two 
methods only were known of producing anesthesia, 
that of inhalation of chloroform, ether, &c., produc¬ 
ing general insensibility, and local anesthesia obtained 
by the action of cocaine or cold on the sensitive nerves of 
a limited region. Prof. Bier has discovered a third or 
middle method by which two-thirds of the body can be 
rendered insensible, and leaving psychic faculties 
untouched. Convinced that the injection of a small 
quantity of cocaine into the rachidian canal would pro" 
duce insensibility of the regions tributary to the nerves 
contained in that cavity, he injected hydrochlorate of 
cocaine into the rachidian canal of six patients with 
ages ranging from eleven to thirty-four years, and was 
able after this operation to perform without the 
slightest pain, osboous resections and the opening 
of tuberculous abscesses. He proceeded as follows:— 
By means of subcutaneous injections of cocaine 
he rendered insensible the lumbar region, and then 
practised the tapping of the canal according to the 
method of Quincke with the aid of a very fine canula; 
to this he adapted an ordinary Pravaz syringe, containing 
from one-half to a one per cent, solution of oocaine, and of 
which he injected from ten to sixty drops, representing 
from one-tenth to one-third of a grain. In five or eight 
minutes after the injeotion the lower limbs were 
rendred completely insensible, and the anesthesia crept 
up the body as far as the sternum. The effect lasted 
forty-five minutes, and then gradually disappeared. 
None of the patients presented any uneasy symptoms, 
but three of; them, however, suffered from vomiting 
and headache for a few days. All of them looked on, 
while being operated on, with complete sang froid, 
asserting that they felt no pain. 

Medical Students—French and Foreign. 

According to the latest statistics there are, in the 
Paris Faculty of Medioine, 3,866 students, of which 486 
are foreign, while in the different schools of the pro¬ 
vinces they number 4,403, of which 345 are foreigners. 
Consequently the total for the present year is 8,269 or 
47 less than last year, and 647 less than the year 1895. 
The largest decrease is to be found among the foreign 
students. Of the nationality of these latter, 34 are 


147 from Bulgaria, 34 from Greece, 15 from England, 76 
from Roumania, 226 from Russia, 22 from Switzerland, 
131 from Turkey, &c. 

^ermang. 

[from our own correspondent.] 

Berlin, May 5tk, 1899. 

The Surgical Societt. 

Hr. Libmann, Greifswald, read a paper on 
Fractures of the Skull. 

In lesions of the brain he said we must distinguish 
between the uninjured and the injured skull. Whilst 
in the latter group the destruction of the brain mass was 
greater, in the first the injury was generally the so-called 
concussion of the brain which might be fatal, the theory 
of which was not explained. The view was extensively 
held that capillary apoplexies were the cause, but this 
did not agree with the clinical BymptomB, and in experi¬ 
ments on animals on presentation of similar symptoms, 
these'apoplexies were not found. Then a general lesion of 
the brain had been assumed to be a molecular displace¬ 
ment, whereby the absence of apoplexies and the often 
surprisingly rapid disappearance of symptoms had been 
explained. 

In order to form some definite idea, the speaker had 
carried out a number of experiments in imitation of force 
within the interior of the skull, 1, in falls from a 
he ght, 2, in blows on the head when this rested on a 
firm base ; 3, when it was freely movable. He 
had an iron box made, and filled with starch 
paste, in the middle of which, a metallic ball was 
placed, and then the box was hermetically sealed. If 
the box was now dropped from a great height it would 
be found that the ball had moved towards the spot 
struck in the fall.'but if it were struck while resting 
on a firm ground, the ball did not move, again, if struck 
whilst freely moving, the ball moved towards the spot 
on which the blow was struck. These appearanoes 
depended on the known physical law' of inertia. When 
we have to determine the effect of a fall on the 
contents of the skull, we have to bear in mind the 
varying consistencies of the contents. The white sub¬ 
stance has the greatest density, then the grey substance 
then the blood, and lastly the cerebro-spinal fluid. If a 
man fell on his skull from a great height, the blood 
would be forced towards the capillaries, but would not 
rupture them without great force. The white substanoe 
would be propelled further than the giey, and a want 
of correspondence would arise between them. Hemor¬ 
rhage would take place mostly in the grey substance, 
because it was very vascular, and because it had a less 
firm consistence than the white. 

The speaker then made experiments in reference to the 
occurrence of fracture of the skull. For the purpose, he 
took glass balls, which he filled with gelatine, one 
completely and one incompletely. On letting them fall on 
the floor, the fall caused large cross fissures in the one, 
whereas in the other there were only radial fissures, 
starting from the point struck in the fall. A skull filled 
with lead wire, on being struck, showed only local injuries, 
unless the blow was very powerful. A skull filled with 
gelatine and hermetically closed, was broken into pieoes 
by the production of circular and radial fissures. 


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May 10, 1899. 


A 0 S T R I A. 


The Medical Press. 487 


Herr Gussenbauer mentioned, in connection with 
Kocher’s address, that in bis experience many cases sup¬ 
ported his (Kocher’s) theory, where others did not. In 
cortical epilepsy excision of the cicatrix had not un- 
frequently been useful. Also in osteoplastic operation 
on the skull, followed by firm healing of the bone, the 
epilepsy was sometimes permanently cured. 

In regard to Libmann’s paper, the speaker had omitted 
one factor that had to be reckoned with, viz., that the 
blood and cerebro-spinal fluid were not under equal pres¬ 
sures, moreover, the pressure in the arteries differed from 
that in the veins. The cerebro-spinal fluid, under changed 
conditions of pressure, did all the mischief. 

Herr Libmann, in reply, said that the cerebro-spinal 
fluid forms a pad which afforded protection for the other 
contents of the skull. 

Dr. Priedriech, Leipsic, read a paper on 

Air-Carried Germs and Bacterial Absorption, 
and concluded from a number of experiments that infec¬ 
tion during an operation might be considered as 
excluded, and further that for infection to take place a 
certain amount of pressure was necessary, as when the 
tail of a mouse was cut off and anthrax germs were 
lightly applied, no infection took place, whilst if some 
pressure were applied over the wound, the animals died 
within thirty or forty hours. 

Hr. Sanger, Crefeld and Schlosser, Prague, read papers 
on the well-worn subject of infective sterility of the 
hands and gloves for operations. 

Hr. Schnitzler, Vienna, discussed. 

Latent Organisms 

with a view of ascertaining whether organisms oould 
remain latent in the system for any length of time, and 
later on take an active stage. Animals that were refrac¬ 
tory to certain organisms were inoculated with them, 
and months afterwards a second morbid substance w as 
introduced. The virulence of the material first injected 
at once showed itself. Frogs were inocculated with the 
staphylococcus. These remained local, and caused no 
general infection. If ever frogs were narcotised how¬ 
ever, they died, and staphylococci were found in all the 
organs, the chloroform had lowered the resisting power 
of the organism. It followed from this that frequently 
for a micro-organism to become active there must be a 
disposition, a lowered vitality, for example, through a 
chill. This explains late suppuration in cases of 
foreign bodies. 

Hr. Hoffa, Wurzburg, related a case of 

Habitual Luxation of the Knee-cap. 

The patient was a girl who some years ago experienced 
a sudden pain in the knee and fell down. Sinoe that 
time the condition had become worse, and the girl came 
to the hospital. As soon as she went a few steps, the 
patella became displaced, she bad violent pain in the 
knee, and fell down. Various kinds of bandages were 
tried, without avail. Le Dentu had proposed the 
following operation in such cases: A transverse fold was 
to be formed in the capsule of the joint, stitched into the 
form of a roll, whereby the capsule was shortened. The 
speaker operated in his case in that way, and got an 
excellent result. The patella remain firm, and a previ¬ 
ous atrophy of the quadriceps had quickly improved. 

Hr. Krttnlein related a case of 

Traumatic Ulcer of the Stomach, 
and showed a preparation from a man, aged 48, who had 


ciroular resection of the pylorus performed in November 
last, for stenosis of it. He was a healthy man who, in 
June last, was struck with a hay-fork in the neighbour¬ 
hood of the stomach. He felt violent pain at the time, 
but this disappeared, so that in two or three days he 
was ready for work again. Then he lost his appetite, 
and lost flesh ; the pains returned, and three weeks after 
receipt of the injury frequent vomiting took place, but 
with no blood; finally all food was rejected, and sym¬ 
ptoms of closure of the pylorus became pronounced. The 
operation was performed, and the patient had gained 
8 lbs. in weight. The ulcer was very large, of circular 
form, and implicated the whole pylorus, the ulceration 
passing down into the sub-mucosa. Carcinoma could 
be excluded by the microscope. The case was interesting 
from the point of view of accident insurance, for there 
could be no doubt that the injury led to the ulceration. 

Hr. Wagner Konighutte related a similar case. A 
young healthy man had a contusion of the abdomen 
five years before, and a day or two after, copious 
bleeding took place, and since then haemorrhage had 
taken place from the stomach at intervals. 


JluBtria. 

[from our own correspondent.] 

Vienna, May 6th, 18W. 

Bile Colouring Matter in Urine. 

At the “ Medical Club ” Dr. Jolles read a long paper 
on the various tests in use for the detection of bile in 
urine and its quantitative estimation. He referred to a 
paper on the same subject which he had published in 
1894 to show the inaccuracy of Huppert's test which had 
been brought forward at that time to supersede all 
others. In practice it was found to be misleading, as a 
large quantity of the bilirubin escaped detection. 

J. Munk had recently introduced a novel method which 
is an advance on the former, yet a large quantity of the 
bilirubin passes undetected according to Jolles’ proofs. 

Jolles’ own method, whioh is the most perfect extant, 
may be briefly Btated10 cc. of the suspected urine is 
placed in a test tube to which is added 1 cc. of chloro¬ 
form, 5 cc. of a ten per cent, solution of chloride of 
barium, well shaken, and then allowed to stand for a few 
minutes. The clear supernatant fluid is then syphoned 
off, and the sediment treated with two or three cc. of 

Hubb’s iodine solution and 1 cc. of concentrated 

lvv 

hydrochloric acid. The test tube is well shaken and 
again allowed to stand. If the slightest trace of bile be 
present the later sediment will have a bluish-green 
colour. The chloroform solution will assume the bluish* 
green colour also if the iodine solution be applied to it. 

The iodine solution is made by dissolving O'13 gramme 
of iodine and 0‘16 gramme of mercuric chloride in 
100 cc. of alcohol (90 per cent.). For practical purposes 
Jolles proposes the combination of these two solutions as 
a ready qualitative test for bile. 

Jolles’ quantitative te st is based on the fact that bilirubin 
in urine, when treated with an alcoholic-iodine solution, 
produces a green colour, which must be in the proportion 
of one molecule of bilirubin (C,„ H,, N, OJ to two 
atoms of iodine. The method is completed by trituration. 

Operative Myopia. 

Fukala showed two cases on which he had operated for 


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THE OPERATING THEATRES. 


Mat 10, 1899. 


4-88 The Medic al P ress. 

myopia; the one was — 33D. the other —11D, and 
both become emmetropic after removal of the lens. 
According to the —18 dioptric diotum the removal of the 
lens in the - 11D eye should have converted it into a 
hypermetropic one which, strange to say, was not the 
case sb demonstrated in the patient exhibited. 

Elschnig asked Fukala how be determined the myopia 
before the operation, as the results surprised him. The 
only explanation of this strange phenomenon which he 
could suggest would be in the altered radius of the 
cornea. His own opinion was that no operation of this 
sort should be undertaken with less than - 14 dioptres, 
but — 11D was certainly a surprise. 

Fukala replied that the one with —11D was deter- 
mined by Schnabel, while the other was worked out by 
Sattler. He confirmed it himself by a 10 mm. from the 
convexity of the cornea. 

Schnabel said that he was familiar with both of thecases, 
and must confess himself surprised at the result, as he 
expected to have to apply + 7D or + 8D to neutralise 
the hypermetropia after the operation. There were 
exceptional conditions in this case that ought not to be 
lost sight of before establishing any rule. The eye, 
although requiring—11D to correct it, had an aiial 
length of 30 mm., which would favour such an operation. 

Fukala replied that the presence of unusual circum¬ 
stances induced him to perform the operation, as the 
patient, from the nature of his work, found the myopia 
a great burden to himself, and he therefore determined to 
convert it into a hypermetropic eye, which would be more 
suitable for the patient’s duty. He thought the explana¬ 
tion of thiB phenomenon might be found in the changes 
of the long axis of the eye after the removal of the lens. 
Schnabel thought Fukala’s explanation was not sufficient, 
as a myopia of — UD could only become emmetropic 
after the removal of the lens if the lens had a very high 
refractive power. 

This condition could not be accurately diagnosed in 
the living eye, and was therefore impracticable in prac¬ 
tice. He was of opinion that no useful result could be 
obtained by following this unusually fortunate 
example. 

Elschnig described Fukala’s hypothesis as fanciful, 
and absolutely without scientific support. 


^he operating theatres. 

ST. MARY’S HOSPITAL. 

Primary Amputation of Thigh for Injury.—Ex¬ 
treme Shock. Intba-Vknoub Saline and Brandy Injec¬ 
tions.— Mr. Quarry Silcock operated on a lad, set. 16 , 
who had been run over by a cart, the wheel passing over 
his right thigh. On admission he was extremely 
collapsed; stimulants were given, and his condition 
slightly improved. An examination revealed a compound 
comminuted fracture of the middle of the femur and very 
extensive laceration of the muscles at the back of the thigh 
and calf, exposing the bones. O wing to his collapsed con¬ 
dition immediate operation was thought inadmissible, 
and restorative measures (rectal injections of saline 
and brandy) were employed. On being seen again by Mr. 
Silcock the temporary dressings were found to be soaked 
with blood owing to the tossing; therefore the boy was 
taken to the theatre, his general state being, however, 
but little improved. An amputation was done in the 
npper third of the thigh, and it was found necessary to 


utilise the skin which had been stripped from the fascia 
lata at the time of the accident to fashion flaps in the 
hope that it might survive. The superficial and deep 
femoral vessels were ligatured in one mass close to their 
bifurcation. During the operation three pints of sterilised 
physiological saline solution, containing two ounces of 
brandy, were slowly transfused into the left median basilic 
vein. The amputation was done as rapidly as possible; a 
very small quantity of blood being lost, the elastic tour¬ 
niquet proving very effective. 

Mr. Silcock said that primary amputation of limbs 
for injury were becoming excessively rare owing to the 
successful conservatism of modern surgery. In the case 
upon which he had just operated amputation was 
rendered necessary, although the femoral vessels were 
intact, owing to the extensive laceration of the muscles 
on the whole extent of the back of the thigh, and the 
tearing away of the skin over the whole area of the 
lower three-fourths of the thigh, together with the com¬ 
minution of the bone, and also owing to the fact that the 
damaged tissues were ingrained with dirt and filth, which 
it would have been impossible to remove. He pointed 
out that when the lad was first seen at the hospital he 
seemed to be actually moribund, and immediate ampu¬ 
tation was out of the question; therefore he determined 
to see him again in a few hours, hoping his condition 
would be improved. When seen, however, in about 
three hours, these hopes had not been realised, 
no improvement having taken place, but the oozing 
which was now evident through the dressings made in¬ 
terference absolutely necessary. Mr. Silcock said he 
had utilised the damaged 6kin, as there was insufficient 
covering for the stump, even if the limb had been re¬ 
moved at the hip-joint. The femur, however, was sawn 
through just above the junction of the upper and 
middle third. He pointed out that the effect of the 
saline and brandy injection was extremely marked ; the 
radial pulse, which at the beginning of the operation 
was imperceptible, was nearly at once readily appreci¬ 
able. How far the admixture of the brandy with the 
saline was responsible for these good effects he was 
unable to say, as he had had no previous experience of 
the intra-venous injections of alcohol, but he had been 
induced to try the method in this case owing to the 
apparent hopelessness of the patient’s condition. Hewas 
however inclined to think chat the alcohol played a 
comparatively small part in the restorative effect, because 
stimulants had been tried very freely before the opera¬ 
tion, though certainly not by intra-venous injection. He 
did not suppose that anyone would go so far as to say 
that the same amount of alcohol injected intra-venousiy 
by itself would have been of great avail (of course, in 
any case it oould not be employed exoept in a state of 
very considerable dilution). He remarked that at a 
future time the condition of the stump would have to 
be dealt with in order to get rid of the probable conicity 
which would obtain if it became largely uncovered owing 
to the loss which he feared would take place in the flaps 
by sloughing, a condition whioh, though foreseen at the 
time of operation could evidently not be avoided. 

For the following account of the subsequent progress 
of the case, we are indebted to the courtesy of Dr 
S. Maynard Smith. 

The patient recovered fairly well from theamesthetic, and 
his condition slowly improved throughout that night and 
the following day. At 3 a.m. on the morning of the next 


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Mat 10, 1890. 


LEADING ARTICLES. 


The Medical Pbesb. 489 


day he suddenly became worse, and showed symptoms of 
severe collapse. The radial pulse was absent from the 
wrist. A second transfusion of two and a half pints of 
saline solution, containing two ounces of brandy, was 
made into the right median basilic vein. There was 
an instant improvement which was well maintained, and 
rapid progress has since been made to convalescence. 
Parts of the flaps formed of the damaged tissues 
became gangrenous, and were, therefore, removed, but at 
present the patient is convalescent, and healthy granula¬ 
tions cover spots whence the gangrenous patches were re¬ 
moved. The effects of the second injection of saline and 
alcohol were, therefore, as excellent as those of the first, 
and evidently more lasting, as they formed the starting 
point of the patient’s convalescence. 


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8ALU8 POPULI SDPREMA LEX.” 


WEDNESDAY, MAY 10, 1899. 


THE PRINCE OF WALES’ FUND AND THE 
SMALL HOSPITALS. 

The Royal Fund for the London hospitals is based 
npon principles so generous and so humane that the 
average man is tempted altogether to suspend his 
critical faculty. At the same time it will hardly be 
denied that a young institution is likely to possess 
some at least of the follies and imperfections of 
youth. The methods of raising money by philatelic 
devioes, for instance, and by the granting of orders, 
savour rather of the ways of the charitable 
bazaar than of a royal appeal on behalf of a 
splendidly humane object. But it is with the dis¬ 
tribution of the Jubilee Fund we are concerned 
rather than with its peculiar views upon eleemosynary 
ethic6. First and foremost comes the question of the 
small hospitals and their share or otherwise in the 
awards. The lesser institutions stand in a sort of 
no man’s land, and we note on the General Council 
of the Prince of Wales’s Fund the names of well-. 


I known philanthropists who have openly advocated 
; the extinction of the smaller hospitals. These 
particular views have been enforced by the Metro¬ 
politan Hospital Sunday Fund, but we are glad to 
say that the Saturday Fund has taken a jnster view 
of the matter, and has made awards freely to the 
medical charities, great and small. As regards this 
point we long ago pointed out that one of the Funds 
must be right and the other wrong, but so far as we 
can remember no satisfactory explanation has ever 
been given by the Sunday Fund, of the principles 
upon which they have refused awards to most 
of the institutions. We exposed long since 
the fallacy of insisting upon a fixed relation 
between maintenance and to impose such a 
condition is to foster exti&vaganre of the wildest 
kind in hospital administration. At the same 
time the Sunday Fund has again and again granted 
solid Bums to institutions that laboured under grave 
unanswered public charges of dishonest management, 
while it refused any help to other medical charities 
administered with prudence and economy to the last 
penny. Are we to assume that the Prince's Fund 
will adopt the policy of swamping the small 
hospitals ? The answer to this question will be found 
in the list of awards, and meanwhile we should feel 
greater faith in the actions of the Council if fewer 
of its mem here were not already committed in that 
direction. The offer of a Visiting Committee to 
visit each hospital applying for a grant is a 
comparatively slight safeguard if the minds of the 
Council are made up beforehand. Certainly, the 
greater number, if not all, of the smaller hos¬ 
pitals that have altered their methods of accounts 
in compliance with the conditions imposed by the 
Sunday Fund, and who have applied for a grant with 
clean hands, have come empty away. Is the same 
thing to happen in the case of the Prince of Wales’ 
FundP It seems that if the smaller Institutions are 
to be thus tabooed, the better plan will be to transfer 
their allegiance to the Saturday Fund, which is the 
only great central distributing agency in the metro¬ 
polis which has treated them with common fairness. 
With the smaller charitable Institutions, as with 
other social[organisation8, unity is strength. Then 
there is another point on which we want some 
sort of definite assurances from the Prince of Wales’ 
Fund, namely, as to their attitude upon the great 
question of hospital reform. At least four of the 
large hospitals make a money charge to patients, a 
fact that affords a curious commentary upon the 
ways of those responsible for the administration of 
vast charities. Is the fact of a money payment being 
exacted from patients taken into account by the 
Prince of Wales’Fund? Then there is the further 
point of wards for paying patients which are 
founded by several of the great hospitals, such as 
Guy’s and St. Thomas’s, upon funds subscribed for 
the relief of the poor, if carried on to the injury of the 
main mass of the medical profession. There are 
many other matters involved in this knotty question 
of hospital abuse, but we venture to ask if the Royal 


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490 The Medical Press. 


LEADING ARTICLES. 


Fond takes into consideration the fact that any 
particular hospital does or does not institute 
systematic inquiry with a view of excluding 
improper persons from participating in the 
funds of the charity. The constitution of the 
General Council of the Royal Fund is not above 
criticism. Among the really active members may 
be noted many who are committed to the support of 
the pay system by hospital patients, and of other 
abuses of which the general practitioner has com¬ 
plained bitterly for many a year. The Council iB not 
representative of any but a narrow section of philan¬ 
thropists. The main mass of the medical profession 
and the smaller hospitals are unrepresented. With a 
little more attention to these points we venture to say 
that the Prince of Wales would be more likely to 
convert the medical profession as a whole into active 
supporters from their present position of luke-warm 
critics. 


A HOSPITAL SCANDAL. 

The affaire of the Liverpool Hospital for Cancer 
and Skin Diseases appear’ to have fallen to a very 
low level if the literature emanating from its officers 
can be accepted as any measure of their morality. It 
seems that there are three honorary medical officers 
on the staff, Dre. Crawford, Taylor, and Whitford, 
and their relationship appeal’s to have recently become 
strained, although some of the present charges date 
as far back as 1883. Notwithstanding these irregu¬ 
larities apparent harmony reigned until about 
two or three years ago when ominous clouds began to 
gather around the institution. They culminated in 
open charges of immorality, &c., against the senior 
Medical Officer, Dr. Crawford, which could only be 
met by a thorough investigation into the serious 
accusations brought forward by his two colleagues* 
Dre. Taylor and Whitford. On October 13th, 1898, 
the General Committee of the hospital selected 
five of their number to investigate the charges 
and report to the General Committee. This would 
have been an excellent opportunity for clearing up 
Buch an obnoxious scandal had the General Committee 
at this time acted prudently. In the selection of this 
Sub-Committee, however, three friends of the accused 
officer were chosen, to whom the accusers took excep¬ 
tion on their appointment and in the presence of the 
Sub-Committee. The chairman’s notice was forcibly 
directed to the fact, but he, poor man, could not see 
anything “ wrong or inexpedient in Mr. Millar acting 
on the Sub-Committee,” although Mr. Millar hap¬ 
pened to be Dr. Crawford's private solicitor and 
patient. We are told in the Sub-Committee’s report 
of March 8th, 1899, that their labours were preceded 
by an invitation to the Medical Officers to propose 
suggestions as to improvements in the internal 
management of the hospital.” Now comes the 
denouement. Whitford accuses Crawford (1) of using 
the hospital for personal gain; (2) of ignoring the 
regulations as to fees; (3) of having retained the ser¬ 
vices of hospital nurses for his private purposes; 
and (4) that impropriety had existed between Craw¬ 


Mat 10, 1899. 

ford, the matron, and the wards maid, &c. Crawford 
retaliates by accusing Whitford of visiting the 
matron at improper hours. Finally, the Sub- 
Committee concludes with recommendations for the 
better government of the hospital, finding that the 
charges brought against Crawford by Whitford 
and Taylor had “ no foundation,” and that there 
was no harm in the matron being kissed “ without 
her consent.” Indeed, they “ could not understand 
a lady of Miss Thompson's character remaining on 
friendly terms with a man who had been guilty of 
improper conduct, while they considered her indis¬ 
creet in permitting Dr. Whitford’s visit* to be so 
frequent at such late hours.” This report was signed 
by the five members, one of whom has since with¬ 
drawn from the position, and presented to the General 
Committee on March 23rd, and adopted with two 
dissentient votes, Dre. Taylor and Whitford. On 
April 10th the General Committee again met with a 
number of disapprovals, calling on Dre. Whitford 
and Taylor to resign, as well as the matron. A 
requisition was then sent to the Liverpool Medical 
Institute calling a meeting for April 29th, 
to consider the anomalous position of affaire which 
resulted in that body refusing to have anything to do 
with such questionable matters. The latest to hand is 
that a general meeting of the donors, subscribers, &c , 
of hospitals is called to meeton the 10th inst. (to-day) 
to decide what future steps are to be taken to restore 
order. We wish them God-speed, and we trust that 
the steps decided upon will have the desired effect. 
We have studiously avoided any unnecessary per¬ 
sonal details, even though some of them appear to be 
distinctly germane to the matters under considera¬ 
tion. We are, however, less concerned with the 
morality of individuals than with the good manage¬ 
ment of a medical charity. 


THE CARE OF EPILEPTICS. 

It is remarkable that such a deserving class of 
hapless persons as chronic epileptics should not have 
excited more sympathy in this country than the past 
has proved to be the case. This fact has attracted a 
good deal of notice among our Continental neigh¬ 
bours, especially in view of the solicitude whioh we 
have ever displayed for our insane. This country set 
the example to the world in showing how the insane 
should be provided for, and the reputation which 
we enjoy in this regard is one which is not likely 
to be lost. With respect, however, to the care of 
chronic epileptics, the reverse is the case. While 
epileptic colonies and asylums, both on the Continent 
and in America are comparatively numerous, it can 
scarcely be said that in this ooiintry any serious 
effort has as yet been made to deal with the ques¬ 
tion. As a matter of fact, up to the present there 
are only three epileptic colonies in England. Of 
these, one is at Chalfont, providing for about 50 
inmates ; another near Liverpool—the Maghull Home 
—with accommodation for about 150 inmates; and a 
third at Godaiming, providing accommodation for 50 


Digitized by LjOOQle 



May 10, 1899. 

female epileptics. Altogether then, it would seem 
that throughout the country only two hundred and 
fifty chronic epileptics can be provided for in special 
homes for the purpose. It is true that the London 
County Council intend to have an epileptic colony at 
their new asylum, now building, on the Horton Manor 
estate in Surrey, and that something of the eame 
kind will also be carried out in Lancashire] by the 
Chorlton and Manchester Union. Nevertheless, the 
fact remains that probably many thousands of un¬ 
fortunate epileptic persons are now living about the 
country under conditions entirely unsuited to the re¬ 
quirements of their pitiable state. As showing moreover 
the backwardness which prevails in this regard, men. 
tion may be made of the fact that in Scotland nothing 
whatever has been done in the making of provision 
for chronic epileptics. And yet, as Dr. Ireland points 
out in an interesting paper upon this subject in the 
current number of the Scottish Medical and Surgical 
Journal, there are probably no fewer than six 
thousand of this unfortunate class of persons in 
Scotland alone. According to Pelmann’s statistics 
there are fifteen epileptics to every ten thousand of 
the population, and upon this showing it may readily 
be gathered, how great is the need for extending and 
multiplying these epileptic colonies. Dr. Ireland also 
draws attention to the marked progress which this 
movement is making in the United States. This 
progress is ehown by the following statement of Dr- 
Powell:—“ During the last two years a wave, a 
movement, a sentiment, has spread over the United 
States for segregating epileptics in colonies, provided 
liberally with land, shops, schools, and expert medical 
attendants. In 1894 the Craig colony, so well known 
by reputation in this country, was opened in New 
Tork, and a ‘national society for the study of 
epilepsy, and the care and treatment of epilep¬ 
tics ’ is now doing good work in furtherance 
of its objects. Part of the duties of the Society is to 
organise new homes based upon a study of the epi¬ 
leptics’ needs, and," quoting from Dr. Powell, “ the 
study of the utilisation of the epileptics’ labour, for 
economic, scientific, and ethical reasons, as well as 
the study of the educational methods to be employed, 
including manual, industrial, intellectual, and moral 
forms and forces.’’ No one who has paid the least 
attention to the subject can dispute that, apart from 
all other reasons, upon the common grounds of 
humanity alone adequate provision for chronic epi¬ 
leptics is an urgent matter of social reform 
which should claim the attention of the State- 
Moreover, one feels bound to admit that philan¬ 
thropy could scarcely find a better outlet than 
that of making happy the lives of persons whose 
disease has caused their lot to become so pitiable. 
We trust that Dr. Ireland will follow up his excellent 
appeal for help in this direction, in the paper above 
referred to, by takiog some active steps to bring the 
urgency of the movement before a wider circle than 
that of the profession, and try and influence the public 
to see how much philanthropy could do for chronic 
epileptics. 


The Medical Punas. 491 

&ott* mt Current topics. 

Cocainisation of the Spinal Cord. 

To Professor Bier, of Kiel, belongs the credit for 
suggeBtirg and practising a new method of procuring 
what may be termed localised general anaesthesia. 
Starting with the idea that the injection of a small 
quantity of cocaine into the 6pinal canal would sup¬ 
press, for the time being, the functions of the nerve roots 
and of the non-medulla ted nerves contained in the 
cavity, he puthis theory to the test in six patients suffer¬ 
ing from surgical lesions, their age varying between 
eleven and thirty-four years of age. Under the influ¬ 
ence of the injections he was able to perform resec¬ 
tions, erasions, &c., without pain although conscious¬ 
ness was in no wise affected. He first anjesthetises 
the soft parts over the lumbar region by the subcu¬ 
taneous injection of a solution of cocaine and then intro¬ 
duces a fine trocar into the spinal canal by Quincke’s 
method. Through the canula he injects a quantity 
of solution equivalent to from a fiftieth to a quarter 
of a grain of the anaesthetic. Within from five to 
eight minutes of the injection complete analgesia 
of the lower limbs is produced, which gradually ex¬ 
tends to the trunk. In three cases it extended to 
the nipple, and, in one instance, the subject being a 
child eleven years of age, it involved the whole of 
the body, leaving only the head free. Insensitiveness 
to pain lasted about forty-five minutes, and then 
gradually disappeared. Sensibility to touch and 
heat was not affeoted, but the application of hot 
bodies did not give rise to pain. No untoward 
symptoms followed the injections, except in one or 
two instances vomiting and rather persistent head¬ 
ache. Dr. Bier did not hesitate to try the effects of the 
injections on himself and on his assistant, Dr. Hilde- 
brandt, and in his own case, as the cannula did notfit the 
trocar with sufficient accuracy, he lost a considerable 
quantity of cerebvo-epinal fluid. This accident gave 
rise to marked vertigo whenever he assumed the 
erect position, and this symptom did not subside 
until after nine daj s repose in bed. In other respects 
his experience confirmed that of his patients. We 
do not suppose that this method of inducing regional 
anaesthesia is likely, for the time being at any rate, to 
take the place of general anaesthetics, but, as under 
strict antiseptic precautions, the procedure appears 
to be devoid of any immediate or subsequent risk, it 
might conceivably render service in cases when the 
administration of chloroform is contra-indicattd. 

Curly Hair. 

The tendency to curliness of the hair is a stinking 
feature in certain individuals, and is characteristic 
of certain races, but the etiology thereof is one of the 
physiological conundrums which have hitherto 
eluded scientific investigation. No subject of 
original research, however, is too high or too low for 
a Fellow of the Royal Society and Professor Thomson, 
at the recent conversazione of that very select body, 
was enabled to demonstrate the factors underlying 
the production of curly hair, though he did not go so 


NOTES ON CURRENT TOPICS. 


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492 The Medical Press. NOTES ON CURRENT TOPICS. Mat 10, 1899. 


far as to define its bearings on character or tempera¬ 
ment. He enumerates three factors in the process, a 
peculiarity of the hair shaft, the action of the hair 
muscle, and the sebaceous gland. Straight hair is 
usually circular in section and it is straight because 
it is cylindrical, a shape which renders it proof 
against distorting influences. If the shaft, on the 
contrary, he flat and riband-like, it is unable 
to resist the pull of the little muscular fila¬ 
ment which is attached to each hair root, and 
this traction gradually modifies the direction of the 
hair follicle from which it springs. The curre thus 
produced in the follicle thereafter confers a curve on 
the growing hair, and as the formation is general 
curliness results. There is another variety of curli¬ 
ness which is not due to this process, but is more or 
less intimately associated with the application of 
metal tongB, heated to a suitable temperature, the 
effect whereof is to induce asymmetric contraction of 
the hair shafts. The etiology of this form of hair- 
curl does not stand in need of any scientific explana¬ 
tion, it is merely an outward and visible manifestation 
of innate vanity with which science has nothing to do. 
We know that under the influence of powerful 
emotions, especially those of a disagreeable nature, 
the hair is apt to become straighter than usual. This 
is due to the contraction of the hair muscle, and the 
phenomenon is well rendered in the colloquial phrase 
expressive of the hair “ standing on end.” More 
obscure is the not less colloquial phrase which attri¬ 
butes to certain indescribable emotions the effect of 
making the hair curl.” Of this a scientific explana¬ 
tion is necessary, and, unfortunately, is not forth¬ 
coming. Each individual hair may stand on end, 
like quills upon the fretful porcupine, but science 
does not afford us any trustworthy clue to the par¬ 
ticular circumstances under which the hair will curl 
in response to an inward psychical disturbance. 
Obviously Professor Thomson has but touched the 
fringe of the subject. 

Academical Protectionism in France. 

The protectionist policy in regard to foreign 
studeiits, which was inaugurated in France some 
two or three years Bince, is bearing its fruits. 
In deference to obscure, but none the less effi¬ 
cacious. political considerations the French Govern¬ 
ment introduced restrictions in respect of the 
admission of foreign students which threaten to 
eliminate that inoffensive but not uninteresting 
individual from French academical circles. The 
Paris medical school had. for many years, occupied 
an almost unique position in the educational world, 
though of late the ever increasing progress of the 
German school has tended to undermine that posi¬ 
tion. Not satisfied with this natural decay the Govern¬ 
ment thought proper to decide that, in future, foreign 
medical students would have to be relegated to the pro¬ 
vincial universities and, adding injury to insult, such 
students were virtually debarred from obtaining 
the ordinary diploma conferring the right to practise 
medicine- The result has been a steady decrease in 
the number of foreigners registered as students in 


France. From 1,137 in 1893, the number has steadily 
diminished to 840 in 1899, and as years go by this 
number will infallibly undergo still further diminu¬ 
tion. Foreigners object to being sent into the pro¬ 
vinces when their primary object in coming to France 
is to avail themselves of the exceptional opportunities 
for study which the Paris school affords, and they 
particularly resent the trick of offering them a 
spurious and valueless diploma in lieu of that 
accorded to their French colleagues. No better means 
could be devised for destroying the prestige of the 
French schools abroad, and if this be the object of 
these illiberal measures the Government maybe con¬ 
gratulated upon their success. 

A Comparison in Morality. 

Certain French journalists, delighted to find an 
opportunity of criticising their neighbours, have 
drawn a very sombre picture of English morality, 
based on the prevalence of a class of advertisements 
in the daily and weekly press to which attention has 
been called somewhat forcibly of late. Much as we 
deprecate the publication of such advertisements, we 
cannot admit that they afford prima facie evidence 
of any widespread demoralisation in our midst. As 
well might we infer an exalted standard of morality 
among our neighbours across the Channel from the 
absence of similar advertisements in their journals, 
for, curious to relate, none such are to be found in 
their otherwise impure columns. There is one touch 
of nature which makes all the world kin, and that is 
in respect of sexual irregularities. We believe in all 
sincerity that we are a more moral nation than many 
others, the French among them; but this does 
not preclude a certain proportion of incontinent, 
though possible loyal subjects, and some misguided 
women who “ have stooped to folly, and find too late 
that men betray ” sacrifice money and principle in the 
vain endeavour to physically rehabilitate themselves. 
In truth, the publication of these advertisements 
might justify a slur on our commercial honesty, but 
certainly not on our morality, seeing that none of the 
nostrums so speciously brought before the public have 
in reality any claim to be considered a specific for 
menstrual irregularity due to physiological causes. 

Undertakers’ Charges. 

Last week a somewhat gruesome find was made 
in the goods dep6t of a London station. The size and 
weight of a long rough deal case roused the suspicion 
of the railway officials, who opened the box and dis¬ 
closed a polished pine coffin, with a brass name plate 
bearing an inscription. Inquiry showed that the 
coffin contained the body of a young actor who bad 
died recently of pneumonia while touring in the 
provinces. As he was in poor circumstances, and 
his comrades wished to save expense, they resorted 
to thiB novel way of removal. It is stated that the 
carriage of the case was 16s. 2d., while the removal 
of the body over the same distance would have been 
£11 198. This incident shows up in a ghastly 
fashion the way that the railway companies 


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May 10, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press 493 


extort money from the friends and relatives of dead 
persons. The disproportion between the carriage 
of the deal case and the coffin is monstrous and cruel. 
After the strolling actors had paid the undertaker’s 
charges, it was hardly likely they would be able to 
find the wherewithal to fill the greedy maw of the 
railway monopolists, to whom death appears to be a 
mere signal for plunder. The only thing we know of 
that at all compares with the funeral carriage railway 
rates is the bloodsucking of the undertakers. Taking 
advantage of the outburst of sorrow-stricken helpless¬ 
ness that follows, or should follow, the death of a 
near one, they proceed to fleece the friends in a way 
that is little short of criminal. Charges and fees rain 
down freely as April showers. To our mind one of 
the most rational institutions in the United Kingdom 
is the Funeral Reform Association. It is to be hoped 
that the excellent body in question will turn its 
attention to the question of railway tariffs for the 
dead. 


Election of Examiners at the Royal College 
of Surgeons, Ireland. 

These annual elections took place, in accordance 
with the darters of the College, on Tuesday, the 2nd 
inst. These Charters prescribe that, at this date, the 
Council of the College may. if it thinks fit, resolve to 
declare any Professorship in the College to be vacant, 
but, should they omit to do so, the Professors retain 
their offices, ijtto facto for another year. Within the 
memory of the College no Chair has thus been 
declared vacant, friendly hints having always proved 
sufficient to obtain the resignation of any Professor 
who was not regarded as capable. On this occasion 
no Chair was declared vacant. 

The election of Examiners caused a very close 
contest in respect of the Surgery, Midwifery, and 
Ophthalmology Courts. For Anatomy the outgoing 
Examiners, Professor Bermingham and Fraser, were 
re-elected, as were al6o those in Physiology, Histo¬ 
logy, Biology, Pathology, Chemistry and Dentistry. 
For the two Surgical Examinerships previously held 
by Professor Stoker and Mr. Patteson seven candi¬ 
dates presented themselves, including Mr. H. G. 
Croly, Mr. F. Conway Dwyer, Mr. MacFeely, Mr. 
Dallas Pratt, and Mr. Edward Taylor, and it has 
transpired that the result depended on a casting 
vote. In effect, Mr. Croly and Mr. Conway Dwyer 
were elected, succeeding the two out-going ex¬ 
aminers. For the Midwifery Examinership there 
were four competitors, Mr. Hearn, Mr. Fred Kidd, 
Mr. Alfred Smith (the out going examiner), and 
Mr. Stevens. In the end, Mr. Kidd was elected 
after a spirited contest. For the position of Ex- 
mainere in Ophthalmology three candidates offered 
themselves, viz., Messrs. Arthur Benson, who had 
resigned his seat on the Council to become eligible, 
Mr. Maxwell, and Mr. Louis Werner. The two last- 
named gentlemen were chosen. There was also close 
competition for Examiners in the Preliminary Edu¬ 
cation Court, Mr. J. L. Woodroffe and Mr. John 
Fraser being eventually elected. 


Watering the Streets. 

Some different method of watering the streets and 
highways is urgently called for, and the matter 
should be taken into careful consideration by the 
vestries and other authorities concerned. The hap¬ 
hazard method of sending the contractors’ water 
carts round the thoroughfares, as at present obtains, 
is, perhaps, just the worst method of achieving the 
objects aimed at from a sanitary point of view. Much 
of the foulness of the air pervading the streets in 
summer is due to the decomposition of the mud in 
the hot sunshine after the water carts have rendered 
it moist. Filth on the streets in a dry state has no 
obnoxious effluvia, and does no harm to the public 
health, unless, perhaps, it is disturbed by winds and 
deposited in the form of dust. On the other hand, 
foul emanations arising from moist decomposing 
mud are offensive to the olfactory sense, even if 
they are not directly harmful, and, moreover, to pro¬ 
vide a culture ground for pathogenic bacteria, such 
as the water-carts afford by the moisture they dis¬ 
seminate, is distinctly objectionable upon scientific 
as well as hygienic grounds. We are glad to see that 
some steps have been taken to raise this matter again 
by members of the profession. The Lewisham Board of 
Works have been memorialised by a number of medical 
men in the south-east suburbs, who point out the* 
injuriousness of the present system, and suggest that 
the roads should only be watered in the early morn¬ 
ings and then thoroughly swept. In this suggestion 
we heartily concur, and now that the roadways and 
thoroughfares are so much occupied by cyclists it is 
important, in the public safety, that the watering 
process should be carried out at a time when it does 
not constitute a risk to “ wheelmen.” The treacher¬ 
ous, slippery surface of a freshly watered dirty 
thoroughfare has, upon many occasions, been the 
direct cause of loss of life to unwary cyclists. 

Stamp-lickers’ Tongue. 

A commentary upon the paragraph which ap¬ 
peared in our issue of last week was in circulation at 
the very moment of our going to press. A case of 
fatal blood-poisoning occurred at Preston, and was 
the subject of a coroner’s inquiry at Fleetwood. The 
deceased had a wounded knee, to which a piece of 
stamp-paper had been applied, and it was suggested 
that the cause of death was to be found in the gum. 
Dealing with this point, the Postmaster-General last 
week wrote to the coroner saying that pieces of the 
paper in question had been examined, both biologi¬ 
cally and chemically, in the Government laboratory 
without detection of any irritant substance. There 
was no evidence that the gummed stamp-paper 
at present in use was capable of setting 
up blood poisoning, and it was unlikely that 
the death of deceased was in any way con¬ 
nected with the application of the stamp. With 
all due deference to the Postmaster-General we 
should like to ask that distinguished official of what 
the sticky substance of postage stamps is composed ? 
Is it or is it not, as alleged, obtained from the serum 
of the horse ? If bo, are any special steps taken to 


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494 Thk Medical Press. NOTES ON CURRENT TOPICS. 


exclude bacterial contamination P A plain answer to 
these plain questions is clearly within the grasp of 
the scientific advisers of the Post Office, and will go 
far to allay the public curiosity upon a subject which 
has a direct bearing upon every citizen of this vast 
empire, to say nothing of the rest of the world beyond 
seas. 

(Esophagismus. 

(Esophagismus is a very rare condition, and its 
etiology is involved in considerable obscurity. That 
its occurrence, however, is associated with the abuse 
of tobacco, as has been stated, receives some confirma¬ 
tion from a case recorded by Dr. Lowe in the cur¬ 
rent number of the Inter-Colonial Medical Journal 
of Australia. The patient was a labourer, whose his¬ 
tory was that he could only force food into his stomach 
by taking a pint or so of water afterwards. The 
difficulty of swallowing had persisted for three years 
and a half, and it would generally occur several times 
during a meal. If he could not force the food down 
by taking fluid, regurgitation would follow, and 
nothing would pass into the stomach. The condition, 
he complained, was becoming worse, so much so that 
at the present time he was obliged to leave the table 
about three times during a meal in order, to force the 
food down or allow it to regurgitate. There was no 
history of hypochondriasis, syphilis, injury, gout, or 
rheumatism, and the health in other respects was 
good. A probe-pointed bougie could be easily passed 
into the stomach, and there was no evidence of 
oesophageal stricture or of any organic disease. The 
only detail of importance to be obtained from the 
history was that the patient had been an excessive 
smoker. The author merely records the case without 
saying whether he had attempted anything in the 
matter of treatment. 

No Medical Privilege. 

Considerable curiosity was excited in medical 
circles by a paragraph which went the round of the 
press a short time since relating to the acquittal of a 
Gosport practitioner of a charge of riding his bicycle 
on the footpath, in virtue, it was alleged, of an old Act 
of Parliament which authorised medical men, on their 
way to an urgent case, to take the shortest route. 
We learn from the organ of the Cyclists’ Touring 
Club that the statement in question belongs to the 
categorj of pure inventions.” When called upon to 
answer the charge, the practitioner in question gave 
it as his “ impression ” that an old statute existed 
which authorised his violation of police regulations 
and the hearing of the case was adjourned to admit 
of the production of the Act. As was to be expected, 
it was not forthcoming, but the magistrates consented 
to dismiss the case upon payment of costs, coupled 
with the injunction that the defendant should go and 
sin no more. 

The Mechanical Dispenser. 

Some one who can afford to advertise in the Times 
for pleasure and not apparently for profit has been 
poking fun at the firm of Boots and Co., who have 


May 10 , 1899. 

been running a score of branch chemists’ shops with 
the aid of unqualified assistants. The firm is now 
threatened with the extinction of this line of busi¬ 
ness by the possible passing of the Companies Act 
Amendment Bill, and, being naturally anxious in 
mind at the prospective loss, is offered by advertise¬ 
ment the following kindly suggestion :—“ To Inven¬ 
tors.—Wanted, for the use of limited liability drug 
companies, a mechanical arrangement (incapable of 
qualification) to facilitate the delivery across the 
counter of articles subject to the obstructive provi¬ 
sions of the Pharmacy Act. so as to afford a conve¬ 
nient means of free trade distribution. Very liberal 
terms offered for a machine that would secure perfect 
immunity for companies.—Apply to Boots, care of Mr. 
John Smith, 123 a, Dashwood House, Broad Street, 

E.C.” - 

London School of Tropical Medicine. 

The dinner, at which the Right Hod. Mr. Cham¬ 
berlain will preside this (Wednesday) evening, at the 
Hotel Cecil, in connection with the London School of 
Tropical Medicine, gives promise of a decided success, 
both financially and socially. The Lord Chamber- 
lain, Lord Lister, Lord Strathcona and Mount Royal, 
and the Marquess of Lome have intimated their in¬ 
tention of being present, and the extensive resources 
of this large hotel are expected to be tested to the 
full. Among the contributors to the fund for the 
School are the Colonial Office. £3,550; the Bishop of 
London (Marriott Bequest), £2,000 ; the King of the 
Belgians, £200. The Japanese Embassy has also 
consented to allow their new battleship, the ‘ Shiki- 
shima, to be exhibited for the benefit of the charity 
previous to its leaving the Thames. 

Oyez ! Oyez! Oyez! 

We are requested to publish the following an¬ 
nouncement : “Their Royal Highnesses the Duke and 
Duchess of York have consented to open the new 
building of the Royal London Ophthalmic Hospital, 
alias the Moorfields Eye Hospital. The new building 
is in City Road, about one mile from the present 
site in Blomfield Street. Provision is being made 
for forty additional beds, and for a much larger out¬ 
patient department. The hospital at present relieves 
over 400 cases a day.” If any of our readers can 
find in the two concluding sentences any source of 
satisfaction they are to be congratulated. To the 
profession at large this ever-increasing pauperisation 
of the public is a perpetual menace. 

The Prevention of Consumption. 

The great statutory general meeting of the 
National Association for the Prevention of Consump¬ 
tion and other forms of Tuberculosis was held on the 
4th inst., the Earl of Derby in the chair. Dr. St. 
Claii Thompson read the report of the organising com¬ 
mittee and defined the scope of the work before them. 
He announced that 1,252 members had already been 
enrolled, and 25 branches had been formed, chiefly 
through the action of medical societies. The 
financial situation was satisfactory and on motion 
from the chair the report was adopted and the 
council elected. 


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Mat 10, 1899. 


PERSONAL. 


Tne Sensational Performance Again. 

Last week the recurring scandal of the “shocking” 
accident to the acrobat took place before the eyes of 
a public audience at the Alexandra Palace, London. 
A performer who goes by the name of the “ American 
Blondin,” after a series of daring feats on a tight rope 
at aheight of ahundred feet,wenttothe roof of the huge 
building to take his “ long dive” into a net stretched 
below. On rebounding to some height he struck for 
a second time the net, which gave way, and he was 
■dashed with great force into the orchestra stalls. He 
had a leg broken and was terribly injured about the 
head and body. It is said that the poor fellow had 
talked of the possibility of an accident, and only 
lately said he hoped a big crowd would see it if 
ever it happened. The reason for this curious 
wish may have been simple vanity, but there 
is no hope left that the sight of such accidents will 
■ever fill the mind of the public with disgust at this 
kind of amusement. A list of the persons killed in 
public performances during the last fifteen years 
would afford a good deal of reflection for the student 
of human nature. How is it Government does not 
step in and stop this waste of human life for the open 
and avowed purpose of putting money into private 
pockets P Life is protected in other directions, often 
in what may be termed an almost grandmotherly 
fashion ; yet here we have an abuse of the most 
flagrant character allowed to flourish as the green 
bay tree. Where is the London County Council P 
When Parliament fails, that energetic body has often 
-come forward to fill the gap. Here is on opportunity 
for a solid reform by way of control and licensing of 
places of public amusement. 

The Dundrum (Co. Dublin) Cause Celebre. 

The hotly-discussed question of the election of a 
Medical Officer to this district, referred to more than 
once in these columns, has been finally settled by 
the appointment of a Dr. Carroll. It will be recol¬ 
lected that a previous election was declared void by i 
the Local Government Board on the ground of “ irre¬ 
gularity,” tbe fault consisting in the absence of a 
voter which was obtained by a bogus telegram. We 
cannot blame the Local Government Board for 
having quashed the proceedings under the circum¬ 
stances, but the point of the business is that the 
candidate who had been formally elected on the 
occasion was, by this decision, ousted from every 
chance of occupying the coveted position, although the 
Local Government Board itself admitted that he was, in 
all respects, a desirable selection. Both he and his rival 
competitor were told that they might compete at the 
new election; but everyone knew that this intimation 
only added insult to their injury, because there was 
not the faintest shadow of a chance that either of 
them would succeed. In the interval between the 
two elections the operation of the Irish Local Govern¬ 
ment Act had created a complete bouleversement, the 
religion and politics of the elective constituency (the 
only consideration which determines a dispensary 
election in Ireland) having diametrically changed. 
The effect of the decision of the Local Government' 


Thk Mbdical Pbbss. 495 

Board has been to deprive the previous successful 
candidate of the professional income to which he had 
been lopking forward for over twenty years, and he 
has our hearty sympathy. What is of more import¬ 
ance to the Poor-law Medical Officers of Ireland is 
that by this case it seems to be established that the 
Local Government Board has absolute power, with¬ 
out giving any reason, by the simple process of 
refusing its sanction, a very serious matter indeed 
for candidates without friends. 


Patent Medicine Frauds. 

A man named Grigor was prosecuted a few days 
ago at Bow Street Police Court, London, for having 
obtained money on the false pretence that a certain 
nostrum compounded by him, which he calls 
“ Varixia,” is a sovereign cure for varicose veins. It 
transpired that the stuff is a weak solution of Witch 
Hazel, and, of course, perfectly inert, and that it was 
made up for him by a chemist for 2jd., bottle all 
complete, and sold at 2s. 9d. His own defence was 
as follows: “Many patent medicines are absolute 
frauds. They owe their success not to their merits 
but to extensive advertising.” He was remanded. 

An Improvised Stomach Pump. 

Db. Burns, of Sunderland, who was called to a man 
who had attempted suicide by swallowing rat poison, 
found himself in a dilemma owing to his not being 
provided with a stomach pump. Nothing daunted* 
he is reported to have passed a tube into the stomach 
of the patient, and to have sucked out the contents, 
thus saving his life. 

The Royal Zoological Society of Ireland has issued 
invitations for a Garden Party on May 19th, for the 
opening of the new building erected to perpetuate, in 
the gardens, the memory of the Revd. Prof. Haughton- 
The Lord Lieutenant and Countess Cadogan have 
promised to be present, and the meeting is to be 
addressed by His Excellency and by Lord Roberts 
and Sir Thomas Ball. We avail ourselves of this 
opportunity to congratulate the Society upon its 
recent activity and prosperity. The new Hon. Sec., 
Prof. Cunningham, is a host in himself, and is ably 
assisted by new Councillors, and the last report 
issued by the Council is, in style and material con¬ 
tents, quite a different product from its predecessors- 
If the administration persists in this policy it will 
speedily restore to the Gardens their lost popularity. 

The date for the opening of the new building of 
the Royal London Ophthalmic Hospital, in City 
Road, by the Duke and Duchess of York, is Monday, 
June 26th. 


PERSONAL. 


Mr. Robkrt Stroyan, who died last week at Johannes¬ 
burg, has bequeathed £ 2,(XX) to the Norwich Hospital. 


Mr. Brydok8 Williams has contributed a donation 
of .£6,000 to the Prince of Wales’s Hospital Fund. 


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496 Thb Medical Press. 


SCOTLAND. 


Mat 10, 1899. 


Mb. Francis Sanderson Morrison, F.R.C.S.Irel., of 
Dundalk, has announced his candidature for the Council 
of the Irish College of Surgeons in the interest specially 
of the provincial Fellow«>. 

Mr. Alban Doran, F.R.C.S., will be the Orator at the 
anrnial conversazione of the Medical Society of London 
on Monday next. He has chosen " Shakespeare and the 
Medical Society ” as his subject. 

Miss S. F. Fox, of Wimbledon, headed the list at the 
last occasion of conferring degrees at the Durham 
University, and she also took honours in the first 
examination for the degree of M.B. 

The Dean of the Medical Faculty of Edinburgh Uni¬ 
versity, Dr. T. R. Fraser, has returned from his duties 
as President of the Plague Commission ; he met with an 
enthusiastic reception f rom his large class of students. 


It is understood that Dr. D. A. Welsh, assistant to the 
Professor of Pathology in Edinburgh and Pathologist to 
the Royal Infirmary, is a candidate for the post of Pro¬ 
fessor of Pathology in Dundee, rendered vacant by 
Professor Muir's translation to Glasgow. 

Sir W. H. Flower, the newly elected President of 
the Zoological Society, was in his younger days an , 
Army surgeon, and went through the Crimean campaign. 
He was subsequently appointed Assistant-Surgeon to the 
Middlesex Hospital. 

Mr. R. B. McCausland, M.B., F.R.C.8., surgeon to 
Stevens' Hospital, Dublin, has announced himself as a 
candidate for a seat on the Council of the Royal College 
of Surgeons, Ireland, at the coming election on the first 
Monday in June. 

Dr. Walter Essex Wtnter, F.RC.P., has been 
appointed Lecturer on Pharmacology and Therapeutics 
at the Middlesex Hospital Medical School, and Mr. Alex. 
G. R. Foulerton, F.R.C.S., D. Ph. Lecturer on Public 
Health at the same institution. 

Surgeon-General Sir W. Guyer Hunter, K.C.M.G., 
will take the chair at the annual dinner of the Indian 
Medical Service at the Hotel Cecil on June 8th. The 
Hon. Sec. is Mr. P. J. Freyer, 46, Harley Street, London, 
to whom all communications should be addressed. 

Dr. George Johnston Stoney, some time chief in the 
laboratory of Loid Rosse’s great telescope in King’s 
County, afterwards Secretory to the Queen’s University 
in Ireland for several years, and well known in other 
capacities as a very distinguished scientist, has been 
awarded by the Royal Dublin Society the first “ Boyle ” 
medal ever struck, in consideration of his most valuable 
publications on Boyle and Marriott’s law. 

The late Sir B. W. Richardson, M.D., F.R.S., who in 
his day was known as the Apostle of Temperance, is to 
have a Memorial Brass unveiled to his memory at the 
London Temperance Hospital on Thursday, the 18th 
inst. The Medical Temperance Association, of which he 
was for some years president, originated the idea, and 
few who have worked for the cause deserved the honour 
more. Dr. Sims Woodhead, Dr. Clark, M.P., and other 
members of the profession will take part in the cere, 
monial. 


gtartlmtb. 

[from OtJR own correspondent.] 


Edinburgh University. 

From a report recently issued by the General Council, 
it appears that the number of students attending the 
University continues steadily to decline. The total 
number in 1890-1 was 3,488 ; in 1897-8, 2,780. The fall 
is most conspicuous in the medical faculty (from 1,961 to 
1,405) and in arte. In the latter, however, the docrease 
of 200 is more apparent than real, and is due to the 
creation of a faculty of soienoe in 1893. There is a con¬ 
siderable decrease in the number of divinity students, 
but the number of those studying law has re¬ 
mained pretty constant. In contrast to the dimi¬ 
nution in the number of students, it is note¬ 
worthy that the expenditure (now under the control 
of the University Court) on salaries to principal, pro¬ 
fessors, lecturers, assistants, and examiners has increased, 
from .£48,167 to .£54,213. The principal and professors 
only benefit by the increase to the extent of some .£1,600, 
while the salaries of lecturers amount to J24.798, as com¬ 
pared with .£1,226 nine years ago. Steps are at last 
being taken to catalogue the University library. The 
work will, of course, take a good many yearB and cost 
much money, but it will incomparably increase the 
value of the library. Two University chairs. History 
and Physiology, are now vacant. 

Medical Students and Glasgow Fever Hospitals. 
— Should Fees be Charoed?—Dr. Johnston, Medical 
Superintendent of Belvedere Hospital, has reported to 
the Corporation Hospitals Committee on the question of 
clinical instruction in the City fever hospitals to 
Btudents attending the medical schools in Glasgow. It 
was pointed out by the superintendent, in tabular form, 
that the attendance was increased from 38 in 1893 to 127 
in 1897-98. Formerly it was not compulsory for students 
to attend fever wards or hospitals of that kind, but now 
the new regulations of the General Medical Council 
make it compulory on all medical students in their 
fourth year to attend cliniques and lectures on fever and 
infectious diseases, and the medical superintendent (and 
lecturer) in order to meet the increased number of 
students was obliged to increase his classes from 
two to five, and latterly to seven, which, he says, 
is the maximum number that he is capable of 
undertaking. Further, the number of students are 
increasing steadily, and the period of time over which 
the course of instruction extends has been prolonged, 
until only two months (August and September) in the 
year are quite free from regular classes. The Medical 
Superintendent says it is worthy of note that, so far as 
he is aware, no student has ever carried infection from 
the hospitals, or contracted any infectious disease 
during the period of attendance at the cliniques. Now 
the question arises: Should the Corporation charge the 
students a fee for their instruction on fevers ? The 
students naturally feel this an extra call on their already 
overtaxed pockets, and it is pointed out that it will be 
an advantage to the community for the practitioners of 
the future to become familiar with the symptoms and 
appearance of fevers, &c.; they will be better able to diag¬ 
nose them at an early stage, and so assist sanitation. Weao 
not say that a fee should not be charged for the 
advantages derived in being taught the practical part 
of infectious diseases, but let it be a modified fee. The fee 
for reporting a case of infectious disease is 2s. 6d., and a 
penalty of 40s. for not reporting, which seems somewhat 
absurd, and should be modified, when it is remembered 
that measles, although an infectious disease, is not 
included in the list of such for report. It is to be hoped 
that the Corporation will be able to see their way to 
save the already overburdened student from this extra 
tax. 

The Dundee Medical School. —Dundee possesses 
an excellently equipped medical school, and is not un¬ 
naturally anxious to attract a large number of students. 
Owing to the transference of Dr. Muir to Glasgow Uni¬ 
versity, his chair at Dundee is vacant, and University 
1 Jottings suggests that Dundee could not get a 


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Mat 10, 1899. 


CORRESPONDENCE. 


Th* Medical Press. 497 


teacher with a more attractive personality than Dr. 
Suther lan d, assistant to the Professor of Pathology in 
Glasgow University, who is among the number of 
applicants for the Chair of Pathology in Dundee College. 

Typhoid Epidemic. —An outbreak of typhoid fever 
has taken place in Bathgate, a mining locality some 
little distance from Glasgow. At the outset the subjects 
were seized with influenza, but after a week or, in many 
cases, fourteen days, the well marked appearanoe of 
typhoid fever showed itself. This peculiarity seems to 
have misled practitioners of the district, who returned 
the cases as influenza. During the past three weeks 
more than thirty cases have been reported, and several 
deaths have taken place. Since the recognition of the 
disease the cause of the outbreak has been discovered to 
be due to the water supply, and is causing much alarm. 


MEDICAL SOCIETY OF LONDON. 

The meeting on Monday evening last commenced as 
a general meeting for the election of officers, &c., Dr. F. 
T. Roberts being elected President for the ensuing year. 

The first thing after the routine business had been dis¬ 
posed of was a report by Messrs. Gould, Sheild, and Stanley 
Boyd in reference to Mr. Battle’s case, illustrating 
“the value of Coley’s fluid for inoperable tumours.” 
Having read the hospital notes of the case, and the pub¬ 
lished accounts and examined microscopical specimens 
prepared by Mr. Shattock, they formulated the follow¬ 
ing conclusions :—(1) That the pathological appearances 
were not conclusive; (2) that the clinical history did 
not exclude syphilis; and (3) that in view of the ex¬ 
treme difficulty of accurately diagnosing sarcoma from 
inflammatory formations only those cases the nature of 
which had been indisputably proved should be admitted 
as evidence of the value of any therapeutical measure. 

Twenty Cases of Encysted Vesical Calculi. 

Mr. Bruce Clarke pointed out that in these cases 
where the stone is fixed to the bladder wall the usual 
symptoms of stone are absent, hsematuria and pain rarely 
occur, and cystitis is usually the only symptom with 
which these cases are associated. At an early stage the 
symptoms they present are assumed to be due to some 
other cause, and the stone is often only detected when 
the bladder is opened. This was so in half the cases he 
then related The exact position of the stone in the 
bladder wall varies considerably. Some are imbedded 
in the prostate, and some lie loose in cysts in other parts 
of the bladder, but these cysts are usually found near its 
base. The author showed that most of these cases 
occurred in persons between the age of 60 and 70, and 
insisted on the desirability of exploring doubtful cases 
of cystitis which do not yield to ordinary methods of 
treatment. 

Mr Swinford Edwards concurred in praise of supra¬ 
pubic exploration, and deprecated attempts to crush en¬ 
cysted calculi in situ. 

Mr. Buckston Brown insisted on the importance of dis¬ 
tinguishing between sacculi and pouches, pointing out 
that though a stone in a post-prostatic pouch could 
be removed suprapubically without laceration of the 
bladder wall, that was not the case with a really encysted 
calculus. 

Mr. Freyer said he had operated on nearly 1,000 cases 
of stone in the bladder, and had only met with 20 or 25 
instances of encysted stone. He pointed out that when 
the opening connecting the pouch with the bladder was 
small, a cutting operation was necessary, preferably the 
suprapubic operation, but if the opening were large the 
stone could be dealt with in situ. In 400 operations for 
stone on patients of all ages, with stones of all sizes, a 
cutting operation had only been found necessary in 8. 

Mr. F. Eve related two cases of Resection of the Large 
Intestine with Recovery, and a discussion ensued, in 
which Mr. Battle and Mr. Wallis argued against the 
use of a button or bobbin in anastomosis of the large 
jntestine, both surgeons preferring lateral anastomosis by 
suture. 


(EomfiponDme, 


We do not hold ourselves responsible for the opinions of out 
correspondents. 

THE ATTENUATION OF SYPHILIS. 

To the Editor of The Medical Press and Circular 

Sir, —Dr. George Ogilvie asserts in the Medical 
Press and Circular of May 3rd, that the “ similarity” 
of the aggravated form of disease among British 
troops invalided home from India, to that depicted by 
Fergus son in Portugal, was first pointed out by himself, 
and states that my statement “ in proof of the truth of 
Fergusson'8 views that the similarity of the aggravated 
form of disease among British troops invalided home 
from India was originally adduced by myself ” “ is a 
production of daring imagination, a fiction, Ac. 

In the Lancet of Jan. 29th, 1898, I stated that 
“ Dr. Ogilvie considers that the sad state of the 
British Army at the present time in India (which 
I might say is a counterpart to the state of the 
Army noted by Fergusson in Portugal, is sufficient to 
considerably shake any theory of general immunity. 
The observations of William Fergusson (not Ferguson), 
for two years the Inspector of Hospitals to the Portu¬ 
guese Army, soem to me to be so conclusive, and, moreover, 
verified at the time by Staff Surgeon Jebb that it is im¬ 
possible to accept Dr. Ogilvie’s interpretation.” I repeat 
it was impossible. In Dr. Ogilvie’s paper in the British 
Journal of Dermatology, November, 1897, and, as Dr. 
Ogilvie states, noticed in the Lancet, he had discredited 
Fergusson’8 observations on mitigated disease in 
Portugal in 1812; had enunciated the view that “ the 
hereditary transmission of syphilitic immunity was a 
remote possibility, and that the attenuation of syphilis, 
whenever it takes place, is affected by the improvement 
in hygienic preventive and therapeutic measures ” 
(ride his letter, Lancet, March 5th, 1898). Not 
one word had he said of Fergusson’s alter¬ 
native views of climate or noted causes of mitigation 
of syphilis, and while Dr. Ogilvie noted the sad state of 
the British troops invalided home from India; sub¬ 
scribed to the explanation of malignancy by lack of 
hygienic preventive and therapeutic measures as opposed 
to attenuation, he did not note the aggravated form of 
syphilis among British troops depicted by Fergusson in 
Portugal, nor his explanation of climate with its 
“ febrile affections,” intemperance, Ac. 

Such conclusions and omissions, obviously founded 
upon imperfect knowledge of Fergusson’s work, led me 
to direct attention to the work of this great Army Sur¬ 
geon in the fourth volume of the Transactions of the 
Royal Medical and Chirurgical Society, not only in 
justice to his name and work, but in favour of the many 
causes of mitigation and aggravation of syphilis. 

In the Lancet of April 23rd, 1898, in defence again of 
Fergusson, I state: “ tie advanced the alternative view 
of climate (malaria) and intemperance to account for 
increased virulence, either of which theories may apply 
at the present day.” Again, May 24th, as opposed ta 
mercurial abuses. 

On the other hand. Dr. Ogilvie, in his paper in the 
British Journal of Dermatology, July, 1898, in noting 
the aggravated form of syphilis in troops invalided 
borne from India states, “ The resemblance this 
description bears to Fergusson’s narration is 
striking.” Again, in the Bri'ish Medical Journal, of 
November 19, 1898, he asserts, “ In my paper on syphilis 
among British troops, Portugal, 1812, India 1896, to 
which you refer in the British Medical Journal of 
November 5, I have pointed out that there exists a 
striking resemblance between the state of affairs among 
British troops in Portugal, 1812, as described by 
Fergusson, and ‘the state of affairs among British 
troops in India, 1896.” On both occasions this simi¬ 
larity is used by Dr. Ogilvie 'to further his contention 
that malignancy is explainable by lack of hygienic pre¬ 
ventive and therapeutic measures, and that whereas 
Fergusson later admitted the aggravation of syphilis 
among British troops in Portugal by the abuse of mer¬ 
cury, so now, perhaps, “ a similar cause might be opera¬ 
tive in India.” 


Digitized by Vj(_ 



le 



CORRESPONDENCE. 


May 10, 1899. 


498 The Medical Press. 


Unless Dr. Ogilviehas noted the “similarity ” anywhere 
else previous to my letter in the Lancet-, of Jan. 29th, 
1898,, I repeat the “similarity” was originally adduced 
by myself, and in proof of the truth of Fergusson’s 
observations and views respecting malaria as an aggra¬ 
vating factor in the foreigner, and in no way incon¬ 
sistent with attenuation in the native. 

2. With regard to Prof. Neumann and Dr. Ogilvie’s 
remarkable statements, I think if your readers will 
refer to Dr. Ogilvie’s paper they will find my remarks in 
the Medical Press and Circulir, March 1st, correct. 

Dr. Ogilvie’s statement in his paper as opposed to that 
in the Medical Pbess and Circular is as follows:— 
Prof. Neumann in his historical introduction, “ says that 
Portugal is ‘ less infected ’ with syphilis with regard to 
the intensity of the disease as well as its extent, that 
the course of the disease is a very favourable ” one, that 
“spontaneous cure is not rare,” that this benign 
character of the disease is apparent in the hospitals, 
that he, therefore, is in opposition to Fergusson, who 
“pointed out the malignancy (?) of syphilis in 
Portugal.” This latter statement is evidently a slip of 
the memory excusable in so bulky a work. The 
note of interrogation is Dr. Ogilvie’s, and he here 
clearly objects to the statement that Fergusson 
pointed out malignancy in Portugal. But Fergusson, 
corroborated by Guthrie, did point out malignancy in 
Lisbon, in contradistinction to the attenuation noted in 
the bulk of the people, and I assumed that Neumann, 
being aware of this, found himself in opposition, and 
deliberately stated it, and that it was not a slip of the 
memory as Dr. Ogilvie supposed. Dr. Ogilvie now states 
that Neumann has corrected the statement as a mis¬ 
print, which I regret, for from this as well as from his 
previous views noted by Dr. Ogilvie discrediting 
Fergusson's observations on mitigated disease in 
Portugal, I fear he is not fully acquainted with Fergus- 
sons remarkable work. Dr. Ogilvie thinks it a curious 
malady to show extremes between “very mild” and 
“ malignant,” but there is no inconsistency in 
Fergusson’s observations, because it is known that 
in seaport towns, e.g., Lisbon, syphilis from various 
causes assumes for the most part an aggravated form. 

3 With regard to Professor Tamowsky (St. Peters¬ 
burg), Dr. Ogilvie does not quote correctly the statement 
which appealed to me in favour of transmitted hereditary 
immunity. He states that Tarnowsky relates “thirty 
cases of syphilis in the majority of which both parents 
and children had acquired syphilis,” whereas my quota¬ 
tion is “ in syphilis which never enters the gummatous 
period, and which is even exclusively limited to the 
initial symptoms abortive syphilis so to say, parental 
syphilis has transmitted a lesser receptivity to the 
syphilitic diathesis.” I must leave it to your readers to 
judge for themselves the importance of such a statement, 
and to compare it with the apparently contradictory 
opinion Dr. Ogilvie quotes from the same authority, i 
While adhering to transmitted immunity as one cause 1 
of modified syphilis, I deny, and have denied that it is 
the only cause. Dr Ogilvie limits his interpretation of 
attenuation to “ acquired immunity, hereditarily trans¬ 
mitted,” whereas it has been my endeavour to direct 
attention afresh not only to modified syphilis, but to the 
many causes of attenuation, apart from the question of 
treatment. 

4. With regard to Dr. Ogilvie’s complaint that I have 
unfairly drawn attention to his wrong spelling of Fer¬ 
gusson’s name, which he says was done by mistake, and 
that I have not done so to others, the point is that it is 
Dr. Ogilvie who professed to throw discredit on Fer¬ 
gusson and his views, presumably with a full acquain¬ 
tance of Fergusson’s original work ; whereas in this first 
paper there is no evidence of such ; and the repeated 
incorrect spelling of Fergusson’s name supports this 
view, which Dr. Ogilvie has not thought fit to deny. 

On the contrary, the late Mr. Henry Lee’s conclusions 
and appreciation of Fergusson’s work were founded on 
knowledge of Fergusson’s original work. The mistake 
in the spelling of the name occurring in his chapter in 
his work " On Syphilis,” was occasioned, as he informed 
me, through his having wriiten this chapter (1862) from 
memory of Fergusson’s original work. This will be at 


once evident to those who are acquainted with the pub¬ 
lished lectures of Mr. Lee, delivered at the Lock Hos¬ 
pital in 1854, in which the name of Fergusson is spelt 
correctly. 

I am, Sir, yours truly. 

May 6th, 1899. John A. 8haw-Macxenzik. 


“THE ANTI-VIVISECTION GALA.” 

To the Editor of The Medical Press and Circular. 

Sir, —Your leader on this subject has at least the 
merit of being good tempered, and, therefore, I am in¬ 
duced to put in a word to say that I am the “ eminent 
surgeon ” who took part in the function and against whom 
you perpetrate at least two mistakes. You seem to think 
that my conversion to anti-vivisection views is a recent 
matter, but it is a matter of nearly thirty years old. 
My first contribution to the literature of the subject 
was made twenty-six years ago, and the paper, 
which has been made a kind of text-book for the 
cult is eighteen yeais old, has appeared in nearly a 
dozen different languages, with combined issues of some 
half a million copies. If such a connection could bring 
about the fall for which you obscurely prophesy, I should 
have felt it long ago ; yet, strangely enough, I never did. 
On the contrary, when the paper was read I had only one 
medical supporter, a woman, whilst now I could com¬ 
mand hundreds. 

Some day I shall have a tombstone put over me and an 
inscription upon it. I want only one thing recorded on it, 
and that to the effect that “ he laboured to divert his 
profession from the blundering which has resulted from 
the performance of experiments on the sub-human 
groups of animal life, in the hope that they would shed 
light on the aberrant physiology of the human groups.” 
Such experiments never have succeeded, and never can; 
and they have, as in the cases of Koch, Pasteur, and 
Lister, not only hindered true progress, but they have 
covered our profession with ridicule. 

I am. Sir, yours truly, 

Lawson Tait. 

195, Newhall Street, Birmingham. 

[How anyone can gainsay the unquestionable benefit 
to science of observations on living animals surpasses 
our comprehension. We are driven to the conclusion 
that Mr. Tait and his f ellow anti-vivisectionists have a 
blind spot in their mental retime.—E d.] 


MEDICAL AID ASSOCIATIONS. 

To the Editor of The Medical Press and Circular. 

Sir, —I think it is evident that the Medical Aid 
Officer has totally misinterpreted the letters that have 
appeared on the subject. Speaking for myself I have in 
no instance dealt with the question of salaries. In fact 
I submit that the remuneration received by medical 
offiers is hardly worth commenting upon. What is most 
objectionable is the system of canvassing for patients. I 
feel sure that “ Medical Aid Officer ” will not be prepared 
to defend a system whereby medical men build up prac¬ 
tices by filching other practitioners’ patients. I am not 
generally in the habit of using “heated’’language in my 
correspondence, and 1 venture to appeal to you, sir, 
whether I have done so in this particular instance. It 
may interest the “ Medical Aid Officer ” to know that 
at a very largely attended meeting of the South Wales 
Branch of the British Medical Association held at New¬ 
port on May 2nd, a resolution that I proposed on the 
subject of medical aid associations was considered too 
mild, and that one was actually proposed and unani¬ 
mously carried asking the General Medical Council to 
declare it “ infamous conduct in a professional sense ” 
for any medical man to hold office in any of the medical 
aid associations in which canvassing for patientB is 
resorted to. 

I would humbly submit that if we are desirous of 
keeping up the dignity of the medical profession we 
should, by every means in our power, put an end 
to the system of “ touting ” which is rapidly 
bringing medical men to the level of credit drapers. 




MEDICAL NEWS 


1 kk Medical Press. 499 


_M ay 1 0, 1899. 

How can we possibly expect the working classes 
to oonsider ours a dignified profession when they find 
men willing to ally their names to associations whose 
existence entirely depends on a house-to-house visitation? 
It may be convenient for some of the leaders of the 

J irofession to ignore the existence of the evil, but I would 
ike to point out that serious diseases are not usually 
cured by ignoring their presence. 

I am, Sir, yours truly, 

Cardiff, May 3rd, 1999. T. Garrett Horder. 


(Dbituartj. 


DR. JOHN EUSTACE, OF DUBLIN. 

The death of this much esteemed gentleman, at the 
ripe age of seventy-nine, has been announced within 
the last week. He and his brother—dead now for many 
years—were specialists in Psychology, and the joint pro¬ 
prietors of two private asylums, situated at Drumcondra, 
near Dublin, which establishments Dr. John Eustace 
held until his death. His qualification of M.B. and 
M.D. of the University of Dublin, dated from 1851. He 
was a member of the Society of Friends, and was univer¬ 
sally respected, not only for his integrity, but for his 
business capacity and his geniality and kindliness. 


JJarliamentart) 4ftetos. 

Vaccination.— 8ir W. Priestley (Edinburgh and St. 
Andrews Universities) asked the President of the Local 
Government Board whether it was true that in Ipswich 
and other localities, where previously there had been 
great opposition to vaccination, the cases of vaccination 
had notably increased sinoe the passing of the Act of 
last year, and that many parents who had been per¬ 
suaded to apply for certificates of exemption had not 
presented them to the vaccinating officer, but had subse¬ 
quently had their children vaccinated. Mr. Chaplin, in 
reply, said there was distinct evidence that in a number 
of localities where previously there had been a great 
amount of default under the Vaccination Acts the 
number of vaccinations performed since the new Vacci¬ 
nation Act came into operation on January 1st last has 
been in excess of that for any corresponding period in 
recent years. In respect of Ipswich, theaverage quarterly 
number of vaccinations performed by the Public V aocinator 
during 1897 and 1898 was only 33, whereas in the first 
quarter of the present year the number vaccinated was 198 
Mr. Chaplin, in reply to Mr. Webster,|stated that accord¬ 
ing to the latest information it was not the fact 
that during the present small-pox epidemic in Hull all 
the cases admitted to the hospital—which were 26 and 
not 25—were unvaccinated. Nineteen had been vacci¬ 
nated, and the Medical Officer of Health reports these 
cases to be of a modified character and that none had 
died. (Cheers.) The remaining seven were unvacci¬ 
nated ; of these four had died. He had no means of 
estimating the proportion of unvaccinated persons of 
all ages in Hull, but during the last five years for which 
returns have been received some 20 per cent, of the 
children whose births were registered in the two Unions 
in which Hull is comprised, and who survived when the 
returns were made, were then unvaccinated. 

Medical Officer for the Education Department. 
—The Committee of Council of Education have decided 
not to appoint a Medical Officer to deal with public 
health questions that are constantly occurring in connec¬ 
tion with elementary schools, but propose for the pre¬ 
sent, at any rate, to refer matters under the Superannua¬ 
tion Act to the Medical Officer emoloyed by the Post 
Office and the Civil Service Commissioners. 

- •- 

iftebtcal iletos rntb ftoe* ICtsts. 

Medical Defence Union. 

The following officers of the Union have been reap¬ 
pointed for the year:—President, Dr. W. S. A. Griffith, 

F. R.C.P.; treasurer, Dr. J. A. Masters, M.R.C.P.; hon. 
sec., Dr. Campbell Pope, F.R.C.S.; general secretary, A. 

G. Bateman, M.B. 


The following members have been elected vice-presi¬ 
dents of the Union, and, together with the executive 
officers and elected members, form the Council of the 
Union:—Mr. Gunton Alderton, L.R.C.P.; Mr. C. A. 
Ballance, F.R.C.S.; Dr. Edgar Barnes; Dr. James Barr, 
M. J.C.P.; Mr. James Bisshop, L.R.C.P.; Mr. A. H. Dodd, 
L.R.C.P.; Dr. Lovell Drage; Mr. Samuel Evans, J.P., 
L.R.C.P.; Dr. W. A. Elliston, J.P. ; Dr. J. S. Ferris ; Mr. 
E. Clemson Greenwood, L.R.C.P.; Dr. W. P. Herring- 
ham, F.R.C.P.; Surgeon-General C. M. Jessop, M.R.C.P.; 
Dr. J. A. Masters, M.R.C.P; Dr. Arthur Luff, F.R.C.P.; 
Dr. C. H. Milburn; Mr. Marmaduke Shield, F.R.C.S.; 
Dr. Frederick Nicholls; Dr. Edward Nix; Dr. Reginald 
Pratt; Dr F. A. Purcell; Dr. Prior Purvis; Dr. Walter 
Rigden; Dr. R. Saundby, F.R.C.P.; Dr. F. J. Wethered, 
F R.C.P. 

The French Hospital and Dispensary. 

The thirty-first annual dinner on behalf of the funds 
of this institution took place on Saturday, the 6th inst., 
at the Hotel Cecil, M. Paul Cambon, the French Ambas¬ 
sador, in the chair, snnported by the Lord Mayor of 
London and Sheriffs, ana by many members of the corps 
diplomatique. The chairman said he had himself had 
an opportunity of inspecting the hospital, and had been 
greatly impressed by the ample provision for the care 
of the sick. He also spoke on terms of commendation of 
the convalescent home which had been recently opened 
at Brighton in connection with the hospital. He con¬ 
gratulated them upon living at the latter half of the 
century, than which he believed at no time had social, 
Christian and charitable sentiments more stirred the hearts 
of men. The Italian Ambassador responded to the toast in 
French. He pointed out that the hospital received not 
only French sufferers but sufferers of all nationalities. 
He alluded to a certain minister who was reproached 
for having appointed as surgeon to a vacant post a 
candidate who had not obtained the highest marks at 
the competitive examination. On being pressed to 
defend his selection he said that the candidate in 
question was the most conservative among the candi¬ 
dates, adding that conservatism in a surgeon was a 
valuable quality. The Lord Mayor also responded to 
the toast, which he thought tended to promote feelings 
of amity and good fellowship between the two peoples. 
During the evening the secretary, M. Pontdepeyre, 
announced subscriptions and donations amounting to 
.£3,200. The musical arrangements were under the 
direction of Chevalier lito Mattei, who was assisted 
by Mdlle. H61fcne Michaelis, M. J. Thomas, and Signor 
Giuaeppi Maggi. 

University of Durham. 


At the Convocation holden on Saturday, April 29th. 
1899, the following degrees were conferred, viz.:— 
Doctor in Medicine. 

Addenbrooke, Bertram, M.B., 

B.8., Durh. 

Baker, Alexander, B.A., Paris, 


M.B., B.S., Durh. 

Bennett, Norman, M.B., B.S., 
Durh. 

Bryant, Charles Hilary, M.B., 
B.8., Durh. 


Daly, Bam say Lamy, M.B., B.9., 
Durh. 

Dlx, William Ralph, M.B., B.S. r 
Durh. 

Francis, Harvey, M.B., B.S. r 
Durh. 

Sparks, John Peel, M.B., B.S., 
Durh. 


Doctor in Medicine (Practitioners of fifteen years’ 
standing). 


Allen, T. W. J., M.H.C.8., 

LBC P 

Bateman, F. A. N., M.R.C.S., 
L.B.C P. 

Fearnley, William, L.R.C.S., E. 
Freeman, William T., M.B.C.S., 
L R C P 

Jones! W. Makeig, M.B.C.8., 
L.S.A., D.P.H. 

Lane, Alex., M.B.C.8., L.8.A., 
F.B.C.8., I. 


Lawrence, H. Crippe, M.B.C.S., 
L.R.C.P. — 

Lessey, Sandford 8., M.B.C.S , 
L R C P 

Lettis, Thomas, M.B.C.S., L.8. A. 
Mark, Leonard P., M.B.C.S., 
L.R.C.P., L.S.A. 

Slater, William, M.B.C.8., L.S.A. 
Thistle, Frederick T., M.B.C.S. r 
L.R.C.P. 


Bachelor in Medicine [(M.B.). 


Bailey, Ernest Castleifh, L.S.A 
Boyd. James William Hugh 
Brown, Robert T., M.B.C.S., 
L.R.C.P. 

Cann, Thomas Ponsford 
Davison, Henry Edward 
Dudgeon. H. W., M.B.C.S., 
L.R.C.P. 

Fox, Selina Fitrherbert 
Hartigan, James Andrew 
Hemmans, Lawrence Fielder 
Hethcote, Douglas 
Inman, Ernest 


Johnson, Samuel Percy 
McConnell, James 
Milligan, James 

New man,Herbert B. C., M.B.C.S. 
L.R.C.P. 

Picton, Guy Brougham 
Stevens Bertram C., M.B.C.S., 
L.BC.P. 

Tuxford, Arthur Wren 
Vincent. Ralph H., M.B.C.S., 
I L.R.C.P. 

Watson, Thomas Blandford 


Digitized by VjVJU 




500 The Medical Press. 


NOTICES TO CORRESPONDENTS. 


May 10, 1899. 


Notices to 

(Fomoponbntto, Short letters, &r. 

Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive lignatur* or 
initials, and avoid the practice of signing themselves “ Header,” 
“Subscriber,” “Old Subscriber,” 4c. Much confusion will be 
spared by attention to this rule. 

FEES FOE ATTENDANCE ON A MEDICAL MAN. 

To the Editor of the Medical Press and Circular. 

Sir,—T he writer has attended a retired medical man at latter's 
own request, one attendance lasting for seven weeks. 

Patient died recently, leaving property, real and personal, to well- 
to-do relatives and the religious body to which he belonged, but 
nothing to the writer. As he left neither wife, family, nor poor 
relations behind, would not writer be justified in sending in a bill as 
for attendance in the case of an ordinary well-to-do patient? The 
amount of estate for distribution exceeds £6,000. 

I am, Sir, yours truly, 

“ Dcbicm." 

[We do not hesitate to express the opinion that the case described 
by our correspondent fully justifies his demanding bis fees and 
enforcing his claim. If his doing so could have been, or could now 
be, of any injury to his medical confrere or his relatives, our corre - 
spondent might judiciously abstain from doing so, but, in our 
opinion, the circumstances narrated entirely absolve him from the 
observance of etiquette, and will acquit him of unkind or unsym¬ 
pathetic treatment of the family. We should, however, suggest 
that, for the sake of his own self-respect his demand ought to be 
moderate. He would follow the bod example of the family if he 
made any grasping claim.— Ed.] 

Pxvensit. —A damp upper soil is almost invariably connected 
with malaria. It is also associated almost certainly with specific 
diarrhoea, with typhoid fever, and in all probability with tubercu¬ 
losis. Among other possibilities is that of the relation of cancerous 
diseases to dampness of soil, a theory that is ardently advocated in 
some quarters. Coming to your question, we should advise you to 
get a dry and porous soil if you can do so conveniently. If pre¬ 
cluded from that course by unavoidable circumstances, the next 
beet thing is to see that the curtilage of your house is well drained 
and that the basement is absolutely impervious throughout. Sub¬ 
soil drainage has nearly rid the Fens of ague. 

TUBERCULOSIS. 

To the Editor of the Medical Press ahd Circular. 

Sir,—I f medical men will urge the preachers and teachers in their 
respective neighbourhoods to induce breeders of stock to show con¬ 
sideration for the animals under their control two advantages will 
result—the animals themselves will be happier and better, and the 
food supplied be wholesomer. 

I am, Sir, yours truly, 

F. Lawrence, 

Hon. Sec. Church Sanitary Association. 
Westow Vicarage, York, May 7th, 1899. 

CURIOSITIES OF THE TELEPHONE. 

A correspondent sends us the following amusing dialogue, the 
source of which we regret being unable to acknowledge, not know¬ 
ing whence it is taken:—“Are you there?” “Yes.” "Who are 
you, please?” “Watt.” " What’s your name, please ? ” “Watt’s 
my name.” “Yes; what is your name?" “I say my name is 
Watt.” “ Oh 1 Well, I'm coming round to see you this afternoon.” 
“All right. Are you Jones?” “No; I’m Knott.” “ Who are 
you, then, please ? *’ “I’m Knott.” “ Will you tell me your name, 
please?” “I’m Will Knott.” “ Why won't you ? ” “I say my 
name is William Knott.” "Oh! I beg your pardon.” “Then 
you’ll be in this afternoon if I come round, Watt ? " “ Certainly, 
Knott." They were then “ rung off ” by the Exchange. 


Jtteetmgs ot the gorietue attb lectures. 

Thursdat, Mat 11th. 

British Gynecological Societt.— 8.30 p.m.—Specimen—Dr. 
H. Snow: Large Mammary Intracystic Sarcoma. Papers Mr. J. 
W. Taylor, Birmingham: The Treatment of Gonorrhoeal Salping¬ 
itis. Dr. John Campbell. Belfast: A Case of Pyosalpinx in which 
one of the tubes contained nineteen ounces of pus. 

Brixton Medical Societt.— 9 p.m.—Mr. Percy Dunn.- On some 
points in the Treatment of Iritis. 

Central London Throat, Nose, and Ear Hospital.— 5 p.m. 
Dr. Dundas Grant: Clinical Anatomy and Physiology of the Ear. 


Uacairriw. 

Bath, Royal Mineral Water Hospital.—Resident Medical Officer; 
unmarried. Salary, £100 per annum, with board and apart¬ 
ments. Applications to the Secretary by May 15th 

Bedford County Hospital. — House Surgeon. Salary, £100 per 
annum, with apartments, board, lodging, and washing. Appli¬ 
cations to the Secretary by May 15th. 

Betblem Hospital.—Two Resident House Physicians for six months. 
Apartments, complete board and washing provided, and an 
honorarium at the rate of £12 12s. per quarter. Applica¬ 
tions, endorsed “House Physicians.” to the Treasurer, Bride¬ 
well Hospital, New Bridge Street, E.C., by Mav 15th. 

London Temperance Hospital, Hampstead Road, N.W.—Assistant 
Resident Medical Officer. Remuneration at the rate of £50 per 
annum, with residence, board, and washing. Applications to 
the Secretary by May 20th. 

Glamorgan County Asylum.—Junior Assistant Medical Officer. 
Salary £130, rising to £150, with board, lodging, and washing 
Applications to the Medical Superintendent by May 13th. 

Grove Hall Asylum. Bow, E.-Junior Assistant Medical Officer. 
Salary £120 per annum, with board, lodging, and washing. 
Applications to the Medical Superintendent. 

Hospital for Women, Soho Square, W.- House Physician for six 
months. Salary £30. Applications to the Secretary by May 
13th. 

West Riding Asylum, Wadsley, near Sheffield.—Fifth Assistant 
Medical Officer. Salary £100 per annum, increasing to £150. 
with board, 4c. Applications to the Medical Superintendent 
by May 16th. 


^ppoininunts. 


Aitchison T., M.B., C.M.Edin., Medical Officer for the Willington 
Quay District of the Tynemouth Union. 

Bower, George, L.R.C.P., M.R.C.S., D.P.H., Clinical Assistant to 
the Chelsea Hospital for Women. 

Cameron, John, M.B., Ch.B.Edin., House Surgeon to the Central 
London Ophthalmic Hospital. 

Coplet, Mr., Resident Surgeon in Mercer's Hospital, Dublin • 
Assistant Medical Officer in Guinness’s Brewery, vice Dr. Lums- 
den, appointed to the chief position. 

Dempsey, Martin, M.D., Visiting Physician tolthe Mater Miseri- 
corditB Hospital, Dublin. 

Foulerton, Alex . G. R, F.R.C.S., D.P.H., Lecturer on Public 
Health at the Middlesex Hospital Medical School. 

Gordon, Thomas Eagleson, M.B., F.R.C.S.Irel., Surgeon to the 
Adelaide Hospital, Dublin; Medical Attendant to the Bank of 
Ireland, vice Dr. Harrison Scott, resigned. 

Lander, F.J., M.R.C.S.Eng., L.R.C.P.Lond., Medical Officer of the 
No. 1 District, Nottingham Union. 

Martin, James 8 ., M.B., C.M.Edin., M.B.C.S., L.R.C.P.Lond.. 
House Surgeon to the Rotherham Hospital. 

Norwell, J. S., M.B.Edin., Assistant 8urgeon to the Perth Royal 
Infirmary. ' 

Perrins, H. B., L.R.C.P.Lond.. M.R.C.S.Eng., Medical Officer for 
the Barking District of the Romford Union. 

Stabb, Ewen Carthrw, F.R.C.S.Eng.. Surgoon to Out-patients at 
the Great Northern Central Hospital. 

Tait, J., L.R.O.P., L.R.C.S.Edin., Medical Offioer for the Sharn- 
brook District of the Bedford Union. 

Wilson, A. Garrick. M.R.C.S.Eng., L.R.C.P.Lond., Junior Out- 
^en^Surgical Offioer to the Royal London Hospital, Moor- 

Wtnteh,’ Walter Essex, M.D., F.R.C.P., Lecturer on Pharma¬ 
cology and Therapeutics at the Middlesex Hospital Medical 
School. 


Carriages. 


Alexander—Woodward.— On May 3rd, at St. Clement Danes, 
James Whitelaw Alexander, M.R.C.P., L.F.P.S., The Lodge 
"? le y- ^ e ^-^^ econ ' 1 8011 of the late Thomas Alexander. 
M.D. F.F.P.S.Glas., to Laura. Woodward, niece and adopted 
daughter of the late James and Margaret Alexander. Grove 
House, Ripon. ’ 

Kildahl—Willock.— On May 4th, at St. Andrew’s Church, Fnl- 
h*m, Edward Hulse Willock, M.R.C.S.. L.R.C.P., seoond son of 
the late Edward Hulse Willock, 3rd Bengal Cavalry, to Eliza 
oldest daughter of the late William Sobieski 
11 dam, of Dublin. 

Levick—Castledine.— On Anril27th, at Kirkella, Harry Driffield 
®v B-Sc ” E-E-C.S., of 132, St. Paul’s Terrace, 
Middlesbrough, son of Henry Levick, of Thranstone to 
Harriett Minnie Castledine, M.B., B.Sc., daughter of the 
hde Henry Castledine, of Gloucester Gate, Regent’s Park, Lon 


Friday, Mat 12th. 

Clinical Society of London (20 Hanover Square, W.).—8.30 p.m. 
Dr. Hale White and Mr. Golding-Bird: Three additional cases of 
Right Colotomy for Chronic Colitis. Dr. St. Clair Thomson: 
Chronic Empyema of the Maxillary Sinus, undoubtedly of two 
years’ and probably of seven years’ duration associated with 
inveterate cough and periodical headache; completely cured in 
eight weeks by simple drainage through the alveolus Mr. Mark 
Hovell and Mr. F. Eve : Cases illustrating the Pathology and 
Treatment of Chronic Suppuration of the Maxillary Sinus. 

Monday, Mat 15th. 

Central London Throat and Ear Hospital.— 5 p.m Mr. 
Lennox Browne's Lecture on Difficulty of Swallowing. 


garths. 

Eustace.—O n May 4th, at his residence, Elmhurst, Glasnevin 
Dublin, John Eustace, M.D., J.P., aged 73. 

Paget,— May 7th, at Litchfield Lodge, Hereford, Clara, widow of 
8ir George E. Paget, K.C.B., M.D., F.R.8., of Cambridge 
73. “ 

Ptn £ °n May 4th, at Royston, Herts, Sarah Ellen, widow of the 
late Richard Pyne, M.R.C.S., J.P.. aged 89. 

Retnalds.— George Frederick Reynnlds, M.R.C.S., L.R.C.P.. of 4 
NormanyBle, Church Rood, Teddington, almost suddenly, at 
Taquah, West Africa, on Wednesday, February 15th, aged 30 
from blackwatar fever. * ’ 


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May 17, 1899 


The Medioal Press and Circular Advertiser. 




Scott’s Emulsion 

In Diabetes, Gout, Rheumatism 
and Bright’s Disease. 




Should the physician desire cod-liver oil to be a J^ 

* part of the treatment of any of the above diseases, 

| and should he prefer an emulsion of this oil, he CJ 

I will undoubtedly be pleased to know that the sweet 
taste of Scott’s Emulsion is due to GLYCERINE, and 
not to sugar. We do not use sugar to make our Jr 

* preparation palatable. There is consequently no 

l danger from uricacidsemia or glycosuria. il 

' The value of glycerine in Scott’s Emulsion CJ 

cannot be too strongly emphasized. Nature makes 
glycerine in the digestion of fats, showing the need 
of it. The glycerine also facilitates the absorption Jzf 
of the oil, thus further promoting the final object 
toward which the minute and permanent division 
of the oil is the first step. 

Add to this combination of cod-liver oil and 
glycerine, the hypophosphites of lime and soda, 
and you certainly have a preparation that merits JcT 
at least comparative tests. 

SCOTT & BOWNE, LTD., MANUFACTURING CHEMISTS, LONDON, E.C. j£ 

QOOOOOOOQOOQOOQQ 

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LONDON, 1884. 


ADELAIDE, 1887. 


MELBOURNE, 1S88. 


The Medloal Press and Circular Advertiser. 


1899 


BENGERS 


GOLD MEDAL AWARDED 

Health Exhibition, London. 


FOR INFANTS, INVALIDS, 

AND THE AGED. 

This delicious highly nutritive and most easily digested Food is 
specially prepared for Infants, and for those whose digestive 
powers have been weakened by illness or age. 

The following letter addressed to F. B. BENGER <Ss CO., Ltd., is published by special permission 

of the Russian Court. 

“ Balmoral Castle, 

“ Scotland, 25th Sept., 1896. 

“ Sirs,— Please forward to Balmoral Castle one 
dozen 2f6 Tins of BENGER’S FOOD for H.I.M. THE 
EMPRESS OF RUSSIA, addressed to Miss Coster. We 
have received the box ordered from Peterhoff. 

66 Yours truly, F. COSTER. 99 

The Lancet describes it as “ Mr. Benger’s admirable preparation.” 

The Medical Press says :—“ Few modern improvements in Pharmacy have done so much as 
Benger’s Preparations to assist the Physician in his treatment of the sick.” 

The British Medical Journal says:—“ Benger’s Food has by its excellence established a reputation 
*f its own.” 

The Illustrated Medical News says:—“ Infants do remarkably well on it. There is certainly a 
great future before it.” 

A Government Medical Officer writes :—“ I began using your Food when my son was only a fort¬ 
night old, and nofcr (five months) he is as fine a boy as you could wish to see.” 

From an eminent Surgeon : —“ After a lengthened experience of Foods, both at home and in India, 
I consider Beoger's Food incomparably superior to any I have ever prescribed.” 

A Lady writes : — “ Really I consider that, humanly speaking, Benger’s Food entirely saved baby’s 
life. I had tried four other well-known Foods, but he could digest nothing until we began the 1 Benger.’ 
He is now rosy and fattening rapidly.” 

BENOER’S FOOD is sold in Tins at 1/6, 2/6, and 6/-, by Chemists, Ac., everywhere. 

Wholesale of all Wholesale Houses and Shippers, or of the Manufacturers, .. 

F. B. BENGER & CO., Ltd., Otter Works, Manchester. 

Tblkgraphio Address : “ Bender's, MauioHestar." 


FOOD. 


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Bynin 


Perfection of Ciquid extract of malt 


HlfhftlMh firtllkl BYNIN possesses the same diastasic 
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Being Liquid. complete digestion, and preventing the 

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Allen & Hanburys Ltd., 


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xvi 


The Medical Press and Clroular Advertiser. _ May 17 ,189 9 


On an Exact Bacteriological Investigation made to ascertain the Value of 

“Sanitas” Fluid, “Sanitas” Oil, & “Sanitas” Emulsion 

As DISINFECTANTS for GENERAL USE, 

By O. MOOR, (Oantab.), X*. X.O., P.O.S., 

Member of the Society of Public Analysts, Joint Author of “Applied Bacteriology," Ac., Ac. 


4 Danes Inn, W.C„ London, July 2nd, 1898. 

C. T. KiNOZETT, Esq., F.I.C., F.C.S., 

The “Sanitas" Compant, Limited, 

Bethnal Green, London, E. 

Dear Sir, 

I beg to present you my report on the experimental investiga¬ 
tions I have conducted on the preparations manufactured by your firm, 
named “Sanitas" Oil, “Sanitas" Emulsion, and “Sanitas' Fluid. 
IfThe experiments were made to ascertain and establish, if possible, 
on a scientific basis, the efficiency of these preparations, and their 
suitability for the purposes for which they are designed as indicated 
by your publications and labels giving directions for use. 
fhe experiments Instituted for this purpose were as follows 

(o) In the case of the preparations above mentioned, various 
disease organisms—namely, those of Anthrax. Cholera, diph¬ 
theria, 8taphylococcus Pyogenes Aureus and Typhoid were 
brought into contact with the disinfectant for a given time and 
in a manner detailed below, and means were taken to ascertain 
whether the disinfectant employed was sufficiently powerful to 
determine the death of the organism in a given time. 

(b) A second series of experiments was undertaken to ascertain 
the effect when similar cultures were exposed to different 
strengths of these disinfectants for a standard time. 

(c) Experiments were also made to ascertain the effect on 
ordinary air, as regards the removal or extermination of 
organisms suspended in it, by spraying with “Sanitas" Oil and 
“Sanitas” Fluid. 

J >) In the case of “Sanitas" Oil, I have experimented as to the 
Ion of the vapour given off at a temperature not exceeding 
that of the human body. 

(e) Finally, I have tried some experiments to ascertain the 
action of “8anitas" Oil and ‘‘Sanitas" Fluid on the Bacillus of 
• Plague 

Table l. 

EXPERIMENTS WITH “SANITAS” OIL. 

Silk threads Infected with cultures of the following organisms were 
exposed in " SANITAS" OIL for the times shown below and then 
incubated in broth. Growth is shown by a + sign, no growth by a 
— sign._ 


TIMES OF EXPOSURE. 


Controls all grew well. 

Table 2. 

A similar experiment was carried out in the case of “ SANITAS ’ 
FLUID. (Threads.) 


Organisms. 

Times of Exposure. 

l" 

10" | 

30" 

Anthrax . 

+ 1 

- 

- 

Cholera. 

— 

— 


Diphtheria. 


— 

— 

8. P. Aureus. 

+ 

— 


Typhoid. 

| — 

— 



Controls all grew well. 

I next proceeded to ascertain the strengths of these disinfectants 
reouired to ensure the death of the above-named bacteria in a given 
,lme—and in the following experiments the time of exposure of the 
bacteria to the action of the disinfectant was iu all cases ten minutes. 

In these experiments I used the method of shaking together an 
actively growing broth culture of the organism to be tested, with such 
a quantity of disinfectant that the resulting mixture contained the 
strength of disinfectant specified in the tables below; the exact details 
of the method of experiment are described in Pearmain & Moor s 
Applied Bacteriology, 2nd Edition, pages 877-382. (Balliere, Tindall, 
anc' 


Table 3. 

“ SANITAS ’ OIL.—As the Oil is not readily miscible with water 
the “Sanitas" Emulsion, which contains 45 per cent, of “ Sanitas” 
Oil, was employed. 

Ten minutes' exposure. 



1" 

10" 

80" 

Cholera. 

— 

— 

— 

Diphtheria. 

— 

— 

— 

Typhoid . 

— 


“ . 


r cox). 


Organisms. 

Strength employed in Terms 
of “Sanitas" Oil. 

26% 

10 % 

i 6% 

Anthrax . ' 

_ 

— 

, + 

Cholera. 

— 

— 

' — 

Diphtheria. 

— 

— 

— 

S. P. Aureus. 

— 

+ 

+ 

Typhoid. 

— 

— 

— 


Controls all grew well. 

Table 4. 

“ IANITA8” FLUID tested against Broth Cultures, as above. 
Ten minutes' exposure. 


Organisms. 

Strength Employed. 

50% | 25% 10% 

Cholera. 

_ _ _ 

Diphtheria. , 


Typhoid. 



Anthrax and S. P. Aureus were also both destroyed by the 50 % 
mixture in ten minutes' exposure. 

Controls all grew well 

(5) . I have made several experiments as to the destruction of 
bacteria floating in the air of a room by spraying the air with 
“ Sanitas " Oil, and with “ Sanitas ” Fluid—testing the air by means of 
Hesse' » tube. 

Tile removal of bacteria from air by spraying will, doubtless, depend 
very greatly on the mechanical action of the particles of spray, because, 
as is well known, bacteria are very largely removed from air by a 
shower of rain, therefore, too much importance must not he attached 
to such experiments. 

Taking, however, the mean of several experiments, whereas the air 
of the room contained a considerable number of bacteria before spray¬ 
ing, the numbers were reduced, after spraying, to under five per cent, 
of those previously found. 

(6) . “Sanitas’ Fluid does not give off much vapour at ordinary 
temperatures; but, Sanitas" Oil, on the other hand, is sensibly 
volatile at rootn temperature, and I have tested the action of the 
vapour given off by “ Sanitas " Oil, at blood-heat on bacteria similar to 
those used in the broth and thread experiments. 

Some of the growth from agar tubes was smeared on filter-paper and 
suspended in a w ide-mouthed jar containing a little “ Sanitas " OiL 
The whole was placed in the incubator (37° C.), and, after an hour, 
cultures were made on to nutrient media. The result was that only 
the two most resistant organisms—namely, Anthrax and Staphylo- 
loccus Pyogenes aureus - had survived, while Cholera, Diphtheria, and 
Typhoid failed to grow. 

(7) . Having a culture of Bubonic Plague brought by a student from 
Hong-Kong. I tried the effect of “ Sanitas" Fluid and “ Sanitas " OU 
on it. The bacillus was killed in each case by a ten minutes' exposure 
to a strength of 83 per cent, of each disinfectant—the only strength 
tested. 

In conclusion, I regard the results of my investigation as affording 
ample evidence that the “Sanitas" preparations are thoroughly 
reliable, when employed In the strengths and for the purposes 
specified in the directions issued by the proprietors, while their non- 
polsonous nature and pleasant character render them applicable in 
many instances where such substances as carbolic acid or mercurial 
chloride would be Inadmissible or dangerous. 

C. G. MOOR, M.A., (Cantab.), F.LC., F.C.8., 
Member of the Society of Public Analyitt, 

Joint Author of—“ Applied Bacteriology," 

„ „ “ The Analytii of Food and Drugs," 

„ „ “ The Chemical and Biological Examination 

Water." 


THE “SANITAS” CO., Lim., Bethnal Green, E., 

Disinfectant and Embrocation Manufacturers. 


Digitized by v^ooQle 



















“ SALUS POPULI SUPREMA LEX.” 


Vol. OXVIII. WEDNESDAY, MAY 17, 1899. No. 20. 


(Original Communications. 


MALFORMATIONS OF THE 
KIDNEY AND DISPLACEMENTS 
WITHOUT MOBILITY, 

WITH ILLUSTRATIVE CASES AND 
SPECIMENS. 

By DAVID NEWMAN, M.D., F.F.P.S., 

Surgeon, Royal Infirmary, dlasgow. 

(Continued from page 480). 

II. Variations in Form and Size. 

1. General Variations in Form — Lobulation. — 
Slight changes in shape from the typical normal 
kidney are by no means uncommon, and in more 
marked instances the organ may be elongated so as 
to become sausage-shaped, or it may be increased in 
thickness and globular in form, resembling the shape 
of the kidney in the foetus. In a few cases the kidney 
has been found to assume the discoid shape. These 
alterations from what we may assume as the normal 
type, are otten unassociated with any other anomaly ; 
but when an abnormal condition exists, such as malpo¬ 
sition of the kidney, atypical distribution of vessels, 
or malformations of other genito-urinary organs, 
then lobulation of the kidney is more frequent in 
occcurrence, and more marked in degree. In the 
foetus and in young children slight lobulation is seen, 
but usually after the first year of life the lobules 
become fused, and are no longer apparent, unless in 
exceptional cases. In some of these the separation 
of the lobules may not be very distinct on the surface 
of the organ, but if a vertical section of it be* made 
the original lobulated condition of the gland is seen. 
The persistence of this foetal condition is generally 
more marked at the anterior than at the posterior 
aspect of the kidney. A section oi the kidney shows 
the medullary substance arranged in wedges, which 
form the pyramids, separated from one another by 
the columns of Bertini. These pyramids correspond 
to the embryonic. lobules of the kidney, though several 
lobules may fuse together in one pyramid. 

2. Hypertrophy of one kidney —Hypertrophy of one 
kidney is not often met with independently of some 
condition which has produced a functional weakness 
of its fellow. 

Hypertrophy of both kidneys is, however, often 
seen in cases of diabetes insipidus, and perhaps also 
in diabetes mellitus. 

Enlargement of one kidney only may, however, 
occur independently of anyTfunctional inactivity or 
structural defect of its neighbour. The kidney may 
go on increasing in size beyond the normal limit, just 
as we may have excess of growth in one limb, or 
undue growth of individual fingers or toes, of the 
tongue, the larynx, or the lower jaw. 

Case 13 .—Simple hypertrophy of the left kidney 
only, right kidney normal in size and appearance. 

At a post-mortem examination upon a man, set. 36, 
who died from fracture of the bkuII, I found the 


right kidney to be normal in weight, 6$ ounces, while 
the left weighed 10J' ounces. The man was of aver¬ 
age height, and weighed 11J stones. Both kidneys, 
on microscopic examination, were found to be 
typically healthy, with the exception of the histo¬ 
logical elements of the left kidney which were 
uniformly enlarged, as has been observed in cases of 
compensatory hypertrophy. 

(3) Fusion of two kidneys .— (a) Horse-shoe kidney; 
( b ) sigmoid kidnev; (c) disc-shaped kidney. The 
amount of fusion that takes place between two kid¬ 
neys varies greatly. We may have the two organs 
united together across the vertebrae, at their lower 
extremities, by a narrow, thin, and flat isthmus, 
which may be formed of connective tissue only, as 
illustrated in Fig. 12, or the union may be made up 
of kidney parenchyma ; these are the lowest grades of 
coalescence, and from these we meet with all degrees 
of fusion antil we reach a condition where the two 
kidneys become completely incorporated in one 
another, so as to form either one disc-shaped organ 
(Fig. 17), generally situated in the middle line, or an 
elongated body on one side of the spine—the sigmoid 
kidney (Fig. 16); but in fused kidney, however un¬ 
shapely the renal mass may be; the renal form may 
be entirely lost on both sides; the hilum may be 
absent; the pelvis may be distorted; and the blood¬ 
vessels most irregular in their distribution ; there is 
still one feature in all its varying forms, namely, 
that they all possess evidence of two ureters, and not 
one only, as in true examples of single kidney. 

We will first consider the lower degrees of fusion, 
and afterwards will give instances where more com¬ 
plete incorporation of the two organs has taken 
place. 

(a) Horse-shoe kidney is the most common form of 
fusion. The two organs are joined together at their 
lower ends, sometimes by a simple band of tissue, as, 
for example, in Figs. 12 and 13. In other instances 
the union is more complete, while the renal form of 
the two lateral segments may not be retained, as in 
Fig. 14. Or, again, as in Fig. 15. not only may the 
renal outline be considerably distorted, but there 
may also be marked lobulation, as well as anomalous 
distribution of the bloodvessels, or deformity of the 
pelves and ureters. 

Case 14.— Horse-shoe kidney, united by an isthmus 
of fibrous tissue at the level of the bifurcation of the 
aorta. Renal form well retained, (a) 

Horse-shoe kidney from the body of a man who 
died of pneumonia; the isthmus which unites the 
lower ends of both kidneys to one another is about 
1 inch broad, and is situated in front of the bifurca¬ 
tion of the aorta ; that vessel is unusually small in size. 
The right ureter arises from the pelvis by two dis¬ 
tinct channels, and passes downwards in a groove, 
which is more distinctly marked than the correspond¬ 
ing one on the left side. The left ureter occupies a 
similar position, but the pelvis from which it arises 
is almost normal in form. 

The blood supply is by five arteries, which pass off 
directly from the aorta. Two arteries supply the 
right segment, while the left is supplied by three. 
Considering the anomalous distribution, the arterial 

(o) Glasgow Royal Infirmary Museum, Series VII., No 3. 


Digitized by v^ooQle 




Fig, 12, 


into the kidney at the hilum. In the specimen the 
veins have not been preserved (Fig. 12). 

Drs. Sutherland and Edington published in the 
Glasgow Medical Journal, Vol. XLLX., page 89. an 
example of horse-shoe kidney, where the departure 
from the normal is even less than in the case just 
referred to. In their case the two kidneys are united 
by an isthmus of renal tissue which measures 1*3 cm. 
vertically, and 3 mm. antero-posteriorly. Poth 
kidneys, however, are distinctly lobulated (Fig. 13). 

Case 15. — Horse-shoe kidney with lobulation and 


Fig. 14. 

Case 16. — Horse-shoe kidney with complete incor¬ 
poration of the two organs. Lobulation of both seg¬ 
ments, the ureters deformed, and anomalous distribu¬ 
tion of the bloodve88tl8. (a) 

The two kidneys are completely united at their 
lower ends, and the whole renal mass although 
lobulated is, roughly speaking, uniform in diameter, 
and in this respect contrasts with the previous 
specimens. 

When removed from the body the mass weighed 
15k ozs. The arteries, which are small in size, sprang 
direct from the aorta, and the veins passed to the vena 
cava direct. On the right side three arteries enter 
the kidney on its upper aspect, while the left segment 
is supplied by an artery which enters the deformed 
hilum on the right side. Three venous trunks unite 
to form one vein before the blood is emptied into the 
vena cava, while on the left side one vein only leaves 
the kidney from the hilum. On the right side the 
pelvis is divided into three distinct branches, which 
. unite, at the lower limit of the horse-shoe, to form the 
right ureter. On the left side the pelvis is also 
segmented into three parts, forming roughly with 
the ureter the appearance of a St. Andrew's cross. 
The ureter passes downwards in a deep groove on the 
anterior aspect of the horse-shoe. 

As a rule the horse-shoe kidney rests on both sides 
of the spinal column, but lower down than normal, 
the isthmus generally crossing the vertebral column 
about the level of the bifurcation of the aorta. 
The band of union is almost always at the lower 
extremity, so that the concavity of the horse¬ 
shoe presents upwards. Cases, however, have been 
recorded where the union was found to be at the 

(a) Royal Infirmary Museum, (Series VII., No. 4. 


supply is wonderfully symmetrical. On both sides complete fusion of both kidneys, malformation of pelves, 

an artery passes directly to the upper and convex and anomalous distribution of bloodvessel*. 

aspect of the kidney, while the other arteries pass Both kidneys retain to some extent their renal 

• ____ form, and are united at their lower ends by a distinct 

lobule, which is marked off by two deep grooves, on 
the right side the pelvis is not greatly malformed, 
but on the left it is abnormally small, and is separated 
into two distinct branches, one passing to the upper, 
the other to the lower part of the organ. The right 
segment receives one artery, while the left is supplied 
by two, one entering at the hilum, the other close to 
the upper end of the kidney. Both renal veins pass 
out at the hilum (Fig. 14). 


502 r H i Medical Press. ORIGINAL COMMUNICATIONS. 


May 17, 1899. 




May 17, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Pbess. 503 


upper, in place of the lower, ends of the organ. It 
has been already shown that the bond oi union 
between the two segments may be slight, or may be 
very intimate. In the former, the blood-vessels, 
pelves, and ureters seldom depart much from the 
normal in their number or distribution; but when the 
binding of the two organs is very complete, the 
auxiliary structures also are markedly anomalous. 
This circumstance may raise the question whether or 
not the anomalous distribution of vessels may be 
regarded as a cause of the malformation of the 
kidney. The pelvis may be divided into several 
separate cavities, which unite to form the ureter some 
distance from the hilum. Monquiot (a) publishes a 
case where a kidney was placed transversely across the 
lumbar vertebra, and had four pelves, four ureters, 
and as many arteries and veins. Whatever the 
other deformities may be the ureters seldom pass 



Fio. 15. 

behind the renal mass. Durham (6), however, describes 
a case in which the ureters passed behind the organ. 
The united mass weighed 13$ ozs., and was formed 
by the union of the lower extremities. The structure 
oi the kidney is described as normal. 

Sutherland and Edington describe an interesting 
example of horse-shoe kidney, in a male child, where 
there was a pyonephrosis limited to the left segment. 
On this side the pelvis was greatly dilated, and there 
were cavities representing diltted calices, which 
largely replaced the renal tissue and still contained 
remains of pus. The lefc half of the isthmus showed 
a similar lesion; the right side of the specimen and 
the corresponding portion of the isthmus were 
normal. 

Morris (c) describes and illustrates a most unusual 
form of fused kidney, and one with which I am not 
familiar. The two kidneys lie together, as if the 
hilum of one kidney was placed against the outer 
convex aspect of the other. The following is his de¬ 
scription of the specimen :— 

“The two kidneys formed an irregularly shaped 

(a) “ Journal dee Savants,” 1878, Mai 16me. 

(b) Guy’s Hospital Reports,” 1860, p. 407. 

(e) “ Surgical Diseases of the Kidney,” 1885, p. 96. 


mass which weighed 13 ozs., and was lying on the 
front of the promontory of the sacrum. It was not 
an ordinary horseshoe, for the vessels and ureters 
were arranged most unusually. The central part of 
the mass was fissured by a sulcus, in which the ureter 
for the left kidney coursed downwards and the vein 
for the same upwards, passing into the vena cava 

i 'ust above the junction of the two iliacs. In the right 
ialf of the mass the ureters and vessels, instead of 
being situated centrally, were on its outer side ; the 
ureter bein^ in front of the vessels as in the left, and 
as is usual m fused kidneys. The arterial supply in 
each consisted of two or three arteries for eacn half 
of the mass about the size of radials derived from the 
common iliac arteries, and entered the lower part of 
each kidney. The suprarenal capsules were in their 
normal positions. The renal substance to the naked 
eye was nealthy." 

(b) Sigmoid kidney. Sigmoid kidney is an end to 
end fusion of the two organs. In this anomaly both 
kidneys occupy one side of the body only, but while 
the condition is unilateral it cannot be properly 
included under the term “ single kidney.” 

The following specimen from the Museum of the 
Royal Hospital for Sick Children, given to me by 
Dr. Lewis K. Sutherland, illustrates very beautifully 
a typical sigmoid-kidney. I may quo*e his descrip¬ 
tion of it in the Glasgow Medical Journal for 
February, 1898, p. 95:— 

“ Fusion of ieidn'ys in a female child. The fused 
mass, which measures 11‘5 cm. in length, presents an 
elongated reniform outline, and is possibly formed by 
the superposition of one kidney on the other, as 
represented in the accompanying sketch (Fig. 16). 

“ The anterior sarface of the mass is irregularly 
lobulated; the posterior surface is smooth. There 
are two distinct pelves, one above the other, each in 
its own hilum. The upper hilum presents antero- 
intemally ; the lower anteriorly. 

“The ureters, which 
are of normal dimen¬ 
sions pass downwards 
and outwards from 
the corresponding 
pelves, and lie in 
grooves on the anterior 
surface of the mass. 
The upper entered at 
the rignt, the lower 
at the left angle of the 
trigone. The bladder 
was normal. The 
vascular relations were 
not fully determined. 

“ The suprarenal 
bodies were normally 
disposed. An examina¬ 
tion of the generative 
organs was not made. 
Microscopic examina¬ 
tion of the fused mass 
shows normal renal 
tissue. 

“ The specimen was 
removed post-mortem 
from a girl about 7 
years of age. The 
mass occupied the right renal region, and was dis¬ 
tinctly palpable in life (G.H.E.). There was no trace 
of renal tissue found on the left side. 

“ Note. —The appearances suggest an incomplete 
union of two kidneys—the smaller (lower part oi the 
mass) representing the left; the larger (upper part) 
the normally placed right kidney. 

“ From the relations of the lower ureter and pelvis 
inversion of the left kidney may possibly be inferred, 



Digitized 


lOOgle 


504 Thb Medical Press, ORIGINAL COMMUNICATIONS. May 17, 1899. 


as well as coalescence with the anterior surface of the 
inferior extremity of the right kidney. (Royal Hos¬ 
pital for Sick Children.)” 

Almost precisely similar specimens are described 
by Dr. G. Broesike, of Berlin (a), and by Dr. A. 
Birmingham ( b). 

Sigmoid kidney may be regarded as intermediate 
between horse-shoe kidney and disc-shaped kidney. 
The first-mentioned fusion is very complete, while in 
the latter only the lower extremities of the organs 
are united. They differ also in the circumstance that 
the disc-shaped kidney and the horse-shoe kidney are 
most frequently placed in the middle line, while in 
sigmoid kidney one kidney is transferred to the 
opposite side, where it is joined to the lower or inner 
part of the opposite organ. Probably sigmoid kidney 
is the rarest form of fusion. 

(c) Disc-shaped kidney. Disc-shaped kidney is 
applied to those instances where incorporation of the 
two organs is very complete, as for example in the 
following cases—an illustration of which nas been 
given to me by Drs. Sutherland and Edington:— 

“ Fusion of kidneys in a male infant Hypospadias. 
Umbilical hernia sac. The kidneys form a mass of 
approximately reniform outline, measuring 6 - 5 cm. 
vertically, 3 cm. laterally, and 2‘5 cm. antero-pos- 
teriorily. The anterior surface shows distinct lobula¬ 
tion ; the posterior surface is smooth (Fig. 17). 

“ The hilum faces anteriorly or antero-intemally, a 
small amount of renal substance being situated 
towards the middle line behind. Emerging from the 
hilum are two distinct simple pelves, one above the 
other. This is corroborated on making a section of 
the mass. The lower meter passes to the right side 
of the trigone, and is crossed anteriorly by the upper 
ureter on its course to the left side of the trigone. 

There are three sets of renal arteries: (1) an upper, 
entering the upper end of the hilum; (2) a lower, 
entering the lower end of the hilum ; and (3) a third 
vessel supplying the intermediate parts. Branches 1 
and 3 arise from the lateral aspect of the aorta, one 
above the other at the crossing of the renal vein. 
Branch 2 arises from the anterior aspect of the 
aorta to the right and below the origin of the inferior 
mesenteric artery. The renal vein is formed mainly 
by three tributaries emerging from the upper and 
middle portions of the hilum. It crosses the aorta in 
the normal situation of the left renal vein. There is 
entire absence of corresponding renal vessels on the 
right side. 

“ The specimen shows further the obliterated hypo¬ 
gastric arteries, and a portion of persisting urachus 
likewise obliterated. The bladder is normal (shown 
turned downwards and forwards in the figure). 

“ The specimen was removed post-mortem from a 
male infant, set, 2 months, who died of acute broncho¬ 
pneumonia. 

“ The ‘ fused kidney ’ occupies the left side. There 
was entire absence of kidney on the right side. The 
right suprarenal body, however, was present, as 
shown in preparation, but markedly flattened out on 
the under surface of the diaphragm. The left 
suprarenal body occupies its normal position. Both 
suprarenal bodies were supplied by vessels arising 
directly from the aorta, the left receiving in addition 
two twigs from the highest renal artery. The left 
suprarenal vein emptied into the left renal vein, the 
right suprarenal vein directly into the inferior vena 
cava. Microscopic examination shows a normal 
structure. The vasa deferentia, vesiculse seminales, 
and testes were normal. There was fairly well- 
marked hypospadias. There was also a small 
umbilical hernia sac. 

“ Note. —The relations of the ureters to one 

( a ) Virchow’s Archir., November, 18M. 

(b) “ Dublin Journal of Medical Science, Vol. XC., p. 47. 


another, and the origin of the lowest renal artery, are 
compatible with the possibility of the lower half of 
the mass, having occupied a position to the right 
of the median line. (Royal Hospital for Sick 
Children.)" 

C. Variations in toe Pelvis, Ureters, and 

BLOODYE88EL8. 

Malformation of the pelvis and ureters is fairly 
common, but these are generally of little importance. 

The pelvis and upper, two inches of the ureter are 
very frequently abnormal in cases of misplaced or 
malformed kidney, but even where the kidney is 
normal in position and in form the ureters may be 
deformed. These abnormalities have been already 
fully illustrated in the foregoing cases, in some of 
which the pelvis has been seen to be double or in 
several divisions, each of which may have a separate 
connection with the ureter. 

The ureter may be double only for a short distanoe 
in its upper part, but in rare instances it has been 
found so throughout its whole course. We have 
seen ,a double ureter extending to within two inches, 
and cases have been described where it has extended 
to within one inch of the bladder. 




Fio. 17. 


Mr. John Wood (a) describes such a case. He 
says : “ That in a male subject four ureters were'dis- 
covered emerging from the hilum of each kidney, 
they united after proceeding about four inches 
towards the bladder forming a pelvis from which 
sprang the ureter proper. On section of one kidney 
the hilum was found occupied by a quantity of fat 
and connective tissue, embedded in which the ureters 
could be traced to the infundibula communicating 
with the calices and pyramids; thus there was no 
pelvis within the hilum, but the calices united to 
form infundibula of which these ureters seemed to 
form a continuation, and they Ijecame united in the 
pelvis some distance from the kidney." 

Cases also have been described by Thomson, Coen, 
Richmond, Long£, Fer<5, Josso. 

It may be safely said that no abdominal arteries 

(a) " Transactions ” of the Pathologricnl Society, London. Vol. 

I VII, p. 261. 


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May 17, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical .Press. 505 


are more irregular in their distribution than are those 
•which supply the kidneys. They may vary in number, 
in their source of origin, or in tbe mode in which 
they enter the kidney. Cases have been recorded 
where both renal arteries have originated from a 
common stem arising from the front of the aorta, or 
the renal blood supply may be augmented by branches 
from the internal, external, or common iliacs, from 
the suprarenal artery, from the hepatic artery, or 
from the middle sacral. 

The mode of entrance of the arteries also varies. 
They may pierce the kidney at the bilum, or may 
enter at any part of its surface, but most commonly 
abnormal vessels are found at the upper extremity 
of the organ. Again, the renal arteries may give off 
branches to the diaphragm, to the ascending colon, 
to the liver, or to the pancreas. 

These irregularities in source, number, and distri¬ 
bution are well known, and have been fully described 
by Professor M’Alister. (a) 

Professor Joseph Coats showed a specimen at the 
Glasgow Pathological and Clinical Society, (b) which 
has some bearing upon the subject we are now con¬ 
sidering. The specimen was one of hydronephrosis, 
where constriction of the ureter was caused by the 
pressure of an abnormal renal artery. 

Professor Coats says, “ The kidney has been snp- 

? lied by two principal arteries. This arteiy has four 
ranches, three of which pass into the kidney along 
the anterior border of the pelvis, whilst the fourth 
has passed rather downwards and backwards. In its 
passage this artery has encountered the ureter, and 
has crossed the latter shortly before its insertion into 
the apex of the pelvis. There is a deep groove pro¬ 
duced by the artery, beneath which the ureter passes. 
The two rounded bulgings which here conceal the 
parts are, respectively, the dilated first part of the 
ureter and the apex of the pelvis. The dilated 
piece of ureter could be brought out by pulling on the 
ureter, and it was then seen that, at the place where 
the artery crossed the ureter, the wall of the latter 
was greatly thinned, the muscular coat being appa¬ 
rently destroyed.” 

We placed in the museum of the Royal Infirmary 
a peculiar abnormality of the kidney associated witn 
a malformation of one ureter. The left kidney is 
about two inches longer than normal, and is divided 
by a deep groove into two distinct parts, the upper 
-the larger, and the lower the smaller part, are each 
provided with a distinct pelvis and ureter, but the 
ureters join about two inches from the lower border 
•of the organ. 


A SERIES OF CASES OF ARTHROTOMY 
FOR THE RELIEF OF PAIN, REMOVAL 
OF SYNOVIAL FRINGES, LOOSE 

BODIES, AND FIBRO-CARTILAGES. 

By C. B. LOCKWOOD, F.R.C.S., 

Assistant Surgeon and Lecturer on Descriptive and Surgical 
Anatomy, St. Bartholomew's Hospital. 

The first part of Mr. Lockwood’s communication 
referred to four cases in which the wrist joint had 
been opened for the relief of pain. Two of these 
occurred in women, and were possibly pysemic. The 
joint was opened by longitudinal incision betwixt the 
extensor tendons, and was drained for some days, 
after which the wound completely healed. The 
relief from pain was immediate and permanent. The 


(a) “Journal of Anatomy and Physiology,” Vol. XVII., d. 250. 
({>) “ Transactions,” Vol. III., p. 277. 


third case occurred in a man and was proved 
by histological examination to be tuberculous. 
It was treated in a manner similar to the 
two former cases. Pain was immediately and per¬ 
manently relieved, and the disease was arrested. The 
fourth case also occurred in a woman. The inferior 
radio-ulnar articulation was inflamed, and had been 
for four years, and was the seat of extreme pain. It 
was opened by dorsal incision, and as the cartilage 
covering of the lower end of the ulnar wus eroded 
and the bone inflamed, the head was removed. The 
incision was closed without drainage, pain ceased, and 
the ultimate recovery was perfect. 

It was pointed out that in all these cases the opera- 
tion was performed for the relief of pain. Mr. Lock- 
wood had often performed arthrotomy in cases of 
acute septic arthritis in which pain had been present. 
Obviously, under these circumstances, the operation 
was not performed for the relief of pain but to give 
exit to septic or purulent fluid. 

Arthrotomy for tbe removal of inflamed and elon¬ 
gated synovial fringes was next referred to. The case 
of a married woman was described at length. For six 
years she had bad repeated attacks of synovitis, 
latterly the swelling and inflammation of the knee- 
joint had become almost continual. The symptoms 
were very like those which are caused by the presence 
of a loose body within the joint. None could be 
detected, and the joint was opened. The absence of 
a loose body was confirmed, but the whole of the 
synovial fringes of the joint were observed to be 
exceedingly long and inflamed. It seemed likely 
that some of them may have got nipped betwixt 
the articular surfaces. They were all removed. 
For this purpose the ligamentum patellae was 
divided. A speedy recovery ensued. Nine months 
after the operation she said that the knee was better 
than it had been for years. She was able to walk 
about and perform her household duties. The move¬ 
ments of the joint were good and painless. It con¬ 
tained no fluid. Mr. Lockwood thought the mem¬ 
brane was still a little swollen. In connection with 
this case, the best manner of opening the knee-joint 
forthe total removal of fringes was discussed. Another 
case of a similar character was likewise described. 

Next some cases of arthrotomy in chronic osteo¬ 
arthritis were described. These were undertaken 
because the chondrifical and ossified synovial fringes 
got betwixt the articular surfaces either by having 
become detached or because they had very long 
pedicles. One of these patients was in her 70th year. 
Nevertheless, three weeks after four loose bodies had 
been removed from the joint she was walking 
about. In a second case, in addition to pedunculated 
cartilaginous fringes a pedunculated fatty growth of 
the synovial membrane was taken away. In yet 
another case of osteo-arthritis pedunculated fringe 
was removed. The joint ceased to lock, but the 
operation was followed by a certain degree of stiff¬ 
ness due to the progress of the osteo-arthritis. The 
avoidance of this complication was discussed. 
Finally cases of excision of the internal semilunar 
fibro-cartilage were mentioned. One was described 
in which the history four years after the operation 
showed that the result had been perfect. In a second 
case of removal of the internal semilunar fibro-carti¬ 
lage the history was brought down to three years 
after the operation. With the exception of the scar 
the knee-joint was normal. The patient led a most 
active life and considered the joint as good as the 
other, quite perfect in spite of the absence of the 
fibro-cartilage. The third case was peculiar, having 
occurred in a woman. In this, again, the removal 
of the fibro-cartilage, whilst curing the locking of the 
joint, was attended with no other appreciable effect. 


Digitized by GoOglC 



506 The Medical Press. 


ORIGINAL COMMUNICATIONS. 


May 17, 1899. 


GENERAL HEALTH AS A FACTOR IN 
SKIN DISEASE, (a) 

By MORGAN DOCKRELL. M.D. 

In selecting a subject for my Presidential Address I 
was influenced by the desire to point out the importance 
that perfect harmony should exist between those prac¬ 
tising general medicine, and those confining their atten¬ 
tion to the special branches of medicine. And although 
I have on other occasions, and in other places, empha¬ 
sised the fact that the interests of general and special 
practitioners, from a merely commercial view, are 
identical, the present seemed to me to be a fitting occa¬ 
sion to consider the identity of these same interests from 
that higher and more scientific plane where, free from 
personalities, pettiness, and all uncharitableness, we can 
look on disease defacing, as it does, the most perfect 
work of the great Artificer, and, looking, remember that 
no matter how locai such disease happens to be, it exer¬ 
cises an effect on the whole economy, producing general 
disturbance, which reacts on the local trouble, thus in¬ 
dissolubly binding together cause and effect, necessitat¬ 
ing a knowledge of systemic medicine with that of local 
treatment, and making the general practitioner a neces¬ 
sity to the special practitioner, and the specialist of 
service to the general practitioner. 

My object then, gentlemen, this evening is to indicate 
clearly, and I hope convincingly, that it is equally im¬ 
possible, for the specialist to practice his speciality 
successfully without treatment of the general health, as 
it is for the general practitioner of medicine to ignore 
the treatment of local disease on the ground either that 
the patient will grow out of it, or that by the perse¬ 
verance of systemic medicine alone the local trouble 
will be cured. 

And this takes me more immediately to the subject of 
my address to you—namely, “ General Health as a 
Factor in Skin Disease.” To some this title may appear 
almost a paradox, understanding as they rightly do 
that health is the maintenance in equilibrium of all the 
parts of an organised being so that the natural 
functions of all the organs may be performed freely and 
properly, and, therefore, any departure of the cutaneous 
envelope from the normal, either in its secretion, or 
thickness, or appearance constitutes a breach of this 
definition, and is, of necessity, an interference with 
general health. Unfortunately, however, this is not the 
case, and so one finds a large number of those prac¬ 
tising dermatology ignoring the treatment of certain 
skin diseases by other than local means, or at the most 
prescribing certain empirical remedies internally, which 
have a reputation for curing particular diseases, 
without taking the trouble to ascertain the con¬ 
ditions of general health which have led up to 
them. And although it may be urged that such a 
distinguished authority as the late Dr. Tilbury Fox was 
in the habit of dividing diseases of the skin for the pur¬ 
pose of therapeutics into those, “ 1, which are purely local, 
2, which require mainly local remedies, but demand the 
use of such as are general as auxiliaries to cure ; 3, where 
general are the most important, local measures being 
employed as secondary aids to cure.” I believe if he 
were living in these days he would recognise the im¬ 
portance of general treatment in all cutaneous, diseases. 

In the present day we have Kaposi stating “ that 
both pathological histology and experiment have proved 
most cutaneous diseases to be purely local diseases which 
develop in the tissues of the skin, and which in a mea¬ 
sure can be at any time produced at will in one who is in 
perfect health.” 

Jameson, on the other hand, fays: “All measures 
which will cure our patients are not only permissible but 
to be recommended, and thus a combined external and 
internal treatment is best for all.” With this latter 
opinion I readily agree, and I cannot help thinking 
that this, so to speak, impressionist method of 
simply prescribing for the condition that strikes the 
eye, is largely due to the overcrowding of our out-patient 

(«) Abstract of Presidential Address, delivered to the West Kent 
Medico-Chirnrglcal Society, Hay 5th 1899. 


departments which prohibits us from giving that atten¬ 
tion to general health which is so essential to skilful 
treatment, and especially is this the case with those who 
have not had the only true training for specialism, 
namely, some years in general practice. 

For greater convenience I will deal with my subject 
under two heads, namely: 1. Conditions of general 

health requiring treatment first in those diseases where 
internal treatment is said to be unnecessary. 2. Quite 
apart from certain orthodox internal remedies advised for 
particular diseases. 

1. Those diseases where internal treatment is said to be 
unnecessary. 

Now, gentlemen, in the treatment of diseases of the 
skin it is always well to bear in mind a condition which, 
for want of a better term, may be called the “ tone of the 
skin," namely, where the functions are healthy and 
performed with vigour, that is where the skin is well 
strung or in due tension, not over strung. When there 
is any departure from this, the general health is at fault, 
and so one finds certain diseases of occupation taking 
place, as, for example, the form of eczema, which 
affects barmaids, washerwomen, hairdressers, and 
others, who have carried on their calling for years 
without any trouble till from other causes their 
geneial health becomes impaired. Surely there is some¬ 
thing more than mere local irritation to account for the 
square patch of eczema in the palm of the left hand of 
the bricklayer where the brick comes in contact with it, 
and those patches sharply limited in the right hand to 
the parts which grasp the trowel. And if not, how is it 
that he never gets better till his general health is 
attended to, and how is it that as the health improves, 
the local disease quickly responds to treatment. There is 
one factor, and one only, in all these conditions which 
enables the skin to resist the irritation of occupation, 
and that is general health. 

You are all familiar with" Warts” (verruca vulgaris ), 
and, I trust, but few of you hold Kaposi’s view that they 
are not contagious. If you do, you can readily satisfy 
yourselves as to its fallacy by watching how quickly 
children looked after by a nurse with warts on her hands 
contract the disease if they happen to get out of health. 
Warts will last for years, resisting all kinds of local 
treatment until the mal-assimilation and the constipa¬ 
tion, which is so commonly present, are treated. If, 
however, sulphate of magnesia, as advised by Colrat, of 
Lyons, or, in some cases, thyroid extract, be given inter¬ 
nally in combination with local treatment, the warts dis¬ 
appear and no recurrence takes place as so often happens 
when only treated by local means. 

But I can fancy some of you saying, the growth of 
hair out of place in woman can only require the local 
treatment of electrolysis. Here, again, general health 
must be taken into account. Amenorrncea is often 
present, and when treated, strong hairs cease to appear. 
Young unmarried women with strong sexual proclivities 
which remain unsatisfied, require the administration of 
bromides internally. Again, in married women, where 
through the fear of pregnancy the sexual act is not com¬ 
pletely performed, hairs develop and only cease to recur 
on the cause being removed. Again, young widows 
develop hairs, which disappear on re-marriage. And I 
would point out that the loss of mental balance is often 
so great owing to the worry or the disfigurement of 
constantly recurring hairs, that to prevent insanity, 
removal of the ovaries has been found necessary as the 
only way to check their continued growth. 

Lest I weary you I will now pass to the second head, 
viz.:— 

2. Conditions of health requiring treatment quite apart 
from certain orthodox internal remedies advised for 
particular diseases. 

Gentlemen, the treatment of skin diseases is no longer 
a rule of thumb, the time has gone, and well gone, when 
a disease coming under observation means the use of a 
particular drug; it is now known that although a drug 
may be of benefit in one disease its use is subservient to 
those states of general health which have led up to and 
predisposed the individual to the local indication appa¬ 
rent on the skin. Hence it is the duty of every self- 
respecting practitioner who wishes to practice his art in n> 


oogle 


CLINICAL RECORDS. 


The Medical Press. 507 


Mat 17, 1809. 


scientific spirit to make himself conversant with the 
state of health of all the organs of the body, ’o carefully 
inquire into the secretions, and the habits of his | atient, 
and then, and not till then, to turn his attention to the 
disease of the skin complained of; above all, to 
remember there is no therapeutic panacea for any 
disease. Arsenic has its uses, but they are very limited. 
It has been a vastly over-rated drug, and its wholesale 
indiscriminate use has done an immense deal of harm in 
the past, and I fear in the present is still doing a cer¬ 
tain amount. 

If we take the different conditions of general health 
exercising a marked effect on skin diseases, I would 
plaoe over-fatigue as the most important factor. In the 
present state of civilisation we suffer from the over- 
fatigue of work and the over-fatigue of pleasure. The 
old saw that change of work was the best recreation 
no longer holds good. Our pleasures have become a 
toil, and are often harder work than our ordinary busi¬ 
ness. So, complete rest in bed will often cure an eczema 
or a pruritus in a few weeks, which for months, has baffled 
all treatment. 

Then again worry exercises a marked predisposing 
cause in some of the diseases affecting the hair, not so 
much the ordinary anxieties of business as the petty 
annoyances of domestic infelicity, the nagging wife, the 
drunken husband, the sickly child, the interfering 
mother-in-law, all play their part in producing the 
neurasthenia which results in alopecia areata. Here 
your pilocarpin and thyroid extract internally are of no 
avail, unless you build up the nervous system by means 
of electricity, didynim, and other nerve tonics. Habits 
also require attending to, the matutinal pipe often 
indulged in travelling up to town in a smoking carriage 
is highly detrimental, producing, as it does, cardiac 
depression, just as later in the day the heavy luncheon, 
which is followed by brain work results in wasting of 
nerve tissue and indigestion, throughjneither the brain 
nor the digestive organs having the proper blood supply 
to carry on both piocesses at the same time. 

8erual Indulgence also has to be regulated, bearing in 
mind that what is excess in one is but moderation in 
another. Let me quote an example of this. In 1894 a 
patient consulted me for complete loss of hair and gave 
the following history :—As a young man, up to the age of 
25, he had an excellent growth of hair, within three 
months of his marriage he was completely bald, and 
remained so till the death of his wife, which occurred 
four years later. Within a year he had a good head of 
hair, and this remained so till his Becond marriage five 
years afterwards ; but six months only had elapsed when 
he was quite bald again, and has remained so to the 
present day. During his widowerhood he had connection 
about once in four months, while during his second mar¬ 
riage he did not have intercourse oftener than every two 
weeks. 

Uric add also has to be dealt with, not only as a pre¬ 
disposing cause when circulating in the blood, but also 
as an exciting cause when excreted by the skin. At the 
same time I ao not wish to be understood for a moment 
as suggesting that there is any such condition as gouty 
eczema, any more than I believe that urio acid per ee 
means gout. Uric acid plus something else, probably 
either a parasite or a neurosis, may result in a disease of 
the skin, so uric acid plus x results in gout. But that 
there is any of the varieties of eczema particularly found 
in gout, and thus allowing of the term of gouty eczema, 

I absolutely deny. If, then, uric acid in excess is pre¬ 
sent in any patient suffering from disease of the skin it 
must be dealt with by careful dieting, following out one 
of the several methods so ably supported by their dif¬ 
ferent exponents, all equally good for certain individuals, 
though not all equally applicable to the same indi¬ 
vidual. 

Tn those who have had syphilis, and who suffer from 
diseases of the skin not of a specific nature, it is abso¬ 
lutely necessary to treat with anti-syphilitic remedies, as 
otherwise one often finds a comparatively simple disease 
presenting marked obstinacy. 

Time has not permitted me more than briefly to state 
the importance of general health in a limited number of 
cutaneous diseases, but it is of equal importance in those 


I have not mentioned; and so, gentlemen, whether we are 
general practitioners or specialists we each have our 
work to do; let us then do it to the best of our ability, 
recognising the good in all branches of our common pro¬ 
fession, and above all remembering that the care of the 
general health is the chief factor in the treatment of 
disease. 


Clinical piecotbs. 

TWO CASES OF RESECTION OF THE LARGE 
INTESTINE, WITH RECOVERY, (a) 

By FREDERIC EVE, F.R.C.S., 

8ur?ton to the London Hospital and to the Evelioa Hospital. 

Case I. was a large left scrotal hernia, strangulated 
for three days. Herniotomy showed that the sac con¬ 
tained a knuckle of the transverse colon, which was 
gangrenous. A glass tube was inserted into the intes¬ 
tine, and the latter was attached to the wound. Five 
weeks later the intestine forming the artificial anus was 
brought out of the abdomen after opening the perito¬ 
neum, resected and sutured. The intestine was returned, 
and the abdomen closed. Primary union and recovery 
without complication. 

Case II. was an example of carcinoma of the descend¬ 
ing colon, for which the writer was indebted to Dr. F. J. 
Smith. A woman, aged forty-seven, had suffered with 
pain in the abdomen, vomiting, constipation, and occa¬ 
sional meltena for seven months. A tumour in the left 
loin had been noticed for some months. 

Occupying the left loin, just below the ribs, was a 
tumour, movable from side to side, and evidently 
situated in the descending colon. The constipation cul¬ 
minated in an attack of obstruction, during which the 
first operation was performed. This consisted in bring¬ 
ing out the tumour with several inches of healthy bowel, 
and fixing the bowel to the parieties. The bowel was 
drained by the insertion of a glass tube. 

Ten days later the protruding portion of the bowel was 
removed, and mesenteric edges of the divided ends brought 
together with sutures. 

After allowing an interval of a month for the inflam¬ 
matory effusion around the wound to become absorbed, 
an incision was made around the artificial anus down to 
the peritoneum. The latter was not opened, but was 
separated from the parieties for about two inches all 
round the protruding bowel. The free ends of the intes¬ 
tines were refreshed and brought together with Lem- 
bert’s sutures. The parieties were then closed over the 
bowel. The wound was completely healed three weeks 
after the operation. At the present time the patient 
appears perfectly well, and has suffered no inconvenience. 

The writer waB of opinion that in these and similar 
cases the bowel should be drained, even although only 
moderate symptoms of obstruction existed. 

Although Murphy’s button could be inserted very 
rapidly and readily, the intestines could not be com¬ 
pletely drained, and the shock of the resection was added 
to the illness from which the patient was suffering. 

He thought that for the large intestine, at any rate, 
suture was safer than the use of Murphy’s button. 

Case II. was published especially to draw attention to 
the merits of extra-peritoneal resection and suture for 
artificial anus as the safest method. It was introduced 
by the late Dr. Greig Smith. 

This operation was attempted in Case I., but had to 
be abandoned, owing to the extreme thinness and friabi¬ 
lity of the peritnoeum. This was probably due to 
stretching of the membrane from the presence of a large 
hernial sac in its neighbourhood. 


Me. Gordon, surgeon to the Adelaide Hospital, has 
been appointed as Medical Officer to the Bank of Ireland 
vice Dr. Harrison resigned. Mr. Gordon has acted as 
lot mm tenens for some time past. 


(a) Read at the Medical Society of London. May 8th, 1809 



508 The Medical Press. 


TRANSACTIONS OF SOCIETIES. 


May 17, 1899. 


transactions of Societies. 

CLINICAL SOCIETY OF LONDON. 
Meeting held Friday, Mat 12th, 1899. 

Mr. Langton, F.R.C.S., President, in the Chair. 


Dr. Hale White and Mr. Goldisg-Bird read a 
paper on 

THREE ADDITIONAL CA8E8 OF RIGHT COLOTOMY FOR 
CHRONIC COLIII8. 

The object in all three cases was to give the colon 
absolute rest. 

Case I.—The patient was a lady, aet. 36, seen with Dr. 
E. Taylor. She had had membranous colitis 


A. 


twenty years with latterly great pain, and almost com¬ 
plete inability to take food. She was wasted, anaemic, 
and a complete invalid, unable to take any exercise. The 
whole oolon was tender to pressure. On May 13th, 1896, 
the first statre of right lumbar colotomy was performed, 
the bowel being opened six days later. The patient did 
uninterruptedly well, was relieved from pain, and 
gained in strength. In May, 1897, the artificial anus 
was closed. In November, 1898, the patient said she 
was perfectly well, she ate ordinary food, took out¬ 
door exercise, and was about to learn to ride a bicyole. 

Case II.—The patient was a woman, set. 31. In 
September, 1896, she began to have abdominal pain, and 
soon, because of the pain, gave up taking solid food. Her 
illness continued until her admission into Guy’B Hospi¬ 
tal, under Dr. Pye-Smith, in December, 1897, when she 
was found to be passing membrane. She was then 
very anaemic and weak, and was suffering severely. As 
she became worse, in spite of all medical treatment, the 
first stage of right lumbar colotomy was performed 
March 3rd, 1898, the bowels being opened on March 8th. 
She remained four months in the hospital, and when 
she left she was in perfect health, and had remained 
so up to the last time she was seen. It was proposed to 
dose the artificial anus this spring. The patient was 
averse from hurrying, as she was so well in her present 
condition. 

Case III.—The patient, a man, sst. 35, had been in the 
tropics and Egypt. Eight years ago he had bad 
diarrhoea with bleeding. This had continued on and off 
till hiB admission to Guy’s Hospital. He had suffered 
much from abdominal pain. He had been treated 
in hospitals medically without any success. He was 
admitted into Guy’s Hospital in November, 1898. He 
had continuous diarrhoea, had lost control over the 
bowels, was very wasted, aniemic, and had the appear¬ 
ance of a man who had not much longer to live. As 
he was becoming worse, on December 31st, 1898, the 
first Btage of a coecotomy was performed, and the bowel 
was opened five days later. He Rained much flesh and 
colour, quite lost his abdominal pain, and left the 
hospital at the end of February feeling well enough 
to work, and in May reported himself as very well. 
He was now of good colour, and plump. 

The authors referred to their previous published 
case, two other English cases and the German 
case. They pointed out that all a priori argument 
was in favour of a right colotomy for chronic disease 
of the colon, for it secured absolute rest for that 
structure, and the cases now brought forward showed 
clearly that the oolon was not necessary for the main¬ 
tenance of perfect health. They recommended pallia¬ 
tive or curative right-sided colotomy, for severe and, 
otherwise, hopeless examples of the following diseases :— 
(1) Intractable membranous colitis. (2) All forms of 
chronic ulceration of the colon that had resisted medical 
treatment, and which were obviously otherwise incurable. 
Most cases of very chronic dysentery were probably to be 
cured without colotomy. (3) Cases of idiopathic 
dilatation of the oolon. 

The colotomy must be right-sided, and colotomy was 
preferable to csecotomy, for when the latter 
operation was done, fluid feeces escaped from 
the artificial anus, and this gave rise to much trouble, 
while further it was difficult to prevent some faeces 


passing on into the colon. In the three cases of mem¬ 
branous colitis reported, it was interesting to observe 
that the formation of membrane ceased directly 
the bowel was stitched to the skin, "and before 
it was opened. Its formation appeared to be 
reflex'y inhibited, and this was of importance as 
pointing to a large neurotic element in the cases, a 
view which is supported by the fact that membranous 
colitis is most common in women, that all the cases 
operated upon have been women, and all have had a history 
of pelvic troubles. The authors believed that it was not 
necessary to wash out the bowel from the artificial to 
the natural anus, and they considered that more 
experience was needed before deciding upon the time for 
which the artificial anus should be left open, but it 
should certainly not be less than six months. 

The President said that the authors’ results seemed 
to show that an opening into the ascending colon would 
relieve this terrible condition. He himself had a case 
under his care at the present time in which he proposed 
to open the colon. He asked whether from the point of 
view of surgical treatment any distinction was drawn 
between membranous cases and those of mucous colitis; 
also whether there had been any difficulty in closing the 
opening in those cases in which it had been kept open for 
several months. 

Dr. Hingston Fox mentioned the case of a gouty 
woman, set 48, under treatment for chronic colitis. 8he 
had haemorrhage from the bowel, which was attributed 
to haemorrhoids. In August last she took to her bed 
with severe attacks of hemorrhage, and frequent 
motions containing much mucuB and pus. Eneznata 
and local treatment caused much irritation. The sym¬ 
ptoms ultimately subsided very rapidly after the 
sphincter had been forcibly stretched by Mr. Charters 
Symonds, and she remained well for some months, but 
there had recently been some return of symptoms. 

Dr. Norman Dalton asked whether ihe method bad 
ever been tried in cases of acute ulcerative colitis ? 

Mr. J. Charters Symonds said that in the case men¬ 
tioned by Dr. Hingston Fox he had been led to dilate the 
Bphincter because the disease appeared to be localised to 
the lower end of the rectum, and he mentioned another 
case in which there was htemorrbage from the rectum 
in which examination revealed nothing abnormal. In 
that case also the symptoms ceased after dilatation of 
the sphincter. He thought that right colotomy was better 
than left, and mentioned a case in which he regretted that 
he had chosen the left operation. The patient was a 
man, sixty years of age, who had had four attacks of 
haemorrhage from the bowel. There was a hectic tem¬ 
perature and signs of ulceration. A left inguinal colotomy 
was performed and the lower part of the bowel washed 
out. This was followed by temporary relief, but the 
bowel subsequently contracted and the artificial anus 
could not be closed. At the necropsy many nodules of 
new growth could be seen on the wall of the intestine, 
and Mr. Symonds thought that longer relief would have 
been given if the ascending colon had been opened 
instead of the descending. 

Mr. W. J. Walsham asked what method was adopted 
for the purpose of closing the wound. 

Dr. Hale White, in reply, said that the intensity and 
not the variety of colitis was the guide as to surgical 
treatment. He did not know of any caseB of acute ulcera¬ 
tive colitis which had been treated by this method. 

Mr. Golding Bird, in reply, said that he had not had 
any difficulty in closing the wound. He used the 
method which had been employed by Laurie, freeing 
the bowel for three-quarters of an inch round and then 
uniting the raw surfaces by Lemberfs sutures. Cases of 
acute ulcerative colitis were seldom recognised. He 
mentioned one case in which a girl who was admitted 
for supposed anal fissure died with symptoms of 
acute colitis and subacute peritonitis, and after death 
very extensive ulceration of the whole colon was dis¬ 
covered. 

EMPYEMA OF THE MAXILLARY S HUS. 

Dr. St. Clair Thomson related a case of empyema of 
the maxillary sinus, undoubtedly of two years’ and 
probably of seven years’ duiation, with persistent cough 



May 17, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Medical Pbess. 509 


and regularly recurring headache, which was completely 
cured in eight weeks by simple drainage through a tooth 
socket. He recorded the case, because there was a ten¬ 
dency on the part of some rhinologists lately to disparage 
the method of treatment through the alveolar border, 
which was first employed by Cowper as long ago as 1698. 
Indeed, some practitioners held that this method was 
quite futile in cases of long standing. He quoted a 
case in which he had positively diagnosed the empyema 
two years before the patient was operated on, and in 
which the history pointed to the presence of pus in the 
antrum of Highmore for possibly seven years. During 
this period the patient had suffered from chronic cough, 
which had resisted every treatment. She had also for 
more than four years had what she described as a fright¬ 
ful headache, lasting three days, and regularly recurring 
with the cessation of menstruation. The maxillarv sinus 
was opened with a drill through the alveolar border; a 
spiral (Ellis) drainage tube was inserted; and the cavity 
was washed out once daily with a simple alkaline lotion. 
At the end of a month the liquid came through quite 
clear, and doubtless treatment might then have been 
discontinued. For the sake of security the washing out 
was continued at decreasing intervals for another month, 
when the drainage tube was removed and the open¬ 
ing allowed to close. The patient’s cough entirely ceased, 
the headaches never recurred; and the cure was 
confirmed by observation n»ne months afterwards. This 
case suggests that in all cases of empyema of the 
maxillary antrum—especially where there is already a 
hollow tooth socket—this simple method of treatment 
should be tried before having recourse to more severe 
operative measures. The opening is easily made-, the 
patient is able to carry out the treatment at home ; and 
it does net prevent a more extensive operation later if 
the suppuration proves intractable. The case also shows 
that a long history of empyema does not necessarily 
show that the case will resist cure by this easy method. 

Mr. T. Maek Hovell and Mr. Frederic Eve read a 
paper on 

CA8E8 ILLUSTRATING THE PATHOLOGY AND TREATMENT 
OF CHRONIC rMPYEMA OF THE MAXILLART SINUS. 

The paper demonstrated that chronic antral empyema 
was frequently associated with the formation of papillary 
outgrowths from the lining of the cavity so abundant 
in some instances as to fill it. These could only be 
effectually dealt with by free opening of the cavity and 
removal of the growth ; and even then they sometimes 
recurred. Antral suppuration was sometimes the earliest 
symptom of malignant disease commencing in that 
cavity. In six consecutive cases related, numerous 
papillary growths existed in three, a large polypus in one 
case, granulation in ene case, and in only one instance 
was the lining membrane of the cavity natural. 
In the three cases presenting well-marked papillary 
growths suppuration had existed for periods varying 
from five months to three years, while in a patient with 
polypoid growth the discharge from the nostril had 
existed for two or three years. The pus contained 
streptococci in three cases in which a bacteriologi¬ 
cal examination was made. Treatment .— This con¬ 
sisted in freely opening the antrum through the 
canine fossa so that the cavity could be inspected, 
and the growths removed; and in two instances a 
counter opening was made through the inner wall of the 
antrum at the level of the floor of the interior meatus 
The cavity was first packed with iodoform gauze, and 
afterwards treated with antiseptic irrigation. In one case 
the growths recurred,and the antral wall was again scraped. 
The three patients whose antra contained papillary 
growths had previously been treated by tapping through 
the alveolus and the insertion of a tube without im¬ 
provement. All the patients were cured except one, 
who was greatly improved. It was pointed out that the 
antral growths would tend to increase the mischief by 
causing retention of pus owing to the blocking of the 
orifice into the nostril, or such a small opening as could 
be made through the alveolus. The only treatment 
likely to be effectual was therefore free exposure of the 
cavity and removal of the growths. Bare pieces of fangs 
projecting through the floor should be sought for. The 
eventh case related was that of a gentleman, set. 57, in 


whom antral suppuration was the earliest symptom of 
malignant disease in that cavity. On opening the 
antrum it was found to be filled with carcinoma, the 
existence of which had not previously been suspected. 
The superior maxilla was subsequently removed success¬ 
fully. 

Sir Felix Semon thought that it was possible to treat 
the great majority of cases of antral empyema success¬ 
fully by the method of Bimple drainage through the 
alveolus, although there appeared to be a tendency among 
the younger rhinologists in favour of more complicated 
methods of i rocedure. Most of the cases were due to 
mental trouble. In a minority of cases of some standing 
there were papillary outgrowths, and then opening and 
scraping as performed by Mr. Eve and Mr. Hovell were 
required, but the milder method should be tried first as 
a routine treatment. 

Mr. Charters Symonds agreed that alveolar drainage 
should always be the first step. In the long standing 
cases where this did not effect a cure the antrum should 
be opened, and an independent opening made in the inner 
wall below the inferior turbinated bone. It was usual 
in such cases to find polypi or papillary outgrowths. 

Mr. W. J. Walsham agreed with what had fallen from 
Mr. Symonds, and mentioned a case in which the 
empyema was found to be due to a fang which had been 
retained when the tooth with two other fangs had been 
extracted. 

Mr. Eve, in reply, said that he and Mr. Hovell per¬ 
formed simple drainage through the alveolus first The 
cases which they had brought forward represented the 
minority in which this procedure did not cure the 
condition. 

Dr. St. Clair Thomson, in reply, said that the 
interesting paper by Mr. Hovell and Mr. Eve tended to 
confirm his thesis that the simpler method should be 
tried first. He understood that it was Mr. Hovell’s 
practice to try alveolar drainage in all cases, and 
that it was only in the resistant cases that he sought 
the co-operation of Mr. Eve for the canine operation. It 
would be interesting to know the proportion of cases in 
which Mr. Hovell had found this necessary. As to how 
long it was wise to persevere with this simple method, 
he had himself known of cases which bad healed up 
after having to continue it for eighteen months. On 
the other hand, there were many patients in whom the 
secretion of pus continued, but who were so content 
with the daily washing out of the antrum that they 
declined further measures. 

OBSTETRICAL SOCIETY OF LONDON. 

Meeting held Wednesday, May 3rd, 1899. 

Mr. Alban Doran, F.R.C.S., President, in the Chair. 
ruptured tube from a fatal case of tubal 

GESTATION. 

Dr. Addinbell showed the uterus and appendages 
removed post-mortem fiom a young woman, who died 
within ten minutes of her admission to hospital. On 
the previous day, while carrying a tray upstairs, she 
suddenly felt faint, and was obliged to go to bed. The 
doctor who saw her next day ascertained that she had 
missed a period, and diagnosed ruptured tube—a dia¬ 
gnosis which was confirmed by Mr. Bland Sutton. On 
her arrival at the hospital she at once became uncon¬ 
scious and blanched, and in spite of the injection into 
the subcutaneous tissue of over two pints of saline solu¬ 
tion, she shortly afterwards expired. The abdomen was 
immediately opened, and was found full of blood. The 
Fallopian tube on one side was infantile in respect of 
development, and the other had a rupture, from which 
blood was still exuding. No feetus had yet been dis¬ 
covered. The left ovary was large and felt cystic. 

Dr. Horrocks questioned the value of the subcu¬ 
taneous injection of saline solution under the circum¬ 
stances, seeing that it must necessarily be somewhat 
delayed in absorption, as the circulation must have been 
very slow. He would have preferred injecting directly 
into a vein. He referred to the case of a woman who 
after one operation for ectopic pregnancy, subsequently 

gle 


Digitiz 



Mat 17, 1899. 


510 The Medical Press. TRANSACTIONS OF SOCIETIES. 


developed a second extra-uterine gestation in the other 
tube. 

Dr. Mobbis asked whether there were any means of 
distinguishing between tubal abortion and ruptured 
tube. That, he observed, was important, because in the 
case of abortion one need be in no hurry to operate, 
whereas in the other event early intervention was 
indicated. 

Dr. Eden said he had seen the patient on her arrival, 
but her condition was already too grave for anything 
to be done; in fact, she died almost at once. With 
regard to the injection, he pointed out that before 
they had completed the injection of the second pint of 
fluid the first lot had been absorbed, though the whole 
proceeding did not take more than five minutes. Under 
such urgent circumstances, he thought it was better to 
inject subcutaneously than to waste time looking for the 
median basilic vein. 

FIBBOID OF THE BBOAD LIGAMENT WEIGHING FOBTY- 

FOUB AND A HALF POUNDS (TWENTY KILOGBAMMES) 

BEMOVED BY ENUCLEATION ; BECOVEBY. WITH TABLE 

AND ANALY8ES OF THIBTY-NINE CASES. 

Mr. Alban Doban said:—In this case, where the 
tumour seems to be the heaviest of its kind on record, 
the patient was 28, and her last confinement was six 
years before operation. Shortly afterwards a tumour 
developed in the left iliac fossa; three years later it 
became impacted in the pelvis. Dr. Ward Cousins suc¬ 
ceeded in pushing it into the abdominal cavity; this 
gave great relief, but the tumour grew rapidly and 
albuminuria and anasarca set in. The catamenia re¬ 
mained normal throughout. The tumour grew in such a 
manner that the lower ribs were not stretched out, but 
pushed back behind it. In order to spare as much blood 
as possible, the ovarian and round ligament vessels 
were ligatured proximally and distally, the capsule 
divided between the ligatures, which were then 
tightened, and lastly the incisions in the capsule united, 
so that after its complete division horizontally, and the 
securing of the cervix uteri, the tumour was 
enucleated without loss of blood. The cut edge of 
the capsule was drawn together with a purse¬ 
string suture, its cavity being packed with iodo¬ 
form gauze. The serre-nceud was left on the cervix as 
it answered well its purpose, and lay separated by the 
capsule and its packing from the peritoneal cavity. 
Though very weak for a few days, the patient did well. 
The packing was removed in forty-eight hours; the deep 
cavity soon shrunk up. The author, after reviewing 
tables prepared by Sanger, Bayard Holmes, and Lang, 
brought forward a table of thirty-nine cases of “ fibroid ” 
(fibroma and myoma) of the broad ligament, with an 
analysis. In no less than six the patient was under thirty 
years of age, and in just as many over fifty. Menstrua¬ 
tion seemed unaffected, nor was flooding ever noted. In 
two cases, including the author's, there were renal 
symptoms, from pressure on one ureter. The growth was 
often rapid, but in Binaud’s case, closely watched for two 
years, the tumour only attained the weight of 9 oz. The 
large tumours caused pain and discomfort, interfered with 
nutrition, but rarely proved painful. In twenty-seven 
cases, including all under 20 lbs. in weight, the tumour 
was Bessile, embedded in the folds of the broad ligament. 
In eleven, possibly twelve, the tumour was pedun¬ 
culated; in one the pedicle was twisted. In 

twenty-five cases the weight was given. The 

tumour weighed over 40 lbs. in one, the case here 
related ; between 30 and 40 lbs. in two; between 20 and 
30 lbs. in two; between 10 and 20 lbs. in ten; between 
1 lb. and 10 lbs. in eight; and 1 lb. in two. Of the eight 
pedunculated cases, six or possibly seven recovered from 
an operation resembling ovariotomy. Six out of twelve 
simple “ enucleations ” of sessile tumours died, but all 
six date before 1890. Vautrin, of Nancy, twice did pan¬ 
hysterectomy after enucleation, saving both patients. 
Follosson, of Lyons, successfully enucleated the tumour, 
deep in the pelviB, from under the peritoneum (“ para¬ 
peritoneal ” method). In three cases the serre-noeud or 
elastic ligature was applied to the cervix. All re¬ 
covered. When the tumour is small, and limited to the 
side from which it originated, it may sometimes be 


safely removed with its ovary and tube, the hyper¬ 
trophied connecting tissue uniting it to the uterus 
serving as a pedicle. When the tumour is large, the 
removal of both appendages and amputation of the 
uterus is usually unavoidable. Retro-peritoneal 
hysterectomy is probably the beet procedure, if 
practicable. The chief duty of the surgeon in 
enuoleation of broad ligament tumours is to avoid loss 
of blood. The patients are nearly always sickly and 
anaemic, although flooding does not occur in this class of 
tumour, and they bear haemorrhage badly. The author 
urges the method which he adopted as the best way of 
avoiding loss of blood. Pressure forceps on the distal 
side are untrustworthy. 

BETBO-PEBITONEAL FIBBOID UNDKBGOIKG 8UPPUBATION. 

Dr. C. H. Roberts read notes of a case of large retro¬ 
peritoneal fibroid, apparently not of uterine origin, also 
occurring in the broad ligament. Most of the tumour 
had been converted into an abscesB cavity. It, with 
its contents, weighed 38 lbs. It had only slight 
adhesions to the uterus. It was removed from a woman, 
set. 50, who had never been pregnant. It had first been 
noticed thirteen years before, and eight years ago was 
subjected to the electrolytic treatment. During the last 
month she had lost flesh rapidly, but the only definite 
pressure symptom was oedema of the feet. The abdo¬ 
men measured 48 inches. Mr. Meredith removed the 
tumour, the lower Dart was solid, but the upper part was 
tapped, and 13 pints of thin greyish pus escaped. It 
was completely enucleated, and an elastic ligature 
applied to the cervix, which was subsequently cut 
through and removed along with the uterus. 

Dr. Hobbock8 raised the question as to the micro¬ 
scopical signs on which one relied to distingwish between 
fibroid and sarcoma. When he had asked this question 
on a previous occasion, he had been told that if the 
growth recurred it was a sarcoma, and if not, a fibroid ; 
but he urged that one would like something more 
definite for clinical purposes. He thought that clinically 
the President’s case looked malignant. 

Dr. Maclean recalled that eighteen months ago he 
had shown a specimen of fibromyoma of the broad liga¬ 
ment, weighing 14 lbs., removed from a woman, set. 39. 
In the upper part of the tumour was the uterus, three 
times its natural size, and the ovarieB and tubes were 
pressed to the right side. There was a connection with 
the uterus on the right side about the thickness of the 
thumb. 

Mr. Butler-Smtthe pointed out that in view of these 
cases the uterus was pushed up and the vagina elongated, 
and he referred to a case which he had seen with their 
President, in which the top of the uterus was on a level 
with the umbilicus. Under the circumstances the usual 
incision would be useless. He thought the President’s 
case was one in which the intra-peritoneal treatment 
would have been best. He himself had had a similar 
gigantic tumour to remove, but unfortunately the 
patient died during the operation. 

Mr. Alban Doban, in reply, said he had since had to 
operate in two other cases of fibioid of the broad liga¬ 
ment, one of them ending fatally, but it was one that 
had already been tampered with, the patient having four 
years previously been operated upon in the Colonies by 
a surgeon, who, finding a cystic tumour, thought it was 
malignant, and had drained. The wound had never 
healed, and the condition was septic. On operating he 
found a cystic sessile fibroid, and he performed retro¬ 
peritoneal hysterectomy, but she died 63 hours later 
from shock and sepsis. The second case was the one he 
had seen with Mr. Butler-Smythe, and there he operated 
by the intra-peritoneal method. The patient forty-four 
years of age, had first noticedthe tumour four years pre- 
yiously. It proved to be a sessile cystic fibro-myona bur¬ 
rowing deeply behind Douglas’s pouch. He performed 
retro-peritoneal hysterectomy, and as he did not care to 
drain he drew up the capsule firmly from behind the 
cervix, and sewed it over the flap of peritoneum in front 
of the uterus. The patient was actually convalescing, 
but in the second week she had had a sharp attack of 
parametritis. That he pointed out was always a danger 
in retro-peritoneal operations, bnt even so he thought it 

Digitized by GoOgle 




Mat 17, 1899- 


TRANSACTIONS OF SOCIETIES. The Medical Pebbs. 511 


was preferable to drainage. He could not think the 
tumour in his original case was malignant, for such a 
large tumour if malignant would -certainly have pro¬ 
voked severe constitutional disturbance, and would have 
got much softer. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Surgery. 


Meeting held Friday, April 7th, 1899. 


The President, Mr. R. L. Swan, in the Chair. 


hey’s internal derangement of the knee-joint. 

Dr. Knott read a communication on this subject, in 
which he made emphatic objections to the generally- 
received view that this lesion was a displacement of one 
of the semi-lunar fibro-cartilages of the articulation. 
He described the signs and symptoms of the condition 
as it had frequently occurred in his own person, and 
compared them with the original description of Hey, and 
the subsequent accounts of other recognised authorities 
on the same subject. Dr. Knott’s own view was that a sub¬ 
luxation of the corresponding condyle of the femur took 
place, the joint then becoming “ locked,” with the arti¬ 
cular surface of the condyle “over-riding” the prominent 
margin of the inter-articular fibro-cartilage. 

Mr. T. Myles said that the most striking feature of 
the descriptions in the text-books of this injury was the 
apparent total ignorance of tbe ordinary elementary 
anatomy of the knee-joint. For instance, in a recent 
work of Allingham’8 (?) he has evidently never dissected 
the attachment of the internal semilunar cartilage. He 
himself had 6een a considerable number of cases. In 
two cases he opened the joint expecting to find a loose 
cartilage, but found a pedunculated cartilage in the knee- 
joint. One case had a history pointing to displacement 
of the internal semilunar cartilage, but he found a small 
pedunculated cartilaginous body, growing from the 
front of the joint, projecting between the condyle and 
tibia. On two other occasions he found the anterior 
attachments of the internal semilunar cartilage com¬ 
pletely torn away. Annandale (?) originated the opera¬ 
tive treatment of this condition, but personally he had 
always failed to attach the semilunar cartilage to the 
tibia In every case in which he removed a piece of the 
cartilage the patient always complained of permanent 
weakness in the joint. Skiagrams of the affection he 
considered to be most misleading and absolutely futile, 
and the length of the ligamentum patella; would be 
compensated for by the increased contraction of the 
quadriceps extensor. 

Mr. R. C. B. Maunsell had removed a semilunar car¬ 
tilage a year ago from a girl’s knee. She had complained 
for several years of recurrent attacks of the dislocation. 
Recovery was rapid, and the patient was now perfectly 
strong. 

Mr. Cboly mentioned the case of a gentleman who 
came to him with one knee slightly fiexed and hopping 
on the good leg ; his knee-joint was “ locked.” He failed 
to find relaxation of the ligamentum patellae, nor could 
he feel anything nummular on the inside of the knee. 
Extension, followed by sudden flexion, gave instant relief, 
and patient insisted on walking home. The interesting 
thing was the slight violence causing the affection, but 
that applied to all dislocations. The joint was locked in 
all the cases he had seen. The reason why the external 
cartilage was not displaced was that the popliteous 
tendon tied it so tightly in its groove. He thought there 
was a difference in symptoms of loose cartilage and this 
affection. The former caused a sickening sensation 
within the knee itself, whereas the latter caused intense 
pain over the line of the internal semilunar cartilage. 
He thought that Mr. Maunsell was very fortunate in the 
case where he had removed the cartilage, but he did not 
approve of the proceeding. 

ADVANCEMENT OF THE RECTI MUSCLE8 OF THE EYEBALL. 

Mr. Story described the method of advancing tbe 
recti muscles in the treatment of strabismus, which he 
had devised more than three years ago, and had con¬ 


sidered to be his own peculiar property till a publication 
in the “ Annales d’Oculistdque” had informed him that 
the essential point in his operation had been anticipated, 
so far as publication was concerned, by Valude. The 
essential point is splitting the tendon longitudinally, and 
suturing each half of it separately to the conjunctiva or 
sclerotic. Each half is engaged in a loop of suture lying 
at right angles to the direction of the fibres of the tendon, 
and the knots are tied over glass beads to prevent the 
sutures cutting too rapidly through the conjunctiva, 
i Mr. Benson was impressed by the satisfactory results, 

! the operation not being followed by the disfigurement 
! which often resulted from lumpiness of the edge of the 
tendon near the margin of the cornea in former opera¬ 
tions. He himself had employed a modification of 
Schweigger’s operation, and frequently shortened the 
tendon rather than advance it to the edge of the cornea, 
and had been well satisfied with the results. One of the 
great difficulties was not so much to get a result as to 
get the result, and it was extremely difficult to measure 
the amount of result that will be obtained. In his modifi¬ 
cation of Schweigger’s operation it was neceesaiy,in order 
to avoid strain on the sutures, to put in an anchor suture. 
The pulley operation was a most abominably complicated 
thing to do. He thought it probable that for the majority 
of cases the operation described by Mr. Story would 
answer the purpose better than any other single opera¬ 
tion. 

Mr. Maxwell pointed out that when a tendon is 
advanced it is not the cut end alone which unites to the 
eyeball, but the conjunctiva having been raised up from 
the globe, a raw surface is left below and above, and the 
tendon becomes adherent to that raw surface at the 
level of its division to the eye. The great objection, he 
thought, in almost all operations, is that the tendon is 
divided, and if any slipping should occur, the patient's 
condition is worse than formerly. Another objection is 
that the suture is inserted into the tendon at one side, 
which iB firm enough provided the thread is carried 
across the tendon, but the other end is inserted into the 
conjunctiva, which is soft and delicate and easily torn. 
He described a method of his own to obviate slipping, in 
which tendon was stitched to tendon and the muscle 
was not divided at all, and even if slipping should occur, 
the original condition would remain. 

Mr. Story, in reply, approved of Mr. Maxwell’s opera¬ 
tion. He did not think that there was the same chanoe 
of one of the sutures giving way in his operation as in 
many others, because the only pull in his operation was 
directly along the tendon to the conjunctiva. 


HARVEIAN SOCIETY OF LONDON. 

Meeting held Thursday, May 4th, 1899. 

Peyton Beale, F.R.C.S., Vice-President, in the Chair. 

abthrotomy for the relief of pain. 

Mr. C. B. Lockwood related a series of cases of 
arthrotomy for the relief of pain, an abstract whereof we 
publish on page 505. 

Mr. Howard Marsh insisted upon the importance of 
the subjects raised in the paper. In regard to pain as a 
symptom of many joint affections he pointed out the 
important part played by tension and agreed that in 
many instances this was best relieved by free incision 
into the joint. Transverse division of the patella was 
perhaps the most satisfactory method of freely exposing 
the interior of the knee. Mr. Marsh had operated in 
about forty cases for the removal of the internal semi¬ 
lunar fibro-cartilage ; in all the result had been satisfac¬ 
tory, and in none had any impairment in the function of 
the joint been recognisable. In a few instances the 
affection had been met with in women and twice in 
children under ten years of age. 

Mr. Herbert Allingham had operated in fifty cases 
for one or another of the various conditions mentioned in 
Mr. Lockwood’s paper. The series included eighteen 
cases in which the internal semilunar cartilage was 
excised and thirteen in which the dislocated cartilage 
was sutured in position, and eleven cases in which loose 


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512 The medical Press. TRANSACTIONS OF SOCIETIES. Mat 17. 189® 


cartilages and three in which osteophytes were removed. 
In one case of chronic rheumatism the joint was drained 
and in three cases although nothing definite was found 
to explain the symptoms the latter were relieved by 
arthrotomy. In Mr. Allingham’s opinion the most satis¬ 
factory view of the interior of the knee-joint was 
obtained by a longitudinal division of the patella through 
an incision beginning at the upper part of the joint and 
continued downwards into the ligamentum patellaa. 

Mr. W. J. Walsham had, during the last 18 months, 
also operated upon about twenty cases of the kind under 
discussion without any mishap. He insisted upon the 
importance of careful preparation of the patient for such 
operation and thought it very advisable to keep the 
knee fixed on a splint for a week, if possible, beforehand. 
He strongly advocated transverse division of the patella 
as the best means of freely exposing the knee-joint. 
Mr. Walsham agreed that the symptoms of a dislocated 
semilunar cartilage were often not such as were 
described in the text-books and might consist of little 
more than a crack or snap during the movements of the 

J oint. In the treatment of such cases after operation 
le advised that movement should be commenced at the 
end of a fortnight and that the patient should be 
allowed to walk at the end of three weeks 

Mi\ Jackson Clarke referred to the case of an athletic 
man who hod had pain in a knee-joint for four years, 
originating in a sprain sustained in playing golf. The 
symptoms were so severe that at first it seemed likely 
that the joint would require to be opened Mr. Clarke, 
however, first tried the effect of a support that prevented 
lateral and rotation movement at the knee. This 
measure proved successful, and enabled the patient to 
play football, polo, and other vigorous games. At the 
end of a year t he apparatus was left off and the patient 
had no further trouble. 

Mr. Raymond Johnson referred to a case in which 
suppuration in the knee-joint followed an operation for 
the removal of a semilunar cartilage. He at once 
drained the joint by free lateral incisions, and recovery 
followed with a very fair amount of movement. He 
believed the infection of the joint took place from the 
skin, and was in part accounted for by the fact that at 
the time of the operation there was still a good deal 
of fluid in the joint. It was certainly much safer in 
these cases to delay operation until the attack of synovitis 
had subsided. A question was asked as to the probable 
nature of some cases of diffuse villous synovitis in which 
there were no definite evidences of osteo-arthritis. The 
speaker also referred to the comparative rarity of the 
origin of loose cartilages in joints resulting from detach¬ 
ment by injury of a portion of the articular surface. 

The Chairman congratulated Mr. Lockwood upon the 
success with which ho had followed up such a consider¬ 
able series of cases. The long villout processes found 
in the synovial membrane in some cases of rheumatoid 
arthritis were microscopically identical with the villous 
rocesses normally found in the rabbit’s knee, and which 
ad masses of mucoid material projecting from them. 
Mr. Lockwood replied. 


BRADFORD MEDICO-CHIRURGICAL SOCIETY. 

Meeting held on April 18th. 

The President, Dr. Bebrt, in the Chair. 

Dr Enrich gave a microscopical demonstration. 

Mr. Hall showed (1) a small dermoid cyst of the 
ovary, in which there were three cavities, the first con¬ 
tained hair, the second teeth and bone, and the third 
a mucoid fluid. (2) A calculus removed six months 
after lithotrity. 

Dr. Kerr showed a case of optic neuritis following 
measles. 

Dr. Rabagliati showed the pelvic organs with some 
intestine removed post-mortem from a patient who had 
suffered from fiecal fistula, following pelvic abscess. 

Mr. Wilmot showed a patient suffering from 
acromegaly. 

Dr. Metcalfe read a paper on the 

OPERATIVE TREATMENT OF PTERINE CANCER. 

After alluding to a case of cervical cancer which he had 


recently had under treatment, Di. Metcalfs discussed 
the relative propriety of the operations of supra-vaginal 
amputation, and of vaginal hysterectomy. While 
admitting that there was a very large body of modern 
opinion in favour of complete hysterectomy he cited 
Schroder, John Williams and others who advocated 
supra-vaginal amputation, and pointed out that the 
immediate mortality from hysterectomy was higher than 
from supra-vaginal amputation, while the recurrence 
rate was no lower. The advocates of hysterectomy 
say that the high recurrence rate is due to the fact that 
hysterectomy has been reserved for more severe cases, 
while supra-vaginal amputation has been practised on 
the early cases. Dr. Metcalfe then described the dis¬ 
tribution of the pelvic lymphatics, and expressed the 
opinion that it is impossible by vaginal hysterectomy to 
remove the whole of the diseased area, together with the 
lymphatic glands, and consequently that if the disease 
has spread beyond the limits of the uterus, recurrence 
is probable after either hysterectomy or amputation of 
the cervix. 

Drs. Rabagliati, Wood, Hall, and Althorpe discussed 
the paper, and Dr. Metcalfe replied. 

Mr. Miall read a paper on 

CONTAGION FROM A HISTORICAL POINT OF VIEW. 

He said : Disease was considered transmissible, in very 
early times, by charms and ceremonies, some of which 
are still extant. Ideas of cleanness and uncleanness, 
which are almost universal among primitive people, also 
involved the idea of contagion which prevailed at the 
dawn of history in Egypt, Persia, and Greece. In India 
inoculation for the small-pox was practised by ihe priests 
still earlier. Thucydides records the contagious character 
of the plague at Athens, b.c. 430, and about the same time 
Hermippus, the comic poet, mentions the itch a6 trans¬ 
missible. A little later Isocrates alludes to consumption 
as contagious, and Aristotle has no doubt of the conta¬ 
gious natui-e of the plague. But the strictly medical 
writers in Greece before the Christian era ignore con¬ 
tagion. They account for epidemics by noxious airs, 
influences of celestial bodies, eclipses, tidal waves, earth¬ 
quakes, famine, wars, and other causes affecting many at 
the same time. The Greeks had no word for contagion, 
but they exnressed the fact in numberless ways, quit© 
unequivocally. Aretscus was the first medical author 
who recognised contagion at all, this was in the second 
century, a.d. Lucretius first uses the term contagion, 
which soon acquired a technical meaning. He was 
followed by Vugil, Ovid, Livy, and most Latin 
authors, except the medical writers. The latter 
do not allude to the subject till we come to Ccelius 
Aurelianus, though the Greeks had long adopted the 
notion. Bubonic plague can be traced back further than 
any epidemic disease ; it is now possible to identify it in 
the sixth century, a d., when it pervaded the Roman 
Empire, eastern and western, for fifty years. According 
to Gibbon, it depopulated the most flourishing 
countries, some of which have never recovered. In 
three months, five to ten thousand persons died 
daily at Constantinople. At this time, Mayrius looks 
upon it as decidedly contagious, while Procopiup, another 
contemporary historian denies contagion in strong terms. 
For a thousand years after this the same disease appeared 
at intervals in every country in Europe. The recognition 
of small-pox by Rhazes in the tenth century was an 
important event in the history of epidemics, for though 
the disease had probably appeared long before, it was not 
properly marked off by physicians. From that time 
measles, chicken-pox, and ultimately scarlet fever, 
typhus, and enteric fever were gradually analysed and 
separated from one another. 'I he belief in contagion was 
gradually placed on a firmer foundation. Rhazes does 
not lay much stress on it, though he admits that small¬ 
pox and measles are contagious. He dwells principally 
on the great susceptibility of children, and the lee9 
susceptibility of older persons. There are thus three 
lines of thought in ancient history in regard to epi¬ 
demics. The idea of contagion, that of the patient’s 
susceptibility, and that of a common cause for epidemics. 
These three theories still contend with one another. 


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GERMANY. 


The Medical Press. 513 


prance. 

[from OUR OWN CORRESPONDENT.] 

Paris. May IS, 1890. 

Pulmonary Congestion Without Expectoration. 

At the last meeting of the Medical Society, M. Renon 
spoke on certain cases in which affections of the lungs in the 
adult followed their course without expectoration. In the 
pulmonary congestion of Woillez the absence of expec¬ 
toration was the exception. Woillez remarked it once 
and the speaker knew of four other examples. In the 
pleuro-pulmonary congestion of Potain expectoration 
was the rule, and he found on record but one case where 
it was absent. 

In spleno-pneumonia that absence was much more 
frequent, and influenza, by modifying considerably the 
regular evolution of pulmonary congestions, had con¬ 
tributed to thefrequency of the phenomenon, M. Huchard 
insisted on a new form, which he styled bronchoplegia, 
in which the patients did not expectorate, and which 
was due to the action of the influenzal poison on the 
pneumoga8tric. 

The common features of these congestions were violent 
dyspnoea and a double souffle, with a slight sound of 
bronchophony. In the majority of cases the absence of 
the expectoration did not much influence the evolution of 
pulmonary congestions, consequently the prognosis need 
not be modified. Exception should be made, however, 
in respect of bronchoplegia, which was frequently fatal- 
The True Cause of Appendicitis. 

M. Taisans said that for a long time already different 
authors remarked a coincidence between appendicitis 
and certain affections of an influenzal nature, hence the 
conclusion that influenza might under certain circum¬ 
stances engender appendicitis. For him this variety, 
far from being the exception, should be considered as 
the rule, as appendicitis breaks out in the course of an 
attack of influenza, or sets in some time after that attack. 
In any case the relation of cause and effect between the 
general malady and the affection of the appendix was 
extremely probable. 

This view of the etiology of appendicitis fur¬ 
nished the only explanation of two facts of incon¬ 
testable reality; viz., that appendicitis had become 
extraordinarily frequent within the last ten years, that 
is to say, since the great epidemics of influenza made 
their appearance. In the Eecond place each annual 
epidemic of influenza is accompanied by a kind of epidemic 
of appendicitis. The speaker concluded by saying that 
in his opinion the true cause of appendicitis was influenza. 

An Incubator ad hoc. 

A medical journal relates the following curious inci¬ 
dent. A young girl became passionately fond of a young 
man who finally refused to marry her. The parents of 
the disappointed belle brought an action against the 
obstinate fiance for seduction. A medico-legal examina¬ 
tion was ordered by the court, which revealed the linen 
stained with blood and the hymen ruptured. The girl 
declared that she had a violent struggle with her seducer 
before he committed the act. No trace of violence, how¬ 
ever, could be found on her body. On examining the 
vagina the medical expert was no little surprised to find 
an oval smooth foreign body there, which turned out to 
be a hen’s egg! In the extraction it broke, and was 
received in a semi-liquid state in a basin. The most 
curious part of the affair would have been if the egg 


j previously fecundated had sojourned the necessary period 
! in the vagina of the young virgin transformed into an 
artificial incubator. She would have been delivered o^ 
a chicken, and the medico-legal question would have 
been complicated with a problem of teratology. 

Prevalence of Typhoid Fever. 

Tho seasonal increase in the prevalence of typhoid 
fever in Paris is once again exoiting publio attention in a 
disagreeable way. Interested pleas are continually 
being put forward with the view of exonerating the 
water supply from the responsibility, and it is quite 
possible, after all, that the extensive disturbances of soil 
which have been entailed by the preparations for the 
approaching exhibition may have contributed to swell 
the death-roll. Although water pollution is always the 
principal factor in the productions of widespread 
epidemics, there are many other possible sources of in¬ 
fection open to explain the numerous more or less 
sporadic cases. Foremost among them is the deplorable 
condition of Paris from a hygienic point of view. There 
are special technical reasons for suspecting the water 
supply, too intricate for explanation here, but a powerful 
Government department is interested in proving that all 
is for the best in the best of worlds, the large number 
of deaths from such an eminently preventible disease as 
typhoid fever to the contrary notwithstanding. 

-» ■ - ■ 

Germany. 

[from our own correspondent.] 

Berlin. May 13th, 188P. 

At the Surgical Society Hr. Eiselsberg, Konigsberg, 
read a paper on 

Hemorrhage from the Stomach after Operations 
During the past three years he had observed ha?mor- 
rhage from the stomach after operations in six case3 in 
seven years in the Konigsberg Klinik. (1) The day after 
Bassini’s operation; (2) after hemorrhage and ligature 
of omentum; (3) after omental hernia ; (4) after extir¬ 
pation of carcinoma of the rectum, there waR no hteme- 
temesis, but collapse and death on the fifth day ; the 
autopsy revealed numerous hemorrhages in the mucosa 
of the stomach and peritonitis ; (5) strangulated hernia, 
replacement, purulent peritonitis, death in three days; 
in the stomach were 30 fresh erosions ; (6) ileus laparo¬ 
tomy, torsion of omentum, hematemesis, death; the 
autopsy showed peritonitis and fresh ulcers of the 
stomach, of carcinoma of the rectum, extirpation ; the 
wound did well, but on the ninth day collapse, black 
stools and death, the autopsy revealed a deep duodenal 
ulcer. There could be no doubt as to the causal rela¬ 
tion between the operation and the htemorrhage. 
Vomiting after narcosis could not be the cause, as in 
two eases there was no vomiting; in six cases, however, 
there was ligature of the omentum, and in the seventh 
the omentum was probably contused. In an experiment 
on an animal, multiple htemorrhages into the stomach 
followed twisting of the omentum. 

Hr. Konig, jun., Berlin, related a case of 
Perbistent Vomiting. 

The patient, a woman (shown), had suffered for fifteen 
years from persistent vomiting* at last all food was 
rejected. In June 1898, posterior gastroenterostomy 
was performed, but with no benefit, and six weeks later 
a second attempt was made. This time the two loops of 


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514 The Medical Pbbhs. 


Al) STRIA. 


Mat 17, 18(9. 


intestine were nnited by Murphy’s button, but again no 
good resulted, the vomiting still continued. The patient 
then came to Berlin under v. Bergmann’s care, when 
laparotomy was again performed. The bowel was firmly 
attached to the stomach and lay behind it. It was 
closely sutured to the stomach, and a communication 
made between the two loops. A further gastroenteros¬ 
tomy was made, this time anteriorly with attachment of 
a broad piece of bowel. The result was good, the vomit’ 
ing ceased entirely and the nutrition was good. She 
had gained 6 kgrm. in weight. 

Hr. Braun, Gottingen, performed gastroenterostomy 
in November, 1897, on a man, set. 25, who suffered 
from severe gastric troubles. The patient did well. 
Eleven months afterwards acute peritonitis came on and 
he died. The cause, as shown by the autopsy, was per¬ 
foration of the jejunum some centimetres from the 
stomach, from an u’cer, apparently caused by outflow of 
gastric juice. 

Hr. Kahn related a similar case. A year after suc¬ 
cessful gastroenterostomy acute abdominal pain came 
on with death within twenty-four hours. A perforation 
had taken place, where the jejunum joined the stomach. 
Anterior ante-colic gastroenterostomy had been per¬ 
formed. 

Hr. v. Bech, Carlsruhe, reported a case of gastro¬ 
enterostomy with Murphy’s button. After some months 
renewed acute symptoms of ileus made a second lapa¬ 
rotomy necessary, when the Murphy’s button was 
found firmly seated in its original position. After this 
the button descended spontaneously, and the symptoms 
disappeared. Ab the cause of illness he had found in 
some cases acute flexion of the intestine from adhesions 
In one case obstruction of the bowel was found to be 
caused by a tumbler belonging to a bedroom water-bottle 
fixed in the rectum. This was with difficulty removed 
without breaking. This patient then called to mind 
that once, on getting out of bed, he had sat down sud¬ 
denly on the water-bottle, with the tumbler placed in an 
inverted position over it. The neck of the bottle was 
smashed, and the tumbler, which he thought was also 
broken, had passed up into the rectum ! 

Hr. Kader, Breslau, related the case of a woman who 
had been operated on by a gynecologist. Ten days later 
ileus-like symptoms came on. The wound was reopened* 
and the patient remained under treatment for six 
months, and at the end of that time she was discharged 
improved. But again symptoms resembling ileuB came on, 
and the patient became very weak. Then a piece of 
cloth, the size of a pocket handkerchief, was removed 
from the rectum, which had plainly been left in the 
abdomen, and had found its way into the bowel. Later 
on, acute strangulation took place and peritonitis. At 
the laparotomy a loop of small intestine was found 
kinked and gangrenous in the pelvis. Death. At one 
part of the intestine a cicatrix was found, the point of 
entrance of the cloth. In order to study the passage of 
foreign bodies out of the peritoneal cavity into the bowel, 
he performed the following experiment: He drew an 
indiarubber ring round a piece of bowel and returned it 
into the abdominal cavity. Later on the ring had become 
embedded in new growth around it, and still later it had 
passed into the bowel, the wound in the intestine being 
closed with a cicatrix. 

Hr. Hadlich, Kassel, recited the case of a man on whom 
japarotomy was peiformed. At the operation the colon 


was found to end in a blind pouch, a space a hand- 
breadth in width separating the two blind ends. The 
destruction of the intervening portion had probably been 
caused by adhetions, resulting from appendicitis. 

Hr. Henzel recited a case of the long continuance of 
a foreign body in the abdominal cavity. Six years ago a 
young man had been operated on for echinococcus of the 
abdominal cavity. The operation was tedious, and as 
collapse threatened the abdomen was closed in a hurry- 
The patient recovered. Fourteen months afterwards he 
felt violent pain in the region of the sigmoid flexure, 
with drawing up of the left leg and a tumour on the 
left side of the abdomen. Echinococcus was again 
diagnosed. The abdomen was opened, a large quantity 
of exudation was found, and in the midst of this a large 
torsion forceps, which must have been left in at the first 
operation 2$ years before. The patient recovered. 

Jlustria. 

[from our own correspondent.] 

Vienna. May 13th, 18W. 

Hysteria. 

At the Medical Club, Schlesinger showed a female 
patient, set. 16, with peculiar movements of the head 
which were probably hysterical as she formerly had other 
marked nervous movements that suddenly disappeared 
In the present illness the movements of the head were 
backward, and in order to control them the finger had to 
be put in the mouth in order to hold the head forwards. 

Estimation of Phosphorus in the Blood. 

Dr. A. Jolles exhibited an apparatus which he has 
devised for the measurement of phosphorus in haematic 
analysis. Where the phosphorus is present only in small 
quantities as in the blood the process is usually long and 
tedious, but with Jolles’ phosphor-meter the operation 
is greatly simplified. In his demonstration he referred 
to the essential elements of the blood cells and 
emphasised the fact that it must not be considered a 
simple albuminous body, but one containing a phosphatio 
proteid or, as Kossel has aptly termed it, nucleo- 
albumine. Smith had isolated albumen and cytoglo bin 
from the red corpuscles, and altogether these are not 
complete. A group of nucleo-proteids have been formed. 
Becent investigation of the albuminous part of the 
leucocytes and “ nucleo-histon ” show them to contain 
3‘025 per cent, of phosphorus which form by decomposi¬ 
tion a nuclein or leuco-nuclein with 4 7 per cent, 
of phosphorus, the peculiar feature whereof is its 
combination with an albuminous base. It is 
acknowledged that the flat corpuscles have homo¬ 
genous contents and mostly of albumen while 
the nucleus contains the nuclein. The non-albuminous 
substance of the cell is richer in phosphorus as in 
lecithin, which by its acid combination plays an impor¬ 
tant part in the blood. The relative proportion of phos“ 
phorus in the normal blood is constant in the leucocyte’ 
but whatever its function may be there can be no doubt 
as to its importance. In pathological conditions it is 
often increased or diminished in the presence of micro¬ 
organisms, poisons, or other foreign bodies, when the 
task of the leucocytes seems to be to change injurious 
into innocuous material. 

The bacterial; foundation of a bacterial property in 
the leucocyte has been more than once repeated in the 

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Mat 17, 1899. 


THE OPERATING THEATRES. 


publications of Kossel, Metschnikoff, Roux, Hahn, 
Schattenfroh, &c., which would lead us to the conclusion 
that there must be some enhanced property of the cell 
to assume a defensive attitude towards infection by 
causing an increased secretion of alexine. With this 
knowledge, the destruction of red blood corpuscles and 
the increase or modification of leucocytes or other con- 
stituents would probably increase the average amount of 
phosphorus, which could be early recognised as a patho¬ 
logical change. In the normal condition blood serum con¬ 
tains very little lecithin, or debris, as well as phosphate 
of soda. He therefore concludes that the phosphatic 
contents of the cell comprise the total phosphorus, while 
the serum has relatively very little in the normal con¬ 
dition. An examination, to be of any practical service, 
must have for its object the determination of the phos¬ 
phorus present in the cellular element as well as the 
serum. 

The principle of his method is the depth of colour 
produced by potassium molybdate when heated to 
80 degs. C. (176 Fahr.). In order to separate the phos¬ 
phorus from its various combinations in the blood, 
it is first evaporated to dryness, and carbonised and 
subsequently dissolved in soda and nitre (3‘1) with the 
addition of a little nitric acid. It is again evaporated, 
and afterwards re-dissolved in hot water, when itis ready 
for the colorimetric apparatus. Hitherto the inaccuracy 
of the colorimeter when compared with gravimetric esti¬ 
mation have rendered the results very fallacious. To 
overcome this source of error Jolles has devised his 
phosphormeter, which is a combination of various tubes 
containing different quantities of phosphorus, under 
similar conditions which thus can be easily compared 
with the substance under examination. In conclusion, 
he gave a demonstration of 22 healthy cases where the 
blood cells and blood serum contained fixed quantities 
according to age sex, and mode of life. 


‘(The ©perating '(Eheatne. 

MIDDLESEX HOSPITAL. 

Larue Fibho-Cyst of Uterus with an Ovarian 
Tumour.— Dr. William Duncan had under his care a 
patient, set. 55, who, after undergoing a fatiguing walk, 
suffered with acute abdominal pain. She was found to 
have acute peritonitis, and this, under appropriate 
treatment, passed away, and then a cystic tumour was 
detected in the abdomen, reaching up to the level of the 
umbilicus. No vaginal examination was made, the 
patient being a single woman. Abdominal section was 
performed, and when the peritoneal covering was opened 
a large cyst, having all the appearance of an ovarian 
cyst, presented itself. There were numerous recent 
adhesions over the surface; these having been broken 
down a Spencer WellB’s trochar was inserted into the 
cyst and about two quarts of clear serous fluid drawn 
off, and the emptied cyst was drawn out of the abdo¬ 
men ; it was now found to have a solid portion at the base 
and this again was found to be springing from the 
fundus uteri by a fleshy pedicle about an inch in diameter. 
This last was transfixed with silk and tied. Peritoneal 
flaps were cut and reflected down, then the tumour was 
cut across about half an inch above the level of trans¬ 
fixion. The 8tump was covered over by continuous 
sutures drawing together the flaps of peritoneum. On 


Th* Mxdical Prxsb. 515 

passing the hand down into the pelvio cavity this was 
found to be filled by an unilocular ovarian cyst about 
the size of a cocoanut. This was removed in the usnal 
manner and the abdominal walls sutured in three layers. 
Dr. Duncan remarked that this case presented some 
interesting features:—1. That the patient had not only 
a large pelvic cyst of the uterus, but also an ovarian 
cyst filling up the pelvis of the existence of which 
she was absolutely ignorant, nor had they caused 
her any symptoms whatever until the onset of the peri¬ 
tonitis after her long walk. 2. The tumour felt through 
the abdominal wall, and also seen after the opening of 
the abdomen, had all the signs of an ordinary ovarian 
cyst, and it was only after the drawing out of the col¬ 
lapsed cyst from the abdominal cavity that it was found 
to be a fibro-cyst springing from the fundus of an 
uterus which was in itself perfectly normal in size and 
appearance. 3. The pelvic cyst, although free from 
adhesions, ceuld not be drawn up until strong pressure 
was made by the fingers of an assistant per vaginam. 
The patient made an uninterrupted recovery. 

WESTMINSTER HOSPITAL. 

Double Castration for Tuberculous Disease of 
both Tebtici es. —Mr. William Turner operated on a 
man, set. 42, who had been admitted with swelling of both 
testicles ; that of the right one commenced two months 
ago and gradually increased in size; it was tender at first, 
but lately has become insensitive; the left testicle com¬ 
menced to swell a month ago and was still tender and 
painful. There was no tuberculosis history in the 
patient’s family, and his children were all alive and quite 
healthy. He lived in the country and there was no cause 
so far as he Inew for this condition. The epididymis of 
both testicles was very much enlarged, and also hard 
i and irregular. At the posterior and outer side of the 
1 right epididymis there was a fluctuating swelling which 
was firmly attached to the skin and not translucent. 
The vas deferens on either side was markedly thickened 
though the structures of the cord were not affected. 
There was an inguino-3crotal hernia on the right side, 
and on examination per rectum a craggy mass about 
the size of the end joint of the little finger was found in 
the position of the right vesicula seminalis, the 
prostate too was slightly enlarged and tender. The left 
1 vesicula was apparently normal. He had been complain¬ 
ing lately of some frequency of micturition, and the 
urine contained a slight amount of albumen, though 
there was no definite indication of pus. There were no 
signs of phthisis or of any other tuberculous lesion else¬ 
where. On the left side an incision was made over the 
external ring, the structures of the cord divided the 
testicle shelled out of the scrotum through the opening, 
the vas and the blood-vessels ligatured separately, 
and divided as high as possible, and the testicle 
removed. On the left side the incision was carried right 
into the scrotum, and the adherent skin removed with 
the testicle en masse. Above, in the inguinal region, the 
incision was carried well external to the internal abdo¬ 
minal ring, the external oblique was slit up, and the sac 
of the hernia isolated; the sac had a large sub-peritoneal 
lipoma attached to it lying in the canal; the lipoma 
was removed and the sac freed; the structures of the cord 
were then separated from their coverings, and the vaB 
isolated. The vessels, &c., were ligatured and divided, as 
on the other side, and the vas separated down about two 


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516 The Medical Press. LEADING 

inches, through the internal ring to the brim of the pelvis’ 
ligatured, and divided, the end being touched with pure 
carbolic, as there was some purulent fluid in its lumen- 
The hernial sac was transfixed and ligatured, after 
Mitchell Banks’ plan, and the canal closed by McEwen’ 8 
method, the external oblique being sewn up with 
a continuous suture. The whole wound was brought 
together with a continuous silk suture, a drainage tube ' 
being inserted in the lowest part of the scrotum. Mr. 
Turner said that he had advocated this operation in j 
preference to simply opening and scraping the abscess, 
particularly owing to the fact of the vesicula seminalis ! 
on the right side being markedly affected, and the pro¬ 
bability of some further trouble in the urinary tract in 
consequence of the albuminuria and of the enlargement 
of the prostate. The ultimate prognosis of cases of this 
description, he remarked, appears to be bad, owing to 
the early affection of the prostate, bladder, and kidneys, 
but he thought it seemed only reasonable to hope 
that a free removal of fo great an amount 
of the disease might give the patient a better 
chance of recovering from the rest of the trouble. It 
was quite evident, he pointed out, that the testicles were 
perfectly useless to him as sexual organs, this being 
borne out by the patient’s history. As regarded the 
immediate prognosis, he thought there did not appear 
to be any reason why the patient should not go on 
satisfactorily; but it might be interesting to see ! 
whether the affection in the lumen of the vas on the ! 
right side would affect that part of the wound with tuber- i 
culous disease, and ultimately lead to the formation of a 1 
tuberculous sinus. He did not consider it justifiable to ' 
continue the separation of the deep parts for the removal ; 
of the remaining portion of the vas in the pelvis, as 
that would have involved the complete removal of the 
right vesicula seminalis, and this, he thought, would 1 
have been very heroic treatment. He hoped, with the | 
removal of the greater part of the disease, the remain- : 
ing portion of the vas would gradually shrink with the 
improvement of the patient’s general health. He did 
not anticipate any nerve us symptoms, such as dementia 
or mania, to follow the removal of both testicles, as they 
were both greatly affected with tuberculous disease, the 
double castration of normal testicles, however, be 
pointed out, having often led to such effects. 


Vital Statistics. 

The deaths registered last week in the thirty-six great 
towns of the United Kingdom corresponded to an annual 
rate of 16’5 per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of this year. 'Ihe deaths registered in each of the last 
four weeks in the several towns, alphabetically arranged, 
corresponded to the following annual rates per 1,(X)0:— 

Birkenhead 18, Birmingham 16, Blackburn 13, Bolton 
19, Bradford 18 , Brighton 17, Bristol 15, Burnley 1(3, 
Cardiff 10, Croydon 15, Derby 9, Dublin 24, Edin¬ 
burgh 18, Glasgow 20, Gateshead 13, Halifax 18, 
Huddersfield 18 , Hull 17, Leeds 18, Leicester 14, Liver¬ 
pool 20. London 1(5, Manchester 20, Newcastle-on-Tyne 17, 
Norwich 14, Nottingham 16, Oldham 17, Plymouth 22, 
Portsmouth 14, Preston 19, Salford 19, Sheffield 14, 
Sunderland 17, S van sea 14, West Ham 10, Wolver¬ 
hampton 17. The highest annual death-rates per 
1,000 living, as measured by last week’s mortality, 
were :—From measles, 2 2 in Manchester, and 2 (3 in 
Bolton; from whooping cough, 18 Birkenhead and in 
Preston, and 2 8 in Burnley; and from diarrhcea, 1\5 
in Derby. In none of the large towns did the death- 
rate from scarlet fever, or from fever reach lO per 1,000. 


ARTICLES. _ _ May 1.7, 1899. 

Registered for Transmission Abroad. 

<£he jiftebical gress aitb Circular. 

Published every Wednesday morning, Price 5d. Post free, 6pi- 

ADVERTISEMENTS. 

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Small announcements of Practices, Assistancies, Vacancies, Books, 
&c.—Seven lines or under, 4s. per insertion; 6d. per line 
beyond. 

Letters in this Department Bhould be addressed to the Publishers. 


^hc <ittcbical ifkees anb (Eirculai*. 


“ SALUS POPULI SUPREMA LEX.” 


WEDNESDAY, MAY 17, 1899. 


SPORT v. VIVISECTION. 

The National Anti-Vivisection Society of Great 
Britain ha6 had another gala day. Our readers will 
remember at the former great foregathering held a 
few weeks since, the promoters killed the fatted lamb 
over an “eminent ” surgeon, who alone of the elect 
of medicine had joined their standard. The fallacies 
of the arguments advanced by their pillar of support 
were pointed out at the time not only in our own 
columns but also in those of several of the leading 
lay newspapers. This second meeting at St. James's 
Hall, following hard on the heels of the first, was 
not sanctioned by a single member of the medical 
profession who has established any claim to scientific 
consideration. A number of titled folk, with the aid 
of a few church dignitaries, met together and showed 
their profound ignorance of the methods and mean¬ 
ings of vivisection, while they calmly assumed the 
right to guide mankind in the regulation of a branch 
of experimental science of which they clearly had not 
touched the fringe. One speaker, a type of the 
sentimentalist, sincere, eloquent, titled, narrow, 
maintained that the Society was engaged in 
one of the noblest causes that had come 
before the nation since the abolition of slavery. 
To prolong human life by the torture of 
animals was morally wrong, and if the vivisectors 
could make us live a hundred years it would be a 
miserable exchange for the extinction of pity in the 
human heart. This curious piece of antiviviseotionist 
metaphysics is l iddled with the fallacy of assumption- 
Let us see Low far it will hold water. I f it be wrong 
to pi-olong human life by the torture of lower animals 
(admitting, for the sake of argument, that question¬ 
begging phrase), surely it is no less wrong to kill 
them for the purpose of sustaining life. Ergo, 


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LEADING ARTICLES. 


we should all become vegetarians or die the 
death. But it is a moot point if there be 
not a remote common origin of vegetable and 
animal life. At any rate, the vegetarian destroys 
alien life every time he eats an onion or munches a 
radish. The vegetarian then supports his own life 
by means that are more cruel, inasmuch as they in¬ 
volve destruction of alien life, than the methods of 
the vivisectionist who merely “ tortures ’ —again 
accepting an absurd term—lower'animals to sub¬ 
serve the welfare of humanity. But what is the 
position of our gentle metaphysician towards the 
sportsman who tortures the lower animals for mere 
purposes of amusement and recreation? For an 
answer to that pertinent question we may turn to the 
utterances of his chairman, the Duke of Portland, 
who has at length answered the repeated ahallenge 
thrown down to the anti-vivisectionists upon the 
matter of sport. The downright views of the noble 
lord are those of sn avowed sportsman. Let us 
examine them. The object of the sportsman, said he, 
was to kill his quarry outright with as little pain as 
possible. Then why does his grace not shoot tame 
deer instead of pursuing them as Master of the Queen’s 
Buckhounds over half a county P Surely instantaneous 
death inflicted by a cartridge would be better for the 
deer than being flayed and disembowelled by 
barbed wire fences and being tom to pieces 
by savage dogs. Moreover, “ the object of 
the sportsman ” — as defined by the Duke — 
namely, to kill his quarry outright with as little pain 
as possible, would be certainly and absolutely attained 
by the keeper’s gun. As with deer, so with foxes- 
Then the noble chairman went on to advance the 
extraordinary argument that sport, and the laws that 
protected it, were the greatest friends to the animals 
pursued, because if it were not for sport they would 
very soon be extinct, and would no longer exist except 
as specimens in the Zoological Gardens. We presume 
his Grace speaks of protected sport, because 
the extinction of wild animals, as, for in¬ 
stance, the giraffe and elephant, is being effected 
at this present moment in Africa still in the sacred 
name of sport. What animals the speaker had in 
view it is hard to imagine. Does he assert that the 
fox and the deer would become extinct in England if 
they were not hunted and shot P If so, we very much 
question whether they would thrive and multiply 
multitudiuonsly were they no longer the object of 
the tender solicitude of sportsmen. Pheasants and 
partridges are not indigenous to this country. We 
venture to assert that the United Kingdom would 
not be a penny the worse were every animal now the 
object of sport in the country extinct within a couple 
of years. Nay, more, it may be pretty safely asserted 
that agriculture and the productive power of the 
nation would be benefited thereby, although the 
sportsman, titled and otherwise, would have to seek 
his diversion in other directions. Henceforth it must 
afford a comforting if somewhat grim satisfaction to 
every sportsman that the animal he is pursuing with 
intent to kill is deriving solid benefit from his kind¬ 
ness. Bad for the individual the chase undoubtedly 


The Medical Pbesb. 517 

must be, but think of his kindred and his posterity 
saved from the obscurity of the Zoological Gardens. 
What creature would think of the terrors of a flight 
for life from the fangs of a bloodthirsty pack, 
when the survival of his species was at stake ? Then 
came the Duke’s trump card, so to speak, in this 
flourish of sportsman rhetoric. Sport tended, so he 
explained to his enthusiastic following, to the better 
understanding of the case, the requirements, and the 
natural habits of animals, which knowledge was abso¬ 
lutely necessary to keep them in health and therefore 
in the enjoyment of life. To round off his argument 
he need only have added that sport tends to the 
better knowledge of how best to kill the unfortunate 
lower animals which it is his tender object 
to keep in health and enjoyment of life. The 
fox and the deer that head the run across 
country may henceforth be happy that they are kept 
by the sportsmen out of the hands of the accursed 
vivisectionists in order that their health and happi¬ 
ness may be maintained—that is to say—up to a 
certain pitch, and apart from such accidents as 
barbed wires or railway engines, or the attentions of 
sharp-fanged hounds. 

To the merely scientific onlooker it would seem 
that the experimental investigation of disease 
conducted upon the lower animals would lead 
to a sounder knowlege of how to prevent and 
how to cure their maladies. Pasteur, who made 
and confirmed his discoveries by means of vivisec¬ 
tion, was enabled to stamp out anthrax in the 
herds of Europe. The saving of suffering involved 
in that simple statement is incalculable. A fact of 
that kind, however, hardly falls within the limited 
knowledge of the anti-vivisector, which rarely ex¬ 
tends beyond the “ torture trough ” and the “ cruel 
and degrading practices ” of vivisection—that is to 
say, words that declare his mind to be made up before 
he approaches the discussion of the subject. The 
Duke of Portland believes that horses are better 
looked after in Great Britain because we are a 
nation of sportsmen. That may be so; but we 
venture to say that any day liis Grace will 
find more cruelty to horses in one short street 
in a busy City than he would find in twenty years 
of vivisection. His Grace is Master of the Queen’s 
Buckhounds. We have often commented on the 
gross cruelty to tame deer hunted under his auspices. 
He has now broken silence, and under cover of a 
veiled attack upon the medical profession has indirectly 
proclaimed to the world his defence of that species of 
sport which seeks to promote the comfort of the 
“carted” tame deer. We trust Her Majesty will 
carefully consider the views advanced by the Duke of 
Portland at St. James’s Hall. 


* THE NEW REGISTERS. 

The General Medical Council has issued the 
“Medical and Dental Register’’ for 1899 within 
the past week, nearly a month later than last 
year’s date, and nearly two months later than 


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LEADING ARTICLES. 


the date of some previous issues. Probably the in* 
creased size of the Medical Register may account 
for some of this delay, but it is a coincidence that 
the lapse of punctuality has occurred just after 
the retirement of Mr. Miller from the Registrarship 
and the accession of Sir William Turner to the Pre¬ 
sidency. The total strength of the British medical 
profession, as represented by the Register, is 35,057> 
and of the dental speciality 4,966, the medical prac¬ 
titioners having increased by 415 since last year, and 
the dentists only by 29, this discrepancy being 
accounted for by the gradual dying off of the mob 
of chemists' boys, tobacconists, and such-like who 
obtained admission to the Dental Register without 
qualification in 1878. It is more than twenty years 
since Mr. Tomes and Sir John Lubbock inflicted on 
the dental speciality this blow, and there still remain 
3,217 such practitioners to be disposed of before 
dentistry can assume its proper status as a speciality. 
We have said that the total strength of the profession 
holding British qualifications in all parts of the 
world is represented by the Register to be 35,057, but, 
as we have repeatedly pointed out, the official list 
affords only a widely approximate estimate of the 
actual number of qualified men. As anyone who has 
to do with the compilation of medical directories 
knows, a very considerable number who obtain quali¬ 
fications never register at all. At first it is incumbent 
on them to save the £5, which the process costs; 
afterwards, when they have established themselves in 
practice, they, in Ireland or the colonies, gain very 
little by registering because they very rarely 
are called upon to sue for their fees. Further¬ 
more, if they succeed to a property or to a 
monied wife, the probability is that they drop 
the profession altogether, and never appear in the 
official list from first to last. Then there are the 
men who die, but whose names remain on the Register 
for years afterwards. The compiler of the Register 
cannot deal with these cases as a directory compiler 
would do, for, before he erases a name he must, even 
if he saw the man die, send to his registered address 
two registered letters at an interval of three months 
asking whether he is alive or not. But, again, the 
individual may not have died, but simply migrated, in 
which case, after his name has been erased, he may 
turn up again, and a long process and payment of a 
renewal fee must be gone through before he can be 
restored. All these sources of error make the Register 
quite unreliable in many respects. We make these 
observations because some of our comtemporaries 
have been grumbling at the inaccuracy of the 
Register, and we do not think it fair to the compilers 
to lay upon them the blame which is chiefly attribu¬ 
table to the law. Much, however, may be done 
by watchfulness. Before the regime of Mr. Miller as 
Registrar the Register teemed with mistakes, and he 
reduced it to comparative accuracy by persistent 
ferreting out of the dead and migrated men. We 
have, as yet, no reason to doubt that the new 
Registrar inherits his energy in this direction. 


Mat 17,1899. 
VENEREAL DISEASE IN THE NAVY. 

The recently issued statistical report of the health 
of the Navy for the year 1897 contains some interest¬ 
ing figures regarding the prevalence of venereal 
disease in the Service during that period. The total 
force of officers and men afloat was 80,540, and out 
of this number 11.906 cases of venereal disease 
were returned. The cases admitted of the 
following classification:—Primary syphilis, 3,956; 
secondary syphilis, 2,177 ; gonorrhoea and ite 
sequelae, 5,773. Again, 218 men were invalided 
in consequence, and there were ten deaths. In com¬ 
parison with the previous year, the ratio per 1,000 
cases of primary and secondary syphilis shows a 
slight increase in 1897, and contrasted with the 
average ratios of the last ten years, there is an 
increase in the latter disease, but a decrease in the 
former of 5 39 per 1,000. Furthermore, a slight 
increase for 1897 is also apparent in the ratioe 
for gonorrhoea and its sequelae. The report shows 
that the ratio of cases per 1,000 for primary 
syphilis was 49T1 ; for secondary syphilis, 27 03; 
and for gonorrhoea and its sequel®, 7167. It 
must be conceded that these figures are very high, 
and far beyond what might be the case were efficien t> 
control exercised in the prevention of contagion. The 
question of invaliding, moreover, must always be a 
serious one, but this is nothing in comparison with 
the loss of time and labour incurred by the men being* 
placed on the sick list while suffering from venereal 
disease. Approximately about 12.000 men were unable- 
to do their necessary duties for longer or shorter 
periods during 1897 in consequence of attacks of 
syphilis or gonorrhoea. On the China station the 
number suffering from the latter disease reached the 
enormous total of 118 per 1,000. It is not needful to 
tax the imagination in order to determine what the 
result of this loss of effective strength would be to 
the Service in the event of hostilities. And after all 
this is the point of view from which the subject 
should be viewed. Social purists, with, of course,, 
the best intentions, cannot, or will not, see that the 
evil arising from the dissemination of foul diseases 
must be worse in its effects than the offence 
against morality by which that dissemination is 
brought about. Surely our first duty in the interests- 
of humanity is to prevent disease. If the reasoning of 
the social purists were carried to its logical conclusion 
it would be an offence against religion for man to 
interfere with the dissemination of disease in any 
form. Fortunately, however, there is no danger of 
such a condition of affairs ever becoming an “article 
of faith ” outside the confines of that limited but mis¬ 
guided sect, the “ Peculiar People.” Nevertheless, one 
of the worst features of the whole matter is that the 
social purists are for the most part utterly ignorant of 
the oftentimes terrible effects of venereal disorders 
upon the health of the victims. The former may or 
may not know that a disease like constitutional 
syphilis is an hereditary one which is apt to 
play havoc with the offspring of syphilitic parents. 
They probably know nothing of the pitiable 6tate into- 


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NOTES ON CURRENT TOPICS. 


The Medical Press 519 


which a youDg wife may be reduced by gonorrhoea 
conveyed to her by her infected husband. These and 
other matters bearing upon the question at issue 
cannot be ignored; under present circumstances, 
however, it would seem to be the case that the race, 
or at least some portion of it, is exposed to serious 
degenerating influences in consequence of the 
sentimental opposition of those who are ignorant of 
their subject. Wiser councils in time may prevail* 
but meantime much harm is being done by the 
absence of measures designed to control the dis¬ 
semination of venereal disorders. 


$0 its on Current ^optce. 

00167*8 Fluid in Sarcoma. 

Not long since, Mr. Battle brought before the 
Medical Society of London a very remarkable case of 
sarcoma which had completely subsided under the 
influence of injections of Coley’s fluid. The case 
excited a good deal of interest, but it was pointed out 
at the time that growths reputed to be malignant do 
sometimes undergo resolution, even in the absence of 
all treatment. Moreover, although Mr. Battle had 
done his best to establish the diagnosis in his case, 
it was objected that it did not rest upon an unassail¬ 
able basis. The question was referred to a committee 
for further inquiry, and their report has now been 
received. They express the opinion that the micro¬ 
scopical preparations do not present unequivocal evi¬ 
dence of the sarcomatous nature of the growths, 
though Mr. Shattock had held that they did ; 
moreover, it was thought that the possibility of the 
growths being syphilitic had not been absolutely ex¬ 
cluded, and it was agreed that the clinical history of 
the case was, if anything, rather opposed to the 
diagnosis of sarcoma. The committee rightly 
enough insist that no conclusions bearing on the 
therapeutical value of a remedy should be based upon 
cases which do not present the necessary element of 
absolute certainty of diagnosis. For the present, 
therefore, Coley’s fluid must be regarded as still on its 
trial. As it is a method of treatment by no means 
devoid of risk to the patient, and in view of the 
extreme difficulty of establishing the diagnosis 
beyond the reach of carping critics a positive con¬ 
clusion is likely to be delayed, but it is better so than 
that a delusive panacea should be foisted on the 
public only to bring discredit on medical science when 
experience has shown that it was only a therapeutical 
Will o' the Wisp. 

The Need of Hospital Reform. 

The Charity Organisation Society are doing their 
best to bring about the establishment of a certain 
hospital board for London, but all who have paid 
the least attention to their efforts must feel irritated 
by the lamentable lack of organisation which they have 
hitherto displayed in the promotion of that object. 
Whoever has been responsible for the proceedings so 
far cannot be congratulated upon the result. One of 
the most prominent features in their undertaking is 
that the Society does not seem to be in touch with 


those anxious to help forward the movement. Again, 
they issued a post-card recently summoning a meet' 
ing upon the subject, giving the names of various 
well-known medical men who were expected to speak, 
one being so described that it was almost impossible to 
comprehend to whom the secretary intended to refer. 
This, of course, was only a small detail, but it is 
sufficient to show that the organisation of the Charity 
Organisation Society in this regard is more inefficient 
than otherwise. At the meeting, however, 
which was held on the 8th inst., Lord Methuen 
in the chair, an excellent, practical, and useful 
speech was made by Sir William Broadbent. 
After pointing out that if a central hospital 
board were established, such a board would be capable 
of abolishing to a great extent the prevalent abuse of 
medical charities. Sir William expressed the hope 
that a union of the Prince of W ales’s and the Hospital 
Saturday and Sunday Funds would be shortly made, 
and that the so-called Central Hospital Council 
would eventually become combined with the proposed 
central board. No better arrangement than this 
could be suggested in the interests of the hospital 
charities, and we are glad to note that these 
views are held by Sir William. If now Sir 
William would only gain the ear of the Prince of 
Wales, and impress upon His Royal Highness how 
valuable the arrangement would be, he would be 
doing a great service to the hospitals, besides placing 
the whole subject of the administration of these 
public funds upon a proper business basis. Under" 
present circumstances it seems difficult to under¬ 
stand why three separate funds Bhould exist. It 
would clearly be better if there were one Common 
Fund, whose administration were placed in the hands 
of a representative body elected from among all the 5 
charities entitled to benefit therefrom. 

Christian Scientists in New York. 

The Christian Scientists have hitherto been' 
allowed a great deal of liberty in New York, but the 
scandal has now become so great that the authorities 
have been compelled to take action. Several families 
have been proceeded against on the charge of 
culpable negligence in not providing medical attend¬ 
ance for relatives who had died, andit is lioj.ed that by 
taking active measures of this kind, it will be possible 
to suppress the evil. It is somewhat curious, how¬ 
ever, that such irregular practitioners as the Christian 
Scientists should have found any favour among a 
practical people as the Americans. In this country 
a good deal of attention was drawn to the matter by 
the death of Harold Frederick, but the evidence 
given at the inquest upon Ihb case revealed some 
eccentricity on his part in regard to medical men 
which was sufficient to account for the mistake that 
he made in having a Christian Scientist to attend 
him. But that there should be any such persons as 
Christian Scientists at all is another curious matter, 
for of all the pretenders among health curers, they 
form a class which has fraudulency stamped upon it f 
j besides being utterly wanting in any detail of attract 
tiveness. 


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NOTES ON CURRENT TOPICS. 


Mat 17, 1899. 


A Vaccination Centenary. 

The hundredth anniversary of the first vaccina¬ 
tions in Vienna, and on the Continent of Europe, 
was celebrated last week in the Austrian capital. 
On May 10th, 1799, a native of Geneva, Dr. De 
Carro, who was practising in Vienna, received from 
Dr. Edward Jenner some vaccine virus, and with it 
he vaccinated his two eldest sons. Dr. De Carro 
had made the acquaintance of our great countryman 
while studying medicine in Edinburgh. Soon after¬ 
wards a law was passed stipulating that vaccination 
should l>e earned out in the Austrian Army. Mean¬ 
while Dr. De Carro began to prepare the lymph in 
Vienna according to Dr. Jenner’s instructions, and 
by him it was sent to all parts of the world—for 
example, to Greece, Turkey, Bombay, Ceylon, and 
Sumatra. Thus, next to Jenner, it is probably 
only just to attribute to this Viennese practitioner 
the credit of disseminating the valuable prophylactic 
measure of vaccination throughout the world. Save 
for the active part which he took in connection there¬ 
with it is quite likely that the benefits of vaccination 
would have been much less quickly disclosed. 

The Unqualified Dispenser. 

The General Medical Council has done its best to 
throw cold water on the outcry against the employ¬ 
ment by medical practitioners of unqualified dis¬ 
pensers, and the Government is apparently delighted 
to have an excuse for leaving matters as they are 
There is not much reason to suppose that such acci¬ 
dents are common, but it is impossible to gainsay 
the assertion that if they are frequent the public 
would not be likely to hear of them, seeing that it 
rests with the person who has most to lose from a 
scandal to get the dead past to bury its dead. Stilly 
one would have expected the General Medical 
Council, which has shown such tenacity (of late) in 
prohibiting unqualified assistants from performing 
professional duties, to have displayed the same 
interest in respect of the assistants equally 
unqualified from a dispensing point of view, 
because dispensing is an essential part of medical 
practice for the bulk of practitioners. Truth 
calls attention to the matter and, very cogently 
asks how it happens that the General Medical Council, 
which dealt out such Rhadamanthine justice three 
yearsago to the man who was acting as the practitioner’s 
assistant without qualification has so far changed its 
mind now that it “ believes that the beet protection to 
the public is afforded by the responsibility of the 
practitioner for the acts and defaults of the servants 
he employs.” Truth suggests, which we would not 
dare to do, that the volte face of the General Medical 
Council is attributable to the fact that the unqualified 
medical assistant did frequently become and was 
likely to become a serious competitor for practice and 
fees, while the bottlewashing boy could not be 
dangerous in that sense. The question is likely 
to come up at the forthcoming meeting of the 
Council, but we are not sanguine of any progress 
being accomplished in this direction. During the 
last few years the most noteworthy measures decided 


upon in Council have been introduced at the instance 
of the Direct Representatives, and the latter are not 
likely to throw themselves into a movement which 
could not fail to render them loathsome in the eyes 
of the majority of their constituents, without, politi" 
cally speaking, any compensation. The fact that the 
outcry was started by the chemists and druggists, 
obviously in deference to trade interests, will not 
commend it to the profession. Public opinion is not 
alive to the importance of the complaint, and in the 
absence of a popular outcry, the unqualified dispenser 
is likely to pursue the even tenour of liis way un¬ 
harmed by interference at the hands of the General 
Medioal Council or of the Privy Council. 

The Baby Incubator in the Law Courts. 

An action was tried last week before Mr. Justice 
Day in which the proprietor of the Imperial Baby 
Incubator sued Dr. Devane for damages for having 
failed to carry out an undertaking entered into, in 
virtue of which Dr. Devane was to examineibabies 
brought for incubator treatment at the Crystal 
Palace, and to attend to the health of both babies and 
nurses. From some cause, or causes, into which we 
need not enter, matters did not run smoothly, and 
ultimately a baby died in the incubator. This led to 
the exhibition being put an end to, and as the plaintiff 
attributed the mishap to the negligence of the doctor 
he claimed damages. We cannot help thinking 
that the managers of the Crystal Palace were 
gravely to blame for having authorised such 
a distressing exhibit, and we fully endorse 
the remarks which fell from the Judge in 
condemnation thereof. There is undoubtedly a sphere 
of usefulness for baby incubators, but that sphere is 
not in a public exhibition. It is a strictly medical 
matter, and in future the proprietor of this apparatus 
will be well advised to restrict his publicity to a 
medical public. It is hardly necessary to add that 
the jury gave their verdict in favour of the defendant. 

Instruction in Tropical Diseases. 

At the festival dinner of the “Dreadnought” 
Seamen’s Hospital Society, which took place last 
week at the Hotel Cecil, Mr. Chamberlain emphasised 
the fact that in the great work of civilisation and 
government our greatest enemy is not the hostility of 
the natives, nor the physical difficulties inseparable 
from residence in countries in which primeval nature 
still holds full sway, but rather the attacks of deadly 
diseases which weaken where they do not kill, and 
carry off many of the ablest and most energetic 
of our countrymen who carry the flag into 
these distant parts. He pointed out that it is not 
so much a question of mere hygiene, though this is 
not to be despised. What is required is a body of 
trained practitioners and, above all, of trained 
observers and investigators, who shall make the sub¬ 
ject their own, and gradually wrest from Nature the 
secret of affording immunity against, and cure for, 
the various murderous diseases which render many 
otherwise eligible parts of the globe uninhabitable for 
human beings. 


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May 17, 1899. 


NOTES ON CURRENT TOPICS. 


Thu Medical Press. 521 


A Liverpool Hospital Scandal. 

Since we alluded to this discreditable affair in our 
laBtisBue, the donors and subscribers of the Liverpool 
Cancer and Skin Disease Hospital have met and 
passed a resolution proposed by the chairman, “ that 
the report of the Special Committee be approved ; and 
that Drs. Taylor and Whitford be removed from the 
office of honorary surgeons to the hospital.” An 
amendment to this was proposed by a member, “ that 
the subscribers and donors being dissatisfied with 
the result of the Committee’s investigation, the Lord 
Mayor be appealed to and requested to appoint a 
committee to investigate the matter raised in the 
report.’' One would reasonably conclude that such 
an amendment was the most honourable and con¬ 
clusive course to pursue in order to escape 
further criticism, and to close a scene that has now 
become repulsive with charges and recriminations, 
and thoughtful men will regret with us that this was 
not adopted. Our surprise is intensified by the chair¬ 
man's preface to the resolution to the effect that cer¬ 
tain letters were not in evidence while the sub-com¬ 
mittee was investigating the management! This is an 
awkward statement. Is there not other information 
still wanting which an independent inquiry would dis¬ 
cover ? Another bad feature was noticeable in the 
voting: forty-five voting for the proposition and 
thirty-three for the amendment. Of the forty-five who 
voted for the proposition thirty-six were stated to 
have qualified as governors ten days before the time 
of meeting at the minimum qualification. This is a 
magical coincidence and phenomenal if true, reflecting 
the utmost discredit on those whose sole aim should 
have been the assurance of offering every opportunity 
for a disinterested inquiry and the restoration of 
order, peace, and confidence in the institution. We 
are not yet without hope that the managers will accept 
an independent inquiry and free themselves of the 
odium that still hovers round the whole transaction. 

Food and Drug Adulteration. 

The fierce tussle which has been going on in the 
Grand Committee on the Adulteration Bill is nearly 
coming to an end. The contending parties may be 
divided into three camps; first, the adulterators who 
want leave to incorporate as much margarine in so- 
called butter, as much starch in cocoa, as much water 
in real butter, and so with other commodities as will 
pay them best; second, the home producers who are 
striving with all their might to boycott foreign pro¬ 
duce by preventing margarine being coloured to look 
like butter, or preventing foreign meat or other pro¬ 
duce being sold as hom e stuff; third,the purists, repre¬ 
sented by the Government, who desire to protect the 
public against both these parties. The only important 
point which remains for decision is whether an invoice 
produced in court shall protect the immediate vendor 
against prosecution. It is the law, at present, that the 
shopkeeper selling an adulterated article shall lie held 
innocent if he can present to the court a warranty 
from the person from whom he bought the article- 
That provision has seldom been operative, because 
either the shopkeeper knew perfectly well that the 


article wa6 adulterated, and asked no questions be¬ 
cause he wished to sell it cheap, or because the pro¬ 
ducer objected to give anything in the way of a 
written warranty, knowing that, if prosecuted, the 
shopkeeper could fall back upon him for damages. 
Consequently the average shopkeeper is never able to 
produce any better evidence than an invoice, and the 
purists strive to have such document accepted as a 
legal guarantee. The sanitary authorities are not 
favourable, because such decision would push them 
back, in their endeavour to force the Act, upon un¬ 
known persons whose names and addresses they can¬ 
not know at first, and who often are out of the legal 
jurisdiction. 

Cat’s Meat Sausages. 

A case tried last week by the North London Police 
Court magistrate ope is up various considerations of 
the deepest gravity as affecting the health of the 
people. To put the matter in a few words a sausage 
maker and a cat's meat dealer, both in the wholesale 
trade, were charged with having deposited and 
sold unsound meat for human food. The collu¬ 
sion and the fact were abundantly proved, and 
from the evidence it appeared that meat not good 
enough for cats was considered fit for sausages. Both 
defendants were fined £50, with the alternative of 
two months' imprisonment. Considering the vast 
amount of untraceable and deadly disease that stalks 
through the metropolis, we venture to consider an 
offence of this kind one of the most criminal that could 
be committed. Everyone who dies from eating such 
a sausage as that vended by these rascals—and such 
deaths must be manifold—is to all intents and pur¬ 
poses murdered by a reckless tradesman for the sake 
of a few pence blood money. Needless to say these 
wretched conspirators paid their fines, and doubtless 
went home chuckling to their suburban villas. The 
only fault we have to find with the magistrate's ver¬ 
dict is that there should have been no alternative to 
the fine, which should have been inflicted in addi¬ 
tion to the imprisonment. Fresh legislation of a 
Draconian character is needed to repress these 
constantly recurring bad meat offences. Some years 
ago the Daily Chronicle emitted a famous Philippic 
against the filthy practice of eating sound horseflesh. 
What has it to say about this fraudulent foisting of 
decayed horseflesh upon Her Majesty's lieges ? 

Joint-Stock Doctoring. 

Further inquiry into the genesis of this new com¬ 
pany, “ Bland Limited,” established in Dublin 
for the purpose of carrying on joint-stock doctoring 
by any number of unqualified persons under the 
cover of one or two registered practitioners, informs 
us that the company is a syndicate established to take 
over the business of Leonard and Co., which carries 
on several branches in Dublin, and is believed to be 
practically under the control of Mr. MacWalter, a 
qualified practitioner. The scheme of the syndicate 
is undoubtedly a strong one from a commercial point 
of view, but if the Lord Chancellor passes the Bill 
for the control of joint-stock doctoring, which Bill 


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522 The Medical Press. 


NOTES ON CURRENT TOPICS. 


May 17, 1899. 


now lies on the table of the House of Lords, there 
will be an end to the company, as also there will be 
if the General Medical Council decrees the covering 
of such method of practice by a registered prac¬ 
titioner to be “ infamous conduct in a professional 
respect.” 

The “Jigger” or “Chigger.” 

The Government of Bombay haB approved 
measures having for object to prevent the introduc¬ 
tion of the disease known as the “ Jigger,” or, as it 
is sometimes written, “ Chigger.” The disease, it 
will be remembered, is produced by a parasite 
known to science as Pule*: penetrans. It usually 
attacks the feet, the female burrowing under 
the skin, where it gradually enlarges to the size 
of a pea. In the earlier stages detection is almost 
impossible, the very minute black spot denoting the 
presence of the insect being easily overlooked. Later 
on, as the enlargement, due to the development of 
numerous eggs, increases, a slight itching or pain is 
felt, and the skin is seen to be discoloured. When 
fully developed, the sac containing the egg ruptures, 
the eggs escape and develop into the mature insect. 
The sac can be wholly removed, but the operation is 
a difficult and delicate one. When the sac is raptured 
a very serious inflammation, proceeding to disease of 
the bone, is sometimes set up. 


The Coming Annual Meeting of the Irish 
Medical Association in Cork. 

So far as the arrangements for the annual meeting 
of the Association have been completed they will be 
as follows:—The meeting will open in the Examina¬ 
tion Hall of the Queen's College on Tuesday, June 
20th, at 3.30 p.m., and at the conclusion of the meet, 
ing the President and Council of the College will 
entertain the members. In the evening the dinner of 
the Association will be held at the Royal Victoria 
Hotel at 7.30 p.m. On Wednesday, the 21st inst., the 
profession in the county and city of Cork will enter¬ 
tain the members on an excursion to the harbour to 
view the Regatta, and luncheon will be served to 
them. We understand that the profession in Cork has 
invited many persons of distinction and official im¬ 
portance to the annual dinner. It is hoped that 
arrangements may be made with the several railway 
companies for the issue of return tickets to members 
attending the meeting at single fares. 

Salaries of Medical Officers of Health in 
Dublin. 

THEGuardians of the South Dublin Union have given 
formal official notice to the Medical Officers of Health 
within their jurisdiction that they will not, in future, 
pay the salary of £25 a year to each, and the doctors 
are referred to the Borough Council, i.e., the Dublin 
Corporation, for their sanitary emoluments. The 
Guardians of the North Union have not yet followed 
this lead, and it is doubtful that they will do so until 
their legal liability is put beyond question. Hereto¬ 
fore, the dispensary doctors have, in their capacity of 


Medical Officers of Health, been recognised as being 
as much the functionaries of the Corporation as of 
the Union, but they have received their salaries with¬ 
out question from the guardians, and these salaries 
have been, we believe, paid exclusively out of the 
rates. Whether the new Local Government Act has 
made a change in this respect we are not at present 
able to say. 

Infectious Disease Notification. 

The Bill to extend the compulsory notification 
system to all sanitary authorities throughout the 
kingdom got its second reading in the Lords last 
week, and may be now considered to be the law of the 
land. There is satisfaction in the reflection that no 
power can compel such authorities to undertake the 
expense and trouble of the system if they do not like 
to do so. They can simply ignore the system, as has 
been done in scores of districts in which, in accord¬ 
ance with the fashionable craze, the adoption of it 
was enacted many years ago. 

The Disinfection of Empty Apartments. 

The Society of Hygiene of the Seine has had 
under its consideration this question. It appears 
that tenants of apartments in which infective disease 
has existed have, on many occasions, vacated the 
premises and gone beyond reach without letting 
anyone know that the rooms were infected, the con¬ 
sequence of which was that new tenants entered into 
possession and, in some instances, immediately caught 
the disease. A change of law was proposed which 
would make the outgoing tenant amenable for this 
concealment. 


The Council Election at the Irish College of 
Surgeons. 

In addition to the names of Messrs. Story, Patte- 
Bon, Morrison, and MacCausland, mentioned in 
another part of our issue as candidates for seats on 
the Council at the forthcoming election, we lecord 
the names of Mr. Dallas Pratt, of Jervis Street Hos¬ 
pital, and Mr. Robert Henry Woods, Throat and Ear 
Surgeon to the House of Industry Hospitals. 

Death of the “Sleeping Boys.” 

Both the Congo boys who have been in the Charing 
Cross Hospital for the last three months, suffering 
from *• sleeping sickness,” are now dead. The disease 
to which they have succumbed is common enough in 
certain parts of Africa, but the parasite—a variety of 
filaria sanguinis hominis—only attacks coloured 
people. 

The action brought by the Medical Defence Union 
for the recovery of a penalty against a retail chemist 
called Tempest, at Pontefract, was heard last week, 
he being charged with falsely representing himself to 
be a doctor of medicine. The case had been tried at 
a previous sitting, but the jury failed to agree. It 
was contended that the defendant had only acted 
within his rights as a registered chemist in giving 
people medicine, although it has been laid down 


Digitized by v^ooQle 



May 17, 1899. 


bCOTLAND. 


-that to feel a person’s pulse and to look at his tongue 
^before giving medicine constitutes an infringement 
of the Apothecaries’ Act. We regret to say that the 
jury grave a verdict in favour of the defendant. This 
is only another example of the ambiguity of the law 
on the subject of unqualified practice, and of the 
difficulty of enforcing it even when the main facts 
are not disputed. 

A melancholy inebriate at Birmingham last week 
■swallowed a quantity of laudanaum with suicidal 
intent, and the task of keeping him awake after the 
administration of the usual remedies fell to a con¬ 
stable, who took his duty au serieux. So vigorously 
did he carry out his mandate that, by the time he was 
relieved, he had scarcely a button left on his tunic or 
shirt, and everyone knows that the buttons are the 
most sensitive parts of a policeman’s attire. We 
gather that the patient resented being shaken up at 
intervals, and retaliated by shaking the constable > 
also at intervals. 

A hospital nurse at Birmingham, who, though 
summoned as a witness, failed to put in appearance 
at an inquest, sending as excuse that she was engaged 
at a serious operation, was last week fined £5, on the 
ground that her place in the operating theatre 
might very well have been taken by some other nurse. 
This is right as far as it goes, but it is to be hoped 
that the hospital authorities will intervene to disarm 
the coroner or else pay the penalty. 

The Jodrell Professorship of Zoology in University 
College, London, will be vacant at the end of the 
present session in consequence of the resignation of 
Professor Weldon. Applications must be sent in 
before June 5th. 


PERSONAL. 

Professor R. E. Jebb, M.P., has consented to dis¬ 
tribute the certificates and prizes at King’s College, 
London, on July 12th. 


The late Dr. C. J. Hare has bequeathed £500, free of 
legacy duty, to the endowment fund of the Royal College 
of Physicians, of London. 

Miss Roberts has presented to the Royal College of 
Physicians of London a portrait, by G. T. Watts, R.A., 
of her father, the late Sir William Roberts. 

Sir Henry Frederick Norbury, M.D., K.C.B., 
Inspector-General of Hospitals and Fleets, and Director- 
General of the Medical Department of the Navy, has 
been placed on the retired list. 

Mr. Ht. Gwynne Laurence, M.B.Lond., came ont 
first in the Honours List for Medicine of the University 
of London last week, taking the Gold Medal and 
Scholarship of ,£100, and first class in obstetrics. 

Dr. J. Buckley Bradbury, Downing Professor of 
Medicine in the University of Cambridge, will deliver 
the Croonian lectures in June on “ Some Points in con¬ 
nection with Sleep, Sleeplessness, and Hypnotics.” 


The Medical Press. 523 

Dr. J. B. Coleman, Visiting Physician to the House 
of Industry Hospitals, Dublin, and Dr. Francis Charles 
Martley, lately of St. Mary’s Hospital, London, have 
been elected to be Fellows of the Royal College of 
Physicians, Ireland. 


Mr J. B. Story, surgeon to St Mark’s division of the 
Royal Victoria Eye Hospital, Dublin, (Professor), and 
recently examiner in ophthalmology in the College has 
announced his candidature for a seat on the Council of 
the Royal College of Surgeons of Ireland. 


The order of the Medjidieh of the second class has 
been conferred by the Khedive of Egypt on Surgeon- 
General William Taylor, C.B., M.D , of the Army Medical 
Staff, and the same order of the fourth class to Lieut.- 
Colonel Arthur Thos. Sloggett in recognition of ser¬ 
vice rendered in the Soudan during the recent cam¬ 
paign. 


£$£otlanb. 

[from our own correspondent.] 


Tuberculosis Prevention Movement in Glasgow. 
—The Glasgow Southern Medical Society has just con¬ 
cluded a lengthy discussion on “ The Prevention of 
Tuberculosis.” In view of the widespread interest in 
the matter and the likelihood of definite action being 
taken by the citizens shortly, it was decided that the 
discussion should not be confined to members of the 
medical profession, but that all classes likely to be 
affected by new regulations should be invited to take 
part in the discussion. Consequently there was a very 
representative body present of all kinds—farmers, health 
officers, veterinary surgeons, &o. The conclusions arrived 
at may be shortly stated as follows : - The mortality in 
this country from tuberculous disease is greatly on the 
decrease, that the disease is preventible, and much can 
be done by the co-operation of the public and the 
medical profession, if not to entirely exterminate it, 
to greatly lessen its ravages. It is a true germ disease 
and not hereditary as was formerly supposed. That it is 
communicable by the milk of cows, still more so from 
man to man, the chief danger being infective expectora¬ 
tion. Bad hygienic conditions tends to its propagation. 
It is proposed that there should be formed in Glasgow a 
society for the spread of knowledge regarding tubercu¬ 
losis, and the means to be used for stamping it out. 
Every assistance is to be given totheRanitary authorities, 
and the City Improvement Trust should see that narrow 
lanes and back tenements be removed so as to admit 
more sunlight into places which are now in perpe¬ 
tual darkness. If the suggestions pointed out by the 
meeting be carried out, even to a minimum degree, we 
shall at last find Glasgow to be a veritable Hygiea. 

Medical Opposition to Notification in Ayrshire.— 
At the last meeting of the Northern District of the Ayr¬ 
shire County Council, the Sanitary Inspector reported 
that several medical practitioners throughout the dis¬ 
trict had intimated that they would not sign the certifi¬ 
cate adopted at the district meeting, for removal of cases 
of infectious diseases to the hospital. It was agreed to 
ask the opinion of the Local Government Board and 
county clerk as to whether the form adopted was within 
the provision of the Act. 

A Medical Election Dispute.— The village of Eagles- 
ham, not far distant from Glasgow, is at present much 
exercised over a muddle which lately occurred in the 
business of the Parish Council. About two months ago 
Dr. Pollock, the medical officer, resigned his appointment. 
Dr. Stuart, of Hamilton, bought the village practice, with 
the expectation that he would receive the public appoint¬ 
ment, he being the only medical man in the village. The 
Parish Council met on March 25th to make the appoint¬ 
ment, when Dr. Robertson, of South Harris, was 


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524 The Medical Press. 


LITERATURE. 


Mat 17, 1899. 


nominated along with Dr. Stuart. Six members attended 
the meeting, three of whom, not including the chairman 
pro tern., supported Dr. Robertson. The chairman, on 
being asked for whom he would vote, made reply which 
conveyed the impression to the clerk that he supported 
Dr. Stuart. A minute was accordingly prepared to the 
effect that Dr. Stuart was duly appointed, which was 
duly signed by the chairman after being read to the 
meeting. Dr. Stuart was duly notified of his appoint¬ 
ment, but it now turns out that the chairman was under 
the impression that when he signed the minutes he was 
doing so in favour of Dr. Robertson, whom he wished to 
support. Dr. Robertson was also in due course informed 
of his success The result is legal opinion is being taken 
to settle the matter. 

Glasoow Mkdico-Chirubgical Society.— The follow¬ 
ing office-bearers have been elected for session 1899-1900: 
President, Mr. H. E. Clark. Section of Medicine— 
Councillor, Dr. J. A. Allan; Secretary, Dr. Hinshelwood. 
Surgery—Councillor, Mr. Maylard ; Secretary, Dr. J. H. 
Niooll. Pathology—Vice-President, Dr. J. Lindsay 
Steven; Councillor, Dr. Teacher; Secretary, Dr. R. M. 
Buchanan. Obstetrics - Vice-President, Dr. Edgar; 
Councillor, Dr. Gibson ; Secretary, Dr. Balfour Marshall; 
Treasurer, Dr. Barclay Ness; Editorial Secretary, Dr. 
W. R. Jack ; and General Secretary, Dr. W. K. Hunter. 


Jkvlmmcntanj 4^ctos. 

The Law ok Constructive Murder was admitted by 
the Home Secretary to require amendment, but the 
matter, in his opinion, presents such grave technical 
difficulties that the Government do not see their way to 
introduce a Bill with that object in view themselves, or 
to offer facilities for such a Bill, during the present 
session. In the meantime, the judges have been asked 
to communicate their views on the matter. 

Preservatives in Fcod. —In answer to a question, the 
President of the Local Government Board said it had 
been decided to appoint a departmental committee to 
inauire into the use of preservatives in food. 

Venereal Disease at Gibraltar.— In reply to a 
question in the House it was stated that during the five 
years ending 1897 the admissions to hospital for venereal 
disease among the garrison of Gibraltar averaged 290 
per annum per thousand, as against 152 at Malta and 
170 among the home troops. The Average daily number 
in hospital was 28 3 per thousand, as compared with 13'5 
at Malta and 15 at home. 

The Midwives Bill has again been postponed, and 
waeput down for yesterday (Tuesday). Unless it then 
reached a second reading its fate is sealed for the present 
session. 

Vivisection. — In answer to Mr. Paulton, the Home 
Secretary stated that the special certificates issued to 
persons desirous of performing certain experiments on 
living animals were merely to authorise them to keep 
the animal alive after the influence of the ansesthetic 
had passed off when killing the animal would necessarily 
frustrate the object of the experiment, and they provided 
that the animal should be killed so soon as that object 
had been attained. He added that he would certainly 
not allow the issue of any certificate for experiments 
involving dissections or painful operations without the 
fresh use of an (esthetics. He declared hiB continued 
adhesion to the paragraph having reference to the 
exemption from the obligation to give an (esthetics, 
pointing out that these certificates were only given for 
such operations as inoculations and hypodermic injec¬ 
tions which were of a comparatively painless character. 

Unqualified Dispensers —In reply to a question by 
Major Rasch as to the grounds on which the General 
Medical Council had declared accidents due to the 
employment by medical men of unqualified dispensers 
were rare, Sir J. Gorst said that the infrequency with 
which such accidents were reported to the Privy Council 
confirmed the opinion that they were very rare, and on 
this acoount the Privy Council had not thought it 
necessary to ask the Medical Council for any further 
information. 


(EorresponOcncc 


We do not hold ourselves responsible for the opinions of ott 
correspondents. 


THE ANTI-VIVISECTION GALA. 

To the Editor of The Medical Press and Circular. 

Sir,—Y ou think that I and my fellow anti-vivi- 
sectionists have a blind spot on our mental retina;, while 
we think that you and your vivisectionists suffer from 
chronic glaucoma. 

It is not a question as to whether science has benefited 
by experiments on living animals or not, that is not the 
issue at all, for “ science ” is a word which is erroneously 
rendered. The real question is whether or not the arte 
of medioine and surgery have not been so consistently 
marked by experiments in themselves most abhorrent,, 
that so much evil has been done and so little good, that 
they should be given up entirely. Everybody admits 
that such method of research is so untrustworthy as to 
be outside the use of surgeons altogether. The last 
important convert, to this view is my much-esteemed 
friend, Mr. Frederick Treves, concerning the surgery of 
the intestines. 

Dr. Vivian Poore, in his recent lectures, tells us that 
the thing medicine has greatest reason to be proud of is 
the banishment of typhoid fever, and this has been 
accomplished absolutely, in spite of the erroneous con¬ 
clusions derived from experiments on animals. Will you 
venture to call the scandalous story of tuberculin a 
scientific triumph ? Is the abi -flute failure of Pasteur’s 
anti-rabic serum a therapeutic victory ? Is the cold 
shoulder already given to antitoxin something very 
scientific and a matter of pride to our vivisection science ? 
You really have incurable chronic glaucoma. 

I am, Sir, yours truly, 

Lawson Tait. 

195 Newhall Street, Birmingham. 

[It is idle to bandy argument with a polemic who 
prefaces the most highly contentious statements with 
the bland “everybody admits.’’ We are curious to- 
know how far “ my much-esteemed friend Mr. Frederick 
Treves” approves of Mr. Tait’s throwing his mantle- 
over him in this patronising manner.—E d.] 


literature. 

DR. SOUTH WOOD SMITH—A RETROSPECT, (a) 

The author gives a picturesque account of the life of 
her grandfather—1788-1861—not in a series of tableaux, 
as is so often done, but in a veritable living-picture 
which irresistibly carries the reader’s interest from start 
to finish. Brought up to become a minister of a body of 
Calvinistic Dissenters, at eighteen, from conscientious 
scruples, he gave that career up and was cut off by his 
family for ever. Left a widower with two daughters 
at twenty-four, he entered Edinburgh University an d 
devoted himself to medicine ; at this time he wrote 
“ Illustrations of the Divine Government.” Qualifying 
he went to Yeovil, where he took charge of a congregation, 
and, at the same time, practised medicine. Soon, how¬ 
ever, he was drawn to London, and was appointed 
physician to the London Fever Hospital; there he 
remained until his retirement from public life on the 
disappearance of the Board of Health in 1854. 

The chief works of Dr. Southwood Smith’s life were 
drawing public attention to the preventibility of fevers, 
the agitation that led to the Factory Acts, and the aboli¬ 
tion of child and woman labour in coal mines ; Dr. Smith 
also took a chief part in the erection of the first model- 
dwellings for the working classes, and established a 
sanatorium for paying patients which was the forerunner 
of the present home hospitals. 

Probably no book outside Charles Kingsley’s writings 

(a ) “ Dr. Soothwood Smith : A Retrospect .' 1 By his Grand¬ 
daughter, Mrj C. L. Lewes. Edinburgh and London : William. 
Blackwood and Sons. 1898. Pp. xll -189. 


Dia 


d by Google 


May 17, 1899. 


NEW BOOKS. 


Tub Medcal Press. 525 


gives a better picture of the splendid work that the sani¬ 
tarians of this century have accomplished. 


TWENTIETH CENTURY PRACTICE (a) 

The editor of this magnificent series of volumes of 
instuction for the practitioner of the now rapidly- 
approaching new century is more and more to be con¬ 
gratulated on the excellent standard of uniformity which 
bas been maintained throughout, and on the regularity 
■with which the successive items have been placed at the 
disposal of the professional public. The theses of which 
-the fourteenth volume is composed inolude “Scarlet 
Fever ” and “ German Measles,” by Dr. Frederick 
Forchheimer, Professor of Physic and of Diseases of 
Children in the Medical College of Ohio, Cincinnati; 
■“Measles ” and “ Glandular Fever,” by Dr. Dawson 
Williams, of London; “ Whooping-Cough,” by Dr. Joseph 
O'Dwyer and Dr. N. R. Norton—both of New York; 
“ Cholera Infantum,” by Dr. A. Jacobi, of New York; 
“ cholera Nostras ” and “ Asiatic Cholera,” by Dr. 
Theodor Rumpf, Director of the New General Hospital 
in Hamburg, formerly Professor at the University of 
Bonn, and Director of the Polyclinic at Marburg; 
" Dengue,” by Sir Joseph Fayrer, Bart.. F.R.S.; “ Beri¬ 
beri.” by Dr. A. A de Arevedo Sodrt, Professor in the 
Faculty of Medicine of Rio de Janeiro, and editor of 
O Bramil Medico ; “ Miliary Fever,” by Dr. A. Netter, 
Physician to the Hdpital Trousseau, Paris, and Professeur 
Agrege in the University of Paris; and “ Malta Fever,” 
"by Major David Bruce, M.B., C.M., of Pietermaritzburg, 
South Africa. 

Among the items included in this rich mine of clinical 
and scientific information, we have studied with special 
interest the artiole on “ Cholera,” by Dr. Rumpf, who has 
here placed before the readers of the “Twentieth 
Century Practice ” the vast store of experience which he 
accumulated during observations of the still recent epi¬ 
demics of that terrible disease in Hamburg. We will 
not pause for a moment to oritioise this splendid contri¬ 
bution to professional literature, but recommend it most 
strongly to the perusal of every practitioner of medicine. 
We will also here remark that the subject of “ Cholera 
Infantum,” to which so little space is devoted in most of 
our text-books of medicine, is here treated in one of the 
ablest articles of the volume by Dr. A. Jacobi. 

Another article which we have studied with peculiar 
interest is that on “ Beri-beri,” by Dr. Sodre. This 
disease, which we had till lately been accustomed to look 
upon as a pure exotic, has recently been transplanted on 
so large a scale to some of our own British—and more 
especially Hibernian—institutions, that this very able 
contribution by the skilled and experienced hand cannot 
fail to attract special attention. 

We think it unnecessary to repeat at any length the 
high opinion that we have formed of this excellent 
volume; we will conclude by observing that it is 
thoroughly worthy of its predecessors. 


POISON ROMANCE. 

“ Poison Romance and Poison Mysteries,” by C. J. S. 
Thompson (The Scientific Press, Limited), is a decidedly 
interesting reading. It reads more like a fairy story 
than a treatise on toxicology. The author deals in 
a positively amusing way with the poisons of antiquity, 
royal and historic poisoners, poisoning plots, and all such 
kinds of fascinating subjects. He gives us the true 
history of the Maybrick case, the case of Dr. Lamson, the 
Bravo mystery, and of many remarkable criminal trials, 
the details of which are summed up in a masterly 
manner. The author is evidently quite at home in this 
gruesome department, and knows how to present his 
material in a readable form. He is a true novelist, who 
has taken toxicology as a basis. A work of this descrip¬ 
tion appeals very largely to the non-medical public, and 
we Bhould not be at all surprised if Mr. C. J. S. Thompson 

(a) “Twentieth Century Practice; »n International Encyclo¬ 
pedia of Modern Medical 8cienceby Leading Authorities of Europe 
and America.” Edited by Thomas L. Stedman. M.D., New York 
City. Vol. XIV. London: Sampson, Low, Mnrston and Co. 
1898. 


blossomed out into a popular writer of some repute. He 
has struck an original vein, and it will be his own fault 
if he does not work it. 


NEW BOOKS AND NEW EDITIONS. 

The following have been received for review since the 
publication of our last monthly list:— 

Bailliere, Tindall, amd Cox (London and Paris). 

On Fractures and Dislocations. Hy Professor Helferich, of 
Griefswald. With 68 full-page plates and text, authorised 
translation (Balliere, Tindall, and Cox’s “Hand-Atlas Series ”). 
Price 15s. net. 

The Analysis of Food and Drugs. Vol. IT.—The Chemical and 
Biological Analysis of Water. By T. H. Pearmain and C. G. 
Moor, M.A.Cantab., F.I.C. Pp. 172. Price 5s. net. 

Cassrll akd Co., Limited (London). 

Hygiene and Public Health. By Arthur Whitelegge, M.D., 
F.B.C.P. Pp. 558, price 7s. 6d. 

Materia Medica and Therapeutics. By J. Mitchell Bruce, M.A., 
Aberd., F.B.C.P.Lond. Pp. 609. Price 7s. 6d. 

J. ahd A. Churchill (London). 

A Short Practice of Midwifery. By Hy. Jellett, M.D., F.B.C.P.I., 
with a preface by W. J. Smyly, M D.. F.B.C.P.I. Second 
Edition. Pp. 281. Price 6s. 

A Class-book of Practical Physiology. By De Burgh Birch, M.D., 
F.B.8. Ed. Pp. 272. Price 6s. 6d. 

Dawbabx amd Wabd, Limited (London). 

The Natural Waters of Harrogate. By F. W. Smith, M.D. Pp 
102. Price is. 

H. J. Glaishbr (London). 

Clinical Lectures on Neurasthenia. By Thoe. D. Savill, M.D. 
Pp. 144. Prioe 5s. net. 

E. Gould axd Son, Limited (London). 

Viscum Album, the Common Mistletoe as a Drug. By George 
Black, M.B.Ed. Price Is. 

Cha8. Griffin akd Compart, Limited (London). 

Practical Sanitation. By George Beid, M.D., D.P.H. Pp. 34*. 
Price 6e. 

Keoan, Paul, Tkench, Trubkek, and Co. (London). 

Victor ron Richter’s Organio Chemistry. Edited by Prof. B. 
Auschutz. Translated by Edgar F. Smith, Professor of 
Chemistry, Univ. Pennsylvania. VoL I. Pp. 625. 

J. P. Lego and Co. (London). 

Hygiene of the Mouth. By B. Denison Pedley, F.B.C.S.Ed. 

L. D.8. Eng. Pp. 94. Price 2s. 6d. 

H. K. Lewis (London). 

Exploration of the Urethra and Bladder. By M. Tuchmann, 

M. R.C.8., M.D., Wurzburg. Pp. 56. Price 5s. 

The Middlesex Hospital Reports for the year 1897. Pp. 392. 
Price 2s. 6d. net. 

A Manual of Surgical Treatment, in six parts. By W. Watson 
Cheyne, M.B., F.B.C.8., F.B.8., and F. F. Bnrghard, M.D.Lond., 
F.B.C.8. Part I. - General Surgical Diseases. Pp. 285. Price 
10s. 6d. 

E. and S. Livinostone (Edinburgh). 

The Students’ Materia Medica. By Grace H. Giffen, L.R.C.P.Ed- 
Pp. 96. Price 2e. 

Longmans, Green, and Co. (London). 

Boyal University of Ireland. Calendar for 1899. 

Macmillan and Co. (London). 

A System of Medicine by many Writers. Edited by Thos. Clifford 
Allbutt, M.D., F.B.C.S., F.R.S. Vol. VI. Pp. 944. Price 25*. 
net. 

Sir I. Pitman and Sons, Limited (London). 

Some Diseases of the Rectum and Anus. By Sir Wm. Thomson, 
F.B.C.8.I. Pp. 56. Price 2s. 6d. 

Thb Scientific Press, Limited (London). 

Burdett’s Official Nursing Directory, 1899. Edited by Sir Hy. 
Burdett, K.C.B. Pp. 651. Price 5s. 

Spottiswocde and Co. (London). 

The Medical Register for 1899. Under the direction of the General 
Medical Council. 

The Dentists’ Register for 1899. Under the direction of the 
General Medical Council. 

John Wright and Co. (Bristol). 

The Medical Annual and Practitioner’s Index for 1899. Pp. 720. 
Price 7s. 6d. net. 

Animal Simples approved for Modern Uses and Cure. By W. T 
Fernie, M.D. Pp. 564. Price 6s. 

Golden Rules of Medical Practice. By Arthur H. Evans, M.D. 
Lond.. F.B.C.S. Pp. 71. Price Is. 


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526 The Medical Press. 


MEDICAL NEWS. 


May 17, 1899 


Jleto Instruments. 

“ MAGENNIS'S MIDWIFERY SURGICAL 
INSTRUMENT.” 

Use .— 1. This instrument by cutting and, at the same 
time, compressing both the cut ends of the umbilical 
cord will supply the place of the 
scissors and ligatures now used in 
midwifery practice. 

2. By the old method of ligaturing, 
the accoucheur, after tying with 
the first thread, stripes the umbilical 
cord along, and then requires some 
one to hold and compress at the par¬ 
ticular place to which ho has driven 
the blood, while he applies the 
second ligature. If he did not do 
this, the moment the umbilical cord 
is cut the bloods spurts over the bed¬ 
clothes, &c. 

3. When the clamp is applied the 
accoucheur is at liberty to attend to 
either the mother or child. 

4 . If the accoucheur is not satis¬ 
fied that the ends are sufficiently 

compressed the 
application of the 
clamp makes the 
tying easy and 
clean. 

Mode of Using. 
—When pulsa¬ 
tion in the cord 
has ceased it is 
to be placed 
between the 
blades of the 
clamp resting on 
the plain side, the knifed side is then pressed flnnly 
down, and the catch retains it in position. 

Messrs. Arnold and Sons, London, are the makers. 


NEW PESSARY HOLDER. 

The introduction and proper adjustment 
of a Hodges’ Pessary has been always a 
puzzle to some practitioners, and it has 
now become fashionable to decry the use 
of this most valuable appliance for the 
reasons above stated. 

By the use of the instrument depicted 
(made for Dr. Alexander Duke, of Chelten¬ 
ham. by Messrs. Arnold and Sons, Smith- 
field), the proceeding will be much facili¬ 
tated, the necesssry manipulation being 
materially assisted by the leverage 
afforded by the holder. 

It is hardly necessary to remark that 
the uterus should be replaced as nearly 
as possible in its normal position before 
the proper sized pessary is placed in situ. 
The neglect of this and the idea that the 
pessary will do all, has decidedly helped 
to bring it into disrepute. A properly 
fitted support will in every case give 
the patient relief, and thus gain her confi¬ 
dence towards subsequent treatment. 


Voluntesr Medical Association. 

The annual dinner of this Association took place on 
Wednesday, the 10th inst., under the presidency of 
Colonel O’Farrell, R.A.M.C., in the unavoidable absence 
of Major-General Trotter. About fifty of the members 
and their friends were present. Among the guests were 
Colonel Sir Howard Yincwt, Colonel Edis, and Lieut.- 
Colonel Daniel. 





^ttcbical ilctos anb $aBB ^Cists. 


The Royal University of Ireland. 

A meeting of the Senate was held on Thursday r 
May 11th, 1899, at 11 o’clock. 

Present: Sir Thomas Moppett, Pro. Chancellor, in the 
chair; Mr. Edward Dense, Judge Shaw, Right Hon. 
OConor Don, Dr. Allman, Sir Chr. Nixon, Rev. Dr. 
Brown, Sir John Banks, Rev. Dr. Leitch, Dr. Cox, Dr. 
M’Keown, Dr. Sinclair, 8ir R. Blennerhassett, Dr. 
Macalister, Mr. E. Cuming, Rev. Dr. Delany, Rev. Dr. 
Hamilton, Sir Wm. Thomson, Dr. Leebody, Mr. Starkie, 
and Dr. Meredith and Dr. McGrath, secretaries. 

A communication was received from the Clerk of Con¬ 
vocation notifying the election of Dr. T. Walton Browne 
as a member of the Senate. A resolution was adopted 
recording the regret of the Senate at the death of the 
late Right Hon. C. T. Redington, vice-Chancellor of the 
University. The election of the Vice-Chancellor was 
postponed to next meeting. 

The results of the Spring Medical Examinations were 
submitted and approved. [Declaring University educa¬ 
tion in Ireland unsatisfactory. —Ed., Medical Press.] 

The debate upon O’Conor Don’s motion adjourned 
from last meeting was resumed, and by leave of the 
Senate the amendment and original motion were with¬ 
drawn. 

It was resolved that a studentship in Celtic langnage- 
and literature be offered for competition in 1903. It was 
ordered that the list of scholars elected in 1897 be 
amended by inserting as first of the second class scholars 
in Modern Literature:—Helena Walsh, Lo reto Convent, 
North Great George’s Street, Dublin. 

An address of congratulation was adopted to Sir George 
Gabriel Stokes, Bart., LL.D., Sc.D., upon his attaining 
his fiftieth year as Lucasian Professor of Mathematics 
at Cambridge University. 

A communication was received from the Conjoint 
Examining Board in England intimating that such 
alterations had been made in their regulations as would 
place the medical students of this University upon the 
same footing as regards the examinations of that Board 
as the medical students of other Universities. 

The Medical Society of London. 

The conversazione of this Society is the first leaf to- 
fall from the tree of medical science, and marks the 
approaching autumn of the medical year. On Monday 
evening the spacious and handsome rooms of the Society 
in Chandos Street were crowded to repletion, and even a 
trifle beyond, by Fellows who had assembled in their 
hundreds to listen to the Oration, which was delivered 
in his best style by that versatile genius, Mr. Alban 
Doran, who chose for his subject “ Shakespeare and the 
Medical Society.” The orator gave abundant proof of 
an intimate acquaintanceship with the most out-of-the- 
way corners of the great dramatist’s literary monument, 
and the quotations with which his discourse was larded 
served him as so many salient points on which to hang 
remarks of exquisite drollery which excited bursts of 
laughter, alternating with rounds of applause as, with a 
light but dexterous wit, he drove home his pungent 
reflections. After the oration, which was preceded by a 
reception by the President, Mr. Edmund Owen, the con¬ 
versazione proper began, the hum of conversation being 
masked by the strains of the Bijou Orchestra and sanc¬ 
tified by the incense burned on the shrine of the Goddess 
Nicotine. 


Medical Sickness and Accident Society. 

The usual monthly meeting of the Executive Com¬ 
mittee of the Medical Sickness, Annuity, and Life 
Assurance 8ociety was held on the 28th ult. at 429, 
Strand, London, W.C. There were present Dr. de Havil- 
land Hall (in the chair), Dr. J. B. Ball, Dr. G. E. Har¬ 
man, Mr. W. J. Stephens, Dr. F. R. Mutsh, Dr. W. 
Knowsley Sibley, Mr. J. Brindley James, Dr. F. J. Allan, 
Dr. J. W. Hunt, Mr. F. Swinford Edwards, Mr. Edward 
Bartlett, and Dr. Walter Smith. The annual report for 
1898 was agreed upon.. It shows that the business of 
the Society has largely increased during the year. The 
Sickness Fund grew from .£53,472 to .£58 211, although 


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MEDICAL NEWS. 


f May 17. 1899. 

from this fond no less than 456,175 was disbursed during 
the twelve months to members incapacitated by illness. 
The quinquennial valuation report was also considered. 
The valuation made by the Secretary, Mr. F. Addiscott, 
F.I.A., and certified by the Consulting Actuary to the 
Society, Geo. S. Crisford, Esq., F.I.A., Actuary of the 
Rock Life Assurance Company, and one of the Public 
Valuers under the Friendly Societies’ Act, shows that 
the Society possesses a surplus fund of between six and 
seven thousand pounds. This, if applied, as at the 
previous valuation in 1894, as a cash bonus, will allow of 
a return of 10 per cent, upon all sickness benefit premiums 
paid during the Quinquennium. These reports will be 
presented to the members at the annual general meeting 
to be held on 24th inst., at 5 o’clock, at the House of the 
Medical Society of London, 11, Chandos Street, Caven¬ 
dish Square, London, W. Prospectuses and all particu¬ 
lars on application to Mr. F. Addiscott, Secretary, 
Medical Sickness and Accident Society, 33, Chancery 
Lane, London, W.C. 

West Kent Medico-Chlrurglc&l Society. 

The Seventh Meeting of the Forty-Third Session, 
1898-99, was held at the Royal Kent Dispensary, 
Greenwich Road, on Friday, M ay 5th, 1899, at 8.45 p.m., 
Morgan Dockrell, Esq., M.A., M D., President, in the 
chair, when the following was the business of the even¬ 
ing:—Dr. Morgan Dockrell delivered his Presidential 
Address on “General Health as a Factor in Skin 
Disease.” After the conclusion of the President's 
Address a very enjoyable smoking concert was held. 
Among the artistes who kindly gave their services were 
Messrs. Courtice Pounds, Carl Brandt, Walter Grace, F. 
H. Cheesewright (vocalist), Charles Frondi (musical 
sketches), H. Wharton Wells (piano), and Dr. Boyd Page 
(conjuring). 

Boyal College of Physicians of Londcn. 

At a meeting of the Royal College of Physicians, 
held on Thursday, the President, Dr. W. Selby Church, 
occupying the chair, the following gentlemen were 
admitted Fellows of the College:—Dr. S. A. M. Cope- 
man, London ; Dr. W. J. Hadley, London ; Dr. H. Hand- 
ford, Nottingham; Dr. P. Horton-Smith, London; Dr. 
C. Ogle, London; Dr. A. Ransome, Bournemouth ; Dr. 
W. H. R. Rivers, Cambridge; Dr. W. J. R. Simpson, 
London ; Dr. W. V. Snow, Bournemouth ; and Dr. H. R. 
Spencer, London. 

Mortality in Foreign Cities. 

The following are the latest official returns, and repre¬ 
sent the last weekly death-rate per 1,000 of the several 
populations:—Calcutta 40, Bombay 104, Paris 20, Brussels 
16, Amsterdam 12, Rotterdam 18, the Hague 13, Copen¬ 
hagen 19, Stockholm 19, Christiania 15, St. Petersburg 
25, Moscow —, Berlin 19, Hamburg 17, Dresden 20, 
Breslau —, Munich 26, Vienna 22, Prague 32, Buda- 
Pesth 24, Trieste 33, Rome 14, Turin (eleven days) 23, 
Venice 39, New York (including Brooklyn) —, Phila¬ 
delphia 21. 

New Process of Cleaning Bed Linen. 

In a circular, ths surgeon-general of the German army, 
Golar, in Berlin, calls the attention of the heads of the 
garrison hospitals to a new cleaning method, which is to 
be employed in future, as thorough experiments have 
proved it to be of advantage. By this method, petro¬ 
leum is added to the water besides soap and soda, taking 
as many grammes of it as there are litres of water used; 
e.g., 30 grammes of petroleum to 30 litres of water. This 
admixture of petroleum does not only admit of an easier 
cleaning, as well as less tear and wear on the linen, but 
the wash also retains its colour, is thoroughly disinfected, 
and the expenses are considerably reduced by a saving 
in soap.— Scientific American. 

The Oxygen Home. 

Princess Louise, Marchioness of Lorne, attended the 
n.nnnn.1 meeting of the Oxygen Home for the Treatment 
of Ulcers and Wounds by Oxygen Gas, 2, Fitzroy Square. 
Mr. Burdett-Coutts, M.P., chairman of the general com¬ 
mittee, presided. Sir Francis Osborne, the hon. secre- 


The Medical Press. 527 

tary, read the third annual report, in which the com 
mittee recorded the continued success of the oxygen 
treatment. Since the home was opened, three years 
ago, 231 cases had been treated, and of these 172 had 
been cured. Of the 101 cases treated last year 66 had 
been cured. Dr. Granville Ban took seconded the resolu¬ 
tion, which was carried. The Marchioness of Lorne 
visited the wards of the hospital before she left, and 
praised the admirable arrangements that were in opera¬ 
tion. The outstanding liabilities of the home at the 
end of April amounted to 451,122. 

London 8chool of Medicine for Women 
We are asked to announce that a dog show will be 
held on June 3rd at the London (Royal Free Hospital) 
School of Medicine for Women, Hunter Street, Bruns¬ 
wick Square. Only qualified practitioners, members of 
the teaching staffs at the Medical Schools, and medical 
students may exhibit. Twenty-six classes have "been 
provided; three prizes are offered in each class, and 
a large number of special prizes have been offered. 
Captain Barry, Mr. E. W. Allen, Mr. G. R. Kuhl have 
kindly volunteered their services as judges. Entries 
will be received till Saturday next, May 20th. 
Schedules and entry forms may be obtained by 
applying to the secretaries at Hunter Street, and the 
committee hope that the medical profession will cordially 
support the enterprise, the proceeds of which are to be 
devoted to the building fund of the Womens’ Medical 
School. 

The Royal University of Ireland. Medical Degrees. 

M.B., B.Ch., B.A.O. DEGREES. 

Upper Pass. William Cahill, Qu. C., Cork: Bartholomew J. 
Hackett, Cath. Univ.; "Edmond McDonnell, Qu. C., Cork:. "John 
W. D. Megaw, Qu. C., Belfast; Andrew Murphy, Qu. C., Cork; 
•Robert Steen Qu. C., Belfast. Those marked thus (*) may pre¬ 
sent themselves for honours. 

Pass. Richard Athern, Qu. C., Cork; Peter J. Burke. Cath. Univ., 
Patrick J. England. Qu. C.. Cork: Francis S. Irvine, Qu. C.. Bel¬ 
fast : Frederick C. McHee, Qu. C., Belfast ; Hugh J. McNabb, B.A., 
Cath. Univ.; William O’S. Murphy, Qu C., Cork; Robinson Officer, 
Qu. C., Belfast: William Paisley, Qu. Cs., Galway and Belfast and 
Univ. Edin.; William Rice. Qu. C., Cork; and Isobel A, Tate, Qu. C. 
Belfast. 

M.D. DEGREE EXAMINATION. 

Pass. —Mina-L. Dobbie, Lond. Sch. Med. Women; Joseph 
P. Trengley, Cath. Univ. and private Study. 

THIRD MEDICAL EXAMINATION. 

Upper Pass.— ‘Joseph G. Anderson, Qu. C., Galway; Mameff 
Gorman, Cath. Univ. ; ‘Archibald G. Heron, B.A.,Qu. C., Belfast; 
Oswald E. Jackson, Qu. C., Belfast: John C. McCarroll, Qu. C., 
Belfast; ‘David McMordie, B.A., Qu. C., Belfast; and ‘John 
O'Leary, Qu. C., Cork. Candidates marked * may present them¬ 
selves for honours. 

Pass.—W illiam Barkley, Qu. C., Belfast; James P. Brady. Cath. 
Univ.; Frederick C. Bullen, Qu. C., Cork; John S. Cargin, Qu.C.; 
Belfast; Michael Crowley, Cath. Univ.; Frederick Garland, Cath. 
Univ., Timothy J. Hartigan, Cath. Univ.: John P. Higgins. M.A., 
Qu. C., Cork; Robert Kennedy, Qu. C., Belfast; Patrick Kerley, 
Cath. Univ.; Samuel McClure, Qu. C., Belfast: John McCrea, B.A., 
Qu. C., Belfast; John A. Mills, B.A., Qu. C., Galway ; James Park, 
Qu. C., Belfast; Chestnut Peacock, Qu. C., Belfast; Herbert C. 
Quirke, Mnson Coll., Birmingham; Hugh B. Smith, Qu. C., Belfast; 
and William J. Thompson, Qu. C., Belfast. 

University of Durham. 

At the third examination for the degree of Bachelor 
in Medicine, during April, the following candidates 
have satisfied the Examiners :— 

Honours—Second Class. 

Born, Edward Turner, College of Medicine, Newcastle-on-Tyne. 
Wigfleld. Frederick P., College of Medicine, Newcastle-on-Tyne. 
Pass List. 

Alstrom, Hedda, London School of Medicine for Women. 
Blandford, Laurence J., College of Medicine, Newcastle-on-Tyne. 
Brown, George Burrows, College of Medicine, Newcastle-on-Tyne. 
Braund, Henry, Guy's Hospital. 

Cooke, Edleeton Harvey, St. Thomas's Hospital. 

Heslop, James Willie, College of Medicine, Newcastle-on-Tyne. 
Jupp, Ralph Tennyson; Mason College, Birmingham. 

Morrison, John Wilson H., College of Medicine, Newcastle-on- 
Tyne. 

Mitchell, John Robert, College of Medicine, Newcastle-on-Tyne. 
Macfadyen, John, College of Medicine. Newcastle-on-Tyne. 

Perkins, Philip Meyler, St. Bartholomew's Hosultal. 

Rhodes. Thomas Basil, Mason College, Birmingham. 

Raw, Stanley, College of Medicine, Newcastle-on-Tyne. 

Swainston Eliot, College of Medicine. Newcastle-on-Tyne. 
Stainthorpe, Wm Waters College of Medicine. Newcastle-on-Tyne. 
Sidswick, John Ernest, College of Medicine. Newcastle-on-Tyne. 

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.JjtoticEB to 

(Tornsponiimto, £hort fetters, &r. 


•3^ Correspondents requiring a reply in this column are par' 
ticularly requested to make use of a distinctive lignature or 
initiate, and avoid the practice of signing themselves “ Reader,” 
•‘‘Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

Reprints.— Authors of papers requiring reprints in pamphlet 
form after they have appeared in these columns can have them at 
half the usual cost, on application to the printers before the type is 
broken up. 

Reading Cases.— Cloth board cases, gilt lettered, containing 
twenty-six strings for holding the numbers of The Medical Pbess 
and| Circelah, may now be had at either office of this journal, 
price 2s. 6d. These cases will be found very useful to keep each 
weekly number intact, clean, and flat after it has passed through 
-the post. 

WANTED, A MALE CHILD. 

A correspondent asks our opinion of the following printed cir¬ 
cular letter, which bears the name of C. F. Knight, M.D., of Lud- 
gate Hill, E.C., and is headed " Confidential.” It seems to have been 
sent round broadcast:— 

“ An American lady of wealth, who wishes to adopt a male child, 
desires me to put her in communication with some one who can 
further her object. 

“ The boy should be between two and four years of age, of gentle 
birth (legitimate or illegitimate), of attractive appearance and pro¬ 
mising character. 

“ The child’s future would be assured: and it occurs to me that 
by communicating with a number of professional men, I may be 
enabled to find some one of them who would be glad to Indicate a 
suitable boy.” 

%* There is nothing actually unprofessional in the foregoing, 
however much one may question the desirability of a medical man 
engaging in this department of research. 

Mr. Gut C. Rotheht.—Y our communication will appear in an 
early number. 

Mr. Ht. Wilson.— The only practical book on the subject within 
our knowledge is: “ The Bontgen Bays in Medical Work,” by Dr. 
David Walsh, Hon. Secretary of the Bontgen Bay Society. 

Dr. W. M. J. will see the matter has been referred to in another 
column. 

Dr. John Knott. —We hope to have space for your paper on 
■“ Internal Derangement of the Knee joint” in our next. 

Dr. D. C. 8. will reoeive a private note so soon as the necessary 
inquiries have been made. We may say, however, in advance that 
we think our correspondent need have no doubt as to the result. 

DUMAS AND THE PHYSICIAN. 

It is related of Dumas that he was one day introduced to a 
pompous old physician who condescendingly said to him, “ You 
produce tragedies, don’t you, young man?” ‘‘I do,” replied 
Dumas, “ like you, only your tragedies are bound in oak.” 

A Lat Reader.— The powder so largely advertised in the news¬ 
papers is only an imitation of the original Carlsbad Salts. The case 
you refer to as recently in the American Law Courts arose from the 
fact that poison was sent to a man of the name of Barnett in a Kut- 
now powder bottle. This man died, and the tragedy is reported in 
a New York exchange to have ruined the Kutnow powder business 
in the United States. We know nothing of the other nostrum about 
which you ask for information. 

Dr. George Fleming’s paper on “ The Eradication of Tuber¬ 
culosis ” is marked for early insertion. 

Oue Paris Correspondent.— The clinical lecture by Professor 
Potain on ‘‘Fever during the Convalescence of Typhoid” received 
with thanks. 

<|ftoitt£0 of the goeietieo mb JCectures. 

Wednesday, Mat 17th. 

Botal Microscopical Society (20 Hanover Square, W.)—7.30 p.m. 
Exhibition of Pond Life. 

North-West London Clinical Society (North-West London 
Hospital).— 8.30 p.m. Clinical Meeting. 

Thursday, Mat 18th. 

Harveian Society op London (Stafford Booms, Titchborne Street, 
Edgware Road).—8.30 p.m. Dr. Caley: Considerations as to the 
Etiology and Significance of Dilated Heart. 

St. George’ 8 Hospital (Hyde Park Corner).—3 p.m. Dr. W. H. 
Dickinson: Fragments of Pathology and Therapeutics. (Baillie 
Lecture. 

Central London Throat, Nose, and Ear Hospital (Gray's Inn 
Boad, W.C.)—5 p.m. Dr. D. Grant: Examination of the Ear. 

Friday, Mat 19th. 

,.^ PI “ IMI0L 9«. ,C * L Society op London (11 Chandos Street, Caven¬ 
dish Square, W.)-8.30 p.m. Paper—Prof. B. H. Saltet (Amster¬ 
dam) : A Study of Enteric Fever in the Netherlands. 


ttecaraus. 


the house. 

Fisherton Asylum.—Assistant Medical Officer. Salary commencing 
at £120, with board, lodging, and washing. Apply to Dr. Finch. 
The Asylum, Salisbury. 

Lancashire County Asylum. Whittingham.—Pathologist. Salary 
£200 per annum, with apartments, board, washing, and attend¬ 
ance. Also Locum Tenens for a few months. Two guineas a 
week. 

Liverpool, Township of Toxteth Park.—Senior Assistant Medical 
Officer for the Workhouse and Infirmary. Salary £125 per 
annum, with board, washing, and apartments. Applications to 
the Clerk to the Guardians. 

Mercer’s Hospital, Dublin.—Resident Medical Officer. 

Royal College of Surgeons of England.—Hunterian Professors, the 
Erasmus Wilson Lecturer, and the Arris and Gale Lecturer for 
the ensuing year. (See advertisement.) 

Boyal National Hospital for Consumption, Ventnor, Isle of Wight 
—Assistant Resident Medical Officer. Salary £80 per annum’, 
with board and lodging. Applications to the Board of Manage¬ 
ment, at the London Office, on or before the 19th insL (See 
advertisement.) 

Victoria University, the Yorkshire College, Leeds.—Junior Demon¬ 
strator in Pathology. Salary £120 

West Biding Asylum, Wadsley, near Sheffield.—Fifth Assistant 
Medical Officer. Salary £100 per annum, rising £10 a year ud 
to £150, with board, 4c. J P 

Wolverhampton and Staffordshire General Hospital.—House Gover¬ 
nor and Secretary, unmarried, or widower without a family. 
Salary £170 a year, with board, washing, and residence in the 
institution. 




Carroll, M. J., L.R.C.P., L.R.C.S.Irel., Medical Officer for the Dun- 
drum Dispensary District. 

Chadborh, C. N., M.B.C.S., L.R.C.P., House Surgeon to the 
Swansea Hospital. 

Edwards, J. Hammerton, M.A., M.D.Cantab., MJB.C.S., LJLC P 
Assistant Physician to the Bedford County Hospital. ’ ' 

Ebeaut, Harold J., L.R.C.P.Lond., M.R.C.S., Senior House Sur¬ 
geon to the Westminster Hospital. 

Hayward, A. E., M.R.C.S., Medical Officer for the Teignmouth 
Sanitary District of the Newton Abbot Union. 

Hudson, F. H., L.R.C.P.Lond., M.R.C.8., Medical Officer for the 
Workhouse and the West Sanitary District of the Buntingford 
Union. 

Kennedy, W. G., L.R.C.P.Irel., L.B.C.8., Medical Officer for the 
Fourth Sanitary District of the Salford Union. 

Kevin, Byrne P., M.D., B.S., B.A.Lond., Medical Registrar to the 
London Temperance Hospital, Hampstead Road. 

Loud, Frank, L.B.C.P.Lond., M.B.C.S., Medical Officer for the 
Fifth Sa n i ta r y District of the Lewes Union. 

Mathias, Richard, M.A., M.B., B.Ch.Cantab.. L.R.C.P., M.R.C.S., 
Medical Officer for the Pentyrch District by the Cardiff Board 
of Guardians. 

Muir, J. C., M.B. Comb., L.B.C.S.Lon<L, M.R C.S., Junior Assistant 
Medical Officer for the Crumpsall Workhouse, Township of 
Manchester. 

RicEjM. W., M.D.Edin., M.R.C.S., Medical Officer for the Gedney 
Hill Sanitary District of the Holbeaoh Union. 

Robinson. Thomas, L.R.C.P.Lond., M.R.C.8., Medical Officer of 
Health for Leicestershire. 

Stewart, Charles Howard. L.R.C.P.Lond., M.B.C.S., L.8.A., 
Medical Officer for the Sixth District (Witheridge) by the South- 
molton (Devon) Board of Guardians. 


girths. 


Bower.— On May 10th, at Longton Lodge, Hendon, the wife of W. 
Bower, M.D., of a son. 

Ketwobth.— On May llth, at Wem, Shropshire, the wife of G. 

Hawson Key worth, M.D., of a daughter. 

Roddis.— On May llth, at Snettiaham, Norfolk, the wife of T. E. E. 
Roddis, M.B., of a daughter. 

Solly.— On May 13th, at Strathlea, Harrogate, the wife of Ernest 
Solly, M.B., F.R.C.S., of a daughter. 


iitaier.— un may nth, at Lindnck House, Finsbury Park, 
London, the wife of George H. Whitaker, M.R.C.S., of a 
daughter. 


Carriages. 


Birkenhead Borough Hospital.—Senior House Surgeon. Salary 
. £100 a year, with board and washing. Also Visiting House Sur- 


Jeathe. 

Jackson.— On May 4th, at Louth, Lincolnshire, Henry W. Jackson, 
M.R.C.S. and L.S.A. 

Jepson.— On May 5th, at Elmfield, Sydenham (suddenly), Octavius 
Jepson, M.D., aged 66 years. 

Pridham. On May 9th, at Hillfield, Broadway, Dorset John W. 
Pridham, M.R.C.S., L.B.C.P,, aged 59. 


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She SUcdital iVas and Circular. 

“ SALUS POPULI SUPREMA LEX.” 


Vol. CXVIII. 


Original (Eonummirations. 


THE TREATMENT OF 

■GONORRH(EAL SALPINGITIS, (a) 

By J. W. TAYLOR, F.R.C.S., 

Surgeon to the Birmingham and Midlands Hospital for Women, 
Consulting Surgeon to the Wolverhampton Hospital for Women. 

P Gonorrhoeal salpingitis is now a well-recognised 
disease, but many of us can remember the time when 
the connection between “ inflammatory disease of the 
uterine appendages ’ and gonorrhcea was by no 
means established. 

When Noegerrath published his treatise in 1872, 
maintaining that gonorrhcea had dreadful conse¬ 
quences; that it was the main cause of pelvic peri¬ 
tonitis and sterility, and that it was practically 
an incurable disease, men first of all looked upon 
him as a wild dreamer and enthusiast. Then, 
little by little, abundant evidence was found 
to corroborate most of his assertions, but it 
was only very slowly that his work received any 
recognition or support. It was not until some ten 
or fifteen years later that the seriousness of gonor¬ 
rhcea in the female began to be generally recognised, 
and enterprising surgeons began to operate freely 
for inflammatory tubal disease by removal of the 
uterine appendages. 

At first operation was generally limited to the 
removal of the appendages on the side chiefly or 
solely affected at the time when the operation was 
undertaken, but the after-history of these cakes was 
not altogether satisfactory. In many instances ex¬ 
tension of the disease occurred on the opposite side, 
and in a short time the patient was in quite as bad a 
condition as before operation, so that a second section 
was needed for the removal of the remaining 
appendages. 

In consequence of this, attention was directed to 
-the advisability of complete removal of the appendages 
in all cases of operation for “ inflammatory disease.” 
Papers were written on the subject—notably one by 
Mr. Tait—advocating this treatment, and for a con¬ 
siderable time it was accepted as final that thorough 
removal of the uterine appendages by abdominal 
section was the one and only cure for gonorrbeeal 
salpingitis. 

But there were difficulties in the carrying out of 
this advice, and the results, while in some cases very 
successful, in others were decidedly disappointing. 
In separating the adhesions, which were often very 
dense, the bowel—particularly the sigmoid flexure 
and rectum—was liable to injury, and injury in 
inaccessible regions. Further, the ovary, when 
peeled or tom away from its surroundings, left some 
of its tissue behind it, and with this there was often 
persistent menstruation: the uterus, which had 
evidently been the centre of infection throughout, 
remained untouched, and in a small proportion of 
cases, notwithstanding the utmost care, local peri¬ 
tonitis and fsecal fistulse resulted, while in othere, 
notwithstanding the utmost thoroughness, menor- 

(a) Paper read before the British Gynecological Society, May 
11th, 1899. For diocusaion see page 535. 


No. 21. 


rhagia and pain persisted after operation, the 
haemorrhage in some of these cases being rather 
aggravated than otherwise by the means undertaken 
for the cure of the disease. 

In the meantime, while this experience was forming 
or, at all events, before it haa been fully formed, 
Pean and Segond in Paris, Doyen of Rheims, and 
Landau of Berlin, recognising the gonococcus as 
the source of the disease, and gonorrhoeal endome¬ 
tritis as the starting-point of infection for both 
Fallopian tubes, not only argued with true logical 
deduction that the uterus should be removed, but 
proceeded directly to put this reasoning into prac¬ 
tice, and began treating cases of inflammatory tubal 
disease by extirpation of the uterus as well as removal 
of the tubes. Tnis was done by the vaginal route, and 
the result was, on the whole, more satisfactory perhaps 
than any treatment previously adopted. At all events 
the treatment was a i-adical one, and if the patient 
made a satisfactory recovery, there was, of neces¬ 
sity, no further trouble from uterine haemorrhage, or 
from the pain and distress accompanying the pelvic 
congestion recurring at each menstrual period. 

This practice has never been thoroughly adopted 
and followed in England as a primary procedure, but 
many English surgeons (including myself) have been 
over and over again glad to avail ourselves of vaginal 
hysterectomy as a cure for rebellious cases, and it 
would be difficult to speak too highly of its value 
when every other means has failed. 

On looking back over all this period of strenuous 
surgical effort—whatever may have been its mistakes 
of enthusiasm and misdirected energy—we cannot 
withhold a hearty acknowledgment of the courage, 
the perseverance, and the honesty of purpose which 
marked in the main each point of progress, or a warm 
appreciation of the splendid saving of life which has 
attended one department of the work from the 
veiy beginning—viz., the operative treatment of 
pyo-salpinx. 

It must, pei’haps, be remembered on looking back 
over this period, that the issues involved in the work 
then beginning were by no means so simple and 
definite as represented in my imperfect sketch. 
Side by side with the question of the cause of pelvic 
inflammation and its treatment was the question of 
its seat—whether it was usually within the perito¬ 
neum ("perimetritis”) or in the cellular tissue out¬ 
side it (" parametritis ”)—and with the elucidation of 
this problem Birmingham was, perhaps, more 
directly concerned than with that which I am now 
more immediately discussing. In addition to these 
two problems a subsidiary one, but one more press¬ 
ing, was the question of the danger of this “ pelvic 
inflammation” if left alone, and there can be 
no doubt that some operators were so im¬ 
pressed with this danger, and so impressed it on 
their followers that for a considerable period the 
finding of any inflammatory tumour in the pelvis was 
considered a valid reason for immediate abdominal 
section. 

All this has been vastly altered during more recent 
years. With greater knowledge and more certainty of 
diagnosis there is more careful differentiation of 
grades of inflammation and the necessities of indi¬ 
vidual cases; we know better what may be expected 


WEDNESDAY, MAY 24, 1899. 


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ORIGINAL COMMUNICATIONS. 


May 24, 1899. 


from rest and medical treatment, and operation is 
reserved for the minority of cases—or, ii this goes 
too far, it is certainly not practised anything like so 
frequently as in former years. 

But what about these cases—cases of undoubted 
salpingitis—that are not operated upon P Do they, 
if they improve under rest and hygienic treatment, 
necessarily relapse and get worse again, as we 
formerly thought, or do they get permanently well ? 

These are questions which I felt needed answering, 
and as I could not find any answer that I could trust, 

I set myself to study the disease as well as I could, 
hoping to find the information I needed by experience. 

If I am not in a position to speak as definitely as I 
should like this evening, I feel I nave learnt during the 
past thirteen years a few facts about the history of 
the disease and its course under treatment that influ¬ 
ence my own practice and justify me, I believe, in 
bringing the subject before tlie notice of my 
colleagues. 

One of the first things that struck me in the 
clinical study of salpingitis was the frequency of a 
syphilitic history ; indeed, in many cases it was more 
easy to elicit this than any clear histoxy of a gonor¬ 
rhoeal dischai’ge, and for some time it was a question 
with me whether syphilis was not a factor in the 
causation that had been overlooked. 

Gonorrhoea—the gonococcus—was perhaps the only 
soux'ce of gonorrhoeal inflammation in the mucous 
membi’ane of the tube, but was it the sole cause of 
tubal obstruction, tubal distension, and pyo-salpinxp 

In some cases of pyo-salpinx possessing a syphilitic 
histoxy, I have found at the opeiation a clearly defined 
nodule of thickening at the uterine end of the tube— 
a nodule which on section had all the appeaiance of a 
syphilitic gumma. In all cases of mai-ked pyo-sal- 

{ >inx the abdominal ostium of the tube is more or 
ess occluded by tubal and peri-tubal swelling, and it 
is at all events possible that a syphilitic thickening 
of the tube may assist in the contraction of the abdo¬ 
minal ostium which appeal's to be the necessarv and 
immediate cause of tubal distension from retained 
secx-etion. 

On consideration, however, of other cases of acute 

E yo-salpinx in which there could be no syphilitic 
istoxy, and in which the obstructive swelling at the 
utei-ine end of the tube was amply accoxinted for by 
the acuteness or severity of the inflammation sur- 
rounding it; on consideration, too, of what I may 
teim the natural frequency of the two diseases in the 
same individual, I felt that the point—interesting hb 
it might be—was of little pi'actical value, and that in 
all probability the ratio of syphilitic and non¬ 
syphilitic cases was not appreciably different to the 
ratio of syphilis with gonon'hcea, and gonoirhoea 
alone, irrespective of tubal disease. 

So far, if my work had not been misdix-ected, it was 
barren of any veiy profitable result. But, after a 
time, another point began to engage my attention, 
which bids fair to be of greater value. 

This point I may perhaps express as the greater 
tractability of gonorrhoeal salpingitis in syphilitic 
subjects, in other words, after some months or years 
of treatment I found a peilection of cure in my 
syphilitic cases that I failed to secure in cases of 
pure and uncomplicated gonorrhoeal origin. 

Before we consider the reason of this, and as I do 
not want you take anything for granted, I will run 
over as shortly as possible a few of my cases which 
are more pi'ominently in my mind. 

Mrs. C. is a patient I have known and watched for 
fifteen years. When fii-st I saw her (in 1884) she 
was suffering from syphilis contracted from her 
husband, and had recently had a miscarriage (at four 
months) which I considered to be due to syphilitic 
disease. 


On recovering from the miscarriage she almost 
immediately showed signs of gonorrhoeal infection— 
a dangerous time for infection to take place as the 
uterus is temporarily dilated. She had gonorrhoeal 
vaginitis and the inflammation spread upwards. 
Pelvic inflammation followed, and a mass formed in 
the pouch of Douglas, having all the characters of an 
enlarged or distended tube. For nearly the whole of 
the next year (1885) she was rather seriously ill—a 
constant patient—and was kept on mercurial and 
iodide treatment. The tubal tumours did not mate¬ 
rially alter, and I was thinking of removing it by 
operation, when in September of this year she un¬ 
expectedly became pregnant. The complication 
of a (possibly) syphilitic pregnancy, very liable to 
abort, and gonorrhoeal salpingitis was specially 
awkward from a surgical point of view, and as the 
genei'al condition of the patient had improved, I 
decided to wait, maintaining the anti-syphilitic treat¬ 
ment mainly for the sake of the coming infant. The 
patient went to her full time and was delivered on 
May 29th, 1886, of a boy, who remains alive and well 
to the present date. After pregnancy was over the 
tumour of the damaged appendage was still to be felt. 
Occasional, but no persistent treatment was main¬ 
tained, and although the tumour steadily deci'eased 
in size and fixity, I find from my notes of occasional 
consultations after this date that it was not until 1890 
that all traces of the tumour had disappeai-ed. This 
disappearance has been final. 

About eighteen months or two years ago the 
patient’s husband died. She has rather lecently 
manned again—much more happily, I believe—and 
is now (at the present date, November 14th, 1898) 
about six months’ pregnant, without a ti*ace of dis¬ 
coverable disease on the most careful examination. 

Mrs. D. I have known and occasionally attended for 
eighteen yea is. A shoi*t time after her marriage she 
was infected by her husband with syphilis, and left 
him. For some twelve years she maintained herself, 
evei-y now and then having some transient syphilitic 
symptom or affection which received temporary 
treatment, but the treatment was left off as soon as 
the symptom was l-elieved. On the whole, she bad 
faix-ly good health, and at no time did she have any 
pelvic, menstrual, or vaginal trouble. 

In 1892 a reconciliation was effected with her 
husband, and she returned to him. Early in l89o 
she began to suffer with pain in the right side, pain 
in the right leg and hip, worse on standing or walk¬ 
ing. worse on changing position, not worse at night. 
At fil’st nothing definite could be found. She went 
to the seaside for a change, and while there was 
seized with violent peritonitis, during which, I under¬ 
stand, her life was despaired of. She had the advan¬ 
tage of every comfort and advice, and a London 
opinion was obtained for hei\ After some weeks of 
careful nursing she returned to Waiwickshire, * 
thorough invalid, and I again saw her. I then found 
marked disease of the uterine appendages on the 
right side. The inflammatory mass formed & 
rather large tumour, and the parts were filed- 
but there was no fluctuation, or evidence of any 
marked collection of pus. I thought an operation 
would be necessax-y, but the patient wished to avoid 
it, and I was ready to try the effect of further treat¬ 
ment. Knowing her old history, and how well sue 
responded in foxmer days to anti-syphilitic trea - 
ment, I gave her gi-ain doses of hyd. c ci-eta and five 
to eight and ten grain doses of iodide of potassium. 
This she has taken ever since, and with steady mi 
provement — impi'ovement without the slight**, 
relapse. She has now no trace of disease on *>>- 
manual examination. She is in robust health, an 
can walk ten or twelve miles with enjoyment. 

Mi-s. E. is a patient I have also known for ah°u 
eighteen years, though I have only very rarely a 


Digi 


jOOQle 


Mat 24, 1899. _ORIGINAL COMMUNICATIONS._ Tn Medical Prim. 531 


tended her. During a large portion of this time she 
and her husband have been under the care of Dr. 
Bull, of Sparkhill. He has attended both of them 
for gonorrnoea and syphilis. 

In July, 1895, I was asked to see Mrs. E. in 
consultation with Dr. Bull. She had been confined 
to her bed for some weeks. She had severe abdo¬ 
minal and pelvic pain, and her temperature had been 
varying between 100 deg. and 102 deg. F. I found 
well-marked tubal disease—a mass on the right side 
reaching above the groin—but the exudation was 
hard and resistant, and there was no evidence of any 
large collection of fluid. 

I advised mercury and iodide as in the previous 
case, arranging, however, to see her again if there was 
no improvement, so that operation might be under¬ 
taken if necessary. From this date the patient 
steadily improved. I saw her nearly a year after¬ 
wards, and there was no trace of the old disease. I 
wrote to Dr. Bull last week, asking for news of her. 
He states :—“ Mi's. E. is in good health, and is now 
managing a business.” This patient has had a child 
since her attack of salpingitis, but it was born at 
seven months and only lived one day. 

Mrs. F. was brought to my hospital out-patient 
room on Feb. 26th, 1896, by Dr. Vinee. She was 20 years 
of age, and had been married nineteen months. She 
had one child, living, and of good general health. 
Pain had been complained of in the left side for six 
months. This was steadily increasing, was worse one 
week after menstruation, and prevented her from 
attending to her duties. The case was already recog¬ 
nised as one of gonorrhoeal salpingitis, and my opinion 
was asked regarding operation. I found a hard, 
tender mass to the left ot the uterus, rather fixed, and 
agreed with the diagnosis already made. I had some 
talk with Dr. Vince regarding my experience of 
these cases, and asked him if there was any history of 
syphilis as well as of gonorrhoea. On March 3rd I 
received the following note from him -.—“Since seeing 
you I have found there is a distinct history of 
syphilis in the husband. He is under me now with 
brain trouble, probably gumma. He has a gonor¬ 
rhoeal discharge at the present time, and the baby is 
practically blind from gonorrhoeal ophthalmia.” I 
thought it quite possible that the case might improve 
with specific treatment, and ordered the patient a 
mixture of the red iodide of mercury (gr. |) with 
iodide of potassium (5 grs.) to be taken three times 
a day (a formula which I use largely for continued 
administration). Thisshehas now taken continuously 
for nearly three years, and with steady improvement 
—improvement in which there has been no history of 
relapse whatever. The recovery has been slow but 
sure and uninterrupted. More than a year after the 
treatment was begun I find this note:—“ Append¬ 
ages palpably diseased on both sides, but not 
tender.” 

To-day (November 10th, 1898) I have examined her 
and find that the right ovary is still fixed, but this is 
the only pathological condition to be found. The 
patient herself states that she is perfectly well, has 
no pain or discomfort, and wishes to know if she 
may discontinue her attendance. 

I could, if I liked, supplement these cases by 
several others, but the four I have cited will, I think, 
suffice. Everyone must acknowledge that they are 
capital examples of cure after severe gonorrhoeal 
salpingitis. One patient can walk twelve miles with 
comfort, another manages a business which she has 
taken up since her illness, another who has only just 
regained her full health lias, nevei-theless, through 
the time of treatment, been attending to the cares of 
her family and the needs of her syphilitic husband, 
while another, after seven vears of freedom from 
disease, has buried her miserable past, married again, 


and is six months pregnant with the first child of a 
second family. 

Can anyone show similar cases of recovery after 
gonorrhoeal salpingitis in non-Byphilitis cases P I con¬ 
fess that until quite recently I could not produce them 
or anything really approaching to them in my own 
practice. And if tne general consensus of skilled 
professional opinion is to be trusted there has been 
no expectation of or belief in similar results since the 
publication of Prof. Sinclair’s book in 1888. 

If the cases I have brought forward then are at all 
exceptional in their recovery to what are we to attri¬ 
bute the happy issue P 

Is the poison of syphilis in my way antagonistic to 
that of gonorrhoea? I do not think that this can be 
maintained for a moment. The one disease does not 
in any way prevent the other, and untreated cases of 
both diseases in the same individual are among the 
very worst that I have encountered. I am forced 
to the conclusion that the treatment of the 
caBe is the main factor in recovery, and I 
am far more interested in putting as clearly 
and forcibly as I can this fact before the notice of the 
Society than in maintaining any special theory of its 
mode of action. At the same time, when I consider 
the difficulty in the untreated disease, not so much of 
obtaining temporary resolution of inflammatoi'y pro¬ 
ducts—this can often be obtained by simple rest in 
bed—but of obtaining a cessation of relapses and a 
steady progress towards permanent recovery, and 
when I find this recovery repeatedly following a 
prolonged and uninterrupted course of special treat¬ 
ment, I question whether this effect is attained simply 
by promoting absorption, but am more inclined to 
believe that the mercury collected in the tissues of the 
body after persistent administration has some direct 
antagonistic action to the vitality and spread of the 
gonococcus in the deeper layers of the mucous and in 
the submucous tissues. In contradistinction to the 
opinion expressed by most writers of the last decade 
I believe it may be possible to destroy the power of 
latent gonorrhoea, as well as that of distinctly local 
and acute affection, and that this may be attained in 
a marked degree by the use of the veiy same means 
by which we attack the poison of syphilis. 

Since coming to this conclusion I have treated 
several cases of pelvic gonorrhoea uncomplicated with 
syphilis by mercury and iodides, and, in every case 
in which it lias been possible to continue supervision 
and treatment, I have had very similar results to those 
already reported. It will be obvious, however, that 
in most of these cases the duration of treatment has 
been as yet insufficient to fully test the value or 
permanence of its results, and that without general 
acceptance of the principles on which the treatment 
rests there is, and will be no likelihood of obtaining 
the same hearty co-operation on the part of the 
patient and medical attendant that is so well and 
cheerfully given in syphilis. One case in point is 
that of Mi* 8. G. She came to my out-patient room on 
September 23rd, 1896, with the history of abdominal 
and pelvic pain of some months’ standing. She was 
also suffering from a chronic vaginal discharge. On 
examination I found that both of the uterine appen¬ 
dages were inflamed and adherent—that on the right 
i side was adherent to the uterus only—that on the 
! left was adherent to the pelvic wall. On October 
22nd I put her on the biniodide mixture to which I 
! have already referred. She took it during October, 
November, December and January, and at this date 
was so much better that only faint traces of any 
disease remained in the pelvis, and she herself refused 
further attendance. For half a year I did not see 
her. She returned on July 8th, 1897, complaining 
as before. Treatment was resumed, and she has 

Digitized by vjOO^ 1C 


Mai 24, 1899. 


532 the Medical Press. ORIGINAL COMMUNICATIONS. 


continued it until the present date. The uterus is 
perfectly free and movable, and there is no trace of 
disease to be found on examinu tion. 

Another case of different type—recent and acute 
(the notes of which are entirely furnished by the 
patient’s medical attendant), may fitly close the 
series to which I ask your attention at this stage of 
my paper. 

“ Mrs. H.. jet. 30, has three children. The last child 
was born on March 25th, 1898, and a good recovery was 
made from the confinement. After a short visit to 
some friends in the following July, Mrs. H. returned 
home on July 16th in the best of health. On July 19th 
she felt some vaginal irritation, followed by vaginal 
discharge, and on July 22nd (the doctor states) I was 
called in to see her. I found her in bed, suffering from 
great abdominal pain, more especially on the right side 
of the abdomen, and from a profuse purulent discharge 
from the vagina. The temperature was 101 deg. F., and 
in the evening this rose to 104 deg. F. On inquiry and 
examination of the husband, I found that he also had a 
discharge from the urethra, which, to my mind, was a 
typical gonorrhoeal discharge. As important questions 
were involved in the diagnosis, specimens of the dis¬ 
charge were sent to London for bacteriological examina¬ 
tion, and gonococci were found in abundance. 

“ The pain, temperature, and discharge continued in 
spiteof douching and other remedies. On August 9th, Dr. 
Anuie Clarke saw her in consultation, and found the 
uterus fixed and the right half of the pelvis completely 
roofed by hard inflammatory swelling. 

“ On August 21st acute pain waB complained of on the 
left side of the abdomen. 

“ On August 31st, it seeming probable that some opera¬ 
tive interference might be needed, Mr. Taylor, of Bir¬ 
mingham, was called in. Gonorrhceal salpingitis, with 
its attendant sub-peritoneal exudation, was found on 
both sides, but at only one point was there any indication 
of possible ‘ pus ’ formation. 

“ Specific treatment was advised in the form of a 
biniodide mixture, and suppositories of ichthyol were 
ordered for vaginal use. 

“ From ten days to a fortnight after this date there has 
been steady and continued improvement. The patient 
got up for the first time on September 25th.” 

In a letter dated November 14th, 1898, the doctor 
writes:— 

“lam glad to tell you that at last our patient is out 
again, free from all pain and discharge, but naturally 
very weak after her long and trying illness. I made a 
vaginal examination last week and all that was to be 
felt was a hard, cord-like band running across the roof 
of the vagina on the left Bide. The right side was appa¬ 
rently quite normal.” 

[To le concluded, in our next.'] 


A 

CASE OF DOUBLE PYO-SALPINX, 

IN WHICH 

ONE OF THE TUBES CONTAINED 
NINETEEN OUNCES OF PUS.—REMOVAL 
BY ABDOMINAL SECTION.— 
RECOVERY, (a) 

By JOHN CAMPBELL. M.A., M.D., F.R.C.S.Eng.; 

Surgeon to the 8nnmritan Hospital for Women. Belfast, and 
Assistant Surgeon to the Belfast Maternity Hospital. 

There are on record several instances of the Fallo¬ 
pian tubes having become distended to enormous 
dimensions— e.g., Lawson Tait removed seven litres of 
fluid from a ha;mato-salpinx ; Stemann operated upon 
a tuberculous tube containing two litres of pus ; and 
Championni^rre met with a pyo-salpinx in which 

(a) Paper read before the British Gynecological Society, May 
11 th, 1 S9». For d iscussiou see page 535. 


there were about twelve hundred grammes of pus. 
The case, however, to which I now venture to call 
attention presents several features of interest inde¬ 
pendent of the size of the tubes. The fact that the 
tumour attuined such proportions without causing 
any notable amount of pain is in itself remarkable. 
Further, the almost entire absence of adhesions 
is quite contrary to all my experience of pyo- 
salpinx, as I have invariably found the larger 
collections of pus associated with numerous dense 
adhesions, Finally, the origin of the condition is 
somewhat obscure. No history of urethritis or 
vaginitis could be obtained. The patient had only 
been married for ten months, and had never been 
pregnant. There was no vise of temperature or other 
sign of tuberculous disease. From the thickness of 
the walls of the tube, and from the absence of acute 
symptoms; I am inclined to believe that the pus 
must have been present long before marriage, and 
that it must have originated in connection with 
some illness during childhood or adolescence. The 
following is a brief history of the case:—Mrs. C., 
set. about 27, and married ten months, consulted me 
on April 25th, 1898. about an occasional pain in her 
left iliac region. She had never been pregnant. 
Menstruation was regular every four weeks, lasting 
four days, and only sometimes accompanied by pain. 
Micturition was normal, and had always been so. 
The bowels were confined. She was a robust, 
well-nourished, somewhat, plethoric woman. Both 
breasts contained secretion. The abdomen was 
distended by a firm oval tumour, springing 
from the pelvis and extending to within two fingers’ 
breadths of the navel. It was most prominent to the 
left of the middle line. On vaginal examination the 
uteres wiis found to be retroverted, with a large 
movable tumour above it, and a smaller fixed one 
below and to the right of it. The urine was normal. 
Operation was advised and was performed on May 3rd, 
1898. A median incision exposed the larger tumour, 
which proved to be the greatly distended left tube. 
Nineteen ounces of pus were withdrawn by aspiration 
and the tube was removed. The right tube was 
then found to be in the pelvis and slightly adherent. 
It was removed entire. From its appearance I esti¬ 
mated that it contained 3$ or 4 ounces of pus. Both 
ovaries were much enlarged, and firm and tough in 
consistence. They were resected, the portions left 
being about the size of normal ovaries. The patient 
made an excellent recovery. I examined her on 
March 15th, 1899. i.e., about ten months after opera¬ 
tion, and found the uteres slightly retroverted. She 
enjoys good health and has been menstruating 
regularly. 

1 am indebted to Dr. Lorrain Smith for having 
preserved the specimens for me. 


INSANITY AND EDUCATION. 

By W. R. MACDERMOTT, M B. T.C.D., 

Medical Officer of Poyntzpass District. 

A common question put to medical men nowadays 
is : Why insanity is increasing ? When we admit the 
increase, what is the usual answer? We either say 
that it is due to unwholesome conditions of life, 
abuse of alcohol, tobacco, tea, and so on; or the 
contrary, to better and more secure conditions of life 
whereby through arrest of natural selection, panmixia, 
the insane, ana those predisposed to insanity survive 
to taint more deeply tne race. The last answer looks 
the deepest and most learned. 

Without any very clear insight into the nature of 
a disease we can often give grounds for it on the 
base of concurrence of facts. In modem life diffu¬ 
sion of education concurs more nearly with increase 


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May 24, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Pbebs. 533 


of insanity than any other fact, both being terms of 
mental import. But if relation of cause and effect 
exists it has not only to be established but valued. ; 
If ten millions of children are being educated—that 
is, exposed to mental strain with the result that a 
greater proportion of them become insane than would 
otherwise be the case—it does not follow that mental 
exercise is wrong or undesirable, since the benefit to 
the many may far outweigh the injury to the few. 
They could not be trained to ride horses or cycles with¬ 
out increase in the chapter of accidents, but no one 
would say that therefore they should not become 
horsemen and cyclists. If, however, education does 
conduce to insanity, it may be not in principle but 
in practice, in faults of educational method. 

Our definitions of insanity and education, we should 
realise, are highly conventional. The philosopher 
Dalton, of atomic theory fame, is said to nave 
scandalised a meeting of Friends to which staid body 
he belonged, by appearing in a pair of bright red 
stockings. They seemed to him to be sober grey, 
but we would not doubt his sanity. If, however, he 
laboured under the sense impression that his leg was 
brittle or made of glass, or if he was affected as the 
man Tuke tells us of, who lost the sense of self- 
identity and looked for himself under his bed, or if he 
had suffered from any one of the large class of similar 
abnormal impressions he would not have escaped so 
easily. If, however, it is allowed in his case that 
there was no defect in judgment, no mental disease, 
it is not easy to Bee how such disease comes to be 
affirmed in what are at bottom precisely similar cases. 
The same thing applies to disease of expression; the 
line we drew between somatic and mental state in 
aphasia, and the allied affections seems a very arbi¬ 
trary one. In general we allow abnormal sense 
impression and expression to be consistent with 
normal mental state so far that little room is left for 
mental disease in any true sense. 

Our ideas of education are, I am afraid, not only 
equally conventional, but false and vicious. When 
we analyse our mental existence we find its most 
striking characteristic impersonal operation. All our 
higher mental determinations might a6 well be 
obtained by an impersonal mind dead to us as by our 
personal selves. Psychologists who insist that the 
phenomenal object has no existence independent of 
the percipient mind, convict the whole human race of 
insanity, out in doing so they unintentionally define 
insanity, and what is so near it, crime. In popular 
thought, an orange, to use the classical Berkleyan 
simile, has independent existence, and is the cause of 
our sensation and perception of it. But — and I am 
not to be understood as trifling—insanity is disease 
of tbe common way of thinking, even if that 
way is psychologically erroneous and, what is 
strange, the disease takes on examination far more 
nearly than could be supposed the form of mind which 
is true and normal according to the psychologist. 
If a boy runs away with the orange from an 
apple-woman’s stall he will scarcely defend him¬ 
self by saying that it was a product of perceptual 
synthesis in his own mind, but we would certainly 
decide that he was far too much under the influence 
of the personal egoistic mind, and that it would be 
advisable to teach him, if necessary, by the birch, to 
reason in the usual impersonal way, however erroneous 
psychologically it might be. In general, the marked 
characteristic in the insane and mentally degraded is 
personal egoistic thought, inability to truly distin¬ 
guish phenomenal object with consequent delusion by 
taking it as a product of mental synthesis, the process 
just as it is most strongly marked betraying its own 
radical incapacity. Again there is inability to 
eliminate personal self in the usual way from such 
ideas as God, king, beggar-man, and so on, and from 
ideas of relation so that the insane person imagines 


those in contact with him to be absorbed in thought 
about him, conspiring against him. Further the 
imperious control which the ordinary realisation of 
independent objective existence exerts on him being 
weakened, he is left more completely to the unregu¬ 
lated impulses of the personal mind. But this exactly 
answers to the concrete, self-contained individual 
mind of psychological definition entirely dependent 
qua mind on personal nature. 

In our educational system, or rather negation of 
system, it is practically thought enough to bring the 
personal mind of each subject into conformity with a 
resultant obtained by a reaction of such minds on 
each other now and in past time. It is enough, 
that is, to bring the subject into conformity with 
some more or less generally received and established 
canon of thinking and of conduct as flowing from 
such 8en»U8 communis. But when we examine the 
social mind we can easily see that it is not only 
. largely formed on the concrete personal mind, but 
superadds to it grievous faults of its own. The child 
is consciously and unconsciously trained up to con¬ 
form thought and conduct to a conventional standard 
of sanity, the vices of which it takes no Jeremiah or 
Juvenal to detect and denounce. Insanity at bottom 
is an exaggeration of the personal egoistic mind, is 
aberration in some ways from tbe impersonal mode 
in thought, but if we examine morbid ideation in tbe 
actual field we will find that it affects nearly entirely 
what is acquired by or socially impressed on the 
mind. It may be said that sucn is tbe case, 
simply because man learns to think just as he 
learns to walk, ride or play the piano, that his 
mental are as much acquired as his bodily abilities, 
and that, therefore, mental disease would necessarily 
show itself in reference to acquired ideas. Suppose, 
however, a man learns to swim, he is determined by 
physical constants in the nature of his own body and 
of water. In the same way, when he learns to think, 
he is determined by a physical nature in mind abso¬ 
lutely independent of him, by what are called the 
necessary laws of thought. But if one thing is more 
certain than another it is that as the personal egoistic 
mind intervenes he cannot even learn to swim aright, 
he is timid, awkward, miscalculates his powers. Much 
more since such mind does not give the necessary 
laws of impersonal thought he is unable, just as he is 
under its influence, to think aright if at all. 

But the personal mind, a bundle of sensations, 
perceptions, and emotions, can be trained, educated 
up to a certain conventional standard of formal 
thought. Animals which have no other mind can be 
trained to do wonderful things, and no doubt they 
have formal automatic thought in doing them. I 
have often noticed, however, that performing animals 
have a puzzled, downcast, hang-dog look, as if 
heartily ashamed of themselves, and doubtful of their 
own sanity. The Anti-Vivisectionists should look 
after the moral dignity as well as corporeal integrity 
of their 'protegee. 

We hardly realise how much for mankind educa¬ 
tion and social training are based on the personal, that 
is the really insane mind. I said just now that the 
boy who stole the orange should be taught to think 
impersonally by the birch, if necessary. By a system 
of rewards and punishments directly influencing the 
personal mind and conformed to its nature, the boy 
no doubt can be got to let the orange alone, but he is 
not thereby made to think impersonally that is 
sanely; the very contrary is the result; he is con¬ 
formed more implicitly to the nature of personal 
mind. 

It cannot be said that education is worse now, 
more directed to influence the purely personal mind 
than “ when civil dudgeon first grew high and men 
fell out, they knew not why,” when the belief in 
witchcraft and other forms of social insanity prevailed. 

O 


534 Thb Mbiiical Press. TRANSACTIONS OF SOCIETIES. Mat 24, 1899. 


The contrary is, perhaps, the case; the impersonal 
mind has a larger field of exercise with the advance 
in Dhysical and natural science. What, however, has 
undoubtedly happened is that a vastly increased 
number of persons are now brought under educa¬ 
tional influences directed to develop the personal 
mind on its own lines, that they are trained exactly 
as performing animals are. 

The common plea for education is itself an illus¬ 
tration of this. The plea is that it opens a career to 
the subject, that it promises better social position, 
improved material status, what-not. This incite¬ 
ment directed to the personal mind is a false one, the 
promise is not and cannot be kept; the number that 
from this point of view education deceives and dis¬ 
appoints is far and away greater than the number it 
serves. 

Far and away the greater number of children who 
attend our schools settle down as labourers, small 
farmers, and so on, with little or no opportunity or 
occasion for the three R's. It would not be true, 
however, to say that they are in the same mental 
state as if not educated. There is a discontent and 
impatience with their lot which the totally unedu¬ 
cated seldom show, there is too much of the “ a man 
is a man for a’ that” in them, a touchy sensitive 
personality with a rare crop of curious bizarre notions, 
the product of the peroeptual synthesis of the 
psychologists, utterly at variance with the laws of 
impersonal mind. They are, as I conceive, far more 
predisposed to insanity than the uneducated. I sus¬ 
pect that the ratio of insane per 1,000 of illiterates 
would be found much lower than the ratio per 1,000 of 
those subjected to an ordinary school education, but 
I have not ascertained the point, writing current 
calamo. 

But it will be said that education must be con¬ 
formed to the personal egoistic mind, to its desires, 
vanities, ambitions, tendencies. If so, we must pay 
the penalty. I, however, deny the position on grounds 
which the limits of this article do not allow me to 
give. 

It is enough to say that the position of the psycho¬ 
logist and evolutionist is a very Questionable one. It is 
open to question whether there is any “ human mind,” 
as a distinct entity evolved from or in relation with 
the nervous system. It is more consistent with the 
mass of biological facts to take mind as an indepen¬ 
dent natural form of existence in varying conformity 
to which animals are evolved in mucb the same 
way as to physical conditions, the bird to air, the fish 
to water. On this supposition the impersonal form 
of mind which man touches, but rests only insecurely 
on becomes quite intelligible. But as man rises to, 
rests on the impersonal level it is disease, insanity, 
in him to revert to the personal level. 

It would be ill for us if our faulty system of educa¬ 
tion was not antagonised and corrected by our un¬ 
conscious race education ever tending to develope 
the impersonal mind, the natural effect of having m 
so many directions to reason impersonally. In 
other words, as far as education opens up to 
us modes and subject matters of impersonal 
thought it serves to counteract the evil of training 
vis like animals, who, in a certain sense, are 
made insane bv an education non-natural to them. 
Still, while for human beings the impassive operation 
of impersonal mind is natural, it is only imperfectly 
so, and while education does incidentally cultivate the 
operation, and therefore tends to raise us to the higher 
level, it is at the expense of an unconscious and 
almost unintelligible struggle with the personal mind, 
animated by egoistic motive. Education rejecting 
the motives of the personal mind is almost 
unintelligible and yet impersonal, that is sane 
thought, allows no more place for personal motive 
in conduct than in geometry; if the law of mind is 


independent of the personal agent in one case it is so 
in the other. This may seem a hard saying, but it 
really follows once we allow that mind is an inde¬ 
pendent natural existence to which we are conformed 
in higher degree than the lower animals, but still 
only in varying degree. 

Thirty years ago Maudsley, in his “ Physiology 
and Pathology of the Mind,” taught that pyschic 
laws are the same in healthy and diseased phenomena, 
only they do not operate under the same conditions, 
and therefore produce different symptoms. We have 
travelled so far from that, as I conceive, sound posi¬ 
tion, that a case of colour-blindness, or, for that 
mstter, eveiy abnormal bodily state should logically 
be regarded as insanity. We are taught now that 
psychosis and neurosis are inseparable concomitants, 
that disease of the last implies disease of the first. 
Without entering into a discussion of the position it 
is enough to say that the most effective limitation of 
insanity we bale is the essentially impersonal habit 
of distrusting and questioning our sense impressions 
and emotional impulses, and education ought to be 
directed more than it is to develope that habit. 

I will end with a more practical suggestion. I see 
that in Prussia, among the moet highly educated people 
in Europe, the number of the insane in asylums rose 
from 13,267 in 1875 to 66,888 in 1897. That is only 
one illustration of many I could give of the wisdom 
of hesitation in enforcing the policy of compulsory 
education to the bitter end. It might be as well to 
go slower. Parliament voted between eight and nine 
millions the other day for education in England and 
Wales. It would be better if it voted more millions 
to raise the material status of the people; it looks 
like social insanity to aggrauate the lot of a mass of 
paupers or semi-paupers by an education certainly 
useless, and very probably with a tendency to add the 
curse of lunacy to their misery. 


^raitBartiflns of gocietus. 

BRITISH GYNECOLOGICAL SOCIETY. 

Meeting helu Thursday, Mat 11th, 1899. 

The President, Dr. H. M&cnauohton-Jonxb, in the Chair. 

LARGE INTRA-CY8TIC MAMMARY BABCOMA BEMOVED 
BY OPERATION. 

Db. Herbert Snow exhibited a photograph of this 
specimen, excised in April last. The patient was a 
married woman, set. 66, two children. There was no 
history of injury, but there had been much recent 
trouble and anxiety, to which, with pressure by tight 
stays, the growth was attributable. It appeared only 
one and a-half years previously, and had rapidly grown 
to a huge size, forming a prominent borBy mass of unequal 
consistence. Was fist noticed as a little lump under 
the inferior aspect of the organ. There was a dull con¬ 
tinuous aching pain, but the general health was sound. 
The axillary region was tender, but there was no gland 
enlargement. The skin was enormously distended, livid, 
marbled by large veins; the nipple almost obliterated 
by the pressure; the whole mobile. 

On excision the growth proved a congeries of whitish 
fibrous masses, which had developed without a primary 
cyst. Part of the cyst-wall remained, but most of the 
fluid contents had disappeared ( as usually happens in 
these cases) through continuous pressure. The solid 
xemainder, after incision, weighed 4 lbs. 4 ozs. The 
wound healed by first intention. 

The microscopic section showed transition between 
well-organised fibrous tissue, and the embryonic spindle- 
cells of true sarcoma. Formerly, these tumours were 
often allowed to ulcerate, and were termed “fungatirg 
adenoma.” They proved then rapidly fatal, through 
exhausting drain or blood serum and attacks of hsemor- 

Digitized by Google 



May 24, 1699. TRANS ACTIONS OF SOCIETIES. _ The Medical Freeh. 535 


rhage. Modern surgery rarely allowed them to proceed 
so far. There were no metaetases, and the localisation 
of the disease, with consequent curability by excision in 
even the most advanced stages, showed a striking con* 
trast to the clinical phenomena of mammary carcinoma. 

Dr. Hetwood 8mith asked how the flaps were 
fashioned in this case P 

Dr. C. H. F. Rooth remarked that he read a paper at 
the International Congress to show how often diseases of 
the breast were associated with and kept up by diseases 
of the uterus. As an example, he had a case in which 
he removed a breast for carcinoma; it healed up, but 
the wound kept on breaking down. He then examined 
the uterus and found a very large ulcer involving the 
cervix and vagina. He cured this, and the breast got 
quite well. He would ask Dr. Snow whether the con¬ 
dition of the uterus was examined in his case. 

The President said that in some of these cases it was 
very difficult to determine whether the disease was a 
true carcinoma, or a transition between that and 
adenoma. He had seen some cases in which the clinical 
condition pointed to scirrhus, but a microscopic examina¬ 
tion showed it to be otherwise. Sometimes also both 
pathological and microscopical indications were so mixed 
up that it was very difficult to say what the condition 
was. Cases such as Dr. Snow’s were not often seen at 
the present day, because they were usually operated on 
earlier. 

In reply. Dr. Snow stated that although the skin 
covering was so tense, there was no infiltration of the 
subcutaneous tissue, as would have been the case with 
a carcinoma. He had dissected off sufficient flaps for 
union by first intention, and did not think there would 
be any recurrence. He fully agreed with Dr. Routh that 
uterine lesions might exert a considerable effect in 
causing mammary lesions; but believed that both much 
more often followed a common cause, the pressure of 
stays hindering development on the one hand, or healthy 
involution on the other. There were no uterine symptoms 
in the present case, and the woman was long past her 
climacteric. It was certainly, however, an excellent 
rule, in the absence of obvious cause for a mammary 
tumour, to seek it in the uterus. The errors in micro¬ 
scopic diagnosis, referred to by the President, Dr. Snow 
considered mainly due to reliance by pathologists on the 
phenomena of prepared sections alone. In these the true 
ehape of the cells was often disguised or altered. It 
was most essential to examine the individual cells as 
nearly as possible in their natural state, as well as the 
hardened thin section. 

1. Mr. J. W. Taylor, Birmingham, read a paper on 
“ The Treatment of Gonorrhoeal Salpingitis.” 

2. Dr. John Campbell, Belfast, read a paper on “ A 
Case of Pyo-ealpinx, in which one of the tubes contained 
19 ozs. of pus.” 

These papers will be found in another part of the 
journal, under the heading of “ Original Communica¬ 
tions.” 

In the discussion on these two papers, 

Mr. Alexander Foolerton said that there was a 
good deal of bacteriological evidence at our disposal 
with regard to the relative frequency of gonorrhceal 
infection in the causation of salpingitis. He had care- | 
fully examined the pus from sixteen cases of pyo-salpinx 
with the following results.-—Cultures of micrococcus 
gonorrhoea, staphylococcus pyogenes albus, and bacillus 
colt communis were each obtained in two cases, and of 
streptococcus pyogenes in one, and in all seven cases the 
parasite present was found in pure culture. In the 
remaining nine cases no culture appeared on the media, 
but in two of them the presence of bacillus tuberculosis 
was proved by other methods. The cultivation experi¬ 
ments in all sixteen oases included the inoculation of a 
smear of fresh human blood on an agar plate, with the 
view of obtaining cultures of the gonococcus if present. 
Such a series as this was, however, much too limited to 
permit of any conclusions being drawn from it. Accord¬ 
ingly he had brought together a number of results pub¬ 
lished by others; and in compiling the statistics he bad 
taken into consideration only work published since 1890, 
and work done by those—such as Menge, Steinschneider, 
and others—who had devoted special attention to this 


matter. Thus his own series of sixteen cases was the 
smallest individual series included. The following 
figures were, therefore, as free as possible from various 
sources of fallacy. In all he had been able to collect 
499 cases of salpingitis so examined, and among these 
cases were 85 in which the gonococcus had been identified, 
or about 19 per cent. On going into the matter in detail, 
however, he found that in about 60 per cent, of the cases 
no micro-organism of any sort had been identified in the 
contents of the tubes. Out of every hundred cases of 
salpingitis, therefore, there were about sixty cases in 
which the pus was, at the time of examination, sterild ; 
there were about twenty cases in which the gonococcus 
was present; and there were about twenty cases in which 
bacteria other than the gonococcus were found. And 
first as to the sixty cases in which the contents of the 
tube were sterile of bacteria, the explanation of their 
occurrence in so large proportion was probably a simple 
one. These cases did not, as a rule, come under bac¬ 
teriological examination until the inflammatory process 
was already of some considerable duration ; and the 
causative parasites had meanwhile died out, partly 
starved for want of nourishment, partly poisoned by 
their own excretory products—just in the same way that 
a number of animalB would perish after a time if closely 
confined in a limited space. Then as to the twenty caseB 
in which bacteria other than the gonococcus were pre¬ 
sent, a considerable number of these cases would have to 
be rejected when considering evidence as to the etiology 
of salpingitis, for the reason that the bacteria present 
were obviously there as the result of a secondary 
infection of tubes already in a state of inflammation 
from some other cause. Thus, whenever bacillus coli 
communis was found in a pyo-salpinx, Mr. Foulerton felt 
sure, as the result of a number of observations which he 
had made in various cases of pelvic suppuration, that its 
presence might always be attributed to a secondary infeo- 
tion from the bowel following the formation of adhesions 
between a tube already inflamed and some neighbouring 
portion of intestine. When, therefore, we considered 
only those cases in which the cause could be proved by 
the exact methods demanded in pathological research 
we found that the gonococcus was present as the causa¬ 
tive parasite in considerably more than half such. And 
that this estimate is, owing to the conditions under 
which examinations are made, considerably less than is 
actually the case is highly probable when we take into 
consideration the further light thrown on the subject by 
clinical observation. He did not think, on the 
other hand, that there was much trustworthy 
evidence of any sort that syphilitic infection 
was an important factor in the causation of 
salpingitis. As to the treatment of salpingitis he had 
very little to say, but Mr. Taylor had offered them a 
sufficient variety to choose from, ranging in severity 
from the administration of biniodide of mercury to the 
performance of hysterectomy. His own view was that 
since an inflamed tube was a serious source of potential 
danger to a woman, and a constant cause of ill-health, 
the sooner it was removed the better. But hysterec¬ 
tomy would, he thought, very seldom be necessary. 
With regard to the prevention of salpingitis, perhaps an 
even more important matter than its treatment, there 
was rather more to be said. Recognising as he did the 
frequency of gonorrhoeal infection as a cause of salpin¬ 
gitis, he thought that surgeons generally had not 
availed themselves of the assistance in the treatment of 
this disease which had been placed at their disposal 
as the result of pathological research, ThuB a 
case of primary gonorrhoeal infection in a woman 
was almost invariably treated as a vaginitis by 
means of vaginal medication of one sort or another. 
Whereas it seemed to have been clearly proved that a 
true gonorrhoeal vaginitis was a rather uncommon occur¬ 
rence. Bacteriologists had shown that gonorrhoeal 
infection of the genital tract in a woman was first 
manifested either by a nrethro-vulvitis or an endo- 
cervicitis, in the majority of cases perhaps by both. 
The vaginitis which occurred with gonorrhoeal infection 
was, on the other hand, not usually caused directly by 
the specific coccus at all, but was rather the result of the 
Bpreading upwards of an inflammatory process caused by 


536 The Medical Press. TRANSACTIONS OF SOCIETIES._ May 24, 1899. 


other bacteria which had gained access to the original 
lesion situated somewhere in the region of the external 
urethral meatus and caused by the gonococcus. Thus in 
489 cases in which the vulval discharge was examined, 
the gonococcus was found 323 times, or in about 
66 per cent., whilst in 680 cases in which the 
purely vaginal discharge was examined, the gonococcus 
was found only 64 times, or in about 8 per cent. 
Bearing these facts in mind the usual treatment of 

S rimary gonorrhoeal infection in women must be con- 
emned as inadequate. The treatment of the disease 
as a vaginitis was the treatment of what was merely a 
secondary complication; it might, indeed, incidentally 
have some good effect on the primary urethro-vulvitis, 
but left the primary endocervicitis untouched. And he 
thought that if more attention were paid to the condi¬ 
tion of the cervical canal in cases of gonorrhoeal infec¬ 
tion, the frequency of so serious a complication (as 
salpingitis undoubtedly was) would be very much 
diminished. 

Dr. Wm. Travers congratulated Mr. Taylor on his 
paper, which dealt largely with the medical aspect of 
these cases. "When he first took up gynaecology it was 
chiefly in its medical aspect; the advance of the subject 
had necessarily led him and others to treat it from the 
surgical standpoint; but there was still much to be said 
on the medical side. His own experience had been that 
perchloride of mercury cured many of these cases of 
gonorrhcea; and in his hospital practice he often gave 
the drug before resorting to operation. And as he went 
on, he found more and more cases cleared up by medical 
treatment. 

Mr. C. Ryall thought that Mr. Taylor laid undue 
stress on syphilis as a cause of the symptoms of gonor¬ 
rhoea. At the Lock Hospital he found many cases of 
syphilis complicated by unrecognised gonorrhoea which 
had been overlooked. As regards preventive treatment, 
he did not think that enough credit was given to work 
done in this country. The best treatment of gonorrhcea 
was, he thought, the local application of nitrate of 
silver, 40 grs. to the ounce, whether the infection was 
one of the vagina or of the cervical canal. 

Dr. C. H. F. Routh said the question was, ‘Wbat did 
really constitute gonorrhoea ? Were other bacilli that 
might be present hostile or otherwise to the gonococcus ? 
They had probably no right to conclude that most of 
these caseB were syphilitic, even if they had got well 
under anti syphilitic treatment; and they should always 
remember that every case of gonorrhoea should be treated 
not only locally, but also on general principles. 

Dr. R. H. Hodgson thought it made very little differ¬ 
ence whether pyo-salpinx was due to gonorrhcea or to 
syphilis. Mercury acted on both, and it was a drug that 
was specially well borne by women. It could be used 
with advantage also when the cervix was first affected, 
and in this way they could treat the disease itself, and 
not merely its tubal complication. 

Dr. George Elder (Tsottingham) commented on the 
fashions that prevailed in medicine and surgery. A few 
years ago they were in the habit of removing the 
appendages when there was a history of gonorrhcea with 
recurrent attacks of pelvi-peritonitis; but now, with the 
swing of the pendulum, they were becoming more con¬ 
servative in their methods. The mercurial treatment 
was advised twenty-five years ago, and the patients got 
well and remained so; but they were much indebted to 
Mr. Taylor because he had given them the reasons for 
the success of the treatment. With regard to Dr. Camp¬ 
bell’s case, he had also seen patients with large pus-tubes 
who were able to get about, showing neither temperature 
nor much pain. The largest cases he had seen had 
been cases of mixed infection, where there had been 
communication between tubes and bowel. 

Dr. Arthur Giles considered that Mr. Taylor’s paper 
was one of great value, and that it would be increasingly 
appreciated when it could be read over at leisure in the 
journals. One point clearly brought out was that 
gonorrhoea was in many cases complicated by an unre¬ 
cognised syphilis, and that these cases consequently im¬ 
proved considerably under anti-syphilitic treatment. 
He was greatly interested in Mr. Taylor’s remarks on 
the value of mercury in the treatment of gonorrhceal 


pyo-salpinx, even when syphilis could be excluded. This 
was a most suggestive point, and one which would 
probably be found very useful in practice. This 
teaching, which on the showing of some previous 
speakers, was not new, had probably lapsed; certainly 
he had not heard it in his student days. But inde¬ 
pendently he had experienced the value of mer¬ 
cury in the treatment of condylomata of the vulva, 
in cases where there was no suspicion of syphilis. 
He had often found that by the internal administration 
of the biniodide of mercury, combined with local applica¬ 
tions of blackwash and blue ointment, condylomata 
nearly disappeared in a week. The infrequency of 
gonorrhceal vaginitis was to be explained by the ana¬ 
tomical structure of the vaginal epithelium, which was 
stratified. Bumon had found that gonococci apparently 
had great difficulty in penetrating this epithelium, while 
they could attack the single columnar layer in the 
urethra and cervix with ease. He had long felt that the 
treatment of gonorrhcea by applications to the vagina 
alone was very inadequate; and that the proper treat¬ 
ment in the quite early stages was to thoroughly disin¬ 
fect the vagina and cervix under an anaesthetic. 

The President said that Mr. Taylor’s paper was an 
important one which would be sure to attract attention not 
only in this country, but also abroad. The discussion 
would help to remind them that gonorrhoea and syphilis 
were mixed up in a large proportion of cases; be had 
himself learned this from the careful observations of the 
late Tilbury Fox. In many cases where syphilis was 
denied without deceptive intention, there had really been 
some syphilitic infection. He had not so far seen the 
view advanced that mercury should be given in cases of 
advanced tubal disease; but thiB was a question that 
required careful attention. An important point in the 
paper was the conservative one of the advocacy of 
posterior vaginal section in the treatment of pyo-salpinx. 
Theie were cases in which, as Mr. Taylor said, medicines 
were useless; and which nevertheless stopped short of 
pyo-salpinx. Still, the indication was operation. It 
would seem to him a dangerous thing to rely too much 
on the vis medicatrix naturae, instead of treatment by 
removal of the adnexa. At the same time his firm 
personal belief was that many adnexa were removed 
unnecessarily. The points raised by Mr. Foulerton were 
of great importance; he had seen it stated that the 
gonococcus was found as the causal factor in 33 per cent 
of cases of pyo-salpinx. It was also important that they 
should remember that the cervix was so often infected; 
much harm might be done by treating the vagina alone 
by forcible douching. He believed that the cause of the 
infrequency of vaginal gonorrheea was, as stated by Dr. 
Giles, the structure of the vaginal epithelium. 

Dr. Campbell’s case was a very interesting one, the 
absence of pain was a notable point in many of these 
cases. A year ago he showed a specimen at the Obstetri¬ 
cal Society, from a patient with a similar history; there 
was no pain until the function of the bladder became 
interfered with. It was a general rule that in tubal 
disease the symptoms might be very slight in propor¬ 
tion to the severity of the condition. 

Mr. Taylor, in reply, said that the main point in his 
paper was not the recognition of the fact of the com¬ 
plication of gonorrhcea by syphilis; but that in cases 
of mixed infection improvement of the salpingitis 
could be effected by anti-syphilitic treatment; and 
that improvement might also occur in cases where 
there was no syphilitic history. He thought that 
both clinical and bacteriological examination would go 
to show that most cases of pyo-salpinx were due to 
gonorrhcea or tuberculosis. The statement that pri¬ 
mary gonorrhceal vaginitis never occurred seemed to 
him too strong a statement; but it might be very tran¬ 
sitory. It had long been recognised that the source of 
danger to the woman was the disease in the cervix; but 
he had found that mechanieal treatment of the cervix 
and uterus might be disastrous, and might lead to salpin¬ 
gitis. In his opinion the treatment by suppositories 
was better. He had not found any harmful result from 
the vaginal douche. 

Dr. Campbell expressed his thanks for the interest 
the Society had shown in his paper. 



May 24, 1899. 


TRANSACTIONS OF SOCIETIES. The Medical Press. 537 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Medicine. 


Meeting held Friday, April 14th, 1899. 


The President, Dr. John W. Moore, in the Chair. 


NOTES ON A CA8E OF ADDISON’8 DI8EA6E. 

Dh. J. B. Coleman made a communication on the 
subject of diseases of the suprarenal capsules, and 
exhibited the viscera and microscopic sections of two 
cases, of which he narrated the clinical history. One 
case presented the classical symptoms of Addison’s 
disease, and it occurred in a girl, set. 20, the duration of 
the disease being three years. Both suprarenal capsules 
were more than double the normal size, and were a mass 
of fibro-caseous material, containing giant cells and 
tubercles; sections of the skin showed brownish-yellow 
pigment in the cells of the rete mucosum; the heart 
weighed only five ounces; in the duodenum close to the 
pylorus there were pin-head-sized greyish nodules, due 
to hyperplasia of lymphoid tissue around the gland 
tubules. The other case was one of primary sarcoma of 
the suprarenal bodies, the patient being a man, eet. 23, 
who presented none of the symptoms of Addison’s dis¬ 
ease. For three months before his death he suffered from 
epileptiform fits and from weakness of his limbs; on 
admission to hospital he presented the signs of ataxic 
paraplegia; after a debauch he rapidly passed from a 
drowsy condition into collapse and coma ; the necropsy 
showed both adrenals uniformly enlarged to the size of 
aman’s fist, the growths consisting of round-celled 
sarcoma; there was a secondary growth about the size 
of a cherry in the wall of the right auricle ; no tumours 
in the brain or cord; the cord showed degeneration in 
the motor tracts and in the posterior columns. Dr. 
Coleman suggested that the epileptiform fits and the 
degeneration in the spinal cord were the result of a 
toxaemia, the latter being due to the diseased condition 
of the adrenals; under the depressing influences of the 
debauch the terminal symptoms were set up—drowsi¬ 
ness, collapse, and coma. 

Dr. R. Travers Smith spoke. 

Dr. Finny pointed out that great destruction of the 
suprarenale could take place without any of the sym¬ 
ptoms of Addison’s disease supervening. There was also 
a group of cases which presented all the evidence of 
suprarenal melasma, while a necropsy showed that the 
suprarenale were perfectly healthy. He himself had an 
example of the latter group under care. The patient 
was Buffering from tuberculous disease, but the 
suprarenale were unaffected. He therefore thought it 
probable that the disease was due to some affection of 
the large nerve elements in the neighbourhood rather 
than to structural changes in the gland itself. 

The President said that, as had been Bhown, there 
were three groups of cases—namely, disease of the supra- 
renals and pigmentation, disease without pigmentation, 
and pigmentation without disease. 

Dr. Coleman, in reply, said he thought Byrom Bram- 
well’B theory the safest, in which he combined the supra¬ 
renal inadequacy and the nervous theory. 

CASES OF PYLORIC OBSTRUCTION. 

Dr. Parsons read a paper on the above subject. 

The President, Surgeon Croly, Mr. G. J. Johnston, 
and Dr. Langford Symes discussed the paper. 

CHRONIC PHARYNGITIS. 

Dr. Robert Woods read a paper on chronic pharyn¬ 
gitis and its relation to nasal obstruction, in which he 
expressed hiB belief that mouth-breathing was the essen¬ 
tial cause of chronic simple inflammations of the throat. 
He reviewed the chief functions of the nose, and 
pointed out how in mouth-breathers the disuse of the 
special apparatus for modifying the air, by warming, 
moistening, and filtering from duet, must affect the 
throat injuriously, since the throat was compelled to take 
on the function of the nose. In support of this conten¬ 
tion he quoted an observation he had repeatedly made, 
that in these cases of chronic pharyngitis, if the velum 


palati be lifted, the pharynx wall under cover of it will 
be found normal. In addition to the more familiar forms 
of nasal obstruction, he drew attention to a common 
condition of the nose where the passage, though free 
enough in the daytime, became stopped at night. This 
results apparently from the difference in level of the 
head between the upright and horizontal positions, there 
being less drainage, and, therefore, greater tendency for 
the congested soft tissues to encroach on the air-spaoe 
in the horizontal than in the upright. The paper con¬ 
cluded with a short account of the operative nasal tieat- 
ment necessary for the cure of the condition. 

The Section then adjourned. 


LIVERPOOL MEDICAL SOCIETY. 
Meeting held Thursday, April 27th, 1899. 


Dr. Macfik Campbell, President, in the Chair. 


Dr. John Hay related three cases of “Pulsus Para¬ 
doxus.*' I the first cases the abnormal pulse condition 
was associated with the dyspnoea of acute bronchitis in 
a child of three years, and was only a temporary 
phenomenon. The second case was one of pericarditis 
with effusion, complicated by serous effusion into the 
right pleural cavity. The removal of this fluid improved 
the pulse condition, but the pulsus paradoxus again 
became well marked, without a corresponding 
accumulation of fluid in the pleural cavity. The 
third case was one of reversed pulsus paradoxus, 
the arterial pulsation in the vessels of the right side of 
the neck and right arm disappearing during expiration. 
It was observed in a man suffering from aneurysmal 
dilatation of the arch of the aorta. The cases were 
illustrated by pulse tracings and charts of the chests. 

Dr. Bradshaw considered that the anacrotic character 
of the pulse in the last case was due to the percussion 
wave being largely lost in its transmission through the 
sac of the aneurysm. It was followed by a slowly 
advancing tidal wave. The increased anacrotism during 
expiration was to be explained by increased interference 
with the passage of the tidal wave. 

Mr. F. T. Paul exhibited a patient on whom he had 
performed colotomy by a new method. The divided 
large intestine was conducted for some distance between 
the muscles of the abdominal wall and then brought to 
the surface. This allowed of efficient control by a light 
horseshoe truss. 

Mr. Thelwall Thomas spoke in favour of Frank’s 
operation, and exhibited a photograph of a man operated 
upon Bix months previously, and who is now following 
his occupation. He saw objections to the Senn method. 

Mr. Rushton Parker eihibited a boy whose right 
upper extremity had been almost totally avulsed by 
machinery, necessitating the removal of the whole, ex¬ 
cept a short piece of the clavicle. The subclavian artery 
had been torn across. Injection of saline solution into 
the veins acted very beneficially. 

Dr. Whitfobd exhibited a patient who had suffered 
from lupus for seventeen years. She came of a very 
“ tuberculous ” family. Some of the scars as the result 
of treatment were elastic and almost undistinguishable 
from normal skin. The treatment had been scraping, with 
the application of caustic potash in sticks. 

Dr. Pbrmewan read notes of a case of “ Acute Rhinitis’’ 
which had caused general infection of the system, and 
in which treatment directed to the nasal condition caused 
rapid subsidence of the fever, &c. 

Mr. W. M. Clemmey related a case of “ Rupture of 
Kidney,” with secondary operation and recovery. The 
patient received a kick from a horse in the front of the 
abdomen on September 21st, 1898. The first symptoms 
of pain, collapse, and retching and hsematuria were 
treated by fomentations and opium. On September 30th, 
owing to the temperature rising, the pain of a grinding 
character not eased, the loin was opened, exposing the 
inflamed kidney, the rupture extending half way 
through the substance, right across the posterior aspect 
and into the pelvis of the kidney. Smart bleeding, 
‘controlled by ice and packing, followed. On Decern¬ 


ed byV^»oogie 


538 The Medical Press. 


GERMANY. 


Mat 24, 1899. 


ber 6th, the tube was removed. On April 13th the 
wound healed, the patient since working as a timber 
carrier and being in excellent health. In three other 
oases of severe kidney injury with the ordinary sym¬ 
ptoms of rupture no operation was required, rest, 
fomentations, ice, and opium being the treatment. 
Whether secondary lesions of the kidney will follow it 
is at present too short a time to say. 


gvma. 

[from our own correspondent.J 

Paris, May 20, 1899. 

Gunshot Wound in the Chest. 

M. Lucas presented a man of 35 at the Academie de 
MMecine who had received two months previously a 
revolver bullet in the chest. The orifice of penetration 
was situated a little to the right of the sternum towards 
the clavicle, and the projectile traversed the lung from 
above downwards. The man was brought to the hospital 
in an almost comatose condition; the pulse was small 
and irregular, and the patient spat up a large quan¬ 
tity of blood. The wound was washed with oxygen 
water and plugged with iodoform gauze, while 
the patient was recommended absolute immobility. 
The following day all the signs of a large effusion of 
blood in the right side of the thorax were present. Sub¬ 
delirium accompanied by prtecordial anxiety being re¬ 
marked during the night, an injection of morphia was 
given, and in two or three days the effusion began to be 
absorbed, and finally the man recovered without any 
more trouble. The radiograph showed the ball to be 
lodged in front of the twelfth rib. The speaker said 
that he seized on this case to state in a few words the 
method to be followed in the treatment of penetrating 
wounds of the chest. Contrary to that which took 
place in penetrating wounds of the abdomen, for which 
the general tendency was to operate as early as possible, 
great reserve should prevail. Not only was it not neces¬ 
sary to interfere in the majority of casee, but the patient 
should be the least disturbed possible. He should be 
examined with extreme discretion, as the simple moving 
to practise auscultation might be fatal to him. The 
patient should not be placed in the horizontal position, 
but rather half sitting up, so as to facilitate the laboured 
respiration. Against the heemoptysis iced drinks hould 
be given, and purgatives, when the first danger had 
passed. To allay the pain and the agitation injections 
of morphine were good treatment, and if great weakness 
is observed recourse should be had to injections of 
serum. 

The patient should be kept on liquid diet as long as 
possible. 

Pneumonia and Cerebro-Spinal Meningitis. 

M. Bendu said that he had treated a child of 6 years 
who had been suddenly seized one night with severe 
rigor, followed by high fever and delirium. The follow¬ 
ing day she was in a oomatose state, the pupils contracted, 
the pulse at 140, and the temperature at 106 degs. F. 
Nothing was observed at that time in any organ. The 
evening of the same day a bath at 92 degs. F. 
was given and an enema of eight grains of antipyrine, 
which produced abundant perspiration and a slight im¬ 
provement of the symptoms. The treatment was kept 
up for four days and at the end of that time pneumonia 
of the apex of the right lung appeared. The cold 


baths were continued and soon an improvement of all the 
symptoms was manifest, but a few days afterwards 
the child presented all the signs of cerebro-spinal 
meningitis (stiffness of the neck, contractions of the 
jaws and limbs, the sign of Kering, rise in the tempera¬ 
ture, &c.) At the same time the pneumonia reappeared, 
warm baths were substituted for the cold baths and four 
ounces of artificial serum were injected daily, Bmall doses 
of calomel and bromide of potassium completed the 
treatment. A fortnight subsequently the child had 
fully recovered. The speaker concluded by saying that, 
although the direct examination of the cephalo-rhachidian 
liquid was wanting in this case, he believed that the 
microbe which provoked simultaneously the pneumonia 
and the meningitis was a pneumonococcus. 

M. Netter said that he considered warm baths to be 
superior to cold baths in persons suffering from pneu¬ 
monia complicated with meningitis. He obtained the 
cure of three patients by this treatment. 


(Sfrtnattp. 


[from our own corbespondent.] 


Berlin. May 20th, 1899. 

At the Surgical Society, Hr. Benda read a paper on 
Tuberculosis of Bones and Acute Miliart 
Tuberculosis. 

He said that experience taught that general tuber¬ 
culosis not infrequently followed operation for tuber¬ 
culous disease of bones, and it was assumed that there 
was a direct connection between the operation and the 
succeeding disease, inasmuch as at the operation the 
veins of the bones had been opened and the tubercle 
bacilli had passed into the system through them. By 
Weigert’s investigations and the proof of the penetra¬ 
tion of the bacilli into the blood vessels, this assumption 
had fallen to the ground. Weigert had shown that pene¬ 
tration from a tuberculous centre took place into the 
great veins, or into the thoracic duct, and that no increase 
in the bacilli took place. From this arose a doubt as to 
whether disease of the bones afforded sufficient material 
for such a flooding of the system, and whether the small 
veins of the bones were large enough for the purpose. 
According to many authors, more remote penetration 
had also taken place, and penetration from 
diseased centres had been proved into a cerebral 
sinus. The speaker’s own material consisted of 
three cases in which general tuberculosis had 
followed operations on bones. In all three cases 
penetration disease had been proved Two were cases 
of tuberculous ooxitis, and one of caries of the vertebral 
column. In one case Weigert’s tubercle of veins, and 
twice tuberculous endarteritis of the aorta and mitral 
valves were present. Here there was enormous growth 
of tubercle bacilli. But a conclusion here as to the rela¬ 
tion of cause and effect between the operation and the 
subsequent miliary tuberculosis would be too hasty, 
as it was only an accidental one. From his search¬ 
ing investigation it was shown that the disease started 
in the intima of vessels. Here took place the first 
metastasis into the bones, and led to tuberculous disease 
into them, and also to the general tuberculosis. From 
this, therefore, there mu9t be a limit to Weigert’s con¬ 
ception as to relationships. 


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The Medical Press. 539 


Mat 24, 1899. _ A U S T 

Hr. Felix Franke, Brunswick, related a case of 

FxBBO-PLA8TIC 0STITI8. 

A patient was admitted into hospital with chronic 
articular inflammation; on the outside of the joint were 
puffineea and fluctuation. On opening the joint a 
peculiar change was observed. The lower end of the 
femur was softened, and for a distance of 10 to 12 ctm. 
converted into porous tissue; only on one Bide was a small 
lamella of cortex. The bone could be cut with the knife- 
There was fibrous degeneration of the bone; thick fibrous 
cords passed through the tissue, and enclosed small 
sequestra of bone. There was very rapid softening of 
bone, as the first symptoms appeared in April and in July 
the disease had progressed so far that operation was 
necessary. The patient stated that eight months before 
the commencement of the disease he had injured him¬ 
self by falling on the knee. The diagnosis arrived at 
was fibrous ostitis, without new formation of bone, 
with subacute course, and probably in connection with 
injury. The ostitis was clearly of a bacterial nature, 
possibly set up by the influenza organism; the patient 
had suffered for a long time from symptoms of that 
disease. 

Hr. Riese related a case of 

PYELITI8 WITH CHRONIC APPENDICITI8 
after an abcess on the right Bide with typhlitis. A large 
swelling formed on the left side, which palpation showed 
to be a renal tumour, then violent'pain came on. After 
some time swelling went down. After several 
such attacks had taken place the speaker decided 
on excision of the appendix. At the operation a cord-like 
formation was found passing from the appendix abscess 
to the left ureter, leading to acute flexion of it, and 
retention of urine in the kidney, besides this, infection 
had taken place from the pus, so that pyelitis had 
occurred. Permanent recovery took place after removal 
of the cord-like structure and the appendix. 

Hr. Duhrasen read a paper on 

Simultaneous Disease of the Appendix and the 
Female Pelvic Organs. 

He said it was the duty of the gynecologist to treat 
other diseases of the abdomen in the course of operation 
for disease of the female pelvic organs. For years he 
had turned his attention to the relations of the gall¬ 
bladder, and also to changes in the vermiform appendix, 
which he had removed nine times in a total of 320 
abdominal operations. He had noticed that in disease 
of the adnexa, appendicitis and attachments of intestine 
to the adnexa and the broad ligament were not infre¬ 
quent. The appendicitis was always simple. Sometimes 
in the case of large pelvic abscesses he had removed the 
adnexa, the vermiform appendix, and the uterus. He 
recommended the incision in the linea alba. 

Dr. Kummel, Hamburg, related 
Two Cases of Resection of the Descending Colon 

with Suture of the Transverse Colon to the 
Sphincter Ani. 

The firat case was a man of 20 suffering from high 
reaching carcinoma of the descending colon. The rectum 
and the diseased sigmoid flexure were removed. The 
transverse colon was then brought down and out through 
the anus, twisted and sutured in position. Recovery- 
The second case was that of a woman who had an arti¬ 
ficial anus made fifteen years previously for carcinoma* 
The ulceration extended very high up. Resection was 
performed, the transverse colon drawn down, twisted. 


RI A. 

and sutured in as before. At first there was collapse, 
but the patient rallied. Then aoute ileus came on and 
laparotomy was again performed. Two necrotic loops 
of intestine were found in the small pelvis; these were 
drawn out and resected. After some months the patient 
was discharged cured. 

The Kaiser Frederick Quelle (Soda Lithia 
Spring). 

This spring, as is known, is at Offenbach on the 
Rhine. With great labour, and after long and perse¬ 
vering effort, a boring was effected reaching a depth of 
275 metres, or not much less than 1,000 feet. At this 
depth an abundance of remarkably clear odourless spark¬ 
ling water gushed forth, which, on being tested, proved 
to have useful medicinal properties. From an analysis 
by the well-known Professor Freeenius, of Weisbaden, 
and others, we learn that the water contains the car¬ 
bonates of lithium, sodium, and ammonium, some sodium 
sulphates, and a relatively active quantity of sodium 
chloride. The water, therefore, may be designated as 
an alkaline saline, and it is principally distinguished 
among the group of useful mineral water by its rela¬ 
tively large percentage of lithium carbonates. It is 
further distinguished from others of the group by the 
small amount of contained am. carbonate, magnesium, 
bicarbonate, and free carbonic acid. On first coming 
from the spring the water is neutral in reaction, but it 
quickly becomes distinctly alkaline. Its abeolute purity 
as regards germs is guaranteed by the enoimous depth 
from which it springs. 


Austria. 

[from our own correspondent.] 

Yibkxa, May 20th, 18W. 

Lyssa Animalia. 

Kraus read a report of the experiments which he, 
in common with Paul, has recently made on birds, with the 
object of testing how far the virus of hydrophobia is 
resisted by this class of animal. He finds that when the 
“ subdural ” membrane in hens, ducks, and geese is ino¬ 
culated with the virus, the incubation lasts from eight to 
thirty days when a train of symptoms appears that re¬ 
minds us much of the appearances met with in quadrupeds' 
There is a form of ataxia and paresis almost amounting 
to paralysis associated with these symptoms, but recovery 
is the general rule, while in quadrupeds it is the excep¬ 
tion. Pigeons and crows seem to be quite refractory. 
The infected membrane of the bird cannot be made to 
transmit the virus to a guinea-pig. 

Hereditaria Tarda. 

Berdach exhibited a young boy, set. 16, with heredi¬ 
taria tarda, which appeared three years ago in the form 
of periosteal thickenings on the tibia, the upper part of 
the arm, and left clavicular region. It may be noted 
that none of Hutchinson’s trias, such as formation of 
teeth, otitis interna, or keratitis parenchyma, were pre¬ 
sent. Father and mother were decidedly syphilitic 
before the birth of the child. No Bymptom of a secon¬ 
dary stage seems to have been present. 

Anchylostoma Duodenale. 

Hugo Goldmann, who is medical officer for the 
“ Brennberg im Oldenberger" Company, read a long 
paper on the history, habitat, symptoms, and treatment 
of the disease. 


Digitized by LjOOQle 


540 The Medical Press. 


THE OPERATING THEATRES. 


May 24, 1899. 


The parasite was for the first time described in 1883, 
when it was found in the bowel of the human subject. 
Its natural habitat is Brazil, India, Borneo, and 
Egypt, which from the latter iv derived the 
name of Egyptian chlorosis. In 1880, during the 
construction of the St. Gothard tunnel, the same malady 
went under the name of “ tunnel disease,” or mountain 
cachexia. 

Since that time it has been discovered to exist more or 
less in works of this kind over the whole of the Continent. 

The parasite is male and female, the female being 
fifteen millimetres long while the male is only ten milli¬ 
metres. The latter is distinguished from the former by 
a bursa copulatrix and a spicula. Its colour is reddish 
brown, sometimes grey, and it has no segmental construc¬ 
tion. The head is bell-shaped, supported by a chitine 
arrangement; the mouth capsule has four large ventral 
and two small dorsal teeth. 

The bowel is almost straight, while the stomach is 
i ecognised as a dilatation in its centre. The seminal duct 
leaves the ventral part of the body about the middle. 
The ovules appear in a small irregular adherent mass 
which undergo segmentation and develop a larva which 
afterwards pass through a stage of cystation. After 
complete development the parasite, with its bell head, 
seizes the mucous membrane with its teeth through 
which it bores with a small stiletto. The duodenum is 
the usual site, but it is not infrequently found in the 
jejunum and ileum in enormous quantities, even exceed¬ 
ing 1,500. 

The disease is usually ushered in by characteristic 
malaise, exhaustion, feebleness of the extremities, head¬ 
ache, flickering of the eyes, noise in the ears, increased 
flow of saliva, and pyrosis. The general appearance is 
aneemic, with sub-icteric colour associated with rapid 
emaciation. There is frequently dilatation of the heart, 
accompanied with a blowing systolic murmur. The 
abdomen is distended and tender to touch. The patella 
reflex is increased; pulse soft and averaging about 120 ; 
respirations, 40; temperature, 38$ degs. C., or 101 j degs. 
Fahr.; no albumen in the urine. A frequent warn¬ 
ing is blood-coloured stools, in which the ovum may 
be discovered. The blood examination is sometimes 
chlorotic, although the haemoglobin is increased. The 
eosinophile cells are in greater number, and the 
reaction of ptomaines can be obtained. 

The prognosis depends very much on the constitution! 
although it is more severe in northern climates. As a 
rule it may be given as favourable if the disease be 
attacked energetically. Pulmonary tuberculosis is 
the chief danger. 

The treatment is varied—thymic acid in doses of about 
one-tenth of a gramme in the form of an oblate after 
meals; extract filicis. max. in capsules, preceded by four- 
tenths of a gramme of calomel, is also highly recom¬ 
mended. 


‘(Ehc (Operating theatres. 

ST. PETER’S HOSPITAL FOR STONE. 

Supra-Pubic Lithotomy in a Cask of Large Stone 
and Enlarged Prostate Rendering Litholapaxy 
Impossible. —Mr. Swinford Edwards operated on an 
old man, ret. 72, who had been admitted for symptoms of 
vesical calculus. The patient had 10 years previously 


undergone lithotrity at the hands of the same surgeon. 
On sounding him a large stone was felt lying behind an 
hypertrophied prostate. An endeavour was made to 
crush the stone by means of the largest lithotrite which 
could be introduced (it was found impossible to pass 
Bigelow’s large instrument) and although by this 
means large pieces were shaled off the stone, the calculus 
could not be fairly broken, therefore a supra-pubic 
operation was decided upon. Mr. Edwards tried to 
distend the bladder but this was found to be impossible 
as it would only hold about two ounces of fluid. A 
silver catheter through which the viscus had been 
injected was left t» sit* to act as a guide. On 
cutting down above the pubes, the bladder wall was 
found to be much hypertrophied; there seemed to be at 
least one-third of an inch of tissue thickness between the 
finger in the wound and the inlying catheter. The 
bladder was now incised, and the stone with some diffi¬ 
culty extracted owing to its size. Part of the circum¬ 
ference was found to have been broken off and lay in 
fragments around it in the bladder. All these were ex¬ 
tracted by means of forceps and scoop after the stone 
itself had been removed. A large rubber drainage tube 
was now inserted, and the bladder freely flushed out with 
boracic acid solution. The tube having been made fast 
to the parieties, the upper and lower extremities of the 
wound were brought together by silkworm gut sutures, 
two sutures of the same material having pre¬ 
viously been employed to bring together the ab¬ 
dominal aponeurosis. Mr. Edwards commented upon 
the enormously thickened bladder wall, and upon the 
conformation of the interior of the viscus: he found on 
introducing his finger that the base with the posterior 
wall was practically divided into two compartments by 
an enormously hypertrophied inter-ureteral bar whifb 
thus divided the deep post-prostatic pouch from the poet- 
trigonal pouch, the prostate around the vesical orifice 
was found to be enlarged and bossy. He remarked that 
having failed to pass an instrument suffi ciently 
large to crush the stone, two courses appeared 
to be open to him, one being a perineal lithotrity, 
and the other the one he had selected. His 
reasons for preferring the latter to the former were that 
he considered it a better operation where the prostate 
was so hypertrophied. In cases of a large stone which 
cannot be crushed, and in which the prostate is not 
appreciably enlarged, he considered that a median 
peiineal cystotomy with crushing of the stone tn sit* is 
a better operation than the supra-pubic cystotomy as it 
affords better drainage. The stone was smooth excepting 
where the outer surface had been chipped off by the 
lithotrite, it was evidently composed of uric acid, and its 
weight was estimated at about three ounces. 

MIDDLESEX HOSPITAL. 

Relapsing Appendicitis. Appendectomy.—Mr. 
Andrew Clark operated on a strong, healthy-looking 
girl, ret. 25, who had been admitted for continuous pain 
in the right iliac region ; she had suffered from a similar 
pain some months before, but had recovered under medical 
treatment. After admission on the present occasion, 
although vomiting was persistent for a few hours the 
pain partly subsided with rest, but was still most marked 
at McBurney’s point, and although the symptoms of the 
acute attack quite disappeared after a few days there 
still remained slight rigidity over the right iliac fossa; 
there was no pain nor tenderness, and no fever. The 


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Mat 24, 1890. 


LEADING ARTICLES. 


The Medical Press. 541 


patient was anaesthetised, and an incision 3 inches long 
made oyer the region of the appendix. On introducing the 
finger; the appendix was immediately felt and drawn to 
the surface. There were no adhesions. The appendixlooked 
thickened and baggy. The mesentery of the appendix 
was i ransfixed and ligatured, and the process itself removed 
about half an inch from the caecum, its peritoneum being 
dissected by a circular incision and stripped up, so that 
after the appendix had been ligatured and removed 
it could be sewn over the stump. The parts were then 
carefully swabbed with weak perchloride of mercury, 
the abdominal wall sewn up layer by layer, and the 
wound closed with collodion. Mr. Clark remarked that 
this was a case in which appendectomy had been 
determined on after the patient had had two distinct 
attacks, and, looking at the part removed, it would 
be seen that it was a case in which the operation 
was likely to be of the utmost benefit to the 
patient, for although no concretion, or indeed any 
evidence of disease beyond its puffiness could be observed, 
even after removal, yet on laying it open, the canal half 
an inch beyond where it was examined was found to 
be distended with pus; this would most assuredly have 
set up fresh trouble soon after the patient began to get 
about again. The operation itself, he pointed out, was 
about as simple as it could be, and gave rise to no diffi¬ 
culty in its performance. The case, he thought, rather 
tended to confirm the opinion of those who say that it is 
wisest to remove the appendix after a single attack, and 
not to wait until inflammation has occurred outside the 
appendix and given rise probably to localised suppura¬ 
tion. 


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“ SALC8 POPDLI SUP EMA LEX.” 


WEDNESDAY, MAY 24, 1899. 


MEDICAL JURISPRUDENCE OF INSANITY- 
This wide and much debated question, like the 
poor, is ever with us, and we are accustomed to hear 
many extreme views propounded, and sometimes not 
without reason. Professor Richard Brown, St. 
Mungo’s College, Glasgow has, in the Law Magazine 


and Review for May, taken up the cudgels and fought 
the battle from a lawyer’s point of view. We do not 
remember to have heard some of the arguments here 
given so emphaticaUy, by any other lawyer, though 
it is conceivable that not a few legal luminaries have 
had them in their mind's eye. The article is written 
apropos the appearance of a recent work by Dr. 
Clevenger, of Chicago. It is somewhat on the lines of 
Isaac Ray in America, and Maudsley in this country. 
Professor Brown runs foul of Dr. Clevenger at the 
outset, and we confess to some approval of his strict- 
tures on what seems a rather pedantic utterance. 
Clevenger opens thus:—“ Precisely as the exactness 
of modern research in the field of mental disease is 
demonstrated to intelligent jurists, so will there be 
improvement of the common and statutory laws 
relative to insanity.” Brown retorts, “ We take 
this to mean that every change in the medical 
view of insanity must be accompanied by a 
corresponding change in legal responsibility. In 
other words, every departure from the normal, which 
justifies a medical man in declaring a person insane, 
absolves that person from the legal consequences of 
a criminal act.” This is, perhaps, toofree a rendering, 
and the word justifies begs the question. If the diagno¬ 
sis is justified then Professor Brown has no case. It 
is much too soon, however, for Dr. Clevenger to speak 
of the exactness of modern research in the field of 
mental disease as a medico-legal quantity, whatever 
we may say of it in the histological department of the 
same field. The lawyer’s view is that “ writers like 
Dr. Clevenger view the law only from the standpoint 
of medicine, and ignore the true object of legal 
punishment which is the safety and security of 
society," or in the words of the old Scottish indict¬ 
ment “ that others may be deterred from committing 
the like crimes in all time coming.” And yet crime 
does not. cease! What then is the efficacy of the 
remedy. He holds strong views on the subject of so- 
called moral insanity, or moral imbecility, and with 
these we strongly sympathise. Here the physician 
is apt to go beyond the physician's province, 
and talk of responsibility which is really a 
judicial question. In the case of innate depravity* 
in contradistinction to moral imbecility—if any such 
distinction can be drawn, Ray says, “ the law must 
take its course,” but Professor Brown adds, “We 
may fairly ask whether it is not quite as open to the 
man of ‘ innate depravity ’ to say * I could not help 
it,’ as to any ‘ moral imbecile.’ ” He thinks, and. we 
fear, truthfully, that sympathy does enter into 
the medical treatment of such cases. “ On the one 
hand, the presence in the community of strong per¬ 
sonal or sympathetic feelings often excites an unrea¬ 
soning fury against the perpetrator of an atrocious 
crime. . . . On the other hand, we sometimes 
lose sight of the wrong done, and allow our sym¬ 
pathies to concentrate themselves upon the circum¬ 
stances and surroundings of the criminal." With 
such views we must, to some extent, concur, and 
medical men, and especially asylum medical men, 
will find this review a wholesome and helpful one. 


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542 The Medical Pbess. 


LEADING ARTICLE?. 


Mat 24, 1890. 


Unfortunately, medical expert evidence is not yet 
regarded with the unqualified favour that it might 
receive if medical men themselves were careful not to 
take sides in a case, as they are apt consciously, and 
often unconsciously, to do. 


THE SELECTION OF ENGLISH POOR-LAW 
MEDICAL OFFICERS. 

We have received a circular letter calling attention 
to the special circumstances attending the recent 
appointment of medical officers by the Bradford 
Board of Guardians which raises several questions of 
general interest. It is asserted that the guardians 
have departed from the time-honoured custom 
of throwing such posts open to competition, 
and have, instead, selected two particular medical 
men, excluding applications from other practitioners. 
There seems to be a considerable amount of commotion 
among the medical profession in Bradford at the pre¬ 
sent time in consequence. We are not quite sure that 
we understand the precise merits of the controversy 
which appears to have divided the profession in the 
stirring democratic city into two or more camps ; but 
bo far as we can gather, there seems to have been a 
considerable amount of difference of opinion on the 
question of abuse of the medical charities. Some 
members of the profession hold that there is gross 
abuseof the charities, and strenuously assert thatmany 
persons, well able to pay for medical services, per¬ 
sistently, and for many years past, have made use for 
private purposes and from sordid motives of funds 
collected, avowedly for the relief of the poor 
of the city. Other members of the profes¬ 
sion, on the contrary, allege that while, no 
doubt, some amount of abuse may be shown 
to obtain in the distribution of the relief given by 
the medical charities, that abuse is no greater than 
must necessarily attach to all charities while human 
nature continues to be what it is, a little too much 
inclined to selfishly grasp to itself what was intended 
for less favoured parties; but they say that on the 
whole no great amount of abuse has been shown to 
exist. Naturally, perhaps, the outside practitioners 
seem to take the former view, while the members of 
the various hospital staffs seem to incline to the latter. 
There are numerous exceptions, no doubt, and pro¬ 
bably a good deal more will be heard on both sides 
respecting the merits of the controversy and the 
various facts of the case. The question is by no 
means settled, and we are not yet in possession 
of sufficient materials to enable us to form 
an opinion. But one great fact seems to 
be certain—viz., that on this question the diver¬ 
gency view has been so great that a great many 
medical practitioners, while they do not seem to have 
left the older medico-ethical society, in whose 
deliberations they still take part, and at whose meet¬ 
ings they vote, have yet thought it advisable to 
found a new society called the Bradford and West 
Riding Medical Union, and it appears to be the 
secretaries of this new society who have issued a 
circular convening a meeting of the whole profes¬ 


sion in Bradford and the district. The meeting 
was duly held, and was very largely attended. 
Certain medical practitioners appear to feel 
aggrieved that the guardians have made appoint¬ 
ments to posts paid for out of the ratepayers’ money 
without throwing those posts open to public com¬ 
petition. If this be so it is a view for which, in our 
opinion, much may be said. Probably the guardians 
are acting within their legal rights. No doubt they 
have been advised in this sense. We have no wish 
to question their right. But as to the expediency 
of the oourse they are taking surely much is to be 
said. We have not a word to say against the gen¬ 
tlemen they have appointed, or as good as appointed. 
No doubt their standing, if somewhat youthful, 
justifies the confidence, the “oomplete confidence,” 
which the guardians are said to repose in them. 
Neither do we even say, if the guardians “ offered ” 
these gentlemen the appointments, sb we are told 
they have done, the gentlemen were bound to 
raise any difficulty as to accepting them. That 
was a question which appealed to their discretion. 
Both Dr. Campbell and Dr. Crowley withdrew on a 
previous occasion for reasons which, at that time, 
seemed convincing, but which do not now seem 
adequate to Dr. Crowley. But it does seem strange 
to us that “ eminent local physicians, surgeons whose 
knowledge and skill involve them in being summoned 
in a consultative capacity,” are not thought good 
enough by the guardians to be allowed even to com¬ 
pete for the poets, although evidently the general 
public think them good enough to be called in in 
consultation with their own family attendants. That 
general public, as ratepayers, contribute to the pay¬ 
ment of the salaries of the gentlemen who are thus 
thought so supremely fitting for the new posts 
that no others need apply, even if they are willing 
to do so. which, of course, may or may not 
be the case. Perhaps the practitioners in question 
may be too busy to do the work of the new posts 
properly. But if so, they would not apply for the 
posts. If they did apply it would be because they 
felt they were able to find time to do the work. Surely 
that is a point which might have been left to their 
own discretion. But if ratepayers call in consultation 
with their family attendants eminent local practi 
tioners, when their own lives are at stake, it is 
curious that they should think those same practi¬ 
tioners ought to attend to the lives and healtli of 
paupers in the workhouse. Of course the eminent 
local practitioners might not have wished to apply 
for the posts. But on what grounds of public utility 
should they have been prevented from doing so, if they 
did wish ? On this point no information appears to be 
offered. It may fairly be asked whether the guar¬ 
dians, in the exercise of their authority, and in their 
discretion as representatives of the ratepayers, have 
been sufficiently careful in this matter to avoid even the 
appearance of jobbery or of favouritism, of which we 
do not, indeed, accuse them in this case, but which it 
is quite evident might, in other circumstances, be 
construed in such a sense P There is another aspect 


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May 24, 1899. 


LEADING ARTICLES. 


THE MEDICAL PREB8. 543 


of the question which is evident even to the lay mind, 
Bince the Bradford Observer refers to it. Physicians 
and surgeons who do not take general practice are 
dependent for a large part of their practice on the 
goodwill of general practitioners. Do the gentlemen 
in question sufficiently realise how much they may be 
affected in the future by a feeling or by a possible 
feeling in the minds of practitioners who might call 
them in in consultation, that these very men were de¬ 
priving the practitioners of emoluments and of offices, 
which they might think ought to have been filled by 
themselves ? This is a very grave question, indeed, 
for Dr. Crowley and Mr. Hall. Are we to understand 
that, in a district so rich as Yorkshire and as cities 
in the West Riding, competition in the medical pro¬ 
fession is so keen that pure physicians and pure 
Burgeons actually accept appointments which prac¬ 
titioners have been in the habit of filling ? If so, 
may not the practitioners in self-defence proceed to 
inquire whether there is, after all, so much in a name 
as has been supposed, and whether a so-called pure 
physician and pure surgeon is any better for the 
purpose of helping the general practitioner than the 
“ eminent local physicians and surgeons ” whom they 
have been in the habit of consulting ! Is notone of 
the chief reasons why there are pure physicians and 
pure surgeons at all, because in no circumstances will 
such men compete with general practitioners ? And 
if so, may not the practitioners think that in trans¬ 
ferring their consultations from eminent local prac¬ 
titioners to pure physicians and pure surgeons, they 
may have escaped one form of competition indeed, 
only to fall into another quite as grave, or even more 
so ? We shall await the issue of the position in 
Bradford with some interest. 


GONORRHCEAL SALPINGITIS AND ITS 
PREVENTION. 

The recognition of the far-reaching effects of 
gonorrhoea in the female constitutes quite a recent 
addition to our knowledge of the subject. At one 
bound gonorrhoea, formerly regarded as almost a 
trivial disease when it affected the female generative 
organs, has come to be regarded as a potential factor 
in the production of far-reaching and grave conse¬ 
quences. Our information on this subject is still far 
from complete, and great interest, therefore, attaches 
to the record of collective investigation and expe¬ 
rience such as we are enabled to offer to our readers 
in the papers read and discussed at the last meeting 
of the British Gynaecological Society. Mr. J. W. 
Taylor, of Birmingham, brought forward an interest¬ 
ing series of cases pointing to conclusions which 
embody sundry elements of novelty, notably in 
respect of the often unsuspected association of 
syphilis and gonorrhoea in the same subject. He has 
found as a matter of experience that in cases of 
salpingitis it is oftener much easier to elicit a history 
of syphilis than of gonorrhceal discharge. We are 
justified in supposing that gonorrhoea cannot be the 
only factor at work in the production of this serious I 


complication, otherwise it would be much more fre¬ 
quent than it is, though it cannot be described as at 
all rare. It may be that the co-existence of syphilis 
is the missing and hitherto overlooked factor, though 
at present this does not amount to more than a surmise- 
Mr. Foulerton, who has collated the notes of 499 cases 
of pyosalpinx bacteriologically examined, finds that 
the actual presence of the gonococcus was only de¬ 
monstrated in about 19 per cent., but evidently 
this proportion cannot be accepted as evidence that 
the gonococcus was only to blame to that limited 
extent. In many instances other organisms were 
found, due to infection from without, or from the 
adjacent and sympathetically inflamed intestine. It 
is only fair to assume that in many cases the gono¬ 
coccus, having lighted up the inflammatory process, 
dies out, either from want of nourishment or 
poisoned by its own excretory products. One note¬ 
worthy point to which attention was called by Mr. 
Taylor was the greater amenability of treatment 
of gonorrhceal salpingitis in syphilitic subjects, 
a result which obviously admits of several 
interpretations. This brings us to the ques¬ 
tion of the treatment of the originating gonor. 
rhoea, and there seems to be a general consensus 
of opinion that the disease is not treated in general 
with the seriousness it deserves. It is not the vulvar 
or vaginal inflammation which constitutes the direct 
source of the mischief, but the infection of the cervix 
of the uterus whereby the inflammatory process gains 
an entry into the more internal parts. It is not un¬ 
likely, as suggested, that treatment directed to the 
cervix, when found on vaginal inspection to be 
infected, might stay the further progress of the morbid 
process and save the tubes from implication. The 
routine treatment by vaginal irrigations can 
obviously have no effect on the inflammatory pro* 
cess when once it has gained a footing in the cervix, 
and nothing short of drastic local measures can 
possibly be attended by any measure of success* 
Another point in the treatment which merits more 
than passing attention is the alleged efficacy of anti¬ 
syphilitic treatment even in cases where no syphilitic 
history can be elicited. The administration of mer¬ 
cury associated with the application of either mercury 
or nitrate of silver to the cervix is claimed to go far 
in arresting the disease in its initial stage, and these 
are points which the practitioner ought to bear in 
mind. Of course, when we are discussing the jrreven- 
tion of a disease the results are open to criticism, 
because only the results of observation on a very 
large scale will enable us to affirm an unquestionable 
beneficial action. Inasmuch, however, as the treat¬ 
ment conforms to one’s theoretical notions it is sure 
to command respect, and we cordially commend to 
the consideration of our readers the interesting and 
instructive discussion which followed the papers 
published elsewhere. 


Dr. W. Senn, of Chicago, has come forward as a can¬ 
didate for the Governorship of Illinois, on the Republican 
ticket, whatever that may mean. 


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544 The Medical Press. 


NOTES ON CURRENT TOPICS. 


Mat 24, 1899. 


on Current topics. 

The Bacteriology of Meat Infection. 

The comparative frequency of cases of poisoning 
by alimentary products, vaguely described as ptomaine 
poisoning, gives a peculiar interest to the real 
nature of their causation. The subject as a whole is 
involved in veiy great obscurity, partly due to the 
fact that our knowledge of the intimate processes of 
albuminous disintegration is notoriously incomplete. 
Another difficulty arises from the fact that these 
processes are very fugitive and run through their 
various phases with great rapidity. It is probable 
that the deadly chemical substances which are 
responsible for the grave symptoms that sometimes 
follow the ingestion of tainted meat are transitional 
products, here to-day and gone to-morrow, so that they 
often baffle all attempts to demonstrate their existence, 
There is reason to believe, moreover, that the some¬ 
what clumsy methods of research at present employed 
. in these investigations are ill-adapted for the detec¬ 
tion of such unstable bodies as the incriminated 
toxins. Considerable interest, therefore, attaches to 
the researches brought last week before the Patholo¬ 
gical Society by Dr. Durham, who has attacked the 
problem from quite another standpoint. Thanks to 
the publicity given to Widal’s reaction for typhoid 
fever, most people are by this time familiar with the 
phenomenon known as “clumping.” Briefly stated, 
clumping is the tendency displayed by certain micro¬ 
organisms to group themselves when, to the fluid con¬ 
taining them, is added the serum of an animal 
which has been immunised against these parti¬ 
cular microbes. It follows that if the serum of 
a patient who is suspected to have been affected by a 
particular microbe, gives this reaction with a culture 
of the incriminated microbe, we should be justified in 
inferring that the suspicions were correct. There 
remains the question whether the symptoms caused 
by the ingestion of tainted food are due to infection 
by the living organism or are really symptoms of 
intoxication by the products which it elaborates 
The balance of evidence is in favour of their being 
cases of infection, but we are still only on the 
threshold of the subject, and much painstaking re¬ 
search is still necessary before the precise significance 
of these various phenomena will be made clear. 

The Surgeon's Wardrobe. 

Under the stimulating influence of a firm belief 
in the gospel of antisepsis many modifications in the 
apparel of the operating surgeon have been suggested, 
and some of them have actually been carried into 
practice. It is not so very many years since that 
the hospital surgeon put on his oldest coat before 
taking the knife in hand, but that ill-conditioned, 
greasy, and blood-stained garment has been relegated 
to the dusthole and its place taken on self-respecting 
surgeons by a clean linen overall. The apron has 
not yet become acclimatised in this country, though 
its use is universal elsewhere. More recently it has 
been urged that the surgeon ought to have a 
clean-shaven face in order that the dust from 


beards and moustaches should not fall upon and 
infect the patient. Failing this, he is advised to wear 
a mask. The latest crank of this kind is the proposal 
to operate in rubber gloves. What a prospect for the 
future! Dressed in a shiny pink dust-proof overall, 
with a mask coloured to fancy, and wearing rubber 
gloves, the surgeon of the twentieth century will be 
an object, if not of beauty, at any rate of curiosity. 
Let us hope in defence to the patient's susceptibilities 
that when arrayed in full canonicals th9 surgeon of 
the future will not come upon the scene until the 
patient has been mercifully rendered unconscious. 
Otherwise the element shock will cer tain ly have to 
answer for an increase in the mortality after 
operations. 


Hospital Reform. 

The burning theme in the rank and file of the 
medical profession is the abuse of hospitals. So it has 
been for the last score of years, and so it will con¬ 
tinue to be, so far as one can judge, for many a year 
to come. This being the case it is not a little curious 
to see the half-hearted way in which medical men 
handle any movement which has for its end and aim 
the removal of that particular abuse. Here, for 
instance, is the Hospital Reform Association, 
moderate in tone, exact in method, with a compara¬ 
tively scanty, albeit enthusiastic, following that tells 
volumes of the apathy of the profession. Well may 
philanthropists laugh the general practitioner to 
scorn, and go on swelling the already huge 
medical charities, and encouraging those who 
can afford to pay fees to contribute to 
the proceeds of the devastating hospital-monger. 
Last year it was pointed out at Edinburgh that the 
medical profession ehould be fully represented on 
the management of every medical charity in the 
United Kingdom. It is all very well to growl and 
grumble, but something more is needed, for that kind 
of thing never yet mended an abuse. The subscription 
to the Hospital Reform Association is five shillings, 
and the energetic secretary, as everyone knows, is Dr. 
Garrett Horder, of Cardiff. Every medical man who 
feels the stress of hospital competition—who that 
deals with the middle classes does not ?—will do well 
to join this movement. The mere mustering of 
medical practitioners, with a common object in view, 
is a desirable thing. There could hardly be a better 
inscription for the rallying business than that of 
“ hospital reform.” 

Wooden Water-pipes. 

A relic of the good old times—we had almost 
forgotten our serious mission for the nonce and had 
written the good old “ piping times,”— is now to be 
seen in some of our London streets. Lying by the 
side of the highway are numbers of moderately-sized 
lengths of tree trunks with a good sized hole bored 
through the centre. These are the water-pipes of our 
ancestors, but they have been replaced by iron in this 
progressive age, just as the famous wooden walls of 
Old England have given way to steel. In the light of 
the modern knowledge of germs it is interesting to 


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Mat 24, 1899. NOTES ON CURRENT TOPICS. Thb Medical Press 545 


speculate on what must have been the condition 
of water conveyed through several miles of decay¬ 
ing logs fastened together end to end. It would have 
been hard to invent a more perfect plan for fostering 
and breeding microbes of all sorts .and conditions. 
Tet our forefathers lived through it all, that is to say ( 
more or lesB of them survived, and that at a time 
when there was only a tithe of the surplus population 
about which we are all complaining nowadays. What 
better lodging could the merry microbe wish than the 
soft dark interstices of a water-logged wooden pipe ? 
Tet the ways of microbes are manifold, and not by 
any means known to us yet in all their inwardness. 
Epidemics spread by water delivered through imper¬ 
vious iron pipes have been with us ever since the intro¬ 
duction of these pipes and filters ! What old-fashioned 
wooden pipe could be worse for poisoning water than 
the average modern filter until we got the Pasteur 
porcelain filter type. 

Intestinal Worms and their Symptom¬ 
atology. 

The symptoms associated with the presence of 
parasitic worms in the alimentary canal are curiously 
inconstant. In some instances the symptoms are 
merely those which might be expected from the 
mechanical effects of their presence, but in others 
they determine constitutional disturbances which 
may assume a grave form, running on to epileptiform 
convulsions, and even syncope. It is customary to 
attribute these symptoms to “ the reflexes,” but this 
is merely a refuge for the destitute in the matter of 
diagnosis. A possible explanation may be found in 
the toxicity of the excreta of these parasites, as sug¬ 
gested by Mr. G. H. F. Nuttall in an American con¬ 
temporary. Various observers have placed on record 
the existence of irritating properties in the tissues of 
certain varieties of intestinal worms, provocative of 
sneezing, intense conjunctivitis with chemosis when 
accidentally brought into contact with the eyelids, 
and even of oedema of the glottis and aphonia, when 
inhaled. It must be borne in mind that these para¬ 
sites are living beings which discharge excreta like 
other living animals, and it is probable, though it 
would not at present be Bafe to speak more affirma¬ 
tively, that these excreta may, under certain circum¬ 
stances, either in the diet or the idiosyncrasy of their 
hosts, provoke constitutional symptoms of a toxic 
character. 

A Nurse’8 Action for Inadequate 
Instruction. 

A rather novel action is being tried at the Bristol i 
County Court, where an aspirant nurse is suing Dr. 
W. L. Christie for damages on the ground of fraudu¬ 
lent misrepresentation and breach of agreement. 
Dr. Christie, who is M.D. of New Zealand and 
F.R.C.S.Eng., is stated to be the proprietor of a pri¬ 
vate adventure cottage hospital at Bedminster, and 
to have advertised for young women desirous of being 
trained as nurses in exchange for a fee ranging from 
£5 to £10. The 6cope of the instruction may be in¬ 
ferred from the fact that three months’ training was 


assumed to fit the probationer for the duties of dis- 
trict nurse. Lectures were to be given daily, 
side by side with practical instruction at the 
bedside. The plaintiff gave a lamentable account 
of the “ hospital.” which, it seems, is pari 
of a house for which Dr. Christie paid fifteen shillings 
a week rent. There was no kitchen, and apparently 
only one ward, a room upstairs containing two beds, 
a cot, and a cradle. The plaintiff complains that 
there were no in-patients from January 19th to 
March 4th, no lecturer, and virtually no tuition at all, 
so she left. As the case is still mb judice we abstain 
from the comments which our pen itches to make, 
but whatever view the jury may take of the merits 
of the case the circumstances show in a clear and 
unfavourable light what a fallacious and utterly un¬ 
trustworthy thing a “ training ” may be. Even if 
Dr. Christie had fulfilled his contract to the letter, 
let us suppose for argument’s sake that he had done 
so, what would be the value of three months' training 
at such an institution ? Really, not enough to 
enable the aspirant nurse to deal with the simplest 
case. We defer further observations until the case 
has progressed to the bitter end. 

County Councils and Quacks. 

The Durham County Council has taken a decided 
step to deal with the rampant quackery prevailing in 
their district. They have framed a bye-law, the 
object of which is to deal with the vendors of quack 
remedies who infest the local towns, and swindle the 
public by inducing them to purchase their goods- 
Primarily, this new movement is for the purpose of 
protecting the local tradesmen, but it will do 
further good by protecting the public against them¬ 
selves. If the public were not easily gulled the trade 
of the quack would soon cease, but a plausible quack 
can usually beguile an ignorant, unsuspecting, and 
confiding person into buying worthless and messy 
concoctions. We trust that the example here set by 
the Durham County Council will be followed by the 
other Councils throughout the Kingdom. It is cer¬ 
tainly a step in the right direction. 

Consultants as “ Cutters.” 

“ Cutters ” is a term of opprobrium applied in the 
world of pharmacy to those enterprising retailers who 
peek “ small profits and quick returns,” but it finds 
an application even in the medical world. The latest, 
and possibly the most objectionable, scheme which 
has thus far been foisted on the profession is that 
emanating from Birmingham. At the recent annual 
meeting of the Hospital Saturday Fund of that city 
it was proposed to engage the services of a physician 
and a surgeon at a princely salary of £500 yearly, 
whose privilege it would be to give consultations at 
lialf-a-guinea apiece to all and every. The scheme is 
grotesque on the face of it, and is based on an utter 
misconception of what constitutes a consultant. A repu¬ 
tation as consultant is not the necessary appurtenance 
of any medical or surgical degrees or diplomas. It is 
the outcome of a longperiod of hard work and gradually 
extending experience which ultimately place certain 


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546 The Medical Phebs. 


NOTES ON CURRENT TOPICS. 


May 24, 1899. 


men in a position of superior knowledge and wider 
experience than iB the lot of the average practitioner. 
When a man has attained that position his work is 
cut out, and he is not likely to solicit the doubtful 
honour of giving consultations at a hugely reduced 
fee. At the salary proposed the managers of the 
Fund can only hope to secure the services of ambi¬ 
tious young men who are postulating for the position 
of consultants, a status which they cannot as yet 
haye attained. We can at present only touch on the 
more obvious absurdities of the scheme as a whole, 
but when we have an opportunity of considering th e 
practical working details, as we propose to do 
shortly, the absurdities will become even more 
apparent. 

The London Chamber of Commerce and 
Secret Commissions. 

The Committee of the London Chamber of Com¬ 
merce have replied to the protest addressed to them 
by the Council of the British Medical Association, 
calling attention to the accusations made against 
medical men in regard to secret commissions which 
appeared in the public press some time ago. The | 
reply is most unsatisfactory. The accusations are 
neither substantiated nor withdrawn. All that the 
Chamber of Commerce have admitted is that the 
information upon which their report on secret com¬ 
missions was based was furnished them in confidence 
by a "pharmaceutical chemist,” and “a jeweller, 
optician, and silversmith.” That is to say, a 
series of most damaging statements are made 
against the profession on the testimony of two 
persons into whose bona fides in the matter the 
Chamber of Commerce have apparently taken 
no trouble to inquire. Nevertheless, the reply 
states that the Chamber of Commerce “ believe that 
the information received by them fully justifies the 
statement ” regarding the secret commissions paid to 
medical men. Surely, however, it would have been 
better if this commercial body, before believing any¬ 
thing, had taken the trouble to verify the 
statements made to them. We submit that 
in the absence of any confirmatory inquiries 
the accusations to which we allude cannot be 
regarded as anything else than worthless. Moreover, 
the Committee of the London Chamber of Commerce 
must see that they owe it to the medical profession 
either to withdraw or confirm the charges which they 
have made. If they cannot produce evidence in 
support of the latter, then they should have the 
common fairness to make the amende honorable, and 
withdraw what they have said. 

The Size of the Brain as aMeasure of Intellect. 

It is generally assumed that there exists a distinct 
relationship between the size of the brain and intel¬ 
lectual capacity. There are not wanting facts, how¬ 
ever, which run counter to this view. One salient 
example is that of the late French statesman, Gam- 
betta, whose brain only weighed 1,200 grammes. On 
the other hand, the heaviest brain on record is that of > 


a London newspaper boy, whose brain weighed 2,400 
grammes, in spite of the fact that he is stated to have 
been “ a bit of an idiot.” A brain weighing 2,340 
grammes once belonged to a Scandinavian peasant, 
of whose intellectual status it may be said that “ pre¬ 
vious to the age of seventy he never showed signs 
of any extraordinary intelligence, and he has never 
shown any since.” A female Indian dwarf had a brain 
which weighed no less than 2,200 grammes, being 
seventy grammes heavier than the brain of Tour- 
geneff, the celebrated Russian novelist. The average 
weight of the human brain has been variously put as 
from 1,500 to 1,650 grammes, and an analysis of the 
brain-weights of sixty intellectual men works out an 
average of 1,776 grammes, which is not much superior 
to the average. Evidently quantity of brain substance 
is of less importance than quality in respect of the 
possession of intellectual qualities of a high order. 
It is less the number of cerebral cells than the way in 
which they are grouped and connected up, and the 
facilities for prompt and efficient regeneration. These 
are conditions and processes which are for the 
most part beyond the ken of the physiologist, be he 
never so painstaking. 

Tuberculous Persons on Passenger Ships. 

A communication in a morning contemporary last 
week drew attention to an important detail concerning 
the welfare of passengers on the large steamships 
carrying the mails to our Colonies and elsewhere. 
Upon some of the vessels it regularly happens that 
tuberculous persons are conveyed, generally those suf¬ 
fering from advanced phthisis, and no provision is made 
for their special isolation. That is to say they are placed 
in the same cabins with healthy passengers in which 
combined spaces, of course, especially during rough 
weather, the ventilation must be of the worst. A 
specific instance is related in which two cabins con¬ 
taining four berths each were occupied by one or 
more passengers suffering from advanced phthisis. 
Clearly in their own interests it would be advisable for 
the directors of the steamship companies to provide 
separate accommodation for tuberculous persons; the 
danger of infection is, perhaps, less on a sea voyage than 
would be the case under ordinary circumstances 
owing to the free presence of ozone. But of late so 
much has been said publicly regarding the infective- 
ness of tuberculosis that an element of sentiment has 
now been introduced into the matter, and the public 
have come to understand that they must avoid ex¬ 
posure to such infection at all hazards. We think 
that this feeling is the right one to encourage. The 
more care the greater safety. In the past there can 
be no question that much of the dissemination of 
tuberculous affections was directly due to the neglect 
of precautions against the conveyance of infection; 
consequently any step designed to prevent healthy 
persons from coming into contact with tuberculous 
ones under conditions favourable to the dissemination 
of the disease, should in these days receive every con¬ 
sideration and attention. We earnestly commend to 
the steamship companies concerned the urgent neces- 


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May 24, 1899. NOTES ON CURRENT TOPICS. The Medical Pbssb. 547 


sity of complying with the demands of the time in so 
far as the isolation of tuberculous persons is 
concerned. 

Is the Supply of Oxygen Coming to an End? 

Lord Kelvin must plainly now be included 
among those disturbers of the public peace who 
promulgate unpleasant notions. In a word he 
has announced as the result of some researches that 
the supply of oxygen in the world is coming to an 
end. His conclusions ia based upon the following 
facts. The total amount of combustibles in the 
world, in the form of gas, peat, and coal, has been 
estimated at 340 million millicn tons, and each ton 
of coal consumes during its combustion three tons 
of oxygen. Consequently, in view of this ratio, 
unless some other means can be discovered of obtain- 
ingpower, long before the world’s coal supply has been 
used as fuel, he holds that all the oxygen will have 
been used up which gives life to the fire. But in basing 
some remarks upon these facts an American scientist 
has “ gone one better,” to use a common expression. 
He does not hesitate to state expressly that it will be 
necessary in the future to resort to artificial air in 
order to preserve life. He believes that huge 
artificial air meters will have to be erected whence 
people will have to adjourn to draw their daily 
supplies of oxygen. Further that the only 
possible way of existing at. all will be for 
both men and women to wear air helmets like 
those used by divers. But so far it will be seen 
that these pessimists have only considered the needs 
of mankind. What about animals P Under the 
shadow of an airless world no animals could exist, 
and as mankind has to consume animals in order to 
live, an airless world would be useless to men even if 
they found means to supply themselves with oxygen. 
Upon the whole, then, the matter need not be taken 
seriously—just for the present. 

What is the “ Strumous" Diathesis 1 

We are within, approximately, a few months of the 
dawn of the twentieth century, and yet it seems 
there is someone desirous of retaining the use of the 
obsolete terms “ strumous ” and “ strumous diathesis.” 
Sir Dyce Duckworth, in his Harveian Oration last 
year, expressed himself to the effect that, in many 
cases neither tubercle bacilli nor caseous matter 
can be detected in the enlarged lymphatic 
glands of “ strumous ” individuals; but that 
the glands represent a good soil wherein tubercle 
bacilli may lodge and induce caseation should 
they gain entry, and hence he concluded that “ the 
peculiarity of the lymph system justifies the use 
of the term ‘ strumous inflammation,’independent of 
the modem idea of tuberculosis.” These being Sir 
Dyoe’s opinions, it would be interesting to learn from 
him his precise explanation of the pathology of the 
particular inflammation which he describes as 
“ strumous. r He claims that it is not tuberculous, or 
dependent upon the tubercle bacillus. But this is a 
curious position to take up, for the term “ strumous " 
was introduced especially forthe purpose of describing 


those forms of disease which we now know to be due 
to tuberculosis. If Sir Dyce Duckworth's “ strumous 
inflammation ” is not caused by the tubercle 
bacilli, by w^at is it caused P The question is merely 
one of pathology, and as modem pathologists have 
altogether discarded the obsolete term “strumous ” for 
that of “ tuberculous,” which correctly describes the 
pathology of those diseases dependent upon tubercu¬ 
losis, it is clearly a retrograde and antiquated step to 
endeavour to retain the former term. In a few years 
the word “ strumous ” will be almost forgotten; 
even now we doubt whether medical students of the 
present generation ever hear their teachers use it, 
for it has been displaced by “ tuberculous,” and what 
is “ strumous ” is “ tuberculous,” and what is not 
“ tuberculous ” is not “ strumous.” 

A n ti-V accinationiat Martyrdom. 

Now that Mr. Balfour’s ministry have provided 
an easy exit to the anti-vaccinationist by way of 
“ conscientious objection,’’ it is not a little amusing to 
see how some obstinate followers of the cult still 
( insist on posing as martyrs in the police-courts. Too 
lazy or too stiff-necked to avail themselves of the 
device that has been contrived for their behoof with 
such sapient cunning, they fail to enter the necessary 
formal notice demanded by the Act. Then they are 
summoned to face the magisterial presence, from 
which they emerge sadder at the loss of a fine and 
prouder with the crown of a self-made martyrdom, 
but we fear hardly wiser men from their experience. 
Last week one of these obstinate subjects of the realm 
informed a London magistrate in so many words 
that he intended to put the law at defiance. He was 
promptly fined a sovereign and costs, and declared 
he had no money, and would go to prison for seven 
days in default, but he was allowed a week further in 
which to reconsider his decision. .With this kind of 
behaviour one can have little sympathy. After years 
of clamour the anti-vaccinationists have persuaded— 
not to say coerced—the Legislature of this kingdom 
to grant them a concession that is condemned by 
practically the united voice of the medical profession 
as fraught with danger for the future. Those who 
chooBe to go to gaol in spite of this sop to their 
ignorant faddism cannot be said to deserve a better 
fate. The man who defied the law before the Bal- 
fourian loophole took up a position that we could 
comprehend; but now—well—we shall have more to 
say when the next epidemic of small-pox is within 
the walls. 

A Curious Case of Intestinal Obstruction. 

At the recent meeting of the German Surgical 
Congress, Rehn, of Frankfort, reported a curious 
case of intestinal obstruction. The patient was a 
servant girl, 25 years of age, in whom he had occasion 
to resect part of the small intestine. She made 
a good recovery and returned to her work, but four 
months later she came complaining of severe 
abdominal pain and constipation. The symptoms 
ultimately developed into those of acute intestinal 
obstruction and abdominal section had again to be 


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548 The Medical Press. 


NOTES ON CURRENT TOPICS. 


Mat 24, 1899. 


performed. At the operation the obstruction was 
found to be due to a gauze compress. The mystery, 
of course, was how the foreign substance bad come to 
be located in the intestine. Rehn thought it highly 
improbable that the compress had been accidentally 
left behind at the first operation, and had lain for 
four months without giving rise to any symptoms; 
and yet the only other solution to the mystery re¬ 
maining was that the patient had swallowed the 
compress. There was, however, no history whatever 
of this having occurred, and it ‘is very difficult to 
believe that the patient could have done any such 
thing. Thus the mystery remains unsolved, the case 
being one having many points of interest. 

Dogs and Hospitals. 

Whatever hospitals may have done for dogs, the 
time seems now to have come when dogs will be 
called upon to do something for hospitals. An experi¬ 
ment is about to be tried at the Royal Free Hospital 
of holding a medical dog show in aid of the building 
fund of the London Medical School for Women. 
Qualified practitioners, members of the teaching staffs 
of the medical schools and medical students are invited 
to send their canine friends for exhibition. Again 
champion dogs will be on exhibition as a special feature 
of attraction. The day fixed for the show is Saturday, 
June 3rd, between the hours of half-past one and 
seven o’clock p.m. All those who desire further in¬ 
formation thereupon should communicate with the 
Honorary Secretaries, 8, Hunter Street, Brunswick 
Square, W.C. 


Alkaptonuria. 

Alkaptonuria is the term applied to a curious 
abnormality of the urine which, though apparently 
very rare, is of considerable interest to the physio¬ 
logical chemist. The most salient feature of the 
urine in these cases is that, although of normal 
appearance when passed, it promptly acquires a deep 
brown colour on exposure to air. This coloration is 
greatly intensified by alkalies, and although no sugar 
iB present the urine reduces Fehling's solution. The 
first instance of the kind on record dates as far back 
as 1822, when Dr. Alexander Marcet read an account 
of a case before the Medical Chirurgical Society, the 
patient being an infant only eighteen months of 
age. Since that time some thirty-three cases have 
been published, including four observed by Dr. 
Pavy. In a paper read at a recent meeting of 
the Royal Medical and Chirurgical Society, 
Dr. Gatrod called attention to the principal 
features of this curious and rare affection. We call 
it affection, but in point of fact its presence does not 
appear to be incompatible with good health. It is 
much more frequent in males than in females, in the 
proportion of twenty-three to eight. The phe¬ 
nomenon sometimes shows itself early in life, some¬ 
times even from birth, it is sometimes constant, but 
occasionally intermittent. Although it may present 
itself in several members of the same family it doe B 
not appear to be transmissible from one generation 


to the following. Dr- Garrod's researches point t<y 
homogentisinic acid as the one constant abnormal 
substance present in alkapton urines. This sub¬ 
stance in an alkaline medium displays a marked 
affinity for oxygen, with which it combines to form 
a dark pigment. It is quite possible that this con¬ 
dition is more frequent than might be supposed 
from the foregoing figures, but that owing to one’s 
ignorance of its nature that it has escaped recogni¬ 
tion. 

The Council of the Royal College of 
Surgeons, England. 

From several points of view the election of coun¬ 
cillors of the Royal College of Surgeons this year 
will be remarkable. First of all. there will be only 
two vacancies open for competition, and each of 
these will be competed for by the present holders 
of the appointments. Next, Sir William Mac- 
Gormac, whose term of office expires this year, 
by whom the third vacancy would have been created, 
happens to occupy the Presidential chair, this 
office being a yearly one, which terminates after the 
Council election in July. The bye-laws provide that 
under circumstances of this nature the President 
shall continue as a member of the Council for a year 
after the expiration of his ordinary term. Thus, if 
Sir William MacCormac has the honour again 
conferred upon him this year of being elected 
President, he will still find himself a mem¬ 
ber of the Council for another year in 1900. 
The retiring members are Mr. Jessop, of Leeds, 
and Dr. Ward Cousms, of Soutbsea, the President¬ 
elect of the British Medical Association. It is also 
worthy of note that no councillor has died, so far, 
during the collegiate year .which will close on J une 30th 
next. However, apart from these facts, the probability 
is that the election will prove tame and devoid of any 
excitement. Only on very rare occasions has it 
happened that a retiring councillor who seeks re-elec¬ 
tion has been unsuccessful; consequently under these 
circumstances it is probable that aspirants for the 
Council will forego a contest this year, and wait for a 
more favourable opportunity of securing the suffrages 
of their constituents. 

The Midwives Registration Bill. 

This measure, with many others of greater merit, 
may be regarded as lost for the present year. It was 
talked out by Sir William Priestly, its leading advo¬ 
cate, but was really killed by Mr. T. P. O’Connor. 
As the Government have made it known that, after 
Whitsuntide, all the time of the House must be given 
to Government business it is pretty certain that the 
profession and the midwives will have another year 
to devise a modus vivendi. 


Dr. Thomas Gregor Brodie, of St. Thomas's Hos¬ 
pital, has been elected by the Royal College of Physicians 
of London, to be director of the Conjoint Research Labora¬ 
tories on the Embankment. Dr. Brodie was elected by 
the Royal College of Surgeons in April last. 


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Mat 24. 1899* 


OBITUARY. 


The Medical Press. 549 


Mr. Howard Marsh, F.R.C.S., of Bruton Street, W., 
is'to be married in July to the daughter of Admiral Sir 
John Dalrymple Hay. 

Dr. Edward Ward has been appointed to succeed 
Mr. Mayo Robson when the latter resigns the post of 
Professor of Surgery to the Yorkshire College on July 
31st next. 

Mr. William Stoker, Professor of Surgery in the 
College School, has announced his intention to offer him¬ 
self as a candidate for a seat at the forthcoming election 
of Council of the Royal College of Surgeons in Ireland. 

Mr. Edward P. Wills, who had previously given 
the magnificent sum of .£20,000 to found the Bristol 
Jubilee Convalescent Home, has added another contribu¬ 
tion of £5,000, suggesting that the total fund for endow¬ 
ment should not be less than £100,000, of which £80,000 
have been already subscribed. 

A memori al, with the signatures of Sir Jas. Crichton 
Browne, M.D., Sir Hy. Thompson, F.R.C.S., Mr. Anderson 
Critchett, F.R.C.S.Ed., Mr. E. Nettleship, F.R.C.S., Ac., 
has been presented to the Local Government Board, with 
the view of stopping the degradation of charity school 
children by begging of passers-by on Derby Day. 

Dr. Moir, who was familiarly known as the father of 
the Royal College of Physicians, died in Edinburgh last 
week at the advanced age of 91 years. Dr. Moir was born 
in 18*18, in a French prison, where his father, a naval 
surgeon, who had been captured during the great war, 
had been joined by his wife. When his father regained 
his liberty, he settled in Edinburgh, and John Moir 
studied for the medical profession, and obtained his 
degree in 1828. 

Sir Frederick McCoy, Professor of Natural Science 
in the University of Melbourne, whose death is 
announced by cable, was the acknowledged chief of the 
scientific world of the southern hemisphere. Formerly 
Professor in Queen’s College, Belfast, he was appointed 
forty years ago to the chair of natural science in the 
then newly founded University of Melbourne, which he 
has occupied ever since. He was a F.R.S., D.Sc.Cantab, 
and the recipient of countless honours from foreign 
sovereigns and scientific societies. Eight years ago he 
received a knighthood. 


Haitian}). 

[from our own correspondent.] 


A Medical Moderator. —Each year during the 
month of May, the Thursday on which all Edinburgh 
holds holiday in honour of Her Majesty’s birthday, sees 
the inauguration of the annual Assemblies of the Church 
of Scotland, and the Free Church’s parliaments. The 
Established Church representatives enter on their yearly 
conduct of business under Royal auspices, the Queen 
opening their Assembly in the person of a Lord High 
Commissioner ; the Free Church meeting opens more 
quietly, but both have their Moderators, or presidents, 
elected for the year from among the ranks of their 
ministers. The Moderator of the Free Church Assembly 
who has been thus honoured by his brethren is the 
well-known medical missionary, the Rev. James Stewart, 
M.D., Hon. F.R.G.S., of the Lovedale Institute in Cape 
Colony, Africa, he having been elected ModeratorJJof the 


Free Church Assembly. The friend and companion of the 
famous Scotchman, Livingstone, Dr. Stewart has done 
more than any other man for the good and welfare of the 
African races and against the evils of the slave trade. 
The election of a medical missionary to the highest 
office his Church can bestow is an encouraging 
sign of clerical tolerance and large-mindednees. Only 
one other medical man has, as far as we know, 
occupied the chair as Moderator at the annual delibera¬ 
tions of the Scottish Presbyterian Churches. Principal 
Lee, who filled the office for the Established Church 
about sixty years ago, possessed a medical as well as a 
divinity degree. Sir William T. Gairdner wrote a letter 
to the Edinburgh Scotsman last week, mentioning his 
recollections of Dr. James Stewart as a medical student, 
and directing attention to the interesting circumstances 
attendant on his present position. 

Our Infirmaries. —For some time past the Royal 
Infirmary has been in a state of “ hot water,” but it is 
not*now singular, as another city infirmary has its bone 
of contention also. The directors of this latter recently 
appointed a deputation in order to visit a number of the 
leading hospitals in England and ascertain the best 
methods both of sanitation and antiseptic treatment. 
The deputation, it is stated, spent £36 on their trip and 
no doubt enjoyed themselves, but their pleasant dreams 
are being disturbed and converted into nightmares 
brought about by the murmurings of the staff, because 
the deputation consisted entirely of laymen : we certainly 
agree and sympathise with the staff, and it does seem a 
very extraordinary procedure to send a number of lay¬ 
men directors on such an important errand without the 
inclusion of at least one of the staff, either medical or 
surgical, or preferably one of each. Unfortunately, the 
lay directors have generally the notion that the medical 
and surgical staff have little or no right to suggest a3 to 
improvements or otherwise in reference to the infirmaries. 
The surgeons are appointed for the purpose of cutting 
off limbs and for the treatment generally of injuries ; 
the physicians, for the purpose of prescribing pills, 
potions, and bolus* s, and carrying out the behests of the 
lay members generally, but not to participate on such 
festive occasions or trips : they must simply be controlled 
and be contented with Bumble, an individual which every 
infirmary seems to possess. 

A Stranoe Claim.— A person by the name of John 
Lamb Thomson raised an action against Dr. Devon, 
Medical Officer of II.M. Prison, Glasgow, claiming £500 
as damages for an assault alleged to have been com¬ 
mitted on him by the defender on December 20th, 1897, 
when the plaintiff was a prisoner in Duke Street Prison, 
Glasgow, the assault consisted in the plaintiff while a 
prisoner being vaccinated by the defendant. The trial lasted 
four days, and the sheriff-substitute found in favour of 
the defendant with expenses. To this decision the plain¬ 
tiff appealed, and the sheriff has confirmed the decision 
of the sheriff-substitute, and with additional expenses.^] 


(Dbituarn. 


JOHN MOIR, M.D., F.R.C.P.E., F.R.S.E., OF 
EDINBURGH. 

Edinburgh has just lost the doyen of her medical 
men, the late Dr. John Moir, at the advanced age of 
91 years Born in prison, his after-life belied such an 
inauspicious beginning. His father was a naval Burgeon, 
and in 1808 was a prisoner of war in the French fortress 
of Yerdun, where his wife had joined him some time 
before, to share his trials. In 1827 John Moir obtained 
the licence of the Royal College of Surgeons of Edin¬ 
burgh, and a year later, when 20 years of age, became 
an M.D. of Edinburgh University, becoming a Fellow of 
the Royal College of Physicians in 1837. For many 
years he was one of the leading obstetricians in Edin¬ 
burgh, and even up to a Bhort time before his death 
interested himself, despite his burden of many years, 
in medical matters and philanthropic schemes. Of a 
deeply religious temperament, he was an energetic 
adherent of the Free Church of Scotland, and a moving 
spirit in all missionary ventures. He was one of the 


Diai 


IIZ6Q Dy 


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550 The Medical Press. 


PARLIAMENTARY NEWS. 


Mat 24, 1899. 


original founders and directors of the Edinburgh 
Medical Missionary Society, indeed with his death the 
last of the original directors has departed this life, 
while the names of some of his sons are enrolled among 
the most successful medical missionaries trained and 
sent out by that excellent institution. 

John Moir performed his life’s long work without fear 
and without favour; an honest, trustworthy physician, 
content to win the regard of men by upright and honest 
endeavour rather than by any striving after personal 
publicity. 


MR. H. B. HEWETSON, F.R.C.S, F.L.S., OF LEEDS. 

The death of Mr. H. B. Hewetson, ophthalmic and 
aural surgeon to the Leeds General Infirmary, re¬ 
moves not only a surgeon whose work was well known 
in the provinces, but one who gained for himself a 
wide reputation for his knowledge of that most fasci¬ 
nating of subjects Natural History. He was a Fellow 
of the Linnean, the Royal Geographical, and the Zoolo¬ 
gical Societies, as well as a member of the Ornithologi¬ 
cal UnioD. Furthermore he was an artist of some 
repute, and found time to do much travelling. 
No one could have taken up so many subjects in science 
and art, as the late Mr. Hewetson did, and excel in 
them, without having an abundance of natuial gifts; 
hence, in his way, he was a genius, and his loss, there¬ 
fore, will be the more keenly felt by all of those who 
profited by, and valued, his acquaintance. The gap in the 
community which he has left will be a difficult one to 
fill. 


Corrtspmtfience, 

We do not hold ourselves responsible for the opinion* of our 
correspondents. 


THE “DOSSIER SECRET” OF THE LONDON 
CHAMBER OF COMMERCE. 

To the Editor of The Medical Press and Circular. 

Sir, —The London Chamber of Commerce holds a 
secret inquiry, the nameB and the precise allegations of 
the witnesses are not published, and no facility is 
afforded for cross-examination, even so much as would 
bear on the bona-fides and respectability of the witnesses. 
This is precisely the procedure that has paved the way 
to all the lies, forgeries, and wickednesses of the Dreyfus 
affair—yet on evidence not an iota more trustworthy than 
that for which Dreyfus was sent to the Devil’s Island the 
London Chamber of Commerce, with a colossal disregard 
for the most elementary principles of fairness and 
common courtesy, make certain grave accusations which 
cannot be, or at any rate have not been, substantiated. 

Allegations made by a body of men so impervious to 
reason and fairness may well be disregarded. They may 
be sincere, but are indiscreet in their action, or it may 
be merely the pi^oygrbial j:ed herring to divert public 
attention from the Chamber itself. 

I am. Sir, yours truly, 

A Non-Commissioned Practitioner. 

THE BIRMINGHAM CONSULTATIVE INSTI¬ 
TUTION. 

To the Editor of The Medical Press and Circular. 

Sir,— Judging from the tone of Dr. Saundby’s letter 
in a contemporary he evidently thinks that no one outside 
the Midland metropolis is entitled to make any remarks 
on the question at issue. 

The Hospital Reform Association, with the idea of 
lessening the amount of abuse that exists, more espe¬ 
cially in the special hospitals and in the special depart¬ 
ments of general hospitals, made a definite recommenda¬ 
tion to the effect that it was desirable to provide an 
Institution where people of moderate means could obtain 
the advice of specialists at a reduced fee. The Council 
were of opinion that such an institution should be 
established on strictly business lines, and that to pre¬ 
vent well-to-do people from obtaining advice at it it 
should be made an absolute rule that every patient 
should bring a note from a medical man, stating that he 


(or she) was not in a position to pay the ordinary fee 
of consultants. 

As one who has watched the attitude taken 
up by many of our hospital physicians and 
surgeons, one cannot help noticing the amount of 
zeal thrown into the opposition to this proposed 
Consulting Institution by the leading consultants of 
Birmingham, and compare it with the apathy shown by 
the same gentlemen when the question of hospital reform 
was brought under their immediate notice a year or two 
since. As I remarked in the Birmingham Daily Pott, 
the idea of paying his consultants a fixed sum per 
annum for their services is most objectionable and ought 
not to be permitted. 

I may remind you that Birmingham is a city where 
the percentage of out-patients to the population is a very 
high one; and also that in spite cf a very efficient 
and exhaustive inquiry in the year 1892 little or nothing 
has been done to reform the system of out-patient 
relief. I am. Sir, yours truly, 

T. Garrett Horder. 

Cardiff, May 20th, 1899. 


THE APPOINTMENT OF POOR-LAW OFFICERS. 

We have received from Drs. Crowley and J. Basil 
Hall a communication in which they point out that in 
reference to the meeting convened by “The Bradford 
and West Riding Medical Union,” 

1. The meeting was not representative. Invitations 
in several instances were omitted, and the majority of 
practitioners of any position took no part in the pro¬ 
ceedings. 

2. The Bradford and West Riding Medical Union is 
not representative nor, indeed, recognised as anything 
more than a society recently got up by Dr. Hime in 
opposition to an old standing medico-ethical society with 
which he has quarrelled. 

3. The committee of the older society (Bradford 
Medico-Ethical) has met and discussed these appoint¬ 
ments, and decided that no steps should be taken in the 
matter. 

4. That neither Dr. Crowley nor Dr. Hall is on this 
committee. 


}3avliamentitv£ .iletos. 


Post-mortem Examinations in Scotland. — In 
answer to a question by Sir William Priestley, the Lord 
Advocate stated that in Scotland no person except the 
medical men instructed to conduct the necropsy is 
allowed to be present at a post-mortem examination 
except with the consent of Crown counsel or on the 
order of the sheriff. Crown counsel may, in their dis¬ 
cretion, sanction the presence of a medical man who has 
attended the case or in the interests of the accused; but 
this is done only on condition that he is to be present 
merely as an onlooker, and is not to interfere in any way 
with the Crown examination. No formal intimation is 
given that a necropsy is to be held, but in aU 
cases where any person is in custody on suspicion of 
causing death a necropsy is made as a matter of course, 
so that an accused person or his advisers cannot be in 
doubt as to the necessity of making immediate applica¬ 
tion for permission to send a nedical man to witness the 
necropsy if they so desire it. The quarter to which 
application should be made is the Procurator-Fiscal, 
whose duty it is in all cases of urgency to oommunicate 
by telegraph with the Crown Agent for the instructions 
of Crown counsel. If an independent post-mortem 
examination is desired it can be made after the Crown 
examination. 

The Midwives Bill has once again been postponed. 
The date assigned for the discussion is May 31st—the 
Derby Day. Abrit omen ■' 

Isolation Hospitals (Amendment) Bill.— The 
Isolation Hospitals (Amendment) Bill amends and 
extends the Act of 1893, by giving District Councils and 
joint Boards power to transfer to County Counoils any 
hospital provided under the Public Health Act,, 1875, 
or any local Act, and to empower County Councils to 


Digitized by Vj 


MEDICAL NEWS 


The Midcal Press. 551 


May 24, 1899. 

raise the necessary funds for structure and establish¬ 
ment expenses on the security of the county rate. Lord 
Lichfield strongly supported the necessity for some such 
measure, and Lord Harris, on behalf of the Government, 
gave the Bill a qualified support, and the second read¬ 
ing was carried on the understanding that the committee 
stage would be deferred till after Whitsuntide. 

The 0ystkr8 Bill. —Lord Harris’s Bill enabling 
County Councils to inspect oyster beds and to analyse the 
water in which the oysters are laid, wss read a second 
time. The Councils will have power, if they judge neces¬ 
sary, to prohibit the removal of oysters from a given 
area for a period of ten days, the proprietor of the bed 
having the right to petition the Local Government Board 
on the merits. Other clauses provide penalties under 
the Act, and there is a special clause dealing with foreign 
oysters that might have been subject to contamination. 


^Caboratorg ^otcs. 

ESVACH WATER. 

This is a valuable aperient water containing a con¬ 
siderable proportion of sodium and magnesium sulphates, 
to which, in the main, its action is doubtless due. These 
salts, when administered alone, are unpleasant in taste, 
and usually have so disagreeable an effect owing to their 
griping action as to render them unpopular as a 
medicine. In the case of the newly-introduced aperient 
water, “ Esvach,” this objection has been successfully 
overcome without interfering with its medicinal proper¬ 
ties, owing to the presence of a considerable proportion 
of bi-carbonate of soda. This salt in conjunction with 
the magnesium sulphate no doubt gives rise to mag¬ 
nesium bi-carbonate, and the result is that not merely 
is the taste of the water far less bitter than would other¬ 
wise be the case, but the value of its aperient properties 
is'materially enhanced. 

In our analysis we found the total solid residue, 
obtained on evaporation of the water, to be 4 H7 per 
cent., nnd the constituents are approximately as 
follows :—Magnesium about 100 percent., carbonic anhy¬ 
dride, 11 per cent., sulphuric acid (calculated as S0 4 ) 
600 per cent., the remainder consisting essentially of 
salts of sodium with small quantities of other salts. 

As the water is an active aperient it is well adapted 
for the use of travellers, seeing that a moderate dose will 
produce the required effect. The sole wholesale agents 
for this water are Messrs. Davy Hill and Son, Yates 
and Hicks, (54 Park Street, Southwark. 

VIBRONA SHERRY. 

Yibbona Sherry, samples whereof we have received 
from Messrs. Fletcher, Fletcher and Co., is a combina¬ 
tion of the neutral hydrobromates of the cinchona 
alkaloids in a pure dry sherry of the Amontillado type. 
Tho wine is of light alcoholic strength, and is exception¬ 
ally free from sugar, and its tonic and appetite-giving 
properties will be appreciated by those who object to 
the comparative sweetness of analogous preparations 
with a basis of Madeira. The presence of the alkaloids 
as hydrobromates enables this tonic wine to be taken 
without fear of inducing cinchonism even by persons 
with an idiosyncrasy in that direction. Vibrona Sherry 
has a delicate flavour with a grateful bitterness, and 
should be especially serviceable to persons of gouty or 
dyspeptic tendencies. 


Jtte&ical ^cIbs. 


The Canadian Medical Association. 

The next annual meeting of the Canadian Medical 
Association will be held at Toronto on August 30th, 31st, 
and September 1st next. The President will be Mr. 
Irving Cameron. The meeting promises to be an im¬ 
portant one, inasmuch as the final details will probably 
be decided on in connection with the scheme of medical 
registration throughout the Dominion. This is a matter, 
of course, of supreme importance to the colony generally. 
Dr. F. N. G. Starr is the Secretary of the Association. 


Medical Exhibition. 

The Medical, Surgical, and Hygiene Exhibitors Asso* 
ciation opened their annual exhibition of objects and 
appliances germane to medicine and the allied sciences, 
at the Queen’s Hall, Langham plaoe, W., yesterday 
(Tuesday), and it will remain open until Friday, 26th 
inst. 

Injuries from X-rays. 

An important case against X-ray operators is shortly 
to come before the courts in Chicago. In 1896 the 
plaintiff sustained an injury which affected his ankle, 
and he submitted it to the X-ray operators. He 
claims that the apparatus was improperly handled, for 
he received a serious burn which necessitated the ampu¬ 
tation of his foot. The claim is for 25,000 dols. damages. 
A similar case resulting from the use of the X-rays 
occurred in Paris a short time since to a young woman. 
It was necessary to have three exposures, and after the 
third somewhat severe lesions appeared on the skin 
causing a long illness, and the doctor was sued for 5,000 
francs, and the matter has been referred to a committee 
of experts. The moral is that skiagraphers had better 
be prudent until experience has sufficiently demonstrated 
the latent capabilities of their apparatus for good and 
ill. 

Death Under Chloroform at Dudley- 

An inquest was held at Dudley last week on the body 
of a man, a?t. 35, who died while chloroform was being 
administered prior to his being operated on for strangu¬ 
lated hernia. It was stated that not more than two 
drachms of the anaesthetic had been given, and the 
medical evidence favoured the view that death was due 
to sudden dilatation of the heart. We are not told how 
the chloroform was given, whether by means of an inhaler 
or by the pernicious “ open ” method; but the chances 
are great that it was flopped on to a towel and held over 
the patient’s face. The usual verdict was returned. 

Scholarship for Medical Research. 

The Technical Education Board of the London County 
Council is co-operating with the Asylums Committee in 
offering a scholarship of £150 a year, tenable for two 
years, for students of either sex (preferably qualified 
practitioners), to enable them to carry on investigations 
into the preventible causes of insanity, the scholar to 
carry on investigations in the pathological laboratory 
attached to Claybury Asylum. A similar scholarship 
has been held during the past two years by Dr. J. O. W. 
Barratt, who has carried on valuable original investiga¬ 
tions into the causes of insanity, many of which have 
been recently published. Dr. Barratt has recently been 
appointed pathologist at the Wakefield Asylum, and the 
scholarship which he has held is therefore vacant. Can¬ 
didates must be resident in London. Application should 
be made to the secretary of the Technical Education 
Board, 116, St. Martin’s Lane, W.C., not later than 
Wednesday, June 7th. 

Death from Anthrax. 

An inquest was held at Liverpool on the 16th inst. on 
the body of a man employed by a tanner, who died from 
anthrax. It was stated that the deceased had been 
engaged in “fleshing” hides from China, which, before 
being dealt with, were treated with carbolic acid and 
bleaching powders. The handliug of Eastern hides is 
recognised to be particularly dangerous, and this is the 
second death from anthrax at Liverpool under similar 
circumstances during the last few weeks. 

Naval Medical Service. 

The undermentioned gentlemen who competed on 
May 8th and following days at Examination Hall, 
Victoria Embankment, for appointments as surgeons in 
the Royal Navy, have been granted commisssions:— 


Name. 


Marks. 

Name. 

Marks. 

H. M. Hart-Smith, 

B.A. 


T. Marle8-Tliomas . 

. 1,953 

M.B. 


2,538 

A.W. Nourse 

1,901 

S. H. Wood. B.A., M.B. . 

2,451 

J. H. Jones. 

1,878 

P. T. Sutliffe, M.A., 

M.B. 

2,411 

A. H. Prichard 

1,820 

J. P. H. Greenhnlgh 

M.B 

2,203 

H. L. Geoghegan, B.A 

1 

L. A. Baiss 


2,179 

M.D. 

1,804 

C. R. Nicholson ... 


2,172 

A. J. Laurie. 

' 1,804 

J. T. M. McDougall 


2,090 

S. J. Haylock. 

1,687 

E. T. Burton 


2.006 

J. E. Powell 

1,085 

R. Hughes 


1,992 

J. N. Robertson, M.B. 

1,643 

G. M. 0. Richards 


1,968 

J. H. Lightfoot 

1,632 

N. J. Roche. 


1,959 

P. G. Williams 

1,612 


Digitized by LiOOJ 




552 The Mbdical Press 


NOTICES TO CORRESPONDENTS. 


Mat 24, 1899. 


Notices to 

Cforrcfiponbcnts, Short fetters, &t. 

Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive signature or 
initiate, and avoid the practice of signing 1 themselves “ Beader,” 

Subscriber,” “ Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

Reprists.—A uthors of papers requiring reprints in pamphlet 
form after they have appeared in' these columns can have them, at 
half the usual cost, on application to the printers before the type is 
broken up. 

Local Kf-ports asd News.—C orrespondents desirous of drawing 
attention to these are requested kindly to mark the newspapers 
when sending them to the Editor. 

Original Articles or Lf.tters intended for publication should 
he written on one side of the paper only, and must be authenticated 
with the name and address of the writer, not necessarily for publica¬ 
tion, but as evidence of identity. 


EFFECTS OF EDUCATION. 

A patient the other day called on the doctor of his society to 
explain why he was not at home when the latter called to see him 
about the rheumatism of the feet from which the sick member 
suffers. Patient: You see I went down to the “Central.” not the 
Cent ml police office, but the Central electric station to get a tew shock* 
to see if it would do my ]>ains any good. Doctor : Well ’ and how 
did you stand the shocks ? Did you bear them well ? Patient : Oh, 
yes;’ for the person who has charge of the electric current told me 
that he had applied fire rampins to each foot, and for a good long 
time, and I never flinched ; in fact, he had never known anyone to 
stand so many vampires before without singing out. 

ErsTicrs.— Croup is a general term you had better avoid. How¬ 
ever, if you must use it in deference to jocular usage, you 
had better reserve the term “true croup” to diphtheria of the 
larynx, and false croup to catarrhal laryngitis. Both aredangcrous 
conditions, of course, and want active treatment. The diphtheritic 
form is by far the more serious, but operation mortality is now 
much reduced by the antitoxin injections. Your question is impor¬ 
tant, although we doubt if the term croup (really a symptom I will 
be rooted out of the vernacular for ages to come. 

F. 0. Smith.— 1. Certainly ; with pleasure. 2. Half an ounce of 
carbolic acid nlmost always fatal. Wash out stomach with Epsom 
salts, and give half-ounce doses of sulphate of magnesia and sul¬ 
phate of so<1a. The soluble sulphates combine with the carl>olic 
acid to form harmless sulpho-earholntes. Olive oil in large doses 
— e.(/.. a couple of wine-glassfuls. The 1-50 grain of sulphnte of 
atropine may be given hypodermically. The sale of this substance 
ought to be restricted, as the numbers of suicides and accidental 
deaths through its agency are very great. We can hardly be said to 
have n really satisfactory antidote yet for this poison. :5. Seud us 
notes of the case by all menus, nnd the fuller the better. We are 
always glad of terse, practical clinical experiences. 


Jtteetinge of the §otictics ant) -Cccturcs. 

Thcrsdat, Mat J6th. 

Dermatological Society of Great Britain ani> Ireland (20, 
Hanover Square, W.).—+.30 p.m. Annual Meeting. Mr. Jonathan 
Hutchinson will read a Paper and open a Discussion on Diseases of 
the Nails with special reference to their Significance as Symptoms. 
Exhibition of cases, drawings, microscopical nrejiarations, Ac. 

Central London Throat, Nosb, and Ear Hospital (Gray's Inn 
Rond, W.C.)—5 p.m. Dr. D. Grant: Diagnosis and Treatment of 
Obstructive Deafness. 

Fridat, Mat 26th. 

Clinical Society of London (20, Hanover Soiuire, W.).—8.30 

£ ..m. Annual General Meeting. Election of Officers for Session 
809—1800. Papers : - Mr. H. B. Robinson : Acute Intestinal Ob¬ 
struction caused by au Adherent Vermiform Appendix forming a 
Band associated with Fcetal Arrangement of the Peritoneum. - Dr. 
C. Fox : A Case of Generalised Htemorrhugic Erythema in Bright’s 
Disease.—Mr. H. Allingham: A Case of Aneurysm of the Sub¬ 
clavian Artery, Ligature of the first portion of the Vessel followed 
in thirty-eight days by Removal of the Aneurysm. The patient will 
be shown. 

St. Georoe's Hospital Medical School (Hyde Park Corner).— 
3 p.m. Dr. W. H. Dickinson : Fragments of Pathology and Thera¬ 
peutics. (Boillie Lecture.) 

Royal Academt of Medicine in Ireland.— Obstetric Section.— 
Papers: 1. Polycystic Ovarian Tumour. Prof. Kinken.l (Galwny). 
2. Notes on a Successful Case of Cesarian Section. Dr. Kidd. 3. 
Treatment of Ureter injured during Hysterectomy. Specimens.— 
1. Dr. Smyly: Myomatous Uterus removed by Abdominal Hyste¬ 
rectomy, Doyen’s method j Tuberculous Ovarv removed by Abdo¬ 
minal Section. 2. Dr. Gienu: Myomatous Uterus removed by 
Retro-peritoneal Hysterectomy. 3. Dr. Smith: a, Three Myoma¬ 
tous Uteri removed by Retro-neritoneal Hysterectomy ; h, Pyosal- 
pinx; c, Ovarian Cystomata ; a. Myomatous Uterus showing large 
abscess cavity removed by Panhysterectomy. 

Monday, May 28th. 

Csntral London, Throat, Nose and Ear Hospital (Gray's Inn 
Road).—6 p.m. Mr. Lennox Browne, on Tuberculosis and Allied 
.Conditions. 


Tuesday, Mat 30th. 

Hospital for Nervous Diseases (Welbeck Street).—1 p.m. I>r. 
T. D. Savill: Neurasthenia. 


Vacancies. 

Birmingham.—Assistant Resident Medical Officer, at the Work^ 
house Infirmary. Salary £100 per annum, with furnished apart¬ 
ments, rations (no alcoholic liquors), coals, gas, laundry, and 
attendance. Applications to the Clerk to the Guardians, Pariah 
Offices, Edmund Street. 

Brighton, Hove, and Preston Dispensary.-House Surgeon to the 
Western Branch. Salary, £140 per annum, with furnished 
apartments, coals, gas, and attendance. 

Glamorgan County Asylum, Bridgend.—Junior Assistant Medical 
Officer. Salary £130, rising £10 a year to £150 if approved, with 
board (no beer or wine), lodging and washing. 

Hollowny Sanatorium, Virginia Water.—Senior Assistant Medical 
Officer. Snlary commencing at £300 per annum, with board, 
lodging, and washing. 

Kidderminster Infirmary and Children’s Hospital —House Surgeon, 
uuniamed. Salary £1+0, increasing £10 per annum to £170, 
with rooms in the Infirmnry and attendance (option of board 
at £+0 per annum). 

London County Council.—Scholarship in Sanitary Science, of the 
value of £150 per year, tenable in the Pathological Laboratory 
of the Claylmry Asylum. Applications to the Secretary of the 
Technical Education Board, 116, 8t. Martin’s Lane. (See 
advert.). 

Staffordshire General Infirmary, Stafford. - House Surgeon. Salary 
£100 per annum, with bonrd, lodging,and washing. Also Assist¬ 
ant House Surgeon. Salary £50 per annum, with board, lodg¬ 
ing, and washing. 

Victoria University, the Yorkshire College. Leeds.—Lecturer on 
Practical and Operative Surgery. Emoluments from students' 
fees only. Also Junior Demonstrator in Pathology. Salary 
£ 120 . 

West Riding Asylum, Wndsle.v, near Sheffield.—Fifth Assistant 
Medical Officer. Salary £1«K» per annum, rising £10 a year up 
to £15o, with board, Arc. 


Appointments. 

Andrews, Hexpy Russell, M.D.Lond., M.R.C.S., L.R.C.P., 
Obstetric Registrar and Tutor to the London Hospital. 

Briscoe, J. C„ M.R.C.S. L.R.C.P., House Physician to King's 
College Hospital, Loudon. 

Cowie, R. M., M.R.C.S., L.R.C.P., Surgical Registrar to King’s 
College Hospital, London. 

Crispin, E. S.. M.R.C.S., L.R.C.P., House Surgeon to King's 
College Hospital, London. 

Fema, C. E., M.B.Durh., M.R.C.S., L.R.C.P., Assistant Honse 
Accoucheur to King's College Hospital, London. 

Gard, H., L.tt.C.P.Edin., L.K.P.S.Glasg., Medical Officer for the 
Northern Sanitary District of the Parish of Devonport. 

Greenwood, Frank R., M.R.C.S., L.R.C.P.Lond., Resident 
Medical Officer to the Cliildrun'a Hospital,*Birmingham. 

Gut, J., M.B., C M.Glasg., Assistant Medical Officer at the Infir¬ 
mary of the Leeds U nion. 

MacMullen, W. D.. M.R.C.S., L.B.C.P., Assistant House Phy¬ 
sician to King's College Hospital, London. 

Mowll, R. R., L.S.A., House Surgeon to King’s College Hospital. 
London. 

Nash, James T. C\, M.B., C.M., D.P H., an Assistant in the Bacte¬ 
riological Department of King's College, London. 

Parsons, A. R. C., M.R.C.S , L.R.C.P., House Surgeon to King’s 
College Hospital, London. 

Roberts, G. A., M.R.C.S., L.R.C.P., House Physician to King's 
College Hospital, London. 

Saunders, L. D., M.R.C.S., L.R.C.P., House Accoucheur to King's 
College Hospital, London. 

Stewart, A. R., L.R.C.P., J .R.C.S.Ed., L.F.P.S.Glaag,, Medical 
Officer for the Newton Heath Sanitary District Prestwich 
Union. 

Thomas, L. Kirkbt, M.R.C.S., L.R.C.P.Lond., Resident Surgeon to 
the Children's Hospital, Birmingham. 

Wright, P. P., L.R.C.P.Lond., Medical Officer for the Upper Hol¬ 
loway Sanitary District of the Parish of St. Mary, Islington. 


Dicths. 

Drew.— May 18th, at Water Hall, Oxford, the wife of Arthur G. 
Drew, F.R.C.S., of a son. 

Jones.—M ay 11th, at Claybury, Woodford, Essex, the wife of 
Robert Jones, M.D.. of a son. 

Sttan. —May 16tli, at at 2, Chapel Place, Ramsgate, the wife of 
T. G. Styan, M.A., M.D.C&ntab, of a daughter. 


Carriages. 

Ensor Cox.— Ou May 16th, at the Parish Church, Minchin Hamp¬ 
ton. Cecil Arthur Ensor, M.R.C.S., L.R.C.P., son of John A. 
Ensor, Surgeon, of Tisbury, Wilts, to Irene Margarita, 
daughter of the late Edward Gordon Cox, of Hyde Brae, 
Gloucestershire. 


Jeaths. 

Grimbly. —On May 1+th. at the Grange, Summertown, Oxford, 
Richard Grimbly, M.R.C.S., formerly of Banbury, Oxon, aged 
8+ years. 

Watts.— On May 12th, at Battle, William Edward Monekton Watts, 
M_R.C.S., aged 68 years. 


Digitized 


by VjOOglC 



— 


May 81, 1890 


The Medical Press and Circular Advertiser. 


1U1 



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in the manufacture of ‘Kepler* 
Malt Extract is watched and 
controlled with the utmost 
scientific care. No inferior or 
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only the finest selected winter- 
malted barley. The processes 
and the machinery employed are the outcome 
of years of special experience in the preparation 
of Malt Extract for dietetic use. These great 
advantages are fully recognized by physicians. 



In small and large bottles, Is. 8d. and 3s. each. 

Burroughs Wellcome & Co., London and Sydney. 

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She HWiral 3?rcss and Circular. 


O 


" SALU8 POPULI StJPREMA LEX." 

Vol. CXYIII. WEDNESDAY, MAY 31, 1899. No. 22. 


©riginal (HAtmmmitatHms. 


THE TREATMENT OF 

GONORRB(EAL SALPINGITIS, (a) 

By J. W. TAYLOR, F.R.C.S., 

Surgeon to the Birmingham and Midlands Hospital for Women, 
Consulting Surgeon to the Wolverhamptcn Hospital for Women. 

(Concluded from page 532). 

The view of the disease and its treatment which I 
have presented for your consideration has not only 
its medical but also its surgical aspect. 

If we may hope for some radical control of pelvic 
gonorrhoea from medicine not onl^ will operation be 
less frequently nece66ary, but partial operations which 
were formerly derided and stigmatised as useless will 
find a legitimate use, and prove, in conjunction with 
medical means, a higher and better method of treat¬ 
ment than that of complete removal of the appen¬ 
dages so strongly urged in former years. 

For instance, the free opening of pus-cavities 
without ablation of the uterine appendages or the 
removal of a pyo-salpinx of one side only when the 
tube and ovary of the opposite side are so far free 
from disease and perfectly healthy, may be good 
practice, and is sound in principle if we can guard 
against the extension of disease. 

As an adjunct or handmaid to surgery, too— 
after operation has been performed—the specific 
treatment of the patient may sometimes ensure a 
success that otherwise might lie wanting. When the 
woundrefuses to heal,the stitches are ulcerating out— 
the drainage track is sloughing—the temperature 
hectic and the appetite wanting—when the case 
seems slowly going to the bad some two or three 
weeks after the immediate danger of the section has 
been successfully passed (a not very uncommon 
sequel after abdominal section for pelvic gonorrhoea 
with abundant pus-formation and almost confined to 
this class of case), the power of the biniodide to im¬ 
prove the condition in my own hands has been 
marked and almost immediate in its action. 

If my contention is right, we may hope from the 
use of specific treatment, for a selective action in 
cases beiore operation—limiting the necessity of the 
latter—for a freedom of choice that was formerly 
unknown during operation of various methods more 
or less conservative, and finally (after operation) for 
its influence as an aid to recovery that may materially 
improve both immediate and remote statistics. 

This brings me to the consideration of pyo-salpinx 
and its treatment. 

I incline to the belief—based mainly, perhaps, on clini¬ 
cal and operative observation—that dangerous pyo-sal¬ 
pinx is but rarely a purely gonorrhoeal disease, that 
it is usually a product of mixed infection, and that 
the more dangerous element comes from the intestinal 
tract. 

It is always—or nearly always—started by gonor¬ 
rhoeal inflammation, but so long as it remains a sac of 
purely gonorrhoeal pus it is usually small and only 
rarely dangerous. But as the pus-sac enlarges it 

(a) I'sper read before the British Gynecological Society, May 
11th, 18U9. Por discussion see page 536—last No. 


comes into immediate relation with the bowel* 
and usually with the sigmoid flexure and rectum. 
The pus-sac is infected from the neighbouring 
bowel — like a broad-ligament pregnancy under 
similar conditions—the condition becomes urgent, 
the patient cannot sleep for pain, and the tempera¬ 
ture, though sometimes unreliable, may rise to nigh 
pyrexia. 

Then operation is needed, and no unnecessary delay 
is permissible, and the operation I wish to recommend 
with the utmost force of which I am capable is that 
of posterior .vaginal coeliotomy—the thorough open¬ 
ing of the pouch of Douglas from the vagina—the 
digital and bi-manual exploration of the tumour or 
tumours from this situation, the tapping of all pus- 
cavities deliberately carried out, the enlargement of 
all openings thuB made, and the establishment of 
pelvic drainage from all infected parts by a tampon 
or tampons of iodoform gauze. 

If this operation is done as I have advised—by free 
incision (no puncture or simple tapping is sufficient), 
the urgent symptoms are at once and thoroughly 
relieved, a condition of imminent danger of death is 
converted sometimes as if by magic, into one of peace¬ 
ful rest and happy convalescence. 

The maximum of relief—I speak advisedly, for the 
peritonitis following removal of a double and adherent 
pyo-salpinx is often severe, and the after result in no 
way better than that attained by the operation I am 
advising—the maximum of relief is attained with the 
minimum of danger and the minimum of injury to the 
sexual organs concerned. I have repeatedly employed 
this method of treatment during recent years and 
have followed it up in most cases (so far as I have been 
able to do so) by specific treatment. In each of these 
cases 1 have been more and more satisfied with the 
efficiency of the means employed and impressed with 
the vast superiority of this operation to the removal 
of the tubes by abdominal section. 

The following cases may be taken as recent examples 
of its value. 

Mrs. I., set. 28, had been married four years. Her 
husband confessedly had contracted gonorrhoea since 
his marriage. Six weeks ago the patient had a green 
discharge from the vagina, and for four weeks had 
suffered with severe abdominal pain. 

I saw her on the evening of May 25th, 1898, in 
consultation with Dr. Miligan. 

She evidently had some general acute peritonitis. 
The abdomen was distended and tympanitic ; the legs 
drawn up. She had frequent vomiting, a pulse of 
120, and a temperature of 103 degs. F. She was r try 
feeble, very restless, and crying with pain. On 
vaginal examination a mass was found in the pouch 
of Douglas, and pushing the uterus to the left. The 
tumour was acutely tender. A dose of calomel wus 
ordered to be given at once, followed by frequent 
enemata, and it was arranged to move the patient to 
my house for operation on the following day. On 
May 27th I opened the pouch of Douglas, separated 
adhesions, and evacuated a large quantity of foul 
pus from the right Fallopian tube. The abscess 
cavity was washed out and packed with iodoform 
gauze. 

In the evening her pulse was 96. She was com¬ 
fortable ; her bowels bad been opened with a simple 


Diai 


, y Google 




554 Phi Medical Press. 


ORIGINAL COMMUNICATIONS. 


May 81, 1899. 


enema, and she Lad a fairly good night’s rest after¬ 
wards, “ the first good night for weeks.” The patient 
made a good recovery. 

Mrs. J., rot. 24, married four years, came to my 
out-patient room on August 25th, 1898, complaining 
of abdominal pain and dyspareunia, which had been 
increasing for six months. On examination I found 
what I took to be an enlarged and tender left ovary 
that was evidently the source of the pain complained 
of. I ordered a mixture of bromide and viburnum, 
and gave some general hygienic advice. 

On October 27th, the patient was brought to the 
hospital evidently suffering from intense pain. She 
was crying, and stated that she had had no sleep for 
four nights on account of this Her temperature 
was lOldegs. F. On again examining her 1 found a 
fixed tender mass to the left of the uterus pushing the 
latter to the right. This was acutely sensitive to touch, 
and I believed it to be caused by a distended tube. 
On closer inquiry into her case I found that there 
was a distinct history of copious purulent vaginal 
discharge some three years ago. I altered the 
diagnosis to one of acute pyo-salpinx, and admitted 
her into hospital Operation was done on October 
31st. I opened the pouch of Douglas through the 
posterior fornix and evacuated some dirty and rather 
foul serum from the pelvis. On examination through 
the opening thus made I found the left tube was 
dilated into a large pus-sac, having thick walls, and 
being very adherent. I first tapped this with a trocar 
and cannula, and afterwards opened up the punctured 
incision with my fingers. One or two secondary col¬ 
lections of pus were also set free. The cavities were 
sponged out and packed with iodoform gauze. 

The patient, who had been before the operation 
almost a type of misery, immediately altered. In 'the 
morning she was smiling, happy, and good-tempered, 
and said that she had passed the best night she had 
had for several weeks. She has made uninterrupted 
progress, and leaves the hospital to-day. 

I do not wish it to be inferred that I regard pos¬ 
terior vaginal coeliotomy as the only operation to be 
undertaken in pyo-salpinx. When the tumour is 
large and prominent or “ presenting ” towards the 
abdominal aspect, abdominal section may prove a 
better means of access to the seat of mischief. 
Wherever this seat of mischief is most accessible, 
there is, in nine cases out of ten, the best point of 
attack. 

I will not, however, dwell on this part of my sub¬ 
ject, but pass on to the consideration of the limita¬ 
tions to success in the treatment of gonorrhoeal 
disease, and any means we possess of avoiding them. 
These may be shortly considered under three heads: — 

1. The severity or complications of the disease 
preventing recovery. 

2. The carelessness and distaste of the patient for 
any prolonged treatment. 

3. The effect of adhesions in causing sterility and 
occasional pain. 

1. The first is undoubtedly the most important. 
In spite of all that may be done in the future I quite 
believe that there will remain a residuum of intract¬ 
able cases, and among these I would particularly 
point out cases complicated with uterine fibroid or 
anything which tends to cause or increase uterine 
haemorrhage. When bleeding is severe no patient or 
medical attendant will continue a course of treat¬ 
ment which is not immediately directed to the 
stopping of the haemorrhage. In addition to this, 
both mercury and iodides in some people appear to 
increase the tendency to bleeding. In all of these 
cases 1 j'ecommend vaginal hysterectomy, with or 
without removal of the appendages. It is not only 
the most rational operation in theory, but is produc¬ 
tive of the best final results when conservative surgery 
is hopeless. 


2. The carelessness and distaste of the patient for - 
treatment will often be an annoying feature and 
source of failure, as it is so often in syphilis. In 
some cases the biniodide mixture causes nausea, and 
even vomiting. When this is the case smaller doses • 
may be tried, or recourse may be had to a method of 
treatment, which is occasionally very useful. Only 
one dose of iodide is given in the day, but this is a 
large one—from 15 to 20, 30 or 40 grains. This is • 
taken the last thing at night before going to sleep. 
Every other night, or every night if necessary, a 
Plummer’s pill (pil. hyd. subchlor. co.) is taken at the - 
same time. The patient keeps all her medicine in 
her bedroom, and only needs to remember it on. 
retiring to rest. 

3. The effect of adhesions as a limitation to full - 
recovery is a more important matter. Occlusion of 
tubes and peri-tubal adhesions, consequent on gonor¬ 
rhoeal salpingitis, do not partake themselves of any 
specific character and must be regarded rather as • 
secondary mechanical results of the inflammation 
which has been caused by the pelvic gonorrhoea,. 
differing in no essential from peritoneal adhesions 
elsewhere, such as those caused by injury, by 
appendicitis, or by gall-stones. 

Their absorption and disappearance will not, there- - 
fore, be secured by the cure of the gonorrhoea. The 
cure of the gonorrhoea will be the necessary pre¬ 
liminary, but the actual disappearance of adhesions - 
will probably depend on the perfection of the general 
health and the power of relative mobility enjoyed by 
the adhering organs. 

As a necessary oonsequence it will, I believe, be 
found that sterility will still result or persist when 
the appendages of both sides have been attacked by 
disease before any treatment has been begun. But if 
energetic treatment is started when only one side is - 
affected and the opposite tube is healthy, one may 
reasonably hope that the healthy tube will remain 
healthy and the patient retain her fertility. Such is - 
the explanation, I believe, in both of the cases I re¬ 
ported at the beginning of my paper, in which con¬ 
ception took place at a period subsequent to the 
salpingitis,while in the acute case of pelvic gonorrhoea, 
notwithstanding the comparatively short duration of 
her illness, both sides have suffered and future 
fertility is hardly to be expected. I shall be inte¬ 
rested to watch this case and see if my forecast is • 
justified. 

For similar reasons a remainder of occasional and 
slight pain may be rather frequently expected in the - 
most favourable cases—such a sequel as is often met 
with after an ovariotomy from adhesions to the stump. 
This depends mainly, I believe, on the involve¬ 
ment of intestine or omentum in attachments. 

If these escape the patient has no pain—if they are 
involved, the patient may have occasional discomfort 
and sometimes acute, if transient, colic. 

The consideration of this subject would not be 
complete without some reference to prophylaxis, and to 
the treatment of acute and chronic gonorrhoeal vagini¬ 
tis. In the acuter forms of gonorrhoeal salpingitis when •. 
specific vaginitis and endometritis are also present, 
and in gonorrhoeal vaginitis when it may still be 
possible to limit the upward spread of the disease, - 
focal treatment is of vei-y great and indeed of 
primary importance. 

As regards the gonococcus, the strongest and best 
local germicides known (according to Neiaser) are the 
nitrate of silver, the percbloride of mercury and 
ichthyol, and it iB on one or more of these that chief 
reliance should be placed. 

In all cases of acute gonorrhoeal salpingitis in 
which the uterus and vagina are also affected, I use 
a vaginal suppository of ichthyol (10 per cent.) every 
night and a douche of crude acetic acid during the - 



May 31, 1899. ORIGINAL COMMUNICATIONS. _ |Thx Mxpical P»«M| 555 


day. In oases of complicated gonorrhoeal vaginitis, 
especially in hospital practice, I generally use a 
vaginal suppository of silver nitrate (gr. $) every 
night, and the same vaginal douche of pyroligneous 
acid (5ss. and Oj) twice during the day. 

If, as only very rarely happens, the patient comes 
almost immediately after exposure to contagion it 
may be advisable to disinfect the vulva, vagina, and 
cervix manually, as in a vaginal cceliotomy. 

In one case of vaginitis oi about two days' duration, 
in which the patient was already feeling considerable 
and rapidly increasing discomfort, but in which, it is 
only fair to say, the gonorrhoeal origin was never 
thoroughly established, I did this with the very best 
result. The disinfection was repeated three times, 
and the patient was directly cured with no retension 
or relapse. 

In cases where there is no evidence of endometritis 
or tubal disease the local treatment advised contains 
all that is required, and this should be applied in the 
simplest possible manner. No unnecessary examina¬ 
tion should be made, and the use of the sound should 
be forbidden as most dangerous. 

It is only in cases of tubal disease, where the appen¬ 
dages are evidently affected by gonorrhoeal inflamma¬ 
tion, in gonorrhoeal rheumatism or arthritis, in 
gonorrhoeal endocarditis, or in persistent and incur¬ 
able discharges due to gonorrhoea, that the local 
treatment must be supplemented by the administra¬ 
tion of mercury and iodides, as described in the 
earlier sections of my paper. 

To emphasise and make ready for discussion the 
main points contained in this communication, I have 
prepared a short abstract, or precis, of the proposi¬ 
tions I am disposed to maintain, and on which I 
invite the criticism of my colleagues. 

First .—That a large number of women who are 
suffering from tubal disease have been at Borne time 
or another exposed to the infection of syphilis as 
well as of gonorrhoea. That these undoubtedly show 
marked improvement after a prolonged course of 
mercury and iodides, and in the course of this treat¬ 
ment unless acute pyo-salpinx intervenes (in which 
medicine is useless) it is the rule rather than the 
exception for all gross physical signs of disease to 
slowly and permanently disappear. 

Secondly .—That many cases in which there is no 
history of syphilis, including cases in which there is 
the unmistakable history of gonorrhoea, pure and 
simple, as the sole cause and starting-point of tubal 
disease, do similarly improve and get permanently 
well under the same course of treatment, provided 
always that the disease stops short of acute pyo-sal¬ 
pinx and its dangerous complications. 

Thirdly .—That acute pyo-salpinx is peculiarly 
liable to occur in the first place on the left side of 
the body, and its special severity is probably due to 
secondary infection from the’rectum. Thatcasesof pyo- 
salpinx, whenever possible, should be treated by free 
incision of the posterior vaginal fornix, by thorough 
exploration and emptying of all pus-cavities from the 
pouch of Douglas, and by iodoform gauze drainage. 
That this is far preferable to the older operation of 
removal of the appendages which is not only much 
more dangerous, Dut is peculiarly liable to be followed 
by faecal fistula, an operation-sequel sometimes worse 
than death itself. 

Fourthly .—That such cases of mixed infection and 
acute suppuration treated by operative evacuation of 
the pus, with or without removal of the appendages, 
do sometimes not only recover but remain perma¬ 
nently well without further treatment, the acuteness 
of the inflammation appearing to terminate the 
process of infection. In other cases, recovery is not 
so complete or relapses are met with, and these cases 
should De followed up by a course of specific treat¬ 


ment, the beneficial result of this being often imme' 
diately manifest when the wound tissues are un¬ 
healthy and the healing is delayed. 

Fifthly .—-That occlusion of the tubes and peri* 
tubal adhesions con sequent, on gonorrhceal adhesions 
have no direct specific causation, and must be 
regarded rather as secondary mechanical results of 
the local peritonitis which has been caused by sal¬ 
pingitis. 

Their absorption and disappearance will not there¬ 
fore be necessarily secured by the cure of the 
gonorrhoea, and sterility may persist although 
gonorrhoea is entirely eradicated from the system. 

Sixthly .—That in gonorrhoea of the pelvis there 
will probably remain a residuum of intractable cases, 
particularly cases of complication with other diseases 
such as fibroids of the uterus. That in these cases 
operative removal of the organs affected will still be 
required, and that vaginal hysterectomy whenever 
possible, with or without extirpation of the uterine 
appendages is pot only the most rational operation 
in theory, but is productive of the best final results. 


CONSIDERATIONS AS TO THE ETIOLOGY 
AND SIGNIFICANCE OF DILATED 
HEART, (a) 

By H. A. CALET, M.D., 

Physician to Out-Patients, St. Mary’s Hospital, Ac. 

Before discussing the etiology of pathological 
dilatation of the heart the author alluded to dilatation 
of the heart under physiological conditions of the 
circulation. Reference was made to the work of Roy 
and Adams, Starling and others, with a view to show¬ 
ing that whilst within certain narrow limits the 
dilatation induced by some exertion might be a 
mechanical advantage in relation to the ventri¬ 
cular output, these limits were soon passed, and the 
dilatation was then an evidence of heart-fatigue. 
This might be prematurely induced by the strain 
to which the heart muscle was subjected being ex¬ 
cessive, or by the heart muscle itself being out of 
condition, but it was especially easily produced if 
both factors were combined; and under such circum¬ 
stances a condition which was in the first instance 
physiological might very readily pass into dilatation 
which was definitely pathological. 

The important principle in relation to dilatation 
under physiological conditions of the circulation was 
that the liability to its occurrence depended upon 
the inter-relation between (1) the element of in¬ 
creased mechanical strain leading to increase of intra¬ 
ventricular pressure; (2) the condition of the myo¬ 
cardium at the time being. 

In respect to dilatation under pathological con¬ 
ditions, the element of mechanical strain as a factor 
in its causation was first considered. The principal 
causes of increased intra-ventricular pressure were 
referred to, and it was pointed out that in addition 
to the primary effects of the increased strain, owing 
to alterations in the physical condition of the heart, 
certain additional factors had to be considered, 
more especially the consequences of increase of resi¬ 
dual blood in the ventricles, and the effects of tension 
on a muscular sphere or spheroid like the ventricle. 
Variations in the coronary circulation and the rela¬ 
tion between the blood pressure in the systemic circuit 
and that in the coronary area must also be borne in 
mind. Dilatation, in the causation of which myo¬ 
cardial weakness was the primary and predominant 
factor was then considered, reference being made to 
the dilatation of acute Bpecifio diseases, with or with- 

(o) Abstract of paper read before the Harreian Society of London, 
May 18th, 1899. 



ogle 


556 The Medical Press. ORIGINAL COMMUNICATIONS._ May 31, 1899. 


out actual myocarditis, to fatty and other forms 
of degeneration, senile myocardial weakness, the 
dilatation of nervouB and general debility, of some 
forms of anaemia and that due to toxic causes 
such as alcohol and tobacco, and probably also to 
toxic substances present in auto-intoxication of 
gastro-intestinal origin. The differences in the degree 
of dilatation from these various causes were discussed, 
and stress was laid on the fact that in relation to 
prognosis the degree of dilatation must always be 
considered in conjunction with the condition of the 
heart muscle with which the dilatation was associated. 
Whilst chronic dilatation might be due to increased 
strain alone, or to primary myocardial weakness alone, 
in the most severe forms of dilatation both factors 
were frequently combined, and the principle enunci¬ 
ated in connection with physiological dilatation was 
similarly illustrated in the case of pathological dilata¬ 
tion, namely, that the essential point was the inter-rela¬ 
tion between the element of mechanical strain and 
the condition of the myocardium at the time being 
Even in cases in which the element of increased 
mechanical strain was the chief factor in the causation 
of the dilatation, its later developments were often 
traceable to the supervention of myocardial changes. 
The latter part of the paper was devoted to the 
significance of dilatation. Just as physiological 
dilatation (beyond certain narrow limits) was an 
evidence of heart fatigue, pathological dilatation was 
an evidence of heatt over-6train, past or present, and 
frequently the precursor of heart failure. 

In disease, as under physiological conditions, it 
was broadly true that the heart’s power of doing 
work was in inverse ratio to the degree of dilatation, 
but the gi eater the deviation from the comparatively 
simple condi'ions of a healthy heart dilated by exces¬ 
sive strain, the less could reliance be placed on the 
degree of dilatation as per se a gauge of the severity 
of the lesion. 

In order to estimate with any approach to accuracy 
the significance of any given case of dilatation, 
attention must be given to the degree of dilatation, the 
condition of the myocardium with which the dilata¬ 
tion was associated, its precise etiology (with especial 
reference to the retention of the cardiac dilatation to 
the general health, and the relative importance of the 
mechanical and myocardial factor's in its production), 
the extent to which the dilatation interfered with the 
work of the heart in relation to the general circulation, 
and the degree of recuperative power, as evidenced 
by the course of the case and the effects of treatment. 
A broad view on lines such as these was essential if 
the extremes were to be avoided of making too much 
or too little of any given case of cardiac dilatation. 


ON UTERINE CANCER AND ITS 
TREATMENT, (a) 

By Thos. MORE MADDEN, M.D., M.R.C.P.I., 
F.R.C.S.Ed., 

Obstetric Physician to Mater Misericord'a* Hospital, Dublin. 

The author referred to the increasing frequency 
of malignant diseases of the uterus, and more espe¬ 
cially to the various methods available in their treat¬ 
ment, as employed in his wards in the Mater Miseri- 
cordia? Hospital, Dublin, where, during the past 
twenty-five years, upwards of a hundred cases of this 
kind have come under observation. Within the last 
six years there were 31 cases of uterine carcinoma 
and 12 instances of vulval or vaginal malignant 
disease, or 3 per cent, of the former in a total of 
1,054 gynaecological cases. In the preceding five 
years there were 23 cases of uterine and 11 of vulval 

(o) Abstract of paper read at Royal Academy of Medicine in 
Ireland, April 21st, 1899. 


or vaginal malignant disease noted, and in his earlier 
14 years’ service there a somewhat similar proportion 
was observed. Confining himself now, however, to 
the last eleven years referred to, the general origin 
of uterine cancer in the cervix was shown in 47 of 
these 54 cases. Its connection with parturition or 
lacerations was evinced by its occurrence in 39 child¬ 
bearing women and in only 15 nulliparous or un¬ 
married. While the predisposing influence of age 
was Bhown by the fact that 36 of these patients were 
from 40 to 55 years of age, 10 were beyond the latter 
period; 8 were under 40, and of these one was an 
instance of medullary carcinoma uteri in a girl only 
16 yeara old. The writer lays special stress on the vital 
importance of the early recognition of this disease by 
local investigation as well as by microscopic examina¬ 
tion of specimens removed by curetting in every in¬ 
stance of possibly adenomatous or cancerous disease of 
the uterus. He believes that disease to be primarily 
developed in the cervix in the vast majority of 
instances. Moreover, he holds that it frequently 
remains localised there for a sufficient period to per¬ 
mit its complete and effectual cure by the timely 
amputation of the cervix, which, followed by the 
application of the actual cautery to the wound so 
produced, he regards as the safest, most effectual, 
and reliable method of treatment in such cases. In 
exemplification of this the following facts are adduced 
from cases in which Dr. More Madden removed the 
cervix for cancer, and subsequently traced the after¬ 
history of the patient. In 31 instances in which the 
cervix was thus amputated there was no mortality 
consequent on the operation; in one of these, how¬ 
ever, the disease returned in the uterus four months 
subsequently; in 5 cases it returned there or else¬ 
where within a year; in 2 within two years; in 1 
within three years; and in 1 nearly four years after 
operation. But, on the other hand, in 10 cases there 
was no return within a period of four yeara, and in 
some there was no recurrence ten years after the 
amputation of the cervix; in 5 cases the information 
was limited to two years, and in 6 to one year, and 
indicated no return of cancerous disease within 
these periods. These results immediate and remote, 
may be contrasted with those obtained by hyste¬ 
rectomy for cancer, whether by vaginal or abdo¬ 
minal methods. The writers experience not only 
shows no direct mortality ~from the amputation 
of the cancerous cervix, but also shows that two- 
thirds of the patients so operated on were free from 
recurrence of cancer at the expiration of the subse¬ 
quent periods mentioned. Can any better results, or 
any results as good be claimed for hysterectomy 
under similar circumstances? Therefore, only in 
capes where cancer lias distinctly originated in the 
fundus or body of the uterus, or in instances of car¬ 
cinoma which has extended upwards from the cervix, 
and then merely as a palliative measure to relieve 
great suffering, and possibly prolong life for a little, 
does hysterectomy appear to nim justifiable. In but 
one of the cases of tne latter kind in which the winter 
was then forced to resort to hysterectomy, was the 
patient still alive and apparently well at the end of 
two and a half yeara subsequently, in other remaining 
cases the disease recurred earlier in other organs. For 
the relief of pain in cases of inoperable uterine cancer, 
Dr. More Madden recommends conium and orthoform, 
and advises special caution in the use of morphia and 
opiates. To mitigate the fcetor of discharge he relies 
on terebenthene injections, peroxide of hydrogen and 
a one per cent, solution of formalin. As local appli¬ 
cations in open carconoma he has experienced most 
benefit from the employment of celandine and methy¬ 
lene blue. Electrolysis, though recommended by 
others, bad failed in his hands. Finally, ho sums up 
his experience of the treatment of this disease, in 
hospital and private practioe during more than a 


oogle 


May 31, 1899. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 557 


•quarter of a century, by saying that up to the present 
the best possible prospect of the cure of uterine 
-cancer rests, as a general rale, in its early detection 
and prompt removal by the cervical method described 
in this communication. 


DILATATION OF THE STOMACH, 

WITH ESPECIAL REFERENCE TO 

ETIOLOGY AND TREATMENT, (a) 

By JOHN A. LICHTY, M.Ph., M D. 

The term, "dilatation of the stomach,” has of 
recent years been surrounded by considerable 
obscurity. The most satisfactory classification of this 
-condition is that given by Pepper and Stengel as 
atonic dilatation and obstructive dilatation. These 
-terms define themselves. They are also in accord 
-with the classification of Riegel and Boas, who speak 
of:—1. Simple gastric atony, or motor insufficiency, 
or myasthenia without dilatation. 2. Atonic dilata¬ 
tion without pyloric stenosis. 3. Secondary dilata¬ 
tion (motor insufficiency due to pyloric stenosis). 

In this paper, atonic dilatation, in its broadest 
sense, will be considered with special reference to its 
-etiology and treatment. 

For the purpose of study, the causes of atonic 
-dilatation may be divided into two groups. The 
first group includes the direct, or mechanical causes ; 
the second, the indirect, or nutritional causes. Clinic¬ 
ally, however, this classification is of little conse¬ 
quence, for rarely will it be found that a dilated 
stomach is due to a single cause, or that the causes 
may even be found under a single group. 

Under the direct, or mechanical causes, may be 
■discussed :—I. Too bulky meals. Too much food is 
taken at a single meal. This is not always because 
the individual is so very hungry, but because such a 
large variety of food is furnished for each meal, and 
-the appetite is over-stimulated. At the same time, 
an excess of fluid is taken, adding greatly to the 
weight of the food ingested, as well as interfering 
with the process of digestion. 2. Rapid eating, or 
bolting of food. An individual who eats rapidly takes 
more food than is necessary, does not masticate it 
well, and uses an excessive amount of fluid, either 
water, milk, tea, coffee, or alcoholic drinks, to hasten 
the disposition of a meal. 3. Certain diseases of the 
stomach, such as chronic gastritis. In this condition, 
the food remains longer in the stomach than normal, 
fermentation takes place, gases are evolved, and the 
stomach is distended. 4. Abdominal tumours and 
pregna ncy . These conditions distend the abdominal 
walk. When the tumour is removed, or after labour, 
the abdominal walls being relaxed, the stomach is 
not supported as before, and dilatation takes place. 
-5. Chronic constipation. The colon being heavy with 
large masses of feeces, considerable tension is brought 
upon the greater curvature of the stomach 
which tends to dilatation. 6. Constriction of waist 
by too tight, and suspension from waist of too 
heavy, clothing. Many women (and some men) wear 
-tightly laced corsets, which are supposed to give the 
body a more natural and graceful shape. Thus the 
organs are pushed out of shape. The abdominal 
muscles arc put in splints, so that from disuse they 
soon lose their tone and strength, and fail to afford 
the normal support to the stomach. The mischief 
■done by the corset, and moderate lacing, however, is 
not nearly as great as that which results from sus¬ 
pending heavy clothing from a waist which has no 
support and stiffness. The constriction and weight 
of heavy skirts, worn over the ordinary corset waist, 

(o) Abstract of pu per read before Ihe Ontario Co. Medico] Society, 
■Canandaigua, N.Y., January 10th, 18»9. 


roduce a great amount of tension and dragging 
own upon the abdominal organs. 

It is said by some writers that sometimes the small 
omentum is unusually short, and the pylorus holds a 
higher position relative to the fundus than normal. 
The increased resistance to the passage of food into 
the duodenum, thus produced, tends to dilate the 
stomach. 

Under indirect, or nutritional, causes, may be con¬ 
sidered :—1. Worry, anxiety, and overwork, either 
mental or physical. When food is taken under such 
circumstances, digestion is often retarded, and some¬ 
times entirely absent. Not only the secretory, but 
also the motor, function of the stomach is impaired, 
and the stomach becomes dilated. 2. Neurasthenia. 
There is scarcely any doubt that this neurosis is 
nearly always accompanied by faulty nutrition. The 
patient eats, but, under the severe nervous and 
mental strain, does not digest or assimilate sufficient 
nourishment to maintain normal strength or body 
weight. Worry is the initial cause more often than 
overwork. This impedes digestion and assimilation. 
The highly-organised nervous system soon feels the 
lack of nutrition, and then the fatigue neurosis mani¬ 
fests itself, which agajn reacts upon nutrition, and 
thus a vicious circle is established. The nervous 
energies are remorselessly continued, and reserve 
strength is steadily expended. The patient says she 
is “ living on her nerve.” She would be nearer tell- 
itg the truth if she were to say she is living upon 
the fat of her abdomen. The fat tissue which is so 
essential to support the organs and hold them in 
a position best suited to perform their functions is 
used up, and the organs begin to sag. The stomach, 
besides becoming dilated, is often associated with the 
other organs in a general enteroptosis. In a paper 
which I read before this Society a year ago, upon 
movable kidney, the subject of faulty nutrition was 
considered with some detail. 3. Certain diseases of 
the central nervous system, such as tabes, multiple 
sclerosis, &c. Atonic dilatation may follow as a 
result of febrile diseases, especially typhoid fever. 
Anaemia and chlorosis are mentioned by some 
writers as causes of atonic dilatation, while others 
speak of these blood conditions as the result of dila¬ 
tation of the stomach. There is no doubt that these 
conditions are frequently associated, but their causal 
relation is rather uncertain. It would seem to me 
that their early association is a coincidence, but later 
in the course of each condition the other may occur 
in a secondary relation. 

Dilatation of the stomach, when it is considered 
simply as a symptom, must be associated with the 
symptom group which reveals the underlying disease, 
before its diagnosis, or recognition, can to of any 
clinical value. To make a diagnosis which will be 
of any value thei-apeutically both the chemistry and 
motility of the stomach must be considered important 
factors. Not many years ago all study was directed 
to the chemistry of the gastric juice; later, the size 
and motility of the Btomach have been receiving the 
most attention. Neither of these factors can be 
safely ignored. 

The normal position of the stomach, as described 
by Luschka, is as follows :—“ The pylorus lies in the 
angle between the right border of the xyphoid and 
right costal cartilages. The lower border lies well 
above the umbilicus, and the fundus lies beneath the 
base of the left lung, and is almost covered by its pro¬ 
jecting margins.” Deviation from the normal size 
and position can be readily detected by inflating the 
stomach through a tube with a rubber bulb. The 
succussion splash also affords important information 
in reference to size and position, but more expressly 
■ in reference to the tone and power of the muscular 
' walls. The use of the stomach tube is necessary to 

D 

)gle 


558 Thb Medical Pbess. 


ORIGINAL COMMUNICATIONS. 


May 81, 1899. 


obtain the information which the chemistry of the 
gastric juice furnifihes. 

It is not within the scope of this article to refer 
intimately to diagnosis. In passing, it may be well 
to add that it is important to distinguish between 
gastroptosis and atonic dilatation. A knowledge of 
the exact position of the pylorus will enable one to 
differentiate between these two conditions. Gastro¬ 
ptosis is sometimes associated with dilatation. 

The treatment of dilatation of the stomach may 
be divided into: (1) Hygienic, (2) Dietetic, (3) 
Physical, and (4) Therapeutic. 

1. Hygienic. The role which tight and heavy 
clothing, suspended from the waist, plays in this 
condition has already been referred to. All clothing 
must be worn loose, and suspended from the shoulders. 
This cannot be accomplished by putting the abdomen 
and chest into splints (a corset) and then fastening 
the heavy skirts to the corset. Neither can it be 
accomplished by using the ordinary commercial 
corset waist, and having the tight belts of the skirt 
buttoned to it. This last contrivance is a snare and 
a delusion, and intended to relieve a woman’s con¬ 
science rather than the abdominal organs from pres¬ 
sure. Usually, when asking one of these patients 
with dilated stomach in reference to the way she 
wears her clothing, or if she wears a corset, she will 
either say, “Yes, I wear a corset, but very loose,” or, 
“ No, I wear only a corset waist, and suspend my 
skirts from the hips.” 

After considerable study and experiment, I have 
found a plan which I can, unhesitatingly, recommend 
to these patients. I ask them to wear union under¬ 
suits ; instead of a corset or a corset waist, I have 
them put on a waist fitted by a dressmaker, specially 
instructed; this waist being so made that when a 
skirt is buttoned to it the weight is really thrown 
upon the shoulders. To accomplish this three points 
must be observed : - First,the goodB, which is usually 
white drilling, must be so cut that when the skirt is 
fastened to it the weight will be in the direction of 
the weave of the goods and not diagonal to it, as it 
is in the corset waist of the shops. Second, the waist 
must fit exactly to the shape of the body, with suffi¬ 
cient room for respiratory expansion. Third, the 
buttons for the attachment of the skirts must be so 
high that when the necessary weight is thrown 
upon them, they do not pull below the line of the 
smallest circumference of the patient’s waist. To 
such a waist, both the petticoat and the dress skirt 
are buttoned. The belts must be comfortably loose. 
Overtlm waist, the ordinary drees waist, or a basque, 
is worn, loose, but neat, and not hooked to the skirt 
below. During cold weather, instead of adding an 
underskirt, knitted woollen tights of desirable weight 
should be worn. Such a combination will afford com¬ 
fort, and, at the same time, permit the most fastidious 
to comply with the varying fashions. These patients 
frequently go to sanatoriums, where the life is such 
that tight dresses cannot be comfortably worn. They 
wear wrappers and spend much of their time lying 
down. Improvement, if not entire recovery, takes 
place, and they return home, where they again put on 
their unhygienic clothing, and in a short time relapse 
to their former miserable condition. 

2. Dietetic. In dilatation of the stomach, one 
must contend with the unfortunate circumstance that 
the very organ which is needed most to hasten a 
recovery is seriously disabled. It is essential, if the 
patient is below her normal weight (and this is nearly 
always the case) that she should regain, or go above, 
her normal weight. The abdominal organs must be 
in part supported by the normal amount of fat 
which is found in the abdomen in health. I know of 
no one food which will restore this more readily than 
milk in definite quantities at regular intervals. 

I am aware that a liquid diet in dilated stomach is 


contrary to the teachings and writings of many for 
whose opinions I have the greatest respect. They 
tell us “ a modified dry diet, concentrated, with meals 
at long intervals, coarse vegetables, and, if necessary,, 
nutrient enemata, so that the stomach may have very 
little weighty material, and have long periods of rest. 

I have never yet succeeded in getting these patients 
to gain in weight upon such a r/gime. If one adopts 
the dry diet, and also has the patient take as much 
water as one in health ought to take in a day, I dare¬ 
say the weight of the food and water will be equal to 
the weight of the milk necessary for one day. But 
these patients need to take more fluid than a healthy 
individual, because they nearly all suffer from partial 
anuria, are constipated, and in a condition of auto¬ 
intoxication. 

I have had very satisfactory results in many cases 
by giving these patients two glasses of good, rich 
milk, with two raw eggs at meals, say at 8 a.m., 
1 p.m., and 6 p.m.; and two glasses or milk at 11 
a.m., 4 p.m., and 9 p.m.; sometimes giving air 
additional glass at midnight, or early in the morning. 
After these meals and lunches, the patient is required 
to lie flat on the back, or on the right side, for a 
period of thirty to forty minutes. I do not see that 
there can be any danger of aggravating an existing 
dilatation when the patient follows this course, for the- 
weight of the food is not exerted against the lower 
curvature of the stomach, but against the posterior 
wall, which is well supported by the underlying 
tissues. 

With such a diet, the kidneys become very active,- 
the bowels often become regular, and the patient 
gains in weight. When the patient regains the normal 
weight, a meal of solid food is allowed at 1 p.m., con¬ 
sisting of a mutton-chop, and zwiebach, with about 
four ounces of water, and for the four o’clock lunch 
are substituted about twelve ounces of water. The- 
other meals and lunches remain the same. If, after a 
week of experience with the mid-day meal, the patient 
holds her weight, a meal of solid food is ordered for 
breakfast, much ns the mid-day meal, with the addi¬ 
tion of a well-cooked cereal, and to the dinner are- 
added green vegetables and soft-boiled eggs. The 
atient is advised to eat butter freely. Thus, gra- 
nally, the patient is given three meals of solid food 
a day. 

What of the patients who cannot take milk or raw 
eggs? There are many who think they belong to- 
this class, but it is surprising to see how few really 
suffer from such an anomaly. The usual opinion is 
that there is too much acid in the stomach and the 
milk is curdled. From a careful study of the chemistry 
of the gastric contents, and observations upon the 
effect of milk in a number of cases, I have found that 
patients with hyperacidity are more likely to take- 
milk without discomfort than those who have an 
absence of acid. A most decided case of hyperchlo- 
rhydria took milk easily, while one of achylia 
gastrica could not take it at all. It is not well to 
continue one diet with these patients too long. After 
ten days or two weeks of milk and raw eggs, it is 
well to have the patient take plain water for ten or 
twelve hours, equal in amount to the milk which 
would have been taken during the same time. After 
this, the milk is again resumed. All foods which are 
likely to cause fermentation must be avoided. Among 
these are potatoes, rice, and white bread. Raw fruit 
and an excess of sweets and fats must also be 
avoided. 

3. Physical. Under this are included massage of 
the abdomen; certain exercises intended to develop 
the abdominal muscles ; faradic electricity applied to 
the abdomen, and alternate hot and cold packs, or 
alternate hot and cold douches applied to the 
abdomen. 

The application of electricity in these cases has 


Digitized by VjOOg le 


AT 31, 1899. 


TRANSACTIONS OP SOCIETIES. The Medical : Pbess. 559 


been a question upon which there has been a diversity 
of opinions Physiologists have proved that it is 
impossible to cause a contraction of the muscles of 
the stomach by the external application of the elec¬ 
trodes of a faradic battery, but that if one electrode 
is applied intra-gastrically, and the other over the 
abdomen, the muscles can be contracted at will. This 
has led to the use of the intra-gastric electrode. If 
the chief end of the application of electricity to the 
abdomen in these cases is to cause a momentary con¬ 
traction of the muscles of the stomach, the intra- 
gastric electrode ought to be of the greatest value. 
But more than this can be accomplished with faradic 
electricity in these conditions. The tone and strength 
of the relaxed muscles of the abdominal walls can be 
increased, and I believe that the digestion and assimi¬ 
lation of food can be increased. Gynaecologists, 
especially those who employ electricity, claim that 
they can alter tissues in the pelvic organs by applying 
electricity, pericutaneously. If this is true, would it 
not seem reasonable that electricity, applied in the 
same way, would, at least, alter the delayed func¬ 
tional activity of the stomach and bowels ? I have 
used faradic electricity pericutaneously, and have 
obtained very satisfactory results. 

4. Therapeutic. There are several drugs which can 
be used to great advantage in the treatment of atonic 
dilatation. Among these, the tincture of nux 
vomica can safely be said to take firstplace. Strychnine 
may be equally effective. A combination of the sul¬ 
phate of quinine and strychnine is often very good. If 
there is diminished HC1 in the gastric juice, small 
and frequently-repeated doses of HC1 are beneficial 
after the meals of solid food. If there is an excess of 
HC1, a combination of sodium bicarbonate, calcined 
magnesia, and bismuth subnitrate can be administered 
to advantage. If the constipation is not relieved by 
the hygienic and dietetic measures, and by the mas¬ 
sage, the electricity and the physical exercises to 
which reference has been made, glycerine suppositories 
may be used. Fluid extract of cascara sagrada, with 
tincture of belladonna and glycerine, may be given in 
small doses, if the suppositories are not effective. 

The prognosis in these cases is good if the physician 
can have full control of the patient. Often the sym¬ 
ptoms will disappear long before the stomach resumes 
its normal size. 


‘9Eron*actum0 of gorutuc. 


CLINICAL SOCIETY OF LONDON. 


Meeting held Friday, May 26th, 1899. 


Mr. Langton, President, in the Chair. 

Mr. H. Betham Robinson described a case of 

ACUTE INTESTINAL OBSTRUCTION, CAUSED BY AN 
ADHERENT VERMIFOBM APPENDIX FORMING A BAND 
ASSOCIATED WITH FCETAL ARRANGEMENT OF THE 
PERITONEUM. 

A female child, set. 7, was admitted into St. Thomas’s 
Hospital in March, 1898, with a history of a week’s con¬ 
stipation and occasional attacks of vomiting, now- 
becoming constant and dark brown in colour. She had 
a pinched appearance; pulse 110, respirations, 38 per 
minute, and temperature 96 8, but without any marked 
collapse. There was acute pain in the belly about the 
umbilicus. Her abdomen moved with respiration, 
and waB not rigid. There was particularly dis¬ 
tension in the middle line above the umbili¬ 
cus, and coils of small bowel were distinctly 
defined. There was comparative dulness on the left side. 
Teere had been no rectal discharge and no lump was to 
be felt there. It was doubtful whether she had passed 
flatus for the last few days. Ihe abdomen was opened 


in the middle line, and a quantity of fluid with a few 
lymph coagula escaped. The small intestine-' was so 
extremely distended that exploration was impossible 
until the intestine was tapped, and three pints of fluid 
removed. In the right flank there was no colon, apd on 
the left Bide the colon was absolutely collapsed, 
which condition was traced along the transverse colon. 
To the left of the mid-line above the umbilicus a 
mass was felt which proved, on examination, to be a 
loop of Bmall intestine close to the csecum strangulated 
under a band formed by the tip of the vermiform 
appendix being coherent to a caseous mesenteric gland. 
Beyond the obstruction the intestine was completely 
compressed, whereas the small intestine on the proximal 
side was very dilated. The ca?cum and the whole of the 
ascending colon retained their primitive peritoneal 
investment, so that they could, and had, passed freely 
over to the left side. The appendix was separated and 
the intestine released. The child’s condition was so bad 
as to require infusion. She did not rally at all after the 
operation and died very shortly. At the autopsy it was 
found that not only were the ascending colon and csecum 
freely movable but the third part of the duodenum had 
a mesentery. 

Dr. Hawkins, of Reading, suggested that the adhe¬ 
sion of the appendix was due to a former appendicitis. 

Mr. Robinson, in reply, said he could not agree with 
this as the specimen showed there was absolutely no 
indication of appendicitis, and, moreover, it was not 
necessary to seek for this as the presence of the caseous 
mesenteric gland was the undoubted factor in the adhe¬ 
sion of the appendix. 

HEMORRHAGIC ERYTHEMA WITH ERIGHT'b DISEASE. 

Dr. Colcott Fox related the case and showed drawings 
of the case of a woman, jet 61, who had suffered from 
bronchitis and acute nephritis probably supervening on 
old mischief. She left the infirmary but returned a 
fortnight later (January 5th) with injected and swollen 
fauces, some erythematous macules on the face, and a 
few petechia; on the legs. On January 10th a general¬ 
ised eruption made its appearance. It was of an 
erythematous macular type Blightly raised with a 
tendency to rapid centrifrugal extension. The eruption 
varied in size from a pinpoint to a finger nail, but 
tended to become confluent, forming patches and sheets. 
The colour was a vivid red, ineffaceable by pressure. 
The smaller lesions were dotted with distinct haemor¬ 
rhagic punctse, and the large older ones acquired a well- 
defined purple border enclosing bluish red centrer. The 
palms and soles were diffusely involved but the fingers 
and dorsal surfaces were at first unaffected. The skin 
of the fingers, wrists, tots, and feet was cedematous. 
The joints of the wrists and hands were tender and 
painful. By January 12th the eruption had become 
almost universal and looked at first glance like Severe 
purpura. Over the abdomen the macula? were mostly 
small and erythematous, and not nearly as haemorrhagic 
as elsewhere. The face was sallow and the forehead 
covered with a morbilliform eruption. The lips were 
swollen and blood stained, and there were a few 
purpuric spots on the gums and palate. After a 
brief pause the lesions became increasingly haemor¬ 
rhagic ar.d even more confluent. On the 15th a 
recent retinal haemorrhage was detected. On the 16th 
meloena occurred, and the patient died on the 17th. 
Before death the haemorrhage was still increasing in the 
skin. Post-mortem a good deal of congestion of the lungs 
was seen, with intense injection of the mucous mem¬ 
brane of the trachea, bronchi, stomach, colon, and espe¬ 
cially of the jejunum and ileum, where it was haemorrhagic. 
There was no endocarditis. The kidneys were small, red, 
granular with a narrow cortex and adherent capsule. 
Microscopical examination of the affected portions of 
skin revealed distension of the lymph spaces and the 
blood vessels of the papillary layer with a moderate cell 
infiltration. The sheaths of the larger horizontal vessels 
v ere, however, densely infiltrated with cells. There was 
apparently no plugging of the vessels and no micro¬ 
organisms were discovered. Dr. Fox observed that the 
eruption appeared to correspond clinically with the 
ioseola of "Willan rather than with erythema multiforme. 



Lv^ 



560 The Medical Pbjss. TRANSACTIONS OP SOCIETIES. 


He observed that one was familiar with cuta¬ 
neous haemorrhage as a complication of or even 
in lieu of the characteristic eruption of infec¬ 
tive diseases such as variola and measles, and it was 
equally recognised that in erythema multiforme there 
was a special tendency to the exudation of blood-stained 
fluid, and even blood itself, which may completely mask 
the essential eruption. Hemorrhage into the slighter 
roeeolar forms of eruption was, however, rare. He added 
that in his experience the appearance of this kind of 
eruption in patients suffering from Bright’s disease 
usually heralded approaching dissolution. They had 
been of two typeB—either the roeeolar type of Willan, 
or of the morbillifoi m type. He mentioned the case of a 
woman who, two or three days before her death from 
granular kidney, became covered with a copious eruption 
of dusky erythematous macules the size of the finger 
nail, closely simulating the roeeolar syphilide. He had 
also seen several examples of a copious generalised mor¬ 
billiform eruption, terminating in profuse desquamation. 

The President observed that the case would be a 
valuable supplement to those brought before the Society 
not long since by Dr. West. 

ANKCRTBM OF THE SUBCLAVIAN ARTERT TREATED BY 
LIGATURE OF THE FIRST PORTION, FOLLOWED IN 
THIRTY-EIGHT DAYS BY REMOVAL OF THE ANEURYSM. 

Mr. H. Allingham showed a man, set. 25, a sailor, 
admitted February 20th, 1899, who three years before 
had noticed a swelling above the right clavicle which 
had gradually increased in size, especially during the 
twelve months preceding admission. On admission he 
exhibited a pulsatile expansile swelling in the right 
supraclavicular region between the sterno-mastoid and 
trapezius muscles, about the size of a tangerine orange. 
There was characteristic Bystolio bruit with delay and 
diminution of the right radial pulse. He ligatured the 
subclavian artery on the cardiac side of the tumour, 
using a kangaroo tendon ligature immediately external 
to the origin of the vertebral artery. Recovery was 
complete, no pulsation being perceptible in the tumour 
or in the radial artery until March 4th, when some slight 
beating was detected in the aneurysm. This continued, 
and the sac became distinctly smaller and harder. The 
patient was anaesthetised whan it was found that 
the tumour, although pulsating, did not expand, 
and it was decided to watch the case for a 
time before proceeding to more radical measures. 
On March 28th it was noted that the aneurysm was 
increasing in an upward direction, and that there was 
decided palpable and visible pulsation. On April 8th 
the whole length of the clavicle was exposed and the 
greater part removed. The aneurism was carefully 
exposed, springing from the upper and anterior aspect 
of the vessel. Silk ligatures were applied above and 
below and the sac removed. During the dissection the 
transversalis colli arteiy was wounded as it crossed the 
tumour, and some few fibres of the brachial plexus were 
divided, the lower cord of which was adherent to the 
sac above. Some difficulty was experienced in separat¬ 
ing the subclavian vein, which received a slight tear, 
which was closed by a lateral ligature. The patient 
rapidly recovered, and was now about, using his right 
arm with comfort. Sectionof the aneurysm showed that 
its cavity was largely occupied by firm clot, the blood 
passing into it from the subclavian and out posteriorly 
by what appeared to be the profunda cervicis. A careful 
examination of the arm was made on May 5th, and it 
was found that pulsation was present in the brachial, 
best marked in the ante-cuoital space, and also 
in the radial at the wrist. The ulnar was not 
felt. The hand and fingers were pallid, and somewhat 
colder than those of the opposite limb, but this condi¬ 
tion was improving daily. He remarked that little or 
no difficulty was experienced in applying the ligature to 
the first portion of the subclavian artery as it was 
approached from below, and the dissection was made 
from the region of the second portion, thus the large 
veins and nerves crossing the seat of ligature were not 
even recognised. 

Mr. Stanley Boyd observed that these cases were so 
rarely successaul that the author deserved to be con- 


MaY 31, 1809. 

gratulated. He had been struck by the fact that the 
pulsation had returned very soon after ligature of the 
first part of the artery. That appeared to be common 
after proximal ligature for aneurysm of the third part of 
the subclavian, and constituted a strong argument in 
favour of excising the sac. With free exposure of the 
aneurysm it ought not to be more difficult co put a 
ligature round the artery at the start than later, and 
that had, indeed, been done on at least three occasions. 
He said the result in this instance after complete removal 
was interesting, and it would be interesting to note 
whether the shoulder dropped in the future more than 
it did at present. In fact, at present there was no 
drooping to speak of. Another interesting point of view 
was the reason why hemorrhage was so very common 
after ligature of the first part of the subclavian. The 
subclavian had been stated to be the thinnest artery in 
the body, and in any case one of the great difficulties 
was to arrange the artery oomfortably after ligature, as 
there was always such a large gap left. 

Sir Dyce Duckworth mentioned the case of a patient 
under his care with aneurysm of the subclavian. He 
bad placed him on a restricted diet, giving large doses of 
iodide of potassium. Mr. Howard Marsh had seen the 
patient, and was of opinion that it would be a very suit¬ 
able case for this operation; but, inasmuch as the 
aneurysm was becoming smaller and was consolidating, 
it was decided not to interfere for the present. 

Mr. Charters Symons related a case of aneurism of 
the second portion of the subclavian in which he had 
attempted to ligature the first part. It was situated 
underneath the clavicle, but the whole posterior triangle 
was filled with a pulsating swelling which extended to 
the sterno-mastoid. He proceeded to apply a ligature to 
the first part on the plan suggested by Ballance and 
Edmunds. On exposing the artery by splitting the 
sterno-mastoid, and on cleaning it, on passing a needle 
from below there was a furious rush of blood which 
ceased on his withdrawing the needle. On reintroduc¬ 
ing the needle the rush of blood recurred. He therefore 
tied the innominate and common carotid on that Bide at 
the same time, and so far the case had done well. 
The curious thing happened that the whole of the 
sac separated, but the patient recovered with a fairly 
useful arm. He asked whether the author had divided 
the head of the sterno-mastoid muscle. 

The President thought the fact that the author had 
used kangaroo tendon for the first ligature and silk for 
the second, was rather ominious. He had never himself 
ligatured the first part of the subclavian for aneurysm, 
but he had had two examples of malignant disease of 
the clavicle in the centre, and be had removed almost 
the entire length of the bone. In both cases a very good 
result had followed with no impairment in either of the 
limbs. If, therefore, it was thought desirable to remove 
that bone, it might be done without hesitation. 

Mr. H. Allingham, in reply, said that he had freely 
divided the sterno-mastoid an inch above the clavicle, 
afterwards uniting it by sutures. By so doing, the inner 
border of the scalenus anticus was easily exposed and 
there the artery was found pulsating, and a ligature 
could readily be passed round it. He had used kangaroo 
tendon for the first ligature in deference totheadviceof his 
colleagues, but on the second occasion he had preferred 
sterilised silk as thw was what he was in the habit of 
using. Before the operation he had tried to find out 
what would be the result of removing tbe bone, but had 
not been able to get any information on the subject. 

The business of the Annual General Meeting was then 
proceeded with. 


ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Obstetrics. 

Meeting held Friday, April 21st, 1899. 

The President, Dr. F. W. Kidd, in the Chair. 

TWO YEAR8’ WORK AT THE SAMARITAN HOSPITAL FOB 
WOMEN, BELFAST. 

Dr. John Campbell gave an account of two year*’ 
work at the Samaritan Hospital for Women at Belfast. 


Digitized 


by UOO^IC 



May 81, 1899. 


TRANSACTIONS OP SOCIETIES. 


The Medical Press. 


The hospital contains thirty beds, as well as nurses’ 
apartments. Of. these, eight are in the isolation wing 
and are devoted to the treatment of cancer and Beptio 
cases. Patients abont to undergo an operation are well 
scrubbed with soap and water, and wear boric compresses 
over the seat of operation for three or four days before¬ 
hand The day before operation the field is well washed 
with soap and water, rubbed with turpentine, again 
washed with soap and water, and finally washed with 1 
in l.COO sublimate solution, and covered by a compress 
wrung out of the same. This preparation is repeated on 
the morning of the operation day. Septic cases are, as 
far as possible, excluded from the operation room. 
Sterilisation by boiling is carried out in regard to every¬ 
thing to which it can be applied. The hands are cleansed 
by thorough washing, followed by washing in turpentine, 
and again in soap and water. They are then put 
through the permanganate and sublimate processes 
in succession. India-rubber gloves are UBed if a septic 
case has been recently handled. The gloves are boiled. 
Chloroform is given by Junker’s inhaler. Sickness 
in a patient is regarded as indicative of returning con¬ 
sciousness and of incompetence on the part of the 
antesthetist. By the sponge and towel methods the 
patient is alternately half-poisoned and half-conscious. 
Flushing the abdomen is done in tuberculous peritonitis 
and cases in which glairy fluid has escaped into the 
abdomen. Drainage is used after flushing, in cases where 
much peritoneal fluid has been present, and in cases in 
which pus has escaped. The current of opinion has now 
set in too strongly against drainage. A glass tube with 
a gauze wick is to be preferred, and the bed-head should 
be raised. Small gauze drains float on the intestines. 
Large ones prevent the bowels from resuming their , 
natural position. A rigid tube keeps the gauze in the 
pelvis. Dressings: Sterilised gauze is used for most 
cases. Iodoform is used for wounds which are drained. 
Post-operative Treatment: Morphia is, if possible, 
avoided. One half grain hypodermio may be given if 
pain iB severe. The amount of fluid allowed depends on 
the amount of vomiting present. During 1897-98 forty- 
four intraperitoneal operations were performed in the 
Samaritan Hospital by Dr. John Campbell, namely:— 
1. Twenty ovarian tumours, including sixteen ordinary 
cysts, three dermoids, and one solid tumour. The 
patients’ ages varied from 21 to 66. In three cases both 
ovarieB were removed ; in four one ovary was removed 
and the other resected. In one case a faecal fistula 
was present for a fortnight, and in one phlebitis 
occurred in the left le^ after puncture of small 
cysts in the corresponding ovary. All the patients 
recovered. 2. Diseases of the tubes were operated on in 
three cases. In one the tubes were catheterised; in 
another a four months’ foetus was removed from the right 
broad ligament; and in one a tumour of myomatous 
appearance was removed from the inner end of a tube, 
the outer end of which was dilated and contained fluid 
like menstrual blood. 8. A fibro-cystic tumour inde¬ 
pendent of the tube and ovary, and not obviously con¬ 
nected with the uterus, was removed from the right 
broad ligament. It weighed 20 lbs. 4. Fibre-myomata 
of the uterus were operated on nine times. Four were 
abdominal operations, done by the intraperitoneal 
method ; two were vaginal hysterectomies; one was an 
enucleation after abdominal section; and one was an 
exploratory incision, in which the appendages could not 
be got out, and the patient could not stand panhysterec- 
tomy. The enucleation case died of shock; the others all 
recovered. 5. One case of cancer of the corpus and one 
of cancer of the cervix uteri was successfully removed 
by vaginal hysterectomy. 6. A case of prolapse and one 
of retroversion were treated by vagino-flxation, with 
good result in both cases. 7. Tuberculous peritonitis 
was incised and drained twice. The case in which there 
was much fluid appears to be cured; the other was not 
benefited. 8. A hyaronephrotic kidney and a tuberculous 
kidney containing abscesses were removed with suooess. 9. 
Gastrostomy for cancer of the (esophagus was done once 
with excellent result. The vermiform appendix was once 
removed. A cancerous caecum was exposed with the 
view of making a faecal fistula and excising the growth ) 
when the patient bad recovered from the effects of the 


intestinal obstruction caused by the growth, but she 
died exhausted after the preliminary operation. The 
mortality of these forty-four cases was 4J per cent., as 
good an average as can be expected, if operations on so 
many different abdominal organs are taken together. 

The President thought that gloves should be used 
in operations only when they suspected that they could 
not render their hands completely aseptic. He did not 
agree with Dr. Campbell's opinion that all the dangers 
of chloroform were due to maladministration. When 
chloroform was administered avttatim he had Been no 
ill effects. 

Dr. Smith said he had practically given up drainage. 
He believed that after a few hours no drainage took 
place, since a layer of protective lymph was thrown out 
round the tube which acted as a foreign body. More¬ 
over, a solid drainage tube pressing against the rectum 
was capable of causing a fistula. The operation he 
preferred was retro-peritoneal hysterectomy, which gave 
excellent results. 

Mr. M'Abdle observed that nearly all the abdominal 
visoera reflected pain to the pelvis after laparotomy. It 
was not uncommon in gouty affections of the kidneys to 
have the pain referred to the pelvic region, and in many 
instances of spinal lesions the chief pains were pelvic. 
He strongly advocated the intraperitoneal method of 
operating, and considered diainage of the peritoneal 
cavity unnecessary, except where there was some intes¬ 
tinal lesion or some infection of the peritoneal cavity. 

Dr. Purefoy said he was one of those who practised 
drainage, but he had never used a rigid tube. The 
gauze drain, in the form of a Mikulicz’ bag, or otherwise, 
he was satisfied was of the utmost use. 

Dr. Campbell, replying, said he believed that sudden 
death during the administration, of chloroform was 
generally due to the use of a too concentrated solution. 
With regard to drainage, it. was quite true that it was 
useless after a few hourp, but it was during those few 
hours that it was especially required. He considered 
the vaginal method of operating on fibroids the best, 
when it could be done. 

ON UTERINE CANCER AND IT8 TREATMENT. 

Dr. More Madden read a paper on this subject which 
is published in abstract elsewhere. 

The President said there were many conditions which 
resembled the initial stage of uterine carcinoma. A 
microscopic examination was therefore always desirable. 
He had performed vaginal hysterectomy on seven 

E atients for malignant disease. Four of them, at least, 
e knew to be still alive. 

Mr. M’Ardle said with reference to removal of 
the glands with the uterus and appendages, he had never 
yet seen thorough removal of the retro-peritoneal glands. 
In operations for tuberculous disease of the vermiform 
appendix it was his custom to rip up the peritoneum 
and remove the glandB involved. 

Dr. Smith said sufficient stress was not laid upon 
rectal examination for the purpose of determining 
infiltration of the surrounding tissues. He thought 
that the best ohance for the patient was offered by the 
abdominal method of operating if there was any doubt 
about the case. 

Dr. Purefoy said that when he recognised malignant 
disease in the uterus his inclination was to remove the 
whole organ. 

The Section then adjourned. 


HARVEIAN SOCIETY OF LONDON. 
Meeting held Thursday, May 18th, 1899. 

H. E. Juler, F.E.C.S., President, in the Chair. 

CONBIDEBATION8 AS TO THE ETIOLOGY AND SIGNIFICANCE 
OF DILATED HEART. 

Db H. A. Caley read a paper with this title, a full 
abstract whereof will be found elsewhere. 

Dr. Alexander Moribon considered that the simplest 
method of regarding the etiological factors in the pro¬ 
duction of cardiac dilatation was to remember the essen¬ 
tial triunity of the so-called functional unit, and to 


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562 Thb Medical Press. 


FRANCE. 


May 31, 1819. 


refrain from dissociating the mnscnlar, haemic, and 
neural elements of which it was composed. He protested 
against the tendency of many physiologists of the pre¬ 
sent day in regarding the muscular element as the pre¬ 
dominant factor in sustained rhythmical action, and con¬ 
sidered that both clinical experience and pathological 
investigation, rudimentary though the latter still was, 
pointed to the important rule played by the nervous 
system in such cases. 

Dr. John Broadbent said that the question as to 
what were the factors which determined the relative 
amount of dilatation and hypertrophy after endocarditis, 
was one of great importance. He considered that 
the myocarditis which so frequently accompanied 
endocarditis and not the actual lesion to the 
valves, was responsible for the initial dilatation, from 
which the heart might entirely or only partially recover. 
Subsequently, as the valves became puckered and de¬ 
formed in the process of repair by cicatricial contraction 
of the granulation tissue on their surface, the effects of 
valvular lesion became pronounced, and led to fresh 
dilatation of the heart followed by hypertrophy, which 
constituted a'measure for estimating the extent of the 
valvular lesion. It was important, therefore, not only 
to enjoin absolute rest after an attack of endocarditis 
during the period when the heart was recovering from 
the initial dilatation due to accompanying myocarditis, 
but subsequently to insist on great care and moderation 
in exercise at a later period when the compensatory 
changes called forth by the valvular lesion, were taking 
place. Otherwise undue permanent dilatation with 
excessive hypertrophy might ensue. 

Dr. G. A. Sutherland asked whether dilatation was 
ever present without hypertrophy. Dilatation must be 
either an active or a passive process as regards the car¬ 
diac muscle. A passive dilatation or cardiac failure 
implied that the blood could be pumped through the 
arterial and venous Bystems by the left ventricle in a 
weakened condition, and yet remain under sufficient 
pressure to dilate the ventricle. It was difficult to 
accept such an explanation on physical grounds, as 
venous engorgement and cardiac syncope would appear 
to be a more likely result. Active dilatation, on 
the other hand, might be the calling into play of 
some reserve power in the heart, which by greater 
expansion and more rapid action was enabled to carry 
on the circulation. As compensation was often fully 
established under these conditions, he thought that dila¬ 
tation might be looked on as a conservative process, and 
one not necessarily to be interfered with medicinally or 
otherwise, although it was recognised that over-action 
of the heart was present, and that a breakdown must 
occur in the course of time. 

Dr. Poynton agreed with Dr. Sutherland as to the diffi¬ 
culty in many cases of explaining dilatation of the heart 
upon mechanical considerations. In rheumatism dilata¬ 
tion might be very marked, and the clinical symptoms 
comparatively slight, whereas in other conditions the 
clinical symptoms might be very severe and the dilata¬ 
tion slight. Microscopic examination of the heart walls 
sometimes showed extensive myocardial disease with 
little dilatation, and sometimes the reverse. In rheu¬ 
matism he thought it probable, a view also held by Dr. 
Lees, that the marked dilatation was dependent upon a 

S erial and peculiar action of the rheumatic toxin upon 
e cardiac muscle. The difficulty and complexity of the 
question of cardiac dilatation was illustrated by the 
case of a young man about twenty-four years of age, who 
having been “ out of sorts ” for Borne days went for the 
first row of the season in a “ four oar” to “shake it off. ’ 
On landing after the exertion he vomited, and later in 
the day was seen by a doctor, who found that his heart 
was extremely rapid, his pulse rate being about 
200 to the minute. He was admitted under Dr. Cheadle, 
to 8t. Mary’s Hospital in this condition, and died two 
or three days afterwards, the heart acting to the end at 
this extraordinary rate. The post-mortem showed some 
mitral valvulitis and old pericarditis. The dilatation 
was quite moderate. In this case there were two factors, 
a damaged heart and a mechanical strain, both, one 
would' have thought, leading to extreme dilatation 
rather than a oondition of tachycardia with little dilata¬ 


tion. He thought it was important to get a definite 
idea of the meaning of fibrous changes in the heart- 
wall, for sometimes they were brought forward to 
account for dilatation, and sometimes they were given 
as an explanation of its absence. These fibrous changes, 
which arise in connection with the vessels, were, he 
thought, essentially reparative, and an evidence of 
Nature’s reaction, however imperfect, to morbid pro¬ 
cesses. The valve deformities in rheumatism were 
thus an evidence of reaction to the toxic prooees, 
rather than an evidence of the active effects of the 
toxsemia. He thanked the 8oriety for their permission 
to show the microscopic specimens. 

Dr. Bkzly Thorne was glad to find so much import¬ 
ance attached to the first stages of dilatation, because 
by their early recognition ana relief the physiological 
call for hypertrophy and the ultimate sequel re of de¬ 
generation and loss of compensation could, in a large 
number of cases, be obviated. With regard to tobacco 
poisoning, the practice of inhalation was the most 
certain and rapid in evil effect. Abnormal sexual ex¬ 
cesses were the cause of cardiac dilatation in other 
cases, and some of those the most obstinate. He added 
that myocardial and vascular degenerations which had 
not proceeded to caloification, and especially those 
which were attributable to atheroma and fatty degenera¬ 
tion were among the most amenable to treatment of 
cardio-vascular affections The free ingestion of water, 
at such times as not to interfere with gastric digestion, 
by promoting elimination of toxins, was an effectual 
means of reducing vascular tension in cases in which 
sclerotic changes had not rendered increase of arterial- 
lumen impossible, not excepting cases of commenc¬ 
ing dilatation of the aorta. 

Dr. H A. Calky, in reply, remarked that practically 
we could only estimate alterations in the cardiac nervous 
mechanism by noting any alterations in the frequency, 
or by those of the heart test, and by restricting, as far 
as possible, the amount of contractile vigour which the 
heart muscles possessed. In reply to the question as to 
whether slight degrees of dilatation might not be benefi¬ 
cial it was pointed out that just as a slight degree of 
dilatation under physiological conditions might be a 
mechanical advantage, so a corresponding degree of dila¬ 
tation under pathological conditions might likewise be 
advantageous, provided that it was accompanied by 
sufficient vigour of the heart muscles, with or without 
actual hypertrophy. This had been referred to in the 
papei as strictly compensatory dilatation. 

Dr. Poynton exhibited microscopic specimens illus¬ 
trating various diseased conditions of the myocardium. 
The sections were taken through the left ventricle papil¬ 
lary muscles, and in one case the aorta. They showed 
the general fatty changes that may occur in severe 
rheumatic morbus-cordis, the extreme myocardial disease 
that may occur in some cases if alcoholism, and the 
severe and active changes that may be found in the 
heart wall in acute aortitis, without demonstrable affec¬ 
tion of the coronary vessels. The explanation of the 
condition in these cases of aortitis was in all probability 
that a process analogous to that in the aorta had taken 
place in the heart wall itself. 


cfvance. 

[from our own correspondent.] 

Paris, May 28,1890. 

Section of the Sympathetic. 

At the last meeting of the Acadrinie de Mfcdecine M. 
Franck spoke on his experiments on the section of the 
sympathetic nerve in the treatment of Basedow’s disease, 
and the effect produced on the circulation of the thyroid 
body on that of the brain, the ocular apparatus, and upon 
the head. The cervical cord of the sympathetic acts as 
the nerve of propulsion of the globe of the eye, thanks to 
its action on Muller’s muscle; its section tuppresses or 
attenuates exophthalmia. On the other band thi 


Google 


May 31, 1899. 


GERMANY. 


The Medical Press. 563 


nerve acted simultaneously as constrictor and dilator 
of the vesaels; its section diminishes the tension 
intra-oculaire and can consequently have a bene¬ 
ficial influence on glaucoma. As to the supposed 
vaso-dilating action of the cervical sympathetic on 
the thyroid gland it did not exist. Irritation of this 
nerve determines, on the contrary, contraction of the 
thyroid vessels, and its section consequently cannot do 
otherwise than add a paralytic vaso-dilatation to the 
active congestion of exophthalmic goitre. 

The vaso-constrictive cerebral action of the sympa¬ 
thetic is none the less apparent; it is thus that 
section of the cervical cord increases the cerebral blood 
current. The profit that could.be derived from its 
section for Basedow's malady and for epilepsy was pro¬ 
blematic, the theory of cerebral anaemia in these two 
affections being very questionable. 

The cardiac nerves derived from the sympathetic are 
only furnished in a small proportion by the cervical 
cord, they derive for the most part from the superior 
thoracic region. Their suppression is consequently only 
complete in the case of total resection. Irritation of the 
aortic and cardiac branches, like that of the sympathetic, 
are capable of provoking a series of troubles in the circu¬ 
lation similar to the accidents of Basedow's malady. 

Treatment of Uremia by Water Diet. 

M. Renon said that there were cases of acute or chronic 
uraemia where the patients could not support the milk 
diet; the accidents persist, in spite of the milk, and 
perhaps even on account of the milk, which becomes a 
poison, as in cases of acute enterocolitis, and probably 
.for the same reasons. In such cases, consequently, 
some other agent than milk should be employed. M. 
Mathieu showed that in the oourse of chronic gastric 
uraemia the patients could be treated simply with water, 
and he knew that M. Bar treated for the last year by the 
hydric diet, and with good results, women suffering from 
gravid albuminuria and from eclampsia. He thought, 
consequently, that in uraemic patients who did not sup¬ 
port the milk the hydric diet should be observed. In 
five cases he prescribed this treatment. At the end of 
three or four days the vomiting, diarrhoea, and dyspnoea 
had disappeared, and the days following rice-water and 
vegetable soup were ordered, and gradually the milk diet 
was resumed. 

The Action of Coloured Light on Man. 

Dr. Eaffegean has published an interesting account of 
his treatment of nervous affections by coloured light. In 
a room papered in red and with red glass windows he 
placed a maniac, who, for a long time, was sombre, affected 
with taciturn delirium, and ate rarely of his own accord. 
Three hours after being placed in this room he visited 
him, and to his great surprise he found him smiling all 
over, and asked to be given something to eat. 

Another patient took it into his head that the air was 
full of poison, and remained all day with his hands over 
his mouth to prevent the air from entering. He was 
placed in the red room, and the following day he seemed 
quite rational, asked for his breakfast, which he swal- 
owed with avidity, and at the end of a few days he was 
able to be sent home. On the other hand, a maniac, 
very violent, and wearing the straight jacket, was put 
into a room with blue glass windows, and in a few hours 
he became calm and gave no further trouble. 

M. Lumi&re, the well-known dry-plate manufacturer 
at Lyons, was obliged to substitute green coloured glass 


in all the windows of his large room for the usual red, 
as the work people sang all day, gesticulated, and the 
men made love to the women. Since the substitution 
they are quiet, do not speak a word, and seem less 
fatigued when they leave off work. 


(Sermanp. 

[from our own correspondent.] 

Berlin, May 27th, 1809. 
Transplantation of Cartilage into the Larynx. 

At the Surgical Congress Dr. von Branegoldt, Dresden, 
gave a note on the subject in connection with some 
cases of stenosis of the larynx. In some cases of 
stricture dilatation did not always lead to recovery, and 
scarcely to improvement. In such cases success could 
only be attained by resection and the implantation of 
fresh firm tissues into the stricture. The transplanta¬ 
tion of hyaline cartilage had not, up to now, been 
attempted, but he had practised it in four caseB with 
success, where there was defect of cartilage. In one 
case, that of a child, there was extensive papillomatous 
growth on both vocal cords. Laryngofissure was per¬ 
formed, the papillomata removed, and the surface 
cauterised. After five or six weeks stenosis was 
apparent, which could not be overcome by dilatations, 
nor could it be kept from getting worse. It was not 
possible to implant soft tissue, as on inspiration it would 
have been drawn in like a flap. He then attempted to 
implant rib cartilage with the perichondrium. The 
cartilage was first of all implanted into the skin, 
and then the skin, made firm by the cartilage 
into the larynx. Intubation was also performed. The 
success was complete. The patient breathed aod spoke 
well. He had endeavoured to discover whether the carti¬ 
lage remained alive or not after the implantation. Some 
weeks &go he implanted some caitilage from a rabbit 
under the skin of the back, and showed in a microscopic 
specimen young vessels passing into the cartilage, a 
proof that it remained alive. 

Hr. Krettner, Tflbingen, read a note on 
The Extension and Prognosis of Cancer of the 
Penis. 

In two cases of cancer of the penis he found, contrary 
to his expectation, disease in the pelvic glands, while the 
inguinal glands were free. In order to come to an 
understanding of this striking fact, he made a series 
of injections of the lymph vessels of the neighbour¬ 
hood, and found two groups, a superficial and a deeper. 
The superficial lymph vessels led to the inguinal glands, 
the deeper, almost without exception, direct into those 
of the pelvic. In amputation of the penis extir¬ 
pation of the inguinal glands blocked the way for the 
spread of the disease. This was only in the early 
stages. Wherefore operation should not be delayed 
when cancer attacked that organ. 

Hr. Most, Breslau, read a paper on the 
Lymph Vessels of the Stomach and their Relation 
to the Extension of Cancer, 
and showed preparations and drawings illustrative of 
the subject. 

Hr. Kraske, Freiburg, said that a few weeks ago a 
patient came under his treatment who had long 
been treated for ulcer of the stomach, but now 
showed symptoms of disease of the bowels. A high- 


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564 The Medical Press. 


AUSTRIA. 


Mat 31,1899. 


seated tumour could be felt from the rectum. 
Operation was performed, and the tumour removed 
from the sigmoid flexure, along with the bowel impli¬ 
cated. The extirpated piece showed an unusual appear¬ 
ance. There were two separate patches of the disease 
inside, not raised, but sunk and ulcerated, and a doubt 
arose a8 to whelber the disease was carcinoma or not. 
Five days after the operation vomiting and pain came 
on, and three days later death. The autopsy revealed 
still fuither stenoses of the same kind both in the small 
and large intestine and also in the stomach. In the 
bowel the carcinoma lay especially below the mucous 
membrane. The disease of the stomach was the primary, 
the other secondary. The disease passed first into the 
left gastroepiploic artery, which also passed to the 
right and there united with the gastro-duodenal. The 
superior pancreatico-duodenal was a lateral branch of 
this, which encircled the head of the pancreas and sup¬ 
plied the greater part of the duodenum. The organ was 
again connected with the inferior pancreatico duodenal, 
this was the inferior mesenteric, which divided into two 
branches, the left colic whioh supplied the descending 
colon, the superior hsemorrhoidal which passed to the 
upper and middle part of the rectum. 

Clinical Contributions to Perityphlitis. 

Hr. Karewski remarked on the importance of accurate 
differential diagnosis. It appeared that when bladder 
symptoms were present the prognosis was better. On 
the other hand attacks not preceded by peritonitio 
symptoms gave a worse prognosis, as here the abdominal 
cavity was a virgin one that reacted more readily on 
interference, with peritonitis. Retro-peritoneal suppu¬ 
rations were common, but they were, as a rule, of benign 
nature, but they could sometimes be malignant when 
they were only partially extra-peritoneal. 

Hr. Gussenbauer, Vienna, said that vague pains often 
depended on adhesions which might be spread over a 
large part of the abdomen. If these were relieved the 
pains generally disappeared. 

Hr. Hummel, Hamburgh, would not operate in mild 
cases; in medium cases only when serious attacks came 
on; in diffuse peritonitis at once and without loss of 
time. Out of 850 cases he had operated in 67 with 32 
deaths ; out of the remainder there were only 11 deaths. 
The pulse always gave the clue as to whether a cas e 
should be operated on or not. Rehn had operated 19 
times in diffuse peritonitis, nine of the patients recover¬ 
ing. Hr. Ewald, Berlin, also depended more on the 
pulse than on the temperature. 

Hr. Kftrte, Berlin, said hiB standpoint was that gene¬ 
rally the appendix was not to be resected, and in any 
case a free interval should be waited for. As a rule, 
simple opening of the abscess was enough. It should 
not be forgotten that 90 per cent, of appendix cases got 
well with intei nal treatment. Statistics proved that. 

Hr. Jordan, Heidelburg, related a case of acute peri¬ 
tonitis that got well without operation. There was high 
fever, pulse 140, vomiting, collapse. Operation was 
declined. He heard nothing more for six weeks, when 
the patient was brought to him suffering from chronic 
peritonitis. After watching the case for a week an in¬ 
cision was made, and a large quantity of purulent 
material removed. Complete recovery took place. 


JluBtria. 

[from our own correspondent.] 

Vienna, May 27th, 1SW. 

Bontgen Rats and 8tcosip. 

At the Gesellschaft der Aerste, Shiff, in conjurctioD- 
with Freund, gave their experience of the Bontgen rays- 
on sycosis and favus. In both diseases when the rays 
were applied seven and thirteen times respectively com¬ 
plete recovery was obtained, leaving the skin free from 
all inflammatory contractions and smooth. The action 
of the rays seem to be anti parasitic as no recurrence had 
appeared after the second month. 

Herpes tonsurans was equally amenable to the rays. 

Rupture op Gall Bladder. 

Hochenegg showed a woman, set. 47, on whom 
he had operated for presumptive volvulus. The 
history began with an illness that seems to have bem 
intermittent in its character, with violent pains in the 
abdomen, accompanied by vomiting. This went on for 
some time, till a sudden tear, as if something had given 
way in the abdomen, occurred, and a large tumour formed 
which necessitated immediate action. No gas or ftecea 
came from the bowel, neither was there vomiting or 
hiccough present after this occurrence. On opening the 
abdomen it was found filled with gall-coloured fluid, 
and six litres being drawn off. Further exploration 
revealed the gall bladder torn and collapsed, and 
remained a large stone. After removing the stone and 
washing out the abdominal cavity the gall-bladder waa 
stitched and the wound dosed, after whioh the patient 
steadily returned her usual health, as might be seen 
from her present condition thirty days after operation. 
Owing to the wide diffusion of fluid in the peritoneal 
cavity, a drainage tube was left in the wound to prevent 
imbibition if possible. 

Hochgnegg remarked that this condition of stone in 
the gall-bladder was not an uncommon occurrence, as 1,700 
such cases were now recorded, 472 of which had been 
laparotomised, as no other form of treatment waa rational, 
under such circumstances. 

Fabricius said that he had had three similar oases under 
his care some time ago which had been allowed to pro¬ 
ceed further than Hochenegg's cases. Tie first waa 
diagnosed as a case of hernia at the umbilicus which waa 
treated till it burst and discharged a large quantity 
of purulent matter. On examining the opening a few 
gall stones were discovered embedded under the skin 
around the orifice. The second case had a similar history 
and was diagnosed as a fibroma, being located about the 
same place. The third was somewhat different but 
formed a large abscess in the sheath of the rectus 
muscle the discharge containing the gall stones. 

Chronic Cavernitis. 

Griinfeld presented a patient with a chronic swelling 
about 5 c.m. wide and 6 o.m. long on the corpus of the 
penis entirely destroying the function of the organ. 
Ihere was no pain with the swelling, which for some 
time has been considered malignant, though no confirma¬ 
tion of this could be adduced beyond swelling of the 
left inguinal glands. In malignant cases the Rftntgen 
rays reveal a sort of cartilaginous substance which, 
strange to say, is present in this case. The microscope and 
symptoms were against, while the size of the glands said the 
Rdntgen rays appearances were in favour of malignancy. 


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Mat 31, 1899. 


feOUTH AFRICA. 


Myoma Operations. 

Wertheim next read his paper on 53 operations for 
myoma which he has performed during the last year 
and a half. Since Chrobak promulgated his methods 
of vaginal and “ moroellement,” five years ago for the 
removal of myoma, Grttnfeld tells us that he has devoted 
most of his time to testing the different forms, and 
within the last year and a half has had 53 of this nature. 
He claims several modifications which are of considerable 
advantage. 

His conclusions are that no tumour should be removed 
by this method if it rise above Hie umbilicus, as the loss 
of blood is too great to justify the operation. The 
length of time the patient has to be under chroloform is 
another danger to be feared. If the tumour be pedicu- 
la ted, it should be ligatured, and the stump returned to 
the uterus. In the case of multiple myoma the uterus 
must be removed with the tumor. The vaginal operation 
is limited in another class of cases; if these be anemic or 
affected with myo-degeneration, even when the 
tumour is small, this method should not be practised, as 
the hemorrhage is apt to be so great as to precipitate a 
fatal result. Intra-ligamentary myoma, as well as the 
adhesive inflammatory form, should be removed by lapa¬ 
rotomy. He has operated 36 times by the vagina, but in 
two intra-ligamentary oases had to abandon this method 
and complete the removal by laparotomy, 25 times 
“ moroellement ”—six times dismembering and three 
times enucleation. Of the 36 operations, one died of 
myo-degeneratio cordis. 

The radical cure he favoured was by total extirpation 
and supravaginal amputation, where there was less 
danger of wounding the ureters, and by removing the 
organ of the menstruating membrane danger was also re¬ 
moved, as well as fear of carcinoma in stum p. 

The indications for total extirpation were:—(1) Col¬ 
loid myoma, which developed in the pouch of Douglas ; 
(2) very large, or multiple myomata, though small; (3) 
infection or complication with pus discharges. 

Of seventeen radical operations he performed, three 
were supravaginal and fourteen total extirpation, with 
only one death. 

§outh Jlfrica. 

[from our own correspondent.] 

Cape Town, May 10th. 

Illegal Practice at the Cape. 

A good deal of interest has been excited locally over 
the prosecution by the police of an American negro, 
named Henry Tate, for illegally practising medicine at 
Claremont, a suburb of Cape Town. The accused claimed 
to be a graduate of the Western Beserve University 
Medical College of Cleveland, Ohio, and had applied for : 
registration here, but had been refused, the diploma not 
satisfying the requirements of the Cape Medical Counoil. 
From evidence it was abundantly proved that the 
defendant had been carrying on an extensive practice, 
both prescribing and dispensing, under the guise of a 
semi-religious institution, thepatientB paying 2s. 6d. per 
week during illness, soul therapeutics being apparently 
included. To make matters safe, 10s. was always paid 
in advance as an entrance fee. He admitted having 
attended 800 patients in two years. The serious 
feature in the business is the implication of a duly 


T he Medical Press. 565 

registered practitioner. Dr. Anthony, a graduate of 
Michigan and superintendent of the Claremont 
Sanatorium, a large institution carried on by the 
Seventh-Day Adventists, which, with ethical ideas 
truly Transatlantic, has extensively advertised itself 
and its doctor. For this reason, and from its tendency 
to subordinate true therapeutical lines to religious and 
vegetarian fads, it has never been in good odour with the 
local profession. Dr. Anthony was alleged by several- 
witnesses to have personally assisted Tate, under the 
name of “ Dr. Green,” and although this was denied by 
the defendant, who stated that the mysterious "Dr. 
Green ” was really Dr. Anthony's son, it was admitted 
that Dr. Anthony had given death certificates to cover 
Tate, and that without seeing the patients. Anthony 
had, in February last, written to Tate declining to con¬ 
tinue this dubious practice,' as it was a violation of the 
laws of the land, but naively admitting that, if his time- 
had permitted his seeing the patients with Tate " once 
or twice,” he could have gone on doing so. Eventually 
Tate was fined .£50, with the alternative of six months' 
imprisonment, but appealed, and was allowed out on 
bail. It may be well to point out that the colonial law 
is in advance of that of England by making the un¬ 
qualified practice of medicine penal, apart altogether 
from professing to be registered. This renders pro¬ 
secutions fairly easy, and, as a matter of fact, there is 
very little quackery in this colony, although it is ram¬ 
pant in the Kepublics. The only defence made in this 
case was that Tate was not practising for gain; but for 
religious purposes. A certificate he gave for the removal 
of a patient to hospital is a gem, and I reproduce it 
verbatim:— 

“This is to certify that I have been the attending phy¬ 
sician of Mr. Charles Fredericks, age 62, from January 
7th, 1899, and I find no contagious disease or Faberish 
disease. But owing to his age and the location of his 
residence, his complaint has been of such Nature and 
now, and there is nothing more can be applied to hia 
life sustenance. Only a quiet nursing, as he is now on- 
his margins to his long home. God help him. There is 
quiok rattling over hia bones. Given under my hand 
thiB 17th day of Maroh, 1899. Dr. H. Tate, M.D.” 

As a sequel to this case. Dr. Anthony has been placed 
upon hiB trial for giving false certificates of death. He 
attempts to justify himself by Baying that he had some¬ 
times seen cases with Tate, and that, although he had 
given certificates at Tate’s request and on his description, 
he had not known that they were not for patients a horn 
he had seen. As the case is still tub judice, it is impos¬ 
sible for me to comment further upon it, but one item 
of evidence demands note. Dr. G. G. Eyre, of Clare¬ 
mont, called as a witness in defence of Dr. Anthony, 
testified that it was a common thing for medical men to 
give certificates simply on’the word of the relatives that 
the patients had been seen by them, without taking any 
means to satisfy themselves of the identity of the case. 
This is justly regarded as a veiy unfair assertion to 
make, and the more so, from the fact that Dr. Eyre 
happens to be the editor of the South African Medical 
Journal, and, as such, would be regarded by the public 
as an authorised exponent of the views of the profession* 
Certainly, no honourable man ever gives a certificate 
without fully satisfying himself as to identity. The 
Medical Association will probably take some steps to- 
clear the profession from the imputation. 


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THE OPERATING THEATRES. 


"May 31, 1899. 


Contamination of the Water Supply. 

Another local matter has made muoh stir of late. The 
water supply of Cape Town is derived from the summit 
of Table Mountain. Acting on the recommendation of 
the Medical Officer of Health for the City, Dr. E. B. Fuller, 
the City Council has lately applied for powers to exclude 
the publio entirely from the catchment area, except oertain 
limited paths. This step was diotated by a fear of pos¬ 
sible contamination of the water supply by typhoid 
excreta, but as the area is nearly 600 acres, about two- 
thirds of the mountain top, the proposal to deprive the 
citizens of their grand old mountain met with a good 
deal of resistance. The Cape Town branch of the 
.British Medical Association discussed the, matter in a 
•fully attended meeting, and a resolution was oarried 
-by a very large majority, protesting against the new 
regulations as drastic and unnecessary. A deputation 
waited upon the Premier, whose sanction to new regula¬ 
tions of this kind is necessary, and urged the view of 
the Association. His reply was not altogether satisfac¬ 
tory, but it was understood that at least some modifica¬ 
tion of the regulations would be arranged. In view of 
the fact that the ascent of the mountain is rather too 
stiff a climb to make it likely that even the ambu¬ 
lant or convalescing cases of enteric fever would under¬ 
take it, and considering that the supply is derived from 
a multitude of trickling rills running over and through 
sand, exposed to strong sunlight and other bactericidal 
agencies, the sanitary zeal of the Council seems to be in 
excess of tbe requirements of the case. The matter has 
not been officially before the Colonial Medical Officers of 
Health, Drs. Turner (formerly of Guy’s) and Gregory, 
but it is understood that they coincide with the opinion 
of the Association. 

Post-Graduate Tuition. 

The advisability of giving South African students the 
first year, at least, of the curriculum here, and of insti¬ 
tuting a Post Graduate School is being mooted, and will 
probably be brought before the Medical Association 
shortly. Dr. Dodd, the President, initiated the idea in 
an address. We have a hospital of about 200 beds, a 
large dispensary, and Government institutions for mental 
disease, sanitation, and bacteriology, besides all the 
machinery for teaching physics and chemistry, with some 
provision for biology, and ought to be able to do some¬ 
thing. 

A New Disease among Miners. 

Drs. Rogers, Brodie, and Hamilton, of Johannesburg, 
have lately published the results of some researches upon 
what they consider a new disease prevalent among mme 
Kafirs in the Golden City, and very fatal. They call it 
“Acute Specific Rhinitis,” and consider it due to a 
diplococci, which they think is identical with Frenkel's 
pneumococcus, only more virulent. The morbid appear¬ 
ances, as shown in twenty-six cases, are a purulent 
rhinitis leading to meningitis, suppuration of the sinuses, 
middle ear suppuration, and parotitis. Croupous pneu¬ 
monia was present in most of the cases, and there was 
generally peritoneal effusion. The cases with no pneu. 
monia or very little were as fatal as - the others. 
Dysenteric diarrhoea generally occurred at the last. 

Active preparations are being made for the South 
African Medical Congress, which will meet here in 
-October next. Dr. C. F. K. Murray is the President¬ 
elect. 

A Masonic Lodge named after Mr. Kendal Franks, 


F.R.C.S., late Surgeon in Ordinary to the Lord- 
Lieutenant of Ireland, has been opened at Johannesburg. 


(Operating theatres. 

ROYAL FREE HOSPITAL. 
Nephro-Lithotomy in a Case of Obscure Diagnosis. 
—Mr. Battle operated on a man, set. about 40, who had 
been suffering from obscure symptoms for some years; 
there had principally been frequent micturition with 
weakness and loss of strength, and occasionally an exacer¬ 
bation with deposit of a yellow character in the urine and 
pain on mioturition. He had been in various hospitals, 
where he had been told that he suffered from cystitis ; he 
had previously been in the Royal Free Hospital, and had 
been subjected to examination under the X-rays, but with¬ 
out any satisfactory result. The opinion held at that time 
was that an enlargement which could be felt of the right 
kidney was possibly dependent on the presence of a 
calculus. The diagnosis was considered to rest between 
tuberculous and calculous pyelitis ; against the tubercu¬ 
lous view was the fact that the patient had suffered for 
some years, and still showed no evidence of tubercle else¬ 
where ; in favour of it was the comparative absence of 
pain or anything approaching a renal colio ; in favour of 
caloulous pyelitis was the fact that there had been inter¬ 
mittent attacks of the kind mentioned above, and that 
these attacks were usually ascribed to exertion, there 
had been blood in the urine, but it had not been a 
marked symptom. At his former visit to the hospital he 
had declined operation, but now asked for it, as his con¬ 
dition was much worse than it had been before. 
He was passing large quantities of pus and 
mucus, and was weak from this cause and 
insufficient food; his condition was so unsatisfactory 
that operation was not immediately performed, but he 
was kept in bed and fed up. As the right kidney was 
large and a little tender, whilst the left could not be 
felt, it was considered that the right kidney was the seat 
of his trouble, and this was explored from the lumbar 
region. Examination of the kidney through the wound 
thus made showed it to be harder than natural, and not 
in a condition of pyo-nephrosis. The finger was easily 
worked through the substance of the kidney as far as the 
pelvis, the lining of which had to be divided with a 
director before a stone, which almost filled it, could be 
fully exposed ; it was even then not possible to find its 
outline, for it was too large; foroeps were placed on it 
with a view of its extraction e» masse, but it broke 
down under their grasp, and it had to be extracted in 
large fragments. One of the extensions passed into 
a calyx, and there bifurcated so that, until the opening 
had been made larger, it was not possible to extract it. 
The kidney seemed remarkably healthy considering the 
number of years that the stone had probably been 
present. Exploration with the finger after removal of 
the stone showed that it had been fully extracted. A 
drainage tube was passed down to the opening in the 
kidney, and the wound closed with deep and superficial 
stitches. Mr. Battle considered that the kidney had 
suffered less than usual because the stone did not extend 
into the ureter so as to produce blocking of that, and 
had formed in such a way that it was practically fixed 
unless any special exertion shook it up. The patient had 
become suoh a hospital bird, going from place to place 


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The Medical Press. 567 


May 31, 1899. 
and resting almost constantly, that attache of irritation 
from this cause were rare. 


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“ 8ALC8 POrULI SCP EMA LEX.” 


WEDNESDAY, MAY 31, 1899. 


THE RIVAL SYSTEMS FOR THE SANA- 
TORIAL CURE OF PHTHISIS. 

Ome of the aspects of the present prominence into 
which the senatorial system of treating tuberculous 
-disease of the respiratory tract has recently sprung, 
although in truth the system is of older growth 
-than yesterday’s, is puzzling both to laymen and to 
medical readers of the wordy warfare waged between 
the apostles and their disciples of its two schools. 
These schools can be best recognised by the names of 
their individual Meccas, Falkenstein and Nordrach— 
Falkenstein with its apostle Dettweiler, Nordrach 
'boasting Walther as its prophet. The Falkenstein 
method has lately been described in these columns. 
Its gospel preaches fresh air and rest in it in a 
recumbent position but under shelter for many 
hours a day; plenty of good food at meal¬ 
times, with fresh milk added between them ; 
windows open at night; walking exercise only 
in moderation and to medical order; absolute rest in 
bed when the temperature is above the normal; wine 
with dinner and supper, and spirits in fever. If the 
weather be wet and inclement the out-of-door life 
.may be modified. The Falkenstein patients become 
feeding and dozing automata, many are benefited, and 
a considerable per centage recover. At Nordrach the 
gospel is according to Walther, and much more 
.-Spartan. Cold winds, rain, snow, or damp, make 
.no difference, Life must be spent, in the open air, 
moving about as much as possible, and with no extra 
.covering, as a rule. If wet, the clothes are aUowed to 
dry on the body; if unwilling to sleep with a wide open 
■window, the window is removed. The system of feed¬ 
ing is also more autocratic. Eat what is set before them 


the patients must; if they cannot at the moment, 
they sit till they can; if they are sick they must 
return to table and begin again. The windows of the 
dining-room are kept wide open, and cheerful breezes 
—by no means to be called draughts—sweep in on 
most occasions over the table and past the occu¬ 
pants. We have seen the salt blowing off the edge 
of the plate when dining under this regime. Now 
many will, and do, object to the definite state¬ 
ments made by the apostles and adherents of either 
system as to its constituting the only right and proper 
method ; how can both be right, yet neither wrong, 
while so different in conception ? There is no doubt 
that both are right in so far as they are severally 
adapted for various different types of patients ; one 
type of patient is benefited by the milder regime, 
injured by the harsher; and vice versd; still another 
type fails to react satisfactorily to either. The 
drawbacks of sanatoria of the Falkenstein class lie 
in their large size and great number of patients, and 
the consequent inability of the physicians to exercise 
sufficient individual supervision, and in the extra¬ 
ordinary custom that persists in them (at least in 
Falkenstein and Hohenhonnef) of closing all the 
windows and doors when the patients are segregated 
together for meals in the dining-hall, and producing 
an atmosphere very inimical to large appe¬ 
tites, as we have had personal experience. The 
only occasions on which the patients are 
brought together in one room are exactly those in 
which the freest circulation of fresh air is indicated, 
apart from the frequent disinclination for food 
brought on by it—at least, upon British and 
American patients. This drawback, of course, 
chiefly occurs in the winter and springtime; in 
summer the windows eurely must be opened. The 
reason alleged is the repugnance of foreigners to 
air and so-called draughts in rooms; but, if made 
part of the treatment, those who refused to tolerate 
it would be better away. But here we have the fact 
that many of these places are conducted by limited 
liability companies, and the departure of patients for 
such causes might lead to decrease in the dividends. 
The Nordrach system, again, aims at individual 
medical control, and limits the number of inmates. 
But even this has a drawback, foi it is seldom 
possible to instal a resident expert laryn¬ 
gologist because of the expense, and even the 
Nordrach treatment requires, it appears, some 
local assistance in laryngeal cases. It is ex¬ 
tremely difficult to find out the truth as to the 
history of laryngeal cases of consumption in sanatoria. 
At Falkenstein many seem to do well. We belitve 
that such patients are not person# grat# at Nordrach. 
Attempts to obtain any statistical conclusions on the 
subject proved abortive; the question was not a con¬ 
genial one at any of the institutions. Taking into 
consideration the after life history of those discharged 
cured or recovered from sanatoria, two interesting 
questions arise. Are such lives insurable P If so, what 
extra premium would be advisable, in the most general 
sense? And should such persons marry afterwards, 


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568 Th* Mkdical Pbxbs. 


LEADING ARTICLES. 


if they have knowingly suffered from serious tuber- 
ulous lesions, but recovered ? These questions will 
require to be answered in the near future, There is 
no doubt that both of these systems can actually 
abolish tuberculous lung mischief. Which of them 
is the better we are disinclined to say, because some 
benefit from the one, others from the rival method, 
and many from neither 

THE PLAGUE IN EGYPT. 

The news that the plague has broken out in 
Alexandria will cause little surprise when viewed in 
the light of past experiences. Its progenitor, the 
Indian outbreak, which happily now seems to be 
declining, has led to an enormous loss of native life. 
The extent of the mortality may be illustrated by 
the fact that a fortnight ago the number of deaths 
from that cause all over India was returned as 953 
“only," or “less than in any week since last July." 
With regard to Egypt, there can be no doubt that 
during the British occupation the sanitary condition 
of the country has been greatly improved, but for all 
that it may be questioned whether the country as 
a whole excels the average Eastern standard of 
public health. In other words, the plague having 
gained a footing in Egypt will not be readily ousted, 
for it is a disease that, above all others, is fostered 
and spread by an unwholesome popular environment. 
When, a couple of centuries ago, the malady slew its 
thousands in Great Britain, its virulence was due to 
the absolute ignorance of sanitary principles that 
prevailed in those days. Better attention to the 
laws of healthy living gradually abolished plague 
from the shores of the United Kingdom, just as 
within the memory of the present generation it has 
thrown off cholera. The practical lesson to be learned 
is that in both instances the malady is sent to 
the rightabout by good public health administration 
What Great Britain has effected in her own country, 
she has failed to accomplish in her Tast Indian 
empire, for the prevailing sanitary conditions are 
simply deplorable. It now remains to be seen what 
will happen in the case of Egypt, where the British 
occupation has had merely a tithe of the duration of 
the supremacy in India. The disease was brought 
into Alexandra, so it is reported, by Russian pilgrims 
who arrived there after having touched at infected 
ports. The story has a ring not unfamiliar in the annals 
of the East, where religious rules and customs have so 
strong a hold upon the popular mind. Itcertainly brings 
home to a thinking man a sense of the huge responsi¬ 
bility involved in the empire of Greater Britain. 
Not only have vast territories to be conquered and 
held by the strong hand, but their sanitary salvation 
must be brought about in the face of deeply rooted 
ignorance and prejuaice. Britain has already paid 
an enormous toll in the loss of life sacrificed to the 
sanitary dangers that lurk in every inch of Indian 
soil. It may, no doubt, be argued, on the other hand, 
that she has gone through a similar ordeal within 
her own walls, a proposition that cannot be seriously 
controverted. It is one thing, however, to pay 


Mat 81, 1899. 

for one’s own experience, but quite another to 
purchase the redemption of races that are not 
our own kith and kin. When the wider aspects 
of the prevention of disease are investigated the 
conclusion is unavoidable that no real advances 
can be made without a corresponding outlay of 
money. To bring up the vast cities of India to an 
average European standard of sanitation would 
involve an expenditure of Gargantuan size. Yet 
plague, to say nothing of other pestilences that stalk 
about by day and by night through these Eastern- 
dependencies, can be excluded in no other way. To- 
decide whether the game is worth the candle 
is a matter outside our province as a medical 
journal, and must be left to the later school of 
political economists, who will have the advantage 
of examining the cost of empire in the fuller 
light of modern preventive science. That 
the task is a mere matter of skilled energy 
and monied administration was abundantly proved at 
Hong Kong, where the plague was rooted out by the 
British from foul and extensive native quarters. 
Imagination reels, however, at the thought of what a 
similar attempt would mean if applied generally 
throughout India. Fortunately, the bacteriologist haa 
given us the key to the etiology of the scourge, and 
has provided a vast number of precise data as to the 
propagation of the specific bacillus by the soil, by 
wild and domestic animals, by vermin and by other 
agents. Nothing can exceed the interest of this 
chapter of modern research, which showed how- 
pigeons could distribute the disease from the 
housetops and ship rats convey the malady 
to far-distant ports. When all is B&id and 
done, however, we are still faced with the fact that 
plague was banished from England before the exist' 
ence of pathogenic microbes was known. That is to 
say, its disappearance was due simply and solely to 
the gradual bettering of sanitary administration. 
Under the circumstances, the progress of the plague 
in Egypt will be watched with no little interest. In 
the Mediterranean there are many ports whose sani¬ 
tary state is about as bad as bad can be, and should 
any of these be invaded by plague the world at large 
will doubtless be furnished with plentiful reminders 
of the danger of delay in the perfection of public, 
health administration. 

INFIRMARIES OR HOSPITALS P 
The conduct of the Bradford Guardians in appoint' 
ing the two medical officers whose appointment baa 
been so badly received by the medical profession in 
thatcity opens up a new'vista in infirmary medical work. 
Let us try to discuss the matter in a fair spirit with' 
out calling in question either the technical right of 
the guardians to act as they have done, or the 
intrinsic fitness of the two gentlemen upon whom 
their choice has fallen. Hitherto it has been the 
universal custom to regard the post of medical officer 
to a Poor-law infirmary as one the duties whereof would 
best be discharged by a general practitioner, indeed, 
the duties are of such an onerous and irksome nature 


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The Medical Pbiss. 569 


NOTES ON CURRENT TOPICS. 


May 31, 1899. 

as to indispose the consultant class of practitioner 
to compete for them. Otherwise it is evident 
that if the guardians had to choose between 
.& Fellow and a Member of the College of 
Surgeons or Physicians their choice must, unless 
nepotism were rampant, fall upon the more highly 
qualified of the two. Under these circumstances it 
seems a pity that the guardians should have imported 
into their selection an element of controversy which 
was totally unnecessary in that, caeteris paribus, the 
gentlemen who have obtained their sanction would, 
under any circumstances, have come out at the top of 
the poll, always supposing that the guardians were 
actuated solely by consideration for the interests of 
the sick in their charge. It follows from what we 
have said, that whatever method of selection was 
.adopted, these two candidates would have been chosen. 
But the selection amounts to a revolution in the prin¬ 
ciples which have hitherto guided guardians in the 
choice of infirmary medical officers. We are 
far from saying that the innovation is not one 
well worthy of approval, but it is of sufficient 
importance to challenge discussion on its merits. 
It has been our policy for years to advocate that 
workhouse infirmaries should be worked on hospital 
lines, that is to say, the senior medical staff should 
be composed of men whose professional status 
is such as to command confidence, and that the vast 
Amount of clinical material which runs waste in 
these, collectively, gigantic institutions, should be 
made use of for purpose of clinical instruction. If 
the guardians individually would only take the 
trouble to investigate for themselves the conditions 
which prevail at hospitals where students are 
admitted they could not fail to be convinced that the 
presence of students is a great incentive to thorough- , 
ness of work on the part of the senior medical officers 
without, absolutely without, any drawback as far as 
the patients are concerned. If in future the infirma¬ 
ries are to be made centres of medical study we cannot 
but approve of the selection of thehighestpossibleorder 
•of physicians and surgeons as medical officers. On 
the other hand, if the guardians imagine that these 
men are going to render the same monotonous and 
unthankful services as those hitherto rendered by the 
-ordinary workhouse infirmary doctor, they are egre- 
giously mistaken. On the other hand, if these con¬ 
sultants imagine that the holding of these posts per 
. ee will give them consultant rank they, too, are mis¬ 
taken ; indeed, the mere fact of their supplanting 
general practitioners at a ridiculously low rate of re¬ 
muneration will inevitably lead to a tacit boycotting, 
which will render their position the reverse of agree¬ 
able, and we cannot blame the medical men of Brad¬ 
ford if they set their faces against a departure which 
-deprives them of sundry remunerative poets without 
Any compensating advantage to the profession or to 
the public. Let us have a clear understanding with 
•the guardians. Are they going to run the infir¬ 
maries on the lines of the general hospital, or are 
they merely trying to get a higher order of medical 
.officer at a remuneration which the general prac¬ 


titioner would despise P In any case we see no valid 
reason why the time-honoured custom of throwing 
open the appointments to public competition should 
be departed from. If the guardians like to append 
certain conditions, such as the possession of par¬ 
ticular diplomas or degrees to the candidature, they 
are, we imagine, at liberty to do so, but above all let 
them avoid even the appearance of hole-in-the- 
coraer manoeuvres. 


fiot zb on <2himnt 

The Medical Education Question in South 
Africa. 

The question of medical education in South Africa 
is attracting a good deal of attention among the 
medical men in the colony. There are those who 
hold that it would be an expedient thing to start a 
South African medical school in Cape Town, while 
there are others who oppose the scheme entirely. It 
has also been suggested that a echool of anatomy 
and physiology might be established as a beginning, 
but the obvious arguments advanced against the 
proposal are that the undertaking would be a very 
costly one, and inferior in appliances and accessories 
to the great European schools, while it is doubtful 
whether the South African students would care 
to avail themselves of its privileges. The situa¬ 
tion is summed up by Dr. Anderson, of Cape 
Town, who expresses the opinion that the ques¬ 
tion of founding a South African medical school 
may be safely adjourned for a generation. “Our 
population,” he Bays, “ is too small to enable us to 
have anything but a make-shift medical school, and I 
do not think that I am wanting in loyalty to South 
Africa when I say that the gain to our professional 
men from some years of close intercourse with the 
great centres of life and thought must far outweigh 
the somewhat narrow advantage of being able to do 
everyth in g for ourselves. ” It must beconeededthatthe 
views expressed by Dr. Anderson closely coincide with 
those generally prevalent among medical teachers in 
London. To found and organise a medical school 
and equip it in accordance with all modern require¬ 
ments is a most costly undertaking, so much so, that 
it is often quite impossible to make these undertak¬ 
ings paying concerns. We believe that in at least 
one medical school in London not only do the 
teachers fail to be paid for their services, but from 
time to time they are called upon to contribute to a 
fund for the maintenance of the school. Again, among 
the large schools, despite the ample entry of new 
students every year, the payments of the teaching 
members of the staffs are much diminished owing to 
the heavy expenditure demanded in order to keep pace 
with the requirements of modem medical education. 
Thus from a financial point of view, medical schools 
in London are by no means in favour, and regarded 
in the same aspect, it seems difficult to comprehend 
how, even with the best prospects, a South African 
Medical School could become self-supporting. There 


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570 The Medical Press NOTES ON CURRENT TOPICS. 


is nothing, however, to prevent a South African 
millionaire building and endowing a seat of medical 
learning in Cape Town, if he felt so disposed, and 
thus perpetuate his name and good works after the 
manner of the philanthropist Johns Hopkins, of 
Baltimore. 

Diabetes in Children. 

Diabetes is acknowledged to be a very rare affec¬ 
tion in children, and the paper, therefore, by Dr. 
Townsend, in the Boston Medical and Surgical 
Journal, for May 11th, in which the notes are given 
of five cases is undoubtedly of interest. In one case 
the child was only one year and eleven months old, 
while the oldest was nine years of age ; a fatal issue 
occurred in all. Prout and Meyer, in a series of 700 
and 380 cases of diabetes respectively, each met with 
only one case under the age of ten years. Again, 
Wegeli has collected 108 cases of the disease in ch ildren, 
among whom there were three children whose age was 
no more than three months each. In children 
diabetes is a much more rapid disease than is the case 
in adults, and the prognosis is always bad. In 
the series collected by Wegeli the shortest course 
of the disease was in a child, aged two years 
and nine months, who was only ill four days and 
then died of coma, while the longest case did not 
prove fatal till after the elapse of four years and a 
half. In the author’s cases the duration of the 
disease varied from two to fourteen months. Atten¬ 
tion is drawn in the paper to the fact that the initial 
symptoms are incontinence of urine, due to polyuria . 
nervous irritability, and great thirst, while strength, 
flesh, and colour may be retained till nearly the end. 
So far as treatment was concerned, the author gave 
his patients codeine, and enforced a strict anti-dia¬ 
betic diet. But in no instance did any real improve¬ 
ment follow, although occasionally a diminution was 
noted in the quantity of sugar excreted. Lancereaux 
believes that the occurrence of diabetes in children is 
due to a relative insufficiency of the pancreas, owing 
to a want of development of that organ. 

Trichinosis in America. 

It is curious to learn that a disease like trichinosis 
is still met with. While in this country the proba. 
bility is that no case has been seen for many years, 
yet in America, we gather from Professor O sler, that 
the disease is by no means infrequent, and some¬ 
times even assumes an epidemic form. Professor 
Osier has paid a large amount of attention to the 
subject, mainly from the point of view of the 
differential diagnosis of the malady. When occurring 
in an extensive outbreak he states that there iB no 
difficulty in the diagnosis, but just the reverse is the 
case when it occurs in sporadic form, and it then 
happens that many of the cases are overlooked. The 
disease, the clinical features of. which trichinosis 
most closely resembles, is typhoid fever, and in order 
to distinguish between the two it is essential to know 
the three main features by which it is possible to 
arrive at a differential diagnosis. According to order 
these features are—(1) muscular pains ; (2) cedema; (3) 


Mat 81, 1899. 

leucocytosis and eosinophilia. Muscular pain is uni-- 
vereal in trichinosis, and is rarely if ever present in 
typhoid fever; again, in trichinosis there is usually 
oedema which is most marked in the eyelids and over - 
the eyebrows. Lastly, leucocytosis and eosinophilia 
present in trichinosis is not known to exist in typhoid. 
All these points, of course, are of interest, but they 
are altogether beside the question when it is remem¬ 
bered that trichinosis is an easily preventible disease 
and with the adoption of the most ordinary precau 
tions could not occur. Meat which is infested with- 
trichina can be rendered quite safe by efficient 
cooking; the parasites are killed by a minimunr 
moist temperature of 170 degs. F., but if a 
lower temperature than this he employed for the 
cooking, the parasites will be afforded the oppor¬ 
tunity of making a new start in the tissues of those- 
who partake of the meat. It has been stated that 
trichinosis seldom occurs in England, not because- 
undercooked meat is not eaten, but because the 
trichina does not happen to infest British pigs.- 
This is possibly the case, but if so, is there any reason 
why the parasite should be allowed to infest the pigs- 
of any other country P 

The Rheumatic Heart. 

Not long since Drs. Lees and Poynton called 
attention in a valuable communication to the sudden, 
and well-marked dilatation of the heart which can be 
made out in patients suffering from acute rheumatism^ 
such dilatation subsiding as the disease disappears. 
In a further communication embodying the resulte- 
of pathological researches on a fatal case of the kind. 
Dr. Poynton shows that the dilatation in question- 
coincides with the existence of a myocarditis which 
may occur quite independently of either endo- or 
pericarditis. Hitherto the marked increase in the 
area of precardial dulness has generally been attributed 
withoutfurther inquiry to pericarditis and the murmurs 
induced by the dilatation have been too readily put 
down to endocarditis. It is highly important that 
current views concerning the pathology of the rheu¬ 
matic heart should be revised in the light of these re¬ 
searches. Cases are on record in which exaggerated pre¬ 
cordial dulness has led toadiagnosisof peri cardial effu¬ 
sion, and in more than one instance attempts have been 
made to drain the pericardium, of course with a disas¬ 
trous result. Dr. Poynton was able to adduce micro¬ 
scopical evidence in abundance, pointing to the 
existence of degenerative lesions in the myocardium, 
and it seems likely that these constitute the source of 
the dilatation, itself a consequence of the weakening 
of the cardiac muscle. The materies morbi is at pre¬ 
sent referred to the hypothetical toxin elaborated by 
a not less hypothetical micro-organism, but bearing- 
in mind that one of the most salient and most con¬ 
stant features of acute rheumatism is the presence of 
lactic acid in the blood, one is at a loss to understand 
why the damage should be localised in one particular 
part of the muscular apparatus. But it is possible that 
it is not thus localised, and in any event itcannot safely 
be affirmed in the absence of concurrent examination of 
' other voluntary and involuntary muscles. It may 


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May 31, 1899. __NOTES ON CURRENT TOPICS. The Medical Pbkss. 571 


well be that the degeneration which attacks the 
heart muscle is only part and parcel of a general 
process involving the muscular system as a whole. 
There are several points in the clinical history of 
rheumatism which lend colour to this assumption, in 
particular, the extreme muscular weakness and 
atrophy which characterise an acute attack of the 
disease. We must leave it to those who are fully 
equipped for such laborious investigations to work 
out the pathology of this interesting subject; but, in 
the meanwhile, it is highly desirable that the general 
practitioner should reconsider his views of rheumatism 
in so far as it affects the heart, because both diagnosis 
and prognosis cannot fail to be profoundly modified 
as the result of the fresh light that has already been 
thrown on the subject of cardiac lesions in association 
with rheumatism. 

Certificated Opticians. 

The Corporate and Medical Reform Association 
are actively moving in the matter of bringing pro¬ 
fessional pressure to bear upon the General Medical 
Council with a view to that body taking steps to deal 
with the question of the certification of opticians by 
the Spectacle Makers Company. For this purpose a 
special fund has been opened by the Corporation in 
order that the campaign of resistance may be brought 
under the notice of all members of the profession. 
The object, of course, is a worthy one, though we 
may doubt whether the General Medical Coun cil will 
concede that the matter concerned really comes 
within the purview of their functions. Again, the 
contemplation of a legal tussle with such a powerful 
company as that of the Spectacle Makers’ would be 
more than likely to weigh heavily in the balance were 
the Council disposed to adopt strong measures. We 
believe that the company in question has emphati¬ 
cally determined to fight for the maintenance of their 
position to the bitter end, and to protect the profes¬ 
sional rights of all of those concerned with them in 
the undertaking. Under these circumstances, there¬ 
fore, it would be only natural were the General 
Medical Council to hesitate before embarking upon a 
course which had every prospect of leading to 
prolonged and exceedingly costly litigation. Thus, 
while the Corporate and Medical Reform Association 
a e quite justified in, and to be commended for, 
doing their best to impress upon the General Medical 
Council that the matter is one for official interference, 
yet. on the other hand, it does not seem to be at all 
possible that anything of importance will come of 
their protest. 

The Physiology of Insomnia. 

Insomnia is the appanage of certain nervous tem- 
peraments, but it is precipitated and predisposed to 
by a large number of dietetic and other errors of a 
distinctly remediable nature. In women tea drinking, 
and in men tobacco, are responsible for much of this 
nocturnal excitability to an extent which the sufferers 
little dream of. Then. too. the condition of tlio 
stomach has much to do with the vascular supply of 
the brain. If the stomach be over full, or if, on the 


other hand, it be empty, the night’s rest is likely to 
be disturbed. These are well recognised and remov¬ 
able causes, but there are other, more subtle, factors 
which are equally capable of preventing sleep. One 
is the intense desire to sleep coupled, it may be, with 
the fear that sleep may not come. Nothing probably 
acts so efficiently as a sleep preventer as the extreme 
desire for it. The importunate ego wanders restlessly 
into the various chambers of the brain, testily inquir¬ 
ing why the cells are not at rest as per order, and 
the half-dormant cells rouse themselves to offer 
excuses, and then the irritable ego retires into its 
cerebral lair, watchfully apprehensive lest its sub¬ 
ordinates should not comply with its orders. The 
muscular system, as represented by the cells in the 
motor area, resent the intrusion and give vent to their 
dissatisfaction by irregular contractions, manifested 
by an attack of fidgets, which the wrathful ego is 
powerless to control. The sufferer’s only chance is to 
give bis Me an occupation of some sort. Give it 
something to do, some calculation to control, some 
problem to elucidate, and forthwith, the moment its 
vigilance is relaxed, the subordinate faculties turn off 
the light and there is peace. This is the general 
principle underlying the tricks suggested by popular 
usage for wooing sleep, the success whereof depends 
upon the ability of the subject to enforce a sufficient 
amount of domestic discipline. 

A Literature of Snippets. 

The Saturday Review deplores the popularity of 
what is described as “a literature of snippets.” 
Instead of reading Ruskin, Gibbons, Shakespeare, or 
Spencer, the average British reader is satisfied with 
an intellectual meal composed of snippets, mere ex¬ 
tracts from current events and annotated descriptions 
of physical and mental monstrosities. Is there not a 
somewhat similar tendency in medical literature ? Is 
there not a certain section of the profession which is 
satisfied to be fed with snippets from contempora¬ 
neous publications. They do not require to know 
much about anything but they want to know some¬ 
thing about everything. It is hardly necessary to 
point out that such knowledge is valueless for all 
practical purposes. We cannot know too much about 
anything, but it is very possible to know too 
little, and in medicine above all too little know¬ 
ledge is a very dangerous thing. Of wliat 
value can it be to know that Dr. X. in some out of 
the way place has prescribed such and such a drug 
in a particular disease. The snippet does not give 
sufficient data to enable the reader to judge whether 
or not he is worthy of credence, and the mere inti-- 
mation that a surgeon in Alaska has successfully (?) 
removed the stomach will not materially essist the 
reader in treating his cases of dyspepsia. The only 
valuable form of medical literature is the monograph 
in which the author’s professional status is set forth, 
and he gives his reasons for arriving at certain con¬ 
clusions. When this is transmogrified into a 
“ snippet ” its educational value is lost, and we have 
instead a bald statement of premises and conclusions. 
Let us beware of this tendency which degrades- 


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572 The Medical Pb*88. 


NOTES ON CURRENT TOPICS. 


Mat 31, 1899. 


medical literature and impairs the logical faculty of 
-the reader. 

The Purity of Drugs. 

Physicians may prescribe, but, after all, the 
worth of the remedies they order is determined 
by the activity of the drugs that are put 
into the bottle. We are happy to believe 
-that with the average respectable chemist their 
-patients are safe, but a slight consideration of the 
matter from the point of view of probability must con¬ 
vince the most confiding customer that now and then 
he does not get what he pays for. Nay, more, in the 
-rare instances in whioh local authorities have troubled 
to test pharmaceutical products a fair proportion of 
•oonvictions have followed under the Sale of Food and 
Drugs Acts, indeed, a more strenuous application of 
-those salutary measures is much to be desired 
in the interests of the publio. What can be 
more desirable, for instance, than the systematic 
supervision of the purity of drugs used as medicines? 
Tet in the vast majority of cases no samples are 
taken by the sanitary boards of our local authorities. 
Perhaps the new districts created by Mr. Balfour in 
-the metropolis will find time to look into this im¬ 
portant matter, and set an example to the Provinces. 
In America, the Massachusetts Board of Health 
analysed 1,380 samples of dings in the year 1896, 
and found 156, or ll - 3 per cent., impure. The per¬ 
centage of similar adulterations during the four 
years preceding was 11 per cent. Among the drugs 
implicated were spirits of nitre, rhubarb, and vinum 
ipecacuanbse. Clearly the matter is worthy of a little 
more attention on this side of the Atlantic. 

The Disinfection of Schools and Churches. 

The Medical Officer of Health of Halifax, in view 
.of a possible epidemic of small-pox, suggests that 
advantage should be taken of the holidays to disin¬ 
fect the elementary schools, and he urged that this 
measure of protection should be extended to Sunday 
schools, churches, chapels, and other places of public 
resort. This is a very valuable suggestion, and one 
that calls for adoption and imitation. As a rule the 
flooring of schools and churches, &c., is of soft 
absorbent wood, which attracts and retains dust in a 
very marked manner. When the floors are moistened 
they invariably give rise to emanations of a highly 
odoriferous character, testifying to their richness 
in organic detritus. Periodical disinfection with 
sulphur or formal would undoubtedly tend to purify 
and sweeten the atmosphere of such buildings, and 
as churches are notoriously ill-ventilated it is not ex¬ 
cessive to ask that steps may be taken to protect our 
bodies against infection while the higher part of us 
is being attended to. 

The Tomato as a Tonic. 

The tomato not only now enjoys great popularity 
as a vegetable, but quite recently experimentation 
has shown that its juice is very valuable as a blood 
tonic. During the recent Hispano-American War 
the juice of the tomato was extensively utilised for 


keeping the American troops in health, with results 
which at the time were regarded as veiy satisfactory. 
Some prejudice will probably always interfere with 
the free use of the tomato, on account of the 
fact that 6ome silly person was once audacious enough 
to say that it caused cancer. But there has never 
been one iota of evidence brought forward in support 
of this absurd notion, and the suggestion is altogether 
preposterous. On the other hand, it would be diffi¬ 
cult to find a more easily digestible, nourishing, and 
wholesome vegetable than the tomato. Moreover, 
the well-known colour and form of tomatoes adds to 
the attractiveness of culinary dishes, and when eaten 
in the raw state they are even more nourishing than 
when cooked. 


The Inebriates Aot. 

Fob some time past it has been more and more 
evident that the new Inebriates Act, from which the 
friends of temperance expected so much, has not yet 
fallen on its feet. Tt is all very well to sentence 
the police court victims of drink to so many years’ 
detention in a “ home,” but it becomes a species of 
burlesque opera sentence when no place of the kind 
exists whither they may be sent. One of the chief 
flaws in the Act, as some of its critics pointed out at 
the time of its passage through Parliament, was to 
be found in the lack of provision of proper detention. 
Before long something practical will have to be under¬ 
taken by Her Majesty’s Government in that direction. 
No doubt the step will mean the expenditure of a very 
large sum of money; but it is likely that, in the long 
run, it would not cost the country more than that of 
maintaining prisoners continually convicted under the 
present system. So far as London is concerned, the 
deadlock was last week exemplified in several cases. 
One woman could not be taken into the only available 
institution because she was not a Roman Catholic. 
One of the magistrates kept a woman in prison 
several weeks while inquiries were being made. He 
said that there were only three such homes as those 
contemplated by the Act. Two were impossible for 
the prisoner, on account of her character and reli¬ 
gion, while the third refused admission because the 
County Council would not contribute to the funds of 
the establishment. 


Sanatoria for Tuberculous Patients in 
England. 

The open-air treatment of phthisis has “caught 
on ” so much with the profession as well as with the 
public that a boom is beginning in the establishment 
of sanatoria for the purpose. One small company 
that we know of, on a small capital, is paying its 
lucky shareholders upwards of ten per cent, on the 
outlay, and there is no doubt that, under proper 
management, institutions of the kind offer good 
prospects of paying a satisfactory dividend. Now 
that the demand lias been created in this regard 
there will probably be no lack of money in order to 
meet it, on the part of the investing public. 


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May 31, 1899. NOTES ON CURRENT TOPICS. Tm« Mbdical Press. 573 


Glaise v. Christie. 

Under the title “ A Nurse’s Action for Inadequate 
Instruction,” we alluded in our last issue to a claim for 
damages based on alleged non fulfilment of contract and 
fraudulent misrepresentation brought by Miss Glaise, 
an aspirant nurse, against Dr. Christie, of Bedminster. 
We are pleased to learn that the jury, without any 
hesitation, gave a verdict in favour of the defendant. 
Indeed, in view of the evidence it would have been 
difficult for them to do otherwise. We gather from 
the later reports that the plaintiff only remained in 
Dr. Christie's cottage hospital for rather less than a 
week, and left in a huff, so that she was hardly in 
a position to affirm that the instruction was adequate 
or otherwise. While we congratulate Dr. Christie on 
the issue of the action we cannot but disapprove of any 
scheme for training nurses which is based upon a 
three months' or even six months’course. Such a 
course of training, even in a large and well-appointed 
hospital, must needs be miserably inadequate, and as 
-the public cannot be expected to enter into these 
details when engaging the services of a nurse it is 
much to be desired that the right to exercise the 
functions of a trained nurse should be restricted to 
women who have passed through a recognised and 
sufficiently protracted curriculum at a public institu¬ 
tion of adequate size. If nurses are to be certificated 
on the strength of a short and perfunctory course, 
the position of trained nurse will soon carry no more 
weight than that of the certificated masseuses who 
have been manufactured by the gross in the interests 
of individual practitioners. 

The Dundrum Dispensary Election again. 

This bone-of-contention district now awaits its 
fifth effort at the parturition of a medical officer. We 
need not recapitulate the very peculiar circumstances 
under which four election meetings of the guardians 
have been already held without result. At the last 
one we understand that the first two votes among the 
favoured candidates were taken by ballot, but the 
final vote for the successful candidate by open voting. 
The Local Government Board has decided that this 
method is illegal, although it is that which has been 
followed for the past twenty years, and has ordered 
that a new election shall be held and the whole pro¬ 
ceedings gone over de novo. 

The Meeting of the General Medical Counoil. 

The Session of the Council opens to-day, and its 
Executive Committee met yesterday to arrange 
business. The budget of the President is very 
full of important business, and it is likely that 
the meeting will extend beyond the week. Among 
the items for discussion are : the proposed increase 
in the disciplinary powers of qualifying bodies, the 
preliminary examinations, the examinations of the 
Apothecaries’ Hall of Ireland, the Medical Aid j 
Associations, the sham diplomas of the Spectacle j 
Vendors’ Guild and suchlike, and several penal | 
cases. There will also be a renewal of the protest 
against the concealment system of transacting 
the Council’s business initiated by the new President. 


If any of the larger questions in which the profes¬ 
sion is interested be settled no one will grudge the 
heavy cost of a long sitting. 

The Institute of Preventive Medicine. 

The munificent bequest of a quarter of a million 
by Lord Iveagh to the Jenner Institute has been the 
subject of an application to the Court of Chancery. 
The donor wished to appropriate the income of the 
grant to research as distinguished from treatment 
of disease, and with this intention a modification of 
the original scheme of the Institute was proposed. 
The result of the application to the Court on this 
occasion was a postponement. 

A Certificate of Sobriety. 

Not everyone charged by the police with drunken¬ 
ness is sharp enough to take the bull by the horns 
and get a medical certificate of non-ebriety. This, 
however, was what a man at Wycombe did last week 
when threatened with a prosecution, and Dr. Nichol¬ 
son, whom he consulted, was able to certify that he 
could co-ordinate his movements well, that he could 
walk a line on the square step, and could repeat sen¬ 
tences clearly. Under these circumstances, the doctor 
expressed the opinion that he was not, at the time of 
giving the certificate, drunk and incapable. Under 
these circumstances, the magistrates could hardly do 
otherwise than dismiss the case. 

Doctors at the Lowest Tender. 

Our readers are aware that the Local Govern¬ 
ment Board for Ireland has recently introduced into 
the Union drug contract system a new arrangement 
by which the Board itself fixes the standard price of 
the drugs and the contractors estimate for the supply 
by stating the discount which they will allow off the 
total of the official prices, such discount being, in 
some cases, as high as 50 per cent. It is reserved for 
the Coleraine Guardians—a canny northern Board— 
to propose to extend the same system to the doctors. 
They suggest that the Local Government Board 
shall fix the maximum in each district and that com¬ 
petitors shall tender for as much less as they will 
accept. The arrangement would be at least econo¬ 
mical, for we could offer to the Coleraine Board a few 
legally qualified practitioners who would be very 
ready to go for 75 per cent, less than the official 
price. Heaven help the unhappy and friendless sick 
poor. 

A Liverpool contemporary states that Dr. Craw- 
[ ford is about to commence legal proceedings against 
Dre. Taylor and Whitford in respect of their alle¬ 
gations concerning his conduct as Medical Officer of 
the Cancer Hospital, as well as against Truth for 
re- editing and commenting upon the same. We trust 
that this report is correct, as, in the absence of 
anything approximating a satisfactory inquiry by 
the management of that institution, the Law Courts 
afford Dr. Crawford an unexceptionable opportunity 
of clearing himself from the damning inuendoes 
which have been circulated on his character. 


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574 The Mbdical Press. 


MANCHESTER. 


Mat 31, 1899. 


The Dublin Public Health Salaries. 

We noted last week that the guardians of the 
South Dublin Union had intimated to all their public 
health officers that they must look for their salaries 
in future to the urban authority, i.e., to the Corpora¬ 
tion. We understand that the latter body has 
accepted the liability, and that in future all such 
salaries will be paid directly out of the borough fund, 
and not pass through the hands of the guardians. 

A special meeting of the Governors of the Royal 
London Orthopaedic Hospital will be held on Thurs¬ 
day, June 8th, for the purpose of considering and 
amending some of the bye-laws. With at least one 
proposal we cordially agree that no one shall be 
allowed to vote, “ who at the dat e of his election to 
the committee, shall have been a Governor of the 
hospital for a period of less than twelve months.” 
Had such a rule been in existence the scandal at a 
Liverpool hospital referred to in our last, by which 
voters were created just before the meeting, would be 
impossible. 

We regret to learn that Mr. Phillips, practising 
in Commercial Road, E., has been the victim of a 
cowardly assault, followed by robbery. He has, how¬ 
ever, the satisfaction of knowing that two, at any 
rate, of his supposed assailants, have been committed 
for trial on a charge of highway robbery with 
violence. 

Mb.Nobman Hat FoaBrs, F.R.C.8.Ed., of Tunbridge 
Wells, has been admitted to be one of Her Majesty's 
Royal Company of Archers and Bodyguard for Scotland. 

Sib Richabd Douglas Powell, Bart., has been elected 
President of the Clinical Society for the ensuing 
session, and Mr. Charters Symons, M.S., and Dr. Percy 
Kidd have been elected secretaries. 

Db. Lippmann, one of the Professors in the University 
of Vienna, has discovered a new element. Full details 
will be brought before the Vienna Academy of Science. 
The matter has aroused much interest in scientific 
circles in connection with the recent discoveries in 
England. 

We regret to learn that the health of Sir Francis 
Laking, M.D., Apothecary-in-Ordinary to Her Majesty 
the Queen and His Royal Highness the Prince of Wales, 
is in an extremely critical condition. Sympathetic 
messages from Royal patients are arriving daily at his 
riverside residence at Marlow, where he is lying seri¬ 
ously ill. 

Jtoilattb. 

[from our own correspondent.] 

Glasgow Univebsitt and its Students. — The 
students of the University are directing the attention of 
the professors to the fact that Anderson's College pro¬ 
fessors encourage their students by giving prizes both 
in books and instruments, to their successful students, 
whilst the university professors content themselves and 
ease their consciences by giving certificates of merit, and 
in a class of from 80 to ICO there may be at most two or 
three first-class certificates ; also in the matter of gold 
medals Glasgow University is far behind the Edinburgh 


University, for ev.ery one given in the former five£or 
six are given in the latter school. The Glasgow 
Univeisity students think that the professors with their 
large incomes might devote a few pounds in the pur¬ 
chase of suitable as well as useful prizes, and thus 
encourage students and show their appreciation of 
the work done as well as the interest and zeal 
of students in their classes. The final examina¬ 
tions are shortly to begin, and consequently many are the 
wailings of the likely-to-be candidates, especially as the 
wards, or certain of them, from now become hidden 
mysteries as regards the cases which they contain. This 
has become imperative, as there is always a tendency for 
laggards to suddenly assume to be very attentive in the 
wards when they are likely te be examined in the clini- 
c&ls. It is reported that this year candidates are to be 
treated to the presence of additional examiners from 
England on behalf of the General Medical Council to 
see that Scottish degrees are not too easily obtained in 
medicine. It is said of one of these assessors that after 
returning from a recent examination in surgery in Glas¬ 
gow, he reported to his Council that as far as he could see 
the cases which candidates were asked to diagnoee were- 
very simple and required no knowledge of surgery, and 
cited a case which he stated was a simple one of epithe¬ 
lioma of the lip, in which there was no credit in 
“ spotting.” The Secretary to the General Medical 
Council at once communicated with the Glasgow exami¬ 
ners asking an explanation. The reply was that the 
examiners bad carefully looked over the list of casee 
shown to students, that there was no case of epithelioma 
of the Up, but that there had been one of a hard specific 
sore of a different kind which the student had diagnosed 
correctly, and probably this was the case referred to by 
the assessor. 


$tattch£Bier. 


[from OUR OWN COBBB8PONDENT.] 


Royal Infirmary. —Much interest is being taken in 
the forthcoming election to fill the vacancies caused by 
the resignations of Professor Leech and Dr. Little. The 
candidates for the post of Assistant Physician are Dr. 
Brockbank, Dr. Kelynack, Dr. Reynolds, and Dr. Wil¬ 
liamson ; while for that of Ophthalmic Surgeon Dr. Hill 
Griffiths and Dr. Emrys Jones are applying. 

Owens College. —A course of lectures on “ Tropical 
Diseases ” is being given during the summer session by 
Dr. Graham Steell. At present no arrangements have 
been made for adequate clinical instruction in this im¬ 
portant department of medicine. 

Medical Staff Cobps. —The members of the Man¬ 
chester Volunteer Medical Staff Corpe have been having 
a busy time at Netley. Fortunately, the weather haa 
been more favourable than in the North, and full parades 
have been possible. The current number of the Owens 
College Union Magasine give a number of illustrations of 
the students* company during their Easter week under 
oanvas, and several well-known medicals are readily 
recognised. 

Lancasbibe Mill Life. —Mr. Allen Clarke, who has 
had a practical experience of the factory life of this dis¬ 
trict, in his recent work on The Effects of the Factory 
System, clearly shows that w The system is unhealthy, 
dangerous, bad for mind and morals, has an injurious 
effect cn family life, unfits woman for motherhood, and 
is causing the people of Lancashire to deteriorate.” 

Wobkhouse Nubses.— The Northern W orkhouse 
Nursery Association haa just issued its eighth *nnn>l 
report. Its objects are to promote the employment of 
trained nurses in the workhouse, and to supply trained 
women to boards of guardians. There are now forty-five- 
union hospitals employing seventy-seven nurses supplied 
by the Association. 


The Infectious Diseases Notification Act (1889) Ex¬ 
tension Bill has emerged from the committee stage in 
the Lords, and the third reading has been put down for 
June 1st. 


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Mat 31, 1899. 


CORRESPONDENCE. 


The Medcal Press. 575 


GtartBponfioict, 

We do not bold onrselrei reaponeible for tbe opinlona of eur 
correspondents. 


THE H08PITALS ABUSE ACT. 

To the Editor of The Medical Press and Circular. 

Sib,—W hy does all the boasted desire to prevent 
abuse of charities avail nothing? The answer is too 
painfully evident to those who quietly watch the mov¬ 
ing spirits with their background of selfish insincerity. 
Tee, were such not the case it would be very easy indeed 
to stop the ever-increasing evil of'certain classes of 
society to impose upon the benevolent. Take for 
instance the abuse of that charity now troubling the 
minds of the charitably disposed benefactors. I refer to 
the abuse of the hospitals. Yet, there is a large sum 
here to be stealthily melted away in Central Boards and 
Organisations. 

If the money lavished upon hospital charities is to be 
applied to the purposes for which it is intended, then all 
that is necessary is a strict economy inside the hospitals 
and a short Act of Parliament outside, thorough outlines 
of which should run: Every person applying to a hos- 

f ital for assistance shall sign a declaration form stating 
is name, address, occupation, weekly and annual income. 
Every person giving a false name or address shall be 
liable to imprisonment with or without hard labour for 
a period of not less than seven days nor longer than 
one calendar month. Every person understating his 
weekly or annual income from all sources shall 
be liable to a fine not exceeding 40s., and a further 
sum of 42s. Bhall be imposed for the eervices ob¬ 
tained in consequence of the declaration form on 
which he had declared falsely. Tbe monies derived 
from fines to goto the police courts and the fees charged 
for services rendered shall go to the funds of the hos¬ 
pital. In no case shall the suTgeon or physician benefit 
by the false declaration fines or fees for service. Every 
hospital shall appoint a sufficient number of investiga¬ 
tion officers to carefully inquire into the statements 
made upon the declaration forms, and whose duty it 
shall be to take immediate proceedings against every 
false declarant. Should any hospital fail, or refuse, or 
omit to appoint such officers it shall then become the 
duty of the Local Government Board to take such 
steps as may be necessary to appoint and attach 
to that particular hospital the officers before 
named, and to charge their salaries and ex- 

e nses upon the hospital. Should any one of 
er Majesty's subjects become aware of any case in 
which no proceedings have been taken within one week 
after the false declaration, then such one of Hex Majesty’s 
subjects may upon depositing .£10 in a police court, as 
guarantee of costs should he fail to obtain a conviction, ■ 
roceed against the false declarant as if he were the 
ospital officer, or he may take action sgainst the hos- 
dital officer for neglect of duty and recover from him the 
sum of £10 for his personal inconvenience, together with 
any proper legal expenses as between client and solicitor. 
In the event of any person requiring immediate 
attention the hospital may give that attention and 
detain the patient in hospital when necessary and 
with his consent; or in the event of the patient 
being incompetent so to decide then he may 
be detained with the consent of those lawfully 
responsible for his maintenance, and who shall be 
required to refund to the hospital a reasonable charge 
for such maintenance and eervices as may Beem fair and 
consistent, having regard to the patient’s social and 
financial position. I would suggest as a wage 
limit, say, 30s. a week for a man without depen¬ 
dents, 40s. a week for a man with dependents, and 
3s. a week for every child over the number of two. 

I would make it a serious offence for any investigation 
officer to receive bribes or to in any way suffer this Act 
to be defeated so far as hiB duties are concerned. Now, 
just for a moment, think bow many investigation officers 
would be required for one of even onr largest hospitals, 
and I believe the reader will agree with me that not 


more than two would be required after the Act had been 
in force for six months. The importance of this subject 
is so great that I feel sure you will pardon the liberty I 
have taken in thus trespassing for so long upon your 
valuable space. 

I am, sir, yours truly, 

Robert Hugh Hodgson. 

Bye Lane, Peckham, S.E. 


ON SEBUM INOCULATION. 

To the Editor of The Medical Press and Circular. 

(Without prejudice.) 

Sir, —I have just arrived in this oountry and have 
read your editorial note on my communication in your 
issue of March 15th on the above subject. Permit 
me to say that the writer of that note has entirely 
mistaken the question which I have put before the 
profession about the compulsory inoculation of cattle for 
diagnostic purposes. 1 shall, therefore, put it in a 
simpler form—namely :— 

Boehms original serum for the cure of phthisis having 
been proved to aggravate the disease, and to cause the 
deposit of new tuberculous nests in the organism, Koch 
modified the serum, which has been proved, by 
veterinary surgeons, to be a sure means of diagnosis 
in cattle. Well, granted that the modified tuber' 
culin (T.B) possesses all the properties which its 
advocates claim for it as a sure diagnostic agent, 
no fault could be found with it as employed by 
the cautious Glasgow people in caset of animals which 
exhibit tuberculous symptoms, or are otherwise ailing. 
But the question which I have before the profession is 
as to whether we are justified in inoculating all dairy cows 
which are perfectly healthy ? The question has been 
forced upon our consideration by the report of a com¬ 
mittee of experts at the Dairy Congress on Tubercu¬ 
losis in August, 1898, that “ Koch’s new tuberculin (T.B.), 
although free from the lethal properties of the original 
fluid, nevertheless contained a poison which lowered the 
heart’s action, spreads tubercles to the lymphatic glands, 
and favoured the development of specific inflammation.” 
This substance we are ordered to inject into healthy 
cattle, notwithstanding that experiments on a large scale 
have shown that 14 6 per cent, of healthy cattle become 
tuberculous the following year after inoculation. Is 
there no reason to fear that the wholesale inoculation of 
healthy cattle may produce far-reaching disastrous 
effects by poisoning our food supply ? 

In my visits to the various European educational 
centres, I shall discuss the subject with some high 
authorities. Should I find that my apprehensions are 
groundless I shall most cheerfully report it in your 
columns. 

I am Sir, yours truly, 

J. R. Wolfe, MJ). 

Hotel Metropole, London, 

May 25th, 1899. 

[Our correspondent bases his arguments on highly 
questionable data. It is precisely for the purpose of 
distinguishing between healthy and apparently healthy 
cows that tbe test is proposed, and post-mortem examina¬ 
tions have almost invariably confirmed the result 
yielded by the test. Tuberculin cannot possibly convey 
infection, though conceivably it may render existing 
lesions manifest, a result to be desired in the public 
interest.— Ed.1 


THE APPOINTMENT OF MEDICAL OFFICERS' 
TO THE BRADFORD WORKHOUSE. 

To the Editor of The Medical Press and Circular. 

Sir, —The communication of Dr. Crowley and Mr. J. B. 
Hall, which appears in your issue of the 24th inst., anenfr 
the above question is a puerile plea in justification of 
their action. The Bradford Guardians’ action is not 
original. They are merely following the example 
of Manchester and Birmingham. In discussing 
the two appointments they must be taken sepa^ 


oogle 


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576 The Medical Press. 


LITERATURE 


Mat 31, 1899. 


rately, in order that they may be viewed in 
their proper light. Dr. Crowley has been ap¬ 
pointed Medical Officer to the workhouse. He is the 
only officer that the Local Government Board will recog¬ 
nise, and he is responsible for the medical supervision of 
the whole institution. Mr. J. B. Hall has practically no 
locus standi at the workhouse so far as the Local Govern¬ 
ment Board is concerned, although the Guardians may 
say otherwise. He is merely an assistant visiting 
Medical Officer. The previous Medical Officer to 
the workhouse was in receipt of a salary of .£120 
per annum. Dr. Crowley has acoepted the appoint¬ 
ment at i?l 50 per annum, and his responsibility 
and duties are no less than those of the previous 
medical officer, although the Guardians have furnished 
him with more assistants. It is not often we find the 
assistant medical officers in receipt of a salary equal to 
that of the principal medical officer. The Guardians, in 
making these appointments, gave as their explanation 
for doing so that they intended to provide the workhouse 
patients with the best possible medical attendance ; also 
that they intended to make the workhouse infir¬ 
mary resemble, in every respect, a general infirmary. 
The Guardians say that their visiting medical officers are 
not to receive a salary but an honorarium. They are 
afraid to call a spade a spade. Now if these appoint¬ 
ments are honorary the guardians have practically in¬ 
troduced medical charity into their workhouse infir¬ 
mary. If the appointment of medical officers is not 
honorary, and it can claim no such appellation, it has 
been accepted at a salary which is far from adequate, 
and is not in consonance with the responsibility attached 
to such an office. The Bradford and West Riding Medi¬ 
cal Union has made much of the arbitrary manner in 
which the guardians have made these appointments, and 
in doing so it has lost sight of the groat principle at 
stake, namely, the introduction of medical charity into 
the Poor law service. 

I trust that the Medical Press an d Circular will give 
space for the discussion of this question. I may say that 
two contemporary journals have adopted a biased atti¬ 
tude which almost amounts to bigotry in refusing to 
open their columns for the discussion of an abuse which 
may have far-reaching consequences. 

I am, Sir, yours truly. 

May 25tb, 1899. H. B. S. 


Xaboratorg ^otcs. 


“ S. N. ” STOUT. 

It is nearly a quarter of a century since we first 
examined this article, and found it what the brewers 
claimed, a pure beer and pleasant to the palate. The 
methods of manufacture in this, as in most articles of 
commerce, have varied considerably during the interval, 
and we approached the analysis after so long a period 
with some curiosity. On examining present samples of 
the “ S. N.” stout (Waltham Brothers, Stockwell), our 
analysis gave the following results:—The specific 
gravity at 155 degrees Centigrade was 1025 (water 
= 1,600). The amount of alcohol was equal to 
4'8 per cent, of absolute alcohol by weight (=10*54 
per cent, proof spirit by volume). The total 
solid residue, dried at 100 degrees Centigrade, 
amounted to 7'7 per cent., and this, on ignition, 
yielded an amount of ash equal to 0.3 per cent, on the 
original sample, testifying to the absence of an exces¬ 
sive amount of salt. The acidity was determined by 
trituration with a standard alkali solution, and was 
equivalent to 03 per cent, as acetic acid. With these 
data before us we are enabled to affirm that “ S. N.” 
stout is. as formerly, a well-made pure article, eminently 
adapted for the use of those who, from taste or for 
therapeutical reasons, require a stimulant of this class, 
the proportion of alcohol is moderate, its keeping quali¬ 
ties are good, and it may safely be recommended for 
general use. 


JCiicraiur*. 

THE LUMLEIAN LECTURES, (a) 

The author commences with perhaps the most diffi¬ 
cult part of his task, namely, the treatment of cardio¬ 
vascular neuroses, or functional affections of the heart-, 
which he aptly defines as “an increased sensibility and 
disordered action of the heart not dependent on struc¬ 
tural change.” These, as he po.nts out, prove, as a rule, 
very refractory to treatment, more especially cases of 
tachycardia, and in their management reliance should 
be placed less in drugs than in the removal of all possible 
sources of reflex irritation. The use and abuse of 
digitalis and of baths and exercises, are judiciously and 
ably discussed, and an interesting table is given of 
fourteen cases of infective endocarditis, collected from 
various sources which have been treated by anti-strepto- 
ooccus serum. Unfortunately, the results are not as 
favourable as one could wish, though there were three 
recoveries, which is a better proportion than can be 
claimed for other methods of treatment. 

For the better understanding of neurosis of the heart, 
two coloured illustrations are given, showing diagram- 
matically the innervation of the heart. 

Those who have already heard or read these lectures 
will be glad to have them published in a handy little 
volume for future reference, and by those who have not, 
they will repay perusal. 


BOLLINGER’S PATHOLOGICAL ANATOMY, (i) 

There are few departments in medical science of 
which it is so difficult for the student and practitioner 
to acquire a sound and comprehensive knowledge as 
morbid anatomy, and there are also few subjects so diffi¬ 
cult to illustrate satisfactorily. We Accordingly consider 
that the medical profession is much indebted to the pub¬ 
lishers for these volumes, which are issued simul¬ 
taneously in England, America and Germany. Though 
there are already atlases of great excellence in 
the field, their high price, in some cases, practically 
prohibitive, prevents their general use. In the present 
instance, however, this objection does not apply. At a 
moderate price, we might say at a remarkably low price, 
an admirable series of coloured plates, with accompanying 
text is supplied, so that no practitioner or student can 
now complain of such prohibition. These volumes con¬ 
tain, in all, 132 coloured figures and 35 drawings in the 
text. These include all the common diseases both of 
the organs usually examined and also of the genital 
organs, bones, joints, &c. There are included, in 
addition, conditions more rarely met with, such as 
acute yellow atrophy of the liver, toxic enteritis 
and nephritis, &c. The ground covered is thus exten¬ 
sive, and after going carefully over all the plates we 
can say that there are very few indeed which are not 
good, while most are excellent. And it seems to us that 
the excellence is most marked in the case of the lesions 
of rarer occurrence, and in the case of the organs of 
which the morbid changes are most difficult to repro¬ 
duce. In connection with the latter remark, we might 
refer to the kidneys and the nervous Bystem. It may be 
stated with confidence that, in view of the price of the 
book, the work of repioduction is of remarkable excel¬ 
lence. 

It is sometimes Faid that it is impossible to illustrate, 
even approximately, all the morbid lesions which may 
occur. This is no doubt true, but each one engaged in 
routine pathological work unconsciously acquires a 
number of mental type-pictureR, by means of which he 
judges of, and interprets, any pathological changes he 
may meet with. We do not, of course, suggest that such 


(a) “ Treatment in Diseases and Disorders of the Heart,’* being 
the Lumleian Lectures. By Sir Richard Douglas Powell, Bart., 
M.D., F.R.C.P. London : H. K. Lewis. Price 16e. 

(b) “ Atlas and Essentials of Pathological Anatomy." By Profeesor 
O. Bollinger. Two Vols., crown 4t0. JPlice 12s. 6d. each. London > 
Bailliere, Tindall and Cox. 1899. 


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Mat 31, 1899. _ MEDICAL NEWS. The Medical Pares. 577 


works as Bollinger’s “Pathological Anatomy” should 
supplant actual observation in the post-mortem room, 
but we consider that to students and others who have 
not such extended experience, this work will be of great 
service in supplying “ type-pictures,” and have, therefore, 
an important practical function. 

In addition to the illustrations, which naturally con¬ 
stitute the most important part of the work, there Is also 
given in the aooompanying text an aooount of the morbid 
anatomy of all the systems. This—the work of an 
acknowledged master of this department of pathology— 
is succinctly and sensibly written, while his judgement 
on subjects which are still matters of dispute is, in our 
opinion, reliable, and, on the whole, correct. 
It is also comprehensive—in fact, we have failed 
to find any subject of importance omitted. There 
is only one point, aid oie of miror importance, 
to which exception might be taken—viz., the extensive 
use of classical or scholastio terms in describing lesions 
—as this tends in some cases to make the student 
regard as separate diseases what are merely one process 
modified by accidental circumstances. Though it is 
only right to state that in most cases the simple English 
equivalent is also given, still we think the subject 
would be simplified if their use were in great part 
discarded. 

We have great pleasure in cordially recommending 
the volumes to students and practitioners of medicine. 




Work of ths Malaria Commission. 

Da. Patrick Manson, Chief Medical Adviser to the 
Colonial office, stated last week that Dr. C. W. Daniels, 
of the Colonial Medical Service, British Guiana, who had 
been making investigations in India, had now arrived at 
Blantyre, in the Central African Protectorate, where he 
bad joined the other members of the Commission 
appointed to investigate the mode of dissemination of 
malaria. Private letters which had reached him from 
Dr. Daniels, which were accompanied by specimens, con¬ 
firmed the theories which had been advanced by Surgeon- 
Major Ross, of the Indian Medical Service, to the effect 
that the parasites of biids, analogous to the parasites of 
human malaria, were transferred by mosquitoes, which 
were the active agents in the propagation of malaria. 

Dental Hospital of London. 

In their recently issued annual report the committee 
of the Dental Hospital in Leicester Square draw special 
attention to the condition of the building fund of that 
institution. To place this fund in a satisfactory position 
they urge it is important that a sum of .£3,000 Bhould be 
raised for the present year, and they make an appeal to 
the friends of the hospital for renewed efforts to attain 
this object. The conveyance of the land having been 
settled, the Charity Commissioners have granted their 
order for proceeding with the work. Last year the 
number of operations performed was 68,298, as against 
62,512 in 1897. 

The Chalfont Epilepsy Colony. 


in addition to many of the leading manufacturing drug* 
gists and all the principal medical publishers. Neverthe 
less, there were many tasteful and artistic exhibits, sucb 
as those of Messrs. Down Brothers, Messrs. Maw, Son and 
Thompson, the Anglo-Swiss Milk Company, Messrs. 
Parke, Davis, and Co., Brand and Co, Cooper and Co., and 
the Kronihal Water Company. During the afternoon 
and evenings of the four days during which the exhibi¬ 
tion was open, the proceedings were enlivened by some 
excellent vocal and instrumental music, to listen to 
which there was usually a large gathering of ladies and 
gentlemen sitting in the balcony seats of the hall. 
Altogether about eighty-five exhibitors took part in the 
show. 

Ths Inebriates Acts Amendment Bill has been blocked 
by Mr. Pickeregill, who will oppose further progress 
until means have been provided for putting into opera¬ 
tion the Inebriates Act, 1898. It is admitted on all* 
hands that the present condition of things, in virtue- 
whereof a person condemned to detention is set at 
liberty on account of the lack of accommodation, is- 
scandalous. The Government do not appear to be alive 
to the discredit attached to recent legislation by the- 
abeence of this very necessary complement of the pro¬ 
visions. 

An Ointment Woman. 

An inquest at Lambeth last week revealed to the un¬ 
initiated the existence of a female quack who practises in* 
the neighbourhood of Brixton: Her speciality appears- 
to be the preparations of ointments which are reputed 
to be specifics for pretty well all the ills that flesh is- 
heir to, from ulcers to bronchitis, and croup to whooping 
cough. She vaingloriously boasted of treating “thou¬ 
sands” of patients a week though she is only assisted by 
her daughter. As her ointment could not be Bhswn to- 
have been in any way responsible for the death of her 
patient, who succumbed to tetanus, she escaped with an 
admonition from the coroner, but if her statements are 
oorrect the only thing she lacks, to be a successful prac¬ 
titioner, is a licence from the Society of Apothecaries. 


PASS LISTS. 


Royal College of Surgeon*. Edinburgh- 
Ths following gentlemen having passed the requisite- 
examinations, were, on the 16th inst., duly elected ordi¬ 
nary Fellows of the College:— 

John Basil Hall, MJLC.S.Eng., L.B.C.P.Lond., do.; Charles 
William Donald, M.B.C.M.. Edward William Soott Carmichael,. 
M.B.C.H.: Robert Black Purree, M.B.C.M.; John Harley Gough, 
M-K.C.S.Eng., L.B.C.P.Lond.; Jas. Wilson McBrearty, LJ1.C.8.E.; 
Wyndham Anstruther Milligan, M.B.C.M.; Henry John Forbes 
Simeon, M.B.O.M., and Charles Benjamin Boesiter, L.B.C.S.E. 

Royal College of Burgeons in Ireland.—Dental Examination. 

The following gentleman, having passed the necessary 
examination, has been admitted a Licentiate in Dental - 
Surgery of the College:—Mr. W. F. Crosse. 

Tne following gentlemen have passed the primary' 
part of the examinations for the Licence in Dental Snr— 
gery Mr. A. L. Harrison, Mr. D. L. Rogers, Mr. J. R. 
Small, Mr. G. M. Sterling, and Mr. G. N. Tate. 


The Duke and Duchess of York will, on Thursday, 
June 22nd, visit Chalfont St. Peter, to open four new 
homes at the colony established there by the National 
Society for Employment of Epileptics, of which bis 
Royal Highness is president. These homes comprise 
two for children, one for men, and one for cases requir¬ 
ing special care and treatment, and they will in the 
aggregate increase the existing accommodation of the 
colony by nearly 100 beds. The cost of building has 
been defrayed by special donations, given respectively 
by Mr. Passmore Edwards, Mr. Frederick Greene, and 
Mrs. Dearmer. 

Tie Medical, Surgical, and Hygienic Exhibition. 

The annual Medical, Surgical, and Hygienic Exhibition 
which was held in the Qneen’s Hall last week was on a 
smaller scale than last year, several well-known caterers 
for the medical public being conspicuous ly their absence, 


At the M.B. Examinations held during May the follow¬ 
ing candidates passed:— 

Fir ft Division. 


A nderton. William Bury} 
Carter. Arthur H nton I 
Clopg, Herbert Bberwellj 

Second 

Beit, Francis Victor Owen 
Bergin, William Marmaduke 
Bishop, Charles Thompson 
Burrows, Harold 
( ann, Francis John Hughtrede 
Clapham, Lucy Beatrice 
Clarke, Arthui Ernest 
Davies, David 
Dixon. Robert Halstead 
Fox, Herewald Eveln. Croker 
Goode, Henry Norman 
Go ling, Chas. Buck man, B.Sc. 


| Edmonds, Agnes Ssrrh, B.A. 

| Greenwood, Frank Redmajne- 


Division. 

Gunlher, Hermann Arthur 
Harding, Henry William 
Knowlton, Alexander John 
Maclnnes, Janet Waldegrave 
Marriage. Herbert James 
Miller, George Valentine 
Sayer, Ettle 
Watts, Eliza Turner 
Wilmot, Philip McKinnell C 
Wise. Ho* ara Edward 
Woodbridge, Elliot Wilson 


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578 Thi Medical Pbbm 


NOTICES TO CORRESPONDENTS. 


Mat 31, 1890. 


Notices to 

(fforrcopoitbeirto, Short &r. 

Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctivi signatwr* or 
initials, and avoid the practice of signing themselves '* Header,” 
“Subscriber,” "Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

Reprints.— Author* of papers requiring reprints in pamphlet 
form after they have appeared in these columns can have them, at 
half the usual;oost, on application to the printers before the type is 
.broken up. 

ECONOMY AD. HOUINUM. 

The Listowel Guardians have refused the requisition of the 
medical officers, backed by the recommendation of the Local 
Government Board, that competent midwives should be appointed 
to the districts. While excusing this refusal of help for the sick 
poor on the ground of economy, their next business was to peas, for 
the second time, a resolution in favour of free luncheons for them¬ 
selves at the expense of the ratepayers, to which proposal the Local 
Government Board has, most properly refused its sanction. 

Dm. Gillbb d* la Tourettx’s Clinical Lecture on “Convulsive 
Twitching” has been received from our French correspondent. 

THE 8ABBATABIAN MONOMANIAC. 

Thx “ Lord's Day ” 8ociety sued, last week, at the Stoke Sessions 
no less than eleven shopkeepers for the offence of 8unday trading. 
The trading consisted in putting some drops in aching teeth, which 
seem to be frequent about that neighbourhood. The Magistrate 
fined the delinquents one farthing each. If he could have sent the 
rosecutors for a couple of hours to the stocks it would be what they 
eserved. 

Dr. H.- The correspondence is far too voluminous for us to be 
able to deal with it as you suggest. Moreover, the matter is one 
that csfis for investigation at the hands of disinterested persons in ! 
a position to gauge the merits. We shall not lose sight of your | 
contention. 

K. B.—We thank you for the newspaper cutting. De minimis : 
non curs l lex. There is, however, a principle Involved, and this, 
divested of its provincial appurtenances, we snail discuss at the first 
opportunity. 

A LUCID EXPLANATION. 

A provincial visitor to Lille on the occasion of the opening of the 
Pasteur Institute in that town, expressed surprise that the Ministers 
.of Agriculture and of the Colonies should have been chosen to pre¬ 
side over the function. It was pointed out to him that they were 
obviously the 'most appropriate officers Of the State in this connec¬ 
tion, seeing that the work of the Institute was so largely concerned 
with “ cultures ” and “ colonies.” 

Dr. J. H.—Good or bad the Notification Act is law, and it is our 
duty to give it our support. Its administration may sometimes 
challenge criticism, but the principle of notification, has, we imagine, 
passed beyond the stage of adverse comment. We have, therefore, 
referred your communication to the W. P. B. 


JEeetmQB of the Societies mb lectures. 

Thursday, Junk 1st. 

British Balneological and Climatological Societt (20 Hanover 
•Square. W.). —3.90 p.m. General Meeting. Election of Officers and 
Council for the year 1809. 4 p.m. Ordinary Meeting. Dr. I. 
Murray : Scarborough as a Health Resort in Phthisis.—Dr. Shirley- 
■ Jones: Treatment of Neuralgia by the Droitwich Brine Baths. 

Central London Throat, Nosb, and Ear Hospital (Gray’s Inn 
Hoad, W.C.).-5 p.m. Dr. D. Grant: Diagnosis and Treatment of 
Nerve Deafness. 

Friday, Junr 2nd. 

Childhood Society (Library of the Sanitary Institute, 72, Mar¬ 
garet Street, W.j.-Sp.m. Discussion on the Education of Children 
Feebly Gifted Mentally under the Care of Guardians (opened by Dr. 
G. E. Shuttleworth). 

West London Medico-Chiburgical Society (West London 
Hospital, Hammersmith, W.).—8.30 p.m. Clinical Evening. Cases 
will be showu by Mr. C. B. Keetley, Dr. L. Dobson, Mr. B. Lake, 
Mr. L. A. Bidwell, Mr. McAdam Eccles, and others. 

Lakymgological Society or London (20 Hanover Square, W.). 
— 5 p.m. Cases and Specimens will be shown by Dr. Permewan, 
Dr. St.Clair Thomson, Dr. J. Horne, Dr. 8. Spicer, Dr. H. Tilley, 
Dr. W. Hill, Mr. de Santi, Mr. R. Lake, and others. 

Monday, June 5th. 

Odontolooical Society of Great Britain.—8 p.m.—Annual 
General Meeting. President’s Valedictory Address. Paper by 
Mr. Kenneth Goadby on “Microorganisms of Dental Caries." 
Casual communications by Mr. P. Preedy, Mr. E. Bartlett, and 
Mr. H. Albert. 


Baranoes. 

Bath.—Eastern Dispensary.—Resident Medical Officer. Salary £130 
a year, with furnished apartments, coals, gas, and attendance. 
Applications to Colonel Eyre, Rockville, Lansdown, Bath. 
Borough of Hove, Sussex.—Medical Officer of Health and Medical 


Offiosr for the Ho*pital for Infectious Diseases. Salary, £450 
a year, rising £25 annually to £550. Applications to the Town 
Clerk, Town Hall, Brighton. 

Cardiff Union. Assistant Medical Officer for the Workhouse. 
Salary £100 per annum, with rations apartments, attendance 
and washing. Applications to the Clerk, Queen's Chambers, 
Cardiff. 

Harris Parish Council.—Medical Officer and Public Yaocinator far 
the Southern Division. 8alary £90; other emoluments. Appli¬ 
cations to Mr. Thoe. Wilson, Solicitor, Lochmaddy, N.B. 

Holloway Sanatorium.—Virginia Water. —Senior Assistant Medical 
Officer. Salary commencing at £300 per annum, with board, 
lodging, and washing. 

Metropolitan Asylums Board.—Assistant Medical Officer at the 
South-Eastern Fever Hospital, ‘New Cross, 8.E. Salary com¬ 
mencing at £100, with board, lodging, attendance, and washing. 
Applications to the Clerk to the Board, Norfolk Street, Strand. 

School Board for London.—Medical Officer for the training-ship 
Skattesburv, lying off Grays. Essex. Commencing salary £100 a 
year. Applications to the Clerk, School Board Offices, victoria 
Embankment, London. 

Staffordshire General Infirmary, Stafford. House Surgeon. Salary 
£100 per annum, with board, lodging, and washing. 

West Norfolk and Lynn Hospital, King's Lynn.— House Surgeon. 
Salary commencing at £80 per annum, with board, Ac. 

West Riding Asylum, Wadsley, near Sheffield.—Fifth Assistant 
Medical Officer. Salary commencing at £100 per annum, with 
board, Ac. 

West Riding Asylum, Wakefield.—Fourth Assistant Modic&l Officer. 
Salary commencing at £100 per annum, with furnished apart¬ 
ments, board, washing, and attendance. 


Appointments. 

Brro&D, W. F.. L.RC.P.Lond., M.R.C.S., Medical Officer for the 
No. 1 Sanitary District at.the Ruthin Union. 

Csowlet, Ralph, H„ M.D.Lond., M.B.C.P., M.B.C.S., Workhouse 
Medical Officer and Visiting Physician to the Hospital, by the 
Bradford Board of Guardiaua. 

Davet, 8.. M.R.C.S., L.R.C.P., D.P.H.Lond., Medical Officer of 
Health to the Urban 'District Council of Cater ham. 

Fbathbrbtonb, O. W. B., L.B.C.P.Lond., M R.C.8., Medical Officer 
for the Radnorshire Sanitary District of the Hay Union. 

Godwin, F. J., KB.'GA, L.B.C.P., House Surgeon to the In¬ 
firmary; Burton-on-Trent. 

Haweihs-Ambler, G. A., F.B.C.S.Edin., Assistant-Surgeon to the 
Liverpool Stanley Hospital. 

Jaceson, THoe., M.D.Edin., M.R.C.S., Medical Officer for the First 
Division of the Grey stoke Sanitary District, Penrith Union. 

Kirepateice, T. Percy C., M.D., Anesthetist and Clinical Regis¬ 
trar to Dr. Steevens* Hospital, Dublin. 

Malins, H., M.B., C.M.Edin., Assistant Medical Officer at the 
Infirmary. Parish of 8t. Marylebons, London. 

Mathew, C. P., L.R.C.P.Lond., M.R.C.S., Medical Officer for the 
Tregony Sanitary District of the Truro Union. 

Bead, B. T., L.R.C.P.Lond., M.R.C.8., Medical Officer for the 
Odiham Sanitary District of the Hartley Wlntney Union. 

Bussell. J., M.B., C.M.Aberd., Assistant Honorary Physician, 
North Staffordshire Infirmary. 

Stone, F. W LJR.C.P., L.B.C.8.IreL, Medical Officer for the 
Bflton Sanitary District of the Warmley Out relief Union. 

Todd, G. D., L.B.C.P.Edin., M.B.C.8 , Medical Officer for the 8elby 
Sanitary District audths Workhouse of the Selby Union. 

Ward Edward, M.B., B.C., M.B.C.S., Professor of Surgery in the 
Yorkshire College Department of Medicine. 

Yonoe, Eugene S., M.D., Honorary Assistant Physician to the 
Manchester Hospital for Consumption and Diseases of the 
Throat. 


girths. 

Murray.— On May 24th, at 110, Harley Street, London, the wife of 
John Murray, F.R.C.S.. of a ton. 

Scon.—On May 25th. at 3. Southgate Road, Winchester, the wife of 
T. W. Soott, M.B., of a son. 


^Karrtagee. 

Mitchell—Nickels.— On May 20th, at Christ Church, Woburn 
Square, Bloomsbury, London, James E. H. Mitchell, M.R.C.S. 
(Eng.), L.B.C.P. (Lond ), Ac., of Middlewich, youngest eon of 
the late Timothy Mitchell, of Eightlands, Dewsbury, to Maria 
Lois, youngest daughter of the late Samuel Nickels, of Sunder¬ 
land, and formerly of Fowey. 


deaths. 

Askwith.— On Tiny 27th, at the Vicarage, Taunton, Marion, widow 
of Robert Askwith, M.D., late of Cheltenham, aged 75. 

Batsman.- On May 19th, at Albion Park, New South Wales, Arthur 
Wigley Bateman, K.A.Oxon., L.B.C.P, and L.B.C.S.Edin., of 
Kibworth, Leicestershire, aged 54. 

Miller.— On May 24th, at Bath, Harriot, widow of the late A. B. 
Miller, M.D., M.B.C P.Edin., daughter of the late Wm. Mor¬ 
gan, of Ravensdale, Kildare. 

Mackenzie. - On May 17th, suddenly, John William Harris 
Mackenzie, M.R.C.S., at Daisy Bank, Cheadle, Staffordshire, 
aged 75. 

Spencer.— On May 17th, at C&seytown, Tavistock, Herl-ort Spencer, 
M.R.C.S., late of Bradford, Yorkshire, aged 06 years. 


Digitized by v^ooQie 







June 7, 1899 


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“ SALU8 POPULI SUPREMA LEX.* 

Vol. CXYIII. WEDNESDAY, JUNE 7, 1899. No. 23. 


(Original Communications. 

HEY’S INTERNAL DERANGEMENT OF 
THE KNEE-JOINT, (a) 

By JOHN KNOTT, M.D., Ch.B. (Univ. Dub.) 

In the volume of “ Practical Observations in 
Surgery,” published by Mr. Hey, of Leeds, is included 
a paper “ On Internal Derangement of the Knee- 
joint, which contains the original description of the 
very peculiar lesion to which the name of this distin¬ 
guished surgeon has since been attached. It is given 
in the following words :—“ This joint is not unfre- 
quently attended with an internal derangement of its 
component parts, and that sometimes in consequence 
of trifling accidents. The disease is, indeed, now and 
then removed, as suddenly as it is produced, by the 
natural motions of the joint without surgical assist¬ 
ance ; but it may remain for weeks or months, and 
will then become a serious misfortune, as it causes a 
considerable degree of lameness. . . . This disorder 
may happen with or without contusion. In the 
former the symptoms are equivocal till the effect s of 
the contusion are removed. When no contusion has 
happened, or the effects of it are removed the joint 
with respect to its shape, appears to be uninjured. If 
there is any difference from its usual appearance, it 
is that the ligament of the patella appears more re¬ 
laxed than in the sound limb. The leg is readily 
bent or extended by the hands of the surgeon, and 
without pain to the patient; at most the degree of 
uneasiness caused by this flexion or extension is 
trifling. But the patient himself cannot freely bend 
nor perfectly extend the limb in walking; he is com¬ 
pelled to walk with an invariable and small degree of 
flexion. Though the patient is obliged to keep the 
leg thus stiff in walking, yet in sitting down the 
affected joint will move like the other. 

‘‘The complaint which I have described may be 
brought on, I apprehend, by any such alteration in 
the state of the joint as will prevent the condyles of 
the os femoris from moving truly in the hollow 
formed by the semilunar cartilages and articular 
depressions of the tibia. An unequal tension of the 
lateral or cross ligaments of the joint, or some slight 
derangement of the semilunar cartilages may pro¬ 
bably be sufficient to bring on the complaint. When 
the disorder is the effect of contusion, it is most 
likely that the lateral ligament on one side of the 
joint may be rendered somewhat more rigid than 
usual, and hereby prevent that equable motion of 
the condyleB of the os femoris which is necessary for 
walking with firmness.” 

Such are the words of the earliest notice of this 
peculiar lesion which we possess, and such is the 
uncertainty as to the accurate diagnosis in which the 
original deecriber has left his readers, and, so far as we 
can see, was obliged to remain himself. 

Sir Benjamin Brodie notices Hey’s observations, 
and says that the symptoms very much resemble 
those produced by a loose cartilage within the joint,” 
but his views of the actual nature of the existing 
condition seem even more indefinite than those of 

(at Head in the Surtrical Section of the Boyal Academy of Medi¬ 
cine in Ireland, April 7th, 1809. 


the latter writer; and he states further on, in refer¬ 
ence to a case which had occurred in his own practice, 
that “ the facts which I am about to state are not 
very easy to be reconciled, either with this hypothesis 
or with that suggested by Mr. Hey.” 

When a veiy junior surgeon I ventured to publish 
my views on this obscure affection. They were based 
upon personal experience of symptoms and signs, and 
on careful anatomical investigation. The lapse of 
time has but served to confirm them, and as they do 
not seem to have indoctrinated the present generation 
of surgical authorities so completely as I could have 
wished, I have determined to submit them once more 
to the examination of my professional brethren. 
Many, at least, of the surgical apostles of the 
present day appear to have made up their minds to 
a very decided view of the actual state of things in 
Hey’s internal derangement of the knee-joint; and, 
without much more conclusive evidence to go upon 
than that which was then possessed by the distin¬ 
guished surgeons whose names I have mentioned, 
unhesitatingly inform their readers or hearers, 
as the case may be, that the symptoms are 
due to a luxation of one of the semilunar 
fibro-cartilages which are interposed between the car¬ 
tilaginous surfaces in the femoro tibial articulation. 

Before proceeding further with my subject I will 
mention that I understand by the term Hey's Internal 
Derangement of the Knee-Joint, an abnormal con¬ 
dition suddenly resulting from the application of 
external violence, and as suddenly reducible by appro¬ 
priate manipulation. 

In the tenth edition of Erichsen’s “Surgery, 1 ' 
edited by Messrs. Marcus Beck and Raymond John¬ 
son, will be found the words of this high authority 
thus written:— 

“ Subluxation of the Knee, Displacement of a 
Semilunar Cartilage, or, as it was termed by Hey, 
internal derangement of the knee-joint, is a common 
and very troublesome accident. It usually occurs 
whilst the knee is slightly flexed aDd the leg rotated 
inwards or outwards.’ Instances of the causation are 
given “ Rising from a kneeling position, or kicking 
a football (the limb affected being that upon which 
the patient is standing), or by striking the toe against 
a stone in walking. 

“ In many cases a distinct fulness can be recog¬ 
nised on one side of the ligamentum patella) in the 
hollow between the tibia and the femur, and there is 
tenderness at the same spot. In the course of a 
short time, in most cases, the joint becomes distended 
by inflammatory effusion. 

“ This accident has been the subject of much in¬ 
vestigation since it was first described by Hey. It 
has long been recognised that it is due to a displace¬ 
ment of one of the semilunar cartilages.” 

In the “ System of Surgery,” edited by Mr. Treves, 
p. 1015 of Vol. I. has the running title of “Displace¬ 
ment of Semi-lunar Cartilage,” calling attention to a 
section the opening of which on this page bears the 
title, “ Subluxation of the Knee, Internal Derange¬ 
ment of the Knee, Dislocation of the Semilunar Car¬ 
tilage.” The writer (Mr. A. Marmaduke Shields) 
proceeds to inform us that: “ Under this heading is 
described a peculiar condition of the knee-joint, 
whioh almost invariably iB associated with a wrench, 



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580 The Medical Pbess. ORIGINAL COMMUNICATIONS. June 7, 1899. 


sprain, or other injury, and which is characterised by 
a sudden sensation of the joint being “ put out ”; 
some fixation and impediment to the movements of 
the limb, more or less pain, and, lastly, by the 
functions of the articulation being suddenly and 
properly restored by an appropriate manipulation. 

Causation and Pathology. — The accident is 
usually produced by a twist of the leg, when the 
knee-joint is flexed and the tibia is fixed, the body 
and femur being suddenly rotated on the tibia. . . . 
swinging the body to make a stroke at golf, or in the 
rotation which occurs in stepping out of a dogcart. 
(Treves.) . . . . “In practice, the internal carti¬ 
lage will be found to be most generally displaced. 
This occurs in violent external rotation, principally 
performed by the biceps. . . . The gap between 
the internal condyle and the tibia is, however, 
increased, and the movable internal cartilage is apt 
to slip between the internal condyle and tne inner 
tuberosity of the tibia. . . . Godlee has argued 
from anatomical considerations that the external 
cartilage is more frequently displaced. Clinical 
experience points, however, undoubtedly to the 
greater frequency of the displacement of the internal 
cartilage.” 

When a student engaged in preparing for my first 
surgical examination, it was considered very necessary 
for every candidate to know the special views of one 
member of the board before which we, unfledged 
aspirants were obliged to present ourselves. His 
explanation of the greater frequency of “ derange¬ 
ment*' of the internal cartilage was its intimate 
adhesion to the corresponding lateral ligament, by 
which it was dragged out of its position when the 
leg was wrenched outward with sufficient force. How 
the cartilage in question could be so dragged out of 
the joint without having its cornual attachments 
torn remained the ineta- physical part of the problem. 

Mr. Herbert W. Allingham in his exhaustive mono¬ 
graph on “ Internal Derangements of the Knee-joint,” 
gives the following account of displacement of the 
semilunar fibro-cartilages:— 

“When rotation outwards takes place, the gap 
between the internal condyle of the femur and the 
head of the tibia will be found to be increased; and 
the internal semilunar cartilage is more movable, and 
consequently is apt to slip too far in between the 
condyle of the femur and the corresponding head of 
the tibia. 

“ A parallel state of affairs results when the tibia is 
rotated inwards, for then the gap between the ex¬ 
ternal femoral condyle and the head of the tibia is 
increased, and then the external cartilage is more 
movable. 

“ When the knee is flexed, the anterior pari 
■ f the internal semilunar cartilage glides back¬ 
wards on the head of the tibia; if the leg be then 
rotated outwards, the internal semilunar cartilage 
will be drawn in between the internal condyle of the 
femur and the head of the tibia. Sudden movement 
of extension will then cause the internal condyle to 
roll on to too much of the internal semilunar cartil¬ 
age. Now, as extension is always combined with 
external rotation of the tibia, the inner tuberosities 
of the latter must make a sweeping movement for¬ 
wards and outwards. The internal cartilage will be 
held by the femoral condyle, and as the tibia makes 
its curve forwards and outwards the coronary liga¬ 
ments will be stretched, or even torn. This, doubt¬ 
less, is what occur8 iD aggravated cases, and when 
the accident has recurred frequently. The converse 
applies to displacements of the external semilunar 
cartilage. In the milder forms there may be only a 
stretching and relaxed condition of the coronary 
ligaments, but when once thus relaxed they are always 
in danger of being further stretched or even ruptured. 


“ There are some conditions which predispose to 
these derangements. 

“ A lax condition of the ligaments about the joint 
caused by general debility or previous synovitis, pre¬ 
disposes to these accidents on account of the insecure 
way in which the femur and tibia are then bound 
together. Prolonged flexion of the knee-joint, as in 
kneeling, strains the anterior part of the coronary 
ligaments, and renders possible a liability to these 
disorders.” 

Our courteous secretary, Mr. John Lentaigne, 
called my attention to the October issue of the Annals 
of Surgery, in which there is an elaborate paper on 
the “ Cause and Treatment of the Subluxation of the 
Semilunar Cartilages of the Knee-joint.” by Newton 
M. Shaffer, M.D., in which the author believes that 
he has established the following “ facts ” :— 

“(1) In many cases of Hey’s joint there is an 
acquired or, perhaps, congenital lateral mobility of 
the knee-joint. This condition existing, the normal 
rotation of the tibia in flexion or extension of the 
knee is greatly increased. 

“ (2) In many cases, if not in all cases, there exists 
an elongated ligamentum patelhe, which so modifies 
the action of the quadriceps extensor muscle upon 
the tibia that the force of its contraction upon the 
tibia is modified or delayed in such a way that exten¬ 
sion and rotation are not synchronously performed. 
And it seems more than probable that this condition 
forms an important factor in the production of the 
subluxation of the semilunar cartilage.” 

And again, the author quotes Allingham’s state¬ 
ments : “ The injury is caused by some sudden and 
almost involuntary movement. Most of the muscles 
governing the joint are then thrown off their guard, 
or fail to act in concert one with the other.” 

Dr. Shaffer then proceeds to say : “ But I do not 
agree with Mr. Allingham when he says ‘ All this may 
occur even in a healthy joint,’ if for healthy we sub¬ 
stitute ‘ normal,’ except under circumstances where 
great lateral pressure is applied, and when a true 
subluxation of the tibia occurs as a result of direct 
violence. In these cases there existed a condition 
which I have attempted to describe, and which 
directly favoured the subluxation. And further, the 
muscles are not ‘off their guard.’ The quadriceps 
acts promptly ; but the patella, instead of clamping 
the femur with a normal length of ligament in the 
trochlea, is tilted upward at the lower end, and the 
muscular effort is so delayed that the movable semi¬ 
lunar cartilage is caught, perhaps only slightly 
pinched, or really dislocated, and sometimes seriously 
damaged.” 

In nearly all the above quoted descriptions of this 
lesion there appears to be a tacit assumption that one 
of the semilunar fibro-cartilages has been displaced. 
Too intimately associated with this unproved assump¬ 
tion is a positively inexplicable haziness in the minds 
of the respective writers regarding the actual struc¬ 
ture of the knee-joint. 

To examine the validity of the grounds for such a 
conclusion is my chief object in making this com¬ 
munication. To do so satisfactorily it will be neces¬ 
sary to call attention to some of the more prominent 
features in the mechanism of the knee-joint, and to 
notice more especially the connections of the fibro- 
cartilages, which concern us so intimately in this 
lesion. 

The upper end of the tibia presents an extensive 
surface, bearing two articular facets separated by a 
rough non-cartilaginous interval, whicn runs in an 
antero-posterior direction, and is chiefly destined for 
ligamentous attachment. Of these facets the internal 
is the larger and of somewhat oval shape, with the 
long axis passing from before backwards; it is also 
somewhat more hollow than the other, although the 


June 7, 1899. ORIGINAL COMMUNICATIONS. The Medical Press. 581 


amount of depression on either side is but slight, and, 
in the recent state, is still further diminished by the 
greater thickness of the articular cartilage in the 
central part. The outer facet approaches the circular 
form. 

The inferior extremity of the femur presents two 
articular facets which are, respectively, more exten¬ 
sive than the corresponding ones on the head of the 
tibia on which they rest. The deep intercondyloid 
notch separates the two condyles, of which the inter¬ 
nal is prolonged downwards considerably further than 
the external—a disposition of parts which determines 
the internal obliquity of the shaft of the femur, and 
the formation of an angle salient inwards at the inner 
aspect of the knee-joint. 

It is obvious that the very shallow depressions on 
the upper end of the tibia can afford no security for 
the condyles of the femur during the various 
movements of the joint. The glenoid cavities for the 
reception of these articular prominences are, accord¬ 
ingly, almost solely formed by the semilunar carti¬ 
lages. Each of the latter structures presents three 
surfaces—a superior, which is markedly concave; an 
inferior, nearly flat; and an external, forming the 
prominent rim, which is connected with the fibrous 
structures surrounding the joint. This rim, in a well 
formed adult knee, is of considerable thickness. 

At the inner (concave) side the cartilage thins down 
to an irregularly festooned edge. On examination of 
the mutual relation of these fibro-cartilages, we find 
that the external forms almost a complete circle, while 
the internal forms a C-shaped curve, elongated from 
before backwards, and of which the extremities em¬ 
brace those of the outer cartilage. These extremities 
(cornua ) are extremely strong, and bind the carti¬ 
lages with great firmness to the non-articular portions 
of the osseous surface, while the circumferential 
aspects of the cartilages are bound—rather loosely— 
to the corresponding margins of the head of the tibia 
by the so-called “ coronary ” ligaments. The other 
surfaces are covered with synovial membrane, and 
glide smoothly—the upper on the cartilaginous sur¬ 
face of the corresponding femoral condyle, the lower 
on the head of the tibia. “ The fore part of each is 
less fixed than the hinder, so that it may be free to 
follow up the condyles as the latter recede from the 
front of the tibia in flexion, and be pressed back again 
into its place in extension ” (Humphry). In the case 
of the external cartilage the posterior cornu has an 
accessory attachment to the femur, which accom¬ 
panies the posterior crucial ligament (cornu postici 
adhiesio jyrimo of Weitbrecht, liaamentum cruciatum 
tertium of Robert. This femoral adhesion causes the 
cartilage to follow, in a limited degree, the movements 
of the lower end of the thigh bone; and its nearly 
circular outline, with the greater looseness of its 
coronary attachments, and the fact that it does not, 
like the internal semilunar fibro-cartilage, adhere 
intimately to the corresponding lateral ligament of 
the joint, all combine to give to the external of these 
cartilages a greater degree of mobility than is per¬ 
mitted to the internal. 

The more obvious movements of the knee-joint are 
those of flexion and extension—characteristic of the 
ginglymus articulation, of which it forms an imper¬ 
fect type. In addition to these, the knee possesses, 
when moderately flexed, a rotatory movement, 
which, as shown by the brothers Weber, may 
attain a range of 39 degs. in the normal joint. The 
vertical axis around which these movements take 
place passes through the head of tibia at the inner 
side of the spine. The use of the greater mobility 
of the outer cartilage is obvious in this condition; for 
if it were absolutely fixed to the head of the tibia, 
any considerable rotatory movement of the latter 
bone would inevitably throw the external femoral 


condyle out of its articular cavity. Slight lateral 
movements of the passive variety may also be demon¬ 
strated in the knee-joint when the leg is semi-flexed. 
In this position, the ligaments being relaxed, external 
pressure will produce movement of the tibia to either 
side; the latter bone gliding, to a very limited 
extent, of course, upon the articular facets of the 
femoral condyles. 

With regard to the more ordinary movements of 
the knee, an interesting anatomical fact has been 
demonstrated by Tillaux. This anatomist pointed 
out that a vertical antero-posterior section tnrough 
one of the condyles is not limited at the lower end 
by an arc of a circle, as formerly represented; the 
cartilaginous surface represents two arcs—one ante¬ 
rior and the other posterior, belonging to circles of 
different radii, and separated by a portion of a very 
flattened ellipse. The mechanical result of this 
arrangement is that in flexion of the knee there is, 
at first, rotation round an anterior axis; towards the 
middle of the movement, a combination of rotation 
and gliding; which is, in turn, replaced by a purely 
rotating movement towards the end of the act of 
flexion. The axis, around which the movements of 
flexion and extension take place, passes through the 
femoral condyles at the level of the attachment of the 
lateral ligaments of the joint. 

An even moderately careful scrutiny of the re¬ 
corded observations of “ internal derangement of the 
knee-joint ” will show that the writers on this sub¬ 
ject have included, under the same denomination, 
two distinct varieties of surgical lesion—one in which 
the displacement is supposed to have affected the 
semilunar cartilage only ; the other in which, besides 
the “ derangement ” of the cartilage there is also a 
change established in the normal relations of the 
articular surfaces of the femur and tibia ; or, in other 
words, an incomplete dislocation of the leg. 

Some cases of the former class would appear to 
have been unaccompanied by prominences or any 
other outward and visible sign of the existing internal 
derangement. This would appear to have been 
re tty much the case in some of the instances observed 
y Hey himself. A good case of the typical “ in¬ 
ternal derangement ” nas been recorded by Bonnet 
(de Lyon): “ A very active man, set. 45, twisted 
his knee in making a movement of external rotation. 
I saw him two days after the accident; no physical 
derangement could be detected in the knee; there 
was merely a small amount of serous effusion into 
the synovial cavity. The patient could walk only 
with extreme pain, he suffered much, and could 
extend his leg upon the thigh but in a very incom¬ 
plete manner. This disproportion between the 
impairment of motion, wnicn was earned to an 
extreme degree, and the inflammation, which was 
but slight, made me think that a luxation of the 
semilunar cartilage had probably taken place. I 
then flexed the knee as much as possible ; this flexion 
was painful. Having done this a first time I ex¬ 
tended the leg, and flexed again. This manoeuvre 
was followed by immediate relief ; the patient was 
able to walk with less pain, and to extend the leg 
upon the thigh completely. The inflammation 
rapidly subsided.” 

Very valuable evidence with regard to the nature 
and mechanism of this lesion was obtained by the 
same surgeon from the results of experiments per¬ 
formed on the dead body. On the cadaver of an 
adult male who had succumbed to a chronic malady, 
Bonnet found that by flexing the leg to form a right 
angle with the thigh, as the body lay in the prone 
position, and suddenly rotating the foot outwards, a 
peculiar snap was felt, after which the limb remained 
in the position of external rotation, with the leg flexed 
upon tne thigh at an angle of about 45 degs. At the 




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ORIGINAL COMMUNICATIONS. 


Juki 7, 1899. 


a ntero-internal aspect of the knee-joint a prominence 
°ould be felt corresponding to the inner tuberosity of 
^he tibia; this prominence projected in front of the 
inner condyle of the femur; the head of the femur 
was carried backwards and inwards. The rota¬ 
tion of the leg, measured by the deviation of the 
foot, amounted to nearly a quarter of a circle. Upon 
extending the leg (for -which a slight effort was found 
necessary) the snapping sendhtion was again felt, and 
the normal relation of the articular surfaces was re¬ 
established. Subsequent dissection of the knee showed 
no displacement of the inter-articular structures, 
and no appreciable laceration of either ligament or 
muscles. In the next experiment he removed the 
patella; and, repeating the movements already 
described, he watched the.'effect on the inter-articular 
structures. The snapping sensation was then found 
to be produced bv the passage of the inner condyle of 
the femur behind the semilunar cartilage, which was, 
accordingly, pushed forwards on the internal glenoid 
cavity of the tibia, but without any laceration of the 
internal lateral, or capsular ligament of the joint. On 
the outer side, the condyle had undergone no con¬ 
siderable displacement; it was carried a little for¬ 
wards from its normal position, but still lay in the 
glenoid cavity formed by the external semilunar 
cartilage. On extension of the limb, with a little 
effort, this peculiar disarrangement was at once recti¬ 
fied. The experiment was frequently repeated, and 
always with similar results. 

Cases have been observed in the living body which 
correspond very closely indeed with the facts above 
recorded as observed by Bonnet on the cadaver. But 
none of these “ derangements ” can properly be 
regarded as a luxation of the semilunar cartilage; 
they are incomplete rotatory dislocations of the leg 
itself. 

The possibility of such a displacement cannot be 
doubted by those who are familiar with the normal 
internal arrangement of the structures of the knee- 
joint, and the author of the present communication 
can add to the evidence already published on this 
subject a description of the accident as it has 
repeatedly occurred in his own person. 

(To be continued .) 


garis Clinical lectures. 

ON 

THE INTOXICATION OF ADDISON’S 
DISEASE. 

Delivered at the Laennec Hospital. 

Bt Dr. CHAUFFARD, 

Protenor Agrege at the Medical Faculty of Paria; Phyaioian to 
the Paris Hospitals. 

The theory of Addison’s disease, still a matter of 
controversy, is based on two fundamental principles. 
One, the result of clinical observation and due to 
Addison, is the existence of a special cachexy, accom¬ 
panied by profound asthenia and pigmentation of 
the skin and mucous membranes, and characterised 
by more or less degeneration of the suprarenal cap¬ 
sules. The other, deduced from experiments and 
formulated by Browning, that the suprarenal cap¬ 
sules form an organ indispensable to life, the total 
loss whereof is rapidly followed by death. 

The problem, thus clearly defined, seemed on the 
way to a satisfactory solution, when the new nervous 
theory was brought forward, according to which the 
cause of the affection is to be sought in a lesion of 
the abdominal portion of the sympathetic nervous 
system and the solar plexus. Addison’s disease may 


be induced, it is asserted, not only by lesions of the 
pericapsular sympathetic system, but also by lesions 
of the solar plexuB, as in the case reported by Ray¬ 
mond, where generalised lymphadenoma was found to 
exist in association with integrity of the suprarenal 
capsules and sclerosis of the solar plexus, compris¬ 
ing the whole ganglionic mass. Tne same is true 
with regard to lesions of the semilunar ganglia, as is 
shown by a case of Brault and Perruchet’s, in which 
a tuberculous mass was found attached to the right 
semilunar ganglion, without apparent lesion of the 
capsules. 

The partisans of the suprarenal theory replied by a 
new and remarkable series of experimental researches, 
having for object to strengthen and confirm clinical 
experience. These experiments, carefully carried out 


their blood shows a special and peculiar toxicity. 
Moreover, the preservation of a small portion of the 
suprarenal parenchyma suffices to neutralise the 
intoxication, and insures their survival. 

These toxins, due to suprarenal inadequacy, exist, 
however, not only in the blood, but also in the muscles, 
whence they may be extracted by means of alcohol, 
and they are physiologically identical with the toxic 
substances elaborated in the muscles of an animal 
in normal condition, when subjected to an excessive 
amount of work. An animal without adrenals, at the 
least exertion, shows signs of rapid and persistent 
fatigue, which does not disappear even after a long 
period of rest. 

Finally, the paralysis which attacks animals whose 
suprarenal capsules have been removed appears to be 
principally due to changes affecting the terminations 
of the motor-nerves, the muscleB themselves being 
but slightly interfered with. We have, therefore, to 
do with a veritable curare-poison. This is a point of 
great importance, seeing that the experimental proof 
of the antitoxic action of the suprarenal capsules on the 
waste-matter of muscular disassimilation furnishes 
the explanation of one of the fundamental symptoms 
of the bronzed cachexy, the so-called Addisonian 
asthenia. 

These experiments, however, only prove two things, 
viz, the rapid auto-intoxication of the organism after 
destruction of the suprarenal glands, and the curare¬ 
like nature of the toxm thus produced or retained for 
want of elimination. Neither the pigmentation of 
the skin and mucous membranes nor the character¬ 
istic gastric troubles of Addison’s disease have ever 
been reproduced by experimentation. 

That, however, is not to be wondered at, seeing 
that ablation of the suprarenal capsules is of necessity 
a coarse measure, too sweeping in its effects and 
incapable of the delicate physiological disassociation 
that characterises the lesions produoed in a slow and 
progressive manner by Addison’s disease. The 
stmptoms as a whole certainly point to an intoxica¬ 
tion. Two cases which hare recently come under 
my observation seem to me very significant in this 
respect. 

One of these was an Italian, fifty years of age, 
whom some of you doubtless saw in my ward at tne 
Broussais Hospital on two separate occasions. He is 
a typical specimen of Addisonian cachexy, without 
other morbid antecedents than a slight attack of 
occupation lead poisoning, A year ago he developed 
a sudden and persistent distaste for foods of all kinds, 
accompanied by vomiting of alimentary or bilious 
matter. He had lost both weight and strength. He 
complained of pain in the lumbar, abdominal, and 
epigastric regions; the characteristic pigmentation 
had invaded the labial, lingual, and bucco-genial 
mucous membranes, as well as the integuments 
covering the face nipples, gluteal furrow, scrotum and 
penis, front of the patella, and dorsal aspect of both 


Digitized by booQ le 


Junk 7, 1899. 


ORIGINAL COMMUNICATIONS. 


Thi Medical Press. 58311 


hands. The only visceral lesion was a slight degree of 
induration of the apex of the left lung. The urine 
was normal. Twice this man was admitted to the 
hospital in a very prostrate condition, suffering from 
a fully developed crisis of gastric intolerance and 
throwing up what little he was able to swallow. On 
both occasions these distressing symptoms subsided 
rapidly with no other treatment than rest, and our 
man was anxious to leave, in the belief that he was 
cured of his ailments and able to resume work. 
Could there be a more striking example of progres¬ 
sive auto-intoxication under the influence of muscular 
fatigue and bad hygienic conditions, showing a con¬ 
stant tendency to disappear in the early stage of the 
disease, as soon as the necessary repose has permitted 
the elimination of the accumulated toxin ? 

The second case, from my private practice, exem¬ 
plifies very well the rapidly fatal course sometimes 
following Addison’s disease. A lady, set. 35, of 
strumous diathesis and delicate from childhood, was 
said to have suffered for several years from nausea 
and attacks of retching, resulting in the ejection 
of a little frothy or viscid matter. In December, 
1892, she consulted one of our most celebrated 
dermatologists, with whom she had been acquainted 
for a long time; but a thorough examination revealed 
no trace or any special pigmentation. She passed the 
winter at Cannes, where she began to rapidly lose 
flesh, and, with the gradual disappearance of her 
strength her skin began to change colour and became 
pigmented. She ultimately developed complete and 
obstinate anorexia. _ 

Late in February, 1893, she returned to Paris, and 
came to consult me. I found typical Addisonian 
pigmentation, with the usual series of localisations 
on the mucous membranes of the mouth, tips of the 
breasts, integuments of the face, and uncovered por¬ 
tions of the body, patellar regions, and nails. The 
face was thin and hollow, the eyes sunken, with black 
rings; the expression was drawn and suffering, 
indicating complete exhaustion of the vital force. 
There was no pain but the appetite was completely 
lost. Motion of any kind produced nausea ; rising, 
taking a few steps, or making a slight exertion were 
sufficient to induce angor, extreme malaise, and 
exhausting retching. 

I decided to try hypodermic injections of supra¬ 
renal juice, but little or no benefit resulted to the 
patient from these injections. The patient dragged 
on until April 7th, when death finally ensued, the 
vital energy slowly fading away without being 
affected either by injections of ether or caffeine, or 
by nutritive or aqueous enemata. The toxin of 
Addison’s disease, in this case, not only exhibited all 
the characteristics of curare, but acted also as a 
poison to the myocardium and the cardiac termina¬ 
tions of the pneumogastric nerves, producing 
paralytic tachycardia. 

The idea of the all-important roh of auto-intoxica¬ 
tion in Addison’s disease must not be pushed too far, 
and it cannot be invoked in explanation of, or as 
furnishing sufficient cause for, all the symptomatic 
phenomena. Though I firmly believe in its existence 
m this disease, I also believe that it alone is not 
at the bottom of all the lesions; and the most pro¬ 
minent link, from a clinical point of view, in the 
symptomatological chain, the pigmentation of the 
skin and mucous membranes, is assuredly not of 
toxic nature. In this connection Alezais and Arnaud’s 
researches and discoveries are to be appreciated at 
their full value, showing us, as they do, that the 
suprarenal lesions alone are not capable of producing 
melanoderma. Something more is needed for this, 
namely, the participation in the morbid process of 
the periglandular capsule, and particularly of the 
small sympathetic nerve-ganglia comprised is the 


fibrous structure of the latter. And, moreover, it 
must be remembered that this part of the sympathetic 
apparatus is far from being the only one, the morbid 
condition of which may influence the chromatogenous 
action of the skin. The experiments of Raymond and 
of Brault and Perruchet show clearly that any irri¬ 
tating, and sufficiently intense, lesion of the solar 
plexus or semi-lunar ganglia may result in pigmenta¬ 
tion of the skin and mucous membranes. 

The physiological mechanism of this process is as 
yet rather difficult to determine. Raymond has ad¬ 
vanced an ingenious theory, according to which the 
human skin normally contains feebly pigmentary 
elements, subject in a certain measure to nervous 
influence in the same manner as the chromatoblasts 
of certain animals are under the immediate direction 
of a special innervation. The Addisonian pigmenta¬ 
tion is then due to dystrophic disturbance in the 
chromatogenous apparatus of the skin, depending 
upon an irritative lesion of the peri-suprarenal or 
semi lunar ganglia, or of the solar plexus. 

Be that as it may, we are constrained to consider 
Addison’s disease as a syndroma implying, in typical 
cases, a double lesion : the almost total destruction 
of the suprarenal glands, and irritation, by compres¬ 
sion or sclerosis, of the neighbouring sympathetic 
ganglia. As a rale, the extension of a caseous infil¬ 
tration of the capsules is liable to produce both these 
lesions. At the same time, either of them may exist 
alone, a circumstance which explains the occurrence 
of double capsular tuberculosis without accompany¬ 
ing melanoderma, and inversely, sympathetic lesions 
and melanoderma without degeneration, of the 
capsules. 

It is this idea which I think must henceforth be 
our guide in clinical and anatomical researches, so as 
to distinctly separate, in the symptomatology of the 
disease, all that is directly due to the glandular lesion 
from that which merely points to accessory implica¬ 
tion of the sympathetic system, and to distinguish 
the complete symptomatic manifestation of Addison’s 
disease from abortive and atypical cases, in which 
only one of the pathogenetic processes is at work. 

To attempt to explain in this way all the abnormal 
oases already published would undoubtedly be a 
difficult undertaking; but it must be remembered 
that the reports are not conceived in a catholic spirit, 
and that each author has been bent upon explaining 
his particular case in accordance with the patho¬ 
genetic theory, to which he gives his preference. 
And it is evident that neither the nervous theory, 
nor the theory of capsular insufficiency alone is able 
to explain all the cases recorded without straining the 
facts. The negative cases, and the so-called contra¬ 
dictory symptoms, only prove the narrowness and 
inadequacy of our pathogenetic conceptions. The 
two theories actually discussed are not at all incom¬ 
patible ; on the contrary, they mutually complete each 
other. To determine the exact relationship existing 
between the symptoms of a toxic nature and those of 
sympathetic origin seems to me to be a most worthy 
object of our endeavours in this direction. And for 
this purpose, clinical observation must go hand in 
hand with experimental physiology. The road to 
success is clearly and unmistakably pointed out to 
us ; all we have to do is to follow it. 


Mb. N. W. Hubbabd, chairman of the Asylums 
Committee of the London County Council, opened a 
new asylum at Horton, near Epsom, on Saturday 
last. Accommodation is provided for 700 patients. 
Dr. F. Bryan has been appointed medical superin¬ 
tendent with Dr. Lewis as his assistant. 

D 


oogle 


584 The Medical Pbesb. 


ORIGINAL COMMUNICATIONS. 


June 7, 1899. 


MALIGNANT DISEASE OF THE 
UTERUS: 

ITS DIAGNOSIS AND TREATMENT, (a) 

By FREDERICK HOLME WIGGIN, M D„ 

Burgeon to St. Elisabeth’s Hospital; Gynecologist to the New 
York City Hospital; President of the New Yerk County Medical 
Association. 

At the present time 7 per cent, of all deaths 
occurring in women over 45 years of age are caused 
by cancerous disease, and of these a very large pro¬ 
portion commence either in the neck or body of the 
uterus. Even at the present time the disease fre¬ 
quently runs its course during the patient's life. 
These facts and a few others will suffice to show that 
there is no subject of greater interest to the general 
practitioner and gynaecologist at the present than 
that of malignant disease of the uterus and its early 
diagnosis, for on this depends our patient’s chance 
of permanent relief from her dreadful malady. 

The results which have hitherto been achieved by 
the gynsBcic surgeon in the radical operations per¬ 
formed for the relief of sufferers from the disease 
which we are considering, while often followed by a 
low rate of mortality, have not been brilliant, when 
the recurrence of the disease is taken into considera¬ 
tion, for according to Thorne, hardly 30 per cent, of 
patients upon whom vaginal hysterectomy has been 
performed for malignant disease of the uterus, and 
who have survived the operation, remained well 
at the end of five years. This poor and discouraging 
result, he attributes (and the writer believes justly) 
to the fact that 70 per cent, of patients suffering 
from this disease, who present themselves to the 
surgeon for examination and treatment, do so in the 
later stages of the disorder, instead of in the earlier, 
as they should. The responsibility for this failure to 
recognise the disease durmgthe earlier months of its 
invasion rests largely upon the general practitioner 
into whose hands these patients usually come first, 
and who seems to be largely imbued with the popular 
idea that all sorts of menstrual irregularities may 
occur during the laot years of a woman’s child-bear¬ 
ing period of life, without being of serious import, 
unless accompanied by a story of pain, foul vaginal 
discharge ana evident cachexia, forgetting that, as 
Baldwin has recently pointed out, these last are the 
“ symptoms, not of incipient, but of inoperable 
disease.” 

Williams, in a recent article on cancer, says that at 
the present time there are probably eight thousand 
women in England and Wales who are suffering from 
malignant uterine disease; while in the State of New 
York alone, during theyear 1898, there were reported 
to the State Board of Health, 4,456 deaths as having 
occurred from cancerous diseases, a large proporti 
of which were undoubtedly those of tne won 
These statements of the common occurrence of 
the disease, coupled by the fact which is borne out 
by the writer’s experience both in hospital and 
private practice, that only a very small proportion of 
cases reach the surgeon at a time really favourable 
for operation, vis., oefore the disease has extended 
beyond the organ where it originated—must be his 
excuse for caning your attention to a brief review 
of what is already well known of this dreadful dis¬ 
order, in the hope that further discussion of the sub¬ 
ject may, by Dringing out individual views and 
experiences, throw more light than we have hitherto 
had on malignant uterine disease in its earlier stages. 

As is well known, cancer is a disease which 
ori ginates in the epithelial structures. At the present 
time, though doubt still exists as to its etiology, the 


(a) Paper read before the New York County Medical A raociatioa. 
May 9th, 1899. Author’s MS. 


recent work of 8anfelico, Roncali, Bra, Bose, 
Gussenbauer, and others, make it seem most 
probable that the time is at hand when the 
micro-organic origin of cancer, will be fully demon¬ 
strated and accepted as a fact. Among the chief 
indirect causes of the disease, may be enumerated 
heredity, locality, age, trauma, and infection caused 
by the following child bearing. A fair proportion of 
all who suffer from malignant uterine disease, as do 
those suffering from other forms of the malady, give 
a family history of cancer, showing that heredity 
plays a part by producing a predisposition to the 
disease. Location of residence is a factor of import¬ 
ance, as there are districts in which the disease is 
unusually prevalent, notably as stated by Park, in 
Bath, England, whose health officer recently reported 
that in his district there were 50 per cent, more cases 
than in neighbouring ones. Luckau, in Germany, 
where seventy-three deaths from cancer occurred in 
twenty-three years, within an area comprised 
by two or three City squares, four deaths 
occurring in one house. The same writer also 
calls attention to the unusual prevalence of the 
disease in the districts immediately surrounding 
Buffalo, N. Y. Age is an important factor in the 
development of the disorder, for while it may occur 
at or during almost any period of life, it is most 
likely to make its appearance between the thirtieth 
and fiftieth year, but more commonly during the 
latter half of this period. 

Women who have borne large numbers of children 
are more subject to it than are nullipara. This fact 
is clearly shown in a study made by Mullins, and 
published in the Australian Gazette for January, 
1897, of 585 cases of females who had died in 
New South Wales of cancerous disease, 202 
of whom had uterine cancer; of these 17 were 
sterile and two were single females, while the 
remaining 183 had been married and had given birth 
on an average to five children each. The other 
factors which enter prominently into the causation 
of the disease are cervical lacerations and neglected 
endometritis. The cervix is much more frequently 
attacked by the disease than is the body of the 
uterus, some observers placing the ratio as high as 
50 to 1, but the writer believes that the uterine body 
is more often the seat of the disease than is supposed 
to be the case. Malignant disease, when located in 
the lower segment of the uterus, makes its appearance 
more frequently before the occurrence of tne meno¬ 
pause than after it, and it is most likely to occur in 
those who have borne many children, and who, as 
previously stated, belong to the lower classes of 
society; while the disease in its corporeal form 
generally begins after the occurrence of the meno¬ 
pause, and in those women who have not conceived. 
The most common form of the disorder is adenocarci¬ 
noma, but occasionally it is of the sarcomatous 
variety, when it runs its course with great rapidity. 
Unfortunately the disease is frequently ushered in 
with few or no symptoms to attract the attention of 
the patient, or of her physician, to the fact that she 
is suffering from a serious disorder. 

But, as a rule, the disease manifests itself by the 
following constitutional symptoms. A general feel¬ 
ing of discomfort, loss of energy, anorexia, and an 
ill-defined sense of fulness and uneasy sensations 
referred to the lumbar, sacral and genital regions, 
accompanied with more or less marked increase of 
vaginal secretion or leucorrhcea. If this discharge is 
examined, it will be found to be less viscid, and more 
watery than it usually is. If the patient is a woman 
between 30 and 45 years of age ana has borne several 
children, a digital examination of the cervix will 
reveal the fact that it is enlarged and indurated and 
possibly slightly nodular. If we inspect it by means 


Jons 7, 1899. 


ORIGINAL COMMUNICATIONS 


The Medical Pbkss. 585 


of a speculum we will find that on one or other side 
of a deeply lacerated oervix there is either a little hard 
nodule or an elevated area of mucous membrane, 
redder in colour than normal, and tending to bleed 
freely when touched. The disease at this early 
stage of its existence simulates very closely 
simple erosion of the cervix, but it is well to 
bear in mind that an eroded surface is smooth and 
velvety to the touch, has not infiltrated edges, and 
that on its surface the curette makes little impres¬ 
sion. Any condition of this sort, however, that does 
not yield readily to ordinary treatment and tends to 
spread, should be regarded with more than suspicion, 
and the diseased tissue at once removed. It can 
then be examined microscopically and the exact 
nature of the disease can then be determined. 

Some years since, the writer had a doubtful case 
under observation, one in which the disease was con¬ 
fined to the cervix, but not wishing to subject the 
patient to an unnecessary operation, a portion of the 
diseased tissue was removed and sent to a patholo¬ 
gist for diagnostic purposes. In about ten days an 
answer was received that the disease was malignant 
in its nature, and preparations were made to proceed 
with the removal of the uterus, when it was found 
that during the interval which had elapsed, the 
disease had made rapid progress. The case being no 
longer a favourable one for operation, the body of the 
uterus and the vaginal wall having become involved 
in the destructive process. Hence it has been the 
writer’s custom of recent years to first remove all 
tissue of a doubtful character and have it examined 
afterwards. 

The early stage of cervical cancer, it should be 
remembered is rather favourable to the occurrence of 
pregnancy, and also that when this condition co¬ 
exists, the malignant disease makes rapid headway. 
At a later stage of cancer of the cervix, we will 
find on inspection either a series of warty growths 
which are friable and bleed easily, or that a deep 
uloer with raised friable edges exists. At this stage, 
microscopical examinations of the diseased tissue is 
not needed to settle the diagnosis, and the patient 
begins to complain of haemorrhage following coitus, 
of metrostaxis, menorrhagia, metrorrhagia, and escape 
from the vagina of foul smelling watery discharges, 
more or less tinged with blood, accompanied by pain. 
The sooner, under these conditions, the uterus is 
extirpated, the better will be the patient’s chances, 
not only for immediate recovery from the operation, 
but for freedom from recurrence of the disease for at 
least three years, which as has been said, is the true 
test of the success of the operation. 

When a patient who is between 45 and 50 years of 
age, or older, and who has never conceived, calls our 
attention to the fact that a few months after the 
cessation of her menstrual flow she has begun to fail 
in health, has also developed a profuse watery leu- 
corrhceal discharge, and that her flow has recurred, 
a bi-manual examination of the uterus should be 
made, and will probably reveal the following con¬ 
ditions—viz., that the body of the uterus is enlarged 
and tender, and possibly nodular, that the external 
and internal os are both patulous. Such a patient 
ehould without delay be placed under the influence 
of an anaesthetic agent, and the cervical canal dilated 
and the uterine cavity explored. If the trouble is 
found not to be due to fibromata, the uterus should be 
removed, and the histological examination of the 
tissues made after this has been done, rather than 
before, as is usually the case. The curettage and 
delay incidental to this procedure before operation 
favouring the rapid progression of the disease, if it is 
of a malignant cnaracter. 

It has been well said that the best treatment that a 
woman suffering from a carcinoma of the uterus can 
receive at the hands of her physician is the early 


recognition of her condition, when the removal of 
the diseased organ should follow, and a cure be 
effected. 

Attention has already been called to the fact that 
by far the largest proportion of cases that reach the 
surgeon do so after the disease has progressed too far 
to give a reasonable hope that the patient will be 
benefited by a radical operation. These patients can 
however, still have much done to relieve their dis¬ 
tressing condition by placing them under the 
influence of an anaesthetic agent, and removing as 
much as possible of the diseased tissue. After this 
has been done the haemorrhage, which is often free, 
can be controlled by packing the cavity with pledgets 
of cotton wet in a solution of antipyrin, or, better 
still, with hydrozone, the pledgets being removed 
after a little while, and if the haemorrhage continues 
the cavity should again be packed with similar 
pledgets,and it is rare that this procedure has to be 
followed more than three times. If the flow of blood 
continues after the third packing has been removed 
the cavity is once more to be packed, and the 
pledgets allowed to remain in place for twenty-four 
hours. The haemorrhage having been controlled, the 
packing 'is removed, and the parts are thoroughly 
irrigated. The vagina and vulva should next be well 
anointed with a salve composed of one part of 
sodium bicarbonate and three parts of vaseline. The 
nterine cavity is then packed with small pieces of 
cotton wrung out in a solution of chloride of zinc, 
which should vary in strength from 50 to 100 per 
cent., according to the thickness of the remaining 
uterine tissue. Any excess of this solution must be 
rapidly removed with sponges, and the vagina should 
be filled with cotton soaked in a saturated solution 
of bicarbonate of sodium, Forty-eight hours 
later all this packing is to be removed, and 
the parts again irrigated. This treatment, which 
has been described by Penrose, has been followed 
for the past two or three years by the writer, both in 
hospital and private practice, with much benefit to 
his patients. The haemorrhage is controlled, the 
offensive discharge disappears for a considerable time, 
and the patient bein£ relieved in a large measure, of 
her sepsis, improves in appearance and gains rapidly 
in weight. Lucas-Cha mpionifere advises the use in 
these cases of carbide of calcium, and gives the follow¬ 
ing technique for its application:—The vagina is first 
irrigated and then a small piece of the carbide is to 
be placed against the ulcerated surface. Bubbles 
soon appear showing that acetylene gas is being gene¬ 
rated. The vagina is now to be carefully packed 
with iodoform gauze. This is to prevent the irritant 
effects of the products of decomposition of the carbide 
of calcium on the mucosa of the vagina and 
vulva. The packing should be allowed to remain in 

? lace for three or four days and then is to be removed. 

'he parts should then be irrigated and all crusts 
removed. This procedure can be repeated at inter¬ 
vals of from two to six weeks as needs be. The claim 
made for it is that it stops haemorrhage, thoroughly 
suppresses odour, and relieves pain in a large pro¬ 
portion of the cases so treated. 

In conclusion, let me call your attention again to 
the fact that pain in these cases is an unreliable 
symptom, only occurring late in the disease except 
in certain cases, where the patient complains 
that she suffers from attacks of agonising 
cramp, like pains which recur during the latter 
part of each afternoon. Such a symptom when 
present in an elderly woman, is almost patho¬ 
gnomonic of cancer of the uterine body and is due 
to pent up secretions in that organ. Haemorrhage is 
a constant symptom, but of the later stages of the 
disease, as is also the foul smelling vaginal discharge. 
Do not wait for a patient to tell you of this concate¬ 
nation of symptoms before you think of a possi- 


Digitized by VjUVJ 




586 The Medical Pbbss. TRANSACTIONS OF SOCIETIES. June 7, 1899. 


bility of malignant uterine disease. The acceptance 
as an axiom of the statement that an increased flow 
of blood occurring before, at, or after the menopause 
is always due to an abnormality and needs careful 
investigation, as to its cause, would undoubtedly 
save innumerable lives. Let me call your atten¬ 
tion to the fact that no form of malignant disease 
is so amenable to operative treatment, or promises 
more brilliant results than does that of malignant 
disease, provided only that the disorder is recognised, 
and the operation is performed while the morbid 
process is confined wholly to that organ, or, in other 
words, during the earlier stages of the disease, or 
before its advent, I would also have you bear in mind 
the fact that even when the disease is not recognised 
till it has passed the stage favourable for an effort 
to bring about a cure of the patient by extirpation 
of the diseased organ, that much can still be done 
in the way of palliative treatment, which will not 
only render the remainder of the patient’s life more 
bearable to berself and her friends, but will aotually 
prolong it. 

Our patients should be taught to return to us for 
examination within three months after confinement, 
and when uterine abnormalities are found they should 
be eradicated by operative means without delay. 
Patients should be further taught that the period of 
life between forty and fifty, which usually includes 
the menopause, is one of danger, and that during 
this period they should be more or less under the 
supervision of their physician, and on our part we 
should be more careful to examine locally all those 
. who have reached this period of life, who complain 
of failing health, increased leucorrhoeal discharge, and 
the slightest menstrual irregularities tending to an 
increased loss of blood. In cases of doubt our patients 
should be given the benefit of it, by submitting them 
at once to operation, while there is yet time and hope 
that the disease may be permanently removed. 

And, finally, while we nave good ground for believ¬ 
ing that at a day near at hand, tne micro-organic 
origin of cancer and its infectious nature will be 
fully established, and that once the life-history of the 
germ is known, we shall be able largely to prevent 
the occurrence of the disease, we must for the pre¬ 
sent base our hope of permanently benefiting a 
greater number of our patients suffering from this 
fearful trouble, not upon improved operative tech¬ 
nique, but upon an earlier recognition of the existence 
of the malady. 


(Elinical JUcoriiB. 


already described. It was confined to the chest, face, 
and arms, and there was no sore throat. The temperature 
fell at mid-day to 102-4 degs., and continued its down¬ 
ward course until it touched normal on the morning of 
the forty-sixth day. The rash gradually disappeared at 
the expiration of twenty-four hours, and there was no 
desquamation. The bowels acted freely from that time, 
and it was not necessary to give another injection. 

Remarks by Dr. Murbell.— As a case of enteric fever 
this patient presents no feature of interest. The point 
is that on two occasions after the administration of a 
soap and water enema there was a marked erythema 
presenting the ordinary characters of a scarlatinal rasb. 
Such cases are not common, although they have been 
described. Dr. Suckling, of Birmingham, has reoorded 
instances of a scarlet rash following the administration 
of enemata, and thinks that they are met with more com¬ 
monly in children than in adults. Dr. Coupland, of 
Stoke-on-Trent, mentions a similar case in which the rash 
was followed by desquamation, and Mr. Staveley says 
that the rash is sometimes observed after the adminis¬ 
tration of a purgative by the mouth in cases of prolonged 
constipation. Some years ago Dr. Burford published a 
note on a mild form of septic toxaemia after enemata. 
These cases are evidently examples of ptomaine poison¬ 
ing. The rectum is capable of absorbing fluids rapidly, 
and when the hot soap and water liquefies the 
motion we get toxaemia. Dr. David Walsh, who is 
an authority on such matters, points out that 
the rash is not unlike that which sometimes 
follows the injection of tuberculin, and suggest 
that it is an effort at excretion by the skin of an irritant 
substanoe. The elevation of temperature in our case is 
a feature of interest. The occurrence of enemata rashes, 
although apparently of trivial import, is worth record¬ 
ing, when one remembers the possibility of the rash 
being mistaken for scarlet fever and of the inconveniences 
which may attend a mistaken diagnosis. 

In another case recently under my care the patient, a 
girl, set. 13, suffering from that curious combination of 
symptoms so frequently described of late, tonsillitis, 
acute rheumatism, endocarditis and chorea, the enema 
was given at night and the rash was observed the first 
thing in the morning. 


^nmeartions of Societies. 

ROYAL ACADEMY OF MEDICINE IN IRELAND. 
Section or State Medicine. 

The President, Dr. Tweedy, in the Chair. 


Meeting held Friday, April 28th, 1899. 

ROOM DISINFECTION, WITH SPECIAL REFERENCE TO THK 
USE OF FORMIC ALDEHYDE. 


WESTMINSTER HOSPITAL. 

Enemata Rashes. 

Under the care of Dr. Murrell. 

William G., set. 14, was admitted with enteric fever 
on the eleventh day of illness. There was at first diarrhoea, 
but subsequently the bowels were confined. He had a 
motion on the twenty-first day, and on the evening of 
the twenty-fourth day he was given an enema of a pint 
of soap and water which acted freely. About thirty-six 
hours later a rash appeared on the abdomen, chest, arms 
as low as the elbows, and on the thighs. It was bright 
scarlet in colour, slightly raised, disappearing on pressure, 
and not attended with itching. It lasted forty-eight 
hours and was not followed by desquamation. There was 
no sore throat. On the thirty-eighth day the bowels were 
open twice, and then for four days there was no 
action. On the forty-second day the temperature, after 
having been normal for sixteen days, rose at 7.30 p.m. 
to 100-4 degs. At 8 p.m. an enema was given of a pint 
of soap and water. At midnight and at 8 a.m. on the 
following morning the temperature was 103*4 degs. At 
9.0 a.m. a rash appeared similar in character to that 


By Dra. Littledale and Kirkpatrick. 

Dr.Littlkdale.— Experiments on the efficacy of forma¬ 
lin vapour were carried out in a room 28 cubic metres 
content, with no opening intoit but thedoor,and 10 grains 
of formalin tabloids were vaporised in an “ alformant ” 
lamp. The yellow air coccus, coli commune, staphylo¬ 
coccus pyogenes albuB, bacillus typhosus, pus, sputum 
and putrid urine were the test objects exposed. Threads 
weie steeped in emulsions of these various objects, 
wrapped in filter paper and lint, or concealed in the 
pocket of a coat or between the leaves of a book, or ex¬ 
posed quite open to the vapour. All the objects freely 
exposed were quite incapable of growing on nutrient 
media after a nine hours’ exposure to the formalin, but 
concealment in a coat pocket or between the leaves of a 
book seemed quite sufficient to prevent their being acted 
upon to any degree, as all bacteria so exposed were not at 
all or only slightly hindered in their growth. The 
sputum was openly exposed on cover glasses, on which it 
had been let dry in the oven at 37 degs. C., and after 
exposure for nine hours no growth took place in broth for 
two days—that is, until the surface layer digested off 
and the deep surface was exposed, as could be seen by 


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j u»* t, 1899. 


TRANSACTIONS OF SOCIETIES. The Medical Press. 587 


the shaggy appearance of the layer on the cover glass- 
Everything in the dried pus, which was openly exposed 
on gauze, was killed, except a leptothrix. Agar tubes of 
definite dimensions were inoculated over a sloped surface 
for a known distance and exposed just immediately after 
inoculation, and after the experiment were kept at 37 
degs. C. Growths appeared in these tubes, but not over 
the whole length of the “ smear,” only the lower part 
furthest from the opening of the tube and terminating 
to a sharply-defined horizontal line, as appears to be the 
case whatever form of generator is used, as most inves¬ 
tigators have had similar experiences. No inoculation 
experiments were undertaken on animals. 

Dr. Kirkpatrick. —The apparent need for an efficient 
yet easily applicable mode of room disinfection is perhaps 
most marked in dealing with such a chronic infectious 
disease as tubercalosis. Such a method can practically 
only be obtained by means of gaseous disinfectants. 
Experience, however, has shown that the methods which 
until recently were employed for this purpose are very 
unsatisfactory. The author proceeded to examine 
critically those in most common use— i.e., sulphurous 
acid, chlorine, and bromine. The experiments of Koch 
were quoted to support his conclusion. As regards the 
first of these, that for practical purposes, it is useless. 
As regards the two latter, Drs. Fischer and Peoskaner 
have proved that to apply them efficiently is quite as 
difficult as to disinfect with germfcidal solutions. The 
possibility of efficient room disinfection by means of 
formic aldehyde generated by Messrs. Zimmerman’B 
“alformant ” was then considered. Experiments by 
various authors were quoted to show what had already 
been done, and the apparatus was described in detail. 
It appeared that this process was very much simpler 
than any other of the modes of gaseous disinfection 
considered, while it was superior to any of them in 
point of efficiency. These conclusions would justify a 
very much more extended trial of this mode of disin¬ 
fection than has hitherto been made, and lead us to 
expect that great practical good is likely to result to 
both patients and attendants from its use. 

Dr. Ninian Falkiner, reviewing the action of chemical 
disinfectants, said they acted in three ways—by oxida¬ 
tion, “ direct or indirect,” “ reduction,” or by “ coagula¬ 
tion of albumen.” Referring to the manner in which the 
disinfecting action of the formalin vapour stops at a 
clearly defined line in the culture tube, it suggests that 
the limit was caused by a chemical change in the vapour 
itself, produced by its action as a chemical oxidiser, it 
being reduced to the condition of an alcohol. 

Dr. Knott was inclined to believe that the stoppage 
of penetration at a certain line in the culture tube was 
due to eddying currents generated by the disinfectant, 
and that the explanation was physical rather than 
chemical. 

The President said that anyone working much amoDg 
the poor knew the great objection they had to disinfec¬ 
tion as carried out at present; a more effective and less 
disagreeable process was, therefore, much to be desired. 

Dr. Littledale, replying, said the penetrating action 
of the vapour appeared to be inversely proportional to 
the vitality of the bacteria—a point which seemed to 
favour the suggestion made by Dr. Ninian Falkiner. 
Their experiments had not given formalin an exhaustive 
trial, as they had used a very weak gas. 

Dr. Kirkpatrick pointed out that among the advan¬ 
tages which formalin had over other gaseous disin¬ 
fectants was the ease and rapidity with which it could 
be used. The result did not depend so much on the 
length of time objects were exposed to the gas, but 
rather on its initial force. Six or seven hours would be 
sufficient to thoroughly disinfect with this vapour, and 
Cn opening the doors and windows afier this the smell 
at once disappeared, which was not the case with sul¬ 
phurous acid or other gaseous disinfectants. 

CANCER IN IRELAND. 

Dr. Martlet read a paper on cancer in Ireland. 
After contrasting the deaths from cancer in Ireland and 
England—the former rate being roughly only 70 per 
cent, of the latter—he illustrated by maps its very un¬ 
equal incidence in different localities, the parts most 


affected being the east of Ulster, Dublin, and Carlow. 
In conclusion, he moved a resolution that the Academy 
should appoint a committee to investigate the distribu¬ 
tion of tne disease in Ireland. 

Dr. T. W. Grimshaw, C.B., Registrar-General, in 
seconding the resolution, remarked that the maps which 
were before them showed that cancer was prevalent in 
the most Anglicised parts of the country; for example 
they might look at Carlow, which they knew to be an 
old English colony, and Dublin, containing a large pro¬ 
portion of the population of English descent. Registra¬ 
tion was not as long in vogue in Ireland as in England, 
and consequently the returns were less trustworthy, as 
they had often to trust to memory for the ages of 
middle-aged people. 

Dr. Havil and had noted the fact that cancer prevailed 
where there were sluggish rivers of considerable size and 
liable to overflow their banks, but they were ignorant as 
to the exact bearing this fact had on the occurrence of 
the disease. 

Dr. John W. Moore, President R.C.P.I., explained the 
preponderance of cases in Dublin and Belfast by the fact 
that in country districts the doctors were often reluctant 
to give cancer as a cause of death, owing to the existing 
dread of the disease, on account of its hereditary nature; 
also the diagnosis of cancer was usually verified in the 
city hospitals by a necropsy, which was not the case in 
the country ; in addition Dublin and Belfast received 
cancer patients from all parts of the country. 

The resolution was adopted by the meeting, and the 
Section then adjourned. 


WEST LONDON MEDICO-CHIRUEGICAL SOCIETY 

A clinical meeting of the above Society was held in 
the Society’s rooms at the West London Hospital on 
June 2nd, Dr. S. D. Olippingdale, President, in the 
chair. 

Mr. Me Adam Eccles showed a boy with a large nsevo- 
lipomatous tumour of the forearm, which had existed 
since birth. 

The case was discussed by the President and Dr. 
Leonard Dobson, and Messrs. Rothery, E. P. Paton, 
C. B. Keetley, and Neville Wood. 

Dr. Leonard Dobson and Mr. C. B. Keetley showed 
a young woman who had been successfully operated on 
for gastric ulcer three weeks previously. The patient 
bad suffered much pain for many months, and was in no 
way better in spite of prolonged medical treatment. Mr. 
Keetley opened the abdomen and found near the 
(Esophagus an ulcer, which had become adherent to the 
diaphragm. The adhesions were separated and the ulcer 
was scraped and closed. The patient made a good 
recovery. 

The case was discussed by Messrs. Bidwell, Neville 
Wood, and Paton. 

Mr. Bidwell showed a child on whom he had operated 
for tuberculous peritonitis, and a man on whom he had 
operated for extensive carcinoma of the rectum. 

The cases were discu86ed by Dr. Dobson. 


NORTH OF ENGLAND OBSTETRICAL AND 
GYNAECOLOGICAL SOCIETY. 

Meeting held at Leeds, Mat 19th, 1699. 

The President, Dr. Donald, in the Chair. 


. Specimens. 

Dr. Hellier showed: 1. Fallopian tube with chronio 
salpingitis ; 2. Uterus with acute puerperal inversion. 

Dr. Braithwaitr : 1. Parovarian cyst; 2. Cystic 
•vary. 

Professor Wright : A ring pessary retained for 
twenty-three years. 

Dr. Gemmell: Uterus removed for epithelioma of 
the cervix. 

Dr. Croft : 1. Series of specimens and microscopio 
sections of gynecological interest; 2. Sarcoma of 

uterus following hydatid mole; 3. Foetal monstrosities. 


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588 Thb Medical P ress. 

Dr. Hellixr read the notes of a case of “ Chronic 
Inversion of the Uterus,” successfully reduced by 
Aveling’s repositor. The labour was instrumental, but no 
haemorrhage or signs of inversion were noted at the 
time. On the fii th day the uterus was found at the vulva 
completely inverted. This was reduced by the medical 
man in attendance, but seme months later as menstrua¬ 
tion was exceesive, an examination was made and the 
uterus again found completely inverted. Taxis under 
ether having failed, Aveling’s repositor was applied. 
This effected complete reduction within 51 hours. It 
was, however, necessary to give the patient an an Esthetic 
to remove the cup of the repositor which had become 
incarcerated in the cervix. 

Remarks were made by Dr. Young, Professor Wright, 
Dr. Lea, and the President. 

Dr. Braithwaite read a paper on “ A Method of 
Treating some Cases of Amenorrhoea by Mechanical 
Irritation of the Uterus with an Intra-uterine Stem.” 
He advised that in certain cases of suppressed menstrua¬ 
tion in which all other remedies fail to bring on the flow 
a vulcanite stem should be introduced. Suitable cases 
are those in which the patient is suffering from symptoms 
such as flushings, headaches, and signs of plethora. The 
treatment is of no value unless there are distinct mens¬ 
trual molimina. It is of no use in cases of infantile 
uterus. The introduction of a stem is also contra¬ 
indicated in the presence of flexions of the uterus, endo¬ 
metritis, or inflammation of the appendages. In some 
cases Dr. Braithwaite has succeeded in establishing 
typical menstruation: in other cases only a single flow 
of blood lasting a few days. The stems may be worn for 
some months, and Dr. Braithwaite has never seen any 
harm arise from their use. In many cases great benefit 
resulted. 

Dr. Hellieb considered that the risk of setting up endo¬ 
metritis and salpingitis in these cases was considerable. 

The President held that stem pessaries should never be 
employed, and did not consider that amenorrhoea could be 
permanently cured by local means, although a h Eemorrhage 
from the uterus might be mechanically caused. He 
believed that in cases in which they were tolerated they 
sometimes caused permanent amenorrhoea 

Dr. Ra'baqliati considered that amenorrhoea must be 
treated by attention to general nutrition, and held that 
mechanical irritation was not justifiable. 

Remarks were also made by Drs. Young, Gemmell, 
and Wright. 

Dr. Swailes read the notes of two cases of " Umbilical 
Haemorrhage.” Case 1 was a feebly nourished child, 
born of healthy parents. The cord came away on the 
fourth day, and the navel appeared normal. On the 
tenth day bleeding commenced, and continued in spite 
of local applications and ligatures. The child became 

{ 'aundiced, and the urine was of high colour. The 
isemorrhage proved fatal two days later. No post¬ 
mortem was obtained. Case 2, a well developed infant, 
bom of healthy parents. Slight jaundice appeared on 
the fourth day. Two days later haemorrhage came on. 
Various styptics were applied, and, finally, hare-lip pins 
were used. The bleeding, however, continued, and the 
child died on the fourteenth day. Post-mortem the um¬ 
bilical vein was patent up to the liver, but nothing else 
abnormal was found. There were no signs of infection. 

Dr. Hellixr said these cases formed a well-recognised 
group, and wero often associated with hemorrhages from 
other organs. The cause was probably navel infection. 
The dry antiseptic treatment of the umbilical oord was 
strongly to be recommended. 


Thb Royal Institution celebrates its centenary 
next week, and, as the Times points out, that occasion 
ought not to be passed in silence. The Institution 
has, by unostentatious but thoroughly sound scien¬ 
tific work, contributed to the public benefit more 
lasting result than other more pushing institutions. 
It can point to the names of Count Rumford (its 
founder, in 1799), to Faraday, Davy, and Tyndall, 
besides many other less distinguished followers, and 
it may well De proud of such men. 


June 7, 1899. 

THE GENERAL MEDICAL COUNCIL 

OF 

EDUCATION AND REGISTRATION. 


SUMMER 8E8SION, 1899. 

Sir William Turnxb, President, in the Chair. 


FIRST DAY— Tuesday, Mat 30th. 

The sixty-Beventh session of the Council was inaugu- 
gurated on Tuesday, May 30th, by the usual Introduc¬ 
tory Address, delivered by the President, who briefly 
reviewed the work before it. He announced, as stated 
last week under the head of Parliamentary Nowb, that 
the President of the Local Government Board had 
“regretted his inability” to introduce a Bill for the 
reform of death registration for the preeent. He com¬ 
mented up on the hostile attitude taken by several of the 
licensing authorities towards the clauses drafted by Mr. 
Muir Mackenzie bearing on the suspension of the right 
to use medical titles by persons whose names have been 
erased from the Medical Register for infamous conduct, 
adding that amended clauses had been drafted which, 
it was hoped, would disarm the opposition of the 
licensing bodies. He congratulated the Council 
upon the fact that a Bill had been introduced by the 
Lord Chancellor to prohibit the practice of medicine, 
surgery, and dentistry by companies. He refened t> the 
complaint emanating from the College of Preceptors 
alleging “ serious errors of statement and fact ” in the 
Report of the Education Committee, and he intimated, 
in respect of the standard of general education, that in 
view of the number and importance of the replies received 
from various authorities on general education the period 
of reference would require to be extended. 

In alluding to the penal cases to come before the 
Council the President cal’ed attention to a curious point 
connected with one of them, vis., whether a registered 
medical practioner, the salaried officer of a provident 
dispensary, could be regarded as “ covering ” an unquali¬ 
fied person who not only acted as dispenser, but visited 
and prescribed for the patients attending the dispensary, 
such dispenser being engaged, not by the practitioner in 
question but by the managers. The practioner, moreover, 
formally denies having consented to the dispenser 
visiting his patients. Passing on to the painful case of 
the late Mr. Hunter, he said he had directed a narrative 
thereof to be prepared for circulation among members of 
Council in view of a possible discussion As might have 
been anticipated this ritumi is marked “ striotly confi¬ 
dential.” 

After the usual vote of thanks to the President for his 
address, various tables showing the results of examina¬ 
tions were received, whereupon Mr. George Brown 
called attention to the fact that in Part 1 of the final 
examination of the Victoria University Ihere had been 
33 rejections and 68 passes, and in Part 2 there were 41 
rejections and 35 passes. He contrasted these results 
with those at the final examination for the same degree 
at the University of Edinburgh, where the rejections 
numbered only 18 and the passes 62, while for 
the M.B., B.Ch. there were 11 rejections and 137 
passes. He wanted some explanation of this 
curious disparity in the results at the two uni¬ 
versities suggesting that men would be sure to 
prefer universities where they would stand a better 
chance of getting through. He therefore moved that a 
special committee be appointed to examine and report 
thereon. In answer to a question by Dr. McVaa he 
admitted that he was not personally acquainted with 
instances of men leaving the Victoria University to go 
to Edinburgh on this account, and he repudiated any 
intention of insinuating that there was anything wrong 
in the way in which the examinations at Edinburgh were 
conducted. 

Dr. McVail was good enough to move that certain of 
the tables be referred back to the committee, but after 
an emphatio statement by the President as to the quality 
of the Edinburgh examinations the Council, on the 
initiative of Sir Dyce Duckworth, passed to “ the previous 
questions.” 


GENERAL MEDICAI COUNCIL 


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GENERAL MEDICAL COUNCIL. The Medical Pbbss. 5b9 


June 7, 1899. 

Honour to whom Honour is Dce. 

Sir William Thomson pointed out that the table 
referring to commissions in the R.A.M.C. was a trifle 
ambiguous, and, as it stood, might be construed as 
meaning that the first thirteen places were won by the 
English Colleges. 

The speaker’s national susceptibilities were soothed 
by a promise that a footnote should be appended placing 
the matter in its proper light. 

Dr. Glover, alluding to the returns of the Society of 
Apothecaries showing that ninety-two persons passed in 
surgery and 169 in medicine, asked whether it was a fact 
that no candidate had passed the examination in both 
subjects. 

Mr. Carter asked for notice of the question before 
answering and pointed out that of thirty-seven of their 
candidates for Army appointments thirty-five had been 
successful. 

The F.F.P.S.G. 

Mr. Victob Horsley asked the Council to declare that 
the action of the President at the last session in ruling 
out of order his motion concerning the alleged insuffi¬ 
ciency of the examination for the Fellowship of the 
Faculty of Physicians and Surgeons of Glasgow, was 
contrary to the Medical Act, 1858. 

The President pointed out that the original motion 
referred to a memorial addressed to the Council by 
certain fellows of the Faculty, but no such memorial 
had been received by him, though a letter from a Dr. 
Woods, addressed to no one in particular, had been 
received. A reply had been sent Dr. Woods to the effect 
that the Council did not inspect the examination for the 
fellowship, and there the matter rested. He urged, 
moreover, that the motion, as recapitulated by Mr. 
Horsley, was not the one which he had ruled out of 
order, and he called upon Mr. Horsley to make his 
motion conform to fac*. 

Mr. Horsley explained that he had understood the 
President to rule that the Council had nothing to do 
with the higher examinations of Corporations, and this, 
he felt sure, was an entire misapprehension. He ex¬ 
plained the grounds in which he based his opinion, and 
urged that to allow the ruling to pass unchallenged 
would be to cut the Council off from a statutory right 
and duty which it owed to the profession and the public. 

The President observed that his opinion, which he 
admitted was only that of a layman, was confirmed by 
the practice of the Council for the last thirty years. 
That practice was based on Section XXX. of the Medical 
Act, 1858. He did not think it was competent for the 
Council to go into the matter, the remedy being in the 
Glasgow Faculty itself. 

Mr. Georoe Brown asserted that under Section XXX 
the Council was entitled to examine into the sufficiency 
of what were termed higher examinations. 

Sir Christopher Nixon Baid that at first sight he 
thought the Council were entitled to sit as judges upon 
the higher examinations, but it would entail a herculean 
task. His own college, for instance, might refuse in¬ 
spection of the examination for the membership, and the 
Council would be powerless. On the whole, he did not 
think the Medical Acts gave the Council power to deal 
with any examination other than that which entitled a 
man to be registered. 

After some remarks by Mr. Teale and some further 
observations by Mr. Horsley, Dr. McYail pointed out 
that the motion invited the Council to censure the Presi¬ 
dent for not having brought before the Council a 
memorial which had never reached him, and he moved 
“ the previous question,” which was carried. 

Inspection or Documents. 

The report of the Executive Committee codifying the 
standing orders regulating the inspection of documents 
belonging to the Council was received and adopted, and 
the Council adjourned to give the various committees 
a chance of getting their reports ready. 


SECOND DAT— Wednesday, May 31st. 
Direct Representation. 

After taking cognitance of certain resolutions passed 


at the last meeting of the British Medical Association 
in favour of an increase in the number of direct repre¬ 
sentatives on the Council, Mr. George Brown moved 
that the Council express the opinion that the time has 
come to confer on the registered medical practitioners 
of England and Wales the power to return an addi¬ 
tional member. After shedding a tear over previous 
motions of like purport which “owing to the exigencies 
of business had not been dealt with,” he explained why 
on this occasion be had restricted his demand to the 
English division. He pointed out that the number of 
practitioners in this division had increased from 16,978 
in 1886 to 21,614 at present. With touching pathos he 
implored the Council to do the thing gracefully, and ex¬ 
pressed the hope that those who had on former oocasions 
voted against the proposal would see the propriety of 
yielding the point. The motion was seconded by Mr. 
Victor Horsley, and then Dr. Glover said a few words 
in support thereof. Admitting that the subject of 
increased representation had in the past been a some¬ 
what ungracious one to the Council, he hoped that the 
passage of years had diminished, and in the future 
would still further diminish that hostile feeling. He 
claimed for the direct representatives a share in the 
good work done by the Council, and he quoted a remark 
by the late Sir George Humphry to the effect that 
the profession supplied the funds it was but fair that it 
should be fairly represented. He could hardly see hew 
the Council could refuse the modest concession sug¬ 
gested by Mr. Brown, and he emphasised the interest 
which was taken by the profession in the questions 
which had to be dealt with by the Council. 

Sir William Gairdner disclaimed any desire to speak 
in opposition to the representation of medical practi¬ 
tioners but he dissented from the view that the repre¬ 
sentation was or ought to be a numerical one. That was 
evident from the fact that while the University of St. 
Andrew’s, with it comparatively small number of gradu¬ 
ates, was represented by one member, the College of 
Surgeons with its huge constituency had also to be con¬ 
tent with one member. The point was that every insti¬ 
tution connected with the medical profession should 
have a voice. He thought the status quo was fairly 
satisfactory, and he complained that the movers for 
additional representation “ left out of account the great 
body of men who have borne the burden of the whole 
for so many years and had devoted so much time and 
attention to it.” He said these movers were a disturbing 
element which they could very well do without. After 
a Parthian shot at the malcontents who, he said, would be 
found to be “men of no distinction” whatever he decided 
to vote against the motion. 

Dr. Little fail'd to see that any valid argument had 
been adduced in favour of the change, and 8ir Richard 
Thorne pointed out that only some 59 per cent, of 
practitioners had taken the trouble to vote at the last 
election, which did not look as if the profession as a 
whole cared very much about direct representation. 

Mr B. Carter intimated his opinion, in other words, 
that the resolution in favour of increased representation 
was “ a put up job,” and advanced the absurd argument 
that if the Council passed the resolution they would have 
to adjourn and await the decision of the Privy Council. 

Sir William Thomson supported the proposal on the 
ground that the great mass of the profession was only 
represented by one-sixth of the Council. With regard 
to the term malcontents, applied by a previous speaker, 
to those who had moved in the matter, he pointed out 
that all reforms were the outcome of discontent, and he 
concluded by characterising the proposal as very mode¬ 
rate in view of the large interests involved. 

Sir Christopher Nixon “ could not see what advan¬ 
tage it would be to the profession to have a representa¬ 
tive directly elected when they had a body such as the 
Council, composed of gentlemen willing to do anything 
they could to benefit the members of the profession. 
(Ironical applause). 

Dr. Pettigrew thought it would add to the labours 
of the Council, and Dr. Leech thought it was undesirable 
to deal with the question piecemeaL 

Dr McYail said he should, as heretofore, vote for the 
motion, but he deprecated an attitude which implied that 


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590 The Medicai Press. 


GENERAL MEDICAL COUNCIL. 


Junk 7, 1899. 


the Counoil had a Tested interest against the general 
practitioner. 

“"Mr. Brown having replied, the motion was summarily 
quelched. 

Reappointment of Registrar. 

At this juncture Dr. McAlistjr proposed the re¬ 
appointment of the Registrar, his being an annual 
appointment, and the proposal was carried ntm. con. 

Unqualified Dispensers. 

Sundry communications were read from the Privy 
Council bearing on the appointment by medical men of 
unqualified dispensers, together with letters which had 
been addressed to that body on the subject. These 
having been assimilated, the President explained that 
the matter had been referred to the Council by the 
Executive Committee, which in the meantime had 
replied to the Privy Council to the effect that while 
accidents might occasionally happen from the employ¬ 
ment of careless or incompetent dispensers such cases 
were probably very rare, and suggesting that probably 
the best protection was afforded by the responsibility of 
the practitioner for the acts or defaults of his servants. 

Mr. Brown expressed dissatisfaction with things as 
they stood, and asked if the committee had any resolu¬ 
tion to bring forward. Failing this he urged that they 
should appoint a committee or pass some resolution 
urging practitioners who dispensed to employ only 
.qualified dispensers. He asked on what data the com¬ 
mittee had arrived at the opinion that such accidents 
were rare 

The President observed that no information had 
reached the Council to justify the supposition that they 
were otherwise than rare. 

Mr. Carter pointed out that the matter bad been 
referred by the Executive Committee to the Council for 
their decision, whereupon Mr. Brown formally proposed 
the appointment of a committee to consider the communi¬ 
cations in question, and onbeiDg seconded by Dr. Bruce, 
vhe motion was carried unanimously. 

The Prmvention of Personation. 

A report by the Executive Committee was read em¬ 
bodying the suggestion that no application for the 
restoration of a name to the Register under 8ection 14 
of the Medical Act and Section 12 of the Dentists' Act 
should be entertained unless the statutory declaration 
contained a statement by a clergyman, magistrate, or 
registered practitioner establishing the identity of the 
applicant. 

Mr. Victor Horsley moved an amendment, which, 
after some discussion, was passed, to the effect that a 
special committee be appointed to report during the 
present session upon the best means to secure the iden¬ 
tification of a person applying to be admitted to the 
Medical or Dental Register, and to prevent fraudulent 
registrations either on the first admission to the Register 
or subsequently. The whole subject of granting certifi¬ 
cates of registration was also referred to the committee. 

Midwives’ and Opticians’ Certificates. 

A report of the Executive Committee was read recom¬ 
mending a resolution ts the effect that as midwifery legis¬ 
lation was before Parliament, it was not opportune to 
discuss the giving of certificates in midwifery. With 
regard to opticians’ certificates the Council exercises no 
jurisdiction over opticians, but would be prepared to 
consider any properly substantiated charge of improper 
conduct made against a registered medical practitioner 
with reference to this subject 
At the suggestion of Mr. Brown, the discussion was 
postponed. 

Reciprocity with Foreign Countries. 
Communications from the Privy Council in regard to 
the right to practice of Italian practitioners in this 
country were read. They comprised one from the 
Italian Ambassador asking whether Italian physicians 
could without a fresh diploma, exercise their profession 
in this country, or at least on foreigners resident in this 
country, and whether, if the answer were in the negative, 
Government would be willing to grant permission to 
Italian physicians to do bo if the Italian Government 
were to engage to grant similar privileges to English 


physicians residing in Italy. The report comprised the 
following resolution of the Executive Committee, “ that 
they would welcome such a recognition of a right by 
English practitioners to practise in Italy as would enable 
Her Majesty in Council, under the provisions of 8ection 
17 of the Medical Act, 1886, to extend similar privilege* 
to Italian practitioners in this oountry. And that 
with regard to the other questions raised in the corre¬ 
spondence, the Executive Committee would refer the 
Privy Council to a letter of date February 24th, 1898, 
addressed to Sir Charles Lennox Peel, containing a reply 
by that Committee to certain questions received through 
the Privy Council from the German Ambassador aa 
regards practice by foreigners in this country." 

Dr. McVail urged that if this were conceded it would 
be difficult to refuse similar concessions to other coun¬ 
tries, and this he feared might work an injustice to 
home made practitioners. 

Mr. Victor Horsley concurred in the principle of 
reciprocity, but suggested that they ought to commence 
with the Colonies. In the interests of the profession he 
thought, however, that the Counoil should not accept 
the motion. 

Dr. Atthill pointed out that it was far more in the 
interests of English physicians in Italy than of Italian 
practitioners in this oountry, and Sir Richard Thorn* 
urged the cause of the “ thousands ” (?) of English 
physicians practising in Italy. After some further dia- 
cussion tending to show that it was not such a far- 
reaching measure as was alleged, the matter was referred 
to Mr. Muir Mackenzie to advise whether the privilege 
could be restricted to authorising foreign practitioners 
to practise only among their fellow-countrymen residing 
in this country. 


THIRD DAT.— Thursday, June 1st. 

This was a penal day, and the first case to be called on 
was that of 

Mr. Samuel Bingham Sheklkton, 
of East Ham, who was charged with having aided and 
assisted one Rowland to procure himself to be registered 
under the name and with the qualifications of one 
Edward Joseph Nugent by making and producing 
fraudulent representations, and, secondly, for aiding and 
assisting Rowland to carry on practice as if he had been 
duly qualified. 

Mr. Shekleton put in a very late appearance and 
narrowly escaped being condemned by default. Even 
when he did answer to his name he appeared to be in a very 
dazed condition and was unable to offer any adequate ex¬ 
planation of the charges alleged against him. He repeated 
incoherently that “he didn’t know,” that he had met 
Rowland in the street and had entered into conversation 
with him, learning among other things that his name 
was Nugent. He fixed the date of this occurrence at a 
time when the real Nugent was practising in the same 
street as the pseudo-Nugent, and he was flustered con¬ 
siderably when asked to explain how it was that the true 
and the false Nugent could have been practising for four 
years in the same street without the fraud being dis¬ 
covered. On the whole he cut a very sorry figure, and 
it did not take the Council long to decide to remove his 
name from the Register. 

Some discussion took place as to the circumstances 
under which Nugent’s name had recently been removed 
from the Register, and regret was expressed that it should 
have been removed under Section 14 instead of under 
the penal clause. It was explained that the name which 
had originally been removed under Clause 14 had 
been improperly restored on the strength of false repre¬ 
sentations, the restoration was thus invalid and the 
subsequent removal was merely reverting to the earlier 
state of things. On the motion of Dr. Church it waa 
decided to call the attention of the proper authorities of 
New South Wales to the circumstanoes of the cane re 
Nugent with a view to action out there. 

The next case was that of 

Mr. James Jerome McKay 

registered as of Bally Roberts, Co. Cork, but practising 
in the Wandsworth Road, S.W. Mr. McKay owee his 




Jum 7, 1899. _ GENERAL MEDICAL COUNCIL, _ Th« Medical Press. 591 

little spell of notoriety to the fact that some months ago [ President he said he had no defence to make and placed 
he wa» ordered by Mr. Braxton Hicks, the Coroner, to himself in the hands of the Council. 


be prosecuted for perjury in connection with the evi¬ 
dence given by him at an inquest. In his evidence given 
before the Coroner the defendant stated formally that 
death was due to brain disease, and that, he had care¬ 
fully examined the heart, lungs, and other viscera, which 
were all healthy. He mentioned that the stomach con¬ 
tained milk, and that the bladder was partly full. 

An examination made subsequently, on the Coroner’s 
order, by the police surgeon (Dr. Kempster), assisted by 
other registered practitioners, proved that no real post¬ 
mortem examination had been made. At the adjourned 
inquest Mr. McKay, after being cautioned by the Coroner, 
and after listening to the evidence of Dr. Kempster, swore 
afresh that his original evidence was correct. For some 
inexplicable reason the charge of perjury was dismissed 
by Mr. Plowden, the magistrate before whom it came, but 
the Coroner considered the case of sufficient importance 
to warrant his bringing it before the Council. 

Mr. McKay was, therefore, charged not only with 
having failed to make the examination which was re¬ 
quired of him, and with having failed to ascertain the 
cause of death, but also with having subsequently 
deposed before the Coroner contrary to the facte. The 
documents in support of the charge comprised the com¬ 
plaint of the Coroner, and a certified copy of the 
depositions at the inquest. The case was taken up by 
the Medical Defence Union, on behalf of the Coroner, 
and Dr. Bateman, representing the Union, called atten¬ 
tion to the responsible nature of the duty of properly 
carrying out a post-mortem examination, any remissness 
wherein might work grievous harm to the lives and 
liberties of Her Majesty’s subjects. The evidence 
of Dr. Kempster, the police surgeon, was to 
the effect that, having been asked to examine 
the body on which the defendant was supposed to have 
already made a post-mortem examination he found that 
the skull cap had only been partly sawn through, and 
that the edges could only be separated for about half an 
inch, so that a proper examination of the brain was 
impossible. On completing the section the brain was 
found to be quite healthy. There was an incision 41 
inches long from the ribs downwards, but the peritoneum 
had not been opened and no examination had been 
made of the thorax, which was intact. On opening the 
thorax he found that one lung was the site of well- 
marked pneumonic consolidation, which indeed was the 
cause of death. The other organs were healthy. 

After the case for the accusation had been concluded 
Mr. McKay was asked to come forward and make any 
statement he might wish concerning the facts that had 
been laid before the Council. He said he based his defence 
on the fact that he had been tried by Mr. Plowden and had 
been acquitted, and it was not right that a man should 
be twice punished (?) for the same offence. He urged 
that it was simply a difference of opinion between two 
medical men, but he did not question the accuracy of 
the description given by Dr. Kempster of the appear¬ 
ances of the body when asked to inspect it after 
he (the defendant) was supposed to have made 
his examination. He disclaimed any wish to say 
a harsh word against the Coroner, but complained 
that he had not been invited to be present at the Becond 
post-mortem examination. (This was ascertained to be 
the case.) He still adhered to his evidence, stating that 
he was convinced, from clinical observation, that death 
was due to the brain, so that a detailed inspection of the 
other organs was not really necessary. He said he could 
satisfy himself as to the condition of the brain without 
removing the skull cap, and as for the other viscera he 
had “felt” them. He said it was not true that the 
peritoneum had not been opened. Asked how he 
could describe the contents of the stomach with¬ 
out opening it, he said he felt something, and 
inferred that it was milk. He saw no reason to doubt 
that the bladder was as described though be bad not 
-opened it. He admitted that he had not opened the 
pericardium, or, indeed, the thorax, but he bad felt the 
heart from the abdominal incision, and could assert t 
that there was nothing wrong with it. In reply to the 


Nothing more remained to be done but to deliberate on 
the case in camera, and in a very brief space of time the 
Council found him guilty of the charge, and ordered the 
removal of his name from the Eegieter. 

The next case was one of a very different kind, it was 
indeed the peculiar case to which the President called 
attention in his introductory remarks. It was one in 
which 

Da. William Stewart, 

of Denton, near Manchester, was charged at the instance 
of the Ashton-under-Lyne District Medical Society, in 
connection with the Denton and District Provident 
Dispensary, of which he is the medical officer, with 
having associated with an unqualified person named 
Burgess, who was alleged to be his assistant, in carrying 
on medical practice, and with being party to this person’s 
administering medical aid and treatment as if he were a 
duly qualified medical man. 

The case for the prosecution was brought forward by 
Mr. Hyde on behalf of the Medical Society, and Dr. 
Stewart appeared in person, accompanied by his legal 
adviser, Mr. Shawcross. Various statutory declarations 
were read setting forth that the assistant had visited 
and made up medicine for patients, and that he had 
given chloroform and assisted in operations. The report 
of the dispensary, whioh was put in, gave close upon 
28,000 as the number of visits made during 1898, inde¬ 
pendently of consultations at the dispensary, operations, 
and confinements, and Mr. Hyde asked whether it was to 
be supposed that the defendant had done all this work him¬ 
self, especially as the labours averaged 4'3 a week, and there 
had been 187 operations in the year. At the suggestion of 
the President Mr. Hyde abstained from going into the 
conduct of the dispensary in respect of tne means 
adopted to obtain members. In answer to Mr. Brown, 
it was stated that the “ trustees ” of the dispensary were 
all labouring men. 

Mr. Shawcross addressed the Counoil on behalf of the 
defendant, and produced statements in disproof of the 
allegations contained in the declarations put in by the 
prosecution. He denied that the visits, if any, made by 
Burgees were for medical purposes, or, if so, that they 
were made with the sanction or consent of the defendant. 
He pointed out that in so far as his relationship with the 
assistant might appear dubious, Dr. Stewart had ex¬ 
pressed his readiness to be guided by the Council. He 
said he did not propose to tender Dr. Stewart as a wit¬ 
ness, but, on reflection, he said that in order to avoid 
importing any prejudice by reason of his not doing so he 
was willing that Dr. Stewart should come forward. 

Dr. Stewart then came forward, and, in reply to Mr. 
Shawcross, stated that he had been medical officer of the 
dispensary for ten years. Mr. Burgess was simply the 
dispenser, and was free to dispose of his time between 
11 and 5 o’clock. He denied that Burgess had ever 
given chloroform for him, though he was present at the 
operations, and he had not even assisted him beyond 
washing the instruments afterwards. Burgess was there 
only from curiosity. In no case to his knowledge had 
Burgees ever visited patients. Burgess had been dis¬ 
penser for about five years, and had gone through a 
medical curriculum at the Queen’s U niversity in Ireland, 
but he looked upon him not as a medical student but as 
a dispenser. He could not say whether Burgess had 
passed any examination. He said he himself could 
easily see from 80 to 90 patients daily at their homes, 
the district being of limited area. Questioned as 
to the numbers of visits to patients he said that it was 
an average, no record or book was kept either of the 
visits or consultations, or of the medicines dispensed. 
The whole of the work, except the dispensing, was done 
by himself. Questioned as to who gave the chloroform at 
one of the operations referred to by the prosecution (a 
case of strangulated umbilical hernia), he said he had 
given it himself while performing the operation, giving 
additional chloroform when necessary. He always did 
this, for he never called in any other medical man to 
assist him, though there were several in the neighbour¬ 
hood. He often gave chloroform without any other 


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592 The Medical Press. 


FRANCE. 


June 7, 1899. 


person present. The other operation referred to was for 
cancer of the breast. 

Cross-examined by Mr. Hyde as to how often he had 
to give chloroform in the 184 operations, he said in about 
one-half, and he had always given it himself. He could 
not say at how many of the operations Burgess had been 
present. Burgess merely attended at the branch dispen¬ 
sary for the purpose of making up his prescriptions. If 
he were absent at a confinement Burgees would not 
attend to the patients or give medicine. He attended 
all confinements himself. 

Mr. Hyde pointed out that Dr. Stewart’B salary 
increased according to the number of members, so that 
the medical officer was the primary gainer when members 
were touted for. 

Dr. Stewart, in reply to the questions, said that the 
dispenser was advertised for and appointed by the 
trustees. He said he had no knowledge of members 
being recruited by canvassers or touts. He himself 
lived six minutes' walk from the principal dispensary. 
He had signed no agreement with the trustees. When 
his attention was called to the fact that in the annual 
report of the dispensary Burgess was described as medical 
assistant, he said he had not previously noticed this 
detail, though part of the contents was furnished by 
himself. It was no p»rt of his duty to revise the report. 
He did not consider that he was doing wrong in giving 
chloroform and operating himBelf. The trustees paid the 
rent of the dispensary. 

The case, having lasted long after the usual time for 
the Council to rise, the further consideration thereof 
was adjourned. 


FOURTH DAT.—Friday, June 2nd. 

The Case of Dr. Stewart. 

The first item on the programme was the adjourned 
consideration of the case of Dr. Stewart, of Denton, near 
Manchester, the evidence wherein is contained in yester¬ 
day’s report. The Council retired into their lair to 
deliberate, and judging from the length of time they 
remained sequestered from the public gaze, the problem 
must have given rise to a good deal of discussion. 

Dr. Stewart was recalled and was asked a number of 
questions. He adhered to the statement that the dis¬ 
pensary was managed by a committee who nominated 
the dispenser without consulting him. The only sub¬ 
scribers to the “ Provident Dispensary ” were the paying 
members. 

Ultimately the Council arrived at the conclusion that 
Dr. Stewart was guilty of the charge brought against 
him, but in view of the fact that the circumstances were 
novel and somewhat peculiar, it was decided to defer 
sentence until the November session, when Dr. Stewart 
will have to put in an appearance again and submit to a 
further interrogatory. 

The Case of Mr. Neville Holland. 

Mr. Neville Holland, practising in Lambeth, regis¬ 
tered as L.S.A., was charged with covering one 
Blumenthal, in connection with a dispensary in Tyers 
Street. He was also charged with being a party 
to attracting practice to the said surgery by public 
advertisements. It was also alleged against him that 
he had violated the undertaking given by him to 
the Council in November, 1895, that if his name were 
restored to the Register he intended to act as an assis¬ 
tant to a registered practitioner. 

The complaint was laid by the coroner for South-west 
London, and was brought before the Council by the 
Medical Defence Union. 

The evidence presented nothing of special interest. 
It was an ordinary case of “ covering” under aggravat¬ 
ing circumstances, because the most unblushing adver¬ 
tisements were shown to have been circulated among the 
public with the object of attracting patients. 

In defiance of the evidence the defendant had the 
audacity to assert that Blumenthal never attended 
patients, at any rate to his knowledge. As to the adver¬ 
tising he pleaded ignorance of the fact that this was for¬ 
bidden, and he urged that in starting a dispensary it was 
customary to anounce the fact in this way. 


After the usual deliberation t* camera the Council 
found him guilty and ordered his name to be removed 
from the Register. 

The Case of William Henry Cosbens, 
of Derby Street, Prescot, was a peculiar one, but it will 
suffioe to state that it having been proved to the satis¬ 
faction of the Council that Cossens had been convicted 
of a misdemeanor and sentenced to four months im¬ 
prisonment, his name was ordered to be erased from the 
RegisUr. 

This completed the business for the day. 

The Council on Saturday was oocupied almost ex¬ 
clusively with dental business. 


Jnm«. 

[FROM OUR OWN CORRESPONDENT.] 

Paris. June 4th, 188®. 

Nature and Treatment of Herpes Zoster. 

Prof. Abadie considers that the nature of the eruption 
of herpes zoster had been until lately misunderstood. 
For a long time it was taught that this affection was 
atrophic trouble of the skin,due to a malady of cutaneous 
nervine branches commonly called neuritis. However, 
M. Brissaud endeavoured to destroy that theory by 
showing that the region where the vesicles were found 
did not always correspond to the topographical distribu¬ 
tion of these nerves. On the other band, he attributed 
the herpes to atrophic trouble of medullary origin. M. 
Abadie refuses to associate himself with either of those 
opinions; for him the lesion is exclusively provoked by a 
pathological condition of the terminal arteries and the 
vaso-motor nerves presiding over their dilatation in the 
region where the eruption is seated. 

In ophthalmic herpes, for instanoe, the eruption which 
characterises it, is developed exclusively on the territory 
supplied by the first branch of the third pair, by the 
ophthalmic branch of Willis. The vesicles run a vertical 
oourse on the forehead near the median line, and in 
appearance along the tract of the frontal and the supra¬ 
orbital branches. Sometimes also the eruption is seen 
on the nose and on the eye of the same side. It is thus 
that it is frequent to observe these vesicles on the cornea, 
where they produce ulcerations difficult to cure. If the 
ophthalmic herpes was due, as it had been believed up 
to the present, to a simple inflammation of the third 
pair of nerves, how could it be admitted that the 
common trunk being inflamed, only one of its 
branches should be affected P With the theory 
that I maintain, continues M. Abadie, the eruption 
developes itself in the vascular region supplied by the 
supra-orbital, frontal and nasal arteries and which is 
really the fact. In the interior of the cranium, on the 
very trunk of the third pair of nerves are attached 
numerous nerve filaments of the great sympathetic 
coming from the carotid plexus, which itself takes 
its origin from the superior cervical ganglion. All these 
filaments are spread out in the walls of the arteries off 
shoots of the ophthalmic artery and in their terminal 
branches. If, then, we suppose that an inflammatory 
process attacks the trunk of the third pair or the 
ganglion of Gasser, it follows that it will influence at 
the same time the filaments of the sympathetic above 
mentioned which accompany the third pair, yet pre¬ 
serving their own individuality. The lesion of 
the sensitive elements of the third pair will 


ioogle 


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June 7, 1899. 


GERMANY. 


Thb Medcal Press. 593 


determine sensitive troubles, hypersesthes ia, anesthesia 
in the regions supplied by them, while that of the vaso¬ 
motor filaments will produce a continued and excessive 
dilatation of the terminal arteries that they embrace, 
dilatation sufficient to provoke a rupture even of the 
succeeding capillaries. It is thus that the seat of the 
eruption is not exactly that of the nerve filaments, but 
of the arteries which they accompany. If, in the great 
majority of cases of ophthalmic zona, no vesicles are 
seen in the regions of the superior or inferior maxillary, 
the reason is that the vaso-motor nerves of this terri¬ 
tory have not the same origin as those accompanying 
the ophthalmic artery, they come from another source. 

M. Abadie believes that the best remedy for zona and 
for the ophthalmic form in particular, is quinine in large 
doees, and that fact constituted an additional proof of 
the theory he advances, as quinine is a vaso-constrictor 
agent, acting on the sympathetic and producing contrac¬ 
tion of the arterial vessels. 

The Feench Congress of Medicine. 

This Congress is to open at Lille, Professor Grassier 
of Montpelier, being President. The promised com¬ 
munications deal with a variety of interesting subjects, 
and the list of speakers include some of the best-known 
physicians and surgeons in France. 




double the normal size. An abscess was opened on the 
posterior aspect, about the size of a walnut. The wound 
was packed and treated openly. The temperature fell 
at once. The left-sided tumour disappeared on the fifth 
day of the operation. The urine was normal throughout. 

On June 20th, 1898, a woman came under treatment 
with panaricium of the right index finger. An 
incision was made. Fourteen days after she had pain in 
the right hypochondrium. By the end of July an elon¬ 
gated tender tumour was felt which appeared to be 
connected with the kidney. The urine was normal. 
On the kidney being exposed, the fatty capsule was 
found to be inflamed. An abscess the size of an apple 
was found in the kidney parenchyma. This was incised 
and paoked, and treated openly. Complete recovery. 
Staphylococcus aureus was found in the pus. 

The third case was that of a man who had suppura¬ 
tion from a cut finger. Pain came on in the left hypo¬ 
chondrium, and an abscess was diagnosed. 

Besides the multiple pyemic abscesses, solitary ones 
were met with in the kidney. When large they pre¬ 
sented characteristic symptoms. By extension to the 
capsule they led to para-nephritic suppurations. This 
might be prevented by early operation. 

Hr. Zondek, Berlin, showed some beautiful macera¬ 
tion preparations, illustrating the arterial system of the 
kidney and its importance in renal surgery. 

Hr. Krause, Altona, read a paper on 


[from our own correspondent.] 

Berlin. June 2nd, 1899. 

At the Surgical Congress Hr. Kronlein, Zurich, read 
a paper on 

Cystic Kidney. 

He said that surgeons had not taken much practical 
interest in the subject as the disease was generally 
bilateral and inoperable; they had therefore to limit 
themselves to those rare cases in which it was unilateral. 
Some surgeons said there were no such cases. There were 
such, however, probably acquired, and not of a conge¬ 
nital nature. He showed a preparation. The patient, a 
woman, set. 38, came to him in August of last year, with 
a tumour in the abdomen. The diagnosis was tumour 
of the left kidney half filling the abdomen, reaching 
from the pelvis to the diaphragm, and extending beyond 
the middle line. The patient was three months pregnant. 
No exploratory puncture was made. At the operation a 
transverse incision was made from the left attachment 
to the umbilicus. There was no great difficulty, although 
large vessels ran over the capsule. The right kidney and 
liver were healthy. The tumour was a large cystic 
kidney. (J denoma cyeticum.) 

Hr. Jordan, Heidelberg, read a paper on 

The Origin of Perirenal Suppuration from 
Metastatic Abscesses. 

He said that in renal abscesses, besides the ordinary 
suppuration, both pneumococci and bacteria coli were 
found. Three cases of his own had originated in pyemic 
metastasee. The first was a man of 30 with a carbuncle 
in the inguinal region. After a week high fever came on 
with violent pain] in the left hypochondrium, where a 
tumour was found which was diagnosed as renal. Then 
a tumour formed in the right side, the fever went higher, 
vomiting came on, and a pulse of 130. Both tumours had 
an elongated form. The right kidney was opened up, the 
capsule was intact, but the kidney was enlarged to about 


The Operative Treatment of Severe Occipital 
Neuralgia. 

He said that very Bevere attacks were not limited to 
one branch of a nerve, but extended into others. In* 
severe occipital neuralgia, all the branches of the occi¬ 
pital nerve were affected, and thus half of the back of 
head, the ear, jaw, and the upper part of the neck of the 
side affected. It could not be determined that one of the 
nerves was the cause of the affection. Each of the nerve 
trunks of the occipital could be so small that another 
acted for it, and on the other hand one usually small and 
unimportant might by its size become ohief of interest. 
In order to get a good result from operation, therefore, 
one ought not to satisfy oneself by operating on one 
stem; he, therefore, advised the resection of the whole 
of the nerves. He began the skin incision 3 ctm. beneath 
the occipital protuberance, carried it outwards to the 
angle of the jaw, then along the jaw to the attachment 
of the lingual bone. The smaller nerve fibres were 
difficult to find, and were to be prepared from the peri¬ 
phery to the centre. The ganglion was reached without 
any operation on bone, as it lay outside the vertebral 
canal. By this the first and second stems were distin¬ 
guished from the other vertebral nerves, the third 
passed into the vertebral canal and had its ganglion there. 

Hr. Garr6, Rostock, said that in simple reseotion of the 
trigeminus recurrences frequently took place, through 
regeneration of the nerve, and even when the whole 
nerve was twisted out recurrence sometimes took place, 
and even when the Gasserian ganglion was removed 
(contrary to opinion expressed by Krause and Horsley) 
recurrence had taken place through regeneration of the 
nerve. In case of trigeminus neuralgia in an old 
gentleman of 68, the third nerve was resected in 1890, 
and in 1872 recurrence having taken place a second 
resection was performed by Madelung. Recurrence 
again took place. In May, 1895, the Gasserian ganglion 


Digitized by 


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594 Thb Medical Parse. 


SPECIAL ARTICLES. 


June 7, 1890. 


was removed. A year and a half later recurrence again 
took place. Then operation whs again performed; no 
trace of the Gasserian ganglion was found, hut a small 
branch running through the foramen ovale. This was 
removed. Recurrence, March, 1898. Although regenera¬ 
tion of the nerve appeared out of the question, the first 
was Bought for and resected. The neuralgia, however, 
continued, and in November the third was looked for, 
when a strong, vigorous stem was found and removed 
for the third time. Under the microscope the nerve 
showed normal nerve fibres. Then recurrence took place 
in the second branch. This was cut down upon and 
again resected. The patient was now free from pain, 
but one could not say with certainty that it would not 
recur again. 

Hr. Krause said that regeneration of the trigeminus 
had never been known after removal of the Gasserian 
ganglion. He had removed it eighteen times, and had 
never seen recurrence take place. 


Jlufitria. 

[from OUR OWN CORBB8PONDBNT.] 

Vibkwa. June 2nd, 18W». 

Stenosis Pylori. 

At the “ Geselsschaft der Aerzte" Weinlechner pre¬ 
sented a female patient to the 8ociety on whom he had 
operated several times. In 1894 she came to him with 
stenosis of the pylorus and dilatation of the stomach, for 
which he performed pyloric resection with excellent re¬ 
sults The microscopic examination of the resected por¬ 
tion gave no confirmation of malignancy, neither was any 
trace of cicatrices or ulceration to be discovered. The 
following year she was readmitted to hospital with 
perityphlitis in the region of the vermiform appendix. 
Another operation was performed and the appendix 
removed. At this time the stomach and pylorus were 
normal. In 1896 the stomach trouble returned, for 
which laparotomy was again undertaken, when a few 
adhesions between the stomach and omentum, with 
parietals of the abdomen were observed. A portion of 
the bowel was again resected along with a few glands 
of the mesentery that had become calcareous. 

After this recovery the patient remained free from 
any trouble for some seven months, when the stomach 
troubles recommenced, with vomiting and a square 
gurgling area about 4 inches in extent immediately 
below the umbilicus, which persisted in spite of sedation 
and irrigation of the stomach. 

At last gastro-enterostomy was performed, with 
favourable results. The patient has increased in weight 
since the operation to the extent of 9J kilogrammes, 
while the dilatation of the stomach has diminished, so 
that it took 13 inches less sound to reach the lowest 
part now than before the operation. Weinlechner 
gave it as his opinion that the stenosis in this case 
was due purely to hypertrophy of the mucous mem¬ 
brane. ZinsmeiBter recorded a somewhat similar 
experience in a case recently under his care. The 
patient was suffering from cicatricial pyloric stenosis ; 
he performed jejunoetomy without relief. He 
finally performed gastro-entero-anastomosis with com¬ 
plete suocess. 

Rupture of Gall-Bladder. 

Ullmann brought forward other cases in support of 


Hochenegg’s views expressed at the last meeting. The 
first was a case that came to him with the diagnosis of 
lead colic. Laparotomy was performed, and the con¬ 
tracted gall-bladder was found with an opening leading 
into it and gallstone blocking in the orifice. In spite 
of the total extirpation of the gall-bladder, cleaning and 
draining of the peritoneum, the patient died from general 
peritonitis. 

'The second case was that of a female whose illness 
was early diagnosed as one of rupture of the gall¬ 
bladder. Laparotomy was at once performed, the cavity 
well washed and drained with the best results. 

This accident is by no means a rare one in the history 
of the Vienna “ Krankenhaus,” the average being two 
each year. The correct diagnosis of such cases can only 
be obtained by the history of the case with colic, Ac., 
and the symptoms of perforative peritonitis. 

Hochenegg differed from Ullmann in the diagnosis, 
for he was convinced they could easily be diagnosed. He 
added that his cases differed from Ullmann’s in that the 
bladder discharged into the cavity of the peritoneum. 
Again he differed from Ullmann as to the rarity of those 
cases. In infants he thought the case was very rare, 
there being only one case on record by Braun where the 
gall-bladder was found ruptured, after birth, with the 
contents in the peritoneum. 

Ullmann rejoined that all his cases had discharged into 
the peritoneum. 

Gussenbauer added that Hochenegg's did not ill 
rupture into the peritoneum since, as he had admitted, 
there were extensive adhesions around the stomach he 
had to remove. 

Paltauf thought a distinction must be drawn in the 
description of these cases according as the rupture is due 
to necrosiB, due to high tension of the viscus, or simply 
to a rupture of the wall of the organ without any ulcera¬ 
tion. The former is more likely to become sealed round 
the seat of the rupture and to prevent discharge of the 
contents into the peritoneal cavity. Where the rupture 
is sudden the contents will, of course, prompt'y find their 
way into this cavity. 


special Jlrtidcs. 


THE INTERNATIONAL CONGRESS ON 
TUBERCULOSIS. 

There could not well be a more worthy subject for 
disoussion at an International Medical Congress than 
the prevention of tuberculosis, a disease which wreaks 
its ravages among all classes of society without regard 
to age, sex, or nationality. The interest which the 
subject has excited of late throughout the civilised world 
is significant of a tardy awakening from the lethargy 
into which the public had fallen, crushed by the very 
magnitude of the evil with which we are now called 
upon to cope. The English Government was represented 
by fifteen delegates of acknowledged eminence, and the 
names of the foreign participants is a sufficient evidence 
of their special competence. 

In Professor Virchow’s admirable address the situa¬ 
tion is defined with masterly lucidity. While he 
recognises the existence of purely local tuberculous 
lesions which do not necessarily imply contamination of 
the carcass as a whole, the necessity for closer 
inspection of the meat supply is insisted upon, care being 


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Junk 7, 1899. 


THE OPERATING THEATRES. 


Thb Medical Pbkbs. 595 


taken to secure that foreign imported meat shall not 
escape control, an excellent principle, though its appli¬ 
cation will be found to present serious and possibly in¬ 
surmountable difficulties. Owing to the prevalence of 
tuberculous disease among milch cows the destruction of 
all infected animals is declared to be impossible, but unless 
this can be done the value of the tuberculin test as a 
means of detecting latent tuberculosis in animals is 
greatly impaired. If animals which give the charac¬ 
teristic reaction are not to be destroyed, what is to be 
done with them ? Failing this wholesale destruction we 
are fain to fall back upon methodical sterilisation of milki 
but this, in view of the habits of the poor, can never 
afford more than partial and incomplete protection. The 
Professor dwelt upon the importance and frequency of 
tuberculosis among swine, a point which has not hitherto 
received much attention in this country, possibly because 
it is less common here than in Germany, though 
we are hardly in a position to affirm that such 
is the case. In swine, we are told, the seat of infection 
is especially the glands in the neck. As the form of 
tuberculous disease which affects poultry is not identical 
with that from which human beings suffer the danger of 
infection from this source is assumed to be non-existent. 

It is comforting to have from Professor Frankel a con¬ 
firmation of the view that the bacilluB of tuberculosis 
only flourishes in the living tissues, and that it promptly 
loses its virulence when exposed to light and desiccation. 
It follows, speaking generally, that the risk of infection 
is confined to a zone around each focus of the disease. 
Unfortunately, the dense aggregations of underfed and 
unhealthy persons which are found in all large cities 
provide a peculiarly favourable soil for the propagation 
of the disease on these lines. 

Professor Pfeiffer laid stress on the important role 
played by secondary infections, indeed, it would seem 
that it is not until these appear on the scene that the 
condition of the tuberculous patient becomes more or 
less hopeless. 

Professor Loffler dismissed the onetime doctrine of 
heredity as unproved and scientifically improbable, 
but, though we agree that tuberculosis is, at any rate in 
the vast majority of instances, due to infection from 
without, we see nothing inherently impossible in the 
transmission of the disease as such. Syphilis is also a 
disease due to infection from without, yet it is certainly 
capable of parental transmission as we know but too well. 

Professor Kirchner touched on the delicate subject i 
of the marriage of tuberculous subjects, but, however 
desirable it may be in the abstract to prevent such mar* 
riages, we fear that the matter is one which must be left 
to the good sense of better educated communities. Still, | 
as it is a matter in which medical men are sometimes 
called upon to advise, it is well that one’s mind should be 
fully made up, if indeed it were not so before. More to 
the point were his remarks on the imperious necessity 
of having recourse in all cases of tuberculosis to the 
precautions which experience has shown to be necessary 
in respect of persons suffering from a communicable 
disease. Patients for the most part are perfectly 
willing to do what lies with them to prevent their 
becoming centres of infection, and when otherwise they 
piobably sin more from ignorance than from any indis¬ 
position thereto. 

Professor von Leyden brought forward the question of 


sanatoria for consumptives, a departure which is largely 
due to British initiative. The more we consider the 
figures the more obvious does it become that the task is 
one which will heavily task the resources of the richest 
states, unless ably seconded by private munificence and 
local effort. It will be necessary to secure the co-opera¬ 
tion of friendly societies, sickness insurance associations, 
and public bodies generally if the movement is not to fall 
through. So general is the interest in the subject and 
so nearly does the problem touch all classes of society 
that we are sanguine of ultimate success. At the same 
time, as the Professor pointed out, sanatoria can only 
deal with the fait accompli, though by facilitating 
recovery we diminish pro tanlo the tendency of the 
disease to spread beyond its actual foci. 

The problem with which we have to grapple is hydra¬ 
headed, but science has enabled us to recognise these 
heads, and our attention must be devoted to their extinc¬ 
tion by an attack all along the line. The problem 
comprises the better housing and the better alimentation 
of our labouring classes, their education in the means of 
oombatting the foe, the partial segregation or violation 
of the sick, and the protection of the healthy. Science 
has slready done much, but more, much more, remains 
to be done. Let us hope that the wave of public opinion 
which has traversed the old world, will not subside with¬ 
out leaving a permanent mark on the preventive medi¬ 
cine of this century. 


(Dptratm# theatres. 

ST. THOMAS’S HOSPITAL. 

Mteloid of Upper and Lower Jaws treated bt 
Enucleation.— Mr. W. Anderson operated on a girl, 
ret. 24. for myeloid tumours of upper and lower jaws. 
The patient had noticed during the last four years an 
enlargement of the right side of the body of the lower 
jaw ; this inci eased slowly and painlessly, and two years 
ago a small swelling appeared at the root of the nasal 
process of the superior maxilla; there was no glan¬ 
dular enlargement. On admission the right half of the 
body of the lower jaw was found to be increased to the 
size of an ordinary lemon by a growth within the bone; 
most of the teeth over the growth were lost, but the 
gums were entire; the swelling was uniform in surface 
and invested by a shell of bone. A similar but much 
smaller growth wsb found in the superior maxilla at 
the root of the nasal process. The patient was an 
urremic undergrown girl, suffering from chronic 
menstrual disturbances. Mr. Anderson made an 
incision a little below the body of the lower 
jaw, dissected down to the surface of the tumour r 
chiselled away the whole of the shell of bone forming 
the anterior wall and exposed a soft endosteal growth 
this was carefully enucleated with a scoop, the in¬ 
terior of the shell was wiped out with cyanide gauze, 
and the wound closed by subcuticular suture. The 
tumour of the upper jaw was treated in a similar way. 
Mr. Anderson remarked that the co-existence of two 
myeloid growths in the same patient was very rare ; 
there could be no doubt of its nature, and it was this 
certainty that led to the treatment of the condition by 
enucleation rather than by complete excision. It is 
well known, he said, that the myeloid growths have little 
tendency to multiply by the infection conveyed through 


Digitized by LjOOQle 


596 The Medical Press. LEADING ARTICLES. Jukb 7, 1899. 

REGISTERED FOR Transmission Abroad. 


the blood or lymph streams, or to spread by infiltration 
of the adjacent tissnes; hence if the cell growth can be 
completely removed the prospects of a permanent cure 
are very good. The complete excision of the tumours 
would have given rise to great deformity, while the plan 
adopted would leave only a linear scar. 

Histological examination made a few days later con¬ 
firmed the diagnosis. 

HOSPITAL FOE SICK CHILDREN. 

Operation for Old-Standing Empyema. — Mr. 
Abbuthnot Lane operated on a child set. about 6 
years, who presented a small obliquely placed sinus in 
the front of the right chest from which a quantity of pus 
exuded. On passing a probe into this sinus the instru¬ 
ment entered the general pleural cavity. Mr. Lane exposed 
three ribs in the lower and back part of the chest, and 
removed three inches of their length with the intervening 
intercostal muscles, Ac. The pleural cavity was found to 
be open throughout the whole of its length except where 
the diaphragm had formed adhesions to the lower 
limit of the chest. It was not possible to recognise the 
lung on the inner wall since it appeared to have collapsed 
completely, but this was not surprising, as this condition 
of empytema had existed for about six months. The 
pleural cavity was cleaned as thoroughly as possible, and 
then closely packed with iodoform gauze. This process 
was repeated on two subsequent occasions under an 
anoesthetic. On the last occasion the contents of two 
large bottlefuls of decalcified bone were inserted into the 
cavity, these just sufficed to fill it up to the 
level of the ribs. A quantity of iodoform was 
dusted over the wound and iodoform gauze applied 
over it. These dressings were not changed for three 
weeks. Mr. Lane said that the decalcified bone used 
was that suggested by Dr. T. W. Eobinson, Honorary 
Surgeon to the Huddersfield Infirmary, and described by 
him in the Lancet of October 2nd, 1897; Dr. Eobinson 
employed it with the idea that it would form a tem¬ 
porary scaffolding for the granulation tissue cells, which 
would by this means be kept alive and not discharged 
from the surface as pus. He obtained most excellent 
results by its use. Mr. Lane had employed the 
method for a long time with complete success; he had 
never before used it in such large quantities as in this 
particular case, although he had on one occasion filled 
the space which had been originally occupied by half the 
length of the shaft of the femur in an adult with it. He 
pointed out that it is exceedingly important that the de¬ 
calcified cancellous tissue should be kept at rest after the 
insertion of the decalcified bone, and he hoped that the 
mobility of the chest wall and diaphragm was sufficiently 
limited for this purpose. 


Dr. J. B. Bradbury, Downing Professor of Medicine in 
the University of Cambridge, has been appointed 
Croonian Lecturtr for 1899 at the Royal College of 
Physicians of London. “ Sleeplessness and Hypnotics ” 
has been chosen as the subject of his lectures which will 
be delivered at the College on June 20th and following 

days. - 

Dr. Pye-Smith, Physician to Guy’s Ho-pital and a 
jnember of the Senate of the University of London, has 
been appointed to the seat on the General Medical 
Council, vacant by the death of Sir Wm. Roberts, as 
representative of the University. 


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JfUbical frees attb fttrrular. 


8ALU8 POPULI 8DPREMA LEX.” 


WEDNESDAY, JUNE 7, 1899 


DISPENSING BY DOCTORS. 

A contemporary professing to represent the 
English general practitioner speaks of “ the claim 
which has been advanced by chemists to a monopoly 
of dispensing” as “ unwarrantable ” and impossible, 
a statement which shows how far the spirit of trades 
unionism will carry those who have their eye fixed on 
their own pecuniary interests. We admit that the 
complete divorce of the medicine trade from medical 
practice in England has come to be almost impossible, 
as has also the purgation of the chemist's trade from 
counter prescribing, but we unfeignedly regret the fact 
and maintain that the desire that the doctors shall stick 
to their own legitimate business of diagnosing and 
prescribing is, in no respect, more “ unwarrantable ” 
than the contrary demand, which our contem¬ 
porary is never weary of pioclahning, that 
chemists shall stick to their's and abstain from 
exercising the doctorial functions. In this matter 
we suggest that the just rights of doctor and 
chemist are on all fours. The chemist may abuse 
his position by advising and prescribing upon 
a dangerously insufficient knowledge of medicine 
and surgery, and by doing so without seeing the 
patient, but, on the other hand, we cannot claim for 
our profession any expert acquaintance with 
chemistry and pharmacy nor any facilities for 
making up medicines equivalent to those enjoyed by 
the chemist. The trades union bias of our contem¬ 
porary is manifested by the text which it selects for 
its sermon, i.e., the employment by medical practi¬ 
tioners of unqualified boys to make up the principals* 
medicines, the result of which practice in one recent 
case was the fatal poisoning of a patient, and it holds 
that it is quite legitimate for a general practitioner 
to employ such an assistant on his own respon- 


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LEADING ARTICLES. 


The Medical Press. 597 


June 7, 1899. 

sibility, and it protests in anticipation against any 
public opinion to the contrary. But our con¬ 
temporary forgets that, for years past, it has 
exhausted its energy and its logic in a screech against 
the analogous practice of employing unqualified assis¬ 
tants by general practitioners. It has represented 
that the assistant employed for diagnosis and visiting 
and prescribing should be put to the sword without 
mercy, unless he can produce a medical qualification, 
and yet it now represents that the analogous assistant 
may with perfect propriety be employed for measur¬ 
ing out medicines and interpreting prescriptions 
without producing a pharmaceutic qualification. An 
observer must be wilfully blind who fails to dis¬ 
cern that the difference between the two cases, 
from our contemporary’s point of view, is 
that the unqualified medical assistant was a 
serious competitor with the general practitioner and 
diverted many of the fees which the practitioner 
might receive, into the till of his employer the doctor, 
while the unqualified dispenser is the essential jackal 
of the general practitioner and enables him to earn 
large profits on medicine vending which he could not 
obtain without his help. The whole dispute is a 
question of shop and of money, and does not deserve 
to be raised to any higher level. 

Apart, however, from these sordid interests 
there is an obvious reason why the function 
of the general practitioner in country districts 
cannot be, at least at present, divorced from 
dispensing. Suppose the practitioner derived no 
profit, direct or indirect, from the medicines which 
he supplies, he would, nevertheless, be compelled 
to continue the supply because there exists in 
most agricultural districts, no other means by 
which his patient could be supplied. Qualified 
chemists do not grow on the roadside, and it would 
be simply impossible for a practitioner to send his 
patient's messenger to the neighbouring town for all 
the medicines which he found it necessary to pre¬ 
scribe. He has no choice but to keep them in his 
own house and send them to the patient when made 
up, and he must, so far, usurp the ’function of the 
chemist, but we can see no just reason why, if he 
employs a dispensing assistant, he should be allowed 
to omploy one without knowledge. In town practice 
we can discern no element save the money profit 
which should induce the practitioner to make up his 
own medicines, but, if he sees it to be his interest to do 
so, we do not discern how he can justly complain if 
his neighbour the chemist follows his example. 


THE QUESTION OF “EXERCISE.” 

It is well for us to have clear ideas on what kinds of 
exercise and games we ought to encourage, and what 
we ought to object to. The spirit of competition is 
now entering so much into nearly all the games, which 
were formerly encouraged for the exercise they 
afforded, that instead of doing good, they may do 
harm. In such exercises as rowing, skating, swim¬ 
ming, and dancing, the chief pleasure enjoyed is 


not from competing with and defeating others ; but 
from the curious effect of movement upon the nervous 
system, whether the individual is alone or in harmony 
with othere. We see this in many animals, indeed, 
more than in onr own species. What we have to 
consider now is whether instead of this being the 
object of the games of to-day, the desire to excel and 
attract attention does not prevail more than it 
ought, whereby the good effects of exercise upon the 
system are changed into the bad results of excess. 
It is well for us to consider carefully what are, or 
ought to be, the objects of exercise, and whether it 
is the mental, the moral, or the physical development 
that we seek for, when exercise is encouraged. We 
doubt much the value of “gymnastics” when we 
desire to improve the two first, the most important 
parts of education, and if any exercise has no object but 
that of developing the muscles, without considering 
its influence as a recreation, it is right that we should 
discourage it when we find it being forced upon those 
who are being educated for the work of life. When 
we have to consider the various games and recrea¬ 
tions which enter into the school and college life 
of the rising generation, we are justified in preferring 
those that afford some occupation for the mental 
as well as the physical qualities of the individual. It 
is for this reason that we doubt the value of the 
gymnasium in comparison with such exercises as are 
afforded by cricket, rowing, tennis, golf and other 
kinds of recreation, which take the mind away from 
the subjects which have occupied it and give it rest 
by change of occupation. It is well for us to have 
some distinct principle to guide us in this matter, for 
there is no subject of greater importance to a nation 
than the education of its youth. It seems to-day as 
if the desire of exhibiting to spectators is 
influencing our games most prejudicially. The 
true enjoyment and benefit of games is greatly 
marred when vanity is excited by the atten¬ 
tion of on-lookere. There is too much profes¬ 
sionalism, and too much of the spirit of business in 
popular recreations at present to make them serve 
their best purposes, and justify us in encouraging 
them. And with this spirit of exhibition and compe¬ 
tition there creeps in the degrading vice of gambling 
and the chief interest of sports becomes one of specu¬ 
lative betting. Our universities have seriously 
opposed these tendencies, at least the last generation 
did so; and now that exercise of various kinds is 
forming a much more important part of school 
education than it used to do, it is proper that those 
who are controlling our games should understand the 
scientific and moral principles which are important 
in this part of their work. We have more to say on 
this subject later on. 


THE INSPECTION OF “HIGHER" 
EXAMINATIONS. 

The question raised last week by Mr. Victor 
Horsley in regard to the statutory duty of the 
General Medical Council to inspect the so-called 
*' higher examinations ” of the medical Corporations is 


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598 The Medical Press 


NOTES ON CURRENT TOPICS. 


June 7, 1899. 


one of far-reaching importance. It is not one to 
be decided either by precedent or by opinions, for the 
matter rests on the interpretation of certain clauses 
of the Medical Acts, and the construction to be placed 
thereon must be referred the Council’s legal advisers, 
though their opinion on the subject would not neces¬ 
sarily be conclusive. The matter has not hitherto 
attracted much attention, probably because it is ex¬ 
tremely rare for persons to claim registration on the 
strength of the diplomas to which such examinations 
are the passports. Guided by precedent, the President 
last session ruled out of order amotion by Mr. Victor 
Horsley calling attention to the alleged insufficiency 
of the examinations for the fellowship of a particular 
corporation. Though the ruling was technically correct, 
inasmuch as the motion embodied statements which 
were not strictly in accord with the facts, it was con¬ 
strued to mean, and the recent action of the Council 
confirms that construction, that these examinations 
are not within the purview of the duties of the 
Council. The President said that the Council, in 
attaining from the inspection of these examina¬ 
tions, has been guided by Section 30 of the 
Medical Act (1858). This section provides for 
the registration of higher or additional qualifies- ! 
tions,” but of course ssys nothing about the 
examinations themselves, so that this point is left 
open. The law, however, requires the Council to 
inspect qualifying examinations, that is to say, 
examinations which would confer upon the successful 
candidate the right to claim registration. The 
fellowships of the colleges are expressly mentioned 
in the official list of registrable diplomas, and there 
is nothing to prevent a fellow who has neglected to 
register his membership, or who has gone straight to 
the fellowship, claiming admission to the Register on 
the strength of his diploma of Fellow. Indeed, it is 
within our recollection that a gentleman who had 
obtained the higher diploma of the Royal College of 
Physicians of London, practically on the strength of 
his foreign degree, was admitted to registration, 
though this was subsequently the subject of 
discussion which resulted, if we are not mis¬ 
taken, in the College undertaking not to grant 
such higher diploma in future to persons not 
otherwise entitled to be registered. This instance, 
however, establishes the right of the higher 
diploma to admission to the Register, and it 
follows that such examinations are for all 
practical purposes qualifying examinations. Under 
these circumstances it is difficult to see how 
the Council can continue to evade its statutory duty, 
and it is open to Mr. Horsley to raise the question 
afiesh on more definite lines, and to place the Council 
on the horns of a dilemma. It is all very well for 
Sir Christopher Nixon to talk about this or that body 
refusing inspection. It will be time enough to think 
about how to enforce the law when the Council have 
made up its mind to apply it. One rough and ready 
means suggests itself—viz., to refuse registration of 
all diplomas of the stiff-necked body until it had 
bowed the knee. 


$Qt cb <m torrent ‘topics. 

The General Medical Counoil and 
Dispensaries. 

The trial of Dr. Stewart, of Denton, near Man¬ 
chester, on a charge of covering one Burgess in con¬ 
nection with a certain provident dispensary, mark* 
a further step in the evolution of the Council's views 
as to what constitutes “ covering.” The circum¬ 
stances were peculiar in that the defendant claimed to 
be merely the paid officer of a dispensary nominally 
managed by a committee of labouring men who also 
engaged the dispenser whose conduct constituted the 
offence. According to the annnal report some 28 000' 
patients were visited at their homes annually in addi¬ 
tion to close on 200 surgical operations and about tbe- 
same number of confinements. Dr. Stewart said ho 
did all this work unaided except in the matter of dis¬ 
pensing. and he formally denied that Burgess ever 
attended to patients, to his knowledge, or 
assisted at operations. It is worth noting that on 
bis own showing it was Dr. Stewart’s practice to 
give chloroform and operate himself, often without 
the presence of a third party, and this even for such 
an operation as the relief of strangulated umbilical 
hernia or the removal of a cancerous breast. If true r 
this statement conveys its own condemnation, but the 
evidence justifies us in regarding Dr. Stewart's state¬ 
ments with suspicion. Even the figures given above- 
are open to critioism seeing that no books or records- 
of any kind are kept. The question before the 
Council was whether Dr. Stewart could be held re¬ 
sponsible for the conduct of the dispenser, who r 
with or without Dr. Stewart’s knowledge, had oertainly 
visited and treated patients and given chloroform. 
To find that he was not responsible would evidently 
open the door wide to the most barefaced violation of 
the Council's rules on the subject, but, fortunately for 
the Council and also for the profession, it was easy 
to arrive at the conclusion that Dr. Stewart could 
not possibly have been ignorant of his assistant’s 
doings, and if cognisant thereof, he could plainly be 
justly held responsible therefor. This was the view 
taken by the Council who found Dr. Stewart guilty 
of the offence charged against him, but in view of the 
novelty of the circumstances merely bound him over 
to come up for judgment in November. It is impos¬ 
sible to exaggerate the importance of this verdict 
which vindicates professional honesty of purpose, 
without making Dr. Stewart the scapegoat of a vicious 
and intolerable state of things. By this decision the 
Council have made it plain that they are not to be 
hoodwinked by the manipulation of a few puppets 
dubbed trustees or managers, and by inference it is 
laid down that a registered practitioner who asso¬ 
ciates himself with an institution which is run on 
unprofessional lines is himself guilty of unprofes¬ 
sional conduct. Although the point was not formally 
raised in this case it may reasonably he inferred that 
the Council would consider touting for members to 
be unprofessional, and this is another step in advance. 

| The decision will clear the atmosphere. It will no 


Digitized by Goode 



June 7, 1899. 


NOTES ON CURRENT TOPIC8. 


longer be open to practitioners to plead ignorance of 
the views of the Council in the matter, and those 
who sin in future will do so with full consciousness 
of the penalties they are incurring. 

Prison Vaccination. 

A vaccination incident that occurred a few 
weeks since in connection with the Glasgow Prison 
is worthy of a passing note. It appears tnat in the 
course of his duty the Medical Officer of the institu¬ 
tion named vaccinated one of the prisoners. The 
result was an impetiginous arm, and on leaving 
prison the patient brought an action for £500 
damages against the operator. The claim was dis¬ 
missed both at the original trial and on appeal, 
chiefly on the ground that the plaintiff had been 
fully apprised beforehand of the nature of the 
operation to which he was to be subjected. The 
pursuer, on the other hand, contended that he 
was led to suppose that the vaccination formed 
part of the prison discipline, to which he was 
forced to submit. Under such circumstances it would 
certainly be wise for the prison surgeon to lay both 
sides of the case before a prisoner so that there could 
be no shadow of a doubt as to the legal and volun¬ 
tary position of both parties to the proposed 
transaction. As to the unfortunate pus inoculation 
the accident is not after all said and done a very 
serious one. It is less and less likely to occur under 
modem methods, but may occur now- and then in the 
practice of even the most careful Burgeon. Certainly 
where it can be shown that ordinary precaution as to 
sterilisation of hands and skin surfaces had been 
observed, there could be no ground of action for 
malpraxis. 

Joint Stock Consultants. 

Most of our readers are aware that the system 
under which third parties farm out the services of 
practitioners to whom they pay a salary, making a 
considerable balance of profit, is being now extended 
to the employment of so-called consultants. This is 
the "Medical Aid” system, and in Birmingham it 
is being exploited by no less a personage than Mr. 
Arthur Chamberlain, but the original inventor of it 
is a Mr. Bracey, a medical practioner, and connected 
with the Balsall Heath Dispensary. Four years 
ago he succeeded in persuading the managers of that 
institution to appoint seven consultants; these 
gentlemen agreed to accept half a guinea for a con¬ 
sultation, but do not appear to have devoted their 
whole time to the work of the dispensary; it seems, 
however, that Mr. Chamberlain expects that the con¬ 
sultants’ whole time will be required by the institution 
which he proposes, and he offers £500 a year, beside the 
half guinea fee, to anyone willing to accept the position. 

Nothing can be gained, we think, by treating the 
acceptance of the consultative position as a matter of 
medical etiquette. Of course, most self-respecting 
members of the profession will shrink from the pro¬ 
posal that they shall farm out their services for 
Mr. Arthur Chamberlain or anyone else to make 


The Me dical Press. 599 

a profit out of them, still £500 a year, with the 
prospect of considerable addition from consultation 
fees, must be too tempting to be resisted by many 
men, and, in any case, the position cannot be said to 
be anything less than respectable from a pecuniary 
point of view. The question settles itself when we 
consider that a consultant (as the profession under¬ 
stands the term) at half a guinea a visit is an impos¬ 
sibility. The great majority of English patients 
adhere with confidence to the ministration of their 
“ family doctor ” or general practitioner as long 
as they possibly can, and do not feel the 
need for a consultant until they are seri¬ 
ously alarmed. .When they are seriously alarmed 
a ten-and-sixpennny consultant is, not what 
they want. He is cheap but decidedly nasty, and 
one in fact little better for them than the “ family 
doctor,” for whose opinion corroboration or reversal 
is sought. In such circumstances the patient wants 
a specialist of long experience and well recognised 
skill, and the patient will speedily come to learn that 
he can get nothing but a sort of Jack-of-all-tradee 
by contract for ten and sixpence. Such a “ consul¬ 
tant ” will do well enough to correct the diagnosis of 
a general practitioner for the nonce, but, as a judge 
of final appeal we are certain that the public will have 
none of him, but, when it must, it will resort to a well- 
known specialist and pay him the fee which such an 
adviser is entitled to expect. 

The Bogus Post-Mortem Case. 

Our readers will doubtless remember the curious 
case which occurred last year, in which a medical man 
named McKay was charged before Mr. PJowden, 
the Metropolitan Police Magistrate, with wilful 
and corrupt perjury at the instance of Mr. 
Braxton Hicks, the Coroner, in connection with 
certain evidence which had been given before 
him at an inquest. Briefly recapitulated it was 
alleged that McKay had sworn to having made a 
careful examination of the brain and viscera whereas* 
according to the evidence of the police surgeon, 
who, on the Coroner's order, made a subsequent 
examination of the body, no real post-mortem 
examination had ever been made. Recalled 
before the coroner, and confronted with this evidence 
McKay blindly adhered to his previous statements, 
whereupon the Coroner ordered him to be charged 
with perjury. Mr. Plowden, whose behaviour through¬ 
out the hearing of the case was characterised by 
extreme discourtesy and flippancy, laughed the 
case out of court on the ground that it was 
merely a question of a difference of opinion between 
two doctors. We commented on the case at the 
time, and the result of the trial, which took 
place before the General Medical Council on 
Thursday last, amply justifies the views we then 
put forward. Mr. McKay was charged before his 
peers with having failed to make the examination 
required of him and with having falsely sworn con¬ 
trary to the facts. The evidence was overwhelming* 
indeed the defendant had absolutely no defenoe to 


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600 The Medical Press. 


NOTES ON CURRENT TOPICS. 


June 7, 1899. 


offer, and tbe conduct which Mr. Plowden thought so 
lightly of has been adjudged by a full Council to be 
“ infamous,” and to merit the erasure of his name 
from the Register. There is no more responsible duty 
thrown upon the medical practitioner than the 
making of post-mortem examinations, and it is diffi¬ 
cult to qualify, as it deserves, the conduct of a prac¬ 
titioner who deliberately swears to statements which 
he has not taken the trouble to verify, with the result 
that the evidence which he gave was positively mis¬ 
leading. 


Sir George Pilkington, M.P. 

The new member for Southport is a member of our 
profession, and has seen something of hospital and 
private practice when he was a surgeon to the South- 
port Infirmary. His original name was Coombe, and he 
is the son of Dr. Coombe who practised at Upwell in 
Cambridgeshire, but he assumed the name of Pil¬ 
kington and the estates held by Mr. James Pilkington 
who, for nineteen years, represented Blackburn in 
the Liberal interest. Sir George holds the diplomas 
of the London “ College and Hall ” of the year 1870, 
and he has served as Mayor of Southport, and in 
many other public capacities. 


Smoking in Theatres. 

It is reported that the Theatrical Managers’ Asso¬ 
ciation are desirous of introducing the privilege of 
smoking into theatres, and obtaining the sanction of 
the Lord Chamberlain to this innovation. This 
public official has power to make regulations for the 
safety and comfort of the audience, and in the 
exercise of his discretion he has generally prohibited 
smoking. "We trust that this prohibition will be con¬ 
tinued, the Theatrical Managers Association notwith¬ 
standing. A member of the latter body has said. 
“I am certain of this that the first West End 
theatre which gives a light entertainment and per¬ 
mits smoking in the auditorium will make a big 
fortune.” Quite possibly this might prove to be the 
case, but “ a light entertainment ” which could only 
be made attractive by permitting the audience to 
smoke, is scarcely likely, we think, to become a'popular 
feature among the theatre-going public who know 
the difference between a theatre and a music- 
hall. It may be quite true that the habit 
of smoking in their presence is not much 
resented in the present day by ladies, but it 
does not follow that because such tolerance 
has been acquired by custom, that the health of our 
wives and daughters is improved by allowing 
them to expose themselves to a atmosphere reeking 
of tobacco smoke when in search of amusement. The 
ventilation of most theatres, especially in hot weather, 
is bad enough as it is, but if, to the already bad 
hygienic conditions, smoking be added, then 
the theatre, as a source of amusement, will 
become a place to avoid. We submit that in the 
interests of the health of the public who patronise 
theatres the proposed innovation would be distinctly 
harmful. A good play does not require the 


BtimuluB of a pipe, a cigar, or a cigarette 
to make it interesting; on the other hand, 
a music - hall entertainment can seldom be 
tolerated without one or the other. To endeavour, 
therefore, to convert a theatre into a music-hall, and 
to lower the standard of the entertainment of the 
former so as to bring it to the same level as tbe 
latter, appears to us to be a questionable policy for the 
Theatrical Managers’ Association to pursue, apart 
from the other considerations which we have named. 


More Bones in Southwark. 

Metropolitan Southwark appears to be fated to 
intermittent public commotions in the matter of its 
ancient burial grounds. It is not many months ago 
that St. George’s, Southwark, was made a nine days’ 
wonder by reason of an order issued from the Home 
Office to remove and bury elsewhere the remains of 
some two thousand parishioners whose bodies had 
been interred in the crypt of the parish church. By 
the way, it is interesting to learn that the work 
of removal has not yet been commenced, 
although ten months have sped by since the 
issue of the departmental order. Now, the 
neighbouring parish of St. Olave’s, Southwark, has 
got up another little scandal of its own. The Bishop 
of Southwark, wishing to clear the bones out of 
a certain church, secured the co-operation of Dr. 
Bond, medical officer of health, and proceeded without 
further parley to effect the clearance. Whether or 
not his lordship had previously secured the sanction 
of the Ecclesiastical Commissioners we cannot 6ay. 
The matter got wind, however, and unsparing 
public comment, both official and journalistic, there¬ 
upon became the order of the day. The Vestry have 
suspended the medical officer of health, an extreme 
step that will necessitate an inquiry by the Local 
Government Board. Whatever the rights of 
the case may be, it seems hardly wise for 
a public official to commit himself to private 
action in a matter so technical and hedged in by 
legal safeguards and difficulties as the clearance of a 
burial place. History has abundantly demonstrated, 
moreover, that the episcopal ardour is apt to lead to 
legal complication. The Bishop of Rochester, to 
whom His Lordship acts as suffragan, has since 
closed the Church, so that what with the indignation 
of the public and the apparent neglect of legal forms, 
there is every prospect of a rapid thickening of a 
somewhat sensational plot. 

Specialism in Excelsis! 

At the meeting of the American Medical Associa¬ 
tion which takes place on the 6th inst. at Columbus, 
there is to be a section devoted to proctology, an 
euphonious term to designate practitioners (or shall 
we say proctitioners ?) who make the rectum their 
special study. We will make bold to say that the 
proceedings in this section will be much more seemly 
than in the Ethical Section of the British Medical 
Association, in spite of the uninviting nature of the 
subject. * 


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June 7, 1899. NOTES ON CURRENT TOPICS. The Medical Press . 601 


The Prohibition of Indiscriminate Kissing. 

It has been found nece ssary in certain parts of the 
United States to direct the attention of the legisla¬ 
tures to the desirability of prohibiting indiscriminate 
kissing, not, it would appear, in the interests of 
public morality or in d eference to the susceptibilities 
of the American Mrs. Grundy, but with the view of 
checking the Bpread of tuberculosis. Either 
the tubercle bacillus must possess unaccustomed 
virulence in the Western hemisphere or else the 
kissing that goes on there must be unduly, indeed, 
unneces sarily, prolonged. Kissing, even indiscrimi¬ 
nate, has not been included by Sir Richard Thome- 
Thorne among recognised factors in the spread of 
tuberculosis. Assuming the accuracy of the allega¬ 
tion, we may point out that it is one thing to prohibit 
indiscriminate kissing, and another to enforce the 
veto. It would have to be a conditional veto, that is 
to say, no young person would be allowed to indulge 
in promiscuous kissing until he or she failed 
to react to the tuberculin test for the disease, and 
even then the written consent of the parents might 
be insisted upon, duly authe nticated by the nearest 
parson or magistrate. With singular lack of good 
taste, the memorialists have coupled with this repre¬ 
sentation the expression of a desire to restrict spitting 
in public places, as though the two nuisances (?) had 
anything in common. 

Nicholas Senn, M.D., LL.D. 

Dr. Nicholas Senn, of Chicago, has been ac¬ 
corded the honorary degree of Doctor of Laws by 
the Trustees of Jefferson Medical College. Is it not 
about time this farce of conferring honorary degrees 
was abandoned by all self-respecting universities? 
We Bpeak with bated breath, seeing that our own 
universities are still absurdly generous with such 
titular distinctions, and even appear to take plea¬ 
sure in exaggerating the absurdity of the practice 
That a physician or surgeon should be made an 
honorary Fellow of his College is reasonable enough 
when his professional status seems to call for official 
recognition, but to make a medical man who is 
obviously a stranger to law, a doctor of that ilk is 
about as absurd as to make a princess a Doctor of 
Music. A degree either means something or nothing, 
and if the latter it is surely unwise to call attention 
to the fact, thereby sapping the esteem which Univer¬ 
sity degrees still attract among the unlearned. 

The New Vaccination Act. 

The anti-vaccinationists who imagined that Mr. 
Balfour’s surrender of compulsory vaccination had 
placed the game in their own hands have had a sharp 
reminder that unrevoked law holds good in this 
country. Last week in the - House of Commons a 
member moved the reduction of the Local Govern¬ 
ment Board supply because vaccination inspection ; 
generally had been directed to enforce prosecutions 
without regard to the particular views of local boards 
of guardians. In reply, Mr. Chaplin proclaimed him. 
self a firm advocate of vaccination and declined to 
withdraw the circular of which complaint had been 


made. The gist of the document is that defaulters 
should be prosecuted by the inspectors without wait¬ 
ing for directions from their boards. That is 
to say, the officials mentioned are to proceed 
as they have always done under untouched provisions 
of former Acts. The position of anti-vaccinationist 
members is not clear. They have gained the enor¬ 
mous concession of conscientious objection, and now 
they seem to think that the new principle involved 
should free persons who are too careless to avail 
themselves of that method of evading the obligation 
to vaccinate. Reduced to a plain statement, Mr. 
Pickersgill and bis brother anti-vaccinationists are 
making a deliberate attempt to override the law of 
the realm, and to convert their inch of privilege into an 
ell of illegality. It is a way of the sect to pose as 
injured martyrs, and we hope to deal at length with 
some of their arguments in an early issue. 

The New Medical Staff of the Seamen’s 
Hospital Society. 

The Seamen’s Hospital Society have, it is true, 
succeeded in filling the vacancies on the medical 
staff of their hospital created by the resignation of 
the well-known physicians and surgeons which took 
place some weeks ago, but that is practically all that 
can be said upon the matter. As a protest to the 
treatment which the late staff received the appoint¬ 
ments have clearly been left severely alone by physi¬ 
cians and surgeons of acknowledged position, for 
otherwise the names of well-known consultants 
would have figured upon the list of the new staff. We 
are glad that in this respect the committee of the 
Seamen’s Hospital have been taught a lesson. The 
members of their late staff were all well-known mem¬ 
bers of the profession, for the most part attached to 
important hospitals in London—the same cannot be 
said of those whose services have just been secured 
to fill the vacancies. There has, therefore, been a 
distinct loss of prestige in the ti-ansaction, which 
might never have occurred had the committee in 
question acted with that politeness and consideration 
to their late staff such as the latter were at least 
entitled to expect. 

The Typhoid Epidemic in Philadelphia. 

“ After an epidemic of typhoid fever of shameful 
proportions and duration,’’ says the New York Medi¬ 
cal Record, “ in the course of which some thousand 
lives have been sacrificed, the authorities of Phila¬ 
delphia have ordered an investigation of the water 
supply of that city.’’ There are evidently some things 
which they do not do better in the States, or at any 
rate in Philadelphia, In this country any undue 
prevalence of typhoid fever promptly attracts official 
attention, and the district is pounced upon by a Local 
Government Board Inspector, who gives wiggings 
where wiggings are due—and then, as often as not, 
things go on ut ante. We note that this is the 
moment the citizens of Philadelphia have chosen to 
petition the Mayor for “ a quiet Sunday.” If this 
epidemic be allowed to proceed unchecked we shall 
soon have the silence of the grave, and the city 


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602 The Medical Press. NOTES ON CURRENT TOPICS. 


June 7, 1899. 


will cease to have any but an etymological claim to 
its name. 

The Royal Orthopaedic Hospital. 

The dispute at the above hospital raises in a 
pointed form the whole question of the management 
of’the medical charities. It is, of course, known to 
everyone that the interest of the average subscriber 
to the hospitals ends with the payment of his 
donation. The result is that the management is apt 
to drift entirely into the hands of a few persons, who 
may or may not be models of probity and good judg¬ 
ment. While as a general rule we condemn utterly 
the manufacture of “ faggot” votes it must not be 
forgotten that under such circumstances it may be 
the only weapon wherewith to fight an obviously 
corrupt or faulty governing board. In advancing this 
view we do not for a moment reflect on the good 
faith of the committee that has hitherto administered 
this particular hospital, which is obviously above 
and beyond suspicion. At the same time the right 
of the governors of a hospital to manage affairs in 
their own way is indisputable, and no system that 
fails to provide for a free election of management 
can claim to be on a satisfactory basis. The party 
until lately in power at the Orthopa: die Hospital are 
bringing forward a new rule to exclude members of 
the honorary staff from the executive committee. To 
attempt to exclude members of the staff because they 
hold differing views is, in our opinion, the most 
damning method of argument that could be brought 
forward by Sir Walter Gilbey. So far irom that 
course being desirable, we would make the whole 
staff ex officio members of executive, and add to their 
number outside general practitioners. It is only by 
such a leaven that any hospital can hope to be in 
touch with the wants, the wishes, and the aspirations 
of the medical profession at large, interests that are 
now too often ridden over roughshod. 

Typhus Fever in London. 

We learn from the New York Medical Record that 
typhus fever has been mildly epidemic in London 
during the past winter, the diagnosis having appa¬ 
rently only recently been made, most of the cases 
having been returned as typhoid, pneumonia, or 
influenza. There is some excuse for the non-recogni¬ 
tion of the disease by the British medical practitioner, 
because not one in a thousand, even if in large prac¬ 
tice, have ever been privileged to see a case of typhus, 
either in hospital or outside. This is just one of the 
diseases that might advantageously be made the sub¬ 
ject of post-graduate lectures, illustrated by artifi. 
cially coloured wax models to show the eruption. 
Post-graduate institutions, please note! 

Unvaccinated Camp Followers. 

The War Office has intimated that the health of 
troops cannot be allowed to be imperilled by the in¬ 
troduction into their barracks of the unvacciLated 
wives and children of soldiers. Such persons will, 
therefore, have to live outside until they have been 
vaccinated, and they will not, in future, be carried 
to foreign stations at public expense. 


The Elections at the Irish College of Surgeons- 
The annual election of the President, Vice- 
President, and Council of the College came off on 
Monday last, as fixed by the Charter. For the first- 
named offices there was no contest, as it is the custom 
of the College that the President and Vice-President 
shall serve for two years, and Mr. Robert L. Swan 
and Mr. T. Myles were accordingly re-elected nem. die. 
The secretary of the College, Sir Charles Cameron, was 
also re-elected, this office being practically permanent. 
As regards the Vice-Presidency of next year (June- 
1900), which will be vacated by Mr. Myles on his pro¬ 
motion to the presidential chair, the interest in 
centred upon the contest for the honour between Mr. 
Lambert Hepenstal Ormsby, Surgeon to the Meath 
Hospital, and Mr. Francis T. Houston, Surgeon to the 
Adelaide, whose respective claims, as far as can be- 
judged at present, seem to be pretty equally sup¬ 
ported by the Fellows. Already the canvass for votes- 
is in active progress. For election to the 19 seats 
on the Council of the College, 24 Fellows offered 
themselves. All the outgoing Council were candi¬ 
dates, but Mr. Henry Gray Croly and Mr. Arthur 
Benson had left a hiatus by the reoent election of 
the former as an Examiner in Surgery, and 
the retirement of the latter. Of the retiring 
Council all were re-elected except Mr. Arthur 
Chance, of the Mater Misericordia Hospital. Mr- 
William Stoker, professor of surgery in the college, 
and Mr. John B. Story, of St Mark’s Ophthalmic 
Hospital, and Mr. Richard Bolton MacCausland, of 
Stevens’s Hospital, secured the three open seats. The 
total poll (which is taken by ballot papers) was 225 
out of a possible 290 Fellows. 

The Irish Medical Association. 

The Committee of Council met in the Royal 
College of Surgeons of Ireland last week and com¬ 
pleted arrangements for the annual meeting, to be 
held in Cork on June 20th. Efforts are being made 
to obtain the consent of the railway companies to- 
grant to members attending the meeting return 
tickets at single fares. The resolutions to be pro¬ 
posed at the meeting were considered and approved. 
The commentary on the Local Government Board 
rules for the government of dispensary districts was- 
under consideration, and will be issued to members 
during the present week. 


The Birthday Honours. 

The 80th birthday of the Queen has been marked^ 
contrary to the general anticipation, by a scant array 
of honours. The medical profession, however, enjoys 
a good share in the published list. First and foremost 
comes a baronetcy for Dr. Burdon Sanderson, who has 
been a distinguished member of the profession for 
over fifty years. He is Regius Professor of Medicine 
at Oxford, and before taking that post held the 
Waynflete Professorship of Physiology in that Uni¬ 
versity. His name is known throughout the scientific 
world, and no man is more deserving of honour. In tbs 
sister University of Cambridge physiology is further 
1 recognised by the conferring of the title of K.C.B. on 


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June 7, 1809. CORRESPONDENCE. The Medical Press. 603 


Professor Michael Foster, who is also Secretary of the 
Royal Society. His contributions to embryology and 
other branches of physiological research are many 
and famous. In Liverpool Dr. Mitchell Banks, the 
genial and accomplished surgeon, and in Edinburgh 
Dr. John Sibbald, the lunacy expert and commis¬ 
sioner, have each received a well-earned K.C.B. 
Surgeon-General Albert A. Gore, late Principal 
Medical Officer in India, is made a C.B. (military 
division), and Major Baptie, R.A.M.C., a C.M.G. 

Pharmaceutic Judges. 

In a recent suit in the Scotch Courts an interesting 
legal point arose which brought the case to a dead 
lock. The Scotch law forbids a judge to adjudicate 
in the case of a company in which he holds shares. 
This particular suit had to do with the system of 
dispensing by unqualified persons under cover of a 
qualified pharmaceutist. There are thirteen judges 
of the Court of Session, and, of these every man 
waa a shareholder in the company, and, therefore, 
there was no court to try the case until, by com¬ 
promise, it was agreed between the litigants that the 
verdict of one of these judges be taken as sufficient. 

PERSONAL. 

It affordB us pleasure to announoe that the health of 
Sir Francis Laking, M.D., has greatly improved during 
the last few days, and that the serious symptoms have 
subsided. 

Mb. John Shaw, of Wakefield, who died last week, 
has bequeathed .£2,000 to the Wakefield-Clayton Hospital 
and the residue of his estate which is expected to amount 
to at least .£ 60 , 000 . 

We understand that Major Arthur W.P. Inman, of 
the Army Medical Corps, has been appointed to succeed 
Dr. William Carte, as Surgeon to the Royal Hospital at 
Kilmainham (Dublin). 

Dr. G. Granville Bantock, of London, has been 
elected by the “ Soci^te d’ Obstetrique de Gyneecologie 
et de Pediatrie de Paris,” “ Membre Associe Etranger, 
Section de Gynecologie.” 

We regret to learn that Dr. Sinclair Coghill, who only 
returned from the Berlin Congress on Tuberculosis on 
Friday last, at which he read a paper, was seized with 
suden illness at his home, Ventnor, and died on 
Monday. 

Dr. Apostoli, of Paris, is, we understand, engaged in 
writing a chapter on the uses of electricity in gynaecology 
for the third edition of Dr. Althaus’s work on “ The Value 
of Electrical Treatment,” which will embody his most 
recent experience in the electrical treatment of uterine 
disease. 

Capt. Neumann, the Indian Plague expert engaged by 
the Natal Government, has, Bays our South African cor¬ 
respondent, given an opinion that there is little danger 
of an actual epidemic of plague in South Africa. He has 
urged the Government to obtain an ample supply of 
Haffkine’s serum, which he regards as most valuable. 


gtotlanb. 

[from our own correspondent.] 

University Medico-Chirubgical Society. —An ex¬ 
traordinary meeting of this Society was held on the 24th 
ult. to hear a lecture by Dr. Lawrence, of Montrose, on 
“ Some Reminiscences of the Glasgow Medical Schools in 
the Thirties.” There was a large attendance of students, 
including a considerable number of ladies from Queen 
Margaret College. The lecturer described in an inter¬ 
esting manner the condition of things as regards medical 
tuition existing in the thirties in the two extra-mural 
schools, viz., Anderson’s University (now Anderson’s 
College) and Portland Street Medical School; at that 
time these two schools possessed as teachers many men 
of eminence. He referred to the controversy on blood¬ 
letting, which began in 1847 and continued for many 
years, this practice during his time of study was the recog¬ 
nised and unchallenged treatment of all inflammatory 
diseases. The only infirmary in Glasgow at that time 
was the Glasgow Royal Infirmary which was attended by 
all the students, the classes being open to all interested 
without an entrance examination, tbe “ amateur ” 
medicals mixing with the regular students, and among 
the latter many appeared ill-prepared for suoh a oourse 
of study, in which connection Dr. Lawrence (the lecturer) 
bore testimony to the benefit of the Medical Act of 1858, 
which necessitated a preliminary examination before 
entering on a oourse of medical study. 

Glabgow University. —The final examinations are 
now in full Bwing; the students are, however, complaining 
of the length of time over which the dinicals extend, 
owing to the fact that these have to take place entirely 
in the Western Infirmary ; this cause for grumbling 
seems, however, likely to be soon overcome, as it is 
intended to send a part of the students for clinical 
exa m ination to the Royal Infirmary, a part to the Vic¬ 
toria Infirmary, and the remaining part to the Western 
Infirmary. As Professor Sir William T. Gairdner is at 
present in London attending the General Medical 
Council, Professor Stockman is conducting the examina¬ 
tion in Clinioal Medicine. During the winter session it 
is said that much hard work was done not only by the 
students but by the professors, consequently at the close 
both parties were very much fagged 

Health Department, Glasgow.— A salary of £350 

S ir annum is to be paid to the Bacteriologist to the 
ealth Department, who must devote the whole of his 
time to the duties of his office, and be able to undertake 
chemical, microscopical, bacteriological examination, 
and analysis of water, air, soil, milk, tuberculous meat, 
diseased tissues, and pathological substances. For this 
appointment an advertisement is to be inserted in cer¬ 
tain Scottish, English, and German newspapers. It 
would have been more complete to have said “ several 
Continental newspapers.” 


We do not hold ourselves responsible for the opinion* of our 
correspondents. 

ENGLISH r. FOREIGN OPHTHALMIC SURGERY. 
To the Editor of The Medical Prk68 and Circular. 

Sir, —It is probable that some correction will be made 
of the statement in the Sunday Sun that Dr. Pagen- 
stacher is the son of the celebrated oculist, who died 
from an accident Borne years ago. It seems that there is 
more interest taken now in matters medical by the PreBS 
than was the case at one time, but that interest is not 
always such as one can admire. The chief purpose, 
however, of this letter is to ask whether there is any 
good reason for the opinion that this great metropolis 
is not so well supplied with knowledge of the 
Bcience and skill in the practice ol ophthalmics 
as some other countries are. Is it because the 
profession generally does not recognise the neces- 


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604 The Medical Press. 


CORRESPONDENCE. 


June 7, 1899 


sity of something more than a knowledge of com¬ 
mon surgery by those who take up as a specialty the 
treatment of diseases of the eye ? When we consider to 
what extent the science of optics should be studied by 
those who follow this branch of practice, and when we 
see little evidence of this being done, perhaps because 
we are most of us so ignorant of the science ourselves, we 
ought not to be surprised that the public, among whom 
there is some intelligence and appreciation of excellence, 
should go where they can find what they imagine is 
unobtainable at home. If such a specialty as ophthalmic 
surgery is followed for the sole purpose of what is 
generally termed “ making money, ’ there are some of 
us who may not regret that this should be corrected. 

I am, sir, yours truly. 

Presbyopia. 

June 5 th, 1899. 

THE SPECTACLE MAKERS’ DIPLOMA. 

To the Editor of The Medical Press and Circular. 

Sir, —Your editorial on the subject of “certificated 
opticians ” rather seems to throw cold water where warm 
and solid support is needed. The granting of certificates 
to these persons amounted to the opening up of another 
branch of unqualified practice, nothing more and nothing 
less. What does a man like Professor Silvan us Thomp¬ 
son, urbane and accomplished though he be, know or 
care about the wants and wishes of the medical profes¬ 
sion, of which body he is not a member. He has, on the 
other hand, beyond a doubt solid reasons for becoming 
an examiner of the Spectacle-makers’ Court. But 
what of those within our own gate? Dr. Lindsay 
Johnson is also an examiner. 

It is possible the medieal profession can do little by 
way of showing their disapproval of his action; it seems 
likely, also, that the General Medical Council can and 
will do nothing; but how about the Ophthalmological 
Society, of which Dr. Johnson is a more or less promi¬ 
nent member. What steps have that learned body 
taken to justify or to condemn Dr. Johnson's position ? 
It seems to me, as a humble general practitioner, that 
the profession has a right to demand a full and imme¬ 
diate answer from the Ophthalmological Society. 

I am. Sir, yours truly, 

A Qualified Onlooker. 

Croydon, June 2nd, 1899. 

THE MEDICAL APPOINTMENTS TO THE 
BRADFORD WORKHOUSE. 

To the Editor of The Medical Press and Circular. 

Sir, —The whole profession owes a debt of gratitude 
to The Medical Press and Circular for its defence of 
our rights and privileges, and for its advocacy of proper 
principles in the election of Poor-law Medical Officers. 
And not for the first time have you adopted this impartial 
and independent attitude. 

In reference to the recent appointments to our work¬ 
house, in which both the Guardians and two gentlemen 
representing themselves as consultants, have played a 
ro le as novel as it is wrong in every sense, I ask to be 
allowed to reply to the defence of the two medical 
offenders. Dr. Crowley and Mr. B. Hall have attempted 
to excuse themselves, and minimise the gravity of the 
position they have adopted in hostility to the whole pro- , 
fession here, by an amusing artifice—so simple, however, i 
in its nature, that probably most of the readers of your ! 
able criticism of it hardly need to have it pointed out. 
Dr. Crowley and Mr. Hall would have it believed 
that I constitute the opposition to their unprofessional 
oonduct; that I have forcibly dragged together a number 
of gentlemen who have unwillingly oondemned their 
oonduct, and that other professional men and societies in 
Bradford, by notpubliclydisapproving,have approved of 
what they have done ! This device is really too amus¬ 
ing ! Had I the vast power they attribute to me, then 
do they not see that my opposition to their proceedings 
would be a very serious matter ? Yet, though crediting 
me with the ability to drag the profession at my heels, 
they immediately proceed to argue that I am an alto¬ 
gether insignificant person ! As a fact, they do not offer 
one argument in their own defence. They cannot. All 


they do is to indulge in personalities directed against 
myself, and to try to minimise the importance of the 
indignation meeting which condemned their action. To¬ 
me this is most gratifying. It is the strongest proof of 
the excellence of our cause, and of the indefensible action 
of Dr. Crowley and Mr. Hall. It amounts to this: “We 
cannot defend our taking these appointments, so 
let us not attempt to do it, but let us 
abuse Dr. Hime, and belittle the indignation meeting ! ” 
What have I, or that meeting, to say to the propriety of 
Dr. Crowley and Mr. Hall supporting the guardians in a 
line of action which is insulting to every general prac¬ 
titioner in Bradford, which is exceptional in character, 
and is utterly opposed to the fair and honest principles 
which have so far made all public appointments open 
to general competition, instead of being allocated by 
private favour and secret treaty, as in the case of Dr, 
Crowley and Mr. Hall ? If no meeting had been held, if 
I did not exist, their action would be no less repre¬ 
hensible. 

But what are the trivial assertions they do make 
when attacking me, and endeavouring to undervalue the 
medical meeting ? 

1. “ The meeting was not representative.’’ Represen¬ 
tative of what? only medical men were there. ALL our 
hospitals were represented, all our medical societies were 
represented, private practitioners, Poor-law medical 
officers, residents in the city and district, all were there. 
The only parties not represented were Dr. Crowley and 
Mr. Hall, who, for reasons best known to themselves, 
were conspicuous by their absence. There and then was 
the occasion for them to meet their professional brethren. 
They preferred not to do so. And yet they are courageous 
enough to make unwarranted statements about what took 
place at the meeting. 

2. “ Invitations were in several cases omitted.” There 
were 148 circulars issued, and I believe some 120 medical 
men live in Bradford. If anyone was passed over it was 
owing to accident or to his name not being in the 
Directory. 

3. “ The majority of practitioners of any position took 
no part in the proceedings.” As chairman of the meet¬ 
ing, I can say this is quite contrary to the fact. The dis¬ 
cussion was as general as could be desired, or is usual, 
and not one person opposed the resolution condemning the 
action of Dr. Crowley and Mr. Hall. 

4. As to the influence and importance of the Bradford 
and West Riding Medical Union I need say nothing. It 
is not in any way concerned in the unprofessional actions 
of Dr. Crowley and Mr. Hall. The indignation meeting 
was not a gathering of any society, but was a large 
meeting summoned by invitation issued to every medical 
man in the district. As no private individual could 
assume the right to summon such a meeting, and there 
was not time to get a requisition signed, the secretaries 
of the Bradford and West Riding Medical Union were in¬ 
structed to issue the invitations. I was elected to the 
chair by the meeting itself. 

5. “ The committee of the Medico-Ethical Society (an 
older society than the Union) after discussion of the 
action of Dr. Crowley and Mr. Hall, decided to take no 
action.” In assuming that this decision implies approval, 
or that the members one and all do not condemn their 
action, Dr. Crowley and Mr. Hall are deceiving them¬ 
selves, and attempting to deceive your readers. The fact, 
as I am informed on the best authority, is that as it was 
known the Union had decided to take action, the com¬ 
mittee of the other society thought it unnecessary to 
move. But there is no justification for the assumption 
that their inaction implies any approval, or even 
neutrality on the question at issue. 

I have never known equal unanimity on any question 
among medical men in this town, and I imagine that 
though Dr Crowley and Mr. Hall try to whistle cheer¬ 
fully, their conviction is they have made a serious 
blunder. 

I am, Sir, yours truly, 

John Whiteside Hike. 

[On account of great pressure on our space owing to 
the session of the General Medical Council, and other 
matters of current moment, we have been reluctantly 


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June 7, 1899. 


MEDICAL NEWS. 


compelled to omit a large portion of Dr. Hime’a letter, 
but the foregoing contains all the chief points.— Ed.] 


©biter t>. 


NORMAN KERR, M.D., C.M.Glasg., F.L.S. 

It is with much regret that we have to record the 
death of Dr. Norman Kerr, which took place at his 
residence in Hastings on the 30th ult. The temperance 
cause, of which he was the most staunch, consistent, 
and enlightened advocate, will be a great loser by his 
death, for the reputation which he enjoyed in this regard 
was world-wide. Again, the good influence which he 
wielded in advancing the principles of teetotalism was 
by no means confined to this country; throughout 
Europe, in America, and our colonies his name was a 
household word among those who sought to fellow his 
teaching and example. Dr. Kerr was a native of Scot¬ 
land, and received his medical education at the Uni¬ 
versity of Glasgow, where he took the degrees of M.T). 
and C.M. in the year 1861. From an early period in his 
career he began to devote himself to the study of inebriety, 
and having thus started upon his life work his enthusiasm 
for it never failed even to the end. As late as April last, 
feeling somewhat stronger, he journeyed from Hastings 
in order to take the chair at the quarterly meeting of 
the Society for the Study of Inebriety in London. This, 
we believe, was the last time that he was able to under¬ 
take any public duty. In the course of last year his 
failing health compelled him to relinquish his practice 
in St. John's Wood, where he had resided for many years, 
and move to Hastings. The illness from which for some 
months previously he had been suffering was albumi¬ 
nuria, and the quiet, rest, and change of air which he 
obtained at Hastings provedfor a time so beneficial that 
his health greatly improved. However, an attack of 
influenza, followed by bronchitis, proved too much for 
his failing strength, and he gradually sank and died, as 
stated, on the 30th ult. 

At the time of his death he was consulting physician to 
the Dalrymple Home for Inebriates.Preaidentof the Society 
for the study of Inebriety, Chairman of the Inebriates’ 
Legislation Committee of the British Medical Associa¬ 
tion, and a member of the Council of the Metropolitan 
Counties branch, a Fellow of the Linnean Society, and a 
corresponding member of other societies in New York. 
Dr. Kerr was a voluminous writer upon his special sub¬ 
ject, as may be gathered from the perusal of the lon^ list 
of his published works. Perhaps his best known work is his 
treatise on “ Inebriety ; its Etiology, Pathology, Treat¬ 
ment, and Jurisprudence,” the third edition of which 
appeared in 1894. He was also a frequent contributor 
to the medical journals, in which he published many 
thoughtful papers. 

But in paying this small tribute to one who, a quarter of 
a century ago, was a subscriber and staunch friend to 
The Medical Press and Circular, we cannot conclude 
without expressing our admiration for the earnestness 
and singleness of purpose with which Dr. Norman Kerr’s 
advocacy' of teetotalism was always distinguished. He 
could not fail to impress those with whom he was inti¬ 
mately associated that his great desire was to leave the 
world better than he found it by warning his fellow 
mortals against the evils and pitfalls of alcohol. He 
laboured and strove, not for his o vn ends, b ut with the 
sole aim of disseminating the principles in which he 
firmly believed, in order that others might benefit from 
their practice. That such advocacy as his was produc¬ 
tive of good and that he attained by its means his object 
in life, cannot admit of dispute. Dr. Norman Kerr was 
in his sixty-sixth year at the time of his death. 


The Medico-Psychological Association. 

The next examination for the certificate of this Asso¬ 
ciation will be held on July 13th at the various centres 
in England, Ireland, and Scotland. The examination for 
the Gaskell Prize will be held in London on July 14th. 
Particulars of these examinations will be found in our 
advertisement columns. 


The Medical Press. 605 


jftebiatl ^etos. 


The Hoyal British Nurses' Association. 

H.R.H. The Princess Christian has announced her 
intention of presiding at the annual meeting of the Royal 
British Nurses’ Association and of presenting badges to 
members on that occasion. The meeting will be held at 
the Westminster Town Hall, on Saturday, June 10th, at 
3 p m., and will be followed by a rtnn on of members 
and their friends in the grounds of the Earl’s Court 
Exhibition. Full particulars and tickets may be obtained 
from the Secretary, 17, Old Cavendish Street, Oxford 
8 treet, W. 

Society Jor Relief of Widows and Orphans of Medical Men. 

The annual general meeting of the Society was held 
on May 31st, Mr. Christopher Heath, V.P., in the chair. 
From the report read by the secretary, it appeared that 
a sum of .£3,023 had been given during 1898 to the fifty 
widows and twelve orphans in receipt of grants and the 
six recipients from the Copeland Fund. A present of 
£551 had been made at Christmas—viz., £10 to each 
widow, £3 to each orphan, and £5 to those on the Cope¬ 
land Fund. One widow had died and one was taken on, 
three orphans had become ineligible and one had been 
elected. The number of members remained the same — 
287, nine having died, and nine been elected. The 
expenses of the year had been £244 10s., the total 
disbursements £3,267 10s., and the receipts avail¬ 
able for payments £3,326 2s. 8d., leaving a balance 
of £58 12s. 8d. A grant under bye-law 78 of £26 
was made to a widow. A vote of thanks to the Editors 
of the Medical Journals, proposed by Mr. Lynoh and 
seconded by Sir Samuel Wilks, was carried unanimously. 
Sir Thomas Smith was elected a Vice-President in the 
place of Mr. Henry Lee, deceased, and Messrs. Morey, 
King, Grimaon and Leigh, Dr. West and Dr. Whipham 
directors, in the place of the six seniors who retired. 
The funded property had been increased by purchase of 
£500 Birmingham 2J per Cent. Corporation Stock. The 
funded property of the Society on May 1st, 1899, was 
£97,687 15s. lid. The proceedings terminated by a vote 
of thanks to the Chairman, proposed by Mr. Lovett and 
seconded by Dr. Pollock. 

8t. Thomas s Hospital. 

The following gentlemen have been selected as 
House Officers from Tuesday, June 6th, 1899:— 

House Physicians: E. H. Ross, L.R.C.P., M.R.C.S. * 
E. A. GateB, L.R.C.P., M.R.CS. (extension); A. E. 
Stevens, M.B.Durh , L.R.C.P., M.R.C.S. (extension) ; and 
H C. Thorp, M.A., M.B., B.C.Camb. 

Assistant House Physicians: J. Gaff, L.R.C.P., 
M.R.C.S., and A. Bevan, L.R.C.P., M.R.C.S. 

House Surgeons (extension): 8.0. Bingham, L.R.C.P., 
M.R.C S.; E. M. Corner, M.A., M.B., B.C.Camb., B.Sc. 
Lond., L.R.C.P, M.R.C.S.; J. A. Barnes, L.R.C.P., 
M.R.C.S., and J. E. Kilvert, L.R.C.P., M.R.C.S. 

Assistant House Surgeons (extension): H. J. Phillips, 

L. R.O p., M.R.C.S ; P. W. G. Sargent, M.A, M.B., 
B.C.Camb., L.R.C.P., M.R.C.S.; S. A. Lucas, L.R.C.P., 

M. R.C.S. and H. T. D. Adand, L.R.C.P., M.R.C.S. 
Obstetric House Physicians (senior) : S. H. Belfrage, 

M.B.Lond., L R.C.P., M.R.C.S.. and (junior) H. M. 
Scaping, B.A.Camb., L.R.C.P., M.R.C.S. 

Clinical Assistants in the Special Department for 
Diseases of the Throat : E C. Bourdas, L.R.C.P., 
M R.C S. (extension), and L. H. Lindley, M.B., B Ch. 
Oxon. Skin: H. R. Beale, L.R.C.P., M.R.C.S., and N. 
Unsworth, L.R.C.P, M.RC.S. Ear: A. W. Jones, 

L. R.C.P., M.R.C.S. (extension), and A. C. Bird, L.R.C.P., 

M. R.C.S. 

Society of Apothecaries of London. 

The following candidates passed in the subjects indi¬ 
cated during May: — 

Suryerv.-G. H. Bedford. P. Cator, T. A. E Fawcett, A. Killiok, 
D. V. Lowndes. A. Orme, V. S. Partridge, W. Sisam, J. M. Twenty, 
man K. LeG. Woraley. 

Medicine.—E. L. D. Dewdne.v, B. F. Ellery, T. A. E. Fawcett, A. 
Orme, O. C. Sibley. W. .Sisam, H. E. Weston. 

Forsenic Medicine.—E L. D. Dewdney, S. H. Longhurat, A. Orme, 
O. C Sibley, H. E. Weston. 

Midwifery. — T. Burdekin, A. F. Cnrlyou, W. J. H. Hepworth, 
T. E. Holman, H. N. Horton, A. Killick, W. Siaam, F. J. Wald- 
nieier. 


Digitized by L.OOQ le 



606 Thk Medical Pebbs 


NOTICES TO CORRESPONDENTS. 


June 7, 1899. 


Notices to 

(PomBpotibntfo, $hprt ^ettere, «&r. 

99 * Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive signature or 
initials, and avoid the practice of signing themselves “ Header,” 
“Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

JUNCKEB AND STAHL’S THEORIES. 

To the Editor of the Medical Phesb and Circular. 

Sib,— The book your correspondent refers to is that of John 
Juncker, which vu published first in 1718, consisting of 752 4to 
pages. The author was a pupil of Qeorge Ernest Stahl and a volu¬ 
minous writer. Stahl became a disciple of Descartes, and, dissatis¬ 
fied with the iatro-mathematical theory of Oiovanni Borelli, he 
introduced the doctrine of the influence of immaterial principles on 
inert substances. 

Stahl taught that a principle resident in the living body (ammo) 
governed all the functions of life and resisted putrefaction. He 
supposes the anima to have knowledge of the necessary composi¬ 
tion of every part of the body and of the materials to be given to 
each, and to have power to guide aright all the acts necessary to 
the desired end. The vital principle and the nature of medical 
writers differs but in name from the anima of Stahl. 

For the relief of plethora he bled, and his principal remedy was a 
mild aperient. 

Juncker's work, 4to, 1718, is entitled “Conspectus medicina 
theoretlco-practicffi, tabulis cxvi omnes primarios morbus, methodo 
Stahliani tractandos, exhibens; cum indice satis locuplete et piefa- 
tione.8tahlu." 

In all he published ten volumes, all intended to explain and sup¬ 
port Stahl’s views. 

His works were, however, discounted by Baron Haller’s brief 
account of Stahl’s doctrines, and the summary of them that appears 
in Spreogel’s '* Histoire de la Medicine,” tom. v. 

As late as 1708, Stahl published his ‘ * Theoria Medico vers Physio- 
logiam et Pathologiam tanquam Doctrine Medic® partes contem¬ 
plative* et Naturae et Artis veris Fundam entis intaminata Rations 
et in concurrr* experentda, distens.” 

His theory of phlogiston is told in his “ Zymotechnia Fundamen- 
talis,” in 1637. 

Juncker's works are now little read; indeed, they never 
seem to have got beyond the first edition, and your corre¬ 
spondent would not get more than 5s. for the volume. One penny 
a volume is the usual bookstall price of old medical works. 

I am, Sir, yours truly, 

Dublin. Qeobge M. For, F.B.C.S.I. 

N. B. T.—No information has reached us so far which bears out 
our correspondent's complaint. 

Omxoa.—I f our correspondent will forward the newspaper cuttings 
relating to his statements we shall be glad to deal witn the matter. 

Toe no M.D.—There is nothing to take exception to, from an 
ethical point of view, in the course pursued. 

A CASE FOB TREATMENT. 

A coKKXsroNDBKT writes: “ I should be glad of some hints for 
the treatment of a patient, a girl, aged 18, who is troubled with 
nocturnal incontinence of urine. Extract of belladonna for a time 
proved useful, and tonics, but now she is as bad as before. Could 
any of your readers kindly help me P ” 


JtfoctiitQg at the gomties attb lectures. 

Wednesday, June 7th. 

Obstetrical Society or London.—8 p.m. Specimens will be 
shown by Mr. Stott, Mr. Malcolm, Dr. Stevens, and others. Papers: 
.—Dr. Lowers: A Case of Persistent Mento posterior Position of the 
Face in which the Child was delivered Alive by the Axis-traction 
Forceps. Dr. Wilson: Hydramnion in Cases of Uniovial or Homo¬ 
logous Twins. 

Thursday, June 8th. 

Ophthalmological Society or the United Kingdom.—8 p.m. 
Cases and Specimens. 8.30 p.m. PapersDr. Bocklifle and Mr. 
Hainworth: Penetrating Wound of Orbit with Traumatic Meniu- 
gitis, Recovery.—Dr. Beevor and Mr. M. Gunn : Case of Oblitera¬ 
tion of a Branch of the Retinal Artery, following frequent attacks 
of Temporary Amblyopia.—Mr. J. B. Story : Recovery of Sight after 
Partial Occlusion of the Central Art err. 

British Gynecological 8ociety (20 Hanover Square, W.)— 8 p.m. 
Lantern Demonstration: Dr. F. W. N. Haultaln (Edinburgh): On 
a Case of Deciduoma Malignnm. PapersDr. Mendes de Leon 

i Amsterdam): On General Disorders originating in disease of the 
'emale Pelvic Organa. 

Central London Throat, Nose, and Ear Hospital (Gray’s Inn 
Road).—5 p.m. Dr. Dundas Grant on the Diagnosis and Treatment 
of Painful Ear Affections. 

Friday, June 8th. 

Ophthalmological 8ocibtt op the United Kingdom.—8.30 
p.m. Special Meeting for a Discussion on the Operative Treatment 
of Myopia, to be opened by Mr. F. R. Cross. 

Monday, June 12th. 

Central London Thboat, Nose, and Ear Hospital.— 5 p.m. Mr. 
W Wingrave: The Pathology of Nasal Obstruction. 


Dacaitoes. 

Bradford Union Workhouse.- Resident Assistant Medical Officer, 
unmarried. Salary, A" 100, with prescribed rations and apart¬ 
ments. Applications to the CL*rk to the Guardians, Bradford 


Cardiff Union. Assistant Medical Officer for the Workhouse. 
Salary £100 per annum, with rations, apartments, attendance 
and washing. Applications to the Clerk, Cardiff. 

County Asylum, Boinhill, near Liverpool.—Senior Assistant 
Medical Officer, unmarried. Salary commencing at £225 per 
annum, with furnished apartments, board, attendance, and 
washing. 

King's Norton Union.—Resident Deputy Medical Officer at the in¬ 
firmary and the workhouse. 8elary commencing at £170, with 
furnished residence. Rations or attendance not provided. 
Applications to the Clerk, 10 New hall Street, Birmingham. 

Knighton Union.—District Medical Officer and Public Vaccinator 
for the Llanbigter. Salary £100 per annum, with certain medical 
fees. Applications to the Clerk, Knighton, Radnorshire. 

Norfolk County Asylum, Thorpe, near Norwich.—Junior Assistant 
Medical Officer, unmarried. Saloiw commencing at £110 per 
annum and board (no liquors), lodging, and washing. 

Rathdown Union.-Medical Officer for the Dundrum Dispensary 
District. Salary, £110 per annum, with £20 additional as Sani¬ 
tary Officer. (Seeadvt.) 

West Norfolk and Lynn Hospital, King’s Lynn.—House 8urgeon. 
Salary commencing at £80 per annum, with board, residence, 
and waahing. 

Wolverhampton and Staffordshire General Hospital, Wolverhamp¬ 
ton. - House Surgeon. Salary £100 a year, with board, lodging, 
and washing. 

Wonford House Hospital for the Insane, Exeter.—Assistant Medi¬ 
cal Officer, unmarried. Salary £150 per annum, with board, 
apartments, Ac. 


Abraham, Phinras S., M.A., M.D., 6.Sc., F.B.C.S., Surgeon to the 
Hospital for Diseases of the Skin, Blackfriara, London. 

Brewbidgb, R. Harding, B.A.Oxon., B.Sc.Lond., M.B.C.S., 
L.R.C.P., House Surgeon and Registrar to the Royal Ortho¬ 
pedic Hospital, Oxford Street, London. 

Bruce, L. C., M.D., C.M.Edin.. M.R.C.P.Edin., Medical Superin¬ 
tendent for the Perth District Asylum, Mnrthly, Perth. 

Cantlib, James, M.B., C.M.Aberd., I’.R.C.S.Eng., D.P.H.Lond., a 
Surgeon to the Seamen’s Hospital, Greenwich. 

Cargill, L. V., F.R.C.S.Eng., L.B.C.P.Lond., Ophthalmic Snrgeon 
to the Seamen’s Hospital 8ociety .Greenwich. 

Chbistophebson, J. B., M.D.Camb., F.R.C.S.Eng., L.B.C.P.Lond., 
a Surgeon to the Seamen’s Hospital Society, Greenwich. 

Folet, T. McC., L.R.C.P., L.B.C.S.IreL, Medical Officer to the 
Scarborough Workhouse. 

Gret-Edwafds, Charles, B.A., M.B., B.Ch.Trin. Coll., Dub., 
Medical Officer for the No. 1 Anglesey District, Bangor. 

Hewlett, B. T., M.D.Lond., M.R.C.P., M.B.C.8., D.P.H.Lond., a 
Physician to the Seamen’s Hospital Society, Greenwich. 

Kbnnt, C. A., L.B.C.S. and P.I.L.hLRotunda, Medical Officer to 
Ballymahon Workhouse. 

Marshall, C. F., M.D., B.Ch., B.Sc.Vict., F.R.C.8., Assistant 
Surgeon to the Hospital for Diseases of the Skin, Blhckfriare. 

Patne, J. F., M.D., FK.C.P., Consulting Physician to the Hospital 
for Diseases of the Skin, Blackfriara. 

Banein, G., M.D.Glas., F.R.C.P.Edin., M.R.C.P.Lond., a Physician 
to the Seamen’s Hospital Society, Greenwich. 

Bees, D. C., L.B.C.P.Lond.. M.B.C.S., Superintendent and Medical 
Tutor to the Seamen's Hospital Society, Greenwich. 

Walxsb. Henbt Secker, F.E.C.S.Eng., one of the Hon. Ophthalmic 
and Aura] Surgeons to the General Infirmary at Leeds. 


girths. 

Francis. - On Jane 1st, at 84 Wright Street, Hull, the wife of A. G. 
Francis, B.A., M.B., B.8., F.B.C.8., of a daughter. 


^arriagts. 

Buhcombr—Boubfield.— On June 1st, at All Saints', Forest Gate, 
Essex, William Dewey Buncombe, Medical Superintendent of 
City of London Infirmary, Bow, elder son of the late Charles 
Hope Buncombe, F.B.C.S., to Henrietta Mary, elder daughter 
of William Jeune Bouafield, of Forest Gate, Essex. 

Lethbridge—Bellett.— On June 1st, at St. Mary's Church, Badi- 
pole, Weymouth, Sir Alfred Swoine Lethbridge, K.C.8.L, M.D., 
late Indian Political Service, to Edith Seymour, widow of the 
late George Bellett, M.A., Bengal 8ervice, 

Pollard—Euan-Smith.— On June 1st, at St. Philip's, Kensington, 
George Wilfred Pollard, M.D., eldest son of George H. Pollard, 
Esq., of Grassend&le, Taunton, to Ells Maclaurin, second 
daughter of E. Maclaurin Euan-Smith, Esq., of 105Earl’s Court 
Road, London. 

Bendall—Watson.— On June 1st, at St. Mary Abbot's, Kensington, 
Percy Bendall, M.D., of Oxenwood, Cbeam, Surrey, son of John 
Bendall, M.A., to Edith, daughter of Edward Watson, of South 
Woodford, Essex. 

Bobinson—Bidlet.— On May 27th, at All Saints’. Margaret Street, 
London, Norman B. Robinson, M.R.C.S., L.R.C.P.Lond., son 
of the late Major-General D. G. Bobinson, B.E„ to Janet Fair 
Hurst, daughter of Samuel E. Ridley, of St. Helens, Isle of 
Wight. 


geaihs. 

Kerr. -On Mav 30th, at Hastings, Norman Kerr, M.D., F.B.S., 
President of the 8ociety for the Study of Inebriety, aged 65. 

Ollard.— On June 3rd, at 4 Henrietta Street, Bath, John Farmerr 
Ollard, M.B.C.8., L.8.A., aged 74. 

Oxlet. —On May 28th, at Basford, Nottin gham , Alexander Wemyss 
Oxley, of Rotherham, M.B.C.S., L.B.C.P.Lond., aged 25 yean. 

BoocRon.—On May 28th, at Brondesbury Villas, Kilburn, London, 
N.W., Wm. BcKJcroft, J.P., Snrgeon, late of Wigan, in his 70th 
year. 


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The Medical Press and Circular Advertiser. 


Jane 14, 1899 



LONDON, 1884 



ADELAIDE, 1887. MELBOURNE, 1888. 


BENGER'S 


gold medal awarded 

Health Exhibition, London. 


FOR INFANTS, INVALIDS, 
AND THE AGED. 


FOOD. 


This delicious highly nutritive and most easily digested Food is 
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The following letter addressed to F. B. BENGER & (70., Ltd., it published by special permission 

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dozen 2/6 Tims of BENGER 9 S FOOD for H.I.M. THE 
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The Lancet describee it as “ Mr. Benger’s admirable preparation.” 

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Benger’s Preparations to assist the Physician in his treatment of the siok.” 

The British Medical Journal says“ Benger’s Food has by its excellence established a reputation 
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BENGER'S FOOD is sold in Tins at 1/6, 2/6, and 5/-, by Chemists, &c., everywhere. 

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TBLMKiraio Admuess: “ Bandar’s, HE a w oh —fa 11 


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A few Facts in favour of 

Scott’s Emulsion 


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FROM RANCIDITY? 

SCOTT <& BOWNE, LTD, MANUFACTURING CHEMISTS, LONDON, E.C. 


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608 The Medical Pbbss. 

amount of violence is applied to the foot on its inner 
side, when the knee-joint is flexed: the ligaments 
and muscles about the knee—in the relaxed condition 
tion which corresponds to this posture are, as it were, 
thrown more or less completely off their guard. A 
sudden acute pain is at once felt in the joint at the 
inner side, and the patient is unable to move the leg, 
which remains in a slightly flexed position, with a 
certain amount of abduction and external rota¬ 
tion. Sir Astley Cooper, whose description of the 
aetiology of this lesion corresponds more closely with 
my experience than that of any writer whom I have 
had an opportunity of consulting on the subject, has 
observed it to occur most frequently when a person 
in walking strikes his toe, the foot being at 
the same time everted, against any projecting 
body, such as the fold of a carpet. He also met 
with a case of the accident in a person who had 
suddenly turned in bed, when, the bed-clothes not 
allowing the foot to turn with the body, the condyles 
of the the thigh bone were believed to slip from the 
articular cavities formed by the semilunar fibro- I 
cartilages. 

Very few autopsies have, so far as I have been able 
to ascertain, demonstrated the actual displacement of 
the semilunar fibro-cartilages of the knee-joint. A 
specimen was described by Professor Thane in which 
the external cartilage was found displaced in a dis¬ 
secting-room specimen. Beid noted a case in which 
he had discovered (accidentally) in a dead body that 
the anterior segment of the external cartilage was 
detached from the tibia, and displaced backwards and 
inwards. This portion appeared flattened and 
widened, as if the displacement were of old standing. 
No history could, however, be obtained. 

Vemeuil has seen most of the cases of supposed 
luxation of the fibro-cartilages occur in rheumatic 
subjects, and would explain the symptoms present by 
the changes within the joint produced by this disease. 
He mentions a case in which he took the opportunity 
of carefully examining the movements of the joint in 
a.highly emaciated patient whom he was treating for 
some other disease. In this individual, extreme flexion 
of the knee caused a prominence to form on the 
outer side corresponding in position and form to the 
outer margin of the external semilunar fibro-carti¬ 
lage. Palpation gave, at the same time, a sensation 
of crepitation, and the patient felt some pain in the 
corresponding part of the joint. He observes, in con¬ 
clusion :—“ I believe that in my case no luxation of 
the fibro-cartilage took place, for the mobility of this 
cartilage is a normal condition. Accordingly, a new 
element must be added, which I believe to be syno¬ 
vitis.” 

It is observed by Panas (Did. de Med. et de Chir. 
Prat.) that all the cases of luxation of the semilunar 
cartilages belong to a period when the occurrence of 
loose cartilages in the interior of joints, and also the 
existence of arthritis deformans, had still remained 
unknown pathological facts, and he professes to be¬ 
lieve that all the recorded examples of internal 
derangement of the knee-joint were but misunder¬ 
stood cases of one or other of these conditions. In 
this hypothesis he merely corroborates the views that 
had already been enunciated by Velpeau and by 
Malgaigne. The latter eminent authority also points 
out that in the cases in which (as in those recorded 
by Bassius and Dequevauviller) an abnormal projec¬ 
tion was present, and supposed to coiTespond to the 
margin of the displaced cartilage, it was found on 
more careful inquiry that this projection had existed 
before the occurrence of the injury. In a case observed 
by himself, the projection had existed in a healthy 
limb, although to a somewhat less degree. 

The fact that “ internal derangement ” may be 
confounded with a floating body within the joint was 
demonstrated in a case reported by Gimelle. This 


surgeon detailed to the Acad6mie de Mldocine 
(apropos of an observation of luxation of the car¬ 
tilages communicated by Londe) an account of a 
similar case which he had himself met with, and in 
which a corresponding diagnosis had been made. The 
supposed luxation recurred frequently, and the re¬ 
peated trouble led at length to a more careful exami¬ 
nation, disclosing the existence of a foreign body, 
which was afterwards extracted by Larrey. 

The most probable cases of luxation of the semi¬ 
lunar fibro-cartilages that have been recorded are, 
perhaps, those of Lannelongue and Le Fort (commu¬ 
nicated to the Societe de Cbirurgie in 1879). The 
former was that of a girl, ast. 11, who had pre¬ 
viously enjoyed good health, and did not appear to 
suffer from any form of arthritic diathesis. Ten 
months before entering hospital she had suddenly, 
while walking with her mother, and without any 
appreciable cause, experienced a sensation of crack¬ 
ling in the knee-joint. It was not accompanied bv 
any sensation of pain, nor was progression at all 
impeded. The articular crepitus continued, and 
accompanied every movement of the joint. Two 
months later, walking became impeded; but it was 
not till eight months had elapsed after the original 
injury that pain was complained of, when it became 
so acute on any movement of the limb as to 
render walking nearly impossible. Examination of the 
joint when at rest gave merely negative results; 
nothing abnormal could be discovered by sight or 
touch ; there was no displacement and no pain on 
ressure. When the extended limb was gradually 
exed, a crackling sound was perceived as soon as the 
flexion had attained an angle of about 20 degrees; 
and, at the same time, a projection formed on the 
outer aspect of the joint which could be seen and felfc. 

When the limb was brought gradually back to 
the state of extension from the position of right- 
angled flexion, as soon as it had passed through an 
angle of 20 degrees in this direction, another bruit 
was heard louder than the firet, with increased pro¬ 
minence of the tumour, after which complete exten¬ 
sion (with subsidence of the swelling) followed with¬ 
out further opposition. The evidence of the hand 
and ear demonstrated that the bruit and the pro¬ 
minence corresponded to the interval between the 
outer condyle of the femur and the glenoid cavity of 
the tibia; while the displacement obvious to the 
eye on the outer side of the joint apparently impli¬ 
cated the external semilunar cartilage. This promin¬ 
ence formed a transverse ridge, occupying the line 
of the articulation in the depression on the outer side 
of the ligamentum patellae; it was best marked in 
front, and gradually lost when traced backwards. 
When the finger was placed on the skin just before 
the formation of the swelling, it was found to be 
suddenly elevated with a peculiar vibratory sensa¬ 
tion, which conveyed the idea of an elastic band. It 
was compared by Lannelongue to the elevation of 
the skin produced by the pulsation of a large artery. 
After the formation of the swelling it remained till 
the second joint indicated the reduction of the dis¬ 
placement. On the inner side of the joint all was 
normal. The reduction only was accompanied by 
marked pain. In this case Lannelongue considers 
that the only explanation of the phenomena which 
can be offered is that afforded by admitting the 
existence of a subluxation of the external semilunar 
fibro-cartilage. There was no evidence whatever of 
arthritis deformans ; and he believes that the idea 
of a foreign body is out of the question, as the latter 
could not always persist in reproducing an identical 
deformity. 

The case of Le Fort possesses a special interest, 
as it occurred in his own person. The original 
cause of the accident, as the sufferer himself observes, 
presents but few poetic details. This eminent but- 




Junk 14, 1803. 


ORIGINAL COMMUNICATIONS. 


Thi Medical Press. 609 


geon happened to be in occupation of a position 
similar to that which the author of “ Gulliver’s 
Travels” leads his readers to infer was assumed by 
his hero after modestly retiring between two leaves 
of Brobdignagian sorrel. On this occasion the 
professor, while resting on his feet, with both hip 
and knee-joints strongly flexed, suddenly experienced 
a distinct sensation of displacement in the outer pait 
of the right knee-joint. When he raised himself 
from this posture the knee remained flexed, but a 
powerful effort restored it to the extended position. 
This effort was accompanied by acute pain, and a 
loud crackling sensation, as if some displaced object 
had suddenly returned to its place. All pain instantly 
disappeared, and freedom of movement was com¬ 
pletely restored. The lesion subsequently reappeared 
on almost every occasion on which the knee was 
forcibly flexed, so that this movement had to be 
studiously avoided. 

The above cases afford perhaps the strongest cir¬ 
cumstantial evidence which I have been able to find 
of subluxation of a semilunar fibro-cartilage from 
slight or indirect violence. 

An interesting case of injury to the knee-joint 
was communicated to the Pathological Society of 
Dublin by the late Professor it. W. Smith (Feb. 4th, 
1865), in which the fibro-cartilage appeared to have 
been displaced by a very unusual form of direct 
violence. It occurred in a boy of sixteen, who had 
been wounded in the knee by a hackle-pin, the sharp, 
curved pointof which penetratedthe joint on the inner 
side, and close to the line of the long saphena vein. 
The boy fell backwards, and the hook tore its way out. 
Escape of synovial fluid was followed by very severe 
inflammation, which yielded completely to treatment. 
On recovery, a certain amount of stiffness of the 
joint remained, the limb tended to remain somewhat 
flexed, and a distinct projection was found in the 
position of the wound, which presented a curved out¬ 
line, was somewhat elastic to tne feel, and, manifestly, 
was not of an osseous nature. The diagnosis in this 
case was that the hook which penetrated the joint 
had fixed itself in the internal semilunar fibro- 
cartilage, and in tearing its way out had displaced 
this structure from its normal position. The possibility 
of a certain amount of displacement accompanied by 
laceration in such a case, cannot, I think, be ques¬ 
tioned. The evidence afforded by the other cases 
quoted, as well indeed, that derived from the less 
important examples which we have found recorded 
by various surgical authorities, is not so conclusive. 

Sir Astley Cooper observes that “ under extreme 
degrees of relaxation, or in cases where there has been 
increased secretion into the joint, the ligaments 
become so much lengthened as to allow the cartilage 
to glide upon the sui-face of the tibia, and particu¬ 
larly when pressure is made by the thigh bone upon 
the edge of the cartilage. The cartilages which 
receive the condyles of the os femoris are united to 
the tibia by ligaments, and when these ligaments 
become extremely relaxed and elongated, the carti¬ 
lages are easily pushed from their situations by the 
condyles of the os femoris, which are then brought 
into contact with the-head of the tibia; and when the 
limb is attempted to be extended the semilunar carti¬ 
lages prevent it.” There can be, I think, no reason¬ 
able ground for refusing assent to these views—as in 
the case of extreme relaxation of the ligaments, the 
existence of which was pre-supposed by this distin¬ 
guished authority, the parts of the semilunar carti¬ 
lages between their cornua must of necessity be very 
freely mobile, and comparatively easily displaced. 
But the case of a previously healthy joint is a widely 
different one; and, as I understand the phrase, 
“ internal derangement of the knee-joint ’’ deals with 
the latter only. 

Before summarising my conclusions as to the state 


of things existing in the more typical forms of Hey’s 
internal derangement of the knee-joint, I will relate 
the causes, symptoms, and treatment of the lesion as 
it has repeatedly occurred in my own person. It has 
always been the result of indirect , and, in every 
instance, very alight violence. The force has always 
been applied in such a direction as to produce rota¬ 
tion at the knee-joint—when already more or less 
flexed, and with the parts about the joint as relaxed 
as possible — when, indeed, if the expression 
be allowable, the muscles were almost or 
wholly off their guard. It has never occurred to me 
when the limb was in a decided state of active move¬ 
ment. My first experience of the lesion occurred 
when a boy of about twelve, as I was slowly saunter¬ 
ing along a country pasture-field, I lightly struck the 
inner side of the point of my shoe against some 
elevation in the ground, and was instantly brought to 
a standstill by pain of an agonising character deve¬ 
loped in the interior of the right knee-joint, and on 
the inner side. Besides the pain, I experienced the 
mingled sensations of fright and helplessness (as I 
was alone) to a degree which I have never forgotten. 
I soon reached the ground by what, I think, may be 
best described as a mixed movement of sitting and 
falling. The joint was slightly flexed, the leg slightly 
rotated outwards, and all will to attempt, and power 
to carry out, voluntary movement of the limb at the 
knee were absolutely lost. As this accident occurred 
many years before my initiation into the mysteries 
of anatomy, I need hardly say that I made no obser¬ 
vations on the position of the bony prominences 
about the affected joint. But I very quickly applied 
my hands to either side of the knee, and instinc¬ 
tively made as strong pressure as I was able, with 
the vague hope of diminishing the pain. The con¬ 
tinuance of tne pressure had the effect of diminishing 
the flexion of the joint a little ; when, suddenly, I felt 
an exacerbation of the pain, followed by a loud clucking 
sensation, which was conveyed both to hand and ear. 
This sound was followed by instantaneous and com¬ 
plete relief. No sequelte followed. But the lesion 
frequently reappeared, from similar causes, and 
always yielded to the same treatment. It has also 
occurred when, in moving the right foot under a table, 
the inner side of the great toe has struck lightly 
against one of the legs. As at other times, this has 
occurred only when the knee was flexed, and the 
muscles which act upon that joint entirely relaxed. 
The total number of my personal experiences of this 
lesion would amount, I believe, to at least a couple of 
score. By exercising the greater caution which those 
painful experiences have taught me, I have for some 
years‘escaped its recurrence; but have from time 
to time been made to feel that the symptoms had 
naiTowly escaped development 

When I became a medical student, I naturally felt 
a good deal of curiosity about the slighter lesions of 
the knee-joint, but it was some time before I heard 
enough to send me to Hey’s original paper. I there 
at once recognised a description of what I had myself 
experienced. The hearsay descriptions with which I 
had been previously acquainted had not given 
me the same impression. I embraced the first of 
my opportunities after this enlightenment to inform 
myself of the probable nature of the “ internal de¬ 
rangement of the knee-joint,” and have since been 
often able to make a hasty examination of the out¬ 
lines of my own joint while still deranged. The 
evidence afforded by manipulation has added all 
its weight to the negative opinion which I Boon 
formed from other considerations—that the semilunar 
cartilage has never in my case, nor in any correspond¬ 
ing case, been displaced from its tibial attachments. 
Two prominences could on such occasions, be detected 
on the inner aspect of the joint, one directly in¬ 
ternal, evidently formed by the inner border of the 


ed by GoOglC 




610 Tb* Medical Press. ORIGINAL COMMUNICATIONS. 


June 14, 1899. r 


Internal condyle of the femur, and another, lower 
down and somewhat to the front, found on the inner 
side of the ligamentum patellae, and presenting a 
better defined margin. This border, I have no doubt 
whatever, was formed by the superior margin of the 
semilunar fibro-cartilage, still attached to the upper 
end of the tibia. 

Accordingly, my explanation of the nature of this 
lesion, which I look upon as a typical example of 
Hey’s internal derangement of the knee-joint, is 
that by the combined slight rotation and external 
flexion—if I may be allowed to coin a new term— 
given to the leg, the tibia, with its adhering internal 
cartilage undergoes a process of snbluxation. The 
articular end of the condyle being jerked over the 
upper edge of the latter structure, and there becom¬ 
ing hitched, the tibia has its upper extremity locked 
in a position of slight displacement forwards and 
outwards. 

r^A similar rotation of the leg in the opposite direc¬ 
tion, and an analogous displacement of the outer con¬ 
dyle constitute, I believe, the actual lesion in the 
comparatively rarer form of “derangement” which 
affects the outer section of the knee-joint. This rela¬ 
tive infrequency is, to my mind, quite satisfactorily 
explained by the greater mobility of the external 
cartilage, and the existence of strong femoral 
attachments, which secure its adaptation to the vary¬ 
ing positions of the outer condyle. 

Such I believe to be the only form of displacement 
which can occur in the previously normal knee-joint 
as the result of slight or indirect violence. 

The lesions which occur in pathological conditions 
I have designedly excluded, as I do not think that 
they should be examined under this head. 

In concluding this rather lengthy communication 
I feel it to be my duty to apologise to my hearers 
for taxing their patience so heavily in a somewhat 
egotistical attempt to throw a critical light on ,an 
item of surgical mythology; and to reiterate with 
renewed emphasis the statement that an immediately 
reducible displacement of a fibro-cartilage of the 
normal knee-joint, such as most people seem to under¬ 
stand by “ Hay'a internal derangement has never 
jet occurred. 


garis Clinical lectures. 
CONVULSIVE TWITCHING. 

By Dr. GILLES DE LA TOURljJTTE. 

• 

[Reported bt our French Correspondent]. 

The patient to whose condition I call vour atten¬ 
tion is twenty-two years of age. A few days ago she 
came to the hospital accompanied by her child and 
her sister, suffering, according to her statement, 
from St. Vitus’s danoe, which, from the spasmodic 
movements of the muscles of the face and of one half 
of the body, appeared at first sight, not improbable. 
Let me give you, however, the description which she 
herself gives of her conditionDelicate in her child¬ 
hood she was seized when she was eight years old with 
involuntary movements of the muscles of the face 
and soon afterwards her arms were similarly affected, 
so that she could only feed herself with some diffi¬ 
culty. Her parents brought her to the Trousseau 1 
Hospital, where chorea was diagnosed, and she was 
submitted accordingly to the arsenical treatment. 
At the end of two months her condition had so much 
improved that she was able to return to school. Two 
years later the same symptoms reappeared but did 
not last long, and a year subsequently she was 
attacked for the third time. She was treated then 
by antipyriu, and with some success, but the affection 


continued to return with more or less frequency, and 
according to her story, the present is her sixth 
attack. During these fourteen years the physicians 
whom she consulted, and they were many, all agreed 
as to the nature of the affection—chorea—and treated 
her by arsenic and antipyrin. 

Such is groaao modo, the clinical history related by 
the patient, and as you have observed, her remarks 
were accompanied by involuntary movements of the 
face and of the left Bide of the body. I must confess, 
however, with all respect due to the clinicians who 
pronounced the case to be one of chorea, whose pre¬ 
scriptions she showed me, my first impression was 
that the diagnosis required revision, and this for the 
following reasons:— 

In the summary statement made by the patient 
there was no question of nervous seizures; moreover, 
on close inspection of the muscu^fr twitching one 
sees no rhythmical movement, we may consequently 
eliminate the affection known as hysterical chorea. 
Now, chorea, when it presents itself in a patient 
twenty-two years of age, is always of hysterical 
origin, the true chorea, that fiAt described by Syden¬ 
ham, never makes its appearance after the age of 
fourteen or fifteen. On the other hand, we must 
bear in mind that chronic chorea sometimes, though 
rarely, commences before that age, and the patient 
affirms that ^ie had her first attack at eight years of 
age. 

Such were the reflections which came into my mind, 
and my suspicions were confirmed by further infor¬ 
mation supplied by the sister of the patient. 

This woman declared that the twitching in the 
face had never totally disappeared since the age of 
eight, that her sister was in the habit, when worried 
by her child, of using bad language instead of 
making use of the ordinary expressions of vexation 
and reproof quite regardless of the presence of 
strangers. She had been frequently remonstrated 
with for using this bad language, but seemed to be 
unable to check herself. From that moment my 
mind was made up, and in lieu of the diagnosis of 
chorea, at once came to the dsnclusion that the case 
was one of convulsive twitching. It was in 1885, at 
the instigation of my regretted master, Professor 
Charcot, that I undertook the description of this 
affection. I sought to prove in my essay that the 
class of affections grouped under the name of chorea 
was far too comprehensive, and that it was neoessary 
to withdraw from that group an affection not pre¬ 
viously identified, which is in many respects similar 
to the chorea of Sydenham, with which indeed it had 
always been confounded. This affection begins in 
childhood and develops in the same way as true 
chorea, at least in appearance, under the form of 
attacks of incoordinate movements of a certain 
duration, Ip< contrast with what obtains in true 
chorea, patients suffering from the affection under 
consideration, are able to some extent to control and 
even, for a short time, to inhibit the twitchings of 
the muscles by an effort of the will. Further, onoe 
declared, this affection dogs the footsteps of the 
sufferer throughout life. 

A year later, M. Guenon completed the description 
of the symptomatology. He remarked that the 
“ twi tellers ” almost always presented a certain degree of 
mental disturbance bordering on degeneration. Down 
''to 1885 our knowledge of the malady was of the most 
summary, but during the lest few years it has been 
tie .subject of numerous investigations. 

We will now inquire into the distinguishing fea¬ 
tures of this affection, which, as I have already men¬ 
tioned, is so frequently confounded with the chorea 
of Sydenham. Towards the age of seven or eight, a 
child, boy or girl—for the two sexes Bee in to be 
equally attacked—whose nervous heredity is almost 
always well marked, presents involuntary muscular 


Diai 


oogle 




TRANSACTIONS OF SOCIETIES. 


The Medical Press. 611 


June 14, 1899. 


Switchings which sooner or later attract the attention 
of the parents. These twitchings are usually localised 
at first; they affect in preference the muscles of 
the face, twitching the eyelids, twisting the 
mouth with rapid and sudden movements of 
the lips. Sometimes these symptoms are accom¬ 
panied by expiratory laryngeal sounds which later on 
assume a peculiar character. These phenomena may 
remain for a long time localised to the muscles of 
the face, but under the influence of causes difficult to 
define, the movements extend to the muscles of the 
shoulders and of the upper extremities. In the 
majority of cases the twitches do not present the 
systematic character of true chorea, and that fact is 
an important point in the differential diagnosis. 
Again, under the influence of the will, the convulsive 
movements can be arrested for a time, brief though 
it be, but they then recommence with greater 
intensity. I have alluded to an expiratory 
sound emitted by the larynx, a fact which 
shows that the muscles of that organ are 
also affected by the malady. This sound often 
consists of syllables like “ hem,” “ oh,” “ ah,” 
but as the patients advance in years words are pro¬ 
nounced, generally without meaning, but sometimes 
they are coarse and even licentious. A lady of 
Rouen brought me her son, set. 10, to consult me for 
convulsive twitching, and told me that the boy had 
the habit of using words of the coarsest description 
in spite of all she could do to break him of the habit, 
so that she could no longer take him out for walks 
in frequented places. One of my colleagues related 
to me the case of a girl of 12, belonging to an excel¬ 
lent family in the south of France, who was con¬ 
stantly making use of a filthy expression. This, of 
course, very much upset her parents, who engaged 
a governess for the express purpose of breaking her 
of the habit, but it was of no use, the child continued 
to use the expression, and even seemed to take j 
pleasure in so doing. Unless the word is of a filthy | 
nature it would appear to have no value in respect of j 
the diagnosis. It is true that the morbid stigmata j 
does not show itself generally until the patient has 
arrived at the age of puberty, the case above men¬ 
tioned being exceptional in this respect. The pro¬ 
gnosis of convulsive twitching can never be favourable, 
as a complete cure is not to be hoped for; the inten- 1 
sity and the frequency of the paroxysms can be 
reduced by appropriate treatment, but it is impossible 
permanently to arrest this morbid condition which 
nas become, in a sense, inherent to the individual. 
Treatment should be exclusively of a moral order. 


Clinical piecorbe. 

A CASE OF HAEMORRHAGIC INFILTRATION OF 
THE MYOCARDIUM WITH INTERSTITIAL 
MYOCARDITIS, (a) 

Under the care of Dr. John’H. Larkin. 

The patient was a man, sat. 87, who was admitted to 
Bellevue Hospital, January 16th, 1897, with the following 
history :—He had always been in good health till three 
weeks ago. He never had rheumatism; did not use beer 
or whisky. Four weeks ago, on December 18th, 1896, he 
caught cold, but kept on working. For a week he was 
troubled with severe pain about the heart; the pain was 
not made worse by inspiration; it was of a lancing 
character, not constant. The pain still continued, but 
was not so severe as at first. On December 25th, three 
weeks ago, he had to stop work on account of shortness 
of breath and feeling sick generally. Dyspnoea, which 
was at first noticed a month ago, had gradually increased. 


(a) Case brought before the New York Pathological Society, 
April, 1889. 


He bad had orthopncea for three weeks. He had cough, 
with profuse expectoration. On January 14th he raised 
about one-half an ounce of blood. His feet were 
swollen. His temperature was 100 degs. F.; pulse, 
116; respiration, 28. On examination the heart sounds 
were feeble and rapid. There was no murmur. The 
heart was enlarged; the impulse was in the axillary 
line, sixth interspace; the sounds were more distinct 
at this point. There were pleuritic rales over the 
cardiac region and the right base posteriorly. The 
pulse was small, weak, and rapid. When lying down 
there was pulsation of the vessels of the neck up to 
the lobe of the ear ; when he stood erect, only half¬ 
way up, a harsh, short, diastolic murmur, most 
marked over the sternum, developed. On January 29th 
the patient was out of bed three times during the 
night. On the following morning, while sitting up in 
bed, he became unconscious, with twitchings of the 
entire half of the body, including the neck muscles 
but excluding the facial ones. There were yawning 
and lateral nystagmus, with diminution of the pupil of 
left eye. He had Cheyne-Stokes breathing. He died 
shortly afterward. At the autopsy nothing abnormal 
was noticed in the brain. The lungs were normal. 
The heart was slightly increased in size. There was 
no valvular lesion. In the wall of the left ventricle 
was a dark area, which contrasted sharply with the 
surrounding pale heart muscle, extending from the 
endocardial surface to about 3 mm. from the pericardial 
surface. The cardiac muscle in this area was dark and 
quite soft and depressed below surrounding muscle. A 
cross section showed the darkened area to be about 
2 cm. long. The spleen was large and congested. The 
liver was in a state of chronic venous congestion. The 
kidneys showed a large congested surface; granular 
markings were not evident. Microscopical examination 
of the heart showed that the muscle in the infarcted 
area had been replaced by haemorrhagic extravasation. 
Scattered through this blood-clot were remnants of dead 
heart-muscle cells, without nuclei, many containing 
larger and smaller vacuoles. At the periphery of the 
area was a narrow band of newly-formed fibrous tissue, 
with thin-walled blood-vessels and cedematous stroma. 
In places this tissue had proliferated between the musole 
fibres so that it made a solid mass ; and aside from the 
lesion proper it looked not unlike spindle-cell sarcoma. 
Changes in the coronary artery from the same case 
showed extensive obliterating endarteritis. There was 
great thickening of intima, with secondary degeneration 
and calcification. 


‘IrattBacttonB of gocictieo. 

OBSTETRICAL SOCIETY. 

Meeting Beld Wednesday, June 7th, 1899. 

Mr. Alban Doran, F.R.C.S., President, in the Chair. 


SARCOMA OF UTERU8. 

Dr. W. S. A. Griffith read brief notes of two cases 
of sarcoma of the uterus, both of which he had had under 
consideration for a considerable time. Case 1.—The 
patient, a woman tet. 52, was first seen in March, 1897. 
She had had several children the last nine years pre¬ 
viously. There had been no menstrual irregularity 
until two years previously, but she then began to lose 
rather profusely, and this increased in amount. Twelve 
months before there was a flooding. A month before her 
seeing him she had a second flooding. Pain was never 
a prominent symptom. The haemorrhage was always 
followed by relief of what she called pelvic discomfort. 
Quite recently she had complained of sharp pain in her 
womb, accompanied by a little offensive viscid mucous 
discharge. The cervix felt hard and irregular, but this 
was not borne out on actual inspection. He thought it 
a case of fibroid, and on March 13th he dilated the cervix, 
and found an interstitial fibroid of the posterior 
wall. She left well in May, but in September she still 
had irregular loss slight in amount, and had lost slightly 

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612 This Medical Press. TRANSACTIONS OF SOCIETIES. June 14, 1899. 


in weight. He saw her again in July, 1898, when she 
looked well though losing weight. She had a clear 
blood-stained discharge. He did not see her again until 
this year when she had still further lost weight, the 
haemorrhage being profuse and the uterus distinctly 
more bulky. He dilated and removed fragments of what 
proved to be sarcomatous tissue, and on March 23rd he 
performed hysterectomy. She recovered from the opera¬ 
tion, but since then the right kidney had been removed 
for cyst, but this appeared to be independent of the 
original trouble, there being no sign of sarcoma in that 
organ. Case 2.—First seen December, 1897; single, set. 
40. Menstruation had been regular since the age of 28. 
Had lost profusely for the preoeding twelve months. 
For three months there had been much pain, but she 
appeared otherwise in good health. She became anaemic 
and emaciated, and the uterus reached three inches 
above the symphysis. A fibroid was diagnosed, and .n 
June, 1898, he dilated and found a friable sessile mass 
on the posterior wall sections whereof pointed tc 
a degenerating fibroid. She married agains advice six 
months later. When seen some time subsequently, the 
uterus reached 7| inches above the brim, and there was 
a sloughing fibroid projecting through the vulva and a 
large mass was removed. The uterus then returned 
almost to its normal size, but it subsequently re-enlarged, 
and a polypoid mass was removed which proved to be 
sarcomatous. She died from septic trouble. The author 
insisted on the fact that profuse htemorrhages at the 
climacteric period were almost always attributable to 
organic mischief, and ought always to be carefully 
inquired into. 

HTDRAMNION IN CASES OF UNIOVIAX OR HOMOLOGOUS 
TWIN8. 

Dr. Thomas Wilson, in a paper on this subject, 
pointed out that although twins derived from separate 
ova are seven times more common than those derived 
from a single ovum, hydramnion appears to occur 
nearly as frequently in the latter variety as in the 
former. His paper was founded on two cases of uniovial 
or homologous twins which occurred in the writer’s 
practice, and on twenty other cases collected from various 
sources. The usual history of a case of this kind is that 
the patient usually a multipara, for the first few months 
of a pregnancy goes on normally. Then, usually at the 
fourth or fifth month and without any assignable cause, 
rapid elargement of the abdomen begins acutely, and 
leads in the course of a few days or weekB to extreme 
distress by reason of the severe pressure symptoms that 
are set up. The affection ends in nearly every case in 
premature delivery before the enu of the seventh month; 
in the majority of the cases _abour comes on spon¬ 
taneously ; in about 20 per cent, it has to be induced. 
The contents of the uterus are found to be twin foetuses 
of the same sex, one of which is decidedly larger than the 
other and is enclosed in an amnion containing an enor¬ 
mous excess of fluid; the smaller fcetus is provided, as a 
rule, with a normal or deficient quantity of liquor amnii. 
There are a single placenta common to the two foetuses, 
a single chorion, and two amnia. The heart and 
kidneys of the larger foetus are hypertrophied, often, 
enormously. Neither foetus shows any malformation, 
and the mother iB healthy x'he cause of the hydramnion 
is found in the relation of the vessels of the two foetuses 
to the common placenta. The twin whose vessels run a 
shorter or more direct course obtains an undue share of 
blood from the placenta, in which anastomoses take 
place between the vessels belonging to the two foetuses. 
In this way one foetus grows faster than the other, and 
its heart becomes not only absolutely but also relatively 
larger than that of the other; that is to say, its heart 
becomes really hypertrophied. This leads in some way 
to increased uptake of fluid in the placenta, and so to 
increased exudation by this twin This increased exuda¬ 
tion takes the form of excessive secretion, certainly from 
the kidneys, probably from the Bkin, and possibly also 
from the portion of placenta belonging to the affected 
fcetus; and the accumulation of these discharges leads 
rapidly to enormous hydramnion of the same fcetus. The 
diagnosis can often be completely made by observing 
that the signs of a fcetus are limited to a small portion 


of the circumference of a hydramniotic cyst. The appro- 
ariate treatment consists in the induction of premature 
labour by puncture of the membranes. Cate 1.—Seventh 
pregnancy ; symptoms beginning at the fourth month; 
labour induced by puncture of the membranes at five and 
a half months. Larger foetus, contained in nineteen 
pints of amniotic fluid, with lirge heart and kidneys, 
thick umbilical cord with dilated vessels ; smaller twin 
in separate amnion with normal amount of fluid, 
umbilical cord long, thin, velamentous; common placenta. 
Case 2.—Third pregnancy; symptoms beginning at three 
and a half months; labour spontaneous at five months j 
enormous gush of fluid followed by birth of twins con¬ 
tained in their membranes ; larger twin hydramniotic - T 
smaller showing marked atrophy of the wall of the left 
ventricle; common placenta and chorion. Dr. Wilson 
demonstrated the second specimen. The patient had 
been sent in as an urgent case, and while being put 
to bed there was a gush of fluid and the entire ovum 
was found in the bed. Both foetuses were males, 
one being muoh larger than the other. In the larger 
twin the heart was markedly hypertrophied, tl.c hyper¬ 
trophy specially involving the left ventricle. In the 
other foetus the left ventricle was thin (2 mm.) as com¬ 
pared with the 7 mm. of the left ventricle of the other 
foetus. The right ventricle of the smaller foetus was 
4 mm. thick, being thus double the thickness of the left. 
The chorion and placenta were single. There were two 
cords. That attached to the larger foetus was thicker, 
shorter, and attached to the centre of the placenta, 
while the other was attached to the margin. The 
placenta was roughly divided into two unequal portions, 
the larger section belonging to the larger foetus. Injec¬ 
tions showed that i here was a good sized vein running 
from one portion to the other. 

Dr. Spencer insisted that the diagnosis was often ex¬ 
tremely difficult, ballottement being often difficult to 
obtain. In one extreme case of his own he had obtained 
it only with the patient in the knee-elbow position. He 
suggested that before operating in such a case a sound 
should be passed into the uterus to ascertain its aize. 
With regard to the alleged hypertrophy of the heart 
he pointed out that the organs of the foetus varied 
greatly in size so that it was difficult to affirm 
that there was actual hypertrophy. He pointed out, 
moreover that the foetus contained in the hydramniotic 
sac was not alwayB the larger, and he had two observa¬ 
tions in which the contrary was the case. The author’s 
hypothesis would have to account for hydratnnios when 
there was only one foetus. In any event, the author's 
theory did not account for all the cases, and he urged 
that when there was an acardiac foetus one would expect 
the other foetus to be in a hydramniotic sac. In a well 
marked case of his own there was twisting of the cord, 
which he thought might explain some cases of 
hydramnios. The author’s own experiments showed 
that the fluid migl t reach the sac via the maternal 
tissues and also via the foetal tissues, so that on the 
whole the author’s theory was rather hazardous. 

Dr. Duncan said he had only seen two cases of 
hydramnios, but they were well marked. Both were 
cases of single pregnancy, and both were males. The 
last case had been diagnosed by three physicians as 
ovarian tumour. In this case, as indeed in both cases, it 
had taken several weeks to make the distinction, but in 
both instances it was possible to feel the foetus by 
placing the woman on her side and palpating both sides 
of the abdomen. Careful examination in both failed to 
make out uterine contraction, and that was a point of 
importance, because in text-books great stress was 
usually laid thereon. He presumed that the author 
would not suggest treating any of these cases in the 
absence of urgent symptoms. In both his cases labour 
supervened spontaneously at about the seventh month, 
and recovery in both was uneventful. 

Dr. Griffith praised the author for having gone 
into the question of the source of the liquor amnii in¬ 
stead of taking it for granted. In reference to the 
urinary source of the liquor amnii. he pointed out the 
objection based on the difficulty of the fcetus overcoming 
the pressure in the amniotic sac, even supposing that 
urine was secreted. As to the presence of varying qnan- 




June 14, 1899. 


TRANSACTIONS OP SOCIETIES. The Medical Pbebb. 613 


tities of urea, be pointed out that there were no trust¬ 
worthy means of ascertaining the composition of the 
small quantities of kidney secretion available. 

Dr. A. ILouth asked whether it was not a fact that 
many cases of acardiao monstrosities were described in 
which the hydramnios was in the sac of the acardiac 
foetus. The author's theory, moreover, did not explain 
hydramnios with a single foetus. He asked how it was 
that in these cases the foetus was generally puny, gene¬ 
rally female, and why often malformed. He himself had 
been able to detect uterine contraction in two cases at 
the Charing Cross Hospital, andballottement was easily 
obtainable. 

Dr. Spencer, in respect of the origin of the amniotic 
fluid from the foetal kidneys, added that in a number of 
cases of new-born infants he had found the ureters 
greatly distended when there had been obstruction 
below. If the foetus did not pass its urine into the 
liquor amnii it was difficult to e xp lain this distension in 
the presence of obstruction. Without affirming that 
this was the source of the liquor amnii, the question was 
one that required to be answered. 

Dr. Griffith pointed out that similar distension bad 
been observed without any obstruction. 

Dr. Spencer replied that he did not mean necessarily 
organic obstruction, which might be absent even in cases 
of hydronephrosis. 

Dr. Griffith urged that the obstruction might be the 
tension within the sac. 

Dr. Spencer rejoined that this would not explain all 
cases. 

Dr. Wilson, in reply, said that on the whole the evi¬ 
dence was in favour or the liquor amnii being at any 
rate in part derived from the kidneys of the foetus. His 
paper only dealt with hydramnion in cases of uniovial or 
homologous twins, and he did not intend to discuss the 
subject as a whole. There were many varieties of 
hydramnios, of which this was only one group, and they 
required to be studied separately. With regard to the 
intermittent uterine contraction he said that he had 
failed to feel it in one instance, but the next day he had 
seen a wave of contraction. 


BOYAL ACADEMY OF MEDICINE IN IRELAND- 
8ection of Pathology. 

Meeting held Friday, May 6th, 1899. 

The President, Dr. J. M. Purser, in the Chair. 

Dr. Knott exhibited a large series of pathological 
clavicles. 

ANOTHER CASE OF INFECTIVE ENDOCARDITIS, DUE TO 
PNEUMOCOCCUS. 

The Secretary (Professor E. J. McWeeney, M.D.), 
described a case of this disease. Into the left auriole pro¬ 
jected a greyish friable mass of fibrinous material as big 
as a large hazel nut, and springing from the aortic cusp 
of the mitral. The chord® tendineae were involved in a 
mass of similar character, and were much softened and 
ulcerated. Microscopically and culturally the diplo- 
coccus of Fraenkel was the only organism found. The 
edges of the fibrinous mass contained it in prodigious 
numbers, aggregated in small circular colonies. Both 
kidneys were found extensively infarcted, but not the 
spleen. Two months previously patient had developed 
a slight consolidation of both bases, consequent on a 
laparatomy successfully performed for the relief of 
pyloric obstruction by Mr. Chance. The temperature 
had been elevated at that time for two days only, and 
the case was regarded as one of so-called “ ether 
pneumonia.” She was discharged cured of her gastric 
troubles, and re-admitted a month afterwards with the 
symptoms of ulcerative endocarditis. 

DISLOCATIONS OF THE MBTATAR8US ON THE TARSUS. 

Professor Bennett read accounts of two cases of dis¬ 
location of the metatarsus on the tarsus, one of the 
complete dislocation of the bases of the metatarsals 


upwards and outwards; the second an example of dis¬ 
location of the first, second, and third metatarsals 
downwards beneath the tarsus. 

CENTRAL SARCOMA OF BONE. 

Dr. E. J. McWbeney, commenting on a paper by Mr. 
W. J. De Courcy Wheeler on this subject, said that the 
two microscopical sections showed an enormous number 
of giant cells or myeloplaxes. The tissue resembled 
normal bone marrow, with an extreme multiplication of 
the myeloplaxes. The cells were of positively gigantic 
proportions, and some possessed about a hundred nuclei. 
The nuclei of many of the smaller round cells showed 
the mitotic figures, but there was no evidence of the 
mitosis in the nuclei of the myeloplaxes. As for the 
proposition of removing such tumours out of the sarco¬ 
mata, he thought it impossible, for the simple reason 
that there was an unbroken chain of intermediate links 
between a round or spindle-celled sarcoma, with a very 
few giant cells, on the one hand, and a sarcoma crowded 
with suoh cells on the other hand. In Mr. Wheeler’s 
specimen there was no tendency whatever to the forma¬ 
tion of spicula of bone often characteristically formed in 
myeloid sarcomata. 

The President pointed out that in the marrow of 
normal bones the oells resembling the myeloplaxes were 
most commonly met with in young bones, and are very 
rare in the marrow of adult animus. He thought that 
the pathological myeloplaxes were something different 
from the normal giant cells of the marrow, which he 
looked on as osteoclasts. 

Mr. Wheeler, in reply, said there were no bony 
growths thrown out in the tumour. He raised the ques- 
whether material like that occurring in the tumour 
shown by him was taken out of a similar case, could it 
1 be possible, seeing that there was so much spindle-celled 
element, to say positively that it was not a spindle- 
celled sarcoma, but a myeloid sarcoma. 

TWO VA8CULAR TUMOURS OF ABDOMINAL WALL. 

Mr. B. Charles B. Maunbbll showed two specimens 
which had been successfully removed by operation. The 
first was removed from the left lumbar region of a young 
lady, set. 22, and had been gradually growing from early 
childhood. It was large as an adult hand, and on 
examination proved to be formed of dilated lymphatic 
spaces, and of the same character as the congenital cystic 
hygromata of the neck. The second was removed from 
a b»by, 11 months old, and proved to be a venous nsevus. 
It bad been noticed shortly after birth when it was not 
bigger than the head of a pin, and had rapidly grown 
until at operation it measured 16J by lit cms., and 
covered fully a third of the baby’s abdomen. It was 
ulcerated and constantly oozing blood. Mr. Maunselt 
removed it tn matte, a very little blood being lost during 
the operation, the patient making an uninterrupted 
recovery, notwithstanding its tender age. 

PATHOLOGICAL CONDITIONS OF THE TUNICA VAGINALIS 
TEBTIB. 

Mr. Fagan, F.B.C.S., showed the following speci¬ 
mens :— 

1. A large hydrocele opened longitudinally showing 
the relation of the tunica vaginalis to the testis, and 
demonstrating the several coverings of the tunica 
vaginalis, all of which were clearly shown by dissection. 
The external spermatic and transversalis fasciae were 
thin, the cremasteric fascia thick and strong, and the 
tunica vaginalis thick. 2. A hydrocele associated with 
syphilitic disease of the testis. The tumour was removed 
for pain from a man aged 60 who had syphilis seventeen 
years previously. The testis felt stony hard, the tunica 
vaginalis moderately distended; pain was constant and 
unbearable. 3. A large hydrocele, due to malignant 
papillary neoplasm of the tunica vaginalis. Growth 
began first in summer 1898. Hydrocele was tapped 
twice; filled very rapidly after last tapping, and lost its 
translucency. Scrotum became purplish and covered 
with distended veins. No history of injury, syphilis, or 
gonorrhoea; patient in 66th year and healthy, not even 
suffering pain from tumour. When tumour was opened 
a large quantity of yellowish black fluid poured out and 
the papillary growth became apparent. Castration was 

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614 The Medical Press. 


GENERAL MEDICAL COUNCIL. 


performed April 12th, 1899. Patient left hospital 
April 22nd. 

Professsor McWeeney pointed to the existence of a 
typical papillomatous carcinoma, originating from an 
-endothelial membrane like the tunica vaginalis. The 
shape and appearance of the cells was almost identical 
with those composing a villous papilloma of the urinary 
bladder. 

The President said that the specimen referred to by 
Dr.McWeeney was interesting, because the epithelium 
covering the sexual glands is, in the early stage, 
columnar in shape and several layers thick, and grows 
down to form the tubes of the ovary and the tubes of the 
testicle, so that the specimen might be a recurrence to 
the primitive type. 

Tne Section then adjourned. 


EDINBURGH MEDICO-CHIRURGICAL SOCIETY 
Meeting held June 7th, 1899. 

Dr. Wm. Craig, Vice-President, in the Chair. 

Mr. Shaw Maclaren showed a patient after disarticu¬ 
lation at the hip for injury. 

Mr. C. W. Cathcart showed a patient after operation 
for perfos^ted vermiform appendix with geneial peri¬ 
tonitis. 

Mr. F. M. Caird showed a case of secondary syphilis 
-occurring in a young man who presented undoubted 
signs of old congenital syphilis. 

Dr. Sherman showed the following specimens:— (1) 
Malignant pustule ; (2) sarcoma of the anterior part of 
the tempero-sphenoidal lobe, which had produced sudden 
hemiplegia; (3) calcareous deposit on the epididymis, 
probably of tuberculous origin; (4) extensive infarcts of 
the kidney; (6) a tuberculous nodule in the wall of the 
heart. This was a somewliat rare lesion; only eight 
case8 were to be found in the pathological records of the , 
Sick Children’s Hospital for the last ten years. (6) 
Lungs showing diabetic phthisis. 

Dr. James read a paper on a case of 

CONGENITAL SYPHILITIC O8TEITI8. 

The patient had been under observation for about, eleven 
years. A step-brother by a former marriage was healthy. 
By the second marriage there were eleven children, of 
whom patient was the third. The first and second was 
syphilitic,and died soon afterbirth; the fourth,fifth, sixth 
and seventh were premature, and either died soon after 
"birth or were stillborn. The last four children were 
healthy. The patient had shown no signs of syphilis— 
such as shuffles or rash—at birth, but suffered from in- 
testitial keratitis in his second year. When he was nine 
years old be began to suffer from pains in his arms and 
legs, and a node developed on the left tibia. Thereafter 
(in 1892) thickening of the lower ends of both humeri 
was detected, as well as nodes on the opposite tibia 
and on the spine of the scapula. Some years later he 
began to complain of headache, chiefly left-sided, and, 
simultaneously, twitchings of the right side of the body 
appeared, associated with transient attacks of uncon¬ 
sciousness. When admitted to hospital the lad was 
emaciated and apathetic. The right tibia was thickened 
and narrow, and about i in. longer than the left. The 
vision was blurred, there were signs of old keratitis, and 
the optic discs showed fairly well marked papillitis. 
There was right hemiplegia with occasional clonic spasm. 
The vessels generally were thickened, and the glands 
and spleen enlarged. The diagnosis arrived at was 
hereditary syphilis with nodes which had disappeared 
and been followed by osteitis (local granlism of tibia), 
and a gumma in the rolandic area. At the poet mortem 
the tibia was found to consist entirely of cancellous 
tissue, the medullary canal being absent. 

The discussion of the case, both by the speaker and 
by Drs. John Thomson, Alexis Thomson, and Sherman, 
centred round the question whether there was anything 
characteristically syphilitic (“ para syphilitic ") in such a 
case of osteitis, or whether (and to this view most of the 
speakers inclined) the osteitis was merely such as might 
follow any chronic infection of bone. 


June 14, 1899. 

THE GENERAL MEDICAL COUNCIL 

OF 

EDUCATION AND REGISTRATION. 


SUMMER SESSION, 1899. 

Sir William Turner, President, in the Chair. 


FIFTH DAY— Saturday, June 3rd. 

After the completion of a dental penal case, a report 
by the President to the Council on 

Proposed Increased Disciplinary Powers 
was read. It was to the effeot that no great progress 
had been effected in inducing the dissenting licensing 
bodies to fall into line, and a resolution was agreed to by 
the Executive Committee approving of the amended 
clauses drafted by Mr. Muir Mackenzie and requesting 
the President to forward them to the medical authorities 
before submitting them to the Council. 

Communications were received from the Privy Council 
enclosing copy of a proposed bill drafted by the Incor¬ 
porated Association of Medical Practitioners for prevent¬ 
ing persons who have been removed from the Segiaier 
from continuing to act as medical practitioners. 

Mr. Muir Mackenzie’s opinion on the above draft bill 
was read. It was to the effect that if passed into law it 
would make it a criminal offence for such persons to con¬ 
tinue to practice, which would be introducing an alto¬ 
gether new principle to existing legislation, a departure 
which would certainly exoite strenuous opposition, and 
for this reason Mr. Mackenzie “ could not advise the 
Council to support such a measure without very careful 
consideration.” He called attention to the absence in 
the draft of any reference to midwifery, and he con¬ 
cluded by stating his opinion that the clause dealing 
with the payment to the Council of penalties inflicted 
under the Medical Aots was not framed in terms which 
would displace the contention of the metropolitan 
authorities. On the whole he did not think the bill was 
one which deserved the Council’s support. 

The Examination of the Apothecaries’ Hall, 
Dublin. 

Then came up the reports from the Examination Com¬ 
mittee on the inspection of these examinations. With 
respect to the examinations in October, 1898, attention 
is directed to the fact that the Board still manifested 
caprice in the allotment of marks, and appeared at times 
to adjudicate the work of candidates too highly. It is 
added, however, that the Board appears to have made 
considerable efforts to meet the suggestions of the 
Council. With regard to the examination in January, 
1899, the Examination Committee note that they 
attracted as a rule men of inferior attainments “ who 
were striving to pass into the profession by reiterated 
efforts in piecemeal fashion.” The examination of 
April, 1899, consisted in the re-examination of two 
rejected candidates in a solitary subject of the second 
examination, and it is noted that these candidates were 
in process of securing a diploma by piecemeal examina¬ 
tions before different boards in ’different parts of the 
kingdom, a system “ which could not be too strongly 
deprecated,” and which has, moreover, already been con¬ 
demned by the Council. With regard to the examination 
in surgery it is reported that the examination was well 
and fairly conducted. 

SIXTH DAY.— Monday, June 5th. 

The foregoing reports came up for discussion when 
Mr. Tichborne objected to the tone in which some 
matters of fact were stated in the reports, and he criti¬ 
cised the remarks of the two assistant examiners who 
“ rightly or wrongly ” appeared to have acted as inspec¬ 
tors. 

Sir Dyce Duckworth pointed out that they acted as 
inspectors under the Act. 

Mr. Tichborne moved the omission of the prefixes 
“one only” and “solitary” as superfluous, and he 


Digitized by 


J uni 14, 1899. 


GENERAL MEDICAL COUNCIL. 


The Medical Press. 615 


objected to the retention of certain other words and 
clauses. 

8ir Dyce Duckworth pointed out that the use of the 
terms objected to was necessary to emphasise the fact 
that all this machinery had been brought into play for 
a single candidate. He added that the inspections had 
cost the Council .£307 10s. 8d., whioh was a considerable 
amount in view of the paucity of the results. 

Mr. Victor Horsley hoped the Council would sup¬ 
port the committee, and commented on the expense 
which the inspections entailed. He suggested that the 
authorities of the Hall did not realise that they were 
carrying on the examinations at a loss. 

Mr. Tichborne’s amendments having been lost by 
large majorities, the motion that the reports be received 
and entered on the minutes was agreed to. 

Sir Christopher Nixon raised the question whether 
the Council was to oontinue to incur the enormous 
expense of inspection, which he thought was out of all 
proportion to the results of the examinations. 

The President pointed out that the matter referred 
to was not before the Council, though a motion to that 
effect could be handed in. 

Sir Christopher Nixon did not wish to take up a 
position which might appear offensive to the representa¬ 
tive of the Hall. 

The Standard of Preliminary Examinations. 

Sir John Tcke brought up the recommendations con¬ 
tained in the interim report for adoption. He explained 
the steps that had been taken to give effect to the 
Council’s reference to the Committee, and stated that 
the replies received showed that the question was more 
complex than it at first appeared. While, on the other 
hand, it was stated that the proposed raising of the 
standard to the level of the senior local examination 
could be brought into force in 1905, the opinion was 
expressed on the other hand that, if not absolutely imprac¬ 
ticable, it would not be practicable for many years to come. 
The Board of Delegates of Local Examinations of Oxford 
for instance, thought the proposal unwise unless it is 
intended to discourage candidates from beginning their 
medical studies until the age of eighteen. Notes of 
warning had reached them especially from Owens Col¬ 
lege and from Ireland. Another point raised was that 
the relative value of certain of the preliminary examina¬ 
tions accepted by the Council was not well defined. It 
was suggested that three men should be appointed, one 
for each division of the kingdom, who would take cognis¬ 
ance of the plans and regulations of the various bodies 
in order that they might see whether they are in accord¬ 
ance with the regulations of the Council. The experts 
and advisers might hold a conference with the Education 
Committee and draw up a report which he thought 
might enable the committee in November to suggest a 
course by which a system for gradually raising the junior 
examinations could be established. 

The President then moved the adoption of the recom¬ 
mendations extending the period of reference and pro¬ 
viding funds (.£100) for obtaining expert assistance. This 
was carried. 

Report of the Midwives’ Bill Committee. 

8ir Richard Thorne read the report, which embodied 
a number of criticisms on the draft Bill. It is urged 
that the term “ natural labour ” should be retained, as 
otherwise women would be licensed to attend for gain 
cases of abnormality or disease connected with parturi¬ 
tion. It is suggested also that it should be made penal 
for a registered midwife to employ an unlicensed sub¬ 
stitute, and prohibiting such registered midwife giving 
certificates of death or still-birth. It is urged that it 
ought to be made clear that the rules passed by the 
Central Midwives’ Board should not be valid until ap¬ 
proved by the Council, and the use of the term “ qualifi¬ 
cations” is deprecated as likely to lead to misappre¬ 
hension. It is suggested that the local sanitary authority 
should take part in the local administration of any such 
Act, and attention is called to the “ imperative necessity ” 
of making provision for qualified medical assistance in 
all abnormal cases. Speaking on the Bill generally the 
committee advise that the term “ license ” should 
throughout be restricted to the permission granted by 


the local supervising authority to practise in a given 
area and that the document granted by the Central 
Board should be termed a “ certificate.” Further 
suggestions are made in respect of the expenses which 
Council or a committee might incur in connection with 
such bill. The committee accordingly recommend that 
the Privy Council be informed that the Council are 
unable to approve the Bill unless it is recast in accord¬ 
ance with the suggestions made in the report. 

Sir Richard Thorne said there was one important 
clause in the report in which he had been in the 
minority so that he could not propose the adoption of the 
report as it stood. After some discussion an amendment 
deleting the paragraphs concerning the sanction by the 
Council of the xules formulated by the Central Board 
was agreed to. The report was accordingly amended 
and in its altered form was directed to be forwarded to 
the Privy Council. 

Medical Aid Associations. 

A report by the committee appointed to consider this 
subject was received. It embodies a narrative of the 
various steps that have been taken to investigate the 
practices complained of, and the committee suggest to 
the Council that, as the result of their protracted inquiry, 
“the evil is gieat enough to justify the expression of 
strong disapproval” by the Council of touting and 
advertising for the purpose of procuring patients in the 
medical aid department, and of any sanction to such 
methods by registered medical practitioners. A resolu¬ 
tion to this effect was suggested for adoption by the 
Council. 

In moving the adoption of the report Dr. Glover ex¬ 
plained the action of the committee in respect of the 
proposed Board of Conciliation which he thought was the 
only practical course, aDd one which, it was to be hoped, 
would do much to remove the misunderstanding that 
had hitherto existed. 

Mr. Horsley asked the Council to vote against the 
report, urging that they ought not to arrive at any con¬ 
clusion without ampler information. He thought the 
report went too far, and he warned them against doing 
anything that might imperil the dignity of the Council 
or curtail its proper functions. 

Mr. G. Brown, on the other hand, thought the recom¬ 
mendation was worthy of a trial. 

In reply to a question by Mr. Horsley, the Presi¬ 
dent mentioned that in May, 1898, the Friendly Socie¬ 
ties had a membership of 213,917, employing 75 medical 
officers, with an average of 2,849 members for each 
medical officer. 

Mr. Carter thought the proposal oould do no harm, 
and might do good. 

Mr. Bryant, Dr. Leech, and Mr. Teale supported the 
recommendation, but Sir Richard Thorne hoped that the 
representatives of the Council would take no part in the 
formation of any such Conciliation Board, if constituted. 
Though possibly very desirable he thought it would be a 
dangerous Btep for the Council to take. 

Dr. MacAli8ter approved of the recommendation, but 
Dr. McVail wanted to know more about the subject. 
He urged that its adoption might lead to disputes with 
persons who would probably have to come before the 
Council to defend themselves. 

After a long discussion cn a rider to the resolution 
deprecating any participation by members of Council in 
the formation of such a Conciliation Board, a reso¬ 
lution was ultimately carried ntm. con., declaring that the 
Council approved of the proposal to form a Conciliation 
Board consisting of representatives of Friendly Societies 
and medical men, on the understanding that the Council 
should not take part officially in the formation of the 
Board. 

SEVENTH DAY— Tuesday, June 6th. 

Medical Aid Associations. 

Resuming the discussion on Medical Aid Associations 
the President pointed out to Dr. Glover, chairman 
of the committee, that no means had been suggested 
whereby the Council could take action in the matter, 
and he asked him whether he would not supplement his 
motion by suggesting a course of action. 


ized by 



e 




616 The Medical Press. 


GENERAL MEDICAL COUNCIL. 


June 14, 1809. 


After some discussion. Dr. Glover proposed that a 
copy of the resolution of the Council passed on the pre¬ 
vious day should be forwarded to the chairman of the 
committee, to the representatives of the friendly 
societies, and to the various professional bodies and 
members of the profession who had memorialised the 
Council on the subject. 

This matter was ultimately postponed. 

On the recommendation inviting the Council to 
declare that it “ strongly disapproved of medical prac¬ 
titioners associating themselves with medical aid asso¬ 
ciations in which touting and advertising for the pur¬ 
pose of procuring patients is practised,” Mr. Brown 
asked Dr. Glover to substitute the terms of a motion 
standing in his own name to the effect that the Council 
“ regarded as unprofessional ” such conduct. 

Dr. Me Vail pointed out that if they were prepared 
to take action against the persons referred to, then they 
should pass the motion, but he objected to the Council’s 
merely endorsing a pious opinion. 

Dr. Glover, after some further discussion, said he 
wished the resolution to contain words sufficient to give 
notice that if persons lent themselves to such systems 
the Council would be prepared to use its disciplinary 
powers for the correction and removal of such persons. 
Ultimately the resolution was carried unanimously in the 
following terms“ That the Council strongly disapprove 
of medical practitioners associating themselves with 
Medical Aid Associations, by which systematic canvass¬ 
ing and advertising for the purpose of procuring patients 
are practised. 

The Allocation of Fines under the Medical Acts. 

Dr. Glover brought up the report of the Penal Cases 
Committee on this subject, advising a test action. This 
was discussed in camera. 

Additional Qualifications on the Colonial List* 

The Council next proceed to discuss a communication 
from the Privy Council bearing on the claim of Miss 
Rachel Cohen, M.B., Calcutta, registered in the Colonial 
Litt, to have added thereto the F.R.C. S I. which had 
been refused by the Executive Committee on the ground 
that the applicant could not register her higher qualifica¬ 
tion on the Colonial List, the committee’s action being 
based on an opinion by Mr. Muir Mackenzie. 

Mr. Horslet moved that Miss Cohen’s request be 
acceded to. 

Mr. Muir Mackenzie admitted that his first opinion 
had been arrived at without a full knowledge of the facts, 
and ultimately it was decided to accede to the request 
and to direct the Registrar in future to register addi¬ 
tional or higher qualifications on the Colonial Litt. 

EIGHTH DAY.— Wednesday, June 7th. 

Mr. Carter made some caustic remarks on “ the un¬ 
bounded eloquence of certain members of the Council,” 
two of whom, he said, had in five or six days made 138 
speeches, thus unnecessarily prolonging the duration of 
the session. He ironically suggested that no member 
should 8peak more than three times on each motion. 

The President announced that in camera the Council 
had decided to restore the name and qualification of 
Mr. Alfred Freeman to the Register. 

The Hunter Case. 

Mr. Horsley raised the question as to the presence of 
the Council’s legal advisers on this occasion saying that 
it was not right for anyone to question the procedure of 
their legal advisers without it being arranged for them 
to be present. 

The President said that both legal advisers preferred 
not to be present. 

After prolonged discussion, during which Mr. Horsley 
moved the adjournment of the debate in order to put 
himself in order, it was decided that the legal Assessor 
and Solicitor ef the Council be asked to attend a 
meeting of the Council oh Thursday when the proceed¬ 
ings, re Mr. Hunter, would be discussed. 

, Inspection of Higher Examinations. 

Mr. Horsley moved that the Council should record 
its opinion that under Sections xvm. and xx. of the 
Medical Act, 1858, the duty is imposed on the Council of 


inquiry into, and securing, as far as possible, the 
efficiency of any examination which confers a registrable 
qualification mentioned in Schedule A of the said Act. 
He denied that Section m. of the Medical Act, 1886, had 
any bearing on the point at issue. 

The President asked Mr. Horsley whether he held 
that the Council would be entitled to refuse to put on the 
Register as an additional qualification a fellowship 
conferred without any examination ? 

Mr. Horsley said this had no bearing on the point, 
though it was one well worthy of discussion. He was 
not aware that the Council, in expressing its recognition 
of any fellowship had ever laid it down that it was to be 
secured by examination. 

Dr. MacAlister thought that Section 20 of the 1858 
Act limited the qualifications to those obtained after a 
course of study and examination. 

Mr. Carter pointed out that the examination out of 
which this question arose had ceased to be a registrable 
qualification since 1896. 

The motion was put to the vote and declared to be 
lost, 9 voting against, 7 for, 12 did not vote, and 2 were 
absent. 

The Appointment of the Legal Advisers. 

In response to the request of Mr. Horsley, the 
Registrar read the minutes of appointment by the 
Council of the Legal Assessor and Solicitor to the 
Council, and in spite of some opposition the answer was 
entered in the Minutes. 

The First Year’s Course. 

Sir John Batty Tuke moved that the report of the 
Education Committee on the regulations of the English 
and Scottish Conjoint Boards in regard to the first 
year’s course of professional study be received and 
entered on the Minutes. The questions before the Com¬ 
mittee were (1) whether a year of scientific study before 
registration should tn exceptional cases be recognised as 
constituting one of the five years of the medical curri¬ 
culum *, (2) whether a year of scientific study taken 
afUr registration in an institution of the status and 
character of an ordinary secondary or grammar school 
should be regularly recognised as constituting one of tie 
five years required. In regard to the first question the 
Committee state that experience hss justified the protest 
against the practice, but it is pointed out that in all 
the Glasgow cases an examination had been passed which 
would have entitled to registration. With regard to the 
second question the Committee “ regard the system with 
considerable distrust,” and they report that the recog¬ 
nition of teaching institutions where physics, chemistry, 
and elementary biology are taught, without due inspec¬ 
tion, is not in accordance with Resolution II. agreed to 
by the Council in December, 1894. The Committee 
suggest that the Council should require that before 
registration is effected a student should have commenced 
medical study at an university or Bchool of medicine or 
at a scientific institution recognised by one of the licens¬ 
ing bodies and approved by the Council. In this way 
attention would be drawn to any institution to which 
objection might be taken and approval withheld if 
thought desirable. 

Dr. MacAlister thought that registration should only 
take place in regard to institutions which had been 
formally brought before the Council and had been 
approved, in the sense that no objection had been raised. 

Mr. Bryant said the report contained a principle 
which, as representing the College of Surgeons of 
England, he could not for a moment recognise. Most of 
the institutions had been recognised by the College only 
after inspection, and if the Counoil insisted that none 
should be recognised without inspection, it might be 
found possible to do so. 

Dr. Church urged that the demands for registration 
ought not to be made too severe, and he moved as an 
amendment that the old form of registration certificate 
be retained. 

Sir William Thomson, quoting from the letter of 
the Secretary of the R.C.S.I., pointed out that according 
to the recently issued rules and regulations of the Con¬ 
joint Board in England it was possible to obtain a 
medical course of four years in spite of the Council’s 




j un* 14, 1899. GENERAL MEDICAL COUNCIL. 'The Medical Press. 617 


requirements in favour of five years’ course. He urged 
that it was the duty of the Council to see that their 
orders were carried out, and he commented on the atti¬ 
tude of a body which, when challenged, declared that it 
would act as it pleased. He insisted on the importance 
of the issues before them, and explained that with regard 
to the schools alluded to the contention was not that 
these schools were necessarily bad or inefficient for the 
teaching of science. He appealed to the Council to 
declare whether a first year at a grammar school was a 
bona fide year of medical study. He asserted that the 
Council had not intended that the additional year 
should be a sham, and if they approved of this departure 
from their rules the only alternative was that they must 
go back to the four years’ system. It was idle to talk of 
a five years’ course when it was not a five years’ course. 
He asked the Council to accept the report, which was 
put forward as a recommendation and which, he hoped, 
would protect medical education. 

Sir Christopher Nixon, speaking as the representa¬ 
tive of the Royal University of Ireland, said that body 
had always rigidly carried out the Council’s recommen¬ 
dations, and he asserted that, so far as the Dublin 
school of medicine was concerned, no school or secondary 
school professing to teach medical students the subjects 
of the first year’s medical studies would ever be recog¬ 
nised. He expressed surprise at the attitude of the two 
great corporations, which plainly set the Council at 
defiance, and he urged that if this were allowed to pass 
it would possibly have a disastrous effect on other bodies 
that so far had tried to conform to the Council’s direc¬ 
tions. He claimed that the different corporations after 
inspecting these bodies should submit the results of 
such inspections to the Council for its approval. This 
appeared to him to be a test case with regard to the 
power of the Council, and if the Council felt it had not 
the power it might throw out the recommendations of 
the Education Committee. If they did so he feared 
they would undo all the good that had been done in 
years gone by in elevating the tone of medical education. 

Mr. Bbown cordially supported the committee’s 
recommendations and urged the Council to adopt the 
fearless of oonsequenoes. 

Dr. MacAlister pointed out that it was not alleged 
that the oonjoint colleges had broken the rules laid down 
by the Council, indeed they had kept strictly to the 
letter of the law though they had interpreted the resolu¬ 
tions possibly in a sense not anticipated by the Council. 

Dr. Atthill said there was a systematic process at 
work for whittling away at least one of the five years. 

The President pointed out the corporations had 
•actually submitted a list of institutions, but, as he 
understood it, they declined to limit their functions to a 
question of approval by the Council. 

Sir W. T. Gairdnbb observed that science had been 
introduced into the programme of grammar schools to 
.a much greater extent than ever before. 

Dr. Church asked that his amendment might be put. 
He pointed out that it was not the desire of the Conjoint 
Board to run counter to the wishes of the Council, but 
objected only to the Counoil’s going beyond what they 
held were its powers. It was not the business of the 
Council to regulate the curriculum of the Conjoint 
Board. 

The amendment was put to the vote, and lost by 17 
to 9. 

Mr. Brtant complained that Mb college had not been 
properly treated, and he moved as an amendment that 
instead of the committee’s recommendation the Council 
adopt a resolution in the following terms: “That the 
list of recognised teaching institutions forwarded to the 
Registrar at the beginning of each year be reported to 
-the next following meeting of the Executive Committee 
and printed in the Minutes of that committee for the 
information of the Council.” 

The amendment was lost by 18 to 8, and the original 
motion was then carried. There were 18 for, 6 against, 
-6 did not vote. 

The Registrar was directed to call the attention of the 
licensing bodies to the foregoing resolution. 


NINTH DAY— Thursday, June 8th. 

An official notification was received from the Univer¬ 
sity of Oxford appointing Dr. J. F. Payne its repre¬ 
sentative, vice Dr. Church, who had resigned. Dr. Payne 
was introduced by Sir Dyce Duckworth. 

After a little spell in camera, a letter, with documents, 
from the Secretary of the College of Preceptors was 
entered upon the Minutes together with the President’s 
reply thereto. 

Report of Phxrmacopceia Committee. 

The report of the Pharmacopoeia Committee showed 
that 25,255 out of 26,500 copies had actually been sold, 
so that a re-issue was imminent. Note was taken of 
the fact that the Legislatures of Queensland and 
Victoria have sanctioned Acts which provide for the 
adoption of the British Pharmacopoeia therein. It was 
announced that the Pharmaceutical Societies of 
Great Britain and Ireland had been invited to 
appoint representatives to confer with members of the 
Pharmacopoeia Committee, and representatives had been 
appointed accordingly, and a conference had been held. 
The Committee suggest that they be authorised to allow 
the publication of reports reoeived from experts in 
pharmacy and pharmaceutical chemistry upon matters 
deemed worthy of investigation. It was mentioned that 
the India Office and the Colonial Office had agreed to 
the request of the President of Council that a report 
upon the Indian and Colonial Addendum should be for¬ 
warded to the Indian and Colonial medical and 
pharmaceutical authorities. It was added that copies 
of the report had been sent to some 900 authorities and 
experts, and valuable observations and criticisms had 
been reoeived in consequence. A committee has been 
formed in Canada to consider what additions it might be 
desirable to make in the addendum to adapt the Phar- 
macopceia to the requirements of the Dominion, and a 
preliminary report has already been agreed upon. 

The report was adopted. 

The British Pharmacopeia Account. 

On Mr. Bryant’s motion it was decided not to charge 
the disbursements in connection with the preparation of 
the Pharmacopoeia as part of the annual expenditure, 
but that a separate Pharmacopoeia account should be 
kept. 

The Finances of the Irish Branch Council. 

It was agreed to refer the consideration of the financial 
condition of the Irish Branch Council to the finance com¬ 
mittee with power to take legal opinion. 

Reciprocity of Medical Practice. 

The Counoil then proceeded to taka cognisance of the 
opinion drawn up by Mr. Muir Mackenzie on the ques¬ 
tion whether the privilege* to foreign practitioners could 
be restricted to the recognition of practice by them 
among their fellow countrymen only in this country. 

Mr. Muir Mackenzie points out that Her Majesty may, 
by Order in Council, declare that Part 2 of the Medical 
Act (1886) applies to any foreign country. The effect 
of such order in Council would be to admit practitioners 
duly qualified in that oountry to registration here, and 
such registration would confer the right to practice 
medicine in the same way as English medical practi¬ 
tioners. Mr. Mackenzie, consequently, is of opinion that 
the privileges to foreign practitioners cannot be re¬ 
stricted in the manner indicated in the question. 

The opinion as received was entered in the Minutes. 

The Case of the Late Mr. H. K. Hunter. 

After an ineffectual attempt on the part of Dr. McV ail 
to postpone the discussion, Mr. Horsley asked and 
obtained leave to make a statement with reference to the 
proceedings taken in the name of the Council against 
the late Mr. H. K. Hunter, L.S.A. Alluding to the 
general impression outside that the Council had un¬ 
justifiably undertaken proceedings against a duly regis¬ 
tered practitioner, he repudiated on behalf of the Counoil 
any responsibility of the kind, seeing that the Council 
as a whole had never ordered that Mr. Hunter should be 
prosecuted for calling himself a physician, in faot, in 
ordering the prosecution, the Council was under the im¬ 
pression that the person to be prosecuted was an un- 



618 The Medical Press, 


FRANCE. 


registered practitioner using a bogus American degree. 
He complained that the Council as a whole had not been 

? laced in possession of the facts of the case by the 
’enal Cases Committee. 

Mr. George Brown reiterated the complaint that the 
Council had not been placed in possession of the facts of 
the case, and he believed that if the Council had known 
that the prosecution was against a registered practitioner, 
they would have hesitated before giving their sanction. 

Dr. Glover defended the action of the Penal Cases 
Committee, and stated that the prosecution had not 
been taken in an unfriendly spirit, and was certainly 
entered upon without any personal animus. The object 
was simply to settle a question of law. He concurred in 
the regret which they must all have felt at the death of 
Mr. Hunter, but urged that the fact that he had died 
before the appeal came on was proof that the appeal was 
not resisted out of animus against Mr. Hunter. 

Mr. Cabtbr said the committee advised the prosecu¬ 
tion simply as a legal test case on the right to make use 
of the Philadelphia degree. Mr. Hunter had expressed 
a desire to have the matter settled, and had intimated 
his willingness to defend any proceedings on the point. 
The imputation brought againBt the Council of having 
improperly resisted access to documents in this case had, 
he said, no foundation in fact. 

The matter was then allowed to drop. 


TENTH DAY.— Fbidat, June 9th. 

Reciprocity op Medical Practice. 

The question of reciprocity of medical practice in 
regard to Italian medical practitioners, arising second¬ 
arily out of Mr. Mackenzie’s opinion (see yesterday’s 
proceedings), came up fer discussion on amotion by Dr. 
McVail to the effect that the Executive Committee be 
instructed to communicate to the Privy Council the 
tenour of Mr. Mackenzie’s opinion on the impossibility 
of limiting the practice of foreign practitioners to their 
fellow countrymen, ihe Committee to add a covering 
letter indicating the difficulties that surround the recog¬ 
nition of medical graduates in foreign countries over 
whose curriculum or study and professional examination 
the Council can exercise no supervision. 

This was carried, whereupon Dr. Glover moved tliat a 
committee be appointed to consider necessary amend¬ 
ments in the Medical Acts. 

Dr. MacAlisteb and others opposed the resolution on 
the ground that the Council should leave the initiative 
in this matter to persons outside the Council. Ulti¬ 
mately the motion was rejected by a narrow majority. 

Appointment of Examiners. 

Mr. Stoneham was appointed assistant examiner to the 
Society of Apothecaries for five years vice Mr. Bernard 
Pitts. 

It was also agreed to reappoint the present assistant 
examiners in surgery at the Apothecaries’ Hall, Dublin, 
for one year. 

The Issue of Unauthorised Diplomas. 

The Council then proceeded to take into consideration 
the various memorials addressed to it in reference to the 
issue to persons not medically registered of certificates 
or diplomas testifying or implying proficiency in particu¬ 
lar departments of medicine, surgery or midwifery. 

Mr. Bryant brought up for adoption the recommen¬ 
dation of the Executive Committee absolving the Council 
from any present action in respect of certificates in 
midwifery in view of pending legislation, and stating 
that the Council, though it exercised no jurisdiction over 
spectacle-makers, would be prepared to consider any 
properly substantiated charge of improper conduct made 
against a registered practitioner with reference to the 
subject. 

Mr. G. Brown moved an amendment to the effect 
that the matter be referred to a special committee to 
report to the Council in November next. He emphasised 
the importance, as matter of investigation, of the view 
that the assistance of medical men gave a quasi-medical 
character to diplomas conferred by outside bodies. 

Mr. Hobslet seconded the amendment, and insisted 


Jure 14, 1899. 

upon the importance of the complaints embodied in th© 
memorials. 

Mr. Carter urged that the Spectacle Makers’ Com¬ 
pany was only endeavouring to assist spectacle makers 
in acquiring a knowledge of the mechanical part of their 
business. He thought that the Council would be going 
outside its province if it took any action in the matter. 

The amendment was rejected by a large majority, and 
the original motion was then passed. 

Midwives Committee. 

The Midwives Committee was reappointed, with in¬ 
structions to watch any further legislative action that 
might be brought forward. 

The Committee on Medical Aid Associations was also 
reappointed. 

Dental Repobt. 

A report of the Executive Committee (Dental) was ap¬ 
proved embodying the following supplementary notice :— 
“ Any registered medical practitioner who knowingly 
and wilfully assists a person who is not registered as a 
dentist in performing any operation in dental surgery, 
either by administering anaesthetics or otherwise, will 
be liable to be dealt with by the Council as having been 
guilty of infamous conduct in a professional respect.” 

On the motion of Sir J. Batty Tcke, the senior 
examination of the Welsh Intermediate Board was 
added to the list of preliminary examinations qualifying 
for entrance to medical study. 

After the transaction of the usual formal business 
incidental to the fin dc session, the Council deliberately 
broke up. 


Jfrance. 

[from our own correspondent.] 

Paris, June loth, 1896. 

Cacodylate of Soda. 

At the Acad^mie de Medecine M. Gautier spoke at 
length on the properties of cacodylate of soda, which 
he employed as a substitute for mineral arsenic in 
anaemia, intermittent fever, and in consumption,* with 
considerable suooess. Cacodylic acid, he said, was rich in 
arsenical principles, since it contained 54 per cent, of 
metallic arsenic; but the arsenic is in this product in an 
essentially latent organic form, which deprived it of 
all the physical, chemical, and physiological pro¬ 
perties of the ordinary arsenical preparations. 
It was evident indeed, that cacodylate of soda was 
not an ordinary arsenical composition, inasmuch as this 
salt reduces gradually but regularly the fever of phthisis, 
as he has observed in three cases, at the same time, 
stimulating assimilation, and rapidly increasing the 
weight of the body. Further, the stomach supported 
indefinitely from two to four grains daily, whereas they 
all knew that many patients could not take even the 
smallest dose of mineral arsenic. However, in cases 
of pulmonary consumption he thought that the best 
method of administration of cacodylate of soda con¬ 
sisted in hypodermic injections ;the dose should be from 
half a grain to one grain in the twenty-four hours during 
eight days, after which there should be a rest of a 
week, and then continued for another week. The atten¬ 
dant would be guided by the state of the appetite and 
the temperature; if the former declined and the 
thermometer went up, the injections should be recom¬ 
menced. 

Tuberculosis of the Testicle. 

M. Delbet treated the subjeot of the treatment of 
tuberculosis of the teetide at the Society de Chirnrgie. 
He considered from examinations he had made that tho 


Digitized by LiOOQle 


Juki 14, 1899. 


GERMANY. 


The Medical Press. 619 


Highmore bodies were frequently the seat of the disease 
and that these could be easily removed without touch¬ 
ing the gland, which was much more rarely attacked. 
Consequently, castration should be proscribed in most 
cases. 

Formula for Varicose Ulcer6. 

R Phenic acid, 5ss; 

Boric acid, 5>j; 

Powdered camphor, 5ij; 

Ichthyol, 3iv; 

Olive oil, 5iij; 

Zinc ointment, 3iv. 

The Tongue in Influenza. 

M. d’HoTEL draws attention to a character of the 
tongue constituting a pathognomonic sign of that 
mysterious affection known as influenza. If the malady 
is observed during the first few hours of its invasion, the 
tongue may not present any abnormal feature, but the 
following day it is invariably covered with a white 
coating more or less thick towards the centre. Later on, 
according as the affection is of a benign type, or 
becomes complicated or prolonged, the lingual coat* 
ing is seen to diminish from the point or on the 
contrary to remain. This label of influenza is in 
general the last sign to disappear, and it is not 
rare to observe three weeks after the dtbut, a re¬ 
mainder of a whitish triangle at the base of the 
tongue, indicating that the patient not only has been 
through the malady, but also that he is not yet abso* 
lutely free from the morbid condition, although the 
general state of his functions may appear regular; an 
imprudence on his part, a cold, might provoke broncho¬ 
pneumonia, gastro-enteritis or some other complication. 
Another characteristic of this lingual deposit is to 
redden litmus paper when rubbed on it, and not only 
during the first days of the malady, but as long as there 
remains a trace of it on the tongue. 

This acidity persists as long as there remains any trace 
of the fur, and is a natural indication of the treatment 
which is that of frequently rinsing the mouth with an 
alkaline solution such as Vichy water, followed by the 
internal administration of the same. It is evident that 
influenza cannot be cured more than typhoid fever, but 
M. d’Hotel affirms that complications were much rarer 
where the alkaline treatment was used. 


(Scrmattg. 

[from our own correspondent.] 

Berlin, June 10th, 1899. 

Hr. Heidenham, Worms, recited two cases at the 
Surgical Congress of 

Renal Abscess. 

Hr. Euster, Marburg, oould not agree to any distinc¬ 
tion between oongenital and acquired renal cysts; in 
his experience all the cases were congenital. He 
would not decide as to Kronlein’s case; but if 
acquired it was unique. In any case he would warn 
them against drawing a conclusion from it that 
nephrectomy was justifiable in cystic kidney. He 
considered the operation as forbidden under all circum¬ 
stances. Some successful cures had been reported, but 
according to his conviction the cure was only apparent, 
and in all probability the patients died later on. In 
most of the cases that had been diagnosed as uni¬ 


lateral careful examination showed that the other kidney 
was not sound, that the disease was progressing, so that 
removal of the first discovered tumour would be 
exceedingly dangerous to life. The question was, what 
was to be done in bad cases of cystic kidney F If on 
exposing a kidney a cyst was found, the other kidney 
should be exposed, and nephrectomy should only be per¬ 
formed after ascertaining that the other kidney was 
sound. The observation had been made that the worst 
symptoms had often been ameliorated, when the urine 
became suddenly loaded with foreign substances, a sign 
that the cyst had ruptured. Nature should be imitated, 
and the cyst opened, or if several were present, incision 
should be made in sections, and then sutured up. 

Hr. Steiner, Berlin, treated a sixteen year old boy 
with a right-sided kidoeycyst, whilst the left was healthy 
and not enlarged. A sister had died of bilateral kidney 
disease. He, like Euster, was opposed to nephrectomy 
in cystic kidney, as the kidneys became diseased one after 
the other, and therefore if the second kidney was normal 
at the time disease would in all probability follow. Inci¬ 
sion improved the general condition very muoh. 

Hr. Muller, Hamburg, related the case of a man who 
had symptoms of renal calculns. Rdntgen illumination 
revealed the presence of a stone, which on removal proved 
to be composed of carbonate of lime. 

Hr. Samson-Hunelstjerna, Pless, had treated a woman 
who had suffered from cystic kidney for fifteen years. 
Large calculi were passed. After a time the pain on 
that side (the left) ceased, but then pain began on the 
right. An operation was performed. The kidney was 
not large, some calculi were seated on the calyx, not in 
the pelvis of the kidney. Three weeks later an ovarian 
cystoma was removed, upon which complete recovery 
took place. 

Hr. Euster had a year ago performed double-sided 
nephrotomy for nephrolithiasis. The patient had suffered 
earlier from cystinuria; but not latterly, but instead of 
this pyuria from renal calculus. "While in one kidney 
the calculus was a cystic stone, that in the other was a 
large phosphatic calculus. 

Hr. V. Modlinski, Moscow, reported 
Two Cases of Total Extirpation of the Bladder. 

In one case death took place nine days after the opera¬ 
tion. The second case recovered. He was of opinion 
that the operation was indicated :—1. When the walls of 
the bladder were thickly strewn with tumours. 2. In 
malignant tumours of the bladder, although the prognosis 
naturally was bad. The substitute for the bladder he 
manufactured from the vagina of the woman. With a 
man the rectum was cut across transversely 5 cm. above 
the sphincter, the ureters were let in to the lower end. 
The bowel thus cut across was dosed up as to the upper 
end, and an artificial anus formed in the groin or loin. 

Hr. Fritz Cahen, Eoln, related the case of a woman 
who had 

Swallowed a 8et of False Teith. 

She was five months pregnant. She was only able to 
swallow a little water. On passing the sound, 15 ctm. 
from the mouth opening, it came on to a complete- 
obstruction, The woman also suffered badly from 
struma, at the lower end of which was a hard resistance 
with a sharp-edged feel. Attempts to remove the obstruc¬ 
tion made by a colleague had been without avail. The 
question arose whether the hard body felt in the struma 


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620 The Medical Press. 


AUSTRIA. 


June 14, 1899. 


was the foreign body or only an ossification of the struma. 
Against the latter alternative was the fact that on 
swallowing the raw body moved upwards. But the 
struma also made a movement, and perhaps communi¬ 
cated it to the foreign body. (Esophagotomy showed that 
the foreign body was not in the struma, but that the 
hard resistance was due to calcification. Unilateral 
strumectomy was then performed and the teeth found at 
the annular cartilage, they had caused a slight amount 
of perforation of the oesophagus. A stomach tube was 
left in after removal and the wound closed by granula¬ 
tion. 

Hr. Woermer recorded three cases of 

Unusually Large Ovarian Tumours. 

1. On being tapped yielded 30 litres of thick viscid 
fluid. Later on perforation took place with subsequent 
-peritonitis and death. Operation had been declined two 
years before death took place. 2. The weight not stated 
in this case. But the patient had for long been com¬ 
pelled to sit in a chair from the enormous size, and had 
suffered from great difficulty of breathing. Eecovery 
after operation. 3. In this case the operation was suc¬ 
cessful. The tumours varied in weight between 60 and 
112 lbs. In the last case the sudden removal of pressure 
led to haemorrhage, diarrhoea, and bronchitis. 

Hr. Levy-Dom, Berlin, spoke on 
Radiography. 

He said that the technique had so far advanced that 
by areinforcing screen images could be now taken on ordi¬ 
nary plates during one breathing interval. It was best 
to use the interval after inspiration for ordinary purposes. 
He showed two plates of the same individual, taken 
one in the inspiratory pause, and one in the expiratory 
one. He also showed a number of illustrations, echino¬ 
coccus in the lungs with adhesion to the diaphragm, 
one-half of the diaphragm being raised up, a splenic 
tumour and bismuth capsules were found in the fundus 
of the stomach. The disturbing effects of respi¬ 
ration on these was well shown, as the man was photo¬ 
graphed on both deep and shallow inspiration at the 
same exposure. In the picture, therefore, the capsules 
were seen lying one over the other. 

Hr. Hollander, Berlin, spoke on his “Treatment of 
Lupus by Over-heated Air,” and showed some cases. 


Austria. 

[prom our own correspondent.] 

Vienna. June 10th, l£W». 

Influenza. 

Paltauf showed a hardened preparation taken from 
the lung of a patient who had died of influenza. He 
thought that preparation demonstrated Kundraf s theory 
of lobular pneumonia as a result of influenza followed 
by pnrulent formation, necrosis, gangtene, induration, or 
subsequent purulent pleuritis. In his examination of the 
sputum of 100 cases, 56 on the post-mortem table and 44 
who recovered, Pfeiffer's bacilli were found present both 
by Voye’s test of agar cultures and animal experiments- 
These bacilli were found in spleen, kidneys, and meninges. 

The preparation was from a young man, set. 30. The 
appearance was that of progressive purulent interstitial 
pneumonia, pneumonia dessicans, otherwise termed 
phlegmon or lymphangitis of the lung. One of the 


lungs had multiple broncho-pneumonic centres with 
diphtheritic bronchitis in the large bronchi. The micro¬ 
scopic examination of the deposit on the surface re¬ 
vealed mixed streptococci among which were to be found 
the influenza bacilli. 


Murphy’s Button. 

• Frank gave a record of his operation with the Murphy 
button, which was more favourable than Czerny’s report 
of the apparatus. Among the cases submitted was one, 
a male, set. 57, whom he exhibited for inspection. This 
was a case of carcinoma of the sigmoid flexure where 
adhesions existed with the abdomen. In spite of the 
dangers that Czerny dreads, this case improved from the 
hour of operating without any gangrene or subsequent 
trouble. After eleven days the button came away, and 
the patient felt perfectly well. Frank thinks that appo¬ 
sition of the several parte is a principle that should not 
be forgotten. If the mucous membrane get in between 
the peritoneal surfaces union is imperfect; solid food 
should be longer delayed than after an operation by 
sutures. 


Acute Lymphjehia. 


At the Medical Club, Pineles showed a preparation 
taken from a patient, set. 73, who came to him three 
months ago with giddiness, from which he recovered 
and felt fairly well till 14 days before his death, when 
the vertigo returned accompanied with weakness aud 
general malaise. Four days before death there was 
haemorrhage from the extremities and enlargement of 
the spleen, next day he became unconscious with tetanic 
convulsions, and died on the 19th day after the com¬ 
mencement of the seoond attack. 


Examinations of the blood gave 3,000,000 red blood 
corpuscles and 500,000 white; of the latter 96 per cent, 
were mononuclear, or lymphocytio; the rest were poly¬ 
nuclear. There was no poikilocytosis or nucleated red 
blood corpuscles present. 


From the post-mortem it was discovered that all the 
lymphatics were greatly enlarged, the kidney and liver 
were strewn over with white patches, the spleen greatly 
increased in size, while the marrow of the bones was 
very red, though the proximal ends had no fat on them 
whatever. 

The strongest point of the diagnosis was the changes 
present in the medullary elements of the bonee when 
examined by the microscope, as the lymph tissue was 
quite absent. 


Pineles said that Frankel had endeavoured to dis¬ 
tinguish leucaemia into acute and chronic, but this 
distinction he considers is too unscientific to be 
accepted. 


On the other hand he thought some distinction 
should be made between leucaemia and myelsemia, the 
latter having nuclear red blood corpuscles, large fat 
cells, while little change in the elementsof the blood axe 
observed. 

Pineles thought the specimen a good example of 
changes that take place in medulla of bone, at the same 
time demonstrating the alteration of function which 
is an important phenomenon in the animal economy. 

The first of these changes is made manifest by the 
rapid disappearance of the polynuclear leucocytes from 
the blood, which proves the marrow to be an important 
centre of the heemopoitic changes. He considers acute 


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June 14, 1899. CONTINENTAL HEALTH RESORTS. The Medical Press. 621 


lymphffimia to be an infections disease, and capable of 
being transmitted. 

Elschigg confirmed similar hsemorrhagic effusions in 
the retina. 

Pineles said that the fundus of the eye was perfectly 
healthy in his case, which is in accord with all the other 
cases recorded in the literature of acute leucaemia. 

Continental Jjralth Resorts. 

[from our special correspondent.] 

MONT-DORE (Puy-de-Dome, France). 

The season is approaching for the French summer 
resorts, and among these are prominently the Auvergne 
Springs of Central France. In the Puy-de D6me De¬ 
partment alone are clustered within a limited and readily 
accessible district quite a host of renowned mineral-water 
establishments; notably those of Mont-Dore, La Bour- 
boule, St. Nectaire, Royat, ChAtel-Guyon, and ChAteau- 
neuf. Of these Mont-Dore claims the precedence, for its 
antiquity, celebrity of its springs, excellence of its esta¬ 
blishment, superior altitude, and picturesqueness of its 
surroundings. Mont-Dore is over 3,400 feet above the 
sea-level, and the highest thermal station in Central 
France. The loftiest peaks in Auvergne (including the 
Pic de Sancy of about 6,200 feet altitude) arise around 
the small basin in which lie the town and fountains of 
Mont-Dore. 

From the earliest days of the Gauls in France the 
Mont-Dore Springs have had their renown. And when 
the Roman rule succeeded that of the Gaulish chieftains 
Mont-Dore gained in celebrity. In these Gallo-Roman 
centuries Mont-Dore was at the acme of its prosperity. 
The statues, columns, votive tablets, vestiges of baths > 
and other remains preserved in and about the present 
elegant establishment testify that there were not only 
most elaborate bath buildings but also a Pantheon, 
where the Romans and Gauls came to demand health 
from their different Deities, and to demonstrate by 
sculptured mementoes and laudatory inscriptions their 
gratitude to their gods for health restored. At Mont-Dore 
the very stones bear witness largely to the efBoacy of its 
springs. This Pantheon and its adjaoent baths were 
robbed and dismantled by the Vandal hordes of the fifth 
century, and the buildings finally destroyed during the 
raids by the Aquitaine kings in the seventh century- 
For many ages afterwards the historians do not men¬ 
tion Mont-Dore, and it is not until the fifteenth oentury 
that we hear much more about Mont-Dore. For a long 
time the lands on which are the springs had been at¬ 
tached to the feudal domain then known as “ La Tour 
d’Auvergne." Guillaume de la Tour, Bishop of Rodez, 
in the year 1543, legally disputed their ownership with 
Antoinette de La Tour, wife of Jacques de Bourbon. 
The records, testamentary and of weddings, show the 
springs remained the property of the “ La Tour ” family 
until the eighteenth oentury. 

We find the Mont-Dore Baths became again much 
frequented early in the thirteenth century. There is, 
■however, little medically recorded about them until the 
writings of Jean Banc in 1606. In 1787 the value of the 
springs attracted the attention of Monsieur de Chazerat 
the Intendant of the Province of Auvergne, who made 
a new road to them, and much improved the bath build- 


erected during the years 1817-1823. Since then repeated 
enlargements and improvements have been made from 
time to time; until to-day Mont- Dore possesses one of 
the finest, artistically and scientifically, thermal establish¬ 
ments on the European Continent. 

As to the waters themselves, there are thirteen mineral 
springs (only one of them cold), with an average total 
daily flow exceeding 200,000 gallons. The principal 
spring, “ Madeleine," was only refound in the year 1823, 
when, in digging for some new foundations near the 
Pantheon, the ancient Roman aqueduct leading to this 
source was discovered. The water of the Madeleine 
Spring is of 113 degs. Fah, and used for drinking. It 
flows into a large handsome vase near the entrance to the 
hall set apart for ladies’ foot-baths; yielding over 
32,000 gallons every twenty-four hours, discharges itself 
noisily and with gaseous bubbles. Clear and uncoloured 
originally, after contact with the air it whitens as a 
sulphurous water, giving out an odour of carbonic acid. 

The second in notoriety is the “ Cesar Spring ” (some¬ 
times oalled also “ Caroline ”) coming from Roman wells; 
bubbling loudly as it runs into the “ Grand Salle " reser¬ 
voirs : and setting free much caloric, which augments as the 
barometric pressure diminishes. It comes forth from the 
middle of a basin, cut out of a single stone, placed in a 
vaulted grotto of Gallo-Roman construction. The tem¬ 
perature is also 113 degs. Fah., and the yield nearly 
27,000 gallons daily. The peculiar “ buzzing " of this 
spring attracted attention in olden times ; Sidonus ApollL 
narius commenting curiously thereon. 

The waters from the springs, named “ Saint Jean ” and 
“ Grand Bain ” run steadily into the great lava bath of 
the Pavilion (where invalids are plunged) and various 
bathing-rooms. Their yield is over 12,000 gallons each 
twenty-hour hours, and .their temperature (according to 
location of the different baths) varies from 104 degs.| to 
109 degs. Fah. 

A comparatively new spring (found in 1891) called 
“The Singers” bubble out in the Pasteur gallery. It 
has a temperature of 116 6 degs. Fah., and yields daily 
between 88,000 and 34,000 gallons. 

Taken as a whole the mineral waters of Mont-Dore are 
(at their origins) sparkling, clear, and without smell- 
They turn litmus paper red; have at first a slightly 
acid taste which soon becomes salty and astringent. To 
the touch they feel softer than oils or distilled water. 
Their main constituents are :—Carbonic acid, chloride 
of sodium, bicarbonate of soda, arseniate of soda, iron, 
and silica; with traces of lithinm, manganese, borax, 
iodides, and phosphates. The vapours of the bath-rooms 
contain very much carbonic acid, a little iron and arsenio. 

Besides the springs specially named above, are the 
Rigny, Ramon, Boyer, Pigeon, Chaterat, Boyer-Bertrand 
and “ Pavilion ” ; from their constituents, temperatures 
and other leading characteristics, they apparently pro¬ 
ceed from one great source; only varying because of 
the different strata through which they have respectively 
reached the surface. 

The remaining “ Sainte Marguerite ” Fountain varies 
from 60 degs. to 55 degs. Fah. The country people call 
it Veau piquante. It is not perfectly dear; evolves much 
gas; has an add taste, changing rather to bitter, bat is 
quite pleasant to drink with or without wines. It is 
used freely on the hotel tables; and is also employed to 
temper, when desirable, the baths given with, the waters 


ings. An entirely new and larger establishment was of the other springs. 




622 The Medical Press. THE OPERATING THEATRES. June 14, 1899. 


^hc (Operating theatres. 


KING’S COLLEGE HOSPITAL. 

Gastrostomy for Malignant Disease of the (Esopha¬ 
gus. —Mr. Cabless operated on a man, set. 56, who had 
experienced difficulty in swallowing for the last six months. 
The patient bad been seen three weeks previously and 
urged to come in, but refused to do so. At the time of ad¬ 
mission he was utterly unable to swallow, and was much 
thinner than when seen previously. Rectal alimentation 
was used for a few days and the patient’s condition 
slightly improved. Chloroform having been adminis¬ 
tered the abdomen was opened through a linear incision 
extending down for 3 inches from the tip of the eighth 
oostal cartilage, the fibres of the rectus muscle being 
separated. The stomach was found, and a conical portion 
pulled up into the wound the base of which was stitched 
all round tothe parietal peritoneum. Mr. Carless said he 
had intended performing a Frank’s operation, but the 
stomach was too small to admit of it, and therefore the 
apex of the cone was opened, a rubber drainage tube 
without lateral holes was introduced for about 2 cm. and 
stitched to the gastric wall, and the aperture in the 
stomach stitched to the Bkin at the upper horn 
of the incision. The fibres of the rectus muscle 
were freed from the posterior layer of the 
sheath, and drawn over the conical protrusion of 
the stomach and stitched together; the skin in¬ 
cision was then dosed. Mr. Carless remarked that in 
several cases of gastrostomy for malignant disease of the 
oesophagus, he had found the Btomach too small to 
permit of a Frank’s operation being performed, and he 
had been utilising a variety of modifications. He thought 
it quite probable that the plan utilised in this case 
would prove as successful as any of the others, and 
it was certainly much simpler. In the typical Frank 
the apex of the cone was passed under a bridge of skin, 
and stitched to the margin of this second wound, with 
the idea of producing more or less of a valve. In cases 
that had lasted six months or more it was always found, 
however, that the passage into the stomach was direot 
and not angular. He thought that the sphincter-like 
action of the rectus in this particular case woul d prevent 
regurgitation. Another modification which he had 
utilised in a number of cases consisted in the immediate 
introduction of a rubber tube into the stomach; this 
remained fixed for about eight days, and prevented 
escape of gastric juice during that period, an occurrence 
not uncommon after the typical Frank. 

As the patient was somewhat collapsed and in a bad 
state of nutrition an injection of food was made at once; 
though as a general rule Mr. Carless prefers not to feed 
the patient for twenty-four hours. 

It is interesting to note that the patient has done very 
well; the tube was set free on the eighth day, and at the 
present time, two and a-half weeks after the operation* 
there has been no escape of gastric juice. 

GUY’S HOSPITAL. 

Operations for Dislocated Semilunar Cartilage. 
—Mr. Arbuthnot Lane operated on a man, who, during 
the last two years had suffered from sudden attacks of 
pain followed by considerable swelling of the knee-joint, 
which had incapicitated him on each oocaaion for about 
a fortnight. These symptoms were somewhat different 


from those commonly seen in cases of damage to the 
internal semilunar cartilage, in that there was no pain, 
tenderness, or swelling along its attachment to the capsule, 
but that there was instead a painful tender fulness below 
and beneath the inner margin of the patella. On open¬ 
ing the joint in this situation the internal semilunar 
cartilage was seen to be doubled up in the interval be¬ 
tween the two condyles, and to be attached solely by itB 
anterior and posterior extremities to the tibia, having 
lost all connection whatever to the capsule. It was 
excised and the joint closed. Mr. Lane said that al¬ 
though he had operated on a very considerable number 
of displaced and damaged semilunar cartilages, he had 
never seen such a condition as that presented in this 
particular case. 

The same surgeon operated upon another case of pain, 
effusion, and limitation of movement following damage 
to the knee-joint. The patient had made a sudden 
effort while supporting himself on one knee, when he 
experienced a sudden sickening pain in the part, and this 
was followed by a considerable amount of effusion into, 
and acute inflammation of, the knee-joint ; this 
subsided slightly under rest, Ac. The joint was 
tensely distended with fluid and very painful, a firm 
mass as big as the end of the thumb projected forward 
bet ween the inner margin of the patella and the condyle 
of the femur. An incision was made over it into the 
knee-joint, where this lump escaped suddenly through 
the opening made ; it resembled, in appearance, a lump 
of gangrenous omentum, and on section appeared 
to be a portion of the ligamentum mucosum 
which was distended with extravasated blood 
and very acutely inflamed. The contents of the joint 
appeared almost purulent in character. The mass was 
removed, the joint cleared of its fluid and lymph and the 
wound closed Mr. Lane said this case presented con¬ 
ditions that in his experience were very unusual. He 
believed that the synovial fringe had been violently 
compressed between the ground and the under surface 
of the internal condyle. In a paper published in the 
British Medical Journal, December 2nd, 1898, entitled 
“ Detached Pieces of Articular Cartilage forming Loose 
Bodies in both Knee-joints,” he pointed out that if a 
person kneels on one knee an area of the under surfaoe 
of the internal condyle is exposed to direct pressure. In 
the present case it would seem likely that a portion of 
the ligamentum mucosum was included beneath the 
condyle as already remarked. 


Vital Statistics. 

The deaths registered last week in the thirty-six great 
towns of the United Kingdom corresponded to an annual 
rate of 16'5 per 1,000 of their aggregate population, 
which is estimated at 11,404,408 persons in the middle 
of this year. The deaths registered in each of the last 
four weeks in the several towna, alphabetically arranged, 
corresponded to the following annual rates per 1,000.— 

Birkenhead 15, Birmingham 16, Blackburn 19, Bolton 
17, Bradford 16, Brighton 8, Bristol 14, Burnley 21, 
Cardiff 11, Croydon 13, Derby 16, Dublin 22, Edin¬ 
burgh 20, Glasgow 20, Gateshead 17, Halifax 17, 
Huddersfield 16, Hull 17, Leeds 17, Leicester 15, Liver¬ 
pool 24, London 17, Manchester 26, Newcastle-on-Tyne 17, 
Norwich 13, Nottingham 16, Oldham 22, Plymouth 19,. 
Portsmouth 17, Preston 22, Salford 20, Sheffield 18, 
Sunderland 17, Swansea 18, West Ham 10, Wolver¬ 
hampton 22. 


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“ 8ALU8 POPULI 8UPREMA LEX.” 


WEDNESDAY, JUNE 14,1899. 


THE GENERAL MEDICAL COUNCIL. 

The, we believe, absolutely unprecedented length 
to which the but recently concluded session of the 
Council has run to, is the natural outcome of the 
more enlightened policy which has of late years 
actuated that body. It has now, to some extent, 
awakened from the lethargy which characterised its 
earlier existence, imder pressure of public opinion, 
and year by year the number of important questions 
interesting the profession at large, tends to in¬ 
crease. The prospect is opening up of the necessity 
for multiplying the meetings the better to enable it 
to cope with the additional work which recent events 
have thrown upon the Council. When we learn from 
the caustic tongue of Mr. Carter that two members 
made a hundred and thirty-three speeches in five 
days between them, we need no further proof of the 
earnestness with which some, at any rate, of the 
members of Council approach the matters before the 
Council. 

A glance through the summarised report of the 
proceedings which we publish elsewhere will convince 
our readers that the Council has done some good 
solid work during this protracted session. There has 
been singularly little waste of time on personalities 
or in vain discussions of a technical order. On the 
other hand, several highly contentious and ex¬ 
ceedingly important questions have been adjudicated 
upon. The question of the standard of preliminary 
education has been advanced a stage in that a definite 
plan of investigation has at last been decided upon. 
If the committee are to be believed, the issues are far 
more complicated than was thought, and we find 
that the proposal to raise the standard to that of the 
senior local examinations is declared by one authority 


to be impracticable, “ unless it is the intention of the 
Council to discourage students from commencing 
their medical studies before the age of eighteen.” 
That, indeed, were a consummation devoutly to be 
wished, and it of itself constitutes a vei-y cogent 
argument in favour of the change. We are promised 
a working report for next session, and we hope we 
shall get it. 

At last the Council has taken a definite stand in 
respect of the association of registered medical prac¬ 
titioners with institutions of the medical aid type 
which systematically advertise and tout for patients. 
Such medical officers are warned in no uncertain 
terms that such associationship will be regarded by the 
Council as calling for the application of the penal 
powers vested in the Council, but the cutting edge 
of the resolution has been taken off, or at any rate 
blunted, by a resolution approving in abstract of the 
formation of a Board of Conciliation, in the organisa¬ 
tion whereof the Council will studiously abstain from 
taking any official part, but which, it is hoped, will 
help to get rid of the misunderstandings which at 
present exist. We have every confidence that 
this resolution will of itself go far to remedy a 
condition of things which amounted to a scandal. 
Unscrupulous practitioners will no longer be able to 
take refuge behind a board of management, but will 
be held responsible for the sanction which their asso¬ 
ciation with the peccant societies implies. 

We are pleased to announce that the Council has 
broken away from the hidebound interpretation of 
the Medical Act which led the Executive Committee 
to refuse to add the fellowship of the Royal Col¬ 
lege of Surgeons in Ireland to the name of a lady 
who was already registered in the Colonial List in 
•virtue of the M.B. of Calcutta. The Council’s legal 
adviser virtually withdrew his opinion after some 
arguments by Mr. Horsley, and in future the Regis¬ 
trar has been directed to admit such additional or 
higher qualifications to the Colonial List as a matter 
of routine. We must, however, express our regret 
that an ill-advised legal opinion on this point should 
have placed the Council in such a false and undig¬ 
nified position. 

The question of the inspection of the so-called 
higher examinations, raised by Mr. Horsley, is more 
complicated than it at first sight appears. They are 
unquestionably qualifying examinations and as such 
they ought to be inspected by the Council. If the 
terms of the law were strictly adhered to such 
additional qualifications could only be granted after 
a specified course of study but, as is well known, the 
fellowships are not unfrequently conferred on 
persons of professional distinction without any 
examination at all, and it would be difficult to defend 
the admission of these diplomas, conferred honoris 
causa, to the Register. Although Mr. Horsley made 
out a very clear case for the interference of the 
Council this body resolutely declined to be drawn 
into a departure from established custom, though in 
all probability we have not heard the last of the 
contention. 


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624 Tbs Midical Pbkss. 

MEDICAL MEN ON HOSPITAL 
COMMITTEES. 

As many of our readers are aware, a dispute has 
lately arisen among the governors of the London 
Royal Orthopaedic Hospital as to the administration 
of the affairs and the general policy of that institu¬ 
tion. It appears that for many years complaint has 
been made of the serious insanitary state of the 
building, indeed, more thon two years ago Professor 
Corfield made an order for re-construction of drains, 
which was stayed only on the understanding that 
the hospital was to be rebuilt or removed. The old 
committee proposed to sell the site of the hos¬ 
pital for £28,000, but a recent independent esti¬ 
mate from an expert has placed the value at 
£36,000. In view of decreasing income and increas¬ 
ing expenditure, and of the failure of the 
old committee to take any effective steps to set 
matters straight a number of governors elected eight 
new members of committee, and re-elected five of the 
former members. After some protest the old com¬ 
mittee called a general meeting to discuss the chargee 
that had been brought against them. A perusal of 
the report of that meeting goes far to condemn the 
position taken by the old board of management. 
The complaints against their administration were 
brought forward in a perfectly clear, reason¬ 
able, and moderate wsy. As shown by the 
published reports they were met by speakers 
on the other side ohiefly by attacks on the: 
good faith and intentions of those who had advanced , 
the criticisms. What was the main point? the 
insanitary condition of the hospital was ostensibly 
the rock of offence. That defect was substantiated 
by the testimony of the medical staff, by the 
action of the Medical Officer of Health for 
the district, by the commissoners of the Prince of 
Wales’s Fund, and by the records of the hospital for 
many years past. We submit, then, that the old 
committee must have poor grounds of defenoe in the 
face of so sustained a proposition if at a public 
meeting their speakers descend to the level of 
Billingsgate debate and call their critics “ raiders,” 
and assert that almost every sentence of pointed 
criticism iB absolutely false. But that which 
most nearly affects the medical profession is the law 
carried by members of the old committee to the 
effect that “ no acting medical officer of the hos¬ 
pital shall be eligible for election as a member of the 
committee of management.” This motion was intro¬ 
duced by the deputy chairman of the old committee 
in language that fortunately is not often heard 
in public meetings. He advised the governors 
to “ clear out the whole of the present medical 
staff,” especially Mr. Beeves, whom he desig¬ 
nated as an “ arch-conspirator ” in the “ raid.” 
Here, again, we fail in the heated language 
to trace the dignity of men of standing whose 
judgment in administering a charitable undertaking 
has been assailed. Such views will naturally suggest 
that committeemen must have some serious reason 
for objecting to] the presence of members of an 


Jm 14, 1899. 

honourable profession at their deliberations. As a 
member pointed out, the tone of the vice-chairman’s 
speech was better fitted for a meeting of angry 
city speculators than for a benevolent society. 
The members of the old committee, although out¬ 
voted by two to one at the meeting, yet carried their 
point by proxy, a most unsatisfactory way of win¬ 
ing a victory. Then they resigned in a body, which, 
again, points to animus, because if they intended to 
secede they could perfectly well have left it to their 
successors to decide whether they wanted any of the 
honorary staff on the management. Then, again ^ 
why should they retire without courting full investi¬ 
gation of the constitution and proceedings of the old 
committee with regard to the proposed sale of the site ? 
To those who are behind the scenes of the 
professional philanthropic stage, the violence of 
the defenoe will suggest the desirability of a 
thorough investigation of the facts of the administra¬ 
tion of the Royal Orthopaedic Hospital during the- 
past few years. It is hardly necessary to remark 
that of late the view has gained ground smong the 
medical profession that they should be represented 
fully on every hospital management, both in the 
person of members of the honorary staff and also of 
outside practitioners. If that plan were more gener¬ 
ally adopted it is likely that less would be heard of 
the need of reform of hospitals. What can the 
public think of a committee that when approached 
in a spirit of impartial criticism replies by 
vollies of abuse and a recommendation to ex¬ 
clude from any voice in the affairs of the institu¬ 
tion the members of the profession whose gratuitous 
services render the existence of the charity possible P - 
So far as the Royal Orthopaedic Hospital is con¬ 
cerned, we can only say that the full details of the 
attitude of the old committee with regard to the 
insanitary state of the hospital and to the proposed 
sale of the site will be required before general con. 
fidence can be restored to its former basis. Perhaps 
some energetic public journal will sift the matter 
and give a clear account of the facts of the case. 
Things have now gone so far that such a course 
should be welcomed by all real friends of the hos¬ 
pital, which can suffer nothing but injury by any 
attempt at concealment. 


THE “ GRAMMAR SCHOOL ” SCIENCE YEAR. 

Probably the most interesting episode of the recent 
meeting of the General Medical Council was the battle 
of the Irish and Scotch bodies against the London 
colleges on the question of the acceptance by them 
of “ instruction ” in chemistry, physics, and biology 
given to school boys in grammar schools, as compli¬ 
ance with the first of the enjoined five years of medi¬ 
cal study. The Council has always permitted these 
subjects to be studied before student registration, in 
an university or in a competent school of science, but 
it never thought of recognising an ordinary boys’ 
school as such centre of science teaching and, in any 
case, it made it quite clear by its regulations 
these pre-studential studies should not abridge by an 


LEADING ARTICLES. 


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June 14, 1890. 


NOTES ON CURRENT TOPICS. 


The Medical Pres*. 625 


hour the prescribed five years of work, The 
London colleges, however, having once entered 
upon the wide and smooth road of gathering 
into their fold all schoolboys—diplomates in posse, 
thought they might venture to throw aside the 
obstruction which prevented their giving such boys 
a full year’s credit to begin with, and, with careful noise- 
lesBness they advertised that their bread and butter 
proteges could enjoy that benefit. When this move was 
spied by the Irish College of Surgeons it, forthwith, 
took the whip in hand, with which it and its Irish 
and Scotch colleagues have administered a wholesome 
and much-needed castigation to the London colleges- 
On the matter being brought to notice the Education 
Committee at once took it into consideration and, the 
facts being indisputable, reported more than once 
that the action of the London colleges was intoler¬ 
able, and must cease at once. When the report was 
being brought up at the meeting of the Council the 
opening of tho case on behalf of the complainants 
devolved, practically, on Sir William Thomson and 
Sir Christopher Nixon, who were ably supported by 
Dr. Atthill, Sir William Gairdner, and Dr. Bruce. 
Sir William Thomson maintained that the Conjoint 
Board for E ngland was pursuing a course of action 
which was offering a four years’ course instead of 
the five years’ curriculum recommended by the 
Council. He maintained further that this action 
was in absolute opposition to the Council’s require¬ 
ments and recommendations, and yet from their 
statements the representatives of the Royal Colleges 
of England apparently intended to stand by the posi¬ 
tion which they had assumed. He (Sir William 
Thomson) wanted to know what the Council now 
proposed to do. He had been of opinion that the 
Council had direction of these things, and it was for 
them to see that they were carried out. But accord¬ 
ing to what they had heard to-day all those considera¬ 
tions were to be put aside by the two Royal Colleges 
of England, who seemed to say that independently of 
anything that the Council proposed they would do 
what they liked. If the General Medical Council was 
impotent in regard to its own rules, there was 
no use in coming here at all. He was perfectly 
sure that the Council had no intention of 
making study in science at a grammar school 
equivalent to a first year’s medical course. There was 
no question that what the Council intended was that 
the first year’s medical study should be study at a 
university, medical school, or “ scientific institution 
approved by the Council.” That was exactly what 
they wanted to-day. He could not understand how 
they were met at the threshold by two powerful cor¬ 
porations saying that they would not obey the General 
Medical Council. The net result of the debate, after 
a practical admission of the facts by Mr. Bryant, was 
that, to exclude the possibility of recognition of a 
grammar school, the limitation to a “ scientific ” 
institution “ approved by the Council,” was carried 
by a majority of eighteen votes to six. We trust 
that the London colleges will lay to heart this severe 
lesson that the regulations of the General Medical 
Council cannot be abrogated for their advantage. 


fioizs on Current topics. 


The General Medical Council and the 
Apothecaries Hall, Ireland. 

The Examination Committee of the Council, under 
the guidance of Sir Dyce Duckworth, has had a fine 
day’s sport at the ignoble pastime of baiting the 
Irish Apothecaries Hall, a proceeding in which all 
the discredit lies with the persecutors and all the 
sympathy with the persecuted institution. The Coun¬ 
cil, having been defeated before the Privy Council, set 
itself with immense gusto to tie up the Hall with 
all sorts of examinational bonds, the effect of which 
must be to weigh down the institution with expenses, 
and to cause its examinations, if carried on at all, to 
be carried on at a heavy loss. It was called upon to 
appoint two delegate examiners and one inspector 
and no one can complain if these officers were liber¬ 
ally paid. The “ Hall ” acted with great discretion, 
determining to give its detractors no fair opening 
for attack, and to spare neither trouble nor 
money for this object. Three series of examinations 
were held in October, 1898, January, and April, 1899, 
and the reports of examiners and inspectors lie before 
us to the effect that the examinations were all “ suffi¬ 
cient," and were conducted with great care. There is 
no more of adverse criticism to befound in the reporta 
than in the reports on other licensing bodies, 
and, on the whole, it may be taken that, 
as regards the thoroughness of its examina¬ 
tions the “Hall” came off sans reproche. The 
number of candidates, however, was extremely small, 
not more than one or two, sometimes none, for 
a division of the examination, and some of these were 
men who had been rejected in one or more subjects 
before and were now again repulsed. To us it is 
remarkable that any candidate offered himself, con¬ 
sidering the energy and ingenuity which this Exami¬ 
nation Committee has for years devoted to crying 
“ mad dog ” against the “ Hall,” but none the 
less does Sir Dyce Duckworth and his col¬ 
leagues seize the paucity of candidates as 
the occasion for assault. His reports to the 
Council are punctuated throughout with sneers at 
the institution which, as we have said, reflect upon 
his Committee rather than upon the “ Hall.” It 
appears that the assistant examiners and inspectors 
have cost the Council £307 within fifteen months, a 
circumstance which, we suppose, does not disturb the 
equanimity of the “Hall.” It is not any part of 
our policy to sustain the existence of the “ Hall ” 
as an independent qualifying body, and we have 
said a thousand times in years past that we 
anxiously desire to see it absorbed out of existence, if 
possible, by making it the third, or pharmaceutic^ 
side of the Irish conjoint qualifying triangle. The 
oppressive dignity of the Irish College of Physicians 
has prevented this solution of the trouble, and the 
General Medical Council, instead of putting strong 
pressure on that body to assent, has elected itself to 
the function of supporting its policy by squelching 
the " Hall ” per fas aut nefas. We regard such tactics 


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626 The Mbdical Pbxbs. NOTES ON CURRENT TOPICS. Juns 14, 1899. 


as utterly unfair, and will lend them every opposition 
in our power. 

The Birthday Honours and the Anti- 
Vivisectionists. 

A characteristic letter was published last week 
in the Standard from the Hon. Stephen Coleridge, 
protesting against the honours conferred upon Pro¬ 
fessors Burdon Sanderson and Michael Foster, be¬ 
cause of their supposed vivisection practices. It is 
really difficult to understand how such a letter ever 
was published, but as it has been, it should not be 
allowed to pass without comment. Sir Burdon 
Sanderson is represented as having slowly smothered 
dogs alive (sic)—smothering dead dogs is a process 
which has not come within our experience— 
and chronicled their dying convulsions. Then a 
quotation is given from the “Handbook for the 
Physiological Laboratory,” descriptive of experiments 
in connection with asphyxiated animals, concerning 
which Mr. Coleridge points out that no mention is 
made of the use of anaesthetics. The unfairness of 
the attack is that this champion of antivivisection 
entirely omits to state that the experiments 
referred to were performed long before the Anti¬ 
vivisection Act was ever heard of; whereas the 
intention of the accuser obviously is to give 
the public the impression that the experiments 
were only recently performed. That is to say that 
in the opinion of Mr. Stephen Coleridge, a distin¬ 
guished scientist who performed some experiments, 
presumably without anaesthetics, upon animals a 
quarter of a century ago, should never have been 
rewarded by the Queen for his great scientific ser¬ 
vices. Yerily the narrow-mindedness of these 
“ Anti ” faddists constitutes a serious disease. The 
absurdity of the position which they assume makes 
it impossible for ordinary mortals to act charitably 
towards them in such matters and excuse them 
upon the grounds of eccentricity. It was a wonder¬ 
ful answer which a celebrated divine once gave to a 
noted agnostic. “I am an agnostic,” declared the 
latter—“ So I understand,” was the reply, “ but 
I suppose that you would not be flattered were you 
to be described by its equivalent—namely, an 
ignoramus ”—so it is with many of the “ Anti ” 
community; they make everything tally with their 
misguided ideas, and are apt hands at perverting 
the truth. 

Fashion in Faces. 

One result of the forward movement in womenkind 
is the appearance of a luxuriant crop of cherry 
cheeks among the fair sex of the middle and upper 
class. It is no longer the fashion to be lily-white 
and pale as of yore, but rather to court the ruddy 
look of the milkmaid. This change confronts one in 
the parks, in the public streets, in the drawing-room, 
in the theatre, in church, everywhere, in short, where 
the dominant sex congregate. To a great extent it 
is no doubt due to the passion for open-air exercises 
that now reigns almost as supremely as among 
the boisterous athletio male. A short genera¬ 


tion sinoe, when fair woman deserted her mild 
domestic occupations and accomplishments for 
“carriage” exercise or horse-riding she had weU- 
nigh exhausted her round of out-door recreations; 
whereas now, at the close of the Yictorian era, she 
has golf, cycling, tennis, rounders, boating, hockey, 
to say nothing of fishing, shooting, yachting, hunting, 
and, greatest wonder of all, she has, in many cases, 
taken seriously to walking. All this means that a 
change for the better in mind, as well as in body, is 
registered on the bronzed cheeks of the modern 
damsel. The “ vapours ” of our granddames are dead 
as Queen Anne, fainting has gone out of fashion, and 
the average maiden of to-day moves, sleeps, and eats 
like a healthy human being. Clothing, too, must be 
in time brought to a rational standard, for no woman 
living could endure the martyrdom of a long walk 
for two successive days in shoes with high heels and 
pointed toes. If the medical profession were not 
guided by motives of the highest philanthropy they 
would not encourage this ruddy-cheeked movement, 
for it robs them of a lucrative field of practice. 


Lay Views on Cancer. 

A great discussion on cancer is at present raging 
in the columns of an evening contemporary—the 
Echo. Presumably it is only necessary to mention the 
name of this paper in order to afford some idea of the 
character of the discussion to which publicity is being 
given. In its former, and we think better days, the 
Echo did good service in trying to educate the masses 
in progressive science and in taking the lead in 
improving the minds of those who looked to its 
columns for instruction. But latterly, we are sorry to 
note, the policy of the journal has become that of 
cranks, to whom reasoning beings pay but little heed. 
Among other things that the cranks have 
done for the Echo is to have turned it into 
a spiteful anti-vaccination organ, a virulent 
opponent to vivisection, and a persistent and 
unfair traducer of the medical profession. Medi¬ 
cal men do not care, of course, what the readers of the 
Echo think of them, but it is a poor, pitiable policy 
for any enlightened editor to adopt of making capital 
out of slanderous attacks upon a body of professional 
men. If anything scurrilous can be said of 
the practice of medicine, or of its followers, 
there always seems to be an opportunity 
of giving it publicity in the columns of the Echo. In 
the discussion to which attention is drawn above 
medical men are greatly blamed for not having dis¬ 
covered the cause of cancer and the means of 
curing it. Again, instances are related by corre¬ 
spondents in which cancer has been cured by 
persons not in the profession when medical 
men have pronounced an unfavourable prognosis. 
It is, of course, scarcely needful to point out 
to the editor of our contemporary that all such state¬ 
ments should be received with much caution, and 
especially the announcement that there is an estab¬ 
lishment at Berne which has a world-wide reputation 
for curing all cases of cancer, save those in which the 


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June 14, 1899. _NOTES ON CURRENT TOPICS. The Medical Press. 627 


throat is involved. The exception is a brilliant con¬ 
cession to public opinion, in view of the sad ending 
of the late Emperor of Germany, from carcinoma 
of the larynx. 

The Dum-Dum Bullet'Again. 

The Peace Congress at the Hague last week, stul¬ 
tified itself by passing a resolution to the effect that 
the Dum-dum bullet must be prohibited in modem 
warfare. The effects of this bullet have been dis¬ 
cussed and commented upon ad nauseam and military 
experts, with personal experience of its use, have 
repeatedly proved that the objections urged against 
the missile, have been founded upon a misconception 
of the damage it inflicts. We should not have referred 
to the subject again, save for the purpose of pointing 
out that the discussion upon it at the Congress 
clearly shows that those who voted for the prohi¬ 
bition of the bullet could have had no personal 
knowledge of the matter. Again there has 
never been the slightest intention on the part of the 
authorities of ever using the bullet against any 
European troops with which we may be engaged. 
The bullet was designed merely for the object of 
crippling the “ rushing ” power of savage tribes, upon 
whom the projectile of the modem rifle had been 
proved to have but little effect. The case is recorded of 
an Indian native who received sixteen bullet wounds 
caused by a Lee-Metford rifle, during the Chitral 
expedition, but despite this he made a good recovery. 
Before the other European Powers take upon them¬ 
selves to condemn the Dum-Dum bullet, it would, 
perhaps, be better for them first to try the effects of 
their own service rifle projectiles against a tribe of 
savages in warfare, and arrange for the results to be 
recorded by any of their troops who may hap pen to 
survive. However, it would then probably be too 
late to recognise that the Dum-Dum bullet was 
necessary in such engagements. 

Pauper Classification. 

The spirit of dead official conservatism is nowhere 
mom marked than in the treatment of the Poor-law 
population. After years of public agitation and 
scandal a departmental bill was issued and things 
straightway go on as before, to quote the words of a 
well-known song, “ it may be for years, or it may be 
for ever.” For instance, on January 1st, 1895, an 
order is issued from the Home Office, advising 
the classification of paupers. Now, four years 
later, a species of shock of galvanising wonder 
has ran through London at the news of defi¬ 
nite action by a board of guardians on the 
lines of that official monition. Fulham, to its honour 
be it said, has started large separate wards for a 
number of aged inmates who have come to want 
through no fault of their own. They are all over 65 
years of age, and many of them have at one time been 
ratepayers in the parish. They now have greater free¬ 
dom, better quarters, and an ificrease of privileges and 
comfort all round. Their dietary, owing to stem offi¬ 
cial rule, cannot be improved, but it is to be hoped 
that the Home Office will amend the bye-laws in 


that direction. This fresh departure is one of the 
most promising of recent years by way of humanising 
the terrors of a rigorous system. It has taken four 
years for a single Board to carry out the desires of the 
central governing body. We wonder how long it will 
take to put in foroe Mr. Chaplin’s famous depart¬ 
mental order for the separate nursing and care of the 
crippled pauper children of the metropolis. 

Poisoning by Belladonna Plaster. 

The occurrence in the provinces of a case of poi¬ 
soning by means of the absorption of belladonna 
from a plaster reminds us of the still uncertain com¬ 
position of those applications. One of the notable 
features of the recent revision of the British Pharma¬ 
copoeia was the standardising of the emplastrum bella¬ 
donna. Before that time the alkaloidal strength of 
the commercial product varied within wide limits 
from a mere trace up to a considerable potency. The 
only firms we believe that had consistently standardised 
their plasters were Messrs. Mather and Co. of Man¬ 
chester, and Messrs. Seabury and Johnson of New 
York and London, and we fancy that fact has hardly 
been widely enough recognised among the medical 
profession. Belladonna, when applied in the form of 
a sound and trustworthy plaster, is of the utmost 
value in the treatment of many painful 
affections and in the arrest of the mammary and 
other secretions. Its practical value, however, has 
always been discounted by the variability of its com¬ 
position, and many a surgeon has given up the 
plaster as worthless simply and solely because he has 
been using a preparation containing only the merest 
trace of alkaloid or none at all. In future, however, 
all that is to be changed. That is to say, when one 
or two little obstacles have been surmounted. First 
and foremost, when the worthless stocks have been 
sold out. Next, when local authorities take the 
trouble to supervise the purity of drugs vended to the 
public. 

Apprenticeship to Apothecaries in Ireland. 

A question of much importance to the Trish 
Apothecaries' Hall has been raised, last week, by an 
application for a mandamus by a student named 
Miller to compel the Pharmaceutical Society to admit 
him to their Licence examination. This young gentle¬ 
man served the necessary apprenticeship to Dr. For¬ 
sythe, a Licentiate Apothecary, but the Pharmaceu¬ 
tical Society rejects that service as qualification for 
their examination. The point is, that though Dr. 
Forsythe is undoubtedly a L.A.H., he did not obtain 
that qualification under the original Apothecaries’ Act 
of 1791 (which prescribed an elaborate education and 
examination in pharmacy), but under the Medical 
Acts of 1858 and 1886 which made the curriculum 
and examination mostly medical and but slightly 
pharmaceutic. The Court granted a conditional 
order for the mandamus, but, of course, this only 
mean8 permission to the lawyers to earn second fees 
by arguing out the point on a future occasion. 


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628 Thb Medical Press 


NOTES ON CURRENT TOPICS. 


Medical Practice in Kashmir. 

Dr. Neve, writing in the Indian Medical Gatette> 
refers to the various forms of disease met with in 
Kashmir, and the list is an interesting one from 
several points of view. In the first place, despite the 
fact that the country is little more than an alluvial 
plain during the summer months, malarial disease 
is quite rare, owing no doubt to the altitude. But 
diseases of the eye are very numerous, especially 
ophthalmia and entropion, nevertheless cataract is 
much less common than in the plains. Curious to 
relate, skin affections of parasitic origin abound, 
scabies being universal. Again, dyspeptic troubles 
are very frequent, the cause being attributed to the 
exoessive quantities of starch consumed in the form of 
rice. Commonly also dilatation of the stomach is met 
with. Another feature of note is the absence of scarlet 
fever and diphtheria, and the rarity of phthisis, save 
in those who lead indoor lives amid unhygienic 
surroundings, such as shawl-weavers. Rickets, again, 
is a disease which is seldom seen, but rheumatism is 
very prevalent, and Dr. Neve also mentions that during 
the past year, 2,918 operations were performed at the 
Kashmir Mission Hospital, and that of these no fewer 
than 462 were for entropion; on the other hand, 
there was only one case of ovariotomy, and that 
terminated successfully. 


A New Treatment for Tuberculosis. 

Dr. Karl von Ruck has introduced a new 
method of treating cases of pulmonary tuberculosis, 
namely that of the injection of a fluid extract of 
tubercle bacilli. In 78 cases thus treated he claims 
that 64'1 p.c. were cured and 33.3 p.c. improved. The 
serum prepared by his method differs materially from 
that known as Koch’s Tuberculin R. If von Ruck’s 
treatment should prove to be as serviceable in the 
hands of others as it has proved in those of its 
author, the promoters of the open-air treatment of 
phthisis in this country will have to reconsider their 
position. But a good deal of confirmatory evidence 
will be needful before the infection of a tuberculin as 
a cure for pulmonary tuberculosis will be able to con¬ 
vince the profession in this country of the efficacy of 
the method, and until Von Ruck has fully supplied 
the data in this regard it would be premature to speak 
with any enthusiasm upon the subject. 


Infectious Disease Difficulties at Nantwich. 

Several points of practical importance have 
recently been raised at the Nantwich Board of Guar¬ 
dians. In the firet case two patients suffering from 
typhoid fever were removed to the Isolation,Hospital, 
Crewe, where the clerk called upon Dr. Atkinson to 
attend them in his capacity of Medical Officer of 
Health. The patients were paupers from another 
union, and Dr. Atkinson naturally asked for payment 
for his attendance. After a good deal of discussion 
the guardians wisely decided to grant “ reasonable 
renumeration ” for the special service. It would be 
well for all public health officers to resist the demands 
for purely medical services which are made upon 


June 14, 1899, 

them by various local authorities from time 
to time, usually with regard to attendance on per¬ 
sons engaged in parish work. The second case was 
that of a farmer who sent a lad in his employ suffer¬ 
ing from scarlet fever to the Isolation Hospital. This 
step he had taken, bo he claimed, in the interests of 
the public, and he applied to the Rural District 
Council to pay the hospital expenses, for which he had 
become responsible on the lad’s admission. The 
Council decided by a large majority to refuse to pay 
any portion of the cost. This decision will hardly 
encourage other dairy farmers to send off to the hos¬ 
pital any of their employees who may be attacked by 
communicable disease. There is a good deal to be 
said in favour of making a general charge of what 
confers so direct and essential a benefit upon the 
public. 


Professor Osier, M.D., F.R.S. 

Professor Osler, of the Johns Hopkins Univer¬ 
sity, Baltimore, has just arrived in England, and on 
the 16th instant he will deliver the Cavendish Lecture 
before the West London Medico-Chirurgical Society, 
the subject being cerebro-spinal fever. On the 15th 
instant the President of the Society, Dr. Clipping- 
dale, will entertain at dinner Professor Osier, together 
with the President of the Royal College of Physicians 
(Dr. Church), the President of the Royal College of 
Surgeons (Sir William MacCormac), the Council of 
the Society, and other guests. On the 22nd instant. 
Professor Osier will be the guest of the staff of 
the West London Hospital at the Past and Present 
West London Hospital Dinner, which will be held 
at the Trocadero Restaurant. The dinner, which 
was a great success last year when it took place for 
the first time, promises this year to eclipse its record, 
and it is expected that an attendance of 200 at least 
will be reached. 


The Case of the Late Mr. Hunter. 

The long-promised discussion at the General 
Medical Council on the peculiar circumstances under 
which the Council ordered the prosecution of the late 
Mr. Hunter, L.S.A., for styling himself “ physician,” 
proved a very mild affair. Admitting that the Coun¬ 
cil, as a whole, was not cognisant of the exact cir¬ 
cumstances under which the proceedings were to be 
taken—an inexplicable and even unpardonable 
omission on the part of the Penal Cases Committee 
—it is stated that Mr. Hunter himself was anxious 
to have the point cleared up, and had expressed his 
willingness to defend his action in the matter. We 
may take this assurance with the proverbial grain of 
salt, and the same cautious procedure may be applied 
to the statement that it was really a sort of friendly 
suit, in which both parties mutually assisted each, 
other in obtaining a formal judicial pronounce¬ 
ment. The Committee regarded it as a test 
case to establish the Jaw in respect of the use 
of the Philadelphia degree, but, as a matter of 
fact, the legal arguments turned exclusively on the 
point whether a licentiate of the Society of Apotbe- 


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June 14, 1899. NOTES ON CURRENT TOPICS. The Medical Pbess. 629 


caries has or has not the right to dub himself physi¬ 
cian. However we look at it the point was worth 
clearing up, and however much we regret the tragic 
element imported into tho case by the death of the 
defendant, and deprecate the somewhat curious cir¬ 
cumstances under which the proceedings were autho¬ 
rised, we are pleased that a definite statement has 
been obtained. We should even like to see this matter 
pushed to its logical conclusion, for nothing is more 
1 rritating than the sempiternal disputes as to the 
titulary rights of the various orders of medical prac¬ 
titioners. If there be any special rights by all means 
let them be defined; if there be none, then let us 
cease to haggle about trifles. 

Medical and Clerical Enterprise. 

At the Church of All Saints’, South Merstham, a 
notable illustration of the old proverb, “ Cleanliness 
is next to godliness,” occurred on Sunday last, for the 
vicar of the parish secured as a special preacher a 
member of the profession, who resides in the medico- 
aristocratic locality of Queen Anne Street, Cavendish 
Square. The fact that this arrangement of his pulpit 
would obtain was announced by the vicar to 
his parishioners in the following manner:-—“I 
feel that it is almost a farce to come and 
talk to some of you on spiritual matters when 
all the while my fingers itch to open or clean your 
windows, scrub your woodwork, and wash your 
children. So thinking that perhaps you would pay 
more attention and give more heed to what a doctor 
of medicine says I have asked, by special permission 
of our Bishop, a clever friend of mine, who has 
knocked about the world a good deal and seen 
a lot of life, to come down from town and talk 
to us in Church next Sunday evening after 
the prayers are ended on * Cleanliness is near 
of kin to Godliness.’ Dr. Usher, of Queen 
Anne Street, Cavendish Square, W., who is a specialist 
in his own particular line ”—what line—“ and is a 
most entertaining man and interesting speaker, will 
talk on the Gospel of Fresh Air, leaving beds open 
to the air, washing bodies all over as well as juot face 
and hands, washing blankets as well as sheets, flush¬ 
ing drains, not letting the tea stew on the hob 
and so bring on indigestion, and other induce¬ 
ments to taking a nip 4 too often.’ ” This is 
certainly a novel departure in the promotion 
to the gospel of health. Obviously it is capable of 
many developments. In time, perhaps, we shall see 
an announcement in the Times to the following effect: 
“ At the special invitation of the Dean of St. Paul's 
Cathedral, Sir Bouncing Fitzblazes, M.D., F.R.S., 
will preach at the usual afternoon service on Sunday 
next, 4 On the modern methods of feeding babies.’ 
A collection will afterwards be made for the 
benefit of the 4 Go-Cart League,’ for providing 
go-carts for the poorer classes in London whose 
means do not permit of the purchase of this 
necessary appliance for enabling infants to become 
acquainted with the enormous traffic of the metropoli¬ 
tan thoroughfares.” Doubtless other possible deve¬ 


lopments in the same direction will occur to our 
readers. 

Liquefied Hydrogen. 

The fairyland of science is nowhere more wonder¬ 
ful and attractive than in the provinoe of chemical 
research. It is hardly too much to say that almost 
all the great advances of modern science have had 
their origin, directly or indirectly, in the test tubes 
and phials of the chemical laboratory. Ever sinoe 
the days of Faraday and Sir Humphry Davy, 
workers in this fascinating branch of exact investiga¬ 
tion have been seeking for some means of liquefying 
hydrogen. The difficulties in the way have been 
enormous, but they have at length been overcome by 
the patient genius of Professor Dewar, who announced 
his discovery last week at the Royal Institution 
Liquid hydrogen, he pointed out, was not only a 
precious and costly substance, but it was exceedingly 
volatile and had to be preserved with great care. In 
order to protect it as much as possible from radiation 
he surrounded the product with liquid air. The 
physical qualities of liquid hydrogen are of a striking 
character. Thus it is non-magnetic and the specific 
gravity is such that a piece of cork placed in it imme¬ 
diately sinks to the bottom. The temperature at boiling 
point was 21 deg. absolute, or sufficient to yield a pres¬ 
sure described by the discoverer as “ unmeasurable.” 
By its agency a vacuum could be produced of so per¬ 
fect a nature that mercury distilled upwards. There 
can be little doubt that in the hands of this distin¬ 
guished investigator the liquefaction of hydrogen 
and the introduction of a new agent have proved a 
distinct triumph of practice as well as of theory. 
Many distinguished men of science who were present 
at the lecture expressed their belief that the dis¬ 
covery was an invaluable one, and marked an era in 
the history of chemical investigation. 

The Stanley Hospital at Liverpool* 

The journalists of Liverpool have recently raised 
on high the voice of lamentation over the waning for¬ 
tunes of the Stanley Hospital. Founded in 1867, on 
a site given by the late Lord Derby, the institution 
has steadily grown in size. The present movement is 
designed mainly to pay ofE debt, to add to the number 
of beds, and to build a nurses’ wing. All these 
objects are doubtless desirable in themselves, but we 
should like to hear something more of the means that 
are taken to prevent the charity of the Stanley 
Hospital from being bestowed upon improper subjects 
for medical relief, that is to say. upon persons who 
are able to pay private practitioners. We say this 
without any special knowledge of the Stanley Hos¬ 
pital, which we believe to be an excellently conducted 
institution, but we take it as the apparent type of charity 
whose capacity for funds and for patients at any price 
is limitless. The Liverpool Post writes as follows 
“ Perhaps no better test of the development of the 
hospital can be adduced than the figures submitted 
in last year’s report, which show that whilst in 1867 
the total number of attendances during the year was 


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June 14, 1899. 


10,618, they in 1897 had increased to 53,534, and that 
whilst in 1878 there were 241 in-patients, these 
in 1897 numbered 1,047.” We should like to hear 
what steps are taken to exclude patients who are 
able to pay moderate'fees or whose ailments are so 
slight as not to require hospital treatment. Some 
day the medical charities will learn that it would 
have been better to cultivate the friendship of the 
general practitioner. If we mistake not the con¬ 
sultants on the staff may have some reason to regret 
that they also have not paid more attention to the 
demands of their outside brethren. 

The Notification of Phthisis in Manchester. 

The Manchester Corporation have taken an impor¬ 
tant step in regard to the notification of phthisis 
within their jurisdiction. It has been agreed to make 
the disease a notifiable one, and to appoint a medical 
officer with a salary of £200 per annum, whose duties 
will consist in visiting the notified patients at their 
homes, investigating the circumstances under which 
the disease has been contracted, and the conditions 
and arrangements of the infected houses. On the report 
of this official steps will be taken to carry out the 
necessary measures of disinfection. It will be with 
much interest, doubtless,that the sanitary authorities 
throughout the country will watch the result of this 
new development in notification. However ill- 
adapted the Notification Act may be for Ireland, 
it is nevertheless certainly true that its enforcement 
has been beneficial in England. 

Tetanus in Jute. 

An inquiry into the cause of death of a worker in 
a Dundee jute factory elicited, last week, statements 
which, if true, have the highest significance as to the 
pathogeny of tetanus. The operative had injured 
her foot in a jute mangle, and died of lockjaw five 
days afterwards. The inspector of factories stated, 
on examination, that he had taken to London samples 
of the dust from below the mangle, and that upon 
bacteriological examination it was found to contain 
considerable quantities of the tetanic spore. He 
said, furthermore, that though there has been as yet 
no record of a connection between jute and tetanus, 
it seems quite possible that this particular jute, which 
came from Bengal, was capable of developing the 
bacillus rapidly, inasmuch as all the climatic condi¬ 
tions of Bengal are favourable to such development. 

A Pronouncement in Medico-Dental Ethics. 

Be it known to all whom it may concern that the 
General Medical Council, in solemn conclave assem¬ 
bled, have adopted the recommendation of the 
Dental Committee stigmatising as “ infamous conduct 
in a professional respect” any assistance rendered 
by a registered medical practitioner to an unregis¬ 
tered person in the performance of a dental operation 
or by administering an anaesthetic “ or otherwise.” 
In future it will be incumbent on all practitionere 
before consenting to assist anyone practising as a 
dentist to assure himself that he or she has been 
duly registered, failing which precaution they may 


attain some unenviable and uncomfortable notoriety. 
We have nothing to say by way of adverse criticism 
in respect of the Council’s determination, which is 
only the logical outcome of its policy in respect of 
the repression of covering in all its forms. 

St. Mary’s Hospital, Paddington, Bazaar. 

A successful bazaar was held on two days 
last week in aid of the funds of St. Mary's 
Hospital, Paddington. It was entitled a “Streets 
and Squares Bazaar,” because a series of 
local committees was organised representing the 
various streets and squares in the neighbourhood of 
the institution. The sum of £70,000 is needed for the 
completion of the new Clarence wing, and towards 
this a substantial amount was netted as the result of 
the Bazaar. 

Artificial Cardiac Disease for Malingerers. 

Several members of the medical profession in the 
Rhenish district have been arrested for having sup¬ 
plied to conscripts in return for heavy bribes, cardiac 
depressants in order that they might be rejected by 
the military authorities when physically examined. 
The domiciliary visits of the police to the houses of 
these practitioners are stated to have revealed plenty 
of incriminatory correspondence. 

Sir Thos. Grainger Stewart, Professor of 
Medicine in the University of Edinburgh, who went 
to Berlin as the representative of the University at 
the Congress on Tuberculosis has returned home* 
Report has it that he was singled out by the Emperor 
for a private conversation, 


Jtartlanii. 


[from our own correspondent.] 

The General Medical Council and Preliminary 
Examination. —The Council in their recent session has 
been considering, amongst other business, the necessity 
and advisability of raising the standard of the preliminary 
examination, but has found it a really difficult 
business to settle. In Glasgow the standards 
attained by young lads leaving school now 
is said to be lower than it was some years ago, 
and one of the examiners in English has stated that 
the average paper written by candidates for the medical 
and arte preliminary is a shocking production. Many of 
the candidates are unable to put together a few con¬ 
nected sentences into grammatical English — the 
tendency of schools being towards the teaching of 
Latin, Greek, Mathematics, German, French, 
instead of the mother tongue. In such case* 
“ Keys come in handy,” which help the candidates to 
cross the rubicon, and so enter into the pleasant paths 
of the coveted and noble medical profession, and in due 
time attain to the dignity of “ professor,” for a deficiency 
of knowledge of the English language is no bar to a 
professoriate. 

Women on Hospitals and Local Boards. —After a 
largely attended meeting reoently held by ladies for the 
promotion of the return of women to local boards, a 
letter has been sent to the directors of the infirmaries 
and hospitals in Glasgow, in which they are allowed one 
month to decide whether or not they are willing 
to concede the principle of femalo representation on 
the directorate of the various institutions. A com¬ 
mittee consisting of ladies, ministers of religion, and 
a Sheriff, has been appointed to oonfer with the 


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June 14, 1899. 


MEDICO-LEGAL NOTES. 


The Medical Peers. 631 


directors of the infirmaries on the subject, and to assist 
in the selection of lady, representatives in the event of 
the principle being oonoeded. In their communication 
to tne directors the committee make it plain that a 
rebuff or refusal will not end the agitation, stating dis¬ 
tinctly that the matter will be brought to an issue at the 
fiist annual general meeting of each institution and 
successive general meetings until their object is 
attained. The grounds on which the demand for female 
representation are made are chiefly (1) That it would 
tend to make the household management of hospitals 
and infirmaries more efficient. (2) That as regards 
women and children a lady should have the responsible 
power given her of personally seeing to their needs, and 
of bringing suggestions before the board that such 
patients would more readily communicate matters which 
there was a delicacy about to a lady than to a man. (3) 
That a lady on the board would be able to com¬ 
municate more freely with nurses than any man 
on the board. (4) That female representatives on 
the board would, to some extent, relieve the matron 
of entire responsibility; such responsibility at present 
in certain cases is not wholly desirable, and some matrons 
would be glad to be relieved, to some extent, of their pre¬ 
sent complete responsibility. We fail to see how ladies 
will be able to know more the wants and needs of the j 
women and children patients than at present. W hat is 
the use of nurses, resident medical officers, superin¬ 
tendent and matron in an infirmary or hospital, unless it 
be to minister to the needs of patients under their charge ? 
Even supposing the ladies gain their point and are 
admitted on the boards, their information regarding 
patients must be obtained through present channels 
and sources. If these ladies can find out and suggest 
ways by which our present extravagant methods of 
conducting and carrying on our infirmaries can be re¬ 
formed, they will be doing something really of importance 
and value, but when thty suggest to relieve matrons of 
some of their responsibility we do not quite grasp their 
intention, unless it be to make both matrons and nurses 
subordinate to their wills, and ultimately to suggest 
that female representatives should have entire control 
of female patients and children, as well as participation 
in regard to male patients. Glasgow ladies are evidently 
following the lead of the Edinburgh ladies, of whom 
there are two on the directorate of the Edinburgh Royal 
Infirmary. 


Ccmfiponittntt, 


We do not hold ourselves responsible for the opinions of ou 
correspondents. 


THE VICE-PRESIDENCY OF THE ROYAL 
COLLEGE OF SURGEONS OF IRELAND. 

To the Editor of The Medical Press and Circular. 

Sib,—I nasmuch as there was no change in the offices 
of president or vice-president in this June election, 
which took place to-day, I desire to inform the Fellows 
of the College that last year, when I expressed to the 
electors my determination to offer myself for the office 
of vice-president, I felt that my long service to the School 
and College as senior demonstrator, examiner and coun¬ 
cillor, and my seniority as a surgical teacher and as a 
hospital surgeon, might reasonably deserve recogni¬ 
tion by the FoIIowb, and that I might hope to be 
honoured with election to the office I then sought. Un¬ 
happily personal and domestic circumstances prevented 
me from giving prominence to my candidature until 
others had occupied the ground in some degree, and as 
a contest is extremely distasteful to me, and in my 
opinion is not to the advantage of the College, I thought 
it best to refrain from presenting myself for the vice- 
chair until the next legitimate vacancy occurs in June, 
1900. I desire, however, to assure the Fellows that 
under any circumstances I shall do so when that time 
arrives. With this intimation, I trust that my friends 
and supporters among the Fellows will not be induced 


to pledge their votes to any other candidate for the next 
vice-presidency. 

I am. Sir, yours truly, 

L. H. Orm8by, M.D., F.R.C.8.I. 
92, Merrion Square, Dublin, 

June 7th, 1899. 


ENURESIS. 

To the Editor of The Medical Press and Circular, 

Sir, —In answer to your correspondent who has asked 
suggestions for the relief of this troublesome malady, 
many cases of night incontinence of urine have come 
before me at the public dispensary. I have followed 
Trousseau’s treatment with belladonna, often combining 
the belladonna with iron if the patient were amende, 
and with bromides if hysterical. I took care to keep the 
bowels regular, and to act generally on the gentle tonio 
regimen in relation to cheerfulness and general employ¬ 
ment and mode of life. 

But in addition to such wide general principles, I 
insisted that the patients should sleep, even in some cases 
going to bed for one hour or more at mid-day. Every 
employment or duty was to be subordinated to a genuine 
sound mid-day sleep of one hour at least. 

The results have been most gratifying, e.g., a girl, 
rot. 17, who had wet the bed every night since she was a 
child, was permanently cured in a week. Many such 
oases have presented themselves and been cured. 

I am, Sir, yours truly, 

William H. Pearse, M.D. 

Plymouth, June 7th, 1899. 


THE APPOINTMENT OF POOR-LAW OFFICERS 

BY THE BRADFORD BOARD OF GUARDIANS. 
To the Editor of The Medical Press and Circular. 

Sir, —Your issue of May 24th ult. contains a memo¬ 
randum upon the above subject from Dr. Crowley' and 
Mr. Hall. 

The third paragraph of the communication reads as 
follows:—“ The Committee of the older Society (Brad¬ 
ford Medico-Ethical) has met and discussed these 
appointments, and decided that no steps should be taken 
in the matter.” 

The Committee of the Bradford and District Medico- 
Ethical Society take exception to the form of the above 
statement, and to prevent a wrong inference being 
drawn from it, we are instructed to forward to you the 
following extract from the minuteB of the committee 
meeting referred to:—"The question of the proposed 
appointments by the Guardians of the Bradford Union 
of Dr. Crowley and Mr. Hall was discussed, but as there 
was a probability of a meeting of the profession being 
called by another society, no resolution was passed. 
The committee were, however, strongly opposed to the 
character and manner of the appointments.” 

We are. Sir, yours truly, 

W. Horrocks 
A. Manknell 

Bradford, June 10th, 1899. 


^ftcbico-'Jegd Jlotes. 

By W. J. JOHN8TON, B.L., 

Dublin. 

Adulteration of Food. 

The decision of the Queen’s Bench Division in Shortt 
v. Robinson (8 L.T.R. 261) is an interesting illustration 
of the working of the Food and Drugs Act, 1875. The facts 
have already been reported, but we may summarise them 
shortly as follows. A grocer was charged under Section 6 of 
this Act for selling caper tea which was alleged to be adul¬ 
terated. It was proved by the county analyst that the 
tea contained 3 5 per cent, of foreign matter, and the 
prosecutor asked for a conviction The justices, however, 
Btated as a fact within their own personal knowledge 
that caper tea was grown on friable, sandy soil, under 
circumstances which rendered frequent and copious 
showers of rain necessary, and was therefore likely to 


| Hon. 8ecs. 


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MEDICAL NEWS. 


June 14, 1899 


contain a certain amount of mineral matter. They 
thought that, under these circumstances, 3 5 per cent, of 
such matter was not excessive, and refused to oonvict. A 
case was stated for the opinion of the High Court, and 
the question was argued whether the magistrates were 
entitled to take oognisance of facts which were within 
their own personal knowledge, but which were not 
proved in evidence. The Queen’s Bench Division held 
that the justices were so entitled in this particular case, 
and refused to interfere with what had been done in the 
Court below. 

Conscientious Objections to Doctors. 

The well-known and oft-quoted passage from St. 
James’s epistle, “ Is any sick among you P Let him call 
for the elders of the church,” has had a curious history 
in the law courts. The case of Reg. v. Senior (47 W. R. 
367) is the latest stage of this history, and arose on the 
interpretation of Section 1 of the Prevention of Cruelty 
to Children Act, 1894, which declares that any person 
who, having charge of any child under sixteen years of 
age, wilfully neglects such child in a manner likely to 
cause it unnecessary suffering, shall be guilty of a mis¬ 
demeanor. The child in question was suffering from 
diarrhoea and pneumonia, which ultimately caused its 
death, and the father, who belonged to a sect called the 
“ Peculiar People,” and had conscientious objections to 
doctors and drags, refused to call in medical aid. The 
medical evidenoe was that the child’s life would certainly 
have been prolonged, and might probably have been 
saved, if medical assistance had been procured. Was the 
father, who otherwise had been kind to his child, guilty 
of “ wilfully neglecting ” his ohild within the meaning of 
the statute ? Mr. Justice Willes held that there was 
evidenoe that he was, and left the sufficiency of the 
evidence as a question to the jury. When the question 
was argued before the Court for Crown Cases Reserved, 
Lord Russell said that “ wilfully ” in the section meant 
deliberately, and not by inadvertence, and that 
“ neglect ” meant the omission to do something for the 
benefit of the child. In other words," intentional failure 
to take those steps which the experience of mankin d 
shows to be generally necessary.’ In the result, the 
conviction of the prisoner at the trial was upheld. The 
case amounts to a decision that the deliberate omission 
to "all in medical aid, on aocount of honest, conscientious 
belief, is wilful neglect within the meaning of the section. 

At Common Law. —Before there was any legisla¬ 
tion on this subject the rule seems to have been 
different. An instructive case on the point was Reg. v. 
Wagitaffe (10 Cox C. C., 530), which was a decision 
of Justice Willes. In that case, the prisoners, 
who were the parents of the child, had conscientious 
objections to calling in medical assistance, 
honestly believing that God would heal the sick child. 
They also belonged to the sect of the “ Peculiar People,” 
and founded their belief on the same passage in St. 
James’s epistle. As a result of the illness the child died, 
and at the trial of the parents the judge told the jury 
that the mere omission to provide medical advice under 
the ciriumstanceB, when the objection to do so was 
honest and not a mere blind or screen for misconduct, 
was not culpable homicide. This seems to have been 
the rule at common law. 

Legislation on the Subject. —The Act of 1868 
(81 and 32 Yio. c. 122, s. 37) provided, among 
other things, that any parent who wilfully neg¬ 
lected to provide medical aid for his child, thus 
causing the health of the child to be seriously damaged, 
should be guilty of an offence. The decision of Reg. v. 
Bournet (1 Q.B.D. 25), made it quite clear that when a 
person intentionally and deliberately abstained from 
providing medical aid, knowing it to be obtainable, he 
was guilty of an offence under this Act, and the motives 
which operated on his mind did not save him from the 
results of his conduct. This section was repealed by the 
Act of 1894; but although the words “medical aid” 
are left out of the latter Act, it is still the duty of a 
parent, according to Lord Russell in Reg. v. Senior, to pro¬ 
vide medical aid for his children, and the omission to 
do so is wilful neglect. 

(To be continued.) 


STEPHENSON’8 NEW POISON BOTTLE. 

The ingenuity of inventive geniu«es has, for some 
oocult reason, been largely devoted of late to the snb- 
ject of poison bottles, i e.. bottles which by reason of 
roughness of surfaoe, oddity of outline or general un¬ 
shapeliness can be distinguished from ordinary medical 
bottles even in the dark. One of the simplest—and 
therefore one of the best, seeing that simplicity is of 
importance—is that submitted to us by the makers. 
Messrs. Hearns, L mited, Lea Bridge Glass Works, N.E. 
It is made of blue glass, bearing the word “Poison’’ 
in raised letters, and its distinctive feature is a pinching 
in of the waist, giving it, roughly speaking, the outline 
of a fashionable lady. This gives a firm grip, and renders 
it absolutely impossible to handle without becoming 
conscious of its peculiar shape. Any person taking poison 
out of Buoh a bottle even at dead of night might reason¬ 
ably be adjudged ftlo de te without further inquiry. The 
price is not notably higher than the ordinary death trap 
poison bottle, guaranteed to deceive at first sight. 


JRcirical ^ctos. 

The Royal Orthopaedic Hospital. London. 

A meeting of the governors of the above Institution 
was held at 20, Hanover Square on June 8th, under the 
Presidency of Lord Wantage. The five re-elected 
members of the old committee brought forward proposi¬ 
tions for five alterations of rules. The first four changes 
were carried without opposition from the members of the 
new committee, but the fifth involved a good deal of 
discussion and voting. Briefly, the four unopposed 
resolutions provided that the tune qualification for a 
governor's vote, and for membership of the com¬ 
mittee, should be twelve instead of six months; 
that the committee should have power to add to their 
number, and that a fortnight’s notioe of candidature for 
committee should be given to the secretary. The meeting 
appeared to get out of the control of the noble 
chairman at an early period, but it must be said that 
most of the strong language came from the old com¬ 
mittee, who repeatedly characterised the movement for 
reform as a “ raid.” On the other side Mr. Marks and 
Mr. Parker admitted that they had organised the voting 
that ousted the old committee as the only means of 
obtaining urgent and necessary changes of administra¬ 
tion. Their chief grounds were that no effective steps 
had been taken to remedy the unsanitary condition of 
the hospital, although it had been notorious for many 
years past, and had Ted to recent deaths, besides causing 
the grant from the Prince of Wales' Fund to be with¬ 
held. The old committee had allowed income to 
dwindle and expenditure to increase. They had 
proposed to sell the hospital site for .£28,000, whereas 
an independent authority. Sir Whitaker Ellis, valued it 
at .£36,000. Not one of these points was seriously 
shaken by the members of the old committee, which 
included 8ir Walter Gilbey, Sir Ernest Clarke, Alderman 
Bell, and Mrs. Drawer. Indeed, the only point scored by 
them was the modification of a statement of Mr. Parker’s 
that the old members had not helped the new, which was 
altered to the extent that two of the old members had 
latterly helped the new executive. The old members made 
free use of such terms as “ raiders,” “ absolutely false,” and 
of other equally emphatic language, but the climax was 
reached by Alderman Bell who, in moving the fifth resolu¬ 
tion made an extremely bitter and personal attack on one 
of the honorary medical staff, Mr. Reeves, whom he 
designated as an “arch-conspirator.” The alteration 
last-mentioned was to the effect that no medical officer 
of the hospital shall be eligible for election as a member 
of the committee of management. On being put to the 
vote this was lost by a large majority. Both sides then 
produced a number of proxies, and in the upshot the old 
committee carried their point by a small majority. The 
re-elected members of the old management. Sir Walter 
Gilbey, Alderman Bell, Sir Ernest Clarke, Mr. Drawer, and 
Mr. Studd, then handed in their written resignations t* 
the Chairman, Lord Wantage, who intimated his own 
resignation. 


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MEDICAL NEWS. 


The Medical Press. 633 


Summer Trains da Loza. 

It may be of interest to some of onr readers who may 
intend visiting one or other of the Continental Spas, or 
are sending patients thereto, to know that the Interna¬ 
tional Sleeping Car Company has commenced running 
the Carlsbad Express daily to Frankfort, Bayreuth, and 
Carlsbad direct from Ostend in connection with the 
10 a.m. services from London. 

The Engadine, Interlaken and Lucerne Express will 
commence running from Calais on the 8th July until the 
end of the season, in connection with the 11 a.m. ser¬ 
vices from London. 

A new Train de Luxe, to be called the Royan Express, 
will, from 8th July until 12th September, run from 
Paris (Gare d’Orleans) direct to Niort and Royan every 
Monday and Wednesday, starting at 7.50 p.m., corre¬ 
sponding with,the 11 am. train from London. 

The Luchon Express will leave the Gare d’Orleans 
every Tuesday and Thursday at 7.32 p.m., commencing 
on June 27th. From July 22nd until August 19th in¬ 
clusive the Luchon Express will run on Mondays also. 
These trains are composed exclusively of the Company’s 
sleeping, restaurant, and baggage cars. The official 
guiae of the Company, "The Continental Traveller,” 
containing full particulars as to times and fares, is sent 
poet free to intending passengers, from the London 
offices, 14, Cockspur Street. 

The Medical Sickness andrAcddent Society- 

The sixteenth annual meeting of this Society was 
held in the rooms of the Medical Society of London, 
Chandos Street, W., on Wednesday, May 24th, 1899. The 
chair was taken by Dr. De Havilland Hall, chairman of 
the Society. 

Drs. A. S. Gubb, Dr. Walter Smith, Dr. F. J. Allan, 
Dr. J. Pickett, Dr. Knowsley Sibley. Mr. Brindley James, 
Dr. J. B. Ball, Dr. J. C. Williams, Dr. Percy Jakins, Dr. 
Leonard Grant, Dr. Miller, Dr. Barkwell, Dr. Clibborn, 
Dr. Owen, Dr. Culling, Dr. Bateman, Dr. Freeland, Dr. 
Rainsford, Dr. Cahill, Dr. Evans, and Dr. W. W. Hall. 

The Chairman said that on the eightieth anniversary 
of their beloved Sovereign's birth he was only expressing 
the wish of all present in hoping she might yet be spared 
many years to rule ever her people for whom she had 
done bo much. As medical men they ought to be espe¬ 
cially grateful for the example she had set in her rela¬ 
tions with the medical profession. 

He congratulated the Society on the year’s work, 
on the smooth manner in which their business was 
carried on, and on the regular attendance of the 
Executive Committee. The Society was Bteadily 
growing. During its fifteen years’ work it had 
paid over .£40,000 in sickness benefits, and includ¬ 
ing the present surplus, returned over £ 10,000 in 
cash bonuses. By economy of working a considerable 
surplus had been produced in the management fund, 
and a special reserve had been created to cover any 
fluctuation in the value of the investments. The valuation 
had been based on the low rate of 21 per cent., and a 
special reserve created against chronic sickness, the 
relief of which was, in his opinion, one of the most im¬ 
portant functions of the Society. 

There was a trifling surplus in the Life Assurance 
Fund and an insignificant deficit in the Annuity Fund, 
and he felt sure that the Society had acted wisely in 
ceasing to undertake fresh business of this kind, and in 
obtaining better terms for the members by acting as 
agents for the Rock Life Office. 

With regard to the suggestion that the surplus should 
be applied to the extension of the sickness benefit from 
age 65 to 70 he read figures showing that it would be 

S uite insufficient for this purpose and pointed out 
hat the increase of average sickness after age 65, was 
much greater than was generally recognised. For any 
such extension a separate fund would have to be formed, 
and the necessary contributions to it would be of con¬ 
siderable amount. He concluded by expressing the 
thunks of the Society for the aid they received from the 
medical press, and in particular from the British Medical 
Journal and the Medical Press and Circular, and 
hoped that in this way the membership would be in¬ 
creased until it reached a total of at least 5,000. 

The report was unanimously adopted and the distribu¬ 


tion of a 10 per oent. bonus agreed to, and the proceed¬ 
ings closed with a vote of thanks to the Chairman. 

Indian Medioal Berries. 

The annual dinner of past and present members of 
the Indian Medical Service took place in the Victoria 
H a ll , Hotel Cecil, on Thursday last, Surgeon-General 
Sir W. Guyer Hunter, K.C.M.G. in the chair, supported 
by 8ir Henry F. Norbury, K.C.B., Director-General of 
the Naval Medical Department, and Surgeon-General J. 
Jameson, C.B., Director-General A. M. S., Sir Joseph 
Fayrer, Bart., and many other distinguished officials. 
The thanks of those present were accorded to Dr. 
Freyer for the admirable way in which he had 
organised the meeting, which Dr. Freyer acknowledged 
in appropriate terms. 

A Cancer Society, 

A meeting was held in St. Martin’s Town Hall, 
London, on the 7th inst., with Sir Charles Cameron in 
the chair, to inaugurate a society having for its objects 
the prevention, amelioration, and the cure of cancerous 
disease. There was but a small attendance, but if any¬ 
thing can be done to assist in staying the ravages of 
this disease, support will not be lacking. Dr. Herbert 
8now followed with a paper which we hope to publish 
in our next. 

Boyal College of Burgeons In Ireland. 

At a meeting of Fellows held June 5th, the following 
were elected for the ensuing year:— 

President—Robert Lafayette Swan. 

Vice-President—Thomas Myles. 

Secretary—Sir Charles A. Cameron, C.B. 

Council—Archibald H. Jacob, Edward Hallaran Ben¬ 
nett, Sir Philip Cramp ton Smyly, Sir Thomas Stokes, 
Henry Rosboroogh Swanzy, Wm. Stoker, William Ire¬ 
land Wheeler, Sir William Thompson, Austin Meldon, 
D.L., 8ir Charles A. Cameron, C.B., L. Hepenatal Ormsby, 
Richard D. Purefoy, John J. Cranny, Henry Gregg Sher¬ 
lock, John B. Story, Henry Fitzgibbon, Francis T. 
Houston, John Lentaigne, and Richard Bolton M‘Caus- 
land. 

Isolation of Infectious Disease. 

The following important case was heard and decision 
given in London by Justioes Day and Lawrence in the 
Queen’s Bench Division last week. The case was a 
special appeal case from the decision of oertain justioes 
of Workington, Cumberland, and raised a point of 
considerable importance under Section 124 of the 
Public Health Act. Mr. Macmorran, Q.C. in 
support of the appeal, said Section 124 of the 
Public Health Act, 1875, ran as follows :—" Where 
any suitable hospital or place for the reception of the 
sick is provided within the district of a local authority, 
or within a convenient distance of such district, any 
person who is suffering from any dangerous infectious 
disorder, and is without proper lodging or accommoda¬ 
tion, or lodged in a room occupied by more than one family 
or is on board any ship or vessel, may, on a certificate 
signed by a legally qualified medical practitioner ... be 
removed by order of any Justice to such hospital or place 
at the cost of the local authority.” It appeared that 
the respondent was a labourer residing with his wife 
and seven children in a small house of four rooms. 
One of the children was attacked with scarlet fever, 
and though it was properly nursed and had ade¬ 
quate medical attendance, the local authority applied 
for an order to remove the child to the hospital, 
in order that it might not be a danger to the other 
inmates of the house. The Justices refused to make 
the order, holding that “proper lodging accommo¬ 
dation” ought to be decided with reference to the 
wants of the person infected. He (the learned Counsel) 
submitted that the words must have reference to all the 
surroundings of the case, and one of them was that if 
the child was not removed it was likely to be a danger 
to other persons in the house. There was no reflection 
on the parents, who had provided for the child to the best 
of their means. 

Mr. Justine Day said in his opinion the Justices ought 
to have made an order for the removal of the child. 
Therefore the case would be sent back to them. 

Mr. Justice Lawrenoe concurred. 


le 




634 Thb Medical Press NOTICES TO COBBESPONDENT8. Junk 14, 1899. 


to 

CmMponbmtfli, Short IteitrrB, Sec. 

•V Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive tignatura or 
initial*, and avoid the practice of signing themselves “ Reader,” 
“Subscriber," “Old Subscriber," Ac. Much confusion will be 
■pared by attention to this rule. 

Reading Cases.— Cloth board cases, gilt lettered, containing 
twenty-six ■trings for holding the numbers of The Medical Peess 
abd Cibcclab, may now be had at either office of thi* journal, 
price 2s. 6d. These cases will be found very useful to keep each 
weekly number intact, clean, and flat after it has passed through 
the post. 

The Indian Medical Bebv ice .—There are twenty three appoint¬ 
ments to be made in Her Majesty's Indian Medical Service. This 
being an exceedingly popular branch of t he public services, applic¬ 
ants always in excess of vacancies. Notice is given in our advertis¬ 
ing columns of the next examination to be held in London on July 
28th and following days. Applications for admission must be sent 
to the Military Secretary, India Office. 

Public Health.— The Parke* Memorial Prize is limited to com¬ 
petition among the Medical Officers of the Eoyal Navy, Army, and 
Indian Medical Services of executive rank on full pay, with the 
exception of the assistant professors of the Army Medical School 
during their term of office. 

SANITATION IN THE SCHOOLROOM. 

Teacher (to applicant for admission): Have you a certificate of 
vaccination for small-pox ? Yes, sir. 

Have you been inoculated for croup ? Yes, sir. 

Been treated with diphtheria serum ? Yes, sir. 

Had your arm scratched with cholera bacilli ? Yes, sir. 

Have you a written guarantee that you are proof against whooping- 
cough, measles, mumps, scarlet fever, and old age '( Yes sir. 

Do you promise not to exchange sponges with the boy next to you, 
and never to use any but your own pencil ? Yes, sir. 

Will yon agree to have your books fumigated with sulphur and 
sprinkle your clothes with chloride of lime once a week ? Yea, sir. 

As you have met the requirements of the modern s anit a r ians, you 
may climb over yonder rail, occupy an isolated aluminum seat, and 
begin making P's and Q’s as your first lesson .—American Journal 
of Practical Medicine. 

M.B.C.8..L.B.C.P.—The matter is under our consideration, and 
our correspondent will receive a private note in the course of a few 
days. 

Spes.— Full details will be found in our advertising columns. 

F.B.C.S.—The election of president takes place at the first meet¬ 
ing of the Council of the College of Surgeons, England, after the 
annual election of councillors. The procedure is by ballot, each 
member of the Council voting for whom he feels inclined. 

Matron.—W e cannot undertake to advise our correspondent 
under the circumstances. 


Jftecting* of the Societies ant) lectures. 

Wednesday, June 14th. 

Nobth-West London Clinical Society (North-West London 
Hospital).- 8.80 p.m. Clinical Meeting. 

Thursday, June 15th. 

Central London Throat, Nose, and Eab Hospital (Gray’s Inn 
Boed).- 5 p.m. Dr. D. Grant: Diagnosis and Treatment of Danger¬ 
ous Sequel* of Otitis. 

Fbidat, June 16th. 

West London Medico-Chiruroical Society (Town Hall, 
Hammersmith, W.).— 8.30 p.m. Professor W. Osier: Cerebro¬ 
spinal Fever. (Cavendish Lecture). 

Saturday, June 17th. 

Neurological Society of London (Physiological Laboratory, 
Cambridge).—4.15 p.m. Paper: Dr. W. H. K. Bivers: Some 
Physiological Observations on the Natives of Torres Straits. 6.80 
p.m. Dinner in Trinity HalL 


laemtrieo. 

Bedford County Hospital.—Senior House Surgeon for one year. 
Salary, £10u, with apartments, board, and washing. 

Bradford Royal Infirmary. — Dispensary Surgeon, unmarried. 
Salary, £100 per annum, with board and residence. 

Brighton and Hove Dispensary, Brighton.—House Surgeon to the 
Western Branch, unmarried. Salary, £140 per annum, with 
furnished apartments, coals, gas, and attendance, but without 
board. 

County and City Asylum, Hereford.—Assistant Medical Officer for 
ten or twelve weeks. Salary, £2 2s. per week, with board, 
lodging, Ac.—Apply to the Medical Superintendent. 

Oounty Asylum, Koinhill, near Liverpool.—Semor A ss i sta n t 
Medical Officer, unmarried. Salary commencing at £225 per 
annum, with furnished apartments, board, attendance, and 
washing. 

Dundee Royal Infirmary. — Resident Medical Assistant for six 
months. Salary ut the rate of £40 per annum, with board and 
washing. 

Fisherton Asylum.—Assistant Medical Officer. Salary commencing 


at £120 per annum, with board, lodging, and washing.—Apply to 
Dr. Finch, The Asylum, Salisbury. 

Glasgow Corporation. — Bacteriologist in connection with the 
Health Department of the City. Salary at the rate of £350 per 
annum. — Applications to the Clerk (Police Department), 
Glasgow. 

King’s Norton Union.—Resident Deputy Medical Officer at the in¬ 
firmary and the workhouse at Sally Oak, near Birmingham. 
Salary commencing at £170 per annum, with furnished resi¬ 
dence. Rations or attendance not provided. Applications to 
the Clerk, 10 Newhall Street, Birmingham. 

London County Asylum, Clay bury, Woodford Bridge, Essex.— 
Junior Assistant Medical Officer, male. Salary. £150 per 
annum, with board, furnished apartments, and washing. Appli¬ 
cations to the Clerk of the Asylums Committee, 6 Waterloo 
Place, S.W. 

Newport and Monmouthshire Hospital.—House Surgeon. Salary, 
£100 per annum, with board ana residence (no stimulants pro¬ 
vided). 

Owens College, Manchester.—Senior Demonstrator in Physiology. 
Stipend £150 per annum, rising to £200. 

Royal United Hospital, Bath.—House Surgeon on July 1st, for three 
months. Salary at the rate of £60 per annum, with board, 
lodging and washing. 

Staffordshire County Asylum at Stafford.—Medical Officer for two 
or three months. Salary, three guineas per week, with fur¬ 
nished apartments, board, Ac. 

Weet Derby Union.—Resident Assistant Medical Officer at Mill 
Road Infirmary, Everton. Salary, £100, with rations. - Apply to 
the Clerk, Brougham Terrace, Liverpool. 


<2tppointnunt8. 

Allein, F. W., M.B., C.M.Ed., Medical Officer for the.Seoond Sani¬ 
tary District of the Ashton-under-Lyne Union. 

Black, L. P., M.B., B.C.Camb., L.B.C.P.Lond., M.B.C.S., Medical 
Officer by the Braintree Rural District Council, pro tem. 

Bradshaw, J. C., L.R.C.P., L.R.C.S.Edin., D.P.H., Medical Officer 
for the Walton Sanitary District of the West Derby Union. 

Browne, B. 8., L.B.C.P., L.B.C.S.Edin., Medical Officer for the 
Workhouse and the Alcester Sanitary District of the Alcester 
Union. 

Coles, C., M.D.Lond., L.R.C.P., M.R.C.S., Medical Officer of 
Health for the Combined Distriota of the town and shire of 
Leicester. 

Fox, H. C., M.R.C.S., L.S.A., Divisional Surgeon of Metropolitan 
Police for St. Ann's, Stamford Hill. 

Hair, Allan, M.R.C.S., L.B.C.P.Lond., Assistant Medical Officer 
to the North-Weetern Fever Hospital, Hampstead. 

Hughes. J. Bradley, L.B.C.P.Lond., M.B.C.S., Senior Resident 
Medicai Officer to the Toxteth Workhouse Infirmary. 

Law, J„ L.B.C.P.Lond., M.B.C.8., Medical Officer for the Sixth 
8anitary District of the Township of Oldham, the Oldham 
Union. 

McBae G. Douglas, M.B., C.M.Edin,, Assi st a n t Physician to the 
Royal Asylum, Moruingside, Edinburgh. 

Potter, 8. L, L.R.C.P., L.B.C.S.Edin., L.F.P.S.Glasg., Medical 
Officer for the Dewsbuiy Workhouse and Infirmary. 

Scott, J. B., M.B., C.M.Edin., Medical Officer for the Seventh 
Sanitary District of the Ashton-under Lyne Union. 

Slococx, kL L.B.C.P.Lond., M.R.C.8., Medical Officer for the 
Spilsby East Sanitary District of the Spilsby Union. 

Steele, Frank, M.B.C.S., L.B.C.P., Medical Officer to the Casualty 
Department, East London Hospital for Children. 

Stevenson, Roland A., L.B.C.P.Lond., M.B.C.S.Eng., Second 
Assistant Medical Officer to the Fulhiun Road Infirmary, Parish 
of St. George's, Hanover Square, London. 

Tatlor, F. R. P., M.D.Lond., B.S., L.B.C.P.. M.B.C.S., Medical 
Superintendent of the Darenth Asylum, Metropolitan Asylum 
District. 


girths. 

Evans. —On June 7th, at 13 Taviton Street, Gordon Square, London 
the wife of Wilmot Evans, B.S., F.B.C.S., of a son. 

Semple. - On June 9th, at Whitchurch Villa, Sholing, Southamp¬ 
ton, the wife of Major O. Semple, M.D., Royal Army Medical 
Corps, of a son. 


$Uxxi ages. 

Cooke—Jones. —On June 6th, at the Welsh Calvinistic Methodist 
Chapel, Garston, Ebenezer Hunt Cooke, M.A., M.B.. of Bhusa- 
wal, India, to Katie Williams, only daughter of B. W. Jones,of 
Garston, Liverpool. 

Mawdslet—Gardner.— On June 8th, at Holy Trinity Church, 
Ilfracombe, John Herbert St. Hill Mawdaley, of St. gilds , Taun¬ 
ton, to Elizabeth Mawdaley Gardner, youngest daughter of 
Frederick Gardner, L.B.C.P., M.B.C.S., of Belmont, Ilfra¬ 
combe. 


SJraths. 

Ley.—O n June 1st, at Ealing, Edwin Granville Ley, M.D., Deputy 
Surgeon General, late A.M.D. 

Moir.—O n Juue 7th, at St. Andrews, N.B., Robert Moir, M.D., 
F.B.C.S.E., Surgeon Major (retired) Indian Medical Service. 
Pollexfbn. —On June 6tli, John Hutton Pollexfen, M.A., M.D.. 

for twenty-five years Vicar of Middleton Tyaa, Yorks, aged 86. 
Topham.— On June 9th, at Wootton Hill, Bournemouth, Herbert 
Topluun, M.R.C.S , aged 58. 

Tuknouk.—O n June 8th, at Denbigh, Ed. A. Tumour, Mayor of 
Denbigh, only son of Arthur E. Turnour, M.D., J.P., of 
Denbigh, aged 35. 


Digitized 


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June 21, 1800 


The Medioa! Press and Circular Advertiser. 


xiii 



PHARMACEUTICAL SPECIALITIES. 


An ideal astringent in infantile 
diarrhoea, colic enteritis, dysen¬ 
tery, etc. An acetic derivative of 
tannin without taste or smell. 
Insoluble in water or dilute acids, 
but easily soluble in the presence 
of alkalis. 


An ideal substitute for the Salicy¬ 
lates, having no irritating effect on 
the stomach, through which it 
passes unchanged, decomposing 
only in the alkaline intestinal 
fluid. It is free from the un¬ 
pleasant after effects so frequently 
attending the use of Salicylic 
Acid and its salts. 

An excellent substitute for 
Codeine. In doses of l-12th of 
a grain. Heroin has given most 
excellent results in cases of 
Bronchitis, Pharyngitis, Catarrh 
of the Lungs, and in Asthma 
Bronchiale. In the latter two 
cnses the dose may be increased 
to l-6th of a grain. 


TANNIGEN 

(Triacetyl of Tannin). 


ASPIRIN 

(Acetic Ether of Sali¬ 
cylic Acid.) 


HEROIN 

(Di-acetic Ether of 
Morphine). 


May be prescribed in all cases 
where it is desired to produce an 
astringent action on the intestinal 
mucus. Benders especially valu¬ 
able service in acute and chronic 
colic, and is a specific in summer 
diarrhoea of children. 

Dose : Children 2 to 5 grains j 
Adults, 8 to 12 grains 4 or 6 
times a day. 

It has an agreeable, slightly acid 
taste, favourably contrasting with 
the repugnant sweet taste of the 
Salicylates. Extensive clinical 
trials have proved the value of 
Aspirin as a perfect substitute for 
Salicylic Acid and its salts. 

Dose : 16 grains, 3 or 4 times 
a day. 

Heroin does not cause constipa¬ 
tion, and may be administered to 
patients with a weak heart who 
cannot tolerate Morphine. 

Hydrochloride of Heroin. A 

neutral Heroin salt, easily soluble 
in water, and suitable for subcu¬ 
taneous injection. 

Dose, subcutaneously, I-20tli 
to l-6th of a grain. 


Trional, Tannig:en, Salophen, Lycetol, Creosotal, Duotal, Heroin, Aristol, Tetronal, 
Analgen, Losophan, Somatose, Iron Somatose, Milk Somatose, Phenacetine- 
Bayer, Sulfonal-Bayer, Piperazine-Bayer, Salol-Bayer. 


Samples and Literature may be had on application to the Wholesale Depot for all Bayer's Pharmaceutical Specialities, 

THE BAYER CO., Ltd., 19 ST.DDNSTAN’S HILL, LONDON, E.C. 

Also at MANCHESTER, GLASGOW, and BRADFORD. 


Digitized by t^ooQle 




The Medical Press and Circular Advertiser. 


June 21, 1989 


xiv 


On an Exact Bacteriological Investigation made to ascertain the Value of 

“Sanitas” Fluid, “Sanitas” Oil, & “Sanitas” Emulsion 

As DISINFECTANTS for GENERAL USE, 

By O. a. MOOR, M JL. (Oantab.), r.X.O., F.O.S., 

Member of the Society of Public Analysts, Joint Author of “ Applied Bacteriology," Ac., Ac. 


4 Danes Inn, W.C„ London, July 2nd, 1808. 

C. T. Kingzbtt, Esq., F.I.C., F.C.S., 

Thb “Sanitas" Company, Limited, 

Bbthnal Gkbcn, London, E. 

Dear Sir, 

I beg to present you my report on the experimental Investiga¬ 
tions I have conducted on the preparations manufactured bv your firm, 
named “Sanitas” Oil, “Sanitas" Emulsion, and “Sanitas' Fluid. 

The experiments were made to ascertain and establish, if possible, 
on a scientific basis, the efficiency of these preparations, and their 
suitability for the purposes for which they are designed as indicated 
by your publications and labels giving directions for use. 
jfc The experiments instituted for this purpose were as follows 

(а) In the case of the preparations above mentioned, various 
disease organisms-namely, those of Anthrax, Cholera, Diph¬ 
theria, Staphylococcus Pyogenes Aureus ana Typhoid were 
brought into contact with the disinfectant for a given time and 
in a manner detailed below, and means were taken to ascertain 
whether the disinfectant employed was sufficiently powerful to 
determine the death of the organism in a given time. 

(б) A second series of experiments was undertaken to ascertain 
the effect when similar cultures were exposed to different 
strengths of these disinfectants for a standard time. 

( c) Experiments were also made to ascertain the effect on 
ordinary air, as regards the removal or extermination of 
organisms suspended in it, by spraying with “Sanitas" Oil and 

Sanitas " Fluid. 

(6) In the case of “Sanitas" Oil, I have experimented as to the 
action of the vapour given off at a temperature not exoeeding 
that of the hnman body. 

(e) Finally, I have tried some experiments to ascertain the 
action of “Sanitas ” Oil and “Sanitas" Fluid on the Bacillus of 
Plague 

TABLE 1. 

EXPERIMENTS WITH “SANITAS” OIL. 


Silk threads infected with cultures of the following organisms were 
exposed in "SANITAS’' OIL for the times shown below and then 
incubated in broth. Growth is shown by a + sign, no growth by a 


Organism. 

Times of Exposure. 

1" 

10" 

80" 

Cholera. 

_ 

_ 

_ 

Diphtheria. 

— 

— 

— 

Typhoid . 

— 

— 

— 


Anthrax and S. P. Aureus were also killed in 30" exposure. 
Controls all grew well. 

Table 2. 

A sim ilar experiment was carried out in the case of “ SANITAS' 
FLUID. (Threads.) 


Times op Exposure. 


Organisms. 


Anthrax 
Cholera .. . 

Diphtheria . 
8. P. Aureus. 
Typhoid.. . 


30” 




Controls all grew well. 

I next proceeded to ascertain the strengths of these disinfectants 
required to ensure the death of the above-named Iwcteria in a given 
t i„ H ._ an d in the following experiments the time of exposure of the 
tiaeterin to the action of the disinfectant was In all cases ten minutes. 

In these experiments 1 used the method of shaking together an 
actively growing liroth culture of the organism to be tested, with such 
a qu ntity of disinfectant that the resulting mixture contained the 
stiength of disinfectant specified in the tables below ; the exnct details 
of the method of experiment are described in Pearmain & Moor s 
Applied Bacteriology, 2nd Edition, pages 377-382. (Balliere, Tindall, 
and Cox). 


Table s. 

“ BANITAS ' OIL.—As the Oil is not readily miscible with water 
the “Sanitas" Emulsion, which contains 45 per cent, of “ Sanitas" 
Oil, was employed. 

Ten minutes’ exposure. 


Organisms. 

Strength employed in Terms 
of “Sanitas” Oil. 

25 % 1 10 % 6 % 

Anthrax . 

— 

_ 

+ 

Cholera. 


— 

— 

Diphtheria. 


— 

I — 

S. P. Aureus. 

— 

+ 

+ 

Typhoid. 

- 

— 

— 


Controls all grew well. 
Table 4. 


" SANITAS” FLUID tested against Broth Cultures, as above. 
Ten minutes' exposure. 


Organisms. 

Strength Employed 

60% 

26% 

10% 

Cholera. 

— 

_ 


Diphtheria. 

— 

— 

— 

Typhoid. 

— 

- 

- 


Anthrax and S. P. Aureus were also both destroyed by the 60 % 
mixture in ten minutes' exposure. 

Controls all grew well 

(6) . I have made several experiments as to the destruction of 
bacteria floating in the air of a room by spraying the air with 
“Sanitas" Oil, and with "Sanitas" Fluid—testing the air by means of 
Hesse's tube. 

The removal of bacteria from air by spraying will, doubtless, depend 
very greatly on the mechanical action of the particles of spray, because 
as is well known, bacteria are very largely removed from air by a 
shower of rain, therefore, too much importance must not be attached 
to such experiments. 

Taking, however, the mean of several experiments, whereas the air 
of the room contained a considerable number of bacteria before spray¬ 
ing, the numbers were reduced, after spraying, to under five per cent, 
of those previously found. 

(fl). “Sanitas" Fluid does not give off much vapour at ordinary 
temperatures ; but, Sanitas" Oil, on the other hand, is sensibly 
volatile at room temperature, and I have tested the action of the 
vapour given off by “Sanitas" Oil, at blood-heat on bacteria similar to 
those used In the broth and thread experiments. 

Some of the growth from agar tubes was smeared on filter-paper and 
suspended in a wide-mouthed Jar containing a little “ Sanitas " OiL 
The whole was placed in the incubator (37° C.), and, after an hour 
cultures were made on to nutrient media. The result was that only 
the two most resistant organisms-namely, Anthrax and Staphylo- 
loccus Pyogenes aureus - had survived, while Cholera, Diphtheria, and 
Typhoid failed to grow 

(7) . Having a culture of Bubonic Plague brought by a student from 
Hong-Kong I tried the effect of “ Sanitas" Fluid and “Sanitas " OU 
on it. The bacillus was killed in each case by a ten minutes' exposure 
to a strength of S3 per cent, of each disinfectant—the only strength 
tested. 

In conclusion, I regard the results of my Investigation as affording 
ample evidence that the “8anitas" preparations are thoroughly 
reliable, when employed in the strengths and for the purposes 
sped fled in the directions issued by the proprietors, while their non- 
poisonous nature and pleasant character render them applicable in 
many Inst inces where such substances as carbolic acid or mercurial 
chloride would be inadmissible or dangerous. 

C. G. MOOR, M.A., (Cantab.X F.I.C., F.C.S., 
Member of the Society of Public Analyttt, 

Joint Author of—" Avplied Bacteriology,” 

„ „ “ The Analynu of Food and Druos;’ 

„ „ “The Ch'mical and Biological Examination 

Water." 


THE “SANITAS” CO., Lim.. Bethnal Green, E., 

Disinfectant and Embrocation Manufacturers. 


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"8ALUS POPULI SUPREMA LEX.” 


WEDNESDAY, JUNE 21, 1899. No. 25. 


Vol. CXVIII. 


(Eatanbish ^Cccturc 

ON THE 

ETIOLOGY AND DIAGNOSIS OF 
CEBEBRO-SPINAL FEVER, (a) 

By WILLIAM OSLER, M.D., F.R.S., F.R.C.P., 

Professor of Clinical Medicine, Johns Hopkins University, 
Baltimore, U.S.A. 

In practice we sometimes meet with a meningitis 
which is not a sequel to pneumonia or ulcerative 
endocarditis, to ear disease or of injury, and which 
does not mark the terminal stage of a chronic malady. 
As the meninges of brain and cord are both inflamed 
the condition is labelled cerebro-spinal meningitis. 
W hen there are many cases we speak of epidemic 
cere bro spinal meningitis. Until recently my experi¬ 
ence did not extend beyond the sporadic form 
of the disease. However, the recurrence of a small 
outbreak in Baltimore during the past year has 
enabled me to study certain points in this most in¬ 
teresting affection, and has thus determined my choice 
of a subject upon which to address you. 

Of the special features ofc epidemic cerebro-spinal 
fever I shall speak but briefly. 

First, it is one of the most fatal of all acute 
diseases, but fortunately takes a low position among 
destructive epidemics. It spreads slowly and attacks 
only a few individuals so that the general mortality 
may be but slightly increased. On the other hand, 
scarcely any known fever kills so large a proportion 
of those attacked. During the recent Boston epi¬ 
demic out of 111 hospital cases no less than 76 died. 

Secondly, the outbreaks occur in epidemic waves, 
of which the fourth in the present century is now 
prevailing in the United States. For some years there 
have been local outbreaks in widely-separated regions, 
but in 1896, 1897, and 1898 a slight epidemic occurred 
in Boston, and in 1898 cases appeared in Baltimore 
and other towns. From a recent report by Surgeon- 
General Wyman we find that cerebro-spinal fever has 
prevailed during the past year in twenty-seven States. 

Thirdly, among specific diseases cerebro-spinal 
fever comes closest te pneumonia. Sporadic cases of 
both occur during epidemic periods, although more 
commonly so in pneumonia, while both are most fre¬ 
quent in barracks, gaols, and asylums. Even when 
not epidemic there may be remarkable house out¬ 
breaks of cerebro-spinal fever. The seasonal rela¬ 
tions are the same in both, and the two diseases may 
prevail together. Other points of resemblance are 
found in the abrupt onset, the herpes, the almost 
identical character of the fibrino-purulent exudate, as 
pointed out by Netter, and the frequent complication 
of pneumonia by meningitis, and of the latter by 
pneumonia. The degree of contagion iB about the 
same in both diseases, and it has been claimed that 
the organism described in cerebro-spinal fever is only 
a degenerate variety of the pneumococcus. 

On the other hand, Leichtensten urges against 
the view that pneumococcus is the cause of epidemic 
cerebro-spinal meningitis the facts that pneumonia 
is of universal distribution, whereas the otner condi- 


la) Read before the Weet London Medioo-ChirurrlcnL Society, 
June l«th, 1899. ” 


tion is very rare, and in some countries still unknown. 
Croupous pneumonia attacks every age, and some¬ 
what more so with increasing age, while epidemic 
meningitis chiefly affects children and young persons. 
Pneumonia has a typical course and crisis: epidemic 
meningitis has no crisis. The complications also 
differ. 

The Bacteriology of Cerebro-Spinal Fever. 

More than twelve years ago Weichelsbaum described 
a diplococcus with special cultural peculiarities, which 
he claimed to be the specific organism of the 
disease. In 1895 his observation was confirmed by 
Jaeger. No mention, however, was made of the fact 
in Allbut's System, published in 1896, or in Lownes 
and Thompson’s System in 1897. Weichelsbaum has 
been confirmed by Heubner, Councilman, Mallory, 
and Wright, and the organism, known as the 
meningo - coccus, or the diploooccus intra- 
cellularis meningites, is now regarded as the 
specific cause of the malady. The subject is fully 
discussed by Netter in Yol. XVI. of the “Twentieth 
Century Practice.’’ My own cases have been 
carefully investigated by my colleagues, Drs. Gwyn, 
Harris, and Welch. The meningococcus in cover- 
slips from the exudate is usually a diplococcus lying 
within the polynuclear leucocytes ; hence the term 
intracellularis. It may also occur free. It is stained 
with the ordinary reagents, and iB decoloured by 
Gram’s method. It grows best on Loefller’s blood 
serum, on which it forms round, whitish, shining, 
viscid-looking colonies, with smooth, sharply-defined 
outlines, which contain a diameter of 1 to li milli¬ 
metres in twenty-four hours. It is found in the 
cerebro-spinal exudates, and has been rarely isolated 
from the blood, pus from joints, pneumonic areas in 
the lungs, and nasal mucus. 

Our clinical and pathological experience with the 
organism is as follows:—In twenty-one cases which I 
have seen lumbar puncture was made in sixteen. In 
three cases seen in consultation the diagnosis was so 
clear that puncture was not made. In Cases 1 and 
2, both mild, the puncture was made, one on the 
sixth and the other on the seventh day, but no 
organisms were found, In Cases 3 and 4, admitted 
late in the disease, it was not thought necessary to 
perform it. Of the remaining fourteen cases, in 
thirteen the diplococcus intracellularis was present 
on covers lips and in cultures. In the fourteenth 
case its presence was doubtful on the coverslips, but 
the staphylococcus was found in culture. Of tne five 
autopsies the diplococcus intracellularis was present, 
and m two had been found during life. In one the 
streptococcus and in another the staphylococcus was 
isolated. 

Microbic Association in Cerebro-Spinal 
Fever. 

It is interesting to note that the diplococcus intra¬ 
cellularis is often found to be not in pure culture. In 
the Boston epidemic other organisms were often 
found, particularly in lumbar punctures taken in the 
course of the disease. In a large number of Netter’e 
cases the pneumococcus was present. In our own 
series it was found only once in the fluid obtained by 
lumbar puncture. Another point in diagnosis is that 
after five or six weeks or longer the diplococcus 


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Diqi 





junk 21, 1899. 


636 The Medical Press. ORIGINAL COMMUNICATIONS. 


intracellul&ris often disappears. The chief organisms 
found in association are tne pyogenic organisms, the 
pneumococcus, and rarely, the tubercle bacillus. 

On the whole, then, our observations support those 
of Weichelsbaum, Jaeger, Councilman, and others, 
that in epidemic cerebro-spinal fever there is an 
organism with special cultured peculiarities which 
may reasonably tie regarded as the exciting cause of 
the disease. Among recent observers, Netter alone 
appears to doubt this, and says that he found the 
diplococcus intracellularis in 16 only out of 39 cases, 
and in 10 of those the pneumocoocus was present at 
the same time. 

Netter’s position is illogical and confusing. In his 
article in the “ Twentieth Century Practice ” he 
assumes that cerebro-spinal fever may be caused by 
either the pneumococcus or the diplococcus intra¬ 
cellularis. That a oerebro-spinal meningitis may be 
due to the pneumococcus is everywhere acknowledged; 
but it is unlikely that so specific an affection as 
cerebi;< -spinal fever should be caused by two different 
organi&ms. Towards the close of the article the in¬ 
consistency of this view seems to impress him, for 
he says, “ certain peculiarities prevent us from con¬ 
cluding that the two diseases are absolutely identical.” 

The Diagnosis. 

In cerebro-spinal fever the disclosures of the 
post-mortem room are just as mortifying as in 
pericarditis. Who has not in enteric fever or pneu¬ 
monia made an absolute diagnosis of meningitis, only 
to illustrate the dictum of Stokes that there is no 
single nerve symptom which does not and may not 
occur independently of any lesion of brain, nerve, or 
spinal cora ? It is very doubtful if either tubercu¬ 
lous or pyogenic organisms cause an acute primary 
.cerebro-spinal lepto-meningitis. 

The onset of the disease is peculiar. As a rule 
it is more abrupt than that of any other known 
disease, with the possible exception of pneumonia. 
The patient may be seized when at work or during 
sleep, he has rigors or chill. This onset is very 
different from that of the tuberculous form. In 
sporadic cases of cerebro-spinal attacks there may be 
no fever at first. (Various charts illustrating the 
peculiarities of temperature were here shown on a lan¬ 
tern screen.) In two cases there was no elevation of 1 
temperature for three or four days, then the 
curve ran up suddenly to 104 degs. or 105 degs 
Another chart showedextreme fluctuations from about 
normal to 106 degs. and 108 degs. (the latter pre¬ 
ceding death). In another less common type the 
fever was oontinnous, resembling the third week or 
recovery stage of enteric fever. In one case regarded 
as typhoid the diagnosis of cerebro-spinal fever was 
established by lumbar puncture. One protracted 
case showed extreme irregularity, and at one time an 
inverse type of temperature—that is to say, a morn¬ 
ing record higher than that of the evening. In some 
the fever is of a remarkably intermittent nature. It 
differs, however, from the paroxysms of intermittent 
fever in extending over twenty-four hours, whereas 
the intermittent periodicity occurs every twelve 
hours. 

Kebnig’s Sign. 

This interesting sign, first described by a Russian 
physician, has been present in all of our cases in 
which it has been looked for. It is an old observation 
that in protraoted meningitis the patients lie with 
the thighs flexed upon the abdomen and the legs 
partly flexed on the thighs. To test for Kernigs 
sign the patient should be propped up in bed in the 
sitting position, then, on attempting to extend the 
leg on the thigh there is contraction of the flexors 
which prevents the full straightening of the leg. On 
the other hand, in the recumbent posture the leg can 
be fully extended. Many patients with meningitis 


cannot sit up, but the test can be equally well applied 
by flexing the thigh on the abdomen, when, on 
attempting to extend the leg, if meningitis be present, 
the limb cannot be fully extended. Fries found the sign 
in fifty-three out of sixty cases, and Netter in forty-five 
out of fifty. Its presence is no indication of the 
intensity of the spinal involvement. Netter’s expla¬ 
nation of the phenomenon is as follows: In conse¬ 
quence of the inflammation of the meninges the roots 
of the nerves become irritable, and the flexion of the 
thighs upon the pelvis when the patient is in the 
sitting posture elongates, and consequently stretches 
the lumbar and sacral roots, and thus increases 
their irritability. The attempt to extend the knee is 
insufficient to provoke a reflex contraction of the 
flexors while tne patient lies on his back with the 
thighs extended upon the pelvis, but it does so when 
he assumes a sitting posture." 

Lumbar Puncture. 

By means of Quincke’s lumbar puncture we can 
now say when a meningitis exists and are further 
able to determine the form of the disease. The 
technique of the operation is fully described in the 
text-b<x>kB. It is a simple, harmless procedure, 
and in most cases can be undertaken without general 
ansBsthesia, or with the aid of a local freezing mix¬ 
ture. The puncture is usually made between the 
second and third lumbar vertebrae, and is done 
with an ordinary aspirating needle. Often a few 
drops of blood flow first, then a dear or turbid fluid. 
A ary tap is unusual in cerebro-spinal fever. The 
needle may be plugged, or may be in contact witl* a 
nerve. In rare cases clear fluid may be obtained when 
meningitis exists, and in a protracted case the fluid 
may be turbid at one puncture and clear at the next. 
A clear fluid may be obtained from a puncture in the 
second lumbar interspace, while lower down a turbid 
fluid may be withdrawn. In a recent post-mortem 
the fluid in the dorsal and upper lumbar regions was 
clear, while that in the lower lumbar and the sacral 
canal was turbid and flocculent. The amount of 
fluid varies from a few drops to a large amount— e.g. 
126 c.c. Cover glass preparations oan be made at 
once, and cultures prepared by running a few cubic 
centimetres of the fluid on to a shunt tube of Loeffler’s 
blood serum. 

Has the lumbar puncture any therapeutic value P 
Williams, of Boston, thought it had, but Wentworth 
takes a contrary view. Netter reports some good 
results. We have given this point careful attention. 
In one chronic case the patient lingered three 
months. Seventeen punctures were made in all 
between the twenty-ninth and the seventy-fifth days 
of the disease, and of these fourteen were positive. 
A turbid, pale yellow fluid was removed at each effec¬ 
tive tapping. On five occasions 100 oc. or more were 
obtained, once 125 cc., and once 126 cc. After the first 
two effective tappings the patient seemed better, the 
ten punctures dropped and he seemed much brighter, 
but he soon became worse, and the fever rose. 
Following the sixth, seventh, eighth and eleventh 
punctures the temperature fell 4 5 degs., 3 8 degs., 
4'2 degs., and 5'8 degs. The drop in the fever 
followed so directly that it seemed only natural to 
attribute it to the lumbar puncture. The thirteenth 
puncture, however, was negative, yet the temperature 
fell 5T degs., and after the fourteenth tapping the 
temperature rose 2 6 degs. Evidently not tne with¬ 
drawal of the fluid, but the peculiar character of the 
disease was responsible for the remission. The diplo- 
coccus intracellularis was found twice. 

Sporadic Cerebro-Spinal Fever. 

To what extent do isolated cases of oerebro-spinal 
fever occur between the epidemics P What is the 
nature of the primary suppurative meningitis which 
is met with from time to time in all communities 

P 




June 21 , 1890. 


ORIGINAL COMMUNICATIONS. 


' The Medical Press. 637 


Neither hospital statistics nor the ordinary death 
returns give any trustworthy information as to these 
•questions, 

From the Fifty-ninth Annual Report of the 
Registrar-General, 1896, I gather that the deaths 
from cerebrospinal fever in England from 1877 to 
1896 inclusive, nave only once exceeded 50 per annum. 
There has been a great reduction in the return since 
1887,233 cases for the ten years ending 1896, against 
406 for the previous decade. In Scotland there were 
only six deaths from cerebrospinal fever in 1895, and 
five in 1896. In Ireland there were 76 deaths from 
this cause in 1896, and the same number in 1897. 

In the United States and Canada the occurrence 
of sporadic cases in the intervals between the epi¬ 
demics has long been recognised. In Philadelphia, 
from 1863 up to the present date, a record has been 
made by Stille, Pepper, and Abbott. They show a 
gradual decline from 1884, when there were 124 
deaths, to 1891, with 23 deaths. From 1892 to 1897, 
the deaths were 22, 35,18, 17, 7, 10; 1898, 24 oases; 
while in the first four months of the present year 
there were no less than 89 deaths. 

At the Johns Hopkins Hospital in the Spring of 
1896 there were four cases of sporadic cerebro- spinal 
fever; the first of the epidemic cases. 

One family presented the following history:—(1) 
a son, a young man, set. 20, returned home with a 
terrible pain in the head. He had fever and vomit¬ 
ing and his head and neck were arched. He was 
■delirious and died in five days; (2) a sister who 
nursed her brother, died in four days; (3) a second 
sister taken ill and recovered ; (4) the mother, worn 
-out with nursing her children, attacked and died in 
two day8. These were five cases of the sporadic form 
in one family. The disease was not epidemic in the 
•city. 

Bacteriology op Sporadic Cerebro-Spinal 
Fever. 

In a number of sporadic cases the organism of 
Weichelsbaum has been foand. The most important 
contribution of late years has been made Dy Dr. 
Hill, of the Great Ormond Street Hospital for 
Children. In a study of the simple posterior basic 
meningitis of infants he isolated from seven or eight 
cases a diplococcus conforming in every respect with 
the diplococcus intracellularis. In ten years there 
were forty-nine fatal cases of the kind at the hospital 
mentioned. Clinically the disease differs from the 
ordinaiy type, as it attacks young children and is 
very protracted. Skin rashes are not frequent. Still 
was able to isolate the diplococcus from the peri- 
arthritic exudates. 

By the kindness of Professor Welch the results of 
the twenty-five cases in our own city in which 
bacteriological examination has been made may be 
bere given. There were six of cerebro-spinal fever, 
eight of pneumococcic meningitis, seven of pyogenic 
meningitis (in which streptococci and staphylococci 
were found together and separately), and four show¬ 
ing unidentified bacilli. 

The pyogenic forms of meningitis do not con¬ 
cern us nere; no case of primary streptococcus or 
staphylococcus came to autopsy. I have already 
referred to the chronic form of cerebro-spinal fever 
in which the pyogenic cocci may alone be present at 
tthe time of death. 

Pneumococcic Meningitis. 

The pneumococcus has long been recognised as the 
most important organism in the production of menin¬ 
gitis, ana the first question is how far sporadic cases 
cf cerebro-spinal meningitis are due to it. Of twenty- 
five cases in the Johns Hopkins Hospital it was 
isolated in eight. Of twenty cases examined by 
Councilman, Mallory, and Wright, it was primary in 

wo and secondary in eight. Netter examined sixty- 


one cases of meningitis bacteriologically, and found 
the pneumococcus thirty-five times, the same with 
streptococcus once, and once with staphylococcus, the 
streptococcus alone thirteen times, the diplococcus 
intracellularis three times. We may consider three 
groups of pneumococcic meningitis. 

1. The meningitis as a complication of lobar pneu¬ 
monia. In Montreal my attention was called to the 
frequency of this complication in eight of one 
hundred consecutive autopsies. The other groups 
are pneumococcic meningitis from local infection,and 
primary pneumococcic meningitis. 

The clinical features of pneumococcic meningitis 
present many points of interest. Is the case 
one of cerebro-spinal fever with pneumonia, 
or of inflammation of the lungs, with an added 
meningitis P This question does not often arise 
at the bedside, as it is most exceptional for the 
meningitis of pneumonia to present the symptoms 
of cerebro-spinal fever, and in doubtful cases the 
lumbar puncture will settle the matter. The age of 
the patient is important. In meningitis complicat¬ 
ing pneumonia all the cases were above the twentieth 
year, a striking contrast to cerebro-spinal fever, in 
which a large proportion are under twenty. A second 
point is the Latency of pneumonia, which is much more 
often recognised in the deadhouse than in the wards. 
Netter states that fully one-half of the cases are latent. 
Headache and early delirium are present in all cases, 
owing to involvement of cortex. On the other hand, 
the mind may remain clear throughout cerebro-spinal 
fever. Spinal symptoms are rare in the meningitis 
of pneumonia. The importance of lumbar puncture 
cannot be too strongly emphasised. In a case of 
pneumonia in the wards of cerebral symptoms, the 

n .cture showed the pneumococcus in the exudate. 

tly, an important point is that meningitis com¬ 
plicating pneumonia is almost always fatal. Person¬ 
ally I have never seen recovery under these con¬ 
ditions. 

Secondary meningitis from local infection from 
nose, ear, &c., is often of pneumococcic origin. 

Primary pneumococcic meningitis exists, and is 
abrupt in onset. The most important point to be 
determined is the exact proportion of primary 
cerebro-spinal meningitis due to pueumococcus and 
to diplococcus intracellularis. 

Treatment. 

In our cases no special drugs were used. Morphia 
was given to check pain, and sponging practised to 
reduced temperature. ^ Our mortality has not been 
very great when we consider the severity of the cases, 
thus eight cases died out of eighteen in hospital, and 
nine among the twenty-one I have seen. A distinguish¬ 
ing feature is the relief of pressure by withdrawal of 
cerebro-spinal fluid. 

In two of our cases the spinal canal has been 
opened, drained, and irrigated. So far as I know, an 
extensive laminectomy had not been done for acute 
spinal meningitis until our first case on November 6th, 
1898, was operated upon by Dr. Cushing. The spinal 
canal was thoroughly irrigated with salt solution 
and a quantity of purulent exudate washed out. No 
change followed in the existing paraplegia. The 
bladder and kidneys became infectea, ana the patient 
died two months after the operation. At the 
autopsy spinal meninges were smooth and looked 
normal. It was impossible to say where the dura 
mater had been inoised, and there were neither adhe¬ 
sions nor thickening of the pia-arachnoid. 

In another case laminectomy was performed on 
the fourth day by Dr. Cushing. A catheter was 
passed beneath the dura mater, and the membranes 
drained and irrigated. For several days the patient 
seemed better, but he developed a htemorrhagic 
cystitis, and died on the sixth day after operation. 
Dr. Musser, of Philadelphia, has also had an un- 


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638 The Medical Pxsss. 


ORIGINAL COMMUNICATIONS. 


Juse 21 , 1899. 


successful case. In England Dr. Rodleston, and Mr. 
Herbert Allingham have reported a case of sporadic 
cerebrospinal meningitis, in which the patient 
recovered after laminectomy and drainage. The 
operation, which has been adversely criticised in 
some quarters, seems to me justifiable in severe 
cases, where the spinal symptoms are very marked, 
on the principle of a desperate remedy for a desperate 
disease. 


THE ERADICATION OF TUBER¬ 
CULOSIS. 

By GEORGE FLEMING, C.B., F.R.C.V.S., LL.D., 

Late Principal Veterinary Surgeon to Her Majesty’s Forces. 

The intense interest that is now being taken by the 

E ublic in the subject of tuberculosis is, it is to be 
oped, an indication that at length active measures 
will be speedily inaugurated to diminish its preva¬ 
lence in man and beast, and ultimately lead to its 
total suppression. For of all the diseases with which 
we are acquainted this is certainly the most prevalent, 
as it is by far the most destructive. It is estimated that 
it destroys, in its various forms, one-seventh of man¬ 
kind, and its ravages are experienced more or less in 
every part of the world. Its pernicious influence 
on human existence may be estimated, when 
we consider that in Great Britain it is account¬ 
able for nearly half the number of deaths 
occurring between the marriageable ages of 15 and 
35 years, and causes one-fifth of the entire mortality. 
What loss it may occasion during the earlier years of 
life is difficult to ascertain, as perhaps more than 
one disease is included under this designation; but 
there can be no doubt that the death rate from tuber¬ 
culosis among children under two years of age is very 
great. The total annual mortality in this country 
from this scourge alone, has been set down at 70.000; 
but it may be greater, for the reason just stated, as 
the disease appeals in various forms, which, receiv¬ 
ing different names, are liable to mislead as to their 
real nature. 

Surely this must be looked upon as a most serious 
affliction, and one which demands every possible 
effort to be made for its removal ! And that its 
mitigation and eventual eradication are possible, 
there can lie no reason whatever to doubt; it only 
requires the devising of proper sanitary measures, 
and the patient and careful enforcement of these, to 
ensure the attainment of this most desirable 
object. But it would appear that these measures 
will not be instituted unless the public press 
for them, and when inaugurated they cannot lie 
earned into successful operation unless the public 
heartily and energetically support them. The 
sanitary measures to be adopted must be based 
on the fact that tuberculosis is an infectious 
disease, and that it owes its maintenance and exten¬ 
sion to its infectiousness alone. It is a disease due 
to a specific germ, a bacillus, and without this germ 
there can be no tuberculosis, phthisis, consumption, 
or whatever other names may be applied to the 
different forms the malady assumes. 

Had this fact been earlier underatood, in all pro¬ 
bability the ravages of tuberculosis would long ago 
have been greatly lessened, and we should not now 
be deploi-ing the sad and astounding mortality it 
occasions. It is indeed, astonishing, that this 
very important feature of the disease, its communic¬ 
ability from diseased to healthy people, should have 
been so long overlooked or only now and again bus- 
pected. The immortal Harvey, more than two hun¬ 
dred years ago, was of the opinion that phthisis is a 
communicable or infectious disorder, and considered 
that it acted like plague, leprosy, and lues venerea, 


“ creeping through the ranks of mortal men, and by 
mere extrinsic contact exciting disease similar to 
itself in other bodies ” And the great anatomist, 
Morgagni, not long afterwards suggested the infec¬ 
tiousness of phthisis. But it is only within a few 
years that its infectiousness has been at all generally 
recognised, and even now there are some persons who 
remain incredulous, and deny that tuberculosis and 
leprosy are transmissible from diseased to healthy 
subjects. 

Not being recognised as an infectious disease, 
attention has until lately been directed entirely to ite 
cure, with what success the figures just referred to 
will show. Though a small percentage of affected 
persons recover, yet it must be pronounced a very 
fatal disorder, and one for which medical treatment 
can do little in the way of cure. It is not so with 
preventive or prophylactic measures, to which, if 
wisely devised and thoroughly carried out, it must 
eventually yield. But the framing of these measures 
and the manner in which they are to be brought into 
operation, must be based on our knowledge of the 
virulent principle on which its existence depends, the 
Bource or sources from which that principle is de¬ 
rived, and the mode in which it is communicated 
from diseased to healthy people Tuberculosis is not a 
disease affecting only mankind ; if we were so limited 
its suppression would be easier, and its diffusion not 
so subtle and evasive. It is very probable that 
all warm-blooded creatures are more or less suscep¬ 
tible to its invasion, aDd that those with which man 
has the most intimate relations - those which 
provide him with a considerable portion of his daily 
food—are largely infected with it. More especially 
is this the case with bovine animals, in which tuber¬ 
culosis generally appears in a chronic form, and 
causes so little disturbance to health in many 
cases that cattle intensely affected may outwardly 
appear in good health and fair condition. This is 
very different to what is witnessed in man, and 
places bovine tuberculosis in a very serious light, as 
we shall tee presently. And yet it is a destructive 
disorder, and is estimated to kill forty thousand cattle 
annually. It has been calculated that from 25 to 40 
per cent, of the cows in London are tuberculous, and 
in Edinburgh, Yorkshire, and Durham from 19 to 23 
per cent. Not long ago. when bovine contagious 
pleuio-pneumonia was being stamped out by 
slaughter-, it was noted that from 20 to 30 per 
cent, of the cattle destroyed were tubercu¬ 
lous. On the European Continent its prevalence 
varies somewhat. In Germany, some years ago, it 
was supposed that from 2 to 8 per cent, of all the 
cattle were affected, but more recent investigations 
have given rise to the belief that it is quite as high as 
in this country. In the Leipsic abbatoir, for instance, 
in 1890, as many as 22 per cent, of all the slaughtered 
cattle were tuberculous; in 1892, 27 per cent.; and 
in 1894, 29£ per cent. And similar proportions have 
been remarked in the abbatoirs of other cities. The 
disease appears to be on the increase nearly all over 
the world, and it is now the most widespread 
of all bovine disorders, though it must be ob¬ 
served that there are some regions where it is 
little if at all known. Is is said that Japanese 
cattle are exempt from it, and in the North of 
Sweden and Norway, North Africa, the Steppes of 
Russia, and in Iceland and Sicily, it seldom if ever 
occurs. Certain breeds are more predisposed to it 
than others, especially those reared on plains, and it 
is rare among hill-bred and wild cattle. It is far 
more common among cattle in towns than among 
those in the open air of the country, and cows suffer 
most severely when compared with bulls, oxen, or 
calves, while old animals are much more frequently 
involved than young ones Where cowsheds are 
unclean, badly ventilated and lighted, and the drain- 


Junk 21, 1899. 


ORIGINAL COMM CJNICATIONS. 


Thk Medical Paxes. 639 


age is defective, thene the disease’ revels if it once 
obtains a footing. 

It is probable that bovine tuberculosis was known 
at a very early period to the Jews and others, and 
that the flesh of animals affected with it was for¬ 
bidden by law to be sold as human food. This 
was more particularly the case in the fourteenth, 
fifteenth, and sixteenth centuries, though it does 
not ’appear that it was so much from dread 
of infection as because it was supposed to 
have some relation to human syphilis, and like 
that malady, it was named the French disease. 
Towards the end of the eighteenth century, however, 
this relationship was denied, and the flesh of tuber¬ 
culous cattle was pronounced fit for food in Germany 
and Austria. In the beginning of this century the 
danger of such flesh was suspected, and in 1816 an 
authority graded it in three classes: 1. That from 
which the tuberculous masses were to be removed; 
(2) that from which the diseased portions were to be 
excised and destroyed, and the remainder sold at a 
low price; and (3) that which was quite unfit for 
consumption. 

But the transmissibility of the disease from one cow 
to another does not appear to have been apprehended, 
and though it was a common affection among dairy 
cows and caused heavy loss, no precautions were adopted 
to check it, nor does inquiry seem to have been made 
ns to its nature; and the great majority of writers 
were of opinion that it was quite different from 
human tuberculosis. More than forty years ago 
I had satisfied myself that it could be com¬ 
municated from an affected to a healthy cow, and 
evidence of such infection was not far to seek in town ; 
dairies. But until experimental research was adopted 1 
little of a positive nature was known. In 1865 
Villemin began these experimental investigations 
which yielded such startling results, and clearly 
demonstrated not only that human and bovine tuber¬ 
culosis were one and the same disease, but also that 
the former could be readily transferred to various 
species of animals by inoculating them or feeding 
them with tuberculous matter; he was, therefore, the 
first to prove that it is a specific infective malady, 
identical in man and cattle. This discovery by 
Yillemin has been strangely lost sight of in this 
country, the credit for it having been given to 
Koch; it was quickly verified and established 
by the experiments of Klebs, Gerlach, Chauveau, St. 
Cyr, Toussaint, and many others. The results were 
eo remarkable, and gave the bovine disease such a. 
serious aspect, so far as the public health was con¬ 
cerned, that I drew attention to the subject in a 
medical magazine, (a) insisting on the danger 
attending the consumption of the flesh and 
milk of diseased animals, and pointing out that 
much of the mortality among young children 
might be due to the latter! And the following year, 
in a work published with a view to the eradication 
of contagious diseases among animals ( b) a section 
was devoted to the subject of bovine tuberculosis, in 
which the following passage occurs with reference to 
milk : “ The commencement of phthisis is generally 
so insiduous in the human species, that it is most diffi¬ 
cult to arrive with any degree of certainty at the 
causes which directly produce or favour its develop¬ 
ment ; but from the evidence before us, it is to be 
feared that at least one of its sources may be referred 
to the milk from tuberculous cattle. It is certain 
that tuberculosis is a somewhat common and a very 
destructive disease, among dairy cattle especially, and 
more particularly among those in towns; that 
the udder is one of the glands not infrequently 

ia) “The British and Foreign Medico• Chirurgical fieri ew," 
October, 1874. 

(6) “ Veterinary Sanitary Science, and Police.” London, 1875. 

Vol.n. 


involved; that infants and adults consume milk in 
large quantities—indeed, it is the staple diet of 
young children; and that phthisis is a very prevalent 
and fatal malady in the human species, and chiefly 
among the dwellers in towns ana cities. There is 
every reason, then, to prohibit the use of milk from 
cows affected with tuDerculosis, and especially for 
infants, who mainly rely upon this fluid for their 
sustenance, and whose powers of absorption are very 
active. Even if it did not possess infective properties, 
its deficiency in nitrogenous elements and fat and 
sugar, and the increased proportion of mineral 
matters, would alone render it an objectionable 
article of diet. It had long been known that it was 
liable to produce diarrhoea and debility in infants, 
but though these died from general or localised tuber¬ 
culosis, tne part played by the milk in its production 
was not suspected.” 

I believe this reference, and that in the medical 
journal already mentioned, is the first intimation, in 
this country at least, of the danger of infection 
through milk when taken as food, and that this mar 
be one of the sources of human tuberculosis. With 
regard to the communicability of the disease among 
cattle, I had also insisted on this in the work just 
quoted from. “There appear to be many facts to 
support the popular notion, that the cohabitation of 
healthy with phthisical cattle will produoe the malady 
in them; the expectorated matters of the diseased 
being probably the active agent in this contamina¬ 
tion. . . there is evidence which appears to prove, in 
the most conclusive manner, that, not only is the 
disease comm muni cable by cohabitation of healthy 
with diseased cattle, but that stalls and stables may 
become so-contaminated by animals suffering from 
tuberculosis that they will infect sound cattle which 
afterwards inhabit them. . . forage soiled by the ex¬ 
pectorations of the diseased and consumed by healthy 
animals will communicate the malady.” 

So deeply impressed was I with the dangers to the 
public health to be apprehended from the existence 
of this disorder in cattle, as well as with its destruc¬ 
tiveness among them, that in 1876 I read a paper 
before the Society of Arts dealing with this sub¬ 
ject (o), and soon afterwards, at the annual meeting 
of the British Medical Association held at Cam¬ 
bridge, I again brought it under notice. In 1880 I 
published a pamphlet on it, bringing together all the 
evidence I could collect, in order to direct public 
attention to it ( b ), and in 1883 I issued another pam¬ 
phlet containing further evidence (c). 

But these efforts to attract attention to this serious 
matter—-serious even because of its increasing preva¬ 
lence and destructiveness among our cattle—met 
with little response, and it was not until Koch, in 
1882, discovered the micro-organism or bacillus which 
is the real genetic influence in the production of 
tuberculosis, that the dangerous character of the 
disease began to dawn upon the pnblic mind. But 
this discovery, important though it was, did not in 
any way prove that the malady was infectious, for 
experimental and clinical observation had done 
this years before, and to Yillemin are we in¬ 
debted for establishing the fact of the communi¬ 
cability of consumption and its identity in man and 
animals# Even after the discovery of the micro¬ 
organism very little advance was made towards the 
prevention of the disease; its cure was the chief object 
of research, and when, in 1890, Koch introduced a gly¬ 
cerine extract of pure cultivation of the bacilli, it was 
as a curative agent for phthisis. But it was 


(a) “The Contagious Diseases of Animals; their Influence on 
the Health and Wealth of the Nation.” 

(b) “ Tuberculosis from a Sanitary and Pathological Point of 
View.” _ 

(e) “The Influence of Heredity and Contagion on the Propaga¬ 
tion of Tuberculosis, and the Prevention of Injurious Effects from 
the Consumption of the Flesh and Milk of Tuberculous Animals." 

D 


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CLINICAL RECORDS. 


June 21, 1899. 


640 The Medical Press. 


quickly found that this “ tuberculin,” as it was named, 
was not a cure, and frequently did more harm than 
confer benefit when inoculated into phthisical 
people. Its particular action upon cattle, however, 
was soon observed; for when inoculated into a tuber¬ 
culous cow, it in a few hours increased the bodily 
temperature to a marked degree, even when the 
animal did not offer any external indications of 
disease. So trustworthy and valuable was this fluid 
found to be as a diagnostic agent in cattle, when em¬ 
ployed with the necessary care and discrimination, 
that it is now largely resorted to as a test in those 
occult cases where the ordinary means of investiga¬ 
tion would only yield negative results. 

(To bconcluded in our next.) 


THREE CASES OF TACHY¬ 
CARDIA. (a). 

By J. MAGEE FINNY, M.D., F.R.C.P.I, 

Physician and Lecturer on Clinical Me licine at Sir Patrick Dun's 
Hospital, Ac. 

I am enabled to bring to your notice the clinical 
notes of three cases of tachycardia, the first two cases 
being examples of paroxysmal heart hurry ; the third 
case was persistent for sixteen days, and ended 
fatally witn gangrene of both lower extremities due 
to arterial thrombosis. 

Case 1. was an elderly lady with chronic valvular 
and arterial disease, who had two attacks of paroxys¬ 
mal tachycardia.while under his care in 1887. The 

J ulse suddenly, with little or no cause, would rise to 
60 from 76, and remained at that rate for some hours 
(4-6), and then the heart recovered its wonted rate. 
The patient made very little of these attacks, and 
complained of but slight oppression in the chest. 
This patient died three years subsequently “ of her 
heart,” when not under my care. 

Case II. was'a lady, set. 52, at the “ period of change 
of life,” who had been under medical observation for 
six months in 1897, and whose heart was frequently 
examined and found free of valvular and other 
disease. Suddenly, and apparently without any 
cause, at 10 p.m., the pulse beat up to 200-240. The 
patient complained of an oppressed feeling under the 
sternum, and sat up in bed, propped up. She was 
manifestly in a state of great fear, but presented no 
sign of pulmonary distress, the breathing being quiet, 
the face free from cyanosis, and the extremities being 
warm. On being reassured she improved, and the 
attack passed away, after the administration of car¬ 
minatives and valerian, in about three hours. A 
second and third attack happened within the next 
three months, and as she was no longer afraid of 
them, she sat through them, and then would say, 
*• now it is gone,” ana the pulse, taken by a medical 
friend, would have suddenly fallen from 160-180 to 
70. For thirteen months this lady travelled abroad 
without any recurrence, and at Nice learned to ride 
the bicycle. Since her return to Dublin at the end 
of 1898 she has had a few recurrences. Those she 
attributes to mental worry connected with her ser¬ 
vants, but when seen in Februaiy, 1899, she was well, 
and her heart and blood vessels were healthy, and 
she was taking to bicycling again. 

Case III. was a previously nealthy servant, set. 23, 
who was sent to Sir Patrick Dun’s Hospital by Dr. 
Bradshaw on June 17th, 1898, with the history of an 
acute attack of inflammation of the throat, high 
fever, 104 degs., and pulse 140 of four days’ duration. 
This may have been influenza, as there was neither 
scarlet fever nor diphtheria. Next .day the tempera¬ 
ture fell to normal, but tachycardia became more 

(a) Head before the Royal Academy of Medicine of Ireland, 
May 19th, 1889. 


pronounced, and the pulse rose to 160 and 200-228, 
and on three occasions it reached 240 by the stetho¬ 
scope, it being impossible to take it at the wrist. This 
rapidity of the pulse persisted without intermission 
until her death on January 28th, or 16 days. All 
through her illness she mide no complaint in any 
way about her heart. She felt no oppression nor 
palpitation, and her breathing was calm and quiet, not 
exceeding 32, and she was able to move and sit up, and 
take ample nourishment without any distress, and she 
slept well. On the 21st she complained of severe pain 
in the right leg and foot, with powerlessne6s, and on the 
22nd of intense agony in the calf of the left leg. It was 
then plain that gangrene had occurred; dry mummi¬ 
fication of the left and moist gangrene with bullae of 
the right foot. Pulmonary congestion - albuminuria 
with haematuria now set in, and she died on the 28th. 
Very large and oft-repeated hypodermics of morphia 
were necessary to give ease. 

I wish to call attention to the rarity of the con¬ 
dition called tachycardia, the remarkable character 
of the pulse, its recurrent or paroxysmal features, 
the length of time life may be maintained, and the 
paucity of post-mortem examinations, peculiarities 
which are referred to in various important contribu¬ 
tions to the subject by Drs. Bristowe Bouveret, 
Herringham, and Williams. The condition may 
come on seemingly without cause, and may attack at 
any age, 70 to 5 years of age. None of the theories 
founded on the teachings of physiology, experiment, 
and pathology quite suit the case of a heart sud¬ 
denly beating 200-240, and as suddenly, after hours' 
or days’ duration, by dav or by night, falling to 
70-80. 

In conclusion, I may mention that of the six fatal 
cases which have been examined after death, three 
showed inflammation or fatty disease of the muscle 
of the heart, and three dilation : and I may contrast 
my own case (Case IIT.) in that the myocardium was 
perfectly healthy and the organ not dilated. The 
cause of the gangrene was arterial and venous 
thrombosis of the Uiac on one side after femoral on 
the other, while the kidneys, lungs, and liver were 
the seat of infarcts; yet none of these infarcts,any 
more than the heart itself, showed any bacterio¬ 
logical evidence of infective or other micro¬ 
organisms. Tho reading of it was probably—first, 
primary febrile, possibly influenza; second, cardiac 
weakness as its effect; tachycardia as another pos¬ 
sible effect of the toxin on the cardiac ganglia; and 
third, thrombosis of the right and left auricles, and 
infarctions (emboli) of the pulmonary and systemic 
arteries. 


(Elinkal J&ecorto. 

MERCER’S HOSPITAL, DUBLIN. 

Thru Caui of Diabetei Intxpidut. 

Under the Care of Db. Lukbden. 

Cabs I. was that of a boy, set. 9, who was admitted to 
Mercer’s Hospital, June, 1898; family history good; well 
nourished, blond, of a fresh complexion, and fairly moist 
skin; tongue and lips very dry, and he complained of an 
insatiable thirst; appetite very poor, vomits occasionally 
after solid food; urinates frequently, and shivers very 
often before micturition; physical examination reveals 
no abnormality ; poise intermittent at times, of low ten¬ 
sion, its rate varying from 75 to 110; complains fre¬ 
quently of headache which causes him to cry out; of an 
excitable and emotional temperament, flushes np when 
spoken to; increased knee jerk, quadriceps reflex slightly 
present and an. attempt at ankle clonus ; temperature 
normal or subnormal. About six or eight months-ago 
it was first noticed. He was drinking large quantities of 
fluid; it did not follow an illness or aocident, although 


joogle 



June 21, 1899. 


TRANSACTIONS OF SOCIETIES. The Medical Press. 641 


a history of a fall on head three or four years ago is to be 
obtained. The polydipsia first appeared. While in 
hospital greatest quantity of fluid drunk in one day was 
860 ozs , the greatest quantity voided being 750 ozs. On 
two occasions when fluids were restricted he drank his 
own urine. The urine was of a pale greenish colour, 
alkaline or faintly acid ; sp. g. 1001-1002. No albumen 
nor glucose was ever discovered, although daily exa¬ 
mined for a period extending over five months. Inosit was 
not present. Urea varied from 160-600 grains in twenty- 
four hours. Eyes normal; blood normal. Various 
treatments were tried in this case, and although his 
general health very great y improved and subjective 
symptoms disappeared when discharged, he was passing 
from 300 to 400 ounces, and drinking about 300 ounces 
fluid in twenty-four hours. 

Case II.—A healthy, vigorous looking labourer, set. 64. 
Good family history; a violent blow on head twenty 
years ago, after which the polydipsia and polyuria 
appeared and has since persisted ; given to alcoholic ex-' 
cesses all his life; skin very dry; complains of dryness 
of mouth and tongue, which is covered with a darkish 
brown fur; appetite good, but not excessive; organs 
sound; no cardio-vascular evidence of granular kidney; 
pulse 72, regular and of distinctly low tension; reflexes 
sluggish; complains of frequent occipital headache and 
pain in lumbar region; very easily tired, and nervous 
when up, prefers to lie in bed; drinks from 260 to 300 
ounces in twenty-four hours and passes about twelve 
pints of a pale coloured urine, faintly acid; no albumen : 
no sugar; density 1003; inosit is present; no caste; eyes 
examined revealed chronic glaucoma, but no retinitis or 
neuritis; has somewhat improved on valerianate of zinc, 
but still polyuric. 

Case III.—Girl, tet. 17, fell on back of head four years 
ago, shortly after which polydipsia and polyuria 
appeared; used to drink upwards of twenty pints a day; 
on admission she was passing and drinking about four¬ 
teen pints daily; pale urine ; sp. gr. 1002 ; neutral; no 
albumen; no sugar; no inosit; no casts ; urea greatly 
diminished, organs sound; pulse tensions low and no 
signs whatever of granular kidney, bhe was first tried 
on various drugs without good effect, finally on vale¬ 
rianate of zinc, commenced in t grain doses thrice daily 
and increased gradually till she was taking 22 grains in 
twenty-four hours. The result was wonderful, the thirst 
disappearing and urine excretion falling to the normal. 
6he nas been under constant observation ever since (four 
months.) Her general health has improved, she has 
gained in weight, and there has been no return of the 
polydipsia or polyuria. 


^ransattions of Societies. 

EOTAL ACADEMY OF MEDICINE IN IRELAND. 
Section of Medicine. 

Meeting held Friday, May 19th, 1899. 


The President, Dr. J. W. Moore, in the Chair. 


NOTE8 ON THREE CA8E8 OF DIABETE8 IN8IPIDUB. 

Dr. Lcmbden read the notes of three cases of diabetes 
insipidus, which will be found under the heading 
“ Clinical Records.” 

The President remarked that two of the three 
patients were males, which was the usual proportion, 
though it was more commonly met with much earlier 
than 64. He mentioned the case of a boy, set. 11, who 
but slightly improved under treatment for about six 
months, but subsequently underwent a spontaneous cure. 

Dr. Walter Smith pointed to the alkaline reaction of 
the urine, and raised tne question of the source of the 
normal acid reaction. He believed that the normal 
secretion in the glomeruli of the kidney was alkaline, and 
that in passing through the convoluted tubes it became 
acid, though whether this was due to the secretion of 
acid or the absorption of alkaline salts he did not know. 
He asked what evidence there was of the presence of 


inosit in the urine of one of tbe cases, inosit having 
nothing to do with the sugar group, but belonging to 
the benzene or aromatic derivatives. Great stress had 
been laid on the relation of nerve injury, especially head 
injuries, to this disease. In his opinion, however, the 
only relation of nerves to the secretion of urine was of 
a vaso-motor sort. 

Dr. Little, referring to the occurrence of the disease 
in old patients, related the case of a middle-aged patient 
in the Adelaide Hospital who used to pass an enormous 
quantity of pale urine of low specific gravity, and 
suffered from intense thirst. He died comatose. Post¬ 
mortem, the coats af the bladder were much thickened, 
and the prostate enormously enlarged, the ureters as 
thick as a child’s &mall intestine, and the kidneys com¬ 
pletely excavated, resembling what is known as surgical 
kidney, but without any ammoniacal magnesium phos¬ 
phate or pus. The case was peculiar in that there was 
no cystitis nor evidence of inflammatory changes in the 
bladder, the ureters, or pelvis of the kidney. 

The President mentioned that the infectious fevers 
seemed to have a remarkable influence on diabetes 
insipidus, and a cure had been known to occur after one 
of these fevers, which they knew often affected the vaso¬ 
motor functions considerably. 

CLINICAL INVESTIGATIONS ON WIDAL’S REACTION AS A 
DIAGNOSTIC IN TYPHOID FEVER. 

Dr. Littlbdale gave an account of 120 cases on 
which he had tried Widal's reaction. At first the 
blood serum and typhoid bouillon were mixed in the 
proportion of 1 to 10, but this was found quite useless, 
as cases other than typhoid gave an agglutination 
reaction. Later the proportion used was 1 to 40. 
Results were divided into positive, negative, and doubt¬ 
ful, but there were only a few of the latter, and these 
would, have probably been eliminated if higher dilu¬ 
tions were used. Three cases of diphtheria that had 
received antitoxin gave an agglutination reaction, as 
did also antidiphtheritic serum itself. Typhus and 
acute tuberculosis always gave negative results. The 
conclusion arrived at was the unquestionable value of 
the test when applied in the second week, as the earliest 
case tested was on the fifth day of illness, and when a 
dilution of not less than 1 in 40 is used. 

Dr. M’Evoy insisted on the fact that Widal’s was 
essentially a quantitative reaction. A German investi¬ 
gator in a recent paper in Berlin claims to have got a 
reaction before W idal’s reaction could be obtained. This 
he accomplished by making cultures with gelatine from 
the faeces, and, on submitting them to a temperature of 
72 degs. for three hours, he states that there is an 
appearance in the colonies perfectly distinct from the 
bacterium ooli communis. 

Dr. Finny Baid there was often great difficulty in 
diagnosing typhoid fever from tuberculous disease. One 
case in particular he remembered in which the patient 
had all the symptoms of tuberculous meningitis, but the 
application of Widal’s reaction gave a positive result and 
a necropsy confirmed the diagnosis, as the ulcers could 
be seen in an advanced stage of healing. 

Dr. Littlsdale, in reply, said he had no experience 
of the test that Dr. M*Evoy had spoken of. He was 
informed, however, that Gartner’s bacillus, which in all 
probability belonged to the race of ooli bacilli, clumped 
long before the typhoid bacillus. It was always very 
difficult to isolate the typhoid colonies in the faeces. 

THREE FATAL CASES OF TACHYCARDIA. 

Dr. Finny read a paper embodying notes of three cases 
of the above, which will be found on page 640. 

The President remarked that the healthy condition 
of the heart, notwithstanding the symptoms during life, 
was notable, as the occurrence of these lesions was 
usually associated with changes in the heart muscle. 
He believed that the diagnosis of influenza would fit in 
with Case III., and the tachycardia could be accounted 
for by the profound nervous disorder which influenza 
was apt to oau«e. 

Dr. W. Langford Symes in this connection referred 
to an account of a case of “ thrombosis and embolism in 
fatty heart,” which he had contributed to The Dublin 
Journal of Medical Science for 1892. 


jOOglC 


Digitized by 


642 The Medical Pbess. 


GERMANY. 


June 21, 1899. 


Dr. Knott said he had an opportunity of observing 
an extreme case of tachycardia in a lady, set. about 30. 
She had always been of a neurotic temperament and 
suffered frequently from epileptiform convulsions. The 
action of the heart became often excessively rapid; so 
quick, in fact, that it was impossible to count the pulse. 

Dr. Little said that genuine cases of tachycardia were 
comparatively rare, and those he had seen were charac¬ 
terised by considerable distress, thus differing from Dr. 
Finny's cases. He cited a case in which the patient 
lived for eight or nine years after the first attack. 
During the intervals of five or six weeks between the 
attacks the patient seemed perfectly well. At first no 
physical signs of disease of the heart could be detected, 
but one day he discovered a slight diastolic aortic mur¬ 
mur, which increased until it became quite plain. The 
only thing that gave him relief was brandy. Another 
case was that of a lady who died suddenly during the 
last attack, which had lasted for twelve days. She had 
been ailing for five or six years, and he could detect 
nothing wrong with her heart. He knew of no drug 
which had any effect on this condition. 

Dr. Finny, in reply, said the duration of cases for eight 
or nine years he knew to be exoeeded in some instances. 
One of Bristowe’s cases lasted for fifteen years, and in 
the intervals the patient was perfectly well. Brandy 
seemed to be the favourite drug, and he had found a cup 
of strong coffee or a draught of cold water often benefi¬ 
cial in stopping the attack. 

The Section then adjourned. 


walls by adherences or otherwise, this pneumothorax exis¬ 
ted already or would not be produced at all. The'exposure 
of the lung would allow the operator to treat simulta¬ 
neously by suture or plugging the traumatic pneumo¬ 
thorax and the hcemothorax. 

M. Championni&re agreed with the observations of his 
colleague, except on one essential point—intervention. 
He was convinced that the patient ran more risks 
from an operation than by being immobilised. 
He knew two individuals who bled profusely from wounds 
in the lung and who recovered by immobilisation, and he 
did not hesitate to say that if their thorax had been 
opened in order to tie the severed vessels, they would have 
suocumbed. It should not be forgotten that wounds of 
the pulmonary organ, even of a considerable extent, unite 
spontaneously when abandoned to themselves, and on the 
other hand th9y bled indefinitely when irritated. In the 
state of collapse, in which the patient generally is under 
these circumstances, pleurotomy was, in his opinion, a 
very grave operation. 

Fracture of both Clavicles. 

M. Guinard related the case of a young man who, 
caught between two waggons, suffered violent lateral 
compression of the thorax. Both clavicles were fractured 
by the accident. The patient recovered very rapidly, 
but with a considerable amount of deformity. 


Jfrance. 


[from our own correspondent.] 

Paris, June 17th, 1899. 

Penetrating Wounds of the Chest. 

At the Academy of Medicine, M. Delenue spoke on the 
treatment of penetrating wounds of the cheBt. The 
greater number, he said, of pulmonary wounds produced 
by bullets, swords, or other similar instruments get well 
without difficulty. The treatment of these wounds, 
whether they be simple or complicated with heemorrhage, 
haemoptysis, haemothorax, the presence of the bullet, Ac., 
shonld be first absolute immobility and antiseptic 
occlusion of the wound, and, secondly, according to the 
nature of the symptoms observed, the employ of 
morphia, ether, caffeine, Ac. Morphia was particu¬ 
larly indicated in the form of injections in wounds 
resulting from duels. In these persons, the inward 
struggle of passion, amour prnpre offended, the efforts 
to appear cool and collected produce, along with the pain 
of the wound, a loss of nerve power which predisposed 
to fainting. It was consequently preferable to treat 
these patients on the spot, at least for the first few days, 
the shock and effort of transportation to a distance ex¬ 
posed them to ha?morrhagic accidents and notably in¬ 
creased the suffering. 

Injections of artificial serum constituted a poweiful 1 
means against the anaemia following haemorrhage on the 
condition that they were neither too rapid nor too abun¬ 
dant, as otherwise they might provoke congestion of the 
lung and increase the dyspncea. 

In severe pulmonary haemorrhage, in haemothorax, 
threatening the existence, the usual methods employed 
for arresting slight haemorrhage would scarcely be relied 
upon; direct intervention should be advised, ligature, 
suture, plugging, compression. The fear of a complete 
pneumothorax should not paralyse the action of the 
surgeon, for according as the lung was retained to the 


Incontinence of urine. 

Besides the incontinence of urine symptomatic of a 
material lesion of the urinary tract, there exists, as is 
well known, an incontinence called essential, with any 
apparent lesion or anterior affection. In certain subjects 
the bladder is particularly sensitive, and the muscular 
fibres do not permit of extension beyond a certain limit 
If it is exceeded the individual is forced to urinate. During 
the night sleep renders this sensation of the want to uri¬ 
nate still more obtuse, the child takes no notice of it, and 
wets the bed. According to Guinon incontinence of 
urine was a stigmate of nervous heredity, for in nearly 
all the cases can be found hereditary antecedents in the 
parents who had suffered from hysteria, chorea, or other 
nervous affections. The medical anti-nervous treatment 
should consequently be the principle of the therapautics. 
Bromide of potassium, valerian, belladonna, Ac., fre¬ 
quently good results are obtained by pills containing 
ergot of rye, iron, and a little belladonna. 


<§n*mang. 


[from our own correspondent.] 

Berlin. June 16th, 1899. 

At the Congress for Medicine after the subject of 
cardiac insufficiency had bten lengthily discussed that 
of the 

Early Diagnosis and Treatment of Aneurysm 
was bronght forward by Hr. Moritz Schmidt, of Frank¬ 
fort. He said the earlier aids to diagnosis rendered one 
possible with tolerable certainty, but two new aids per¬ 
mitted one with almost absolute certainty. One was the 
so-called “tugging" discovered by Oliver, Cardarelli. 
and the Rontgen rays. Tugging was a dragging down 
sensation best observed when the annular cartilage was 
slightly pushed up by the index and middle finger of the 
right hand, the patient’s head being somewhat extended 
backwards at the time. He considered the symptom 


Digitized by v^ooQle 



AUSTRIA. 


The Medical Press. 643 


June 21, 1899. 

an exceedingly important one, Cardarelli believed it 
could be felt in the case of even very small aneurysms. 
It remains to be determined whether it could only be 
felt in aneuryBms of the ascending aorta when the 
tumour was attached to the wall of the trachea. 

Positive results with the second named aid weie 
announced from all sides. The earlier known signs* 
however, still remained, dulness over the manubrium 
stemi, pulsation especially in the first aDd second inter¬ 
spaces, differences in the radial pulses, in fulness and 
time. Auscultation gave less distinct indications. 
Very often no murmur was heard, and when heard it 
might arise from pressure on the aorta by a tumour. 

The differential diagnosis was especially difficult. 
Sarcomata might cause very lively pulsation and 
aneurysm none at all. The diagnosis was most likely 
correct in individuals between 45 and 60 who presented 
the symptoms named, and who had been infected with 
syphilis. The differentiation from a diffuse dilatation 
of the descending aorta was the most difficult. 

As regarded aetiology there was the same variety of 
view as in tabes. That syphilis attacked the arterial 
walls in the form of thickening there could be no doubt. 
The commencement of the aorta was a favourite seat of 
the change. The changes in the intima • differed from 
those of arterial sclerosis in the absence or minimal 
amount of chalky deposit. There were preparations, 
however, that showed both processes. As a result of 
syphilis, probably through disease of the vasa vasorum 
a disturbance of nutrition took place in the media, with 
destruction of the elastic fibres in circumscribed spots, 
in which the cells were arranged in the form of cell 
heaps (sclero-gummatous tissue or milliary gummata) 
The loss of substance in the muscular and elastic struc¬ 
ture was replaced by connective tissue, which “ gave ” 
more readily to the stress of the blood stream. The 
intima was not suitable for successful resistance. By 
weakening of the media neither was in a position to do 
its proper duty. It was not probable that aneurysms 
arose from arterio-sclerosis alone, otherwise they would 
be found more frequently. Some investigators of the 
first rank did not believe in the tetiological influence of 
syphilis. Virchow had spoken against this influence 
last year. Straining and wounds specially favoured the 
occurrence of aneurysm in those thereto inclined, as was 
shown by the great number of men affected. Only in 
Bavaria were they more frequent in women, because 
there these did the hard work. 

He could confirm the favourable influence attributed 
to potassii iodide, especially in not too small doses, 3 to 
5 grms. pro die. An alternation with sodium and 
ammonium iodide was proper, and in the early syphilis 
it should be associated with inunction. After healing of 
the diseased part in the media the connective tissue 
underwent cicatricial contraction and the aneurysms 
became smaller. The sac did not, however, become filled 
with firm clot. The starvation treatment also assisted. 
Possibly the results of the anti-syphilitic treatment were 
due to lessened nourishment, independent of the action 
of the basic disease. By experiments on starving animals 
it was shown that diminished nourishment affected the 
blood pressure, probably by diminishing the quantity of 
the blood. The pulse became smaller, the blood itself 
became thicker, the number of red blood corpuscles in¬ 
creased, with which the increase in haemoglobin went 
hand in hand. In recent years, chloride of calcium in 


doses of 2 grms. had been given to increase the 
coagulability of the blood and the inhalation of carbonic 
acid gas. In Paris, the coagulability is said to have 
increased in two cases by injection of gelatine, 
but soon after communications appeared showing that 
the procedure wasdangerous. In one case the 
patient died suddenly of embolism. The speaker was 
strongly in favour of trying TufnelTa starvation treat¬ 
ment, it decidedly influenced the coagulability of the 
blood. The patient should not be placed suddenly on 
these diminished caloria, but one could go on fairly 
rapidly. The action of the treatment was comprehen¬ 
sible when it was borne in mind that recovery sometimes 
took place spontaneously in the course of exhausting 
diseases. For the treatment a great amount of energy 
was necessary on the part of both physician and patient* 
The quality of the fluid was best varied. A valuable 
complement of the Tufnell treatment was absolute rest 
in bed. It was best to continue the low diet and rest in 
bed at least eight weeks. Then gradual relaxation of 
strictness might be allowed. Here also the maxim was 
in force —varietas delectat. Should such a patient during 
or after treatment be attacked with catarrh, the cough 
must be kept down by opiates in larger than ordinary 
doses. The speaker had observed two patients get 
worse through attacks of cough. He looked upon 
electrolysis as the best means at present known of bring¬ 
ing about coagulation in the sac. It should not be 
employed only in the early diagnosed, still small 
aneurysms; even in the large ones it effected consider¬ 
able improvements and long-lasting recoveries. 

Hr. Hausemann, Berlin, complained that only a one¬ 
sided inquiry wa3 made how many people suffering from 
a particular disease had previously had syphilis. With 
an inverse procedure surprising results would often be 
obtained. During the last four years he had dissected 
sixty-four cases of aneurysm; in twelve there were traces 
of former syphilis. Of these twelve, however, only 
two died of their aneurysm; in the other ten the 
aneurysm was an accidental discovery, and in an early 
stage of development. On the other hand, during the 
same period 350 autopsies had been made in which there 
were indications of early syphilis. Of the syphilitic cases, 
therefore, only 3'43 per cent, developed aneurysm, and 
only 0'57 per cent, died of it. It was not pioved that 
syphilis could cause aorticaneurysm. Syphilis might 
render dilatation of a vessel possible, but he could not 
recognise syphilis as a chief cause of the disease. Potassic 
iodide influenced the coagulability of the blood, and 
cicatricial tissue formed in the blood clot. 


Jlustria. 

[from oub own correspondent.] 

Vibnna, June 17th, 18W». 

Mechanical Treatment of Heart Disease. 

At the “ Gesellschaft der Aerzte ” Herz read an ex¬ 
haustive history of the various methods that have 
appeared and disappeared for the mechanical treatment 
of heart disease, among which were Schott's, Oertel’s, 
and Zander’s. 

Unhappily for science those names had been’grouped 
in schools of a very dogmatic character that did not 
promote the progress of science, though all of,them had 
very good objects in view. The practitioner who would 

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SOUTH AFRICA. 


— .644 Thk Medical Press. 


June 21, 1899. 


right treat his case should select the good from all and 
treat it rationally from a practical point of view. All 
generally admit that the blood pressure in the systemic 
circulation is not to be reduced, but, on the other hand, 
increased if possible as measurement of arterial pressure 
in these cardiac imperfections show a reduction of the 
normal blood pressure. 

The fundamental idea in all these methods iB to stimu¬ 
late and raise this pressure by gymnastic exercise or 
definite movements, according to the whim of the par¬ 
ticular school under consideration. We find, moreover, 
that the very same movement produces very different 
effects according to the records of the individual schools 
which should not be the case if all were effectual. He 
next analysed the methods into movements of resistance, 
progression or traction, voluntary, co-ordinating, and 
passive, and concluded by remarking that the form 
adopted was not so much to be considered as the manner 
of application. 

The gymnastic treatment is not so generally applicable 
as the other forms, except in cases of fatty heart. 
Oertel’s mountain climbing might be grouped under 
the progressive treatment, and which is often accom¬ 
panied with good results. Herz has found by experi¬ 
ment that this treatment is equally beneficial in fatty 
conditions of the heart. Where there is vascular dis¬ 
turbance with enfeebled activity of the cardiac muscle, 
associated with valvular deficiency, the voluntary move¬ 
ments recommended by Schott, of Nauheim, is preferable. 
For this form of treatment Herz proposes an apparatus 
for toning the muscle and increasing the vigour of the 
central nerve system. The progressive form serves to 
calm the whole organism by presumably acting on the 
nerve system. 

In the discussion that followed Exner drew attention 
to two forms of treatment recommended by Bum and 
Herz which they have founded on the phenomena 
obtained by experiment that the influence of muscular 
labour has a marked effect on the breathing. They are 
of opinion that the dyspnoea produced by muscular effort 
is due to an irritation derived from the decomposed pro¬ 
ducts of the active muscles which act on the 
medulla oblongata. They have found by experiment 
that blood taken from animals in this dyspnceic con¬ 
dition and injected into others in a healthy state 
will produce similar dyspnoea. He thought we 
had ample evidence physiologically and physically 
in mountain climbing. The elements of muscular 
change were different on descending hills, and produced 
a form of contraction somewhat similar to an elastic 
band round the body, with a feeling of falling back¬ 
wards. Both forms of exercise have apparently dif¬ 
ferent products. In climbing hills there is weariness, 
perspiration and dyspnoea; in descending hills there is 
similar weariness, perspiration, but no dyspnoea. He 
therefore concludes that the products eliminated are 
different, and that the therapy will influence the heart 
in a different manner. 

Knoll remarked that in ascending hills the forward 
inclination of the body would affect the diaphragm dif¬ 
ferently than when descending, and probably explain the 
dyspnoea. 

Bowel Innervation. 

Pal recorded his experiments on animals in producing 
tonic contractions of the bowel after cutting the 
splarechnio nerve, and irritating the root or stump. 


These experiments were similar to injecting strychnia, 
or a suprarenal extract. The experiments were con¬ 
ducted with an india-rubber ball in the bowel, from 
which the movements were transmitted to a water mano¬ 
meter, to which is attached a revolving diaphragm 
that imparts to paper a graphic description of the 
movements. 


§euth Africa. 

[FBOM OUB OWN COBBE8PON DENT.] 


Cape Town, May 27th, 1899. 

Government and the Colonial Hospitals. 

The Premier, who, as Colonial Secretary, is minis¬ 
terial head of the department dealing with medical 
matters, has intimated to the hospitals of the colony 
that, in future, they will be subject to inspection by a 
Government officer, upon the nature of whose reports 
will largely depend the amount of Government grant. 
It may be explained that, although all the colonial 
hospitals, with the exception of that at Kingwilliams- 
town (primarily a native hospital), are now managed 
by local boards, these boards receive large Government 
grants, usually far in excess of the income derived from 
local sources. For instance, the New Somerset, at Cape 
Town, only raised last year under £3,500 from subscrip¬ 
tions and paying patients, as against £10,000 Government 
grant. The Colonial Secretary partly guards Government 
interests by having two or three nominees on each 
board, but as these are local men, the control is very lax, 
and the local Dogberries are apt, very often from sheer 
ignorance, to perpetrate extraordinary vagaries, as we 
have not yet educated that class of fairly competent lay 
administrators, so generally available in England. The 
intere-ts of the profession are generally absolutely 
ignored, except when some particular local medico is a 
power, and he then usually runs the establishment for 
his own private benefit. At one of our most 
important hospitals, that of Grahams town, an. 
attempt to place the whole control in the hands 
of one local medical man was only recently 
just defeated by a most regrettable, although necessary, 
agitation, during which the said medical man calmly 
stated that he was not going “ to show his hand to his 
neighbours” t/ allowing them to see his operations. 
Sanitation is often very bad, and the provision for the 
training and accommodation of nurses, except in two or 
three hospitals, far from what it should be. Medical 
appointments are purely a matter of local influence. 
Under these circumstances, a certain measure of Govern¬ 
ment supervision will be welcomed by the profession, 
especially if the inspection be, as it is likely, in the hands 
of the chief of the Health Department, Dr. George 
Turner, a broad-minded and thoroughly capable man, 
not afraid of speaking his mind. 


Tee Nursing Question. 

There has been a good deal of newspaper correspond¬ 
ence lately about the nursing arrangements at the New 
Somerset Hospital, where the antiquated system of 
using nurses as housemaids and scrubbers iB still in 
vogue. This institution is hopelessly behind the times, 
and most colonial aspirants for nursing prefer repairing 
to Kimberley or Port Elizabeth, both well-conducted 


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THE OPERATING THEATRES. 


The Medical Press. 645 


nursing schools, to training at Cape Town, with all its 
climatic and social avantagee. 

The controversy referred to in my last communication 
about the proposed enclosure of the catchment area on 
Table Mountain is in fair way of being arranged. A 
large deputation waited upon the City Council the other 
day, and that body showed some signs of modifying its 
original ideas in the direotion of only enclosing the reser¬ 
voir and its actual tributary streams. 

The Bubonic Plague. 

At the last meeting of the Cape Town Branch of the 
British Medical Association, Dr. Turner, the Colonial 
Medical Officer of Health, read for his assistant, Dr. 
Gregory, a paper on the case of Bubonic Plague which 
occurred in the Transvaal some three months ago, with 
illustrative specimens under the microscope. He had no 
doubt as to the diagnosis of the case, although he men¬ 
tioned that Mr. Theiler, the Transvaal Government 
Bacteriologist, a veterinary surgeon, by the way, dis¬ 
agreed with him. The course of the case, its symptoms, 
■and the microscopic appearances seemed conclusive as 
to the case having been truly one of plague. Dr. Turner 
thinks that the infection was contracted at Delagoa Bay, 
where, he believes"sporadic cases have been occurring 
for some time. He attributes the absence of an epidemic 
to the stringent precautions taken by the Portuguese 
medical authorities, who, although they deny that these 
cases are plague, treat them exactly as if they were. 

At the same meeting a committee was appointed, on 
the motion of Dr. Darley-Hartley, who has been agitating 
the matter for some time, to report as to the practica¬ 
bility of initiating some scheme of medical education in 
Cape Town. In the idea in the minds of those interested 
is to form a Post-Graduate School, badly wanted now¬ 
adays, as the task of raising money to proceed to England 
for study is getting, for most men, harder every year, 
and to provide a first year’s curriculum for the student. 

There is a recrudescence of small-pox at Johannes¬ 
burg. Twenty natives died last week, and there are at 
present in the lazaretto three whites and about 150 
Kaffirs. 

The City Council of Cape Town is erecting a very 
complete infectious diseases hospital at Green Point, 
just out of the city proper. 

The Rhodesians are making medical matters a pro¬ 
minent feature in their newly acquired self-government. 
Thanks to Dr. Hans Sauer, a member of the Council, 
the Administrator has promised assistance to the School 
of Tropical Diseases, a Contagious Diseases Bill, and a 
Bill for the Regulation of Dentistry and Pharmacy. 

The recent supplementary elections have added two 
medical members to the Cape Parliament, Dr. Smartt 
and Dr. J. H. Meiring Peck, the latter President of the 
Colonial Medical Council. We have great hopes that 
he will insist on due attention being given to medical 
legislation. The profession is now represented in the 
Assembly by the Speaker (Dr. Berry) and six other 
members. 


Formal notice has been issued of the termination 
of the official existence of the “ Board of Control of 
Irish Lunatic Asylums.” It will remain “ unwept, 
unhonoured, and unsung.” 


%kc Operating theatres. 


ST. PETER’S HOSPITAL FOR STONE. 

Urethbal Pbobtatectomt. —Mr. Swinfobd Edwards 
operated on a man, »t. about 50, who for the past ten 
years had had difficulty in emptying his bladder. At 
time of admission his residual urine amounted to 12 ozs., 
for the evacuation of which he had to pass a catheter 
two or three times a day. His urino was normal. On 
examination per rectum the prostate did not appear to 
be enlarged, but on sounding with a short beaked sound 
one could feel that the prostate was producing an 
obstruction at the neck of the bladder known as the 
condition described by Thompson as “ bar at the neck 
of the bladder.” The patient having been anaesthetised, 
Mr. Edwards introduced Gouley’s prostatome, which is 
an instrument on the principle of a lithotrite, the differ¬ 
ence being that the male blade is sharp, and when 
screwed home is received into the female blade; instead 
of crushing it would therefore punch out a piece of tissue. 
The instrument, once in the bladder, was reversed, the 
blades unlocked, and the female blade made to hug the 
back part of the prostatic bar. The male blade was now 
withdrawn for about an inch, and the sharp concealed 
pin pushed forwards to fix the piece of prostate to be 
removed. The malp blade was next slid forward until it 
engaged the obstruction. The instrument was then 
locked, and screw force applied, by which means a piece 
of the obstructing bar was removed. This manoeuvre, 
after withdrawal of the instrument, was repeated twice, 
although the repetitions were not so successful in re¬ 
moving tissue as the first one. There was not an 
excessive amount of bleeding, and the operation was com¬ 
pleted by washing out the bladder with a weak solution 
of acetate of lead. The amount of tissue removed 
in all equalled in size a small white bean. Mr. 
Edwards remarked that the only difficulty about the 
manipulation was to keep the instrument well pressed 
down on the prostate when pushing home the pin, as the 
instrument was very apt to ride up and so make it difficult 
to catch and punch out the required amount of prostatic 
tissue. He also thought that the instrument could be 
improved upon by having the male blade made a little 
longer by which means more prostatic tissue could be 
removed at one application. In describing the uses of 
this procedure he said it was now some years since he 
had employed it; he had operated in some three or 
four caseB of prostatic hypertrophy, in all of 
which the power of micturition had been improved 
for a time, the good results, however, had not been 
permanent, owing, perhaps, to the fact that the 
cases selected had not been favourable ones, in other 
words, that they were probably cases of general pro- 
static hypertrophy rather than what he considered to 
be the condition Of this case—namely, “ bar at the neck 
of the bladder.” This bar is not always easy to diagnose, 
he said, the condition having to be determined by the 
absence of marked prostatic enlargement coupled with 
the presence of symptoms pointing to prostatic obstruc¬ 
tion, which obstruction is corroborated by careful 
examination of the vesical neck with the aid of a short 
beaked sound in the bladder, and the presence of a 
finger in the rectum. 


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646 The Medical Press. 


LEADING ARTICLES. 


JPHE 21, 1899. 


Registered eob Transmission Abroad. 


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Small announcements of Practices, Assistancies, Vacancies, Books, 
8ic.—Seven lines or under, -Is. per insertion ; 6d. per line, 
beyond. 

Letters in this Department should be addressed to the Publishers. 


‘(Eh t Jflfbirai grfes anil (Eimtlar. 


SALUS POPCLI SDPREMA LEX.” 


WEDNESDAY, JUNE 21, 1899. 


THE INFLUENCE OF CLIMATE AND 
PLACE UPON SYPHILIS. 

If there is a disease whose virulence has been 
modified at different periods by climate and place, 
that disease is syphilis. The literature of the subject 
abounds in instances in which such modification is 
shown, and further there is much evidence to prove 
that in the treatment of syphilis by mercury 
better results are obtained when the climate 
is warm and dry than when it is cold and 
damp. Writing as long ago as 1787 Swediaur 
remarked that this explained why persons who 
could not be cured of “venereal disorders ” at St 
Petersburg or Stockholm became well when they 
went to Italy or Portugal. He further states, “We 
may be authorised to believe that the influence of a 
warm climate upon those infected with lues venerea 
is not inconsiderable; that it may retard the 
progress of the disease; that it may render it 
milder in some of its symptoms, and also 
that it may contribute to increase the activity 
and certainty with which the proper remedies 
operate, and thus render the patient in less danger 
of suffering from some of the sequelae which often 
prove as troublesome as the original complaint.” 
That full knowledge of the facts relating to the 
advantages to be derived from the climatic treat¬ 
ment of syphilis should have been extant* as early as 
the sixteenth century is not a little significant—and 
it is certainly not without interest to note that in the 
present day the value of such treatment is still recog¬ 
nised. The whole subject is discussed in a compre¬ 
hensive paper by Dr. Shaw-Mackenzie in the April 
number of the Journal of Balneology and Climatology. 
He reproduces from the earliest times in the history 


of syphilis the recorded observations bearing upon 
the point, and in doing so brings to light some 
curious reflections and facts illustrative of the expe¬ 
rience of our forefathers in connection therewith. 
Perhaps thequotations which he gives f rpm Fergusson’s 
works are the most interesting; of late this authority 
has received a good deal of attention from the pro¬ 
minence accorded his writings by Dr. Shaw-Mackenzie, 
and there is no doubt that Dr. Mackenzie has dis¬ 
tinctly performed a useful service to those interested 
in the subject by unearthing the views and critical 
observations of an authority like Fergusson, who had 
every opportunity of studying the disease from its 
practical aspects. The striking feature about Fer- 
gusson’s work is not only its originality but the con¬ 
viction which it conveys that his conclusions are 
nothing more than the outcome of his actual expe¬ 
rience. Fergusson was no mere desk worker—com¬ 
piling ideas at his desk, and publishing them to the 
world afterwards as actual facts. He seems to have 
set himself the task of simply placing upon record 
everything that experience had taught him about 
syphilis, and the solidity of his reasoning regarding 
facts within his knowledge shows unmistakably that 
he had no other motive to serve beyond that of re 
cording the truth. It is from this aspect that Fer¬ 
gusson’s work must be regarded as of so much value 
in the present day. In the course of his paper Dr. 
Mackenzie refers to the de novo origin of syphilis, 
but the reference is merely a casual one. Tt would be 
interesting, however, to learn from him to what 
extent such a theory can be substantiated, either 
by personal observation or recorded cases. To de¬ 
scribe a disease in these days as arising de novo, 
is apt to court opposition, inasmuch as bacteriology 
has taught us to discount statements of this kind. So 
far, it is true, bacteriology has not been able to do 
much in elucidating the fons et origo of syphilis; 
but. however this may be, while a great deal is still 
unknown regarding the syphilitic virus, the character 
•of the disease unmistakably stamps it as having a 
microbic origin. In conclusion, we cannot do better 
than refer those who are interested in the subject of 
syphilis to Dr. Shaw-Mackenzie’s interesting paper. 


THE ENGLISH LOCAL GOVERNMENT 
BOARD AS A CENTRAL AUTHORITY. 

The exact position of the Local Government Board 
as a central authority with regard to the district 
administrative bodies is one of considerable import¬ 
ance. Clearly, it must now and then happen that the 
public affairs of a district will fall into unworthy or 
incompetent hands, in which case the absolute need 
of control by a higher power will become painfully 
apparent. Hitherto the Local Government Board 
have played the part of the indulgent parent who 
has rarely stepped beyond the bonds of sparse 
and gentle chiding, however great the errors of 
his offspring. The policy of the board, in short* 
has, more or less, been of that conservative 
kind which lies at the root of every branch of 
British administrative government. Nor can it be 


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Junk 21, 1899. 


LEADING ARTICLES. 


The Medical Press. 647 


denied that the record of this Department has been of 
a brilliant and solid nature, but for all that it has 
been for a long time apparent that some alterations 
•were necessary in order to bring its work abreast of 
.the times. The chief complaint against the Board 
has been the want of 'initiative. Their machinery 
of inspection has been perfected, but the reports 
of the inspectors have been pigeon-holed, and their 
advice to local bodies in many cases has fallen on 
rocky ground. The ill-effects of this purely advisory 
system have been most apparent in the case of local 
Poor-law boards who have refused to bring up work- 
house and infirmary buildings and administration to 
proper standards, of guardians who have failed to 
administer the Vaccination Acts, and of defaulting 
sanitary authorities. Of late, however, there have 
been signs that a new era is at hand in the history 
of the hydra-headed Department at present presided 
over by Mr. Chaplin. Various local bodies have 
been sharply reprimanded and given to understand 
that passive resistance and dilatoriness will no longer 
be permitted to stand in the way of necessary action. 
This new departure was illustrated last week in the 
shape of an ultimatum sent by the Board to the 
Rollesby Guardians. The serenity of that rural 
authority was roughly shaken by an official intima¬ 
tion with regard to the provision for sick paupers to 
the following effect. “This matter has repeatedly 
been brought before the guardians, and the Board 
cannot permit of any further delay in suitable pro¬ 
vision being made for this class of inmates. The 
Board must state that unless the guardians are pre¬ 
pared to undertake to deal adequately with the 
several points mentioned in the Board’s letter of 
April 21st last, they feel it their duty, without 
further warning, to take steps as indicated in 
that letter.” This communication caused a 
good deal of surprise to its recipients, among 
whom we learn “ it was the subject of considerable 
discussion.” There is a refreshing ring about the 
tone of the letter which it is to be hoped will serve 
as an example to other boards that trust to the 
methods of dilatoriness and evasion that have hitherto 
proved efficient weapons in the hands of rebellious 
local authorities. The whole question of the relation 
of guardians to the central authority is one that 
should be definitely settled. Are the guardians 
simply the trustees or the representatives of 
the ratepayers, and as such empowered to ad¬ 
minister the Poor-law according to their own 
will and interpretation; or do they exist only 
as ramifications of a great central administra¬ 
tion P From the Norwich newspapers we gather 
that these considerations have presented themselves 
to the wisdom of the Rollesby Board as fit subjects 
for discussion at the forthcoming Poor-law Confer, 
ence to be held at Ipswich. It is to be hoped that the 
new policy of the Local Government Board fore, 
shadowed in this incident may meet with the 
success it deserves. To replace abstract advice 
by active compulsion means a reform of prime 
importance which must necessarily be carried 


out with due caution and deliberation. Take 
the case of the Medical Officers of Health, who 
are in many instances made the scapegoats of 
negligent sanitary authorities, and who have so far 
looked in vain to the Central Board for assistance. 
It seems clear enough that something should be done 
in defence of those officers, and it is equally beyond 
doubt that any such interference demands the exer¬ 
cise of the highest form of diplomacy in practical 
administration. A great step towards the perfection 
of Local Government Board administration would no 
doubt be achieved by the separation of the Poor-law 
branch from that of the Public Health. Meanwhile, 
we must be content to leave matters in the hands of 
a department that, in the midst of many dangers, 
has, on the whole, steered a course of conspicuous 
safety. 


ANTI - STREPTOCOCCIC SERUM IN THE 
TREATMENT OF PUERPERAL FEVER. 

The report of the Committee appointed by the 
American Gynaecological Society to consider the 
subject of anti-streptococcic serum in the treatment 
of puerperal fever is not very encouraging reading. 
Taking the figures from all available sources, with 
their many possible and probable fallacies, the 
results are far from reassuring, indeed it is doubtful 
whether the serum can be credited with any tangible 
effect in averting the fatal consequences of puerperal 
infection. We will not go so far as to assert that 
the use of the serum mn»t be abandoned, though 
the report affords little excuse for hope, because it is 
possible that the limited use so far made thereof may 
explain to some extent its alleged inefficacy. For in¬ 
stance, it is probable that, as a rule, it is employed only 
in very pronounced cases of streptococcic infection, at 
a stage when no human intervention can obviate the 
toxic effects of the infection. It is also suggested 
that one cause of the \8till high mortality is that 
many observers associate the employment of the 
serum with other means of treatment, notably with 
the use of the curette, which is regarded by some 
authorities as of itself a fertile source of mischief 
In this they probably do the curette a wrong. The 
curette is unquestionably a valuable means under 
certain circumstances, of preventing septic mischief 
after childbirth. Intelligently and opportunely used 
it enables the practitioner to remove from the interior 
of the uterus decomposing fragments of placenta 
and membrane which, if left therein, serve as 
nidus for the proliferation of the infecting 
organism. Once infection has taken place, its 
use can only be a matter of secondary importance. 
It is conceded on all hands that the curette is an 
instrument requiring to be used with prudence and 
care, but we cannot lend support to those who would 
rashly condemn it under all circumstances. It is the 
old question of meddlesome midwifery. It is im¬ 
perative to interfere in certain conditions, it is as 
desirable not to interfere in certain others, and the 
choice of intervention or non-intervention must lie 
with individual practitioner who is called upon to 


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648 The Medical Press. 


NOTES ON CURRENT TOPICS 


deal with the case. Reverting to the serum treat* 
ment one plausible explanation of its inefficacity is 
that there is not one streotococcus but several, and 
that the serum which is operative against one patho¬ 
genic variety is powerless against another, It this be 
so then the serum treatment of puerperal fever and 
of sepsis in general is indeed unlikely to yield any 
measure of success. Unfortunately, this is what one's 
experience of the so-called “ mixed” infections would 
ead one to expect. The value of anti-diphtheria 
serum in cases of pure diphtheria is now pretty well 
established, but its use will not prevent a fatal issue 
when the streptococcus has allied itself with the 
micrococcus. It may, however, be possible to dis¬ 
cover sera which will protect against whole 
families of bacteria, as well as against particular 
members of the families, since these have certain 
biological characteristics in common. In the mean¬ 
while, we must concentrate our attention on the pre¬ 
vention of sepsis, seeing that its cure is still beyond 
our reach. In this department much remains to be 
done, especially in the domain of private obstetric 
practice, where antiseptics have not as yet yielded a 
tithe of the benefits which they are capable of afford¬ 
ing, as evidenced by the results obtained in lying-in 
hospitals. This fact remains a standing disgrace to 
midwifery practice, and it will be interesting to 
observe, in years to come, whether the registration 
of midwives has any effect in reducing the lamentable 
and highly preventible mortality from this source. 


$aUB on torrent topics. 


A Romance of Medical Registration. 

The final scene in an interesting little professional 
drama was enacted at the recent meeting of the 
General Medical Council when the name of Mr. 
Samuel Bingham Shekleton was struck off the rolls- 
The story is amusing as well as instructive. In 1866 
a certain Edward Joseph Nugent obtained the licence 
of the Rojal College of Surgeons, Ireland. He 
emigrated from Dublin in a year or two and set up in 
practice at Woolwich. After a few years there he 
moved to Canning Town, where he traded at the 
address of a quack named Rowlands whose prac¬ 
tice it is suggested that he “covered” for several 
years. In 1895, however, he decided to migrate to 
the Colonies, where he got his name registered in 
the local Colonial Register by showing the authori¬ 
ties the entry in the British Register, and, forthwith, 
he started pi-actice. When leaving England, how¬ 
ever, he left his diplomas in charge of his wife, who, 
with or without her husband’s knowledge, rented 
them to Rowlands, the quack, for 3s. 6d. per week, 
who was thus enabled to successfully personate 
Nugent, the name of the latter still appearing 
in the Medical Register. After a couple of years, 
however, the Registrar had reason to suppose 
that Nugent waB not at Canning Town, and, 
accordingly, in conformity with Clause 14 of the 
Medical Act, he addressed a letter to him at that 


Junk 21, 1899. 

place, and, not having had a reply within six months, 
he struck the name out, as the law obliged him to do. 
This proceeding deprived Rowlands of the power of 
recovering fees or signing death certificates, and he 
was driven to take means to have the name restored. 
Meanwhile he seems to have employed a Mr. Samuel 
Bingham Shekleton, also a Licentiate of the same 
college, to “ cover ” his practice, which he did, living 
professionally in the same house in Canning Town '• 
but the arrangement does not seem to have worked 
satisfactorily, so that Rowlands made up his mind to 
the bold step of applying for re-registration aa 
Nugent. To carry this through he required to pro¬ 
duce a sworn certificate of identification as Nugent, 
and Mr. Shekleton supplied this false certificate upon 
the production of which Nugent (alias Rowlands) was 
immediately reinstated, and his name now appears in 
the Register. Probably Rowlands’s game would have 
gone on very smoothly but that he killed a parturient 
woman by the grossest malpractice and negligence, 
and, the Crown having prosecuted at the instance of 
the coroner, the whole story, which we have given, 
came out. Rowlands was sent to gaol for four years, 
and Shekleton has been struck off the rolls for 
having given the false certificate of identification. His 
defence was ingenious, if not credible— i.e., that, though 
he knew Rowlands for twenty years and worked in 
his house for the past four years he never knew his 
name, but always called him “the doctor.” When 
asked why, in that case, he swore that the man’s 
name was Nugent he could make no reply. We 
understand that the Council of the Irish College has 
followed up the action of the General Medical Council 
by calling on Shekleton to show cause why his lioence 
shall not be suspended. 


The Cancer Society. 

As we have remarked in these columns upon more 
than one occasion, a greater need exists for inquiry 
into the causes and preventive measures of canoer 
than of tuberculosis. Great as is the mortality from 
the latter disease, it is as nothing in comparison with 
the irresistible, agony-dealing ravages of the former, 
and while much regarding the etiology and channels 
of tuberculous infection is known, our information in 
the same regard concerning cancer is sadly meagre. 
We are glad, therefore, to note that some effort is 
now being made to draw public attention to the 
neoeessity of taking active steps towards remedying 
this deplorable state of affairs. Under the presidency 
of Sir Charles Cameron, Bart., M.D., M.P., a 
Cancer Society was formed last week at a meet¬ 
ing held at the St. Martin’s Town Hall. 
The objects of the society are the improvement of 
technical medical education ; popular instruction in 
elementary health laws bearing upon the prevention 
and cure of cancerous disease; the foundation of a 
special laboratory for cancer research; and, last but 
not least, the promotion of a Parliamentary inquiry. 
This latter point is one upon the urgency of which 
we have insisted for some time. There can be no 
doubt that much valuable information would be 

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NOTES ON CURRENT TOPICS. 


forthcoming were a Royal Commission to be ap¬ 
pointed to inquire into the whole subject of cancer. 
A committee of investigation might be appointed, 
with instructions to visit European and other 
countries in which cancer is most prevalent, 
with a view to gleaning facts in regard 
to the cause of its dissemination. It is in 
the highest degree a reprehensible policy to do 
nothing in this important matter; the Government 
must be stirred up |to see the necessity of taking 
action. In a few years more there is every prospect 
of the mortality from cancer exceeding that of any 
other disease. Tel, despite its virulence, the disease 
is allowed to pursue its evil way without any official 
encouragement being offered to advance our know¬ 
ledge of its etiology. We trust that the Cancer 
Society will prosper inasmuch as its objects are most 
praiseworthy and deserving of general support. 


Sweating the Medical Profession. 

A writer to the Newcastle Daily Chronicle last 
week addressed some pithy and caustic remarks to 
the readers of that journal. Under the nom de plume 
of “ M R.C.S.” he alluded to the triumphant 
announcement recently made by the Dean of St. 
Paul's, at a meeting of the Metropolitan Provident 
Medical Association, to the effect that considerably 
over 30,000 members had contributed £5,300 a year. 
Taken at the figures mentioned, each individual has 
paid four-fifths of a penny per week for medical 
attendance and medicine. Well may “M.R.C.S.” 
ask if that is thrift. “ Is it not,” he adds, “ rather 
sweating—sweating the medical profession P Is it 
even good policy? In the long run it is the 
sweater that suffers. The sweated one, to live 
at all, is obliged to scamp his work, and 
to use the poorest and cheapest of materials.” Some 
day it is possible that both philanthropists and the 
recipients of cheap or gratuitous medical sendees will 
see matters in their true light. A snap-shot diagnosis 
and a bottle of physic prescribed after a three 
minutes’ consultation may suffice to stay the fierce 
desire of the professional philanthropist to minister 
to the medical wants of the poor, but it certainly does 
scant service to the latter, and spells ruin to many a 
struggling general practitioner. We wonder how the 
churchman who congratulated the Metropolitan 
Association would tolerate an arrangement that 
placed a number of his own cloth day and night at 
the beck and call of thirty thousand poor parishioners 
at the rate of less than a penny a week. Why should 
not philanthropists provide the poor with cheap law 
and divinity in their own homes ? or must we regard 
medicine as the only permanent charitable necessity 
for our working population ? 

Phthisis and Alcohol. 

The more diseases to which human flesh is heir 
whose origin can be traced to alcohol, the stronger 
becomes the case of the advocates of the temperance 
cause. A French observer, for example, has just 
been investigating the connection between alcohol 


The Medical Pbess. 649 

and phthisis, and in the case of seventeen phthisical 
patients he ascertained that no fewer than sixteen 
had been at some time great drinkers. All of them 
drank brandy or rum, and absinthe. There is now 
the opportunity for some one to make similar in¬ 
quiries into the subject in this country. It would be 
interesting to learn how far English statistics would 
compare with those obtained in France. The condi¬ 
tions, however, would scarcely be identical, for 
absinthe drinking is practically unknown in Eng¬ 
land, while the French people are less addicted to 
drunkenness from beer than is the case in this 
country. 

Mr. Kipling’s Health. 

It is nothing more than natural that Mr. Kipling 
should still feel the effects of the terrible illness 
through which he passed some months ago. It is 
probable, indeed, that many more months will have 
to elapse before he will regain that measure of health 
to which he was accustomed before his almost fatal 
illness seized him. In order to further recruit, how¬ 
ever, he will sail this week from New York for England, 
with a view to passing the summer at his home near 
Rottingdean. All Mr. Kipling’s admirers will wish 
him that restoration to health which he hopes to 
attain, without which, doubtless, it will not be pos¬ 
sible for him to continue his literary work. A per¬ 
sonality so interesting to the world as Mr. Kipling’s 
has become makes it rather a notable fact that he 
should have determined to place himself within the 
clutches of our much-abused climate, even in summer, 
while in the pursuit of health. We can only trust 
however, that he will have no cause to complain of 
the “ samples ” which the clerk of the weather will 
provide for him. 


Mouth Breathing and Cycling. 

A not inconsiderable proportion of people are 
victims of a degree of nasal obstruction sufficient to 
render it necessary to use the mouth more or less for 
breathing purposes. In an even larger proportion 
the obstruction allows of sufficient air being inhaled 
during comparative repose, but muscular exertion, or 
emotion, obliges them to supplement nasal respira¬ 
tion by opening the mouth. If one takes the trouble 
to look at the cyclists who pass, from this point of 
view, some surprise will be caused by the very small 
number among them who can ride at from seven to 
ten miles an hour without breathing through the 
mouth. This relative obstruction is a serious thing, 
because it deprives the cyclist of a great safeguard 
just when circumstances render the safeguard more 
than ever desirable. Whether in the crowded 
thoroughfares of large towns or in the wind-whipped 
roads and lanes of the country, dust is always pre¬ 
sent, usually in very uncomfortable quantities. 
It “ blisters ” the eyes, irritates the delicate mucous 
membrane of the nose, and, if inhaled as the result of 
breathing through the mouth, a tangible quantity 
must inevitably find its way into the bronchi, and 
even into the finer ramifications of the pulmonary air 
passages. The inability to carry on respiration 


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June 21, 1899. 


NOTES ON CURRENT TOPICS. 


650 The Medical Press. 

through the nose should be regarded as a positive 
disqualification for cycle riding, for there can be no 
doubt of the injurious results of inhaling the flinty 
and often microbe-laden dust which the cyclist has to 
meet, unless, indeed, mouth breathers would consent 
to weai* resphators. It must be admitted that a 
respirator, however artistically constructed, can 
never be made a thing of beauty, but it would match 
very well the goggles which many cyclists wisely 
wear when touring, and after all, immunity from 
pulmonary disease would be cheaply purchased at the 
price of sacrificing the modicum of beauty to which 
a begoggled and travel-stained cyclist can lay claim. 

The Transplantation of the Human Ovary. 

In a recent number of the New York Medical News 
a case is reported in which a woman, tet. 39, suffer¬ 
ing from the effects of an artificially-induced meno¬ 
pause in a severe form, was greatly relieved and 
menstruation re-established, by the introduction 
through the vagina into the peritoneal cavity, of a 
healthy ovary removed from a young woman who had 
no further use for the same. Not only did the 
menstrual flow reassert itself but sexual desire was 
re-established, at least so the patient stated. We are . 
unable to imitate our contemporary, the Medical j 
Record, in commenting seriously upon the case, nor 
can we commend the operation for imitation. To 
leave a little bit of healthy ovarian tissue, when 
this is possible, is doubtless a good instance of , 
conservative surgery, but to insinuate a whole ovary, 
belonging 1 to another woman, into the peritoneal, 
cavity is hardly a procedure which commends 
itself to one’s surgical instincts, and is likely 
to set up serious mischief. The operation, indeed, 
may be placed on a par with another recently 
recorded surgical feat, that of removal of the entire 
stomach. It may be brilliant surgery, but from a 
therapeutical point of view of doubtful value. 


Pinchbeck Titles. 

There seems to be a swelling craze nowadays for 
the possession of some qualification or other which 
will enable the owner to print some letters at the end 
of his name. We do not speak of the official degrees 
and diplomas which allow a man to style himself 
M.D., or M.A., or L.S.A., or D.C.L., and so on. Nor, 
again, do we mean certain honorary distinctions 
such as the F.R.S., of which any man may be justly 
proud. So, too, may a distinguished traveller or 
explorer be justified in adding F.R.G.S. to his cogno¬ 
men, but the distinction loses its significance when we 
see it appended to some obscure Smith or Brown, who 
has never been outside his native country, and whose 
knowledge of geographical science is of the scantiest. 
As a matter of fact, his right to the magic letters is 
bought by his entrance fee and subscription to a 
learned society, just as sure as the F.Z.S., F.R.H.S., 
F.R.Z.S., and others are often obtained. It is not 
the use of these descriptive titles, but the abuse of 
them which we criticise. The inherent snobbery 
of mankind is nowhere more painfully apparent than 


in the flourishing trade’ that has been carried on of 
late years by big sham learned societies that confer 
the privilege of a string of letters upon their mem¬ 
bers. Even Christian Science, latest of medical 
quackeries, is in the field with C.S., which reminds 
one in some way of the unqualified practitioner who 
signed himself M.S., and excused himself on the 
ground that he was a medical student. Clearly, any 
self-respecting, learned society should discourage the 
use of unrecognised or pinchbeck titles by its 
members. 


Small-pox in London. 

The first death from small-pox in the whole of 
London has just been announced by the Registrar- 
General. It occurred on the hospital ship Castalia, 
and the unfortunate victim was a man of 32, who had 
been removed from the West-end. Deceased had 
been vaccinated, a fact which may afford some satis¬ 
faction to the anti-vaccinationist party, who are not 
apt to hesitate over such trifles as the fallacy of small 
numbers. A hard nut for them to crack, however, 
will be the decrease of a malady that formerly was as 
rife as measles to a point apprc aching zero. Last 
year there was only one death in the Metropolis 
from this loathsome disease, and during the 
firat six months of the present year there 
has been one more. Look upon this picture 
and upon that. That isolation and improved methods 
of treatment and better standards of life have had a 
good deal of influence upon the result, few medical 
men will be inclined to doubt. On the other hand, 
the vast majority of the profession will assuredly 
attribute the lion’s share of the glory to vaccination. 
Other communicable diseases, such as scarlet fever 
and typhoid fever, although submitted to similar pre¬ 
ventive conditions, have not decreased in anything 
like the same ratio as small-pox. Let us ask this 
question of the anti-vaccinationists. If improved 
environment account for the decrease of small-pox, 
why has it not similarly scotched the plagues of 
scarlatina, summer diarrhoea, and enteric fever, to 
which the bettering of external conditions has been 
equally applied ? 


The Election at the College of Surgeons, 
England. 

The candidates who have come forward for re- ejec¬ 
tion and election to the Council at the Royal College 
of Surgeons, England, consist of Mi*. Jessop, of 
Leeds, Dr. Ward Cousins, of SouthBea, President¬ 
elect of the British Medical Association, Mr. 
Herbert Page, of St. Mary’s Hospital, Padding* 
ton, and Mr. Jordan Lloyd, of Birmingham. 
Of the two latter Mr. Page has on two or three 
occasions unsuccessfully sought the suffrages 
of the Fellows, while Mr. Lloyd makes a plunge 
for the distinction for the first time. A notable 
feature of the election is that three provincial 
Fellows will compete for two vacancies. Their col¬ 
leagues, therefore, will have ample opportunity of 
supporting the provincial representation. 


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June 21, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press. 651 


A Post-Graduate Course of Balneology. 

Medical men who are just now occupying their 
thoughts with the disposal of their approaching holi¬ 
days. may be glad to know of an annual excursion 
which combines the pursuit of pleasure with the 
acquisition of useful knowledge. For some years 
past a scheme has been carried into execution for 
the purpose of enabling French practitioners to 
become personally acquainted with the principal 
French watering-places and health resorts. Early in 
September a rendezvous is given to those who have 
taken the precaution to inscribe their names before¬ 
hand at some town, conveniently situated in view of 
the programme, and thence the members are con¬ 
ducted under the guidance of a selected medical 
authority to the best known resorts. This year the 
excursion, which is open to all qualified practitioners 
irrespective of nationality, is to be under the 
guidance of Professor Landouzy, who will in¬ 
augurate the tournee at Montlu^on on September 
2nd. Members will be taken among other places, 
to La Bourboule, Mont Dore, Vichy, and St. 
Honore, winding up at the end of an eleven days 
circular trip by a visit to Pougues. Special arrange¬ 
ments are made for the transport and reception of 
the visitors, who are conducted franco for p sum not 
exceeding £8 (200 francs), which includes all expenses 
from the point de depart to Pougues. This affords 
an unequalled opportunity of visiting the most pic¬ 
turesque and interesting parts of France ; and us 
members are allowed to bring along their lady rela¬ 
tives, if so minded, nothing is lacking to make up a 
very enjoyable trip. Adhesions are received up to 
August 15th by Dr. Carron de la Carridre, 2, Rue 
Lincoln, Paris, who will be pleased to give all in¬ 
formation concerning the excursion. 

The Eradication of Tuberculosis. 

We publish elsewhere a paper on the subject now 
very much d la mode, viz., the eradication of tubercu¬ 
losis. Though it is but quite recently that the 
possibility of circumventing this disease has been 
taken into serious consideration, the practicability, 
by concerted measures, of eradicating it from our 
midst, is one which the author of that paper has 
for many years been an ardent advocate, and this too 
at a time when it was regarded as a sort of wild-cat 
scheme unworthy of attention. It must be some 
satisfaction to Dr. Fleming to see his pet scheme 
gradually coming to the front with a less remote 
prospect of a co-ordinated attempt being made to 
carry it into effect. The eradication of the disease 
is really a far more important subject than its 
curative treatment, for the latter deals with indivi¬ 
duals while the other concerns countless thousands 
of possible victims. It will be some time yet before 
public opinion has been sufficiently educated to over¬ 
ride vested interests and to make the necessary 
sacrifices of time and money. We possess to a great 
extent the required knowledge, but nothing can be 
done on any considerable 3cale without the hearty 
sanction and support of pub’ic opinion, and Dr. 


Fleming may claim a share of the credit due to those 
who have pereistently striven to spread a knowledge 
of the factors with which we have to deal. 


The Physiological Effects of Castration in 
the Male and Female. 

A great deal of speculation has found expression 
in contributions to the study of the physiological 
effects of castration in the male and female, but, in 
truth, it is fundamentally erroneous to treat the two 
operations as if they had anything in common. The 
ovary is not a gland like the testis, and it is hardly 
likely therefore that the former possesses any internal 
secretion akin to that which is held to be furnished 
by the testis. The loss of this internal secretion in 
the male is credited with the production of more, or 
less marked depression, which not unfrequently 
culminates in melancholia. In the female, on the 
other hand, the functions of the ovaries which call 
for removal have generally long since fallen into abey¬ 
ance so that the ablation of functionally inactive organs 
is not likely to entail any corresponding constitutional 
disturbance. With regard to the sexual appetite, its 
preservation or otherwise must greatly depend upon 
circumstances. The loss of the ovaries in an unmar¬ 
ried female usually leaves the sexual appetite un¬ 
developed, whereas in a married woman the nervous 
system has received previous impressions which may 
keep awake and prolong the period of sexual activity. 
The same thing holds good in maleB. If the testicles 
are removed before puberty no sexual appetite is 
developed, but if what we muy call the sexual habit 
has been formed the nervous system reacts to certain 
stimuli as a matter of routine even though the 
original essential stimulus is wanting. After all, 
these are details of no practical importance, because 
the conditions which call for castration on the one 
hand and removal of the ovaries on the other are 
always such as to render the question of sexual 
appetite a point of more than secondary importance' 


A Lady Resident Medical Superintendent 
of a Lunatic Asylum. 

A new departure in asylum administration was 
initiated last week at a meeting of the Governors of 
the Armagh District Asylum, when four applications 
were received for the position of assistant medical 
superintendent. Only two of these personally 
attended, namely, Dr. Thompson, Oookstown, and a 
lady, Dr. Dora Allman. The latter, on being ques¬ 
tioned by the members of the board, said she had 
been an assistant in the Mullingar Asylum for over 
four years, where the number of patients exceeded 
800. After heating the testimonials, the board de¬ 
cided to appoint the lady applicant for three months, 
and if found satisfactory at the end of that period to 
make her appointment permanent. 

The honour of “ special promotion ” has been 
gazetted of O. W. Andrews, M.B., and W. J. Maillard 
Y.C., M.D., to the rank of Staff-Surgeon in her 
Majesty'8 Fleet. 


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652 Thb Medical Press 


SCOTLAND. 


June 21, 1899. 


Munificent Bequests to Dublin Charities. 

The three executors—Sir William Findlater, Mr. 
J. Merry, and Mr. Robert Bell—to whom the late 
Mr. James Weir confided the charitable disposition 
of his large fortune, have made their award, with the 
result that thirty-four of the Dublin charities divide 
among them £'100.800. Ten of these were not 
strictly medical institutions, and before any portion 
of the bequest could be awarded to them it became 
necessary to apply to the Court of Chancery to define 
the word “ hospital ” in the will. Already ten of the 
institutions benefited have received £1,000 each, but 
as £90,800 still remains in hand it is probable that 
these grants will be supplemented. We may epito¬ 
mise the list by saying that it includes—(1) Twelve 
of the recognised Clinical Hospitals of the City: 
(2) the three Maternity Hospitals; (3) the Victoria 
Eye and Ear Hospital; (4) Cork Street Fever Hos¬ 
pital ; (5) the two Children’s Hospitals; (6) the two 
Convalescent Homes; (7) the Hospital for Incurables 
and twelve other miscellaneous institutions. The 
total sum left by Mr. Weir at his death was £200,800 
of which £100,000 went to his relatives. He began 
life sixty-five years ago as assistant in a grocer’s 
shop, afterwards became the proprietor of one of the 
best known public houses in Ireland, and died at the 
patriarchal age of ninety-two. 

The Baby Incubator Again! 

In commenting some weeks since on the death of 
a baby in an incubator on show at the Crystal Palace, 
we expressed our surprise that any respectable board 
of managers should admit an exhibit which is so 
manifestly unsuited for public inspection. To our 
surprise we find that a similar show is open to the 
public at the Greater Britain Exhibition, at Earl’s 
Court, where, alongside of Savage South Africa, 
and various panoramas and other attractions is an 
exhibit of a certain incubator in which weak and 
prematurely-born babes are stated to be incubated 
under the superintendence of a competent staff of 
trained nurses and medical officers, ready to explain 
and demonstrate the use of this “ marvellous 
scientific and humanitarian novelty.” The exhibit 
can at most have a mccit de curiosity with the public 
for baby incubators are never likely to become a 
stock article of household furniture, indeed, their 
value is altogether questionable. 


Coming Congresses. 

The season for the foregathering of scientists is 
about to arrive. The first on the list is, we believe, 
the “ International Otologioal Congress," which 
meets in London under the presidency of Dr. Urban 
Pritchard from August 8th to 12th. The “ British 
Association for the Advancement of Science ” 
will meet at Dover in September under the 
presidency of Sir Michael Foster. The “British 
Medical Association ” will assemble at Ports¬ 
mouth from the 1st to the 4th of August 
under the presidency of Sir Grainger Stewart. 

Royal Institute of Public Health ” will be held in 


Blackpool from September 21st to September 26th, 
under the presidency of the Marquis of Lome. 
Lastly, *• the Sanitary Institute ” will hold its 
eighteenth congress at Southampton from August 
29th to September 2nd, under the presidency of Sir 
W. H. Preece, K.C.B, 


Jfcothntl). 

[from our own correspondent.] 


Professor Schafer of Edinburqh University.— 
The University of Edinburgh has robbed Cambridge of 
her Jodrell Professor of Physiology, in the person of 
Edward Albert Schafer, M.R.C.S. Eng., LL.D. Aber., 
F R.S. On Friday last, after a long period of excogita¬ 
tion on their part, the Curators of the University, in 
whose hands the power of election lay, proceeded to act 
on the opinions as to the merits of tne various candi¬ 
dates which they had arrived at as the result of their 
meditations, electing Professor Schafer to the Chair of 
the Institutes of Medicine, bo long and ably filled by the 
late William Rutherford. 

The public notices of the appointment state that it was 
the result of an unanimous vote, but that, of course, but 
applies to the final stage in the proceedings, and we 
believe that it was really a very narrow majority which 
had previously determined what the final result was to be. 
Edinburgh University has got a new recruit with a very 
high reputation to live up to and maintain. The methods 
of teaching and the management of large numbers of 
students in one class are somewhat different in the North 
than South of the Tweed, but there is every prospect of 
Edinburgh’s new professor adding more lustre to the Auld 
Toun’s College than it has even at present, of the students 
of medicine acquiring a sound knowledge of physiological 
laws and processes, and nf an important audition being 
made to the tale of work, already of by no means an incon¬ 
siderable magnitude and value, achieved by the Edin¬ 
burgh School. 

Election Tactics. —A matter which has interested 
many and which is connected with the recent contest for 
the Chair of Physiology in Edinburgh University, relates 
to the propriety of candidates allowing, that is the 
mildest term applicable, or if previously completely 
ignorant of what was proposed to be done of their pub¬ 
licly dissociating themselves from it, the publication in 
lay papers, or journals devoted to science apart from 
medicine of partisan puffs in which one candidate is 
described to be all that is good, his name being 
given, the other candidates by inference from 
tiie absence of individual notioe and names 
being far beneath his level. But such para¬ 
graphs are still more reprehensible when the 
favoured candidate is credited with knowledge of and 
experience in subjects connected with the duties of the 
poet he is contesting, of which all the other candidates 
are said to be ignorant, because, forsooth, the writer 
happens to know that this is the case in one instance, 
ana not having heard concludes that it is absent in the 
rest. It is hardly possible to believe that such commu¬ 
nications can appear with the oonaent and approval of a 
candidate, and it is almost more surprising that editors 
of non-medical papers should admit questionable puffs of 
the kind through which the opinion of the publio is 
directed towards one man, the reluctanoe and proper 
feelings of the others preventing them from exposing 
the one-sided, and by omissions, scarcely accurate state¬ 
ments made. 

Appointment of Mr. Leith to Mason’s Collbob.— 
We understand that Mr. R. F. C. Leith, M.B., C.M., 
M.A., B.Sc., F.R.C.P.Ed., one of the Assistant Physi¬ 
cians at the Edinburgh Royal Infirmary, Lecturer on 
Pathology in the Extra-mural Medical School, and until 
lately one of the Pathologists to the infirmary, baa been 
appointed to a Pathological Chair in Mason’s University 
College, Birmingham. Mr. Leith’s career when a student 
was of the most brilliant character, obtaining first-class 


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J uni 21, 1899. 


LITERATURE. 


The Medical Pbebs. 653 


honours, and more than one valuable scholarship. He 
has published a large number of papers upon pathologi¬ 
cal subjects, chiefly in connection with his post as 
pathologist to the Edinburgh Infirmary; a volume 
entitled “Outlines of Lectures on General Pathology,” 
and has contributed articles to the system of medicine 
edited by Dr. Clifford Allbutt. His appointment will occa¬ 
sion a fresh vacancy in the ranks of the assistant 
physicians of the infirmary, the third within the last two 
years. 

-*- 

^tarahestcr 


fFROM OUR OWN CORRESPONDENT.] 


Th* Futubk of thk Royal Infibmaby.— A further 
stage has been reached in the negotiations respecting 
the reconstitution of the Royal Infirmary. At a confer¬ 
ence recently held between representatives of the 
Manchester Corporation and the Royal Infirmary, with 
regard to the proposed purchase of the Infirmary site 
the Lord Mayor intimated what the City Fathers would 
probably be prepared to pay to the hospital trustees. It 
is suggested that £400,000 should be taken as the valua¬ 
tion of the present site; the Corporation to pay 
£260,000, start a fund for £100,000, to be called 
the Manchester Infirmary Out - Patients' Accident 
Endowment Fund, paying half in twenty annual pay¬ 
ments of £2,600, the other half to be raised by public 
subscription; and provide the town centre with premises 
not to exceed £60,000. The Corporation also strongly urge 
that the new infirmary be built on the Stanley Grove 
estate, which was given to Owens College for hospital 
purposes. It is said that if this scheme is accepted, the 
infirmary trustees would he able to have perfect hospital 
accommodation provided without trenching upon their 
capital of £376,000. 

Hospital Appointments. — Numerous changes are 
taking place in the constitution of several of the hospital 
staffs. The appointment of assistant physician and 
ophtbalmio surgeon to the Royal Infirmary is to be 
made in a few days; Dr. Eugene Young has been elected 
to the poet rendered vacant at the Consumptive Hos¬ 
pital by Dr. Milligan’s resignation; Mr. Montgomery 
succeeds Mr. Joseph Collier as the visiting surgeon to 
the Union Hospital at Crumpsall; and Mr. J. W. Smith 
has been elected visiting surgeon to the workhouse 
infirmary at Withington. Further alterations are ex¬ 
pected before long. 

Tubbrculosib. —Manchester has long occupied a 
pioneer position in relation to the prevention of tuber¬ 
culosis. Attempts have recently been made to arrange 
for notification of cases. It is said that there are a 
thousand deaths a year from phthisis in the city, 
and that at present there are three or four 
thousand cases. It has been proposed that a 
medical man shall be appointed as a special in¬ 
spector for this class of case, at an annual stipend of 
£200. Much opposition was raised in the City Council. 
The Sanitary Committee have been directed to recon¬ 
sider the whole matter. It is evident that educational 
measures will be preferable to coercion, if general sup¬ 
port is to be secured in effectually dealing with tuber¬ 
culosis in human subjects. Enthusiasts are apt to delay 
progress through their over-zeal and lack or tact and 
patienoe. 

Tropical Diskabbs. —Manchester, situated on the 
Ship Canal, considers herself a port of no little import¬ 
ance, and in many ways is in direct communication 
with tropical countries. There is every reason, 
therefore, that the lectures now being given by 
Dr. Graham Steell, at the Owens College, on 
tropical diseases, should act as the first effort 
to establish a fully equipped department for the 
teaching and investigation of this important branch of 
] athology. 

Victoria Untvbbsitt. —The following Owens men 
have had their theses iefcepted for the degree of M.D.:— 
C. A. Davies, C. R. Marshall, T. A. RothweU, Peter 


Thompson, and J. D. Windle. Professor Marshall and 
Mr. Thompson have been awarded gold medals, and Mr. 
Rothwell has received the mark of commendation. 


^teature. 


BARBOUR’S ANATOMY OF LABOUR, (o) 

A second edition of this important and classical work 
has been rendered necessary by the number of fresh obser¬ 
vations made since the first edition was published in 
1889. The interest taken in this form of research is 
strikingly shown by the fact that up to 1879 three cases 
only had been reported ; in the following ten years 
reports of ten frozen sections were published, the author 
being responsible for three ; whilst in the ten years that 
have elapsed since the publication of the first edition of 
this work there have been twenty-five cases reported. 
The contribution of the Edinburgh School to this 
result has been considerable; Barbour has examined 
two cases, Barbour and Webster two, and Webster 
four; while Lusk’s case, which comes from New York, 
may be credited to the same school, inasmuch as he had 
the personal advice and assistance in his work of Clarence 
Webster. As might be expected in a record of facts 
as distinguished from theories, the present edition has 
involved practically no correction of the matter of the 
first; but new facts have been gleaned by the recent 
work. Accordingly, the author has left the old matter 
untouched, and has simply added a chapter (chapter 
VII.) of fifty-six pages describing the last twenty-five 
sections; and in the same way he has made an addendum 
of fifty-four pages to Part II., comprising the literature 
of the subject. In its way this Part II. is almost as 
monumental a piece of industry as the description of the 
frozen section itself It is not simply a bibliography, 
but consists of abstracts of contributions to the subject, 
made in the first instance for the author’s own use. No 
fewer than sixty-six contributions are thus abstracted, 
and this part of the work must be regarded as indis¬ 
pensable to anyone working on similar lines. 

The " Anatomy of Labour ” is not a work that appeals 
solely to the anatomist or to the scientific obstetncian; 
it sheds important light on the actual praotice of 
obstetrics, as will be sufficiently evident from the follow¬ 
ing summary of some of the new facts learned regarding 
the second stage of labour. “ The shortening of the antero¬ 
posterior diameter of the bony pelvis by the soft parts 
is for the conjugate, at the brim half an inch, in the 
cavity three-quarters of an inch, at the outlet seven- 
eighths of an inch ; and for the oblique diameter, at the - 
brim almost one inch, and in the cavity still more, due 
to the projection of the obturator internus. The peri¬ 
toneum is, during the seoond stage, lifted out of the 
pelvis anteriorly and somewhat elevated posteriorly . 

. . . The lower portion of the anterior uterine 
wall is thinner than the rest before labour begins; this 
thinning is increased during labour. A corresponding 
thin part develops posteriorly. There is, therefore, in 
normal labour (that is, with no pathological resistance) 
a separation of the uterine wall into two parts at the 
retraction ring. While the anterior vaginal wall retains, 
during labour, its usual length and thickness (2 ins.) the 
posterior stretches to more than twice its former length 
(measuring 7 ins.), and becomes very thin. The flexion 
of the head becomes, during labour, less pronounced than 
it was during pregnancy. Rotation of the head takes 
place before that of the shoulders, and is therefore inde¬ 
pendent of it. The placenta does not become separated, 
as a result of the diminution of its site during the second 
stage. The membranes beoome separated, during the 
second stage, up to the retraction ring, but not above it." 
The author never loses sight of the bearing of science on 
practice ; and, accordingly, we find paragraphs dealing 
in a suggestive way with the question of the manage¬ 
ment of labour, both in the seoond and in the third 
stage. As space will not allow more quotations, we must 


(a) “ The Anatomy of Labour u Studied in Frozen Sections.” 
87 A. B. F. Barbour, M.A., B. 8 c., M.D., Ac., Assistant Physician 
for Diseases of Women to the Royal Infirmary, Edinburgh. Edin¬ 
burgh : W. A A. K. Johnston. 1868. Second Edition. £62 pp. 6 s. 


Digitized 


by VjOOglC 


LITERATURE. 


Junk 21, 1899. 


654 The Medical Pbess. 

refer the reader to the book itself. All the illustrations 
are good, and many of them must be described as excel¬ 
lent. We would gladly see the work in the hands, not 
only of the specialist and the teacher, but also of the 
student and the general practitioner. The plea that 
sound scientific knowledge makes good and successful 
practice needs no advocate at the present day. 


DAWSON WILLIAMS ON DISEASES OF 
CHILDREN, (a) 

This book affords a thoroughly sound suivey of the 
important branch of medical work with which it is con¬ 
cerned. In no instance is necessary detail sacrificed to 
conciseness, while at the same time the more general 
groundwork is given its proper place. For instance, the 
statistics of tuberculosis, a subject of supreme interest 
as regards children, are discussed fully enough to bring 
out the chief facts as to age incidence. The author’s 
table shows that “ the extreme liability to tuborculosis 
during the first two years of life, and, since children 
under six months are very little subject to the disease, 
it indicates a rapid increase during the second six 
months of life." The clear practical description 
of tuberculosis which follows serves to emphasise 
the hopeless nature of the prognosis when once 
the diagnosis is established. The enormous number 
of infantile deaths due to tuberculosis warrants the 
physician in devoting the most painstaking labour to the 
investigation of the subject, and this is what the author 
has done. It is not his part to enter into the field of 
prevention, wherein lies the hope of future generations. , 
Dr. Williams avails himself freely of illustrations to 
portray types of disease. The frontispiece, for instance, 
shows the characteristic attitude of a baby suffering 
from posterior basal meningitis. We venture to suimise 
thatafew minutes stuuy of thatplate would convey to the 
mind of the practitioner a picture that would be indelible. 
Not only that, but he would also carry away with him the 
lesson as to the rallying power of infants labouring 
under that distressing dieease after reading the note 
that “the patient recovered sufficiently to leave the 
hospital.” There is an excellent X-ray photograph of 
the curving of the bones of the leg in rickets, and in 
future editions we shall doubtless be favoured with 
further Rontgen illustrations, which are specially avail¬ 
able in the case of children. This volume may be 
recommended alike to the general practitioner and to 
those who are specially interested in the study of 
pediatrics. 


JESSOP ON DISEASES OF THE EYE. (b) 

The tasteful colour of the binding of this book—by 
which the volume would add lustre to a drawing-room 
table—to say nothing of its convenient size, excellent 
print, and general “ get up ” prepossess us in its favour, 
even before proceeding to peruse its contents, and causes 
us almost to forget that it forms another contribution to 
the already over loaded list, as we think, of text-books 
upon ophthalmic surgery. With its raison d’etre, how¬ 
ever we have nothing to do ; that is a matter 
which concerns the author and publisher. So far as the 
former is concerned, he says in the preface that, in 
writing the manual, his “ endeavour has been to make it 
systematic, practical, concise, and at the same time 
comprehensive,” and on perusing his pages we are glad 
to admit that he has thoroughly succeeded in his task: 
The practical nature of the work is eminently shown by 
the first three chapters being entirely devoted to the 
methods of examining the eye, in which is given pre-> 
cisely the kind of information of which a student is 
most in need when beginning the subject of ophthal¬ 
mology. Again, instead of entering largely upon the 

(a) "Medical Disease# of Infancy and Childhood." Dawson 
Williams, M.D., Physician to East London Hospital for Children, 
4c. Cassell and Co., London and New York. 1898. 

({•) •' Manual of Ophthalmic Surgery and Medicine. ' By Walter 
H.H Jesse®, M.A., M. B.Cantab , F.B.C.B.Eng , Ophthalmic Sur¬ 
geon to, and Lecturer on Ophthalmic Medicine, and Surgery at, St. 
Bartholomew’s Hospital: Consulting Ophthalmic Surgeon to the 
Paddington Oreen Children's Hospital. London: J. and L 
Churchill. 1898. 


description of the anatomy of the eye, a thort and ueeful 
account of the anatomy of the various structures of the 
organ heads the chapters in which the subject of their 
diseases is discussed. This arrangement has much to 
commend it, and is a vast improvement upon the older 
method of dealing at great length with the anatomy and 
physiology of the eye in two or more exhaustive chapters 
So far as the practical part of the volume is concerned 
the chapters are obviously largely compiled from the 
author’s own experience, and the views expressed, espe¬ 
cially as to treatment, are clearly a reflex thereof. We do 
not at all times agree with the author—differences of 
opinion mnst always exist in matters of practice—never- 
thel* ss, we have no hesitation in saying that be has pro¬ 
duced a sound and practical guide to the subject of 
ophthalmology. For the most pert the illustrations are 
good, and the same msy be said of the few coloured 
plates representing certain normal and patho’ogical con¬ 
ditions of the fundus. It is curious, however, to note 
the absence of the central light streak on the retinal 
veins in the coloured plates. A useful chapter is 
added descriptive of eye symptoms and diseases in 
eneral diseases, and in an appendix such matters are 
iscussedas formula?, general rules for operating, lenses, 
spectacles, &c., and the regulations for vision testing of 
candidates for the Government services. Altogether we 
can cordially recommend this hook to the student and 
practitioner. 


LUFF’S PATHOLOGY AND TREATMENT OF 
GOUT, (a) 

This book is a continuation and extension of the Goul- 
stonian Lectures of 1897 on the Chemistry and Pathology 
of Gout. The author considers that the influence of 
many things on the development of gont is in great part 
due to the effect they exercise in the metabolism of the 
liver, and the increased amount of glycocine that passes 
on to the kidneys, which glycocine causes an increased 
production of uric acid by the kidneys. 

The author has shown experimentally that the alka¬ 
linity of the blood is not appreciably diminished during 
a gouty attack ; and that the solubility of sodi'-m 
biurate is markedly increased by the presence of the 
mineral constituents of most vegetables, but diminished 
by the mineral constituents of meat. Practitioners will 
find the book suggestive and helpful when arranging the 
dietary and medication of their patients. 


CLELAND’S DISSECTIONS, (b) 

The fourth edition of this work, now before us, is 
from the pen of the learned Professor of Anatomy in the 
University of Glasgow, and from that of Dr. MacKay, a 
former pupil and assistant. Speaking generally, the small 
work is of great excellence, and could only have been 
written by a master or masters, in the art of dissection. 

It is intended as a dissecting-room guide for 
students, who use the large work on ‘‘Human 
Anatomy ” by the same authors, for the acquisition of 
their detailed knowledge in their evenings at home; 
this purpose being facilitated in this edition,by reference 
to the page or pages of the large work, in which the 
detailed description of the structures which the Rtudent 
has laid bare during the dsy is dealt with. 

The authors, in their short summary, allot more of 
the back to the dissector of the upper limb than is cus¬ 
tomary in the generality of schools, allowing him the 
erector spins? from the level of the spinous process of 
the axis, as well as the spinal canal and the spinal cord, 
although the, latter, it is mentioned (page 18), is only to 
be opened by the senior dissector; one wonders what 
becomes of it in the case of the junior, as no instruction 
is given to the dissector of the head and neck that in 
the latter case he may proceed. In onr judgment 
the general, custom is the better one of allotting 
to the dissector of the. head and neck, the whole of the 

(а) "Goat—its Pathology and Treatment.” By Arthur P. Luff, 
14.D;Lond.,P-B.C.P. London i Cassell sn^Co. 1898. Pp. Tiii-248. 

(б) ” Directory for Dissection of the Human Body." By Prof*. 
Cleland and MacKay. Glasgow : Jag. Maclehose and Bona. Fourth 
Edition. Pp. 198. Brice 3s. fid. net. 


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Junk 21, 1899. LITEBARY NOTES AND GOSSIP. Thk Medical Puss. 655 


erector spinae muscle, with the spinal canal and its con¬ 
tents, as he thus receives the entire cential nervous 
system at one allotment, leaving to the dissector of the 
upper limb what of the back more naturally belongs to 
him—the latissimus dorsi, the rhomboids (perhaps the 
two serrati.) and his share of the trapezius, and the levator 
anguli acapnia). 

If this is done it is the disseotor of the upper limbs who 
loses the two last dayB of the four on which the subject 
lies on its face, and not the dissector of the head and 
neck, page 80. Should the summary of this part of the 
back be transferred from the upper limb to the head and 
neck, it would be an improvement, although there may be 
also two sides to this question. The originality and 
independence of the authors in regard to current fashion¬ 
able description, is exhibited in their remarks respecting 
the pelvic fascia, page 190, a feature much to be admired, 
and one very evident on every page of this small work. 
The book can be cordially recommended to every student 
of anatomy. 


$ittntrg ^otcs itnb (lossip. 

Mr. Jackson Clarke, F.R.C.S., has a work in the 
press on “ Orthopaedic Surgery," which will include the 
advances made by radiography in this department of 
surgery. % # 

Dr. David W alsh has a new edition of his “ Rontgen 
Rays in Medical and Surgical Work ’’ in the press, which 
will contain the latest experiments and appliances in 
this new science, together with illustrations of its prac¬ 
tical application. %* 

The third edition of Sir Wm. Broadbent’s “ Diseases 
of the Heart ” is, we are informed by the publishers, 
Messrs. Bailliere, Tindall and Cox, almost through the 
press, and is expected to be ready for publication in a 
few day 8. %* 

The new “Manual of Surgical Treatment,” by Mr. 
Watson Cheyne, Professor of Surgery in King’s College, 
London, of which Part I. was issued a few days ago, will 
be completed in six parts, forming a comprehensive 
work of reference. * m * 

Messrs. Wrioht and Co., of Bristol, are about to 

issue a “ Synoptical Index ” to drugs and treatment for 
the twelve years 1887-1898, during which the Medical 
Annual has been published, forming, as it were, a key 
and complete index to the twelve volumes. 

%• 

Messbs. Lonomans & Co. announce that the new 

edition of the late Professor Coats' “ Manual of Patho¬ 
logy ” will not be ready until the early autumn. Dr. 
Lewis Sutherland, assistant to the Professor of Patho¬ 
logy in Glasgow University, is engaged on the revision. 
* • 

* 

Messrs. Macmillan and Co., announce for early pub¬ 
lication. in their list of Manuals of Medicine and 
Surgery, a new volume on “ Differential Diagnosis in 
Medicine,’ by Dr. Fied. J. Smith, of the London Hospital. 
The work will range widely over medical diagnosis, and 
is chiefly intended for senior students 
*** 

By a letter in our correspondence columns, it will be 
seen that Dr. Wolfe, late of Glasgow, now of Melbourne, 
author of the well-known manual of “ Diseases and 
Injuries of the Eye,” is now in Leipzig, where, we under¬ 
stand, he is spending his vacation in order to gather 
materials from Continental hospitals for another edition 
of his work. 

# # # 

Our Manchester correspondent informs us that several 
works have recently appeared, or will shortly be issued 
by Manchester men. Dr. Williamson has just published 
a small monograph on “ Syphilitic Diseases of the Spinal 
Cord ”; Dr. Kelynack has completed a manual of “ Prac¬ 
tical Pathology for Students ■" Dr. Moore has translated 
Rieder’s work on “ Urinary Sediments.” 

• • 

In “Vitality,” by Lionel J. Beale, M.D., F.R.S. 
(London: J. & A. Churchill), to hand, the author does 
not agree with the confidence of those who urge that 
purely physical and chemical actions ought to be 


accepted as the true explanation of any form of life» 
nor does he agree with Herbert Spencer that there is 
community of nature between growth, as it oocure in 
everything that lives, and inorganic growth. There is 
much going over of old ground, but the pamphlet is 
written by an able thinker and observer. 

V 

Mr. Hime’ 8 little monograph, on “ Schoolboys’ Special 
Immorality,” is evidently written by one who is con¬ 
vinced of the prevalence of the practices referred to and 
of the possibility of eliminating them to a great extent 
fn m school life by suitable moral instruction and proper 
surveillance. It is an eloquent appeal to schoolmasters 
and others not to continue to ignore these disagreeable 
facte, but to cope with and to overcome them. Every 
credit is due to Mr. Hime for having boldly tackled a 
repulsive subject, and for having handled it firmly but 
with delicacy. The essay will be read with interest by 
others than schoolmasters, but many of the latter may 
find his practical hints usefully suggestive. 

“The Living Substance,” by Gwedolen Foulke 
Andres8 (Boston: Ginn, and Co.), is an attempt to teach 
us more of protoplasm than we have yet learned, and 
certainly on the face of it one would think we should 
now get nearer the truth of what Huxley terms the 
physical basis of life; but if there is more light here it 
is shaded by a rather strained literary effort which spoils 
the scientific effect. The descriptions are by no means 
so intelligible as one would desire, and it is difficult to 
know sometimes where Biitschli ends and the author 
begins. As regards the visible protoplasmic structure 
the evidence seems to be very much the evidence of 
Biitschli. What is wanted here very much is illustration. 
There is none, and though one feels that the author has 
done a large amount of work, microscopic and otherwise, 
she has not done herself full justice in bringing it to 
ligM. 

• 

In “ King’s American Dispensatory ” (the Ohio Valley 
Co., publishers, Cincinnati) we have a book somewhat on 
the lines of the “ Reference Book of Practical Thera¬ 
peutics,” in two volumes, edited by Dr F. P. Foster. It 
is certainly a very remarkable work of reference, and is 
issued in the best American style. It seems to be 
extremely accurate and comprehensive, and is quite up 
to date It is singular that works of this description, 
for some reason or another, command a much larger 
sale in the United States than they do in this country. 
It is well written and well illustrated, and may fairly be 
described as a monumental work. It is certainly 
marvellous that anyone could be found with the time, 
energy, and ability to compile a work of this description, 
and the greatest possible credit is due to the authors, 
Drs Felter and Lloyd, and, we may add, to the publishers. 
We wish them every success in their venture. 

* * 

• 

The “ Golden Rules Series ” (John Wright and Co. 
Bristol), inaugurated by Mr. Hurry Fenwick’s popular 
little compilation, “ Golden Rules of Surgical Practioe,” 
baa been enriched by a similar series of “ Don’ts ” and 
“ Do’s ” in Gyniecology by Dr. S. Jervois Aarons, and in Ob¬ 
stetrics by Dr. W. E. Fothergill, and by Golden Rules of 
Medical Practice by Dr. Arthur Hy. Evans. Mr. Fenwick’s 
aphorisms are well chosen, and for the most part very 
apt and to the point. More than one practitioner during 
the last year or two would have fared better bad he 
grasped such an axiom as the following:—“ Never forget 
that the surgeon who neglects to suture a divided nerve 
or tendon commits the same mistake as he who neglects 
to reduce a fracture.” Gynaecology does not lend itself to- 
this process of treatment as readily as a wide subject like 
surgery, consequently many of the injunctions and (may 
we call them ?) disjunctions do not carry conviction to the 
same extent. Nevertheless there are plenty of things 
in gynaecology as elsewhere which “ were better left un¬ 
done,” and to theminteralia Dr. Aarons has directed atten¬ 
tion. Dr. Fothergill’s “ Golden Rules of Obstetric Practioe ” 
are in reality a series of hints as to what to do and what 
not to do under given circumstances, in fact, a sort of 
“ practical cram book.” 


Digitized by CjOO^Ic 




656 The MedicalIPrbhs. 


OBITUARY. 


June 21, 1896. 


<Dbitu*n>. 


MR. LAWSON TAIT, F.R.C.8. 

WiTH'the death of jMr. Lawson Tait, Great Britain 
has been deprived of the most original surgeon she has 
produced in the last quarter of a century, and the whole 
world of surgery has to deplore the loss of one of the 
most gifted masters of the art. His was one of those 
exceptional minds that mark an epoch in the history of 
any science or art in which they occur. They are alto¬ 
gether out of the oommon, and for this very reason are 
often incapable of being understood by men of ordinary, 
or even above the ordinary, mental calibre. It is not in 
-the light of what we designate clever and able minds that 
we regard such. We are forced to recognise in them 
gifts and powers entirely apart from those that are 
acquired by education, training, and experience. It is not 
with these that the “ infinite capacity for taking pains ” 
•explains the brilliancy and originality of their work, 
-though it may enable them to develop and place it on a 
substantial basis. It is rather that subtle quality of 
brain in which conception 
and imagination play the 
greater part, and which, 
when allied to that other 
.quality, audacity, whioh 
has been taken as another 
reading for genius, give to 
the world and humanity 
their greatest gains. Law- 
eon Tait combined in vary 
ing degree all these quali¬ 
ties. Laborious and pains 
taking in his work, 
strikingly original in the 
ideas which gave it shape, 
characteristically auda¬ 
cious in carrying these 
ideas into operation and 
impressing them upon a too 
reluctant and unbelieving 
profession, be could not, 
and never did, expect to 
escape the jealous carping?, 
the unworthy criticisms, 
and the specious inuendoes 
which contemporaries, 
with no claim to his 
powers as a surgeon, 
or to his manipulative 
resources as an operator, 
were wont to aim at him. 

He has passed away, still a 
comparatively young man, 
at the age of fifty-four, hav¬ 
ing been born in Edinburgh 
in the year 1846. He was 
the son of Archibald Camp¬ 
bell Tait, a Guild brother of Ueriot’s Hospital, to which 
school Lawson Tait was admitted at the age of seven, 
remaining there until, gaining a scholarship, he entered 
Edinburgh University. From 1860 to 1866 he was en¬ 
gaged in his professional studie-*, and was under the 

S udanoe of an able surgeon, M’Kenzie Edwards, a 
vourite pupil of Sir William Fergusson. Here also 
he came under the influence and teaching of Sir James 
Simpson, and determined to pursue the branch of 
surgery that he afterwards adorned, which might be said 
-then to have been in its infancy. In 1870 be became a 
Fellow of the College of Surgeons in Edinburgh, and a 
year later took the Fellowship of the College of Surgeons 
of England. After a short time spent at Wakefield 
as house surgeon, he went to Birmingham, selecting 
this town as an appropriate field for the practioe of that 
department of surgery which he had determined to follow. 
At Birmingham he took an active part in the origination 
of the Women's Hospital, in conjunction with Dr. Savage, 
in whioh institution he afterwards achieved many of his 
most brilliant successes. Here he did not confine him¬ 
self to the pursuit of his profession alone, for he joined 



the staff of the Birmingham Morning Newt, then edited 
by Mr. George Dawson, and was appointed lecturer on 
Physiology and General Biology to the Midland Institute 
in 1871. Tait was but twenty-five years of age when he 
went to Birmingham, and three years before he had per¬ 
formed his first abdominal section. He was only twenty- 
eight when he obtained the Hastings Gold Medal of 
the British Medical Association, which was then 
given to him by Sir William Fergusson, who 
made exceptionally complimentary remarks to the 
young surgeon on the unusual brilliancy and originality 
of his essay on ‘‘Diseases of the Ovaries," an essay which, 
written at a time when the pathology of the uterine 
adnexa had made but little advance, immediately drew 
attention to Tait and established hiB reputation as a 
pelvic surgeon. 

It is not possible in such a notice as this to refer even 
to the most important of the advance in gynaecology in 
whioh Lawson Tait took so prominent ana active a part. 
During the latter part of the seventies his fame had still 
further enhanced the reputation of the Birmingham 

School. His writings on tne phvsiology and pathology of 

the ovaries and Fallopian 
tubes, on the intra-peri- 
toneal method in ovario¬ 
tomy, on tubal fcetation, 
and on the treatment of 
extra-peritoneal manage¬ 
ment of the pedicle by 
damp added to nis marvel¬ 
lous successes in ovario¬ 
tomy, and abdominal sur- 
gory generally, had given 
him a world-wide fame. 
Not in pelvic surgery alone 
did his originality manifest 
itself. In 1879 his paper on 
“ Cholecystotomy " wa» 
read before the Modico- 
Chirurgical Society, and 
appeared in its “Trans¬ 
actions.” Various other 
original feats in abdomi¬ 
nal surgery followed, and 
from different schools in 
America and on the Conti¬ 
nent distinguished sur¬ 
geons came to see his work 
and methods of operating. 
There was but one opinion 
as to his manipulative 
dexterity and deftness of 
hand, oelerity, boldness, 
and completeness were the 
characteristics of Taifs 
operations. There has been, 
from time to time, doubt 
thrown on his statistics, 
hnt there is no gronnd that 
we know of whatever for questioning the accuracy of 
these. Some years since, during a painful episode of his 
life, when those of the Women’s Hospital at Birmingham 


were impeached, he took immediate and unanswerable 
steps to verify them before the profession, and most 
satisfactorily did so. In his earlier cases of hysterectomy, 
when his mortality was very high, the disastrous results 
were published frankly and above board. 

Tait’s fame, however, most specially rests on his bold¬ 
ness in the treatment of diseased conditions of th« 
adnexa bv operation. Undeterred by attacks, and unin¬ 
fluenced Dy hostile criticisms, he established the opera¬ 
tion of oophorectomy as the surgical procedure for 
suppurative conditions of the ovaries and tubes in gives 
cases of bleeding fibroma, and proved the necessity fos 
immediate operation in ruptured tubal gestation- 
advances in gynseoology which were not achieved without 
much obloquy and unjust aspersion. He lived, however 
to see the range of gynaecological surgery in these direc¬ 
tions, and in justifiable operative procedures, pass fai 
beyond the limits which he, in the earlier days of hi 
advocacy, conceived that they would. With man) 


Dioitized by 


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June 14, 1899. 


CORRESPONDENCE. 


The Medical Prebb. 657 


other matters of pelvic surgery his name is associated. 
As, for instance, the treatment of pelvic abscess 
toy abdominal section and drainage, and bis operation 
for ruptured perineum. Lawson Tait was not what can 
be called in the modern sense an aseptic surgeon, and he 
held with characteristic obstinacy of mind to older 
methods of operation. He ignored Listerism, and refused 
to be a disciple of the great English teacher of anti¬ 
septic and aseptic methods. Here, as in his advocacy of 
the anti-vivisectionist movement, we believe that he was 
mistaken, and we cannot but feel that his results, bril¬ 
liant as they undoubtedly were, would have been still 
more so had he adopted, as is now universally done, 
Listerian methods. By ordinary precautions of cleanli¬ 
ness, in conjunction with his great dexterity, Tait’s 
results may be explained. We do not know how far 
those statistics might be modified b> those of all opera¬ 
tions he performed in private practice, but this has 
to be remembered, that if he lost at anytime directly 
-through the neglect of aseptic precautions, the price 
was a dear one to pay for his rejection of Listerism. 
His last communication (but a few weeks ago) to The 
Medical Press and Circular, to which he has been a 
constant contributor for many years, and to which lately 
lie has addressed nearly all his original communications, 
shows how determined and honest was his opposition to 
vivisection. “ Some day,” he said, “ I shall have a 
"tombstone put over me, and an inscription upon it. I want 
-only one thing reoorded on it, and that to the effect 
4 he laboured to divert hit profusion from the blundering 
that hat resulted from the performance of erperimentt on 
the tub-human group of animal life, in the hopes that 
they would shed light on the aberrant physiology of the 
human groups.’" Alas! all too soon has the ruthless 
hand of death brought to an end a career which, at the 
time this was written, no one dreamed was so near to its 
conclusion. 

Lawson Tait was an Honorary Graduate of several 
universities. In politics he was a staunch Liberal, and 
at one time thought of entering Parliament, but was 
defeated at the 1886 election for the Bordesley Division 
of Birmingham by Mr. Jesse Collings. Of late years be 
relinquished much of his practice, building for himself 
a residence at Llandudno facing the Conway estuary and 
the Penmaenmawr mountains, taking an active interest 
in the development of Llandudno, and only last month 
buying the Old Telegraph Inn, on the highest point of 
the Great Orme’s Head, with a view of converting it into 
a sanatorium for consumptives. 

Much more could be written and said of Lawson Tait, 
for his history bas been also the history of British gynee- 
cology for the last twenty-five years. We have naught to 
say to certain personal attributes which brought him 
many and relentless enemies. His best friends—and he 
had hosts of ardent admirers—would have often wished 
that in debate and in medical literature his attitude in 
scientific discussion were other than it was. This ten¬ 
dency doubtless cost him the loss of the highest pro¬ 
fessional and social distinctions, but he could always feel 
the internal conviction that the name of Lawson Tait 
would pass down on the roll of the great British sur¬ 
geons who by their researches and work have been the 
milestones which mark for us and those to oome the 
evolution and progress of British surgery. His death 
came rather suddenly after previous indisposition, at 
his residence, St. Petroks, Llandudno. The remains 
were cremated at Liverpool, and the ashes have been 
deposited, in accordance with his own special request, 
an a cave in his private grounds. 


ME. JAMES ABNOLD, OF 8MITHFIELD. 

We learn with regret the death of Mr. James Arnold, 
-the senior partner in the well-known firm of Surgical 
Instrument Manufacturers, of West Smithfield. We 
have been asked to state that the business will be car¬ 
ried on as usual by the two remaining partners, Messrs. 
J. E. and E. E. Arnold, sons of the deceased. 

. ■■ -♦- 

Mr. Henbt Morris, F.E.C.S., has been re-elected a 
member of the Court of Examiners of the B.C.S.Eng. for 
a further period of five years. 


Ctarwpmrtena, 


We do not hold onrselvw responsible tor the opinions ot on* 
correspondents. 


ON SEBUM INOCULATION. 

To the Editor of The Medical Press and Circular. 

Sib,—I have just read my letter, with the appended 
note on the above subject, in your issue of the 31st ult. 
My commentator evidently does not wish to see the 
difference between the inoculation, for diagnosis, of 
ailing animals, as practised in Glasgow, and the whole¬ 
sale inoculation of the animal virus into all healthy 
animals for diagnostic purposes; although it had been 
proved by experiments, on a large scale, that of the 
healthy animals thus treated 146 per cent, became 
tuberculous the following year. 

The Medical Press and Circular advocates vivisec¬ 
tion and experimentation on lower animals in the in¬ 
terest of the study of human physiology and pathology. 
Now, the lessons which vivisection and experimentation 
teach us are that, “ The higher we rise in the scale 
of zoological life, the more do diseases become com¬ 
plicated, and surgical operations and the administration 
of poisons will more readily prove fatal. Thus, for in¬ 
stance, a surgical operation which may be borne with 
impunity, or a poison which may be eliminated from the 
system and prove harmless in the case of shepherds' 
dogs or horses of Brittany, will prove fatal to pointers 
fchiena de chasse) or to high bred horses (chevaux 
Anglais). Further, the same animal may escape with 
impunity some operations when the nervous system or the 
stomach happens to be in a oertain condition, but will suc¬ 
cumb when in a different state of health. The numerous 
experiments which you have teen me perform here upon 
different animals put this proposition beyond doubt." (a) 

It is, therefore, evident that when we inject an animal 
virus, such as Koch's tuberculin into a number of healthy 
animals, some will eliminate it from the system and 
escape harmless, whil?t in others it will form tuberculous 
nests for the contamination of the organism. And the 
higher the breed the less chance will they have to escape 
contamination. 

He incurs a heavy responsibility who encourages the 
pastoral people of Australasia to practise a system of 
wholesale cattle poisoning because it happens to be 
orthodox and fashionable to-day, but may be considered 
outrageous to-morrow. 

I am, Sir, yours truly. 

F. E. Wolfe, M.D., F.B.C.S.Eng. 

Hotel Hauffe, Leipsic, June 17th, 1899. 

THE POLYCLINIC. 

To the Editor of The Medical Press and Circular. 

Sir, —It seems rather difficult to explain the reasons why 
the Institution just started as the Polyclinic has been 
created If the simple question were asked, for whose 
benefit is it intended, the answer, we suppose, would be — 
for the profession generally; at least tnat part of the 
profession that wants education. The report in the 
dailies of the meeting a few days ago rather leads to 
the impression that as the teachers are to be well paid 
it may not be altogether a one-sided business. Of course, 
the cases that attend will derive benefits, but this point 
is not made muoh of, and it rather looks as if they were 
to be utilised for the two other purposes above referred 
to. Those whose names appear as supporters of the 
Polyclinic are not now connected with hospitals, and it 
is reasonable to ask why the hospital schools should 
lose the aid of men of the greatest experience when the 
most important class of students would derive benefit 
from their teaching. It appears as if the hospital 
sohools will not feel much interest in the Polyclinic, and 
certainly we should think that it would be well if some 
consideration were shown at our hospitals for those of 
the profession for whom the Polydinio is intended. 

It must be realised that those who have cleared them- 

(a) From my M8. report of Claude-Bernard’s “ Demonstrati 
on Experimental Pathology” at the College de Franoe revised 
puli cations by the illustrious lecturer. 



658 The Medical Press MEDICO-LEGAL NOTES. June 21, 1899 


selves of examinations feel the want of that kind of in¬ 
struction which the clinical teacher alone can give, and 
there is no doubt but that the Continental schools far 
surpass ours in the facilities they afford for high-class 
education. Some reform is needed in hospital teaching 
in London, and greater regard should be Bhown by those 
who undertake this duty of using hospital appointments 
lees as means of advertising themselves with a view to 
practice than is the case at present. 

I am, sir, yours truly, 

L. 

BACTERIOLOGY FOR VESTRYMEN. 

To the Editor of The Medical Press and Circular. 

Sir, - It is, in a sense, comforting to learn that the 
organism which gives rise to consumption flourishes only 
in the living tissues, and promptly loses its virulenoe 
when exposed to air and sunlight, the change being due 
to the resulting dessication. It follows that dust from 
the hard high road, exposed to the blaze of the sun, 
when there is any, or to the drying influence of an 
invigorating east wind, is unlikely to contain the active 
bacilli of tuberculosis, for the simple reason that the 
moisture indispensable to their comfort and health has 
been withdrawn. In urban districts the looal authorities 
take such morbid pains to supply an adequate quantity 
of water that the dust, highly charged with organic 
waste and affording consequently a very favourable evil 
for the cultivation of germs, is maintained in a condition 
well adapted for the longevity and multiplication of 
these germs. Local authorities do not take into account 
the principle that streets ought to be watered only with 
the object of preventing dust when they are about to be 
swept, unless, indeed, it be used in such quantities as to 
wash the streets clean. The City of London is, perhaps, 
the only place where this principle is recognised and 
applied, and local authorities in general turn a deaf ear 
to the wails of maimed horses and injured cyclists whose 
mishaps are directly attributable to the vicious plan of 
converting dust into greasy mud. 

It lies with the Press, and especially the Medical Press, 
to educate public opinion on this matter, and I therefore 
venture to call your attention thereto. 

I am, Sir, yours truly, 

A Cycling Bacteriologist. 


^etrico-yegal JJotes. 

By W. J. JOHNSTON, B.L., 
lhiblin. 

(Conclude d.) 

The Magistrates and the Vaccination Act. 

Every decision in connection with the Vaccination 
Act, 1898, is of interest, and especially every decision 
under the famous section which provides that no parent 
■hall be liable to any penalty under the Act of 1867 if 
within four months from the birth he conscientiously 
believes that vaccination would be prejudicial to the 
health of the child. The justices of a certain district 
have thought it wise to adopt the rule that every appli¬ 
cant under this section shall produce a certificate of the 
child’s birth. The defendants in the case of Reg. r. 
Lowndes and others (68 L. J. R. 318) made an applica¬ 
tion to the magistrates, but refused to produce Buch a 
certificate, offering oral evidence on the point instead. 
The justices were obdurate and insisted on the produc¬ 
tion of the certificate. On an application to the Queen’s 
Bench Division for a writ of mandamus to compel the 
Court below to hear the case, the judges held that in 
cases where the birth had been duly registered, it was 
a very proper thing to insist upon the production of a. 
certificate, and that the magistrates were right in 
refusing to hear the case until the rule had been com¬ 
plied with. 

Justification as a Defence in Libel Actions. 

Three recent actions of libel, in which medical men 


were the plaintiffs, illustrate in a convenient way the 
doctrines of the law with reference to professional 
character. The case of Kelly v. Colhoun and others was 
the simplest in point of law. The plaintiff, who was a 
dispensary doctor, complained of certain statements made 
about him at a meeting of the dispensary oommittee by 
two of the members of that committee, and these two 
defendants wheo sued for damages pleaded justification 
—that is, pleaded that the statements were true—which 
is the boldest, but at the same time the riskiest, defence 
that can be set up to an action for libel. The jury found 
that the statements were defamatory, and that they were 
not true, and awarded .£200 damages against each of the 
defendants. 

Privilege as a Defence. —In Forsythe v. Caldwell, 
the plaintiff who was medical officer of a work 
house, complained that a letter sent by the defendant 
to the Local Government Board of Ireland oontained 
defamatory statements about his conduct as medical 
witness at an inquest held by the defendant as 
coroner in the workhouse. The defendant pleaded 
privilege, which is a defence available to protect all com¬ 
munications honestly made for the purpose of discharging 
some legal, moral, or social duty. It is a defence that 
can be rebutted only by proof of malice. The judge at 
the trial held that the communication made to the 
board in question was privileged, but the jury found 
that there was malice and awarded £50 damages, for 
which sum judgment was entered for the plaintiff. 

Fair Comment as a Defence. —The third case 
was Thompson v. Falls, in which the plaintiff, who 
had previously given expert medical testimony at 
a certain criminal trial, complained of some references 
made by the defendant at a public meeting) 
to his conduct at that trial and evidence as a medical 
witness. The defence was a plea of fair comment, which 
is one arising out of the right which the law gives 
everyone to criticise, fairly and honestly, every subject 
that is fairly open to public discussion. The jury, how¬ 
ever, found that the defendant had gone beyond the 
limits of fair criticism, and gave the plaintiff .£50. Of 
these three forms of defence—justification, privilege, 
and fair comment—the first is generally avoided by 
lawyers, and the last two, being in a way a form of 
pseudo apology or explanation, breaks the fall for the 
defendant, if a fall must come. 

The Pharmaceutical Society of Ireland. 

It is a pity that Ireland is not included within the 
Bcope of the Lord Chancellor’s Pharmacy Bill. The 
same state of affairs exists in the sister country as in 
England. The Bill is intended to remedy the effect of 
the decision of the House of Lords in The Pharmaceutical 
Society v. The London Supply Association (5 A. C. 857), in 
wh ich it was decided that the word “person ’ in the old Act 
did not include a body corporate, so as to makelthe de¬ 
fendants liable to the penalty under the Act. In The 
Pharmaceutical Society of Ireland t>. Boyd and Co. (1896, 
2 Ir. R. 394), the Irish Courts gave an exactly similar 
construction to the corresponding section of the Irish 
Act. But the Irish Courts have gone further. They 
have decided that an apprenticeship served with a 
limited company, carrying on business as pharmaceutical 
chemists under a properly qualified manager, did not 
entitle the candidate to be admitted to the Society's final 
examination when some of the members of the company 
were not pharmaceutical chemists. (Beg. [Cleland ] v. 
The Pharm iceutical Society of Ireland —[1896] 2 Ir. B- 
868). But in another case an apprenticeship served with 
a limited company, all the members of which were pro¬ 
perly qualified phai maceutical chemists was held to be 
quite sufficient. (Reg- [ Conyngham ] v. The Pharma¬ 
ceutical Society of Ireland —[1899] 2 Ir. R., 132). 


Royal College of Surgeons of England. 

A meeting of Fellows and Members of the College is 
to be called to consider the draft petition and charter 
now being prepared. Copies thereof will be supplied on 
application. 


Digitized by VJ 


oogle 


June 14, 1899. 


MEDICAL NEW8. 


The Medical Peebs. 659 


Sabotutorg Jlotes. 


ASEPTIC SPONGES (SQUIRE). 

We have received from Messrs. Squire and Sons, of 
413, Oxford Street, W., samples of their antiseptic 
sponges. These consist of cotton fibre subjected to very 
great pressure, and we are told the “ sponges ’ consist of 
discs only a twelfth of an inch in thickness. Placed in 
■water they promptly swell up to fifteen times the original 
size, and are capable of absorbing twelve times their 
weight of fluid. They are useful for a variety of pur- 
poses, but are specially serviceable in plugging the 
anterior or posterior nares for the relief of epistaxis, it 
being possible to obtain any degree of pressure that may 
be required in order to arrest the haemorrhage. 


VAGINAL CAPSULES. 

We have received from the same firm specimens of 
their “ vaginal capsules,” prepared with specially soluble 
carbolised gelatin, serving as envelope for an absorbent 
-tampon, which can be medicated a voVnite A thread is 
attached to facilitate the removal of the tampon in due 
course. These capsules constitute a much easier and 
"elegant” method of introducing medicated tampons 
into the vagina than the ordinary plan via a speculum, 
and they enable patients, when necessary, to continue 
the treatment themselves. 


FERRO-MANGANESE PEPTONATEJ(SQUIRE). 

LYMPH OF THE GLYCERO-PHOSPHATES 
(SQUIRE). 

CHEMICAL FOOD LOZENGES. 

Among the pharmaceutical products samples which 
have reached us from Messrs. Squire and Son, we must 
mention the ferro-manganese peptonate (Squire). This 
fluid preparation contains 13 grains of metallic iron and 
3 grain of metallic manganese, in the form of neutral 
peptonised albuminates. This preparation, pharmaceuti¬ 
cally excellent, possesses valuable therapeutic properties 
in that it is readily tolerated, does not constipate, and 
does not discolour the teeth. The average dose is a 
teaspoonful. 

The glycerophosphates are now well in vogue, and 
their importance as a means of exhibiting phosphates in 
a soluble form is too generally recognised to require ex¬ 
planation. The syrup of the glycerophosphates (Squire) 
is a trustworthy preparation of soluble phosphates in 
combination with glycerine. 

For the convenience of tho?e who cannot well carry 
about bottles of syrup, Messrs. Squire and Sons now pre¬ 
pare their" Chemical Food” (Syr. Ferri Phosph. Co.) in 
the form of lozenges, each of which corresponds to an 
average dose of the syrup. 


4ftei>ical ^etos. 

University of Dublin. 

A meeting of the Senate will be h9ld to-day (Wed¬ 
nesday) to approve the following “ Graces ” from the 
Provost and Senior Fellows for the grant of Degrees 
honoris causa. 

His Excellency Earl Cadogao, Lord Lieutenant of 
Ireland, LL.D. 

Marquess of Lansdowne, LL.D. 

Baron Macnaghten, LL.D. 

Sir G. O. Trevelyan, LL.D. 

Right Hon. Joseph Chamberlain, LL.D. 

Professor D. P. Tiele, of. Leyden, LL.D. 

Professor A. R. Forsyth, of Cambridge, LL.D. 

Professional Amenities. 

A case was tried at the Lambeth County Court a few 
days Bince in which a medical witness showed himself in 
a rather curious light. A working man sued Mr. Shil- 
lingford, L.S.A , of Peckham, for damages, based on 
alleged negligent treatment 'f one of the plaintiff’s 
children. The principal witress for the plaintiff was 
Dr. R. H. Hodgson, who, on being called in, found that 
the defendant had been prescribing opium, which, in 


his opinion, constituted improper treatment. In a letter 
to the defendant’s solicitor he alluded to the plaintiff as 
“ a contemptible liar.” Exonerating evidence having 
been given by various medical men on behalf of the 
defendant, the jury stopped the case, and gave a verdict 
in favour of Mr. Shillingford. 

Cambridge University. 

The work of the Long Vacation Course in the Patho¬ 
logical department will be commenced on Thursday, 
July 6th, and vill consist of 

1. Lectures on General Pathology, Degeneration, In¬ 
flammation, (Edema, Shock, Ac.; Special Diseases of the 
Circulatory System. 

2. Demonstrations in Morbid Anatomy in the post¬ 
mortem room and on formalin specimens. 

3. Morbid Histology—Degeneration, Inflammation, 
and Tumours; Special Diseases of the Visceral Organs. 

4. Clinical Pathology, including examination of blood; 
methods of clinical bacteriological diagnosis, sputum, 
tubercle, diphtheritic exudations, typhoid serum test, Ac. 

5. Lectures on Bacteriology: General and Special 
Pathology of Infective Disease, including the produc¬ 
tion of immunity, vaccination, serum treatment, Ac. 

6. Practical Bacteriology—Methods of inoculation and 
staining; Practical Study of the Important Pathogenetic 
Micro-organisms, and Phagocytosis, Methods of Inocula¬ 
tion, Immunisation, Ac, and the Bacteriological Analysis 
required for D.P.H. examination. 

7. Should a sufficient number of students send in their 
names, a class will be formed for the study of the more 
advanced bacteriological work that cannot be included in 
the above course. 

Mr. Strangeways Pigg (University Demonstrator) and 
Dr. G. H. F. Nuttall (of Berlin) will be associated with 
Professor Woodhead in carrying out the work of these 
classes. They will be assisted by a number of private 
demonstrators. 

A syllabus of the work of, and fees for, the various 
classes, will be sent on application being made to Mr. 
Strangeways Pigg, Pathological Laboratory, New 
Museums, Cambridge. These classes are open to non¬ 
members of the University. 

Tropical Diseases. 

An expedition is being organised by the Liverpool 
School of Tropical Diseases to visit the West African 
coast for the purpose of investigating the causes of 
malaria and other tropical diseases. It is expected to 
start for Sierra Leone early in August, with Major Ross 
as commander-in-chief. The offer made to the Colonial 
Nursing Association, m London, to train three nurses 
for service in the tropics has been accepted. 

Lunacy in North Wales. 

According to the fiftieth annual report of the North 
Wales Counties Lunatic Asylum, the daily average of 
patients amounted to 669, as against 651 during the 
previous year. The percentage of recoveries was 36.56 
per cent, on the admission, and the death rate 8 89 per 
cent. 

Measles in Liverpool. 

Although Liverpool has not suffered as much as 
Manchester and certain other large urban centres from 
the prevailing epidemic of measles, it has been judged 
necessary to close the infant departments of School 
Board and voluntary schools for a fortnight. The 
number of schools affected by the Order is 23. 

London Hospital Medical College. 

The new buildings that have recently been completed 
at the London Hospital Medical College will be opened 
on Tuesday, July 18th, by Lord Knutsford. The open¬ 
ing will be followed by the distribution of prizes to the 
students and nursing probationers in the library of the 
Medical College by Lord and Lady Knutsford. 

Colonel T. O’Farrell, Principal Medical Officer of 
the Home District, has been appointed Principal Medical 
1 Officer at Malta. 


Digitized by t^ooQle 


660 Thk Medical Press _ NOTICES TO 

4totic« to 

Corrcfipottbertts, Short jtettero, &c. 


HT Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive lignature or 
initials, and avoid the practice of signing themselves " Header,” 
"Subscriber,” "Old Subscriber," Ac. Much codfusion will be 
•pared by attention to this rule. 

THE DOCKBELL TESTIMONIAL FUND. 

Oub readers are already in possession of the facts connected with 
the case of Dockrell v. Dougall, in which Dr. Morgan Dockrell 
sought toprevent his name being used in advertisements of 
“Sallyco Water.” His case having failed in the first instance. Dr. 
Dockrell decided to take it to the Appeal Court, before which he 
explained that the unauthorised use of his name on a circular would 
certainly injure his professional reputation, and also indirectly his 
practice. Being unable to prove specific damage, he was again un¬ 
successful, the Judge declining to go behind the finding of the jury. 
In fighting this case he was fighting the right of every man to the 
privacy of his own name, in doing which he has incurred legal costs 
to the amount of several hundred pounds, to reooup which and to 
evince sympathy with him on the part of the profession a Testimonial 
Fund has been started. The following is a list of oemmittee nd 
first subscription list 

£ s. d. | £ s. d. 


Howard Marsh, Eaq., 




Brought Forward 

84 

6 

0 

F.B.C.S. 

2 

2 

0 

Dr. Clemow . 


5 

0 

Dr. James Little. 

3 

3 

0 

Dr. Bowles . 

1 

1 

0 

Dr. Ewart . 

2 

2 

0 

Dr. Love. 


5 

0 

Leonard Bidwell, Esq. 




8ir E. 8ieveking . 

1 

1 

0 

F.B.C.S. 

2 

2 

0 

Dr. Bussell Ryan 


10 

6 

Dr. Sansom . 

3 

3 

0 

Dr. J. 0. Miller 

1 

1 

0 

Dr. Luff. 

1 

1 

0 

Dr. Hyla Grevee 


7 

6 

Sir John Banks. 

2 

2 

0 

Dr. Fergusson. 

1 

1 

0 

Dr. Sunderland. 

5 

5 

0 

Dr. Solly. 


10 

6 

Dr. Savill. 

1 

1 

0 

Dr. Handfleld Jonee ... 

1 

1 

0 

John Poland, Esq 




Dr. Gordon Black 

1 

I 

0 

F.B.C.S. 

3 

3 

0 

Dr. Shaw Mackenzie ... 

1 

1 

0 

Dr. Snow. 

2 

2 

0 

Noble Smith, Esq. 


5 

0 

Dr. Douglas Kerr 

2 

2 

0 

Dr. Lauder Brunton ... 

1 

1 

0 

Ernest Clarke, Esq. 




SirHenry Thompson ... 

1 

1 

0 

F.B.C.S. 

5 

5 

0 

Dr. Kellock . 


10 

0 

Dr. Hyde ... 

5 

5 

0 

Dr. Wm. Hill . 

1 

1 

0 

Dr. Haig. 

1 

1 

0 

Dr. Boss Sinclair 


5 

0 

Arbuthot Lane, Esq. 




Pearce Gould, Esq, 




F.B.C.8. 

3 

3 

0 

F.B.C.S. 

1 

1 

0 

Dr. Leonard Williams,. 

3 

3 

0 

Dr. Woods . 

2 

2 

0 

Dr. Chaldeoott. 

1 

1 

0 

Dr. B. S. Wainewright 

1 

1 

0 

Dr. Mitchell Bruce 

2 

2 

0 

Dr. G. L. Turnbull ... 


5 

0 

Dr. Ward Humphreys.. 

20 

0 

0 

Dr. Robert Barnes 

1 

1 

0 

Dr. Orwin . 




Dr. Fletcher Little 


10 

6 

Dr. Heron . 

2 

2 

0 

Dr. Sima Wood head ... 


10 

0 

Geo. Brown, Esq. 

1 

1 

0 

J. G. Tasker, Esq. 

2 

2 

0 

Henry Fenwick, Esq. 




Dr. Heywooa 8mith ... 

1 

1 

0 

F.B.C.S. 

2 

2 

0 

Dr. Alfred Eddowes ... 


10 

0 

Victor Horsley, Esq. 




Henry Clarke, Esq.. J.P. 

1 

1 

0 

F.B.S.. 




Dr. Dickenson. 


10 

6 

T. A. Howell, Esq 




Dr. MacFarlane. 


5 

0 

C. B. Keetley, Esq. 




Dr. Putsey . 

1 

1 

0 

F.B.C.S. 




Dr. G. Oath cart. 

1 

1 

0 

Dr. Newton Pitt 




Dr. Parke . 


10 

6 

Dr. Snape . 




Dr. Gifford Bennet 

l 

1 

0 

Dr. Windie . 




Dr. Munro . 


5 

0 

(The above form the 




Dr. Cock. 


10 

0 

Committee). 




Dr. J. P.Purvis...’ 

1 

1 

0 

W. O. S. 

1 

1 

0 

Dr. Oliver . 


10 

6 

Dr. Swinhoe . 

5 

5 

0 

Dre. Chaldecott and 




Dr. Bezly Thorne 

1 

1 

0 

Rawlings 


10 

0 

Dr. Botheroe . 

1 

1 

0 

8ir Francis MacCabe . 


5 

0 

Dr. Williams (Pen- 




Dr. Talford Jones, J.P. 


10 

0 

maenmawi) . 


5 

0 

H. Davis, Esq.... 

2 

2 

0 

Carried Forward 

84 

6 

0 

Total 119 

1 

6 


Dr. B. Mander Sxyth (Bingwood).—In consequence of great 
pressure on our space, your communication is unavoidably held over 
until our next. 

THE INTEBNATIONAL MEDICAL CONOBES8, 1900. 

Wr received a comm unicat on while at 1 rcss from Mr. D'A-cy 
Power. Hon. 8« c. f r O eat Biitain. infoin iug us that the meeti g 
of the Congress lias been fixed at the busiest time of the Interna¬ 
tional Exhibition in Paris next year, rendering it necessary that all 
those who propose attending it should give early notice, otherwise 
they will not get rooms. 

LAW80N TAIT. 

(In Memoriam). 

L eft us just in the zenith of his fame, 

A leader of his branch we proudly claim, 

W atchful of symptoms, ready to suggest, 

8 ure of his ground and anxious to contest ; 

0 nward, his motto, not content to wait, 

N eed I recall the name of Lawson Tait. 

T hough gone, thou'st left a mark that shall remain 
A s lasting as our Science nud our Art, 

I mperative thou wert, thy word was plain, 

T hy precept and thy practice n’er depart. 

Cheltenham. Alexander Duke. 


CORRESPONDENTS. _ -'unb 21, 1899 . 

Jftectings of the Societies attb lectures. 

Wednesday, June 21st. 

Royal Meteorological Society (70 Victoria Street, Westminater,- 
S.W.). 4.80p.m. Ordinary Meeting. Papers: Mr. B. H. Scott: 
Heavy Falls of Bain recor ed at the Observatories conne ted with 
the Meteorological Office, 1871-1898.—Mr. B. C. Mossman = Average 
Height of the Barometer in London.—Mr. J. Baxendell : A new 
Self-recording Anemoscope. 

Thursday, June 22nd. 

Central London Throat, Nose, and Ear Hospital (Gray’s Inn 
Boad).—5p.m. Dr. D. Grant: Diagnosis and Treatment of Danger¬ 
ous Sequelae of Otitis. 

Itecanciea. 

Borough Asylum, Portsmouth.—Junior Assistant Medical Officer. 

Salary, £100, with board, lodging, and washing. 

Borough of Burton-upon Trent.—Medical Officer of Health. Salary 
at the rate of £350 per annum.—Applications to the Town 
Clerk, Burton-upon-Trent. 

County Asylum, BainhilL—Senior Assistant Medical Officer, un¬ 
married. Salary commencing at £225 per annum, with furnished 
apartments, board, attendance, and washing. 

Fisherton Asylum.—Assistant Medical Officer. Salary commencing 
£120 per annum, with board, lodging, and washing.—Apply to 
Dr. Finch, The Asylum, Salisbury. 

Glasgow University. Assistant Examiners!) ip in Medicine, with 
special qualification to examine in zoology.—Applications with 
testimonials must be sent to A. E. Clapperton, Esq., 91 West 
Begent Street, Glasgow. (SeeAdvt.) 

Newport and Monmouthshire Hospital.—House Surgeon. Salary, 
£100 per annum, with board ana residence. 

Owens College, Manchester.—Senior Demonstrator in Physiology. 

8tipend £150 per annum, rising to £200. 

Shaftesbury House Private Asylum, Formby, near Liverpool.— 
Junior Medical Officer. Salary, £50 per annum, with board, 
lodging, and was hin g. 

<2lpp0mtment0. 

Barkley, Jas., L.B.C.P., L.B.C.S.Edin., Senior House Surgeon to 
the Belfast Boyal Victoria Hospital. 

Buck, A. H., F.B.C.S.Edin., M.B.C.S , L.B.C.P.Lond., Assistant 
Surgeon to the Sussex County Hospital, Brighton. 

Daniel, P. L., F.B.C.S., Surgical Registrar to the Charing Cross 
Hospital, London. 

Fison, E. T., M.D.Cantab., F.B.C.S.Edtn., M.B.C.S., L.B.C.P., 
Physician to the Salisbury Infirmary. 

Foster, W. J.. F.B.C.8.Eng., L B.C.P.Lond., Surgeon to the 
Boyal Berkshire Hospital, Beading. 

Forster, E., M.A., House Governor and Secretary to the Wolver¬ 
hampton and Staffordshire General Hospital. 

Habbinson, G. B., M.B.. B.Ch. B.U.L, Junior House Surgeon to the 
Belfast Boyal Victoria Hospital. 

Le Quebne, C. P, L.B.C.P.Lond., M.B.C.S, Medical Officer,. 
Southampton Dispensary. 

gttrtha. 

Cantlie. —On June 15th, at 46 Devonshire Street, Portland Place, 
London, W.,the wife of Jiimes Cantlie, M.B., F.B.C.S., of a son. 
Cooke.— On June 16th, at 69 Bridge Street, Cambridge, the wife of 
Arthur Cooke, F.B.C.8.. of a son. 

George. —On June 15th, at 1 Burton Boad, Brondesbury, N.W.. the 
wife of Alfred W. George, M.D.Edin., M.B.C.S.Eng., L.R.C.P. 
Lond., of a son. 

Taylor.— On June 12th, at the Bed House, Northfleld, near Bir- 
mingham, the wife of John W. Taylor, F.B.C.S., of a son. 

^ftarriages. 

Attfield—Herkomer. —On June 14th, at the parish church, 
Bushev, Herts, Donald Harvey Attfield, M A., M.B., son of 
Prof. John Attfield, F.BS., of Watford, to Elsa Anna Iole 
Herkomer, elder daughter of Hubert Herkomer, B.A., of 
Bushev, Herts. 

Gibson—Pettigrew.— On June 15th, at St. Peter's, Cranley 
Gardens, South Kensington, E. Arthur Gibson, M.D., G1 <sgow, 
to Ellen Shaw, daughter of the late William Pettigrew, of 
Glasgow and Chislehurst 

W.i.liams—Wright. -On June 15th, at St. Anlrew's Church, 
Woo d ha ll Sne, Thomas Kenway Williams, M.B.C.S., L.R C t-. 
Lond. of Nottingham, to Alice Mary, only daughter of the 
Rev. George Armitstead Wright, M.A., of Woodhsll Spa, 
Lines. _ 

Heaths. 

Elliott.— On June 15th, at Beulah Hill, Upper Norwoo 1, George 
Robinson Elliott, M.B.C.S., of Sydney, New South Wales, 
aged 78. 

Ferouson. —On June 7th, suddenly, at Cove, Major Ferguson, 
I.M.S., second son of the late John Ferguson, M.D., M.B.C.S., 
Cove, Kincardine. 

Lane. —On June 17th, Deputy Surgeon General, W. B. Lane, 
M.B.C.S. (retired), aged 66. 

Parr.— On June 10th, at Upper Phillimore Place, Kensington 
George Charles Purr, M.D., aged 56. 

Flatbr. -On June 14th, at Northampton Hospital, of pneumonia, 
Leonard Slater, M.A., M.B.. aged 31, fourth son of Jamea 
Slater, of Bescot Hall, Walsall. 

t.—O n June 13th, at his residence, St. Petrock’s, Llan luduo 
West, Lawson Tait aged 54. 


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Site Medical gliwss and Circular. 

“SALUS POPULI SUPREMA LEX." 


Vol. CXVIII. WEDNESDAY, JUNE 28, 1899. No. 26. 


Bufficientto know that the disease is the same in both 
anginal Viiommumcanons. species, and that the opportunities for transmission 

- from one to the other are numerous, seeing that the 

THE ERADICATION OF TUBER- *£* 

CTTLOSTS eons a ^ ecte d with phthisis. 

^ J It is well to know that all animals are susceptible 

By GEORGE FLEMING, C.B., F.R.C.V.S., LL D., of infection. The ox tribe appears to be easily 

infected, so are young pigs. The horse and dog also 
Late Principal Veterinary Surgeon to Her Majesty’s Forces. suffer, and it was thought for a long time that the 

(Concluded from page 640.) was immune, but is is now ascertained that 

he is liable to ordinary tuberculosis, as distinguished 
It was probably from the wide and intense interest from that experimentally produced. Guinea-pigs are 
taken in tuberculin as a curative agent when it was extremely sensitive to infection, and the disease is far 
first tried, and the corresponding disappointment from uncommon among wild animals kept in cap- 
and regret when it failed, that gradually led to the ' tivity, which are possibly infected by their attendants 
present movement for the limitation or suppression or by the food they receive, as well as by infection 
of the disease, in view of its fatal tendency in such a derived from the contaminated places in which they 
large majority of cases, and the difficulties attending are confined. Even birds are not exempt, and fowls 
attempts at curative treatment. In dealing with i are often affected very extensively, this avian tubercu- 
such a malady prevention must surely be more losishaving been proved to be identical with thehuman 
desirable than futile and expensive curative measures, disease, and it is probably conveyed from man to them. 

There can be no doubt that the recognition of ; Parrots, dogs, and cats have become tuberculous 
tuberculosis as a purely infectious disease is essential through being kept in the same room with phthisical 
in order to establish measures for its eradi- persons, and inhaling expectoration dust, or eating 
cation. It is solely maintained and propagated food which had been partaken of by invalids. The 
by its virulent principle or germ, and destroy that! human being and bo vines are, without doubt, instru- 
or prevent its dissemination and the disease becomes mental in infecting other creatures, and these in 
extinct. Mankind is also undoubtedly the great their turn may infect each other, and also the species 
seed-bed of the disorder, and a diseased person may ! which originally infected them, 
infect many scores of healthy ones before he finally 1 We know not to what extent man is infected from 
succumbs; and this infection takes place all the more i bovine or other animals, but as the disease is 
certainly under circumstances which favour the rapid i more or less readily transmissible from cattle to 
development of the malady and the ready dispersion t different species, experimentally and accidentally, it 
of the germs. Hot, dark, damp, and badly-ventilated , may be inferred that he is equally susceptible to in¬ 
dwellings into which are congregated an inordinate fection from them ; clinical observation affords some 
proportion of insufficiently fed persons, are those in striking instances in support of this inference. Con- 
which tuberculosis will revel when once introduced, j sidering the close relationship between man and 
and the air therein becomes infective. It is so cattle, there is reason to look upon the latter with 
in cattle sheds, and we may presume it must be the i the strongest suspicion, as contributing a large share 
same in human habitations. But at all times the : towards the prevalence of human phthisis. Scarcely 
presence of a phthisical person among those who are | any organ or tissue in the bodies of cattle is exempt 
in any way predisposed is a source of danger unless 1 from tubercle invasion; for though the diseased 
great care is taken. Villemin was the first to suggest, I masses are most frequently found localised in or on 
early in 1870, that transmission of the malady in the serous membranes in the chest and abdomen, and 
nun probably takes place more frequently by the in lymphatic and other glands, yet tuberculous 
matter expectorated by phthisical persons becoming deposits are sometimes observed in muscle, in bone, 
dried, accidentally reduced to duBt, and in this form in or on the skin, and in other situations where they 
carried by the atmosphere into the lungs of healthy i are not usually looked for. 

people. i As infection can take place by consuming flesh, it 

The measures for the suppression of the disease | is well to know that, in all probability, this can rarely 
in mankind, so far as its maintenance depends , occur unless it is very much tainted, as when the 
upon transmission from diseased to healthy persons, ; animal has suffered from generalised tuberculosis, 
are sufficiently obvious. But, as we have just seen, and then it can only be regarded as dangerous if im- 
it is not limited to the human species; it prevails perfectly cooked. Thorough cooking will doubtless 
extensively among cattle, and there is good reason to destroy the bacilli, but as this can be seldom effected, 
believe that mankind can be, and often is, infected especially with large joints, all such meat should be 
through the flesh and milk of these animals when proscribed. 

they are tuberculous. The question whether the It is different with the milk from tuberculous cows, 
disease first appeared in man and he communicated Unless boiled to such a degree that the bacilli are 
it to cattle, or whether it was originally a bovine dis- killed it is not safe to consume it as food, even when 
order transmitted to mankind in the manner we now j the udder is not involved. It must be remembered 
apprehend it is conveyed, cannot be answered satis- 1 that the milk has been proved to be infective when 
factorily, nor is this answer a necessity, so far as pre- only the lungs of the cows were tuberculous, and 
ventive or suppressive measures are concerned. It is when no bacilli could be detected in that fluid. Con- 


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652 The Medical Press. 


ORIGINAL COMMUNICATIONS 


June 28, 1890. 


sequently, to be safe, the milk from all tuberculous 
cows should not be allowed as food to man or beast, 
neither should the products from it—such as butter 
and cheese. 

Butin order to get rid of the danger of tuberculosis 
from cattle, as well as to suppress the disease among 
them, and so avert serious loss of property, well- 
devised sanitary measures, thoroughly and energeti¬ 
cally carried out, are absolutely necessary, and it is 
equally necessary that they should be directed and con¬ 
trolled by a central authority. To entrust their execu¬ 
tion to local authorities without central instruction and 
direction is simply losing time and giving rise to 
disjointed action, by which there will be caused 
much annoyance and expense with but liti-le benefit. 
Our experience of the management of such diseases 
by local authorities has been of a very unsatisfactory, 
indeed, painful character, and there can be no valid 
excuse tor again trusting to it. The object is to 
eradicate the disease from the human and bovine 
populations, and as it constitutes in the latter a grave 
scourge entailing a heavy pecuniary loss, and, besides, 
menaces the public health, it is surely as worthy of 
the attention and control of the Central Government 
as were foot-and-mouth disease and contagious 
pleuro-pneumonia, both of which were not nearly so 
important from a sanitary point of view, and yet 
on their suppression no expense or care were spared. 
In the extinction of bovine tuberculosis we have 
a great diagnostic aid in tuberculin, and the 
intelligent use of this will assuredly avert the whole¬ 
sale slaughter of herds and inhabitants of cowsheds 
which so painfully marked our dealing with the two 
diseases just mentioned when a sick animal was 
discovered in their midst. We can deal with tuber¬ 
culosis in a more scientific manner. Tuberculine will 
demonstrate the existence of the disease in an animal 
which appears to be in perfect health, and in 
which no sign of infection could be otherwise 
detected, one inoculation being generally sufficient, 
and the result known within twenty-four hours. This 
is an immense advantage, as it enables those who are 
engaged in investigating the extent of the disease in 
a cowshed or herd, to point out which animals are to 
be suspected and separated from those which do not 
react to the inocnlation, and to adopt the other 
measures required. The test is probably not alto¬ 
gether infallible, for in bad cases it does not give a 
marked reaction, but this is of little importance; as 
the usual symptoms are then so evident that 
there should be no difficulty in distinguishing the 
disease. In some instances animals which have 


should be taken with regard to cleansing and disin¬ 
fection of the place they inhabited. Cleanliness, 
good light and ventilation, as well as good food and 
intelligent management of cattle are obviously 
necessary to preserve their health and prevent the 
spread of disease among them, but above all things 
it is essential to get rid of those which are tuber¬ 
culous. This can only be effected, as has been 
insisted upon, by judiciously framed legislative 
measures carried out by the central authority of the 
Governments© as to ensure uniformity and efficiency. 

The suppression of the disease in man renders 
it necessary that it should be dealt with as an 
infectious malady, and that sanitary and preventive 
measures be observed, especially in schools, workshops, 
and other places where numbers of people are con¬ 
gregated, and that sanitation be carried into dwellings 
which are damp, dark, and insufficiently ventilated. 
People who are tuberculous should be kept apart 
from the healthy as much as possible, and especially 
from young persons, and in hospitals they ought not 
to be admitted among patients affected with other 
diseases, but kept in special wards or buildings. 

With regard to cattle the disorder must be included 
in the Contagious Diseases (Animals) Act, for surely 
it merits this inclusion more than any of the dis¬ 
orders therein enumerated; and as its suppression 
mustentail the compulsory slaughter of badly diseased 
animals, it is only lair that proper compensation be 
given, as has been done in eradicating the other 
scourges comprised in that Act. That tuberculosis 
can be got rid of there can scarcely exist a doubt; 
but in order to attain this most desirable consumma¬ 
tion the intelligent co-operation of the public must 
be enlisted, and especially that of the owners of cattle, 
whether they be breeders, feeders, or keepers of dairy 
stock, as they will have to submit to some incon¬ 
venience and trouble, though they will be the 
gainers in the end. There is no reason at all 
for delay in commencing operations, as everything 
to be known regarding the disease and the measures 
by which it may be successfully combated, has been 
in our possession for years, and if we continue to 
suffer from its ravages, and lament the loss of human 
lives that its presence entails, this must be ascribed to 
our own supineness and neglect. The longer we pro¬ 
crastinate, the greater will the loss be, ana the more 
difficult will the task become. 


A NEW METHOD OF 


given the customary reaction had been found, after 
being slaughtered, to be apparently free from tubercu¬ 
losis ; but this was, in all likelihood, because a suffici¬ 
ently careful examination of the carcase was not 
made, as in many cases tubercle may be present in an 
early stage of formation, perhaps in unusual parts of 
the body, and so elude observation. Such cases have 
been reported. 

In employing tuberculin, care will have to be taken 
to prevent fraud, especially in concealing the exis¬ 
tence of the disease in tuberculous animals about to 
be sold or exported, as when once they have reacted 
they will not do so again for some time; so that in the 
interval they may lie disposed of as free from the 
disease. Its use should therefore be restricted to 
those who can be depended upon to use it properly 
and honestly, and only with the object of diagnosing 
the malady. 

Cattle which react to tuberculin should be segre¬ 
gated, and if giving milk this should not be used as 
food ; the animals themselves, if in good condition, 
should be sent to the butcher, the distribution of 
their flesh as food depending upon the extent and 
character of their disease, wh le every precaution 


VENTILATING SEWERS, (a) 

By SIR CHARLES A. CAMERON, C.B., M.D., 
F.R.C.P., F.R.C S.I., D.P.H.Camb., 

President of the Boyal Institute of Public Health. 

The ventilating openings in the street sewers, 
which are now so general in almost every town in the 
United Kingdom, have not met with universal 
approval. When first used, many complaints were 
made of the unpleasant odours emitted from them. 
The late Sir Robert Rawlineon was wont to say when 
such a complaint was made, “ Put more ventilator* 
in the sewer.” No doubt the larger the number of 
ventilators the less the odours from anv one of them. 
If they were altogether open it would he better than 
their present state of being open only at certain 
points. The houses opposite these points receive 
more than their due share of whatever comes out of 
the sewer, whereas if the sewer were as open as a 
ditch, every house would be treated alike to the 
emanations, if any, from it. 

(a) Paper reed at the Boyal Institute of Architects of Ireland. 
May 25th, 1899. 


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June 28, 1890. 


ORIGINAL COMMUNICATIONS. 


The Medical Press. 66b 


I am bound to say that as a rule there are no sen¬ 
sible nuisances caused by the street sewer ventilators; 
but there are occasional exceptions to this rule. Now 
and then persons complain to the Public Health 
Committee that the ventilators near their houses are 
offensive. On examination these complaints are 
generally found to be justifiable. Ordinary sewage 
generally has very little odour until it becomes stale; 
but now and then what may be termed exceptional 
sewage, having an offensive odour, flows through 
sewers in our streets, and it is chiefly from such 
sewage that the offensive emanations come through 
the ventilators. 

The chief object in the use of ventilators is to pre¬ 
vent a greater pressure of the air of the sewers than 
that of the external atmosphere. It is assumed that 
the gases generated by the fermentation of the organic 
matter always present in sewage might cause the 
sewer air to acquire sufficient pressure to force the 
traps on the bouse drains connected with the sewer 
1 have always doubted very much that the sewer 
gases could acquire a pressure sufficient to dis¬ 
place two or three inches of water. I have 
made many experiments in reference to the so-called 
pressure in the air of sewers. I have had the 
sewer ventilators closed on considerable lengths of 
sewer mains, and have inserted delicate pressure 
gauges in them. I never observed any pressure ex¬ 
cept of the most trifling kind, in the air of the sewers 
when the ventilators were closed. I did. however, 
notice that in the early morning, air often passed into 
the sewers from the streets. This descent of the air 
into the sewer I attributed to the insuction of air 
from the sewer into houses, the drains of which were 
untrapped or provided with defective ones. When 
the fires began to be lighted in the kitchens, air was 
drawn intotbe street sewers, especially in those parts 
of the City inhabited by the poorer classes. According 
to my experience, the pressure which occasionally 
may be observed in the sewers is sometimes caused 
by the wind. When a strong gale is blowing, gusts of 
wind enter the sewer through the ventilating 
opening. 

The second object in ventilating sewers is to pro¬ 
tect the workmen engaged in cleaning or repairing 
them. I greatly doubt that the emanati' ns from 
ordinary sewage are so abundant and dangerous as to 
imperil life or health. The manholes should, of 
course, be open for some time before the sewer was 
entered. Death of workmen from inhalation of sewer 
gases have not been infrequent, but it has been 
caused not by ordinary sewage air, but by sul¬ 
phuretted hydrogen set free from refuse from gas 
works, or from waste gases from gas engines allowed 
improperly into sewers, or from other exceptional 
causes. 

It is worth noting in connection with the subject of 
this paper, that the sewers of one city, as large as 
Dublin, are not ventilated at all. This city is Bristol. 
Its sewers discharge their contents into a tidal liver, 
in which the water rises so high that for a large por¬ 
tion of the day the sewage cannot escape into the 
river. Bristol enjoys a remarkable immunity from 
typhoid fever, and I am informed that no injury to 
the health of the workmen who cleanse the unventi¬ 
lated sewers has taken place. 

Notwithstanding the experience of Bristol. I con¬ 
fess that I am in favour of the ventilation of street 
sewers, though not by the means now generally em¬ 
ployed. I object to the ordinary sewer openings in 
streets which are narrow and confined, and I have 
suggested another method of ventilation, which my 
colleague, Mr. S- Harty, city engineer, has approved 
of, ana uses under c ertain circumstances. In order 
to explain my system it is necessary to say a few 
words in reference to the passage of gases through 
certain solid substances. If we take a gas, say 


oxygen or hydrogen, and enclose it in a vessel of 
metal, glass, or glazed porcelain, it will remain 
there for an indefinite period : but if the vessel 
is composed of unglazed porcelain or plaster of Paris, 
the gas will rapidly pass out of it. If a galvanic porous 
cell be connected with a glass tube, the latter filled with 
wuter, and its open end sealed in water, and a vessel of 
coal, or hydrogen, gas be placed over the cell, the 
water will be immediately expelled from the tube. 
This phenomenon is explained as follows :—All gases 
difEuse in right lines in all directions. The lighter 
gases diffuse more rapidly than the heavier ones, and 
all pass through porous materials. As coal gas is 
lighter than air. it passes more rapidly into the cell 
than the air in the cell passes out of it, and therefore 
pressure is caused, as shown by the expulsion of water 
from the tube. 

I have applied this property of the diffusion of 
gases through porous materials to the ventilation of 
sewers. Cylinders, composed of a mixture of two 
parts of porcelain clay and one of sulphate of lime, 
18 ins. in height and 6 ins. in diameter, are used. 
Four or six are inserted in the crown of the sewer, 
and in a chamber resembling that used for the ordi¬ 
nary ventilators. The rain that enters the chamber 
from the street is carried into the sewer through 
a small syphon, and no wet can get at the 
cylinders. As the cylinders allow air to pass 
freely through them, but effectually bar the pas¬ 
sage of micro-organisms, there can be no greater 
pressure in the sewer air than in the street 
atmosphere. Air continuously comes out of the 
sewer, filtered through the cylinders, and air as con¬ 
tinuously enters the sewer through the porous vessel. 
The action of the filter on the air resembles the 
action of a Pasteur filter on water. The Bewer 
diffuser ventilator is manufactured by Messrs. 
Doulton, of Lambeth, London, and Burslem, Staf¬ 
fordshire. 

The “fresh air inlets’* of the house drains are 
often the outlets for foul air. When they are placed 
in the basement areas of houses they not infre¬ 
quently cause an unpleasant odour. Whenever 
a w.c. is flushed the air in the soil pipe is forced 
out through the inlet into the external air. 
Mica valves are occasionally used at the inlets 
to prevent the gases from the soil escaping into the 
atmosphere. They are never air-tight, and soon go 
out of order. A better protection against the emis¬ 
sion of foul air through the inlet would be a porous 
plate such as is used in the diffuser ventilator. As 
every precaution is usually taken to prevent even a 
“ pin-hole ” in the soil pipe, it seems contradictory 
that a large opening should be made in it. In con¬ 
clusion, I may state that the sewer diffuser ventilator 
has given satisfaction in Dublin, and has been found 
efficacious. They have been in use for the last two 
years, and, on examination, have been found to remain 
quite clean. 

GENERAL DISORDERS, ORIGINATING 
IN DISEASE OF THE FEMALE PELVIC 
ORGANS, (a) 

By Dr. MENDES DE LEON, 
of Amsterdam. 

Mr. President and Gentlemen, —Although much 
honoured by your invitation to read a paper before this 
Society, it was long before I could make up my mind to 
accept it, being hilly aware of the great difficulty in 
finding a subject worthy of detaining your attention. 
As a faithful reader of your admirable journal I cannot 
doubt that every topic of interest has been already die- 

fa) Paper read before the Britirh Gyua-cologicbl Society, June 
8th, 1899. 


664 Thk Medical Press. ORIGINAL COMMUNICATIONS. 


cussed, that all scientific news reaches this important 
centre from all parts of the medical world, so that I do 
not for one instant flatter myself my communication 
will possess the interest of novelty, and merely propose 
to lay before you some results of my own experience on 
a field of investigation which has had its ablest explorers 
among yourselves. 

Although it may be safely averred that the practice 
of specialising in medical science is daily gaining favour 
for the last twenty-five years, and that it is a step in the 
right direction, we must not wholly forget that it is 
not always without its disadvantages. 

Constant concentration of all our energies on the study 
of one particular organ, may, to a certain extent, be 
prejudicial to the demands of the general constitution. 

We become one-sided in our views, and think, like 
Mephistopheles, we can “ AUes curiren aus einem Punkt.” 
On the other hand it will be conceded that the 
(general) practitioner will most likely fall into the other 
•■xtreme—thereby neglecting to pay due attention to 
the morbid condition of a particular organ, in which 
often resides the cause of general-ill-health. 

For it is not with man as with some lower animals, 
where the separate organs exist independently (to a 
certain extent) of each other. On the oontrary, it is of 
vital importance to a generally healthy condition that 
each and every organ should be in good working order. 

This being true for the physiological functions it is 
almost equally so, although not so easy of demonstration, 
with regard to pathological processes, and though it 
often occurs in cases under observation that certain 
affections remain for some time limited to one particular 
organ, it will nevertheless be found that ultimately the 
whole system suffers, through some reflex or more direct 
action. 

There is no necessity to insist upon the fact that the 
conditions of the generative organs in woman which even 
in good health have so strong an influence on the whole 
constitution, should, when affected, awake sympathy in 
distant organs, especially when taking into acoount the 
modes of innervation. 

We are not quite certain by which ways the reflex 
action leads from the internal sexual organs to distant 
organs, although it is oertain that the sympathetic 
nervous system is an important factor. It is universally 
recognised that the whole genital system is innervated, 
particularly by branches originating in the plexus sper¬ 
ms tic us and the plexus hypogastricus. By the first 
mentioned, ovary and tube are chiefly supplied. The 
second form on both sides of the lig. latum an impor¬ 
tant network of nerves, the plexus utero-vaginalis, where 
also congregate smaller branches of the plexus sperma- 
ticuB, continuing its course through the layers of the lig. 
latum to womb and vagina. 

The sympathetic nervous system must, therefore, be 
considered as the track along which is flashed the irrita¬ 
tion originating in uterus and appendages, in a different 
direction. 

It is now seven years sinoe I first endeavoured to 
show, statistically, the very frequent occurrence of 
affections of the reproductive organs in woman. Since 
then there has been ample proof of my conclusions 
being correct. How can it, indeed, be otherwise, if 
we consider the enormous stress brought to bear on the 
internal serual organs, not only by their complicated 
functions, but also by the many noxious influences to which 
they are exposed, and in the first place the fact that the 
peritoneal cavity is by way of the ost. abdomin. tubee 
in continual contact with the outside. 

From these facte we are naturally led to conclude that 
in all cases where the morbid symptoms do not point 
decisively to definite affections of remote organs, they 
must be investigated anew, from a gynaecological point 
of view and similarly, when the hitherto adopted therapy, 
based on the conclusion that distant organs had been 
solely affected, has not led to satisfactory results, gynae¬ 
cological treatment should follow. 

These considerations gradually gaining ground and 
recruiting more and more adherents in the medical pro¬ 
fession as time goes on, it could only be expected that 
gynaecology should conqner, as it has done, an important 
rank among the independent sciences. 


Junk 28, 1899. 

We have only to be careful that a trop de tele, or mis¬ 
placed optimism, should not lead to overstepping the 
limits of our field of action. 

This is why I wish to bring before your notice that 
anomalies of the pelvic organs, although insignificant 
quoad functionem and quoad vitam, may nevertheless 
be the cause of serious disturbance to the general state 
of health. These disturbances which I have already 
qualified as distant symptoms, are generally to be recog¬ 
nised by nervous complaints, functional disorders of the 
nervous system, which very often, through summary 
diagnosis, cause the patient to be unjustly branded as 
hysterical. 

To my great satisfaction I see my opinion on this 
particular side of the question viewed in the same light, 
and even expressed in almost the same words by Dr. Mac- 
naughton-J ones, who writes in his interesting paper on 
uterine reflexes; “ It is something more than injustice 
to her (a woman) if we deliberately and complacently 
ignore the influence that such local disease exerts in 
exciting morbid impulses in her oentral nervous system.” 

In order to elucidate this question, I propose to give 
a brief sketch of what has been written latterly on the 
relationship of genital affections with disorders of other 
organs adding the result of my own experience. 

To take the bull by the horns, we will start by dis- 
ouBsing the abnormalities of the nervous system. These 
have long constituted the bone of contention between the 
specialist and the general practitioner, and a cause 
of dissension among specialists themselves, gynaeco¬ 
logists and neuropathologists alike. It has been long 
an established fact that the genital organs even in the 
exercise of their normal functions are frequently the 
agents of psychical disturbances. We know all about 
the pyschoses of pregnancy and of the puerperal con¬ 
dition, and are aware that the climacteric period can be, 
with predisposed persons, the time of life when neuroses 
or even more severe psychical troubles arise. 

It is not even necessary to be one of the medical pro¬ 
fession to note the powerful influence exercised by 
sexual life on the nervous system of women. 

The consequences are often too serious to be set aside. 
They govern both intimate and social intercourse. The 
subject has engrossed the attention of novelists, at least 
on the other side of the Channel; has taken possession 
of the stage with, to my thinking, disastrous results 
with regard to healthy physical ana moral life. 

It follows naturally that sexual suffering should de¬ 
mand a still greater degree of attention in the patho¬ 
genesis of psychoses. The only difference of opinion 
exists as to the frequency of its occurrence. 

Neurologists and gynaecologists take opposed views, 
and on both sides there is much exaggeration to be 
regretted. 

Whilst the neuropathologist will scrupulously avoid 
all local treatment, for fear it should aggravate the 
psychical troubles, many gynaecologists exaggerate the 
importance in one or other form of sexual troubles re¬ 
garded in the light of an etiological symptom. 

Hegar, in his excellent paper on this subject, gives the 
following resums of his observations :— 

“ Der Eine hat guten Erfolg mit seiner das Allgemein- 
befinden, und das nerven System allein berflcksichti- 
genden Bebandlung und der Andre heilt die an- 
scheinend sehr schweren Leiden durch einen Ring oder 
einen vielleicht ungefahrlichen operativen Eingriff. 

“ Jeder beurtheilt nur die an die Disciplin oder deren 
Vertreter nach solcher Yorkomniseen, und bedenkt 
nicht dass er nur die von dem Andren nicht gebeeserten 
Kranken zu Gesicht gekommt, w&hrend er die Geheilten 
nicht sieht.” 

Investigations made by several writers on the fre¬ 
quency of genital affections among the insane, vary 
considerably as to the result. 

Eisenhardt gives the following:—( “ DieWechsel bezie- 
hungen Zwiscnen intemen und gynsec. Erkrankungen ” ) 
In 100 cases of psyohosis with genital abnormalities, 
Claus found 15; Kerkley, 27; Gnauch and Rippug, 33 ; 
Hertz, 63; Rohe, 74; Danillo, 80, mostly cases of chronic 
inflammation and displacement of the womb. The 
nervous disorders were principally epilepsy, hystero- 
epilepsy, hypochondria, hysteria and neurasthenia. 



Junk 28, 1899. OfilGINAL COMMUNICATIONS. ■‘Thk Medical 665 


Setting aside the probabilities of accidental co-exis- 
ience of causal nexus in the cases above mentioned, the 
•ciphers seemed to me so extremely divergent, that I 
■could not rest without investigating for myself. 

I was fortunate in finding a wide field at Amsterdam 
Lunatic Asylum, which was kindly placed at my disposal 
by the director. 

The result was, however, not wholly satisfactory, 
owing to the difficulties of examination. Many of the 
patients could not be submitted to it without the aid of 
anaesthetics, and of course it would not do, for the sake 
of gratifying scientific curiosity, to place under chloro¬ 
form either the recalcitrants or virgins with narrow 
introitus. 

The Asylum numbers GO female patients, 41 of whom 
seemed to be suitable subjects for this examination. 

Of these, thirteen were intact virgins, who could not 
easily be submitted to bimanual examination, which 
r> ade it difficult to discover possible disorders of 
the adnexa, and rendered the use of the speculum impos¬ 
sible. One had acute vulvo-vaginitis, and with the 
others I found a small anteflexed uterus. 

There were also eight cases of senile atrophy, remark¬ 
able for their existence at a comparatively early age. 
(One of the patients was 36.) 

In the twenty-one remaining cases were found four 
displacements and nine chronic inflammatory diseases 
of the uterus or appendages ; with the eight others no 
genital disorder was discernible. 

In calling attention to these facts it is not my purpose 
to draw conclusions. In order to do so they would have 
to be substantiated by longer observation. I only wish 
to point out that in many instances there was marked 
corelation between the genital and mental disorders, 
a 1 though in others it could be attributed to casual com¬ 
plication. 

As a general rule, it can be stated that psychic or 
nervous troubles arising from disorders of the sexual 
organs have only been observed in predisposed per¬ 
sons, i.e., those with neuropathic tendencies, or 
else hereditary taint, and are rarely if ever found 
with a thoroughly healthy condition. The local 
symptoms that precede neurosis are, in the first 
place continual hemorrhage and purulent discharge, 
also nerve irritation and neuralgia caused by pressure or 
stretching; therefore the symptoms observed in tumours 
or exudates, but more than all in uterine displacements. 

An inquiry into the nature of the influence exercised 
by gyr recological treatment in cases of psychoneurosis 
is of great importance. It is generally considered that 
constant manipulation of the genitalia, particularly 
massage, ought to be avoided in cases of nervous or 
hysterically-inclined persons. 

To my thinking the psychic influence of this treatment 
has been judged erroneously. Personally, I am not an 
advocate for gynecological massage, the result being too 
uncertain, and the mode of treatment painful for the 
patient and fatiguing for the physician, whilst it also 
takes up a great deal of time, although I do not uncon¬ 
ditionally subscribe the assertion that it .produces 
hysteria. 

But neither do I admit that, as some gynaecologists 
advise in these cases, total extirpation of the womb 
should be resorted to as a last resource. Why ? I ask ; 
if treatment of the diseased organs only serves to aggra¬ 
vate the original disease instead of affording relief, how 
can it be thought that total ablation can cure it. Can 
any one seriously entertain the idea that removal of the 
uterus can cure hysteria ? 

Statistical researches have been instituted in England 
and America concerning the occurrence of psycho-gynae¬ 
cological operations, with the following results :—Savage 
found, after 500 abdominal sections, four cases of mental 
derangement. Kinkley only one in 596. Investigation 
by Roke (New York Medical Journal, October 14th, 1893) 
shows the more important fact that in all the lunatic 
asylums of the United States and the English colonies, 
in the course of ten years, only 25 patients were regis¬ 
tered who had become insane, after a gyntecological 
operation. To Czempus-Ebell’s observation that peri- 
neo-plastic operations are liable to bring about psychoses, 
I can but add the result of my own experience, 


which shows in 85 perinteorraphies, only one case with 
this complication. This occurred where curettage had 
been previously practised, necessitating the use of 
anaesthetics twice in four weeks time. As for the rest, in 
rather a large number of benign and also more serious 
operations, I have never observed the appearance of 
psychical troubles. 

On the other hand, recovery from neurasthenia has 
often resulted from gynaecological interference. It wotild 
take up too much of your valuable time to make any 
reference to the numerous bibliographical communica¬ 
tions on the subject, and it will be sufficient for my 
present purpose to remind you of the wordy war that 
still continues to be waged on the subject of the indica¬ 
tions and prognosis of castration for psycho-neuroses. 

Battey, and (about at the same time) Hegar were the 
first who published the results of their experience. 
Since then casuists are continually increasing in number. 

One hundred and forty-seven cases have been tabulated 
by different authors, showing eighty-two cures, twenty 
improved conditions, twenty-five with no improvement, 
six worse since the operation, and fourteen where the 
result had not been known. Personally I have but once 
practised castration for a case of hystero-epilepsy, but 
although the operation was successful and the patient 
made a good recovery, the final result was not satis¬ 
factory, as she had a fit once afterwards, shortly before 
the menses which continued pretty regular, notwith¬ 
standing the removal of the adnexa. 

In the greater number of my cases I have seen mental 
troubles disappear after gynecological treatment, but 
will only refer to the following, as being the most typical. 

Miss v. H., ret. 37, suffered many years from chronic 
oophoritis and peri-obphoritis dextra, causing violent 
painB, emaciation, and all the typical symptoms of neu¬ 
rasthenia. Careful local treatment had been of no avail; 
the patient, a highly intellectual person, became worse 
and worse, her condition degenerating into complete 
melancholia, until she only longed for an end to her un¬ 
happy and useless life. 

On ber own express desire, as a last chance of regain¬ 
ing her energy, castration was practised February 17th, 
1890. Eleven months later she wrote to tell me she felt 
thoroughly well in health and spirits, and, as nurse at a 
hospital, was able to undertake all her duties, even those 
making a demand on muscular strength. 

With regard to its etiology Basedow’s disease should 
be mentioned among the foremost of nervous maladies 
that stand in relation to genital disorders. 

It attacks women four times oftener than men, gener¬ 
ally between the ages of 16 and 30, and frequently occurs 
as a complication with pregnancy. Menstrual disturbances 
constitute one of the principal symptoms, and it has 
often been observed in cases of amenorrhoea that the 
characteristic symptoms of the primary illness, exoph¬ 
thalmos, struma and tachycardia increase with the 
return of the menses. Some writers, for instance, 
Eulenberg and Mathieu have observed the occurrence of 
morbus Basedowii after a gynaecological operation, but 
on the other hand a greater number of recoveries are 
due to gynaecological interference, in cases where it has 
been coexistent with genital disorders. 

To these I can add a case of my own, where in view of 
the result obtained, there could have been no doubt 
whatever as to the causal relationship. 

Mrs. De H., from Medan, was sent to me with sym¬ 
ptoms of chronic endometritis, and subinvolutio uteri, 
post abortum; added to these, the symptoms of morbus 
Basedowii were beginning to make their appearance, so 
that her return to Europe could be no longer delayed. 
After curettage in October, 1893, all bad symptoms had 
disappeared in the space of a few months. Since her 
return to India I received information that she had been 
confined of a living full-grown child. 

In another case of fibro-myoma uteri I found also con¬ 
siderable thyroid enlargement. 

The patient came under my charge, and I removed per 
laparotomy, March, 1892, a large myoma, quite filling 
up the 8mall pelvis. Two days later the struma was 
much smaller, and, since, there has been no recurrence. 
Affections of the peripheric nerves are also found asso¬ 
ciated with sexual disorders. Ischias, intercostal- 

^ C 




June 28, 1899. 


ORIGINAL COMMUNICATIONS. 


666 The Medical Pbkss. 

neuralgia, hemicrania, Ac., are not only founded on 
hysteria, they also appear sometimes as characteristic 
reflex-phenomena. 

Odebrecht communicates a case of trigeminal- 
neuralgia which disappeared subsequently to ventrofixa¬ 
tion, after pessaries had been previously applied in vain. 

Foremost among the organs that either by direct or 
reflex action, are liable to be affected by Bexusd disorders, 
is the eye. 

The pathological changes in this organ which are 
sometimes due to disturbances of the circulation and 
sometimes purely functional, consist, in the worst cases, 
of iridochoroiditis, and can sometimes lead to atrophy 
of the opticus. Chronic amemia, induced by menor¬ 
rhagia or metrorrhagia, therefore principally the result 
of neoplasms and pseudo-endometritis, may also be the 
cause of dire misfortune to the organs of sight, either in 
the form of accommodational disturbances or inflammatory 
processes, amblyopia or amaurosis, whilst optic-apoplexia 
even solution of the retina, iritis and keratitis have been 
found in association with abrupt suppressio menses. I 
have in my practice numerous cases of choroiditis, iritis, 
episcleritis, where on evidence of the therapy that had 
been employed, the origin could be traced to chronic 
endometritis. 

With regard to circulation, acceleration of the heart 
action is the most prominent feature, I have frequently 
observed troublesome palpitations give way, on recovery 
from chronic endometritis. Structural changes of the 
heart can also be accounted for by the existence of 
genital disorders. 

A well-known sign of myoma uteri is the brown atrophy 
of the cardiac muscle which has been accounted for by 
the decrease of hemoglobin in the blood, and whereby 
the muscle is condemned to harder work with less 
nourishment. Next come disturbances of the digestive 
organs, in the list of evils to be brought home to sexual 
disorders. Hildebrandt is right where he asserts : “ Bei 
magenleidende Frauen sollte man fiiglich wegen der imge- 
meinen Haufigkeit in welcher Magenleiden folgen von 
Erkrankungen des U terus sind, niemala eine U ntersuchung 
der Genitalitin unterlassen, auch wenn sonst keine 
symptome auf eine Erkrankung der Geschlechtsorgane 
hinweisen.” 

Gastric disturbances are mostly brought about by 
reflex action and are chiefly observed with nervous 
persons. According to Graily Hewitt 14 per cent, of the 
sufferers from uterine disorders complain of troubles of 
the digestive organs, the minor symptoms being a feeling 
of heaviness on the stomaoh, pains, nausea, Ac. In many 
of these cases the symptoms become aggravated to such 
an extent, that even if life itself is not threatened, it 
becomes a burden to the sufferer. 

The lightest food cannot be retained, emaciation and 
cachexia set in, bringing on mental depression that 
sometimes ends in true melancholia. 

In none of these cases were any perceptible change in 
the secretions of the stomach observed. 

Neither the secretion of hydrochloric acid nor that of 
pepsine has been in any degree modified. The trouble 
originated in affections of the endometrium, or with dis¬ 
placements, particularly with retroflexion, and numerous 
are the recoveries due to timely and efficient treatment 
of the primary' disorder. I will now only mention one 
case which seems to me particularly characteristic. 

Miss v. d. F., set. 39, came to my clinique to be treated 
for uterine haemorrhage. She had always menstruated 
over-abundantly; since two years profusely and in 
advance, and for the last year she was continually losing 
blood, the menstrual type being still recognisable by 
exaggerated bleedings every three weeks. In August 
violent flooding, which greatly reduced her strength 
Between times she had a profuse greenish watery dis¬ 
charge. Great suffering was caused by a very bad state 
of the digestive organs, which she dated from her 
eighteenth year, when after a fall from a ladder, she had 
been carried home senseless. Ever since she had been 
unable to retain anything but liquid nourishment, and 
had occasionally vomited blood. On examination the 
uterus was found movable and unenlarged. Curettage 
on August 15th, removed a quantity of friable mucous 
membrane. The uterine cavity was then stuffed with 


iodoform gauze, and treatment continued by cauterisa¬ 
tion with chloride of zinc. The scraped-out membrane 
was microscopically examined, and found to contain 
besides portions of healthy tissue typical cancerous 
gland-tissue. 

The entire movability of the uterus seemed to give 
the ideal indication for total extirpation, although the 
severe digestive troubles gave matter for serious de¬ 
liberation. As long as she had been in the clinique the 
patient was unable to retain any food, not even milk or 
eggs, which were usually vomited during the night or 
towards morning in the form of a foul-smelling, frothy 
mess. The tongue was white and furred, and the appear¬ 
ance of the patient enfeebled and cachectic. A com¬ 
plication with carc'noma ventriculi was naturally 
thought of, but there were no symptoms of a tumour in 
the regions of the stomach, neither were there traces of 
blood in the vomit. The difficulty lay in solving the 
problem of etiological co-relation between eventual 
cancer of the stomach with the evidently young carci¬ 
noma of the uterine mucosa. 

After mature consideration I concluded for the total 
extirpation per vaginam, which I performed January, 
1894. 

The patient made an excellent recovery, and was quite 
well when she left the clinique at the beginning of 
February. Remarkably enough, there had been no more 
vomiting since the operation; not only milk and eggs 
were retained, but a careful experiment with more sub¬ 
stantial food was successfully sustained. 

Desirous to know the ultimate result, I wrote to the 
family doctor, who replied in June, ’96, to the following 
effect:—“ Miss F. has been in good health ever since her 
return home, and has not required any medical assist¬ 
ance. 1 have had the opportunity of seeing her twice 
or three times every week for the last two years, as her 
mother is a patient of mine. She is looking remark¬ 
ably well, all digestive troubles have ceased except 
occasional constipation, which is easily conquered by a 
mild purgative. There i6 every reason to trust to the 
nonrecurrence of carcinoma, as since the operation, not 
one bad symptom had appeared. 

It is sufficiently obvious that frequent disturbances of 
the urinary excretions and secretions should occur when 
taking into consideration the anatomical relationship of 
the bladder and urethra, with the internal generative 
organs. 

Leaving aside the numerous direct troubles such as 
urine retention in cases of tumours or retroflexio uteri 
gravidi, prolapsus vaginas, with cyBtocele, cystitis 
resulting from blenorrhagic infection, and pruritus vulvse 
from diabetes, we have pathological deviations in the 
uropoietic organs of which some can be considered as 
ieflex-symptoms. 

Tenesmi ad vesicam, as well as polyuria and anuria, 
are frequently observed to be symptoms of endome¬ 
tritis, which disappear with the disease, in the same way 
as retentio urinse occurs after various gynecological 
operations. 

Pathological deviations of the genitalia, besides their 
disturbing influence on the functions of the bladder, 
produce anomalies 6f the kidney which can be easily 
traced to the same origin. 

Virchow first pointed out the origin of hydronephrosis 
in prolapsus vagina? and hypertrophy of the portio 
vaginalis and supra-vaginalis uteri. Freund and Hilde¬ 
brandt communicated cases of hydronephrosis resulting 
from the bending of the ureters in cases of retroflexio 
uteri. 

The wandering kidney is often found associated with ‘ 
disease of the female sexual organs, especially displace¬ 
ments of the womb. Landau has observed the wandering 
kidney 273 times in women to 41 in men—and accord¬ 
ing to Suker's statement, 85 per cent, of sufferers are 
women. 

The dislocation of the kidney has been ascribed to 
various reasons, among others, individual disposition and 
inappropriate clothing, also to a decrease of the intra- 
abdominal pressure or rapid decrease of the fatty 
tissues. 

The first symptom appears in persons with flabby 
abdominal walls, generally accompanied by relaxation of 


Digitized by GiOOgle 



June 28, 1899. 


TRANSACTIONS OF SOCIETIES. The Medical Press. 667 


the peritoneum and its duplicates, which support the 
abdominal organs. 

"When we consider that this slackening mostly occurs 
after pregnancy or the removal of abdominal tumours, 
we have not long to seek why women are such frequent 
sufferers from the rein-mobile. 

Thiriar also indicates causal relationship between rein- 
mobile and disorders of the sexual organs, and observed 
that after nephropexy there came a simultaneous end to 
menstrual anomalies and chronic inflammation of the 
mucous membrane, and he explains this connection by 
pressure from the dislocated kidneys on the vente of the 
plexus spermaticus. 

Before concluding, I would call to mind the frequent 
occurrence of some skin diseases under the influence of 
pathological deviations of the generative organs. 

It is known by every one that many women have 
during the menses a bad complexion and not infre- 
frequently eruptions. 

Pigmentary formation, chloasma uterinum, and dis¬ 
coloration of the linea alba, are universally recognised 
among the symptoms of pregnancy. Hebra, in 1855, 
first called attention to the causal relation between a 
certain class of skin diseases and disorders of the 
genitalia. 

Among others, he mentions a case of eczema and 
urticaria which was completely cured without local 
treatment by the removal of an inefficient pessary. 

Later on, Schauta investigates, and is able to make a 
statement proving undeniable correlation in 26 cases, 
where the genital disorders were mostly retroversio, 
chronic endometritis, salpingitis, and principally myoma 
uteri. 

In the selection of my subject I have been chiefly 
actuated by the desire to make use of this opportunity 
to speak to you of my views on a matter I have always 
had very much at heart, and to express my entire con¬ 
cordance of opinion with Dr. Macnaughton-Jones, by 
whom you have been addressed in a far abler manner, 
and others, who think with me, that all the varied forms 
of misery, liable to be brought about under the influence 
of a pathological condition of the sexual organs, on the 
whole constitution of a woman, cannot be overrated; 
or, to quote once more Dr. Macnaughton-Jones, “All we 
know of the physiology of uterine action, compels us to 
regard the uterus and ovaries as the strongest links in 
the chain of the woman’s health of mind and body.” 

Nothing can be further from my meaning than to in¬ 
sinuate that every ailing woman should be submitted to 
a gynaecological examination. Far from that; however 
undeniable it is that any organ may be influenced by 
sexual diseases, objective examination would reveal a 
marked difference between these symptoms and the 
symptoms belonging to primary disorders of these 
organs. It would never enter my head to suggest the 
necessity of gynaecological examinations to a woman who 
came to me with the characteristic symptoms of gastric 
catarrh, or a well-defined heart disease, and even should 
there be evidence of a co-existent abnormality of the 
generative organs it might turn out to be after all a 
chance complication. 

On the other hand, when objective examination of the 
distant organs and haphazard therapy have merely led 
to negative results never should the importance of a 
gynaecological examination, ad ultimum refugxum, be 
allowed to pass, even in cases where there have been no 
subjective symptoms of genital disorders. 

Positive results will often be obtained by taking 
this measure, after which there still remains to be 
solved the question of etiological relationship; and 
if, therefore, the abnormality that has been revealed, 
is of a nature to legitimate local treatment, according 
to my conviction the answer should be a decided “ yes.” 
Now that it is universally recognised what important 
factors the sexual organs either in a diseased or healthy 
condition are in the organism of women, bearing in 
mind this unmistakable truth, no physician has the 
right to deny his patient, perhaps the only chance of 
delivery from a burden of physical and even mental 
misery, sufficient to poison her life. When choice lies 
between an operation or any other mode of treatment, it 
should be remembered that where there is excessive 


nerve-irritation, hysteria or neurasthenia, the first is 
preferable, when it has been proved that a short course 
of local treatment has not borne satisfactory results. 

I have, lor instance, observed the so called uterine 
dyspepsia resist for months, continued cauterisation of 
the endometrium, when curettage being tried, the 
desired effect was easily obtained. 

Needless to add that I am always careful in drawing 
conclusions from first favourable results; unfortunately 
enough my patients have sometimes returned after an 
interval of good health with the same complaints, for 
which they had first sought relief, although the local 
disorder had completely disappeared. 

The cases, on which my conclusions have been based, 
concern patients that have been at least two years under 
observation, consequently all doubts concerning the 
question of causal relationship are completely removed. 

I have now only to thank you for your kind attention 
and hope you will have overlooked, possible faults in 
expression, due to my unfamiliarity with your language. 


^ransaciimtB of gotietus. 

BRITISH GYNAECOLOGICAL SOCIETY. 

Meeting held Thursday, June 8th, 1899. 

The President, Dr. Macnaughton-Jones, in the chair. 

DECIDUOMA MALIGNUM ' 

Dr T. W. N. Haultain (Edinburgh) showed a 
specimen of this growth, together with microscopic 
sections, and gave a lantern demonstration of micro- 
photographs. (We hope to publish Dr. Haultain’s paper 
with a valuable series of illustrations in our next, on 
completion of the necessary engravings.) 

Dr. Mendes de Leon (Amsterdam), read a paper on 

GENERAL DISORDERS ORIGINATING IN DISEASE OF THE 
FEMALE PELVIC ORGANS, 

which will be found in another column among “ Original 
Communications.” 

In the discussion which followed. Dr. Heywood 
Smith said that Dr. Mendes de Leon’s conclusions must 
find an echo in the experience of most of them. There 
was no doubt that the weman was built up around 
her pelvic organs, so that it was not surprising that there 
should be so many reflex disorders associated with- 
diseases of those organs. 

Mr, Charles Ryall thought that they must all feel 
much indebted to Dr. Mendes de Leon for his interest¬ 
ing paper. They were all familiar with the uterine 
reflexes, but they were apt to forget that diseases of 
other organs might simulate disease of the uterus and 
ovaries. Movable kidney afforded an example. Thus he 
had recently a case in which the patient complained of 
much pain in the pelvis and of intermenstrual pain. One 
surgeon advised oophorectomy, and this was done, but 
she was not relieved. Then another surgeon advised 
hysterectomy, and this was done, but still she was no 
better. It was then found that she had a mobile kidney, 
and after nephropexy had been done she got all 
right. Mastodynia was often found associated with 
uterine disease, but it might be due to interstitial 
mastitis. 

Dr. Burleigh-Robin80n thought that the question 
of the relation between gynaecological operations and 
mental conditions was an important one, and he hoped 
that some Fellow would bring forward a paper on the 
subject of operations on the insane. 

The President said that at a former meeting of the 
Society they had had a discussion on the relation between 
pelvic disease and mental conditions, several well-known 
alienists taking part. The subject had been studied 
more especially in America, and it had been shown that 
there was frequently a definite relation between the two 
factors. British psychologists were agreed that if there 
was uterine disease in a woman who was insane, the 
patient should be examined, and treatment adopted by 
operation or otherwise whenever this was possible. He 
had seen three cases in which women in a condition of 

Digitized by GoOglC 


668 The Medical Press. TRANSACTIONS 

insanity were operated on without any improvement 
following; but others had had a different experience, 
and he could at least say that he had not known of a 
case being made worse by any gynaecological operation. 
There could be no doubt that although the paper they 
had just heard would command universal assent, there 
were still many cases of reflex disorders of pelvic origin 
in which the cause was not properly recognised, because 
the patients did not complain of symptoms referable to 
the pelvis. He knew that affections of the eye, ear, and 
larynx were very often associated with pelvic troubles, 
as were also rectal disorders, and symptoms of spinal 
and locomotor character. He thanked Dr. Mendes de 
Leon, on behalf of the Society, for his most interesting 
paper. 

Dr. Mendes de Leon, in reply, said that of course he 
knew that he could not exhaust such a subject as he had 
chosen for his paper. He thanked the Fellows of the 
Society for the attentive hearing they had given him. 
The one point on which he wished to lay special stress 
was the importance of not vaguely relegating to the 
category of hysteria, patients who might be suffering 
from organic pelvic diseases. 

BRITISH ORTHOPAEDIC SOCIETY. 

Meeting held in the Royal Infirmary, Derby, 
Saturday, May 27th, 1899. 

Mr. Gentles in the Chair. 

Mr. William Thomas showed a patient in whom the 
left popliteal nerve had been injured by a kick from a 
horse, talipes equino-varu6 having occurred as the result. 
Neurorrapny having failed, he performed tarsectomy. 
The result appeared to be excellent. 

Mr. Tubby pointed out how very difficult it is 
to get the ends of a divided nerve together when the 
division occurs close to where the trunk breaks up into 
branches. 

Mr. Robert Jones called attention to the slight 
amount of power still remaining in the extensors of the 
toes, showing that the nerve was not entirely divided or 
else that some union had occurred. He could not under¬ 
stand how the tarsectomy could prevent the foot-droop. 

Mr. Bennett contrasted a case under his care where 
the ulna nerve was injured by fracture of the lower end 
of the humerus without division; but at the operation 
the sheath alone was found to be intact, the nerve 
elements being completely divided and retracted inside 
it. In that case an inch and a half of a rabbit’s sciatic 
nerve was inserted with success. He asked why the 
author did not try nerve-grafting. 

Mr. Muirhead Little mentioned a case in which the 
peroneal nerve had been divided six years before it came 
under his care, in the course of an operation for division 
of the biceps tendons. Talipes equino-varus had resulted. 
He cut down and found a gap of about two inches. The 
upper end of the nerve was bulbous, and the lower a 
good deal wasted. H e excised the ends and succeeded 
in getting the cut surfaces in apposition by flexing the 
knee. No benefit resulted, however, probablv because 
the injury was of such long standing. He asked 
whether Mr. Thomas might not have got the ends 
together in his case by a similar manoeuvre. 

Mr. Luke Freer remarked that after tarsectomy in 
ordinaly talipes equino-varus there is often a relapse. 
To avoid this it might be well to continue with stimula¬ 
tion of the nerve by battery and foot kinetics. 

Mr. Thomas, in reply, said that in addition to tarsec- 
tomy he divided all the flexor tendons. He thought 
that union of the bones caused rigidity of the foot, and 
he laid great stress on the importance of removing a 
large piece of skin in tarsectomy. The nerve was never 
completely divided. This fact would probably account 
for the slight power left in the extensors, and for this 
reason he refrained from nerve grafting. He tried 
flexion of the knee, but did not find it approximated the 
ends of the nerve to any extent. He did not think that 
the battery was of much use. The voluntary use of a 


( JF SOCIETIES. _ June 28, 1899. 

muscle was of far more use in stimulating development., 
than electricity or massage. 

Mr. Carwardine read a paper on a case of Talipes 
Equino-Varus, treated by Phelps s latest operation. The 
chief points in the operation are—1. To thoroughly dis¬ 
infect the skin. 2. Constant irrigation with an anti¬ 
septic during the operation. 3. To make an open incision 
on the inner side, if the skin be short. 4. To cut all the 
parts in order of their resistance, first dividing the tendo- 
Achillis, if tense, then tibialis posticus, abductor pollicis, 
plantar fascia, flexor brevis, long flexors, deltoid ligament. 
5. Then when necessary linear osteotomy of the neck 
of the astragalus. 6. Resection of a wedge of bone 
from the os calcis* the point meeting the osteotomy 
wound through the astragalus. The operation was per¬ 
formed on June 30th, 1888. The boy did well, and on 
November 14th the following note was made. Foot 
perfectly straight, walks fairly, good flexion, extension, 
inversion, and eversion. Good arch to foot, the normal 
length of the foot preserved, and no tenderness of the 
scar. He said that the special feature of the complete 
operation is the alteration of the bony axis of the foot 
without diminution of its length, the inner bord.r of 
the foot being lengthened. The transverse tarsal joint 
and great synovial membrane of the foot are not inter¬ 
fered with, so that the foot preserves its natural mobility 
and elasticity. 

Mr. Little said that he had had some experience of 
Phelps's operation, and had got very good results, and 
had seen no tendency to relapse, or any troubles due 
to the scar. It was important that the wound surfaces 
should be kept apart sb long as possible; hence healing 
must' be very slow. He thought it better to lengthen 
the inner bordtr of the foot by Phelps's operation rather 
than to Bhorten the outer border bv tarsectomy. 

Mr. Keetley raised the objection that the scaphoid 
was not replaced in its proper position over the head of 
the astragalus in the operation as represented by Mr. 
Carwardine, and he thought that the scar must tend to 
cause relapse. The large granulating surface in Phelps’s 
operation was, he thought, a danger. 

Mr. W. Thomas saw no advantage in this operation 
over an ordinary tarsectomy. 

Mr. R. Jones preferred Lund’s operation of astragal- 
ectomy, which in his hands had yielded most satisfactory 
results. 

Mr. Carwardine, in reply, said thht he thought that 
the rigidity earned by tarsectomy was objectionable. 

Mr. Carwardine read a paper on Congenital Absenci 
of the Fibul* with Intrauterine Fracture of the Tibia. 
The patient was five weeks old. The right leg was much 
shorter than the left, and the thigh half an inch shorter. 
The leg was bent rather below the centre almost to a 
right angle, and over the convexity was an umbilicated 
and somewhat adherent scar. The fibula and all the 
elements of the fifth toe were absent. The tibia was 
sharply bent upon itself almost to a right angle, with 
some thickening of the part. The tendon-Achillis and 
skin posteriorly were very tight. (Skiagrams and 
sketches shown.) When the mother was two months 
pregnant she was nearly run over by a carriage and 
pair. To escape the danger she made a sudden da-1 
forwards. He corrected the deformity with great diffi¬ 
culty, owing to the hardness of the bone and tenseness 
of the tendon Achillis, which he divided. He was of 
opinion that the condition was a true greenstick frac¬ 
ture of one tibia across the other in utero by contrac¬ 
tion of the parietes upon a bone which lacked the sup¬ 
port of the fibula. The absence of the fibula and fifth 
toe are developmental. 

Mr. R. Jones thought that no theory of etiology fully 
accounted for the conditions found. It was difficult 
to conceive of any direct injury to the mother giving 
rise to a compound fracture of the tibia when surrounded 
by amniotic fluid. The large proportion of cases giving 
evidence of congenital irregularities of toes seems to 
suggest a joint causal relationship. 

Mr. Luke Freer referred to his case recorded in Vol. 
I. of the British Orthoptedic Society's Transactions, in 
which the fibula seemed to shade away with the tendo 
Achillis. 

Mr. Carwardine read a paper on Tuberculous Abscesses 

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June 28, 1899. 


TRANSACTIONS OF SOCIETIES. 


The Medical Press. 669 


and their radical cure by thoroughly scraping and 
irrigating the cavity. The three cases he had opeiated 
on with complete success were: 1. Large abscess of the 
thigh from tuberculous disease of the pubes. 2. Large 
tuberculous subgluteal abscess of the thigh, probably of 
spinal origin. 3. Psoas abscess extending over the whole 
front of the thigh, the result of tuberculosis of the 
vertebra?. 

Mr. Luke Freer exhibited two skiagrams: (1) Con- 
genical displacement of the left femur. (2) Right coxa 
vara associated with lateral curved femora of rachitic 
origin. 

Mr. Tubby read notes of a case of “ Spastic Hemiplegia, 
with flexion of elbow and wrist and pronation, treated by 
open section of the flexor tendons, especially flexor carpi 
radialis, and detachment of the pronator radii teres from 
its insertion.” A hole was then made in the interosseous 
membrane, and the tendon passed round the back of the 
radius to its outer border, and fixed; thus reversing the 
action of the muscle. Patients after six weeks could 
pick up a pin. He kept the wrist during this time mid¬ 
way between flexion and extension by splints. 

Mr. Keetley opened a discussion on “Coxa Vara.” 
lie described types of the two great varieties, which 
commence in adolesoence. The deformity was rachitic 
in origin. The partial, or even total, absence of rachitic 
change in other parts was no disproof of this, as the older 
the patient the more localised the rachitic changes tend 
to be. The various modes of osteotomy which had been 
earned out or proposed, including a new method, were 
described. In theory the neck of the bone should be 
operated on, in practice the trochanteric region was more 
convenient. Decreased angle of the neck and shaft 
formed the striking feature on a first glance at the 
deformity, but the main changes were in the neck 
itself, especially near the head. In fact, coxa vara was 
s rachitic deformity of the upper epiphyseal region of 
the femur. The deforming influences sometimes ex¬ 
tended far down the shaft. Compensatory genu valgum 
was common. The speaker called attention to a peculiar 
expansion of the facial bones, giving prominence to the 
eyeballs and width and flatness to the upper half of the 
face. Coxa vara in cases of early rickets was very 
common indeed, but during adolescence were rare. The 
commencement of the flood of modern literature on the 
subject dated from the speaker’s own paper, in the 
Illustrated Medical News, for September 29th, 1888. The 
hip-joint was healthy in these cases. For this and for 
other obvious reasons, excision was not justifiable. 

Mr. R. Jones said that he thought that a trans¬ 
trochanteric osteotomy would do all that was needed in 
these cases. 

Mr. Tubby sai i it would be adviseable to divide the 
adductors, and after doing transtrochanteric osteotomy 
to transfer the attachment of the abductors from the 
great trochanter to the lower fragment, so as to increase 
their power of action and abduct the shaft instead of the 
neck of the femur. 

Mr. Muirhead Little pointed out that the deformity 
in infantile coxa vane was very different from tl e ado¬ 
lescent variety. It seemed to be a process sui generis. 
Charpentie had shown that ostitis might cause the , 
deformity. 

Mr. Keetley, in reply, said that he did not think a 
simple linear osteotomy was enough, though when anky¬ 
losis existed, as in coxitis, a linear osteotomy sufficed 
because the upper fragment was fixed. Coxa vara was 
very common in infantile rickets, and often accompanied 
genu valgum. He believed that some cases described as 
separation of the epiphysis were really cases of coxa 
vane. 


The receipts from the great bazaar at the Albert 
Hall, held last week in aid of the funds of the 
Charing Cross Hospital, amounted to £13,300 for 
the two days. This exceeds by £3,300 the amount 
which was realised by the Press Bazaar at the Hotel 
Cecil. 


THE BRITISH BALNEOLOGICAL AND CLIMATO¬ 
LOGICAL SOCIETY. 

Meeting held Thursday, June 1st, 1899. 


The President, Dr. R. Fortescue Fox (Strathpeffer Spa), 
in the Chair. 

Dr. H. Shirley Jones read a paper on 

THE TREATMENT OF NBURITI8 AND NEURALGIA BY THE 
DROITWICH BRINE BATHS. 

Dr. Shirley Jones said he considered obstinate neu¬ 
ralgia and neuritis for the most part associated with, 
and dependent upon a debilitated condition, and believed 
gouty neuralgia to be more the result of weakness, than 
the effect of any uric acid on the nerve itself. The nerve 
most affected is the sciatic, for obvious reasons, for it is 
the most difficult nerve to rest, and the large surface 
over which it extends renders it more prone to injury 
from cold, Ac. Next in frequency is perhaps the fifth. 
Obstinate cases of neuralgia are met with accompanying 
malignant diseases. He had seen also three cases of 
sciatica following the apparently successful removal of 
mammary carcinoma, which would only admit of very 
temporary relief. Each case died within two years of 
onset without any material lbenefit, or any evidence of 
return of malignant disease. He related three cases of 
intense neuritis leading to insanity. 

Dr. Douglas Kerr (Bath) said he could testify to 
the benefit which he had known in severe cases of neu¬ 
ralgia from the Droitwich bath treatment. He asked 
Dr. Shirley Jones for particulars of treatment. 

The President remarked that neuralgia in its various 
forms was usually relieved under balneological treat¬ 
ment. It acted, doubtless, as an eliminant. and also 
tended to remove the subinflammatory conditions on 
which most cases of neuralgia depended. He also called 
attention to the use of cold douches for neuralgia by the 
French. 

Dr. Bowen Davies (Llandrindod Wells) asked for 
further particulars of the methods of treatment at 
Droitwich. 

In reply. Dr. Shirley Jones said he had chosen this 
subject as being of interest, because he thought more 
brilliant results were obtained from these waters in cases 
of neuralgia and neuritis than in any other disease. 
These cases of neuritis which he had mentioned, showed 
a peculiar obstinacy, and each led to a very unusual 
complication, viz., insanity. The treatment he adopted 
at Droitwich in neuralgia and neuritiB consists for the 
most part, for acute cases in the use of a hot reclining 
bath without massage or electricity, but with as complete 
rest as possible. In cases of the lower limb rest in the 
recumbent position, for the upper limb rest in a sling, 
and in uncomplicated cases no drugs at all. For the 
relief of pain he used hot brine as a compress. As the 
acute stages pass off the douche over the course of the 
nerve comes into use, the temperature and the length of 
time varying considerably with the amount of pain and 
idiosyncrasies of the patient from, 115 degs. to 80 degs. 
usually, and he had occasionally found great benefit from 
a temperature as low as 65 degs. given as a douche, 
particularly in cases where there had been atrophy of 
muscles resulting from a neuritin; there too he found 
great benefit from the use of the swimmiDg-bath where 
owing to the great buoyancy of the water, exercise of 
any limb may be effected with a minimum of exertion, 
and thiB he thought a very important point in the 
development of atrophied muscles ; apart from that the 
swimming bath has a very decided tonic effect, and as 
such is very useful in the treatment of chronic neuralgia. 

Dr. Ivor Murray read a paper on “ Scarborough as a 
Health Resort in Phthisis ” which led to some discussion. 


A despatch from Alexandria states that two fresh 
cases of plague have occurred there, the patients 
being natives.— Reuter. 


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670 The Medical Press. 


GERMANY. 


June 28, 1890. 


Jrattcc. 

[from our own correspondent.] 

Paris, June 25th, 1899. 

Creosote and Phthisis. 

At the Academy of Medicine, M. Bucquoy read a paper 
on the “ Treatment of Consumption by Large Doses 
of Creosote.” He said that of all the therapeutic agents 
tried in this disease, creosote was certainly the best, and 
opinions differed only as to the dose that might be given. 
He had known cases in which from one to two drachms 
were given with impunity in the twenty-four hours ; on 
the contrary, an increase of appetite and a decrease of 
the sweatings, and, above all, of the expectoration were 
obtained; the fever also yielded notably. In no case 
did the drug cause irritation of the stomach. 

Cacodylic Acid. 

M. Daulos said he had employed for the last two years 
cacodylic acid internally and externally. Externally he 
used a solution of 50 to 75 per cent, of the non-neutralised 
acid, but internally he preferred the neutralised acid> 
that was to say, cacodylate of soda. He gave it by the 
mouth, or by subcutaneous injection. Taken by the 
mouth it left a disagreeable taste in the throat, and to 
obviate this he was in the habit of using the following 
formula— 

R Cacodylate of soda, 598; 

Rum , 

8yrup t ’ 

Water, 5ij; 

Ess. of peppermint "l j. 

A teaspoonful of this mixture represented exactly two 
grains of cacodylic acid. 

It could also be prescribed in pills with extract of 
gentian. The amount in each pill might be two 
grains. 

He had thus treated psoriasis, acne, lichen, lupus, cuta¬ 
neous tuberculosis, tuberculous adenitis, &c., at the dose of 
from 8 to 12 grains daily for men, and half that amount 
in the case of women, and had obtained some satisfactory 
results. He would add, however, that he had seen two 
or three patients suffer considerably from colic. 

Hemorrhoids. 

M. Schwartz, at the meeting of the Societe de 
Chirurgie, introduced the subject of the treatment of 
hemorrhoids, and said that those of small volume should 
be treated by dilatation and ignipuncture. He treated 
thus a considerable number of patients, and always 
successfully. In voluminous tumours he employed up to 
the last years exclusively the methods of volatilization of 
Richieb. Forthe lasttwo years he practised the operation 
of Whitehead in a certain number of cases, but he should 
add that the operation was very tedious, and in some 
cases the patient lost a considerable quantity of blood. 

M. Delorme said that he preferred Whitehead’s 
method in all cases where the lesions were diffused and 
extensive. 

M. Delbet considered that the thermo-cautery did not 
constitute a perfect hemostatic. On the other hand, its 
antiseptic action was beyond doubt, but to-day it was 
possible to obtain the same result by other meanB, with 
the advantage of procuring union by first inten¬ 
tion, whilst that desirable result could not be 
produced by the cautery. Further, as a modi¬ 
fying agent, the thermo-cautery provoked an in* 


fiammatory process which was not without danger. 
When he was house surgeon under M. Richet, he had 
seen patients endure untold suffering after being treated 
by the volatilization of the hemorrhoids, and several 
succumbed to septic accidents. Unless the hemorrhoids 
were procident and ulcerated, he discarded the thermo¬ 
cautery in favour of the bistoury followed by suture- 
M. Tillaux regarded the thermo-cautery as perfectly 
hemostatic, on the condition that it was employed at a 
dull red, and that it was pressed on the tissues so as to 
break down the walls of the vessels. For more than 
thirty years he had treated hemorrhoids by ignipuncture, 
and always considered it as the simplest and the best 
method for that affection. 


(Scrmang. 

[from OUR OWN CORBB8PONDENT.] 

Berlin. June 24th, 1890. 

At the Congress for Innere Medizin Dr Jacob, 
Cadowaa, read a note on 

Neurotic Insufficiency of the Cardiac Muscle. 

He formulated the follow ing proposition:—There is a 
form of disease similar to degeneration of the cardiac 
muscle, and also mistaken for it, that, in spite of dilata¬ 
tion and arhythmia, as well as equal size of the pulse, by 
a certain order in the disorder can be distinguished from 
a pulse of good tension, and notwithstanding the 
symptoms of insufficiency, allows of a good prognosis. It 
might be named pseudo-degeneration of the heart 
There was a chronic tachycardia, with regular pulse and 
insufficiency easily mistaken for Basedow’s disease, 
especially when associated with a slightly enlarged 
thyroid and prominent eyes. It differed, however, from 
Basedow’s disease in the absence of the hot skin—on the 
contrary, the skin was rather cool—absence of thirst* 
voracity, cardiac murmurs, in short, of all the symptoms 
of exaggerated tissue change. The patients did 
not bear cold bath treatment, but were improved by 
everything that relieved the anaemia. The condition 
improved in a short time, in as many weeks as the 
Basedow required months. The Basedow had not, with 
but few exceptions, a tense pulse. The insufficiency was 
such as arises from hypeienergy. Improvement took 
place most quickly, through measures that reduced the 
tension. The capacity of life of the heart was a constant 
product of its work with the time which this took to 
perform. Dilatation and tachycardia sprang from a 
common source. 

Hr. Behuschky read a note on 

The Diagnosis and Treatment of Primary 
Tuberculous Ulcer of the Stomach. 

The speaker had observed two obstinate cases of ulcer 
of the stomach, the tuberculous nature of which was at 
last determined by the quick improvement that followed 
the use of tuberculinum Kochii. Continuance with the 
tuberculins treatment brought about a rapid disappear¬ 
ance of the symptoms of the disease in contrast with 
years of failure under other methods. The first case 
came under observation in 1892 ,the second only recently. 
The latter he considered to be a primary tuberculous 
affection. The patieut was 35 years of age. He came 
of a non-tuberculous family; he had suffered from 
symptoms pointing to uloer of the stomach for a year 


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AUSTRIA. 


Junk 28, 1899 . 

and a half. Tuberculine treatment was at last begun, 
with a dose of 01 mgm., the second dose was 0 5, the 
third 01 mgm. The temperature rose to nearly 39 degs. C. 
With the reaction the pain disappeared. 

Hr. Loewit, Insbruck, opened a discussion on 
Lkucjemia and Leucocvtosib. 

The most important distinction between the two lay in 
their different aetiology. Leucocytosis waB not a disease 
of itself, but only a symptom. Its aetiology was there¬ 
fore various, and was not yet worked out. The aetiology 
of leucaemia had hitherto been a dark region. From his 
own investigation he had taken up the position that it 
was an infection with haemamoeba of the class of 
sporoi-oa. He would not go further into the method of 
investigation adopted. They were objects coloured with 
great difficulty, and could only be seen under certain 
conditions, although they might be present in the 
blood and the blood-forming organs in immense num¬ 
bers. His examination extended to twelve cases of 
myelaemia. The peripheral blood was principally ex¬ 
amined in dried preparations. In one case it could be 
examined fresh. Parasitic elements were always found 
in the blood in varying quantities. They could be 
divided into several groups. First, a young form, small 
crescentic bodies, in the interior of which a nucleus-like 
body could bo recognised; second, large well-grown 
amoeba forms likewise, with one or eeveral nucleus-like 
bodies; third, sporulation or segmentation forms (rarely 
caudated or whipped). The fourth gToup was the most 
characteristic, of an exquisite sickle shape; they were 
not frequent. 

In order to examine the blood-forming organs, puncture 
of the spleen was performed three times on the living, 
and each time enormous numbers of these parasites were 
found in the juice of the spleen, far more than in the 
blood examined on the same day. His lymphsemia cases 
were limited to six, and they could only be examined in 
dry preparations. The body organs were only examined 
in four cases, two of them fresh. Examination of the 
peripheral blood was at first negative, with a perfected 
method of examination, peculiar bodies were found in 
the lymphocytes of the peripheral blood, which the 
speaker looked upon as parasitic elements, most probably 
identical with those seen by Mannaberg in 1896. With 
better standard methods he found form-elements in 
large numbers, which were much smaller than those of 
myelaemia. He had therefore selected the name hsema- 
mceba leucaemias parva vivax. 

He was able to examine a leucaemic swine spleen. 
There he found the same permanent forms as in human 
myelaemia. He had made transplantation experiments 
on various animals, with success in the case of rabbits. 
Changes were observed within twenty-four hours, which 
reached their maximum in ten or fifteen days. The 
number of leucocytes had increased to 60-80,000 and 
more per cubic millimetre. The animals lost in weight, 
this loss he could not properly explain. Typical 
albumosuria wais found in the infected animals, no fever, 
at most a rise of temperature on the first and second day, 
not again. The animals lived from three to four days 
to ten months. Four out of twenty-eight rabbits 
injected showed a mixed infection of leucaemia and 
tuberculosis. Observation of the parasite in infused 
fresh blood of the infected rabbits was very easy, and 
heir movements could be followed. 


The Me dical Pbes9. 671 

He believed that the parasite formed the irritation that 
led to increase of leucocytes in the blood and the blood 
forming organs, and on the other hand they were respon. 
sible for the great destruction of leucocytes. Investiga¬ 
tion into the relation between the leucocytes and the 
parasite had made it probable that the morbid changes 
for the former were attributable to the life-activity of 
the latter. 

As regarded therupeutics the analogy between leu¬ 
caemia parasite and malaria parasite pointed to trial of 
quinine. He had tried it on two animals, one subcu¬ 
taneously and one intravenously. The second animal 
died on the third day of acute quinine poisoning. The 
parasites disappeared out of the blood only just before 
death. On the other hand there was nothing in the 
body organs of this animal that indicated any associa¬ 
tion with haemamoeba. That was a very meagre result, 
but it lead to the thought that in our therapeutical 
strivings we must attempt to drive the specific parasite 
out of the body. 


Jlustria. 

[from our own correspondent.] 

Vienna, June 23rd, 189ft. 
Symblsphabon following Pemphigus Conjunctive. 

At the “ Gesellschaft der Aerzte,” Moruz Sachs exhi¬ 
bited a man with total symblepharon which had been 
produced by a former attack of pemphigus of the con¬ 
junctiva, and finally soldered the eyelids together, so that 
no line of separation remained to distinguish the upper 
lid from the lower, on the right, while the left had a 
centimetre opening revealing a thin membrane over 
the cornea that further impaired vision by this narrow 
opening. With the right eye he could distinguish dark¬ 
ness from light, with the left he could discern the finger 
at a short distance. A similar condition had partially 
affected the mouth, soldering the cheeks to the gums. 

He concluded by describing the operation necessary 
for the restoration of sight, as plastic interference was 
the only remedy in such cases. 

Schopf showed a patient who was under his care twelve 
months ago with an alimentary condition that was 
diagnosed as carcinoma ventriculi requiring resection of 
the pylorus. On opening the abdomen the stomach was 
found to be hard, and thickened along the greater part 
of its length, involving mesentery and omenti, the latter 
being studded over with Email nodules. The whole of 
the stomach, except two inches at the cardiac end, was 
removed, after which the patient soon recovered. 

The fresh specimen measured 20 cms. (7 87 in.) 
along the minor curvature, and 28 cms. along the major 
curvature. The microscopic examination revealed a 
ly mpho-sarcoma with diffuse infiltration, which reduced 
the lumen of the pylorus to a mere aperture that would 
not admit of the passage of a “ match.” Notwithstand- 
standing the morbid changes and enormous size of the 
organ, the operation was an easy one, as there were no 
adhesions to prevent its speedy removal, the latter 
condition being due to the “ gastroptose ” posi¬ 
tion of the stomach. The patient recovered within 
four weeks after the operation, and was then able 
to take solid food. A year has now elapsed, and the 
patient can take any sort of food with perfect comfort. 
An analysis of the stools show that fibres of flesh food 


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672 The Medical Press. 


THE OPERATING THEATRES. 


June 28, 1899. 


are present at great quantities at times, but the other 
food stuffs are completely digested. 

H^mato-Mtelia, or Multiple Hemorrhages 
in Typhoid. 

Schiff demonstrated several microscopic sections taken 
from the spinal cord of a patient who had died from 
typhoid fever. The patient was 19 years of age when he 
was received into hospital, with all the symptoms 
of enteric fever, enlarged spleen, roseola, bronchitis 
and Widal’s positive reaction. Four days after 
his reception he suddenly collapsed with complete 
motor and sensory paraplegia, commencing a little 
below the fifth cervical vertebra. The respiration 
was phenomenal; at each inspiration the abdomen 
rose like a balloon, while the thorax was lower and 
narrower than normal, thus demonstrating that the 
muscles of the chest and abdomen were paralysed, while 
the phrenic supplying the diaphragm still performed its 
normal function. Death occurred about the second 
week of the disease. 

At the post-mortem no infiltration or effusion was to 
be found in the brain, and a more careful examination 
was therefore made of the spinal cord. 

Sections were made through the third, fifth, and sixth 
cervical segments, as well as the fifth, eighth, and ninth 
of the dorsal region. The latter had small haemorrhagic 
infarcts, while the blood-vessels were greatly enlarged. 
No inflammatory products or signs of inflammation were 
present, although the membranes were hypenemic. 
No micro-organism could be found in the haemorrhagic 
centres. Six similar cases are now on record, one of 
which had specific micro-organisms in the haemorrhagic 
foci (Curechmann’s case). 

From the results in these cases it is usually regarded 
as a degenerative condition of the blood-vessels as no 
trace of an inflammatory nature will sustain a phlogistic 
hypothesis. 

Clinical Ferrometer. 

Jolles exhibited a ferrometer for estimating the total 
amount of iron in the blood which may properly be 
designated as a modification of Fleisch’s thermometer. 
It is an instrument with two tubes, one for a solution 
made from the blood by first evaporating half a cubic 
centimetre of blood and after calcining it dissolve the ash 
in sulphate of potassium, hydrochloric acid, and potas- 
siate of rhodiate. The other is for simple water. The 
total average normal amount of iron in the blood should 
be 0’0424 per cent. 


‘tEhc (Operating theatres. 

WEST LONDON HOSPITAL. 

Opehation for Ruptured Stomach. —Mr. Bidwell 
operated on a boy of six who had been run over by a 
heavy market van about five hours previously. The 
patient was suffering from severe shock, the abdomen 
was distended, breathing being entirely thoracic. There 
was acute tenderness all over the abdomen, most marked 
in the epigastric region, and there was complete absence 
of the normal liver dulness. The patient was put under 
chloroform, and as the shock from the accident was so 
great, normal saline solution was injected into the 
median basilic vein immediately the boy was under the 
enresthetic, and was continued during the whole of the 
operation. The abdomen was opened in the middle line 


above the umbilicus, and immediately there was a con¬ 
siderable escape of gas and stomach contents, together 
with some semi-purulent fluid. On examining the 
stomach a clean-cut rupture about two inches long was 
found in the centre of the greater curvature of the 
viscus, the direction of the rupture being vertical, that 
is to say, in the direction of the circular fibres ; and the 
laceration extended for some distance into the lesser 
omentum. The stomach contents were sponged out of 
the peritoneal cavity as rapidly as possible; the 
wound in the stomach closed in a horizontal direction 
first by a continuous suture going through all the coats, 
and secondly by a row of interrupted Hals ted sutures. 
The abdominal cavity was then thoroughly flushed out 
with normal saline solution, and as the stomach contents 
bad reached into the pelvis, a second opening was made 
above the pubee for the means of drainage. A drainage 
tube and a gauze drain were placed down dose to the 
wound in the stomach, the rest of the incision being 
closed. A second drainage tube was placed through the 
supra-pubic opening into the recto-vesical pouch. The 
patient stood the operation well, the pulse being better 
at the conclusion than at the commencement. Mr. 
Bidwell remarked that the absence of liver dulness 
was a most important sign in diagnosis of rupture 
of one of the hollow viscera. This symptom was 
present in most cases of rupture of the stomach 
from gastric ulcer, he had also found it in two cases of 
rupture of an intestinal ulcer, one case being due to 
tubercle, and the other to typhoid fever. The amount 
of shock in so young a patient would make an operation 
absolutely impossible without the injection of normal 
saline solution; he strongly advocated the plan of rele¬ 
gating thiB duty to an assistant, and having it continued 
during the whole of the operation ; at any rate ia the pre¬ 
sent case the state of the patient was better at the end 
than at the beginning of the operation. He pointed out 
that it was impossible to wash out the peritoneum 
through the median incision above the umbilicus, but it 
was absoluely necessary to make a second opening abov® 
the pubes, since in this case he had found currants, Ac., 
in the recto-vesical pouch. The time that elapsed between 
the accident and the operation he said was much to be 
regretted, since the chances of recovery after rupture of 
the stomach are directly dependent on the amount of 
time elapsing between the accident and the operation - r 
in cases operated on within six hours for gastric uloer 
nearly all recover, there being no special data with regard 
to traumatic rupture, which is a very rare but much 
more serious accident, the accompanying shock rendered 
it still more urgent that operative measures should 
be undertaken with the least possible delay, 
as the opening in the viscus is much larger and 
allows the contents to escape at once in large quan¬ 
tities, in contradistinction to the often mere pin-hole 
aperture of the rupture through a gastric ulcer. 

Twelve hours after the operation the patient again 
became collapsed, and in spite of saline injections, 
gradually sank and died. At the post-mortem it was 
proved that no further extravasation had taken place 
from the stomach. 

WESTMINSTER HOSPITAL. 

Points of Interest following the Operation 
Reported in Operating Theatres of May 17th. —Mr. 
W. Turner related the after history of the case on 


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Junk 28, 1899. 


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The Medical Press. 673 


which he operated for tuberculous disease of the testicle 
on May 10th. For eight days after the operation the 
progress of the patient was perfectly satisfactory with 
the exception of the temperature remaining Blightly 
above normal, varying from 99 degs. to 101 degs. The 
wound was dressed and the stitches removed on the 8th 
day; the wound on the left side was found to be com¬ 
pletely healed, the one on the right was also healed except 
at its lowest part, where the drainage tube had been. 
The following night the patient was very restless, and 
had to be given some morphia, and the next day his 
mind seemed to wander a little; at times he would 
suddenly get out of bed, and occasionally was almost 
maniacal, but in the intervals lay in a semi-somnolent 
condition, and was only roused with difficulty; he took 
his food badly, and his pulse was very rapid, feeble and 
intermittent; the temperature became subnormal and 
remained so for three days; his general condition 
being about the same, after which the temperature 
rose irregularly until his death, whicn took place 19 
days after the operation. The meningitic symptoms 
only commenced 10 days after the operation, he 
became more and more drowsy, and, at one time, was 
very hypertesthetic all over the body ; all his motions, as 
well as his water, were passed involuntarily, although 
the quantity of urine appeared to be about normal; 
there were no other signs of meningitis, and there were no 
eye symptoms. A catheter specimen of urine was ob¬ 
tained, and found to contain a trace of albumen. At the 
post-mortem examination extensive tuberculous menin¬ 
gitis and miliary deposits all over both lungs were found ; 
no disease of kidneys, liver, or spleen. The prostate 
was enlarged, but not definitely tuberculous. The right 
vesicula seminal is was a caseous tuberculous mass, the 
left being normal, and the bladder was unaffected. The 
wounds made at the operation were healed. No other 
tuberculous deposits were found in the viscera. In 
commenting on the case Mr. Turner said that the delirium 
in the commencement and the almost maniacal condition 
of the patient seemed at first to point to the mania 
that sometimes follows double castration, but the 
symptoms came on very late, and the semi-comatose 
condition appeared to point much more to brain trouble! 
the urine never gave any indications of any secondary 
trouble in the kidneys, so that the diagnosis of 
ura>mia was excluded. The patient had tabloids of 
testicular extract given in the hope that his symptoms 
might only be caused by the first supposition, but need¬ 
less to say were useless. There was no doubt from the 
post-mortem appearances, Mr. Turner remarked, that 
the tuberculous deposits in the lungs and meninges 
had been present much longer than the symptoms 
would lead one to suspect, and that the tuberculous 
trouble in the testicle was simply one manifestation of a 
much more generalised disease than was supposed at the 
time of the operation, the genital tract being apparently 
the onlypart involved. From these facts he pointed out 
that it appeared it was not a case of acute tubercu¬ 
losis following operation for the removal of a tuberculous 
deposit, but that the effect of the operation was to light up 
in an acute form the latent trouble in other parts. As men¬ 
tioned in his remarks after the operation, the ultimate 
prognosis of these cases is generally bad, owing to kid¬ 
ney affection ; the above case giving an instance that 
tuberculous disease may be present in distant parts i 
without any physical evidence that can be made out. I 


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“ SALUS. P0PUL1 SUPREMA LEX.” 


WEDNESDAY, JUNE 28, 1899. 


THE AGED POOR AND LOCAL GOVERN¬ 
MENT BOARD INSPECTION. 

From time to time the fact is brought home to us 
that the humanity and mildness of modem man¬ 
ners is in truth the thinnest of social veneers. No¬ 
where, perhaps, is this conviction more frequently 
sustained than in the case of the revelations of Poor- 
law administration that every now and then startle 
the conscience of the community. A disclosure oC 
the kind has just been made in the Law Courts - 
the occasion being a dispute between the guar¬ 
dians of two metropolitan parishes, to wit, St 
George's - in - the - East and Bethnal Green. It 
seems that the plaintiff guardians of St. George’s 
agreed to receive into their workhouse a number of 
paupei-s from the defendant guardians. The action 
was to recover a sum of money due for maintenance 
of the alien paupers, a claim that had been resisted 
by the Bethnal Green Board on the ground that 
their paupers had not been humanely and mercifully 
treated. Upon this issue a long and patient hearing 
was given to the arguments on both sides, and 
the evidence disclosed a state of things that 
one would fain have believed impossible in a so-called 
civilised and Christian country. The issues placed 
before the jury by the learned judge were the 
questions whether harsh and unfeeling conduct 
had been established against the St. George’s 
authorities, whether the food was bad, and 
whether the workhouse was mismanaged. The jury 
returned a verdict for the plaintiffs on the ground 
that there had not been proof of undue harshness and 
oppression, but the important question of the food 


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674 Thb Medical Press. LEADING 

was not specially mentioned. A technical victory has 
thus been scored by the St. George’s guardians, but 
we venture to say that their system, as disclosed 
in the course of this trial, is unworthy of the spirit 
of the times, and smacks woefully of the bad old 
days of Bumbledom. What serious defence can be 
offered for setting old men of ages from sixty to 
eighty day after day to pick oakum for five or six 
hours at a stretch ? With no backs to their seats, 
and with fingers bleeding from the task it is no 
wonder if at least one of them chose rather 
to go out and face death in the streets. More 
than that, for some trifling offence in punctu¬ 
ality, these old men might be refused breakfast, 
and then be forced to this senseless labour upon 
an empty stomach. If that is to be the end of a 
working life, which has been spent in unceasing and 
honourable labour, the times must indeed be out of 
joint. Even in prison administration the f;ict is 
being recognised that to keep a man without food is 
a brutal and unjustifiable punishment. Indeed, the 
prison life has so far improved as to explain why a 
certain number of the waifs and strays of society 
deliberately choose the gaol to the workhouse. 
With regard to the quality of food given by 
the St. George’s guardians it is to be regretted 
that the jury did not give a definite finding, 
but one may hope that in view of the evidence 
brought forward at the trial that some public inquiry 
will be made into the matter. Then there is another 
important phase of the question. As pointed out by 
the learned judge the Local Government Board 
inspector who visited the plaintiff's workhouse with¬ 
out notice gave evidence to the effect that he saw 
nothing to lead him to believe that the inmates were 
otherwise than properly treated. What are we to 
infer from that statement ? Is the tacit sanction of 
Mr. Chaplin’s Department given to the imposition 
of the terribly hard labour of oakum picking 
upon old men during the long hours imposed at 
St. George’s Workhouse ? Is the deprivation of the 
food of the aged a matter of no concern to the Local 
Government Board ? Has the quality of food pro¬ 
vided for the inmates of the impeached institution 
been such as to secure the approval of the Board ? 
Lastly, have all or any of these defects come under 
the notice of the Local Government Board ? If the 
inspector has reported unfavourably upon the internal 
administration of that particular workhouse, why has 
it been left to a neighbouring Board of Guardians 
to bring the matter forward ? In a word, it is desir¬ 
able to know, in the interests of the public, what part 
of the machinery is at fault, for something wrong 
there must assuredly be in a system that allows 
oakum-picking, and deprivation of food in the case 
of aged paupers. Does the flaw lie in the inspecting ? 
Is it in the lack of central initiative, or is it in the 
passive resistance of local authorities ? In any case, 
it is high time that something were done to purge 
the Poor-law system of its grosser evils in dealing 
with the aged poor. 


ARTICLE S._ Jcne 2 8 , 1899. 

PUBLIC BATHS AT HOME AND ABROAD. 

The practice of bathing, it has been observed, if 
not as old as the hills, is at least as old as man. 
Nevertheless, except when bathing happens to have 
been incorporated as one of the rites of the pre¬ 
vailing religion, it has been, from antiquity down¬ 
wards, but too often more honoured in the breach 
than in the observance. Habitual and frequent 
resort to baths seems to be characteristic of a certain 
stage in the evolution of human civilisation. In most 
of the civilisations of which history records the rise 
and fall, public baths formed a prominent feature as 
they approached their apogee. This was notably the 
case at Rome, and the intellectual eclipse which fol¬ 
lowed the destruction of that marvellous civilisation 
was soon marked by a decline in the matter of per¬ 
sonal cleanliness, which persisted in an aggravated 
degree throughout the dark ages down to comparatively 
modern times, indeed we are still far behind the Romans 
in our worship of personal cleanliness. A recent 
number of the Netv York Medical Record contains a 
very interesting article establishing a comparison 
between various nations in respect of bathing accom. 
modation, It is gratifying to find that England is 
far and away ahead of all other nations so far as the 
provision of wash-houses and baths is concerned, 
though the Germans, it appears, were the first to 
inaugurate public municipal baths. In 1794 the 
Corporation of Liverpool purchased and threw open 
to the public a swimming bath, and in 1842 opened 
public baths and wash-houses. The example proved 
contagious, and at present, of the sixty-five county 
boroughs with a population of over fifty thousand, only 
seven are unprovided with public baths. Of the two 
hundred and fifty smaller boroughs, seventy-four 
have placed baths at the disposal of the public. In 
London there are upwards of thirty, in Manchester 
nine, in Liverpool eight, in Glasgow seven, in New¬ 
castle six, in Birmingham five, while Bristol and 
Salford possess four each. Germany shows up weU 
for forty out of forty-five German cities with over 
fifty thousand inhabitants are provided with public 
baths on the English model. Vienna has eleven 
baths, but in France and Italy the movement flags, 
and public baths are much less numerous than else¬ 
where. In most other European countries bathing 
accommodation on anything like an adequate Beale is 
conspicuous by its absence. The condition of the 
United States in this respect is such as to excite 
some surprise. Coming of British stock, one would have 
expected to find among the inhabitants of the United 
States the same enthusiasm on behalf of methodical 
bathing as in the old country, but we learn that public 
baths are in use in a very small number of American 
cities. We gather that in a country containing nearly 
eighty million inhabitants there are but ten cities 
that profess to provide bathing accommodation, 
while in New York State, with its six millions of 
inhabitants, Buffalo and New York City are the only 
two cities which have free bathing establishments. It is 
some satisfaction to learn that New York is awakening 
to the necessity of multiplying bathing accom moda- 


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Junk 28, 1899. 


LEADING ARTICLES. 


The Medical Press. 675 


•tion. It is vastly more important to have a number of 
•comparatively small establishments accessible to the 
inhabitants of crowded districts than to construct 
one or two palatial baths, necessarily at a consider¬ 
able distance from other parts of the city. Even in 
London much remains to be done in providing free 
baths for the labouring classes. No pecuniary 
obstacle ought to be allowed to stand in the way of 
free indulgence in the pleasures of the bath by work¬ 
ing men whose children, at any rate, would be only 
too delighted to avail themselves thereof during the 
summer. Not only would they gain in health, but 
they would thus be enabled to acquire the useful art 
of swimming. Even more important than the pro¬ 
vision of public baths, however, is the provision of 
bath-rooms in private houses, and in this respect 
enormous progress has been effected during the last 
decade or two, more especially in the metropolis. 
In new houses the rent of which averages from £'25 
to £30 per annum a bathroom is now the rule, and 
it is impossible to over estimate the importance of 
these domestic facilities in spreading the gospel of 
cleanliness We hope the day is not far distant 
when a bathroom will be insisted upon in every house, 
no matter how humble, on the same footing as a 
watercloset. From a hygienic point of view one is 
almost as necessary as the other, and as a measure 
of national cleanliness, they constitute a safer guide 
than the proportion of public baths, which are at best 
but a poor substitute for the domestic provision. 


THE ELIMINATION OF THE UNFIT. 

The elimination of the unfit is part of the hypo¬ 
thetical process of the survival of the fittest, and, 
although perverse human ingenuity appears specially 
directed to hindering the action of these, racially- 
speaking, salutary processes, there are plenty of 
examples in nature of the operation of both theoreti¬ 
cal laws. The intellectually and physically weak 
among human beings tend to succumb in the struggle 
for existence in virtue of their inability to secure an 
adequate share of food, Ac., and their greater prone¬ 
ness to infectious and other maladies and their 
inherent weakness is accentuated by undernutrition 
and' unhygienic surroundings, which, moreover, 
operate inimically on their offspring. Syphilitic 
persons are often sterile, and when fruitful their 
offspring is stricken with premature decay, which 
would prove effectual enough were it not for the 
intervention of medical science. Again, most 
men who are above the average in point of 
height or who are intellectually abnormal, whether 
in excess or in the contrary direction, are less 
fruitful, when indeed, not absolutely sterile, and 
their children are usually below the average of 
physical strength. Nature, however, is very capri¬ 
cious in this matter, for she often renders individuals 
sterile for reasons which do not strike one as sufficient 
to merit that penalty, as, for instance, in the case of 
women who have suffered from gonorrhoea. This is 
of itself a tolerably benign malady, yet possibly more 
than any other acquired cause it is productive of 


sterility in the female. An American observer, Mr. 
Bumpus, has taken the trouble to examine the dead 
bodies of sparrows killed during a tempest with the 
view of determining the conditions which determined 
their selection. Put briefly, be found that the 
biggest and the smallest sparrows were those 
which mostly fell victims to the hurricane. The 
heaviest birds, by reason of their greater surface, 
were unable to resist, and, on the other hand, the 
smallest birds, on account of their lees pronounced 
muscular development, were unable to cope with the 
strain. He found, moreover, that among the victims 
were the sparrows with the shortest humeri and the 
longest femora, in other words, the strain fell most 
heavily upon the animals which most departed from 
what we may look upon as the normal type. Putting 
this as a general principle, no doubt this obtains, 
even in human beings, though its influence is not 
usually so brutally expressed. As the average weight 
of the viscera is about the same, whatever the size of 
the individual, it follows that the very large man is 
placed at a disadvantage when compared with him of 
more moderate dimensions. Expressed in figures the 
larger man uses up a much larger proportion of bis 
physiological energy in purely vital processes than 
his more diminutive fellow, and consequently he has 
a less amount of energy for external consumption, 
leaving aside the question of the loss of energy 
entailed by his having to manipulate longer levers in 
locomotion and in manual exercises. The lesser 
vitality of the very small, on the other hand, is prob¬ 
ably to be ascribed to smaller initial vitality, as 
evidenced by restricted developmental energy. Some 
departures from the normal may be advantageous to 
the individual, and in such cases, according to the 
doctrine of the survival of the fittest, these aberra¬ 
tions from the normal type tend to be perpetuated, 
but, on the whole. Nature frowns on all marked 
aberrations of the kind, and even if of their essence 
advantageous Nature does not condone such departures, 
when very pronounced, preferring a gradual ascent. 
It is particularly in respect of exaggerations of the 
higher attributes of human beings that Nature shows 
herself most inexorable. She is willing to overlook 
insignificant variations in colour and shape, but she 
cannot pardon too exaggerated a mental development, 
and accordingly she strikes the offspring of the un¬ 
duly intellectual with a decadence as pronounced in 
its way as the genius of the parent was excessive, 
judged by the normal standard. On the whole this 
is comforting, because if the offspring of the highly 
gifted inherited the talent of their parental stock, 
plus the advantages accruing from their experience 
of the world, the ordinary individual, who in the 
aggregate makes up the masses, would stand no 
chance, and would inevitably become the serf and 
bondman of these more fortunate and gifted persons. 


An outbreak of malarial fever is reported to have 
occurred at the Hague, among the victims, according 
to the reports, being several members of the Peace 
Conference. 


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676 Thk Medical Pbess. 


NOTES ON CURRENT TOPICS. 


June 28, 1806. 


on Current topics. 

Cerebro-Spinal Fever. 

The subject of cerebro-spinal fever discussed by 
Professor W. Osier, in the Cavendish Lecture 
which we published last week, has a special 
interest in this country, inasmuch as it is an 
almost unknown disease. It occurs with such 
rarity that to the majority of English prac¬ 
titioners it is known only by name. Epi¬ 
demic cerebro - spinal meningitis, as cerebro¬ 
spinal fever is otherwise called, is, however, by no 
means a disease with which an intimate acquaintance 
is desirable. Our ignorance of its clinical features, 
owing to its rarity in this country is a matter upon 
which we may congratulate ourselves, for whatever 
the precise etiology of the malady may be, and how¬ 
ever much many points concerning it are involved in 
obscurity, there is nevertheless one definite feature 
belonging to it, and that is the high mortality asso¬ 
ciated with its occurrence. Thus in a recent 
epidemic at Boston, out of 111 cases 76 died, 
making a mortality of 68 5 per cent., a mortality 
which scarcely any known fever attains. Thus it 
is one of the most fatal of all acute diseases, although, 
fortunately, no fever attacks so few individuals in a 
community during its periods of prevalence. But 
another bad feature in connection with the malady is 
the hopelessness of treatment. Osier admits that in his 
series of cases no special drugs were employed. 
Relief from pain was sought by the free administra¬ 
tion of morphia, and ice sponging was resorted to 
whenever the temperature rose above 102 5 F. Again 
a trial ha6 been made of laminectomy with a view to 
the withdrawal of cerebro-spinal fluid, but further 
experience is required of this method of treatment 
before a definite statement, as to its utility or other¬ 
wise, can be pronounced. Perhaps, however to the 
scientific physician the interest of cerebro-spinal 
fever is centred in its bacteriology. This aspect 
of the disease has only recently been investigated, 
but it is now agreed that the specific cause of the 
malady is an organism known variously as the 
meningo coccus and the diplo-coecus intracellularis 
meningitidis. 

A Medical Action for Slander. 

Tn an action for slander brought by one medical 
man against another which was tried last week before 
Mr. Justice Ridley a curious point in law was 
brought into prominence. The defendant was alleged 
to have told his assistant that the reason why he bad 
l>een called in to attend a particular patient was 
liecause the doctor in attendance was on one occasion 
under the influence of drink. The case presented no 
particular interest, being merely a squabble between 
two neighbouring practitioners, but ns privilege was 
pleaded, the judge laid it down that while a doctor 
was privileged in communicating to his assistant the 
nature of the disease from which a patient was suffer¬ 
ing, he was not privileged to tell his assistant why he 
had been called in over the head of another practi¬ 
tioner. Thereupon the defendant withdrew his 


allegation and the case was settled. In the 
main, though, the point is rather fine for 
practical use, we are disposed to concede that 
the judge’s pronouncement is reasonable. It is 
obviously necessary that a practitioner should place 
his assistant in possession of all details that may be 
necessary to his position, but it cannot be said that 
the information concerning the reasons which had 
led to his being called in on this occasion were of this 
nature. We trust the lesson will not be thrown 
away, that medical men in talking of their brethren 
should introduce caution if not charity into their 
utterances. We have no sympathy with anyone who 
deliberately circulates reports concerning a rival cal¬ 
culated to damage the latter in public esteem, and we 
should scrutinise very closely the plea of privilege 
when pleaded as a bar to an action for slander. 

Holiday Leave for Poor-Law Doctors. 

We think it right to warn all Irish Poor-law 
Medical Officers that the boon of a month’s holiday 
in each year provided for them by Article 28 of the 
new Dispensary Regulations is liable to be rendered 
nugatory by the interpretation of the rule by the Guar¬ 
dians. We observe that the Belfast Guardians have 
made a fixed rule that doctors shall not have more 
than a fortnight’s holiday leave and apothecaries not 
more than seven days. This rule is conformable to 
the Dispensary Regulation which declares that 
the annual vacation shall not exceed four 
weeks. Furthermore, before going away, the 
doctor must “nominate a duly qualified practi¬ 
tioner who undertakes to perform the ditties of 
temporary medical officer at a rate of remuneration 
to be stated (? by whom), and until the Local Govern¬ 
ment Board express their approval of the arrange 
urent.” If the word “ stated ’’ means, as it obviously 
does, stated by the guardians, it will be open to any 
board to prevent any medical officer from obtaining 
any leave by fixing such remuneration for his locum 
tenen» as no one will accept. We know already of 
one case in which this has been done, and it seems 
likely that the doctor there will have to do without 
holiday. 

County v. City in Asylum Management. 

A meeting of the Derry Asylum Committee 
a few days ago was made the occasion of ex¬ 
pressing strong dissatisfaction on the part of 
district councils, especially Derry, because it has no 
representative on the Committee of Management of 
the Asylum. The position of Dr. O’Kane in the 
matter was thus expressed:—“ He objected to the idea 
of any antagonism between the city and the county 
in the matter, because he thought the people of the 
county should lie just as much interested in the 
management of the Asylum as the people of the city. 
He wished to say, so far as the city was concerned, 
there was no antagonism towards the county, and he 
hoped they would all work harmoniously together for 
their common good, and for the proper care of the 
lunatics.” The discussion is but a repeat of many 
others which are agitating the country elsewhere. 


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June 28, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press. 677 


The cry for local parochial government is l:eing more 
and more listened to; and there is danger of it 
becoming too much a question of practical politics. 
Of the Derry representatives we know nothing; but 
ambition for power in asylum management is being 
shown by men who each has his own axe to grind, 
and the management of some asylums seems to be 
run more in the interest of the people’s representa¬ 
tives than the patients. Noblesse oblige is well illus¬ 
trated in the conduct of the better class of 
representatives, and they are usually county gentle¬ 
men. The idea of local government by the parish 
units combined, for the benefit of the county and city 
as a whole, is a beautiful conception, but it won't work. 
In some parts of the kingdom—indeed, in many 
parts—the people's representatives are often not up 
to the average mental calibre snd morale of the 
people themselves. All this notwithstanding, the 
tone of the discussion referred to in this case was 
calm and judicial, and probably the city is quite equal 
to the county if its representatives are men of educa¬ 
tion and good standing. 

The Local Government Beard and the St. 

Olave’s Vestry. 

A fortnight ago we mentioned the fact that the 
Metropolitan Vestry of St. Olave's had suspended 
their Medical Officer of Health, Dr. Bond. The 
immediate cause of this extreme step was the action 
of the official in question with regard to the removal of 
bodies from the parish church. It appears that such 
a step could not legally be taken without the 
concurrence of the Ecclesiastical Commissioners, 
the Bishop of the Diocese, and the District 
Medical Officer of Health. Acting upon his own 
interpretation of the Act Dr. Bond helped in 
the removal of the remains. A great outcry 
was thereupon raised in the Vestry, and Dr. Bond 
was suspended on the ground that the Act really 
meant the sanitary authority, although it specifically 
mentioned the Medical Officer of Health. That view 
has not been sanctioned by the Local Government 
Board, which has refused to endorse Dr. Bond s sus¬ 
pension, and has sent a sharp intimation to the St. 
Olave’s Vestry that the medical officer was authorised 
to act individually without consulting the Vestry. 
This decisive support of a medical officer by the 
central authority will come as a welcome harbinger 
of the future to many a harassed medical officer of 
health. 

A New Form of Milk Adulteration. 

Some facts have recently come to light which 
show that an entirely new form of milk adulteration 
is now being adopted. A circular came into the 
hands of a milk vendor in a large provincial town 
from a firm purporting to be manufacturers of “ arti¬ 
ficial milk,” and offering certain terms to the vendor 
by which he could advantageously purchase some of 
the commodity for admixture with his milk, and so 
increase his profits. Inquiry showed that the use of 
the artificial product could be so arranged that one 
churn in six would consist of the spurious article. 
Again, it was stated that many large milk-sellers 


had added greatly to their profits by adopting the 
suggestion of the manufacturers in question. But 
when the latter were requested to give the names of 
their customers as references, the reply was that 
no such request could be complied with, as it 
would be against the interests of the firm to do so. 
Thus, here was a case in which a respectable trades¬ 
man was directly invited to embark upon a fraudulent 
practice, and to do that which he was given to under¬ 
stand was being largely adopted by others in his own 
line of business. Fortunately, however, he made, 
instead, the matter public, and declined to be a party 
to the fraudulent transaction. The worst feature in 
the case is that the detection of the spurious milk by 
analysis has not. so far. brought the offenders within 
the clutches of the law. After this disclosure, how¬ 
ever, the authorities concerned in protecting our food 
supplies from adulteration should make a special 
feature of analysing the milk within their respective 
districts. 

The Sale of Quack Medicines. 

Mr. Braxton Hicks, the coroner, seldom loses an 
opportunity of giving sound advice, when occasion 
arises, to those in his court who require it. A few 
days ago, for example, he read the quack-nostrum- 
buying public an excellent homily upon their folly 
and want of sense. The text was supplied by an 
inquest which he held concerning the death of a 
journeyman tailor, who, a sufferer from epilepsy, 
wasted his money at the rate of eleven shillings a 
bottle upon a quack concoction. The medical evidence 
showed that this concoction consisted of chloroform 
water, coloured with burnt sugar, containing a 
few grains of bromide of potassium ; and that its 
inclusive value, with the Government stamp, 
could not have been more than sixpence. 
The jury were so impressed with these reve¬ 
lations and the coroner's remarks, that they added 
a rider to their verdict to the effect “ that they 
considered that the attention of the proper authorities 
should be called to the gross fraud perpetrated upon 
the public by 6ale of these mixtures at exorbitant prices.’ 
We trust that this pronouncement will have the 
effect of infusing some sense into those easily imposed 
upon persons who so readily accept as truth the 
specious fables of cures contained in the announce¬ 
ments of the purveyors of quack nostrums. If such 
persons could only be induced to realise for a moment 
that the quack nostrum vendor would be quite unable 
to pay for his voluminous advertisements unless he 
overcharged the public for his wares, they would then, 
perhaps be able to understand that it would be much 
more economical to obtain their medicines through 
the usual and regular channels. 

Tuberculosis and Climate. 

In almost every county in England steps are being 
taken to found sanatoria for persons suffering from 
tuberculosis, and in this connection the curious poi t 
has arisen that such sanatoria are about to be built 
in localities where the disease is extensively preva¬ 
lent. For example, it has been asserted that while 


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678 The Medical Press. NOTES ON C URRENT TOPICS. June 28, 1899 


Roth bury in Northumberland—famous as the home 
of Lord Armstrong—is now becoming a favourite 
r®8ort of consumptives, who derive great benefit from 
the locality, the native population of the district 
themselves frequently fall victims to the disease. 
There is doubtless a good deal of truth in this state¬ 
ment. In some Northumbrian villages, especially upon 
the coast, the majority of the population are tuberculous. 
This is partly to be accounted for by the fact that 
inter-marriage to a large extent occurs among 
the resident families, thus a strongly inherited 
predisposition to tuberculosis becomes preva¬ 
lent throughout the district; as is well known, 
girls who come of a tuberculous stock are often 
beautiful specimens of maidenly comeliness, and thus 
the village swains—who may be their cousins— 
early become enamoured, and marriages soon follow 
which, in the light of present knowledge, should 
not take place at all. By this means tuber¬ 
culosis can readily become rife in a district, as 
has oftentimes been proved. Many of the children, 
bora of such parents, die of tuberculous meningitis, 
and those that survive childhood fall early victims to 
phthisis. There is another point of considerable 
interest in relation to this subject, and that is the 
wariness exhibited by Nature in safe-guarding her 
interests in regard to tuberculous persons. Hazard¬ 
ing some guesses, it may be that tuberculous girls 
are often naturally beautiful and prolific after 
marriage because, unless this were so, the ravages of 
the disease would seriously affect the reproduction of 
the species. In short, in order to make up for the 
destructive effects of tuberculosis upon life, Nature 
seems to have made special arrangements for ensur¬ 
ing a reproduction of the species so as to counteract 
the loss. 

A Malarial Investigation Expedition. 

The Liverpool School of Tropical Diseases is 
forging ahead so rapidly in its undertaking, that its 
promoters are deserving of much praise for the 
spirited policy which they are pursuing. In the first 
place they have agreed to receive from the Colonial 
Nursing Association in London three nurses for 
special training in the tropical diseases wards at the ex¬ 
pense of the school. Furthermore they have definitely 
decided to despatch a special expedition for the pur 
pose of investigating the causes of malaria and other 
indigenous diseases on the West Coast of Africa. 
The expedition will be under the direction of Major 
Ross, I.M.S., the recently appointed lecturer, and Mr- 
Annett, the demonstrator, to the Liverpool School. 
As soon as the arrangements for the expedition are 
completed, it will start for Sierra Leone if possible 
early in August, when the malarial season is at its 
height and the conditions are most favourable for re¬ 
search. Major Ross will, in his researches upon the 
West Coast, especially inquire into his theory which 
attributes malaria to the bites of a certain species of 
mosquito. It is this theory which has received so 
much acceptance from authorities upon the subject, 
nnd the results of these investigations will naturally 
be looked forward to with considerable interest 1 


However, nothing could be more calculated to add to- 
the practical value of the Liverpool School of 
Tropical Diseases than that two of its instructors 
should proceed to the very spot where malarial fever 
is most rife in order to perfect their knowledge of the 
subject by personal, scientific, and practical investi¬ 
gation. The success of such a school is at once- 
assured if this is the kind of enterprising policy 
which its promoters intend to pursue. 

Coroners and Post-mortem Examinations. 

A case which occurred before the Sheffield city- 
coroner last week illustrated a point in coroner’s law 
to which attention may be usefully directed. A child 
fell and injured its head, and after having been 
ti-eated for some days as an out-patient at the Shef¬ 
field Royal Hospital was admitted into the Institu¬ 
tion, suffei-ing from symptoms of which she ultimately- 
died. The house physician, with the consent of the 
mother, made a post-mortem examination of the 
body, and found that the cause of death was tuber¬ 
culous meningitis. At the inquest, which was held 
in due course, the above facts transpired, and the 
medical witness was taken to task by the 
coroner for having performed a post - mortem 
examination without having first obtained official 
sanction to do so. The law concerning this detail, of 
course, is very explicit. The body of a person whose 
death has occurred through violence is absolutely 
under the control of a coroner; no one else possesses 
any rights over it; where it lies there it must remain, 
untouched and uninterfered with, until it pleases 
the coroner to issue instructions respecting it. Resi¬ 
dent medical officers, therefore, in public institutions 
should not omit to bear these facts in mind for their 
guidance in all inquest cases. 

The Strawberry Cure. 

On the authority of Linnaeus, the treatment of 
gout by the free ingestion of strawberries has been 
resuscitated, and though we are not yet in the dead 
season it has been taken up by the daily press and 
run for all it is worth. In the biographical notes 
written by Linnaeus himself, and translated into 
English by Joseph Trapp in 1794, we find mention 
of the fact that he succeeded in curing himself 
promptly of a severe attack of sciatica by eating pro¬ 
fusely of strawberries on the advice of his wife, who 
was opposed to his taking opium for the relief of the 
pain. A return of the painful manifestation during 
the succeeding year also proved amenable to the 
treatment. The translator adds significantly that 
“Linneeus died soon after, and so the experiment 
ceased.” Absit omen. After the grape cure the 
strawberry cure. The treatment, which is perfectly 
rational, provided too much importance be not attached 
thereto, has the advantage of being within the reach 
of the humblest, at any rate of those whose symptoms 
happen to fall due during the strawberry sfeason. 
There are probably few among the well-to-do who 
would not be the better for an occasional course of 
“strawberry treatment,” which implies a holiday from, 
the usual too highly nutritious and stimulating diet 

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June 28, 1899. 


NOTES ON CURRENT TOPICS. 


The Medical Press. 679 


and, presumably, a rest from the excitement and 
worry of their daily avocations, In some, no doubti 
the pips contained in this luscious fruit would deter¬ 
mine more or less intestinal discomfort possibly cul¬ 
minating in appendicitis, but this is a contingency 
which must be faced in exchange for the blessed 
hope of getting rid of a troublesome tendency. 
Accurate clinical details of the effects of the “ cure ” 
are wanting, but these we imagine would compare to 
some extent with those of a “ cure ” at one or other 
of the famous watering places where a strict regimen 
always occupies a prominent position. 

The Perils of Patent Medicine Trading. 

If we may judge by the financial condition of 
some of the best known and most successful quack 
medicine companies, as reported in the Chemist and 
Druggist, the public taste for these concoctions is 
very fickle. The first such company to come to 
grief was the American.Hop Bitters Company. The 
vendor who made the business took, in 1886, £60,000 
in cash and £25,000 in debentures for his interest. The 
first year paid £10 percent., the second year nothing, 
and in 1892 the whole affair was sold by auction 
for £3,000. “ Sequah ” came next. He sold himself 
for £150,000 in cash and £100,000 in shares. The 
company paid 14 per cent, first year, showed a lose of 
£25,000 second year, and was wound up without a 
shilling in 1895. Then came Warner’s Safe Cure. 
The vendor took £446,000 in cash and £260,000 in 
shares. The first two years paid 20 per cent., the 
third year 10 per cent, and no dividend has been 
paid to the ordinary holders for five years. 
Last comes Mother Siegel (White and Company), 
This concern was practically altogether in the hands 
of Mr. White, the other directors being—by their 
own confession—entirely ignorant and confiding. It 
paid 10 per oent. in 1898, but on Mr. White’s death a 
month ago, it was found that there was a deficit of 
£40,000. It is said to be still doing a large business, 
though the profits have fallen in one year from 
£90,000 to £50,000. When the business was con¬ 
verted, the vendors took £960,000, of which £626,000 
was in hard savings. 

An Oyster-Typhoid Tragedy. 

The indictment against the oyster as an article of 
food attained crashing proportions in the special 
report upon the subject issued a couple of years ago 
by the Local Government Board. The upshot of the 
agitation was an enormous falling off in the con¬ 
sumption of this dainty and nutritious shellfish. 
Since then folk have plucked up heart again and 
returned to some extent to this favourite article of 
food, with the result that many fresh fatalities have 
been reported. One of the latest comes from Hove, 
where a town councillor has died of enteric fever 
contracted by eating oysters. It seems that a few 
weeks ago he formed one of an oyster supper party, 
and on returning home complained of pains in his 
back. At least four others who supped with him have 
been taken ill, but it is interesting to note that one 
only is reported definitely to b suffering from the 


specific infection. It is to be hoped that the source 
of the oysters will be traced, in order that the par¬ 
ticular source of this disaster may be at once rooted 
up from the midst of the community. In the face of 
the Government report, it seems hardly credible that 
local bodies and oyster merchants should have failed 
to set their culture and storage beds in sanitary order. 
Yet we believe that in many instances nothing what¬ 
ever has been done towards purifying the foul envi¬ 
ronment of the oysters. The tragedy of the Hove 
incident should do much to strengthen the demand 
for immediate oyster legislation by the Government. 
For that matter, however, these tragedies have been 
going on continuously, only they have not received 
the prominence bestowed on the unfortunate occur' 
rence at Hove. 


The Thirteenth International Congress of 
Medicine. 

We have been favoured by Mr. D'Arcy Power with 
an advance copy of the official programme of the 
Thirteenth International Medical Congress, which 
will be held at Paris in 1900, between August 2nd 
and 9th, under the presidency of Prof. Lannelongue- 
There will be five sections, (1) biological sciences, (2) 
medical sciences, (3) surgical sciences, (4) obstetrics 
and gynaecology, and (5) public medicine. The 
English Secretaries are, Dr. A. E. Garrod, Mr. 
D’Arcy Power, and Dr. Keser. As the Congress 
will be held coincidently with the International 
Exhibition, and at a date which will correspond to 
the maximum number of visitors, it is necessary to 
point out that those who propose to attend will do 
well to give early notice of their intention, or they 
may experience considerable difficulty in securing 
hotel accommodation. We are disposed to question 
the wisdom, from a scientific point of view, of holding 
the Congress amid the bustle of a great exhibition 
which cannot but detract from its success in all save 
a numerical respect. Who will be likely to sit out a 
long paper in a hot room when the danse du ventre 
is on view round the corner, and the myriad attrac¬ 
tions of an exhibition in the modern Babylon spread 
a seductive net over all ? 


Joint-Stock Doctoring. 

Some weeks since we called attention to a company 
of speculators which had been organised in Dublin 
under the title of “ Dr. Bland, Limited,” to “ canyon 
the profession of medical doctors, physicians, sur¬ 
geons, apothecaries, pharmaceutical chemists, den¬ 
tists, midwives, Ac.” All the members of the syndi¬ 
cate were unqualified with the exception of two 
medical practitioners, and we ventured to warn 
these gentlemen that their association with 
the practioe of such a company might render 
them liable to the attentions of the General Medical 
Council for “ covering ’’ the practice of unqualified 
persons. We note with satisfaction that one of the 
medical practitioners and one registered pharmacist 
who had joined the concern have taken our hint and 
withdrawn from the dangerous position. 


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€80 Thb Medical Pbess. NOTES ON CURRENT TOPICS. June 28, 1899 


Medical Organisation at Enfield. 

The practitioners at Enfield, to the number of 
•sixteen, have joined hands in the determination to 
refuse to attend persons belonging to any medical 
•aid society, and an advertisement has been published 
to the effect that the practitioners in question, having 
resolved to have nothing to do with medical aid 
societies, have formed a doctors’ club for attendance 
on families whose income is under £'2 a week. 
Hitherto most combinations of the kind have broken 
down owing to the readiness of outside practitioners 
to undertake the work, but in view of the recent 
pronouncement of the General Medical Council, it 
may be anticipated that leos scrupulous men will j 
hesitate before rushing in where angels fear to tread. | 

Auto-Auscultation in Incipient 
Tuberculosis. 

Attention has been called by a French observer i 
to the fact that persons with incipient tuberculosis I 
not perceptible to ordinary auscultation often experi- J 
.ence, when talking loudly, a sensation of local vibra- j 
tion over a given area of the thorax corresponding to I 
a zone of partially solidified subjacent lung. In some 
the sensation amounts to positive discomfort, but 
more frequently jt is not perceived by the patient 
until his attention haB been directed thereto by the 
•physician. The point is worth noting, though in all 
probability a degree of infiltration which would 
expose the patient to this sensation of localised 
vibration would be sufficient to attract attention at 
the hands of the examining physician by the ordinary 
methods of physical investigation. 

Bicycling in Diabetes. 

The question of exercise for diabetic patients is i 
one requiring careful consideration, the more so as I 
the imperfect nutrition from which many of them 
suffer indisposes them to active pursuits. Accord¬ 
ing to Albu methodical muscular exertion, such as ! 
that of cycling, is a therapeutical factor hardly 
second in importance to the regulation of the diet. 
It has the advantage moreover of being more readily 
applied than the latter, which entails a degree of 
patience and perseverance not always at the com¬ 
mand of the sufferers. It is hardly necessary to add 
that the effects of the exercise should be very care¬ 
fully scrutinised at first, not only in respect of the 
urinary sugar, which should be estimated both quali¬ 
tatively and quantitatively, but also in view of its 
effects on the renal function. 

The Union Drug Analyst. 

The Local Government Board for Ireland has 
made it understood that it will not sanction the 
appointment to the post of analyst to an Irish union 
of a simple pharmaceutical chemist. They say that 
candidates must ft haye considerable experience of 
the analysis of drugs, and must have obtained (by 
examination) a diploma in pharmacy, materia medica, 
and volumetric examination of drugs—from recog¬ 
nised examining body,” 


The Late Mr. Lawson Tait and the Anti- 
Vivisectionists. 

The anti-vivisectionists have been making all 
possible capital cut of a passage anent experiments 
on living animals contained in the last communica¬ 
tion from the late Mr. Lawson Tait which appeared 
in our columns. Mr. Tait's views on the subject are 
well known, and the anti-vivisectionists are welcome 
to make the best use they can of the utterances of 
this eminent surgeon whose fame in yearr, to come 
will be based, not on the fads from which he, eminent 
though he was, was not exempt, but on the solid 
surgical achievements the success whereof was 
largely due to the recognition of principles and 
practices obtained by patient and painstaking 
researches entailing the sacrifice of much animal life. 

One Shilling a Week for the Doctor. . 

The guardians of the Cahirciveen Union have, we 
rejoice to say, been mulcted by Judge Shaw with a 
decree and costs. Dr. Walker, of Glenbeigh, having 
been summoned to give evidence at the assizes, gave 
due notice that he must be absent from his district, 
and recommended liis son, naming the fee of 
£1 Is. a day. The duty was performed.- and the 
guardians then voted the munificent sum of Is. for 
the whole period. As we have said they were igno- 
miniously defeated, and we hope that the solicitors on 
both sides will not stint themselves in their costs. 

Small-Pox Epidemic at Hull. 

It is satisfactory to note that the epidemic of small¬ 
pox at Hull lias been circumscribed, the report of the 
Medical Officer of Health testifying to sixty-one cases 
with thirteen deaths. The cases comprised both 
vaccinated and unvaccinated persons, but of the 
former only four out of forty-five succumbed, i.e., one 
in twelve, while of the unvaccinated, nine out of 
sixteen died, i e.. more than one half. No doubt if 
the date of vaccination were taken into account the 
protection afforded .by vaccination would be even 
more apparent, for not one of the fatal cases is re¬ 
ported to have taken place in a revaccinated person. 

The Practice of Medicine in Italy. 

The practice of medicine in Italy, so far as 
foreigners—that is, Englishmen and others—are con¬ 
cerned, is limited to attendance upon persons of their 
own nationality. The Italian Government have 
issued a circular letter to all their Ambassadors to 
this effect, and at the same time have stated that, 
with this exception, it is forbidden to anyone to 
practise medicine generally in Italy unless he pos¬ 
sesses an Italian medical qualification. 

An Unqualified Assistant’s Libel Action. 

An absurd action was tried in the Queen’s Bench 
Division last week in which an unqualified assistant, 
described as an Asiatic, sought to recover damages 
from a number of daily papers for having published 
reports of a county court suit brought by the plaintiff, 
against his erstwhile principal for a sum of money 


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June 28, 1899. 


OBITUARY. 


The Medical Press. 681 


alleged to be due. The circumstances as reported 
were extremely amusing, but ultimately the jury 
stopped the case on the ground that there was no 
libel. 

The Annual Meeting of the Irish 
Medical Association. 

This congress of the members of the Association 
assembled in Cork on the 20th inst. under the presi¬ 
dency of Dr. Hobart. The profession in that city 
had made preparations to receive and hospitably 
entertain their visitors, and were entirely successful 
in securing the conduct of important business and 
the comfort and enjoyment of the members. A 
banquet was held, at which most of the county mag¬ 
nates were present, and on the succeeding day the 
visitors were taken by steamer to Queenstown, and 
round the harbour to view the regatta, and were enter- 
tained to luncheon on board. We regret that the great 
pressure on our space for the accommodation of our 
half-yearly index and other important matters, 
obliges us to postpone publication both of the report 
of the meeting and the annual report of the Council. 


PERSONAL. 

Surgeon-General A. F. Churchill. M B., of the 
Army Medical Staff, has been placed on retired pay. 

Lieut. A. B. MacCarthy, M.B., has resigned his Com¬ 
mission in the Royal Army Medical Corps; and Surgeon 
Captain C. A. MacMunn, M.D., has been promoted to 
Snrgeon -Major. 

The Duke and Duchess of York opened four new 
homes on Saturday last at the colony established by the 
National Society for the Employment of Epileptics, at 
Chalfont, Bucks, of which his Royal Highness is president. 

Dr. G. E. Shuttleworth and Miss F. May Dickin¬ 
son Berry, M.D., B.S Lond., have been reappointed by 
the London School Board for a second year to examine 
defective children and children alleged to be defective, 
who have been recommended for special instruction, and 
to perform cognate work in the blind and deaf centres. 

Inspector-General Henry Macdonnel, C.B.,of the 
Royal Navy Medical Department, who has been placed 
on the retired list after thirty years’ service, was on 
board the Invincible at the bombardment of Alexandria 
in 1882. He was made a Companion of the Order of the 
Bath on the occasion of the Diamond Jubilee in 1897 

Our Manchester correspondent informs us that hono¬ 
rary degrees of the Victoria University are to be conferred 
upon Professor Clifford Allbutt, M.D., F.R.S. ; Professor 
C. H. Herford ; Dr. J. E. Schunck, and Mrs. Henry 
Sidgwick on Saturday next. Mrs. Sidgwick will have 
the distinction of being the first lady to receive the 
honorary degree of the Victoria University. 

Dr. Richard Garnett, C.B., late Keeper of Printed 
Books at the British Museum, was presented on Friday 
last with his portrait in oils, painted by the Hon. John 
Collier, together with a gift of forty-seven volumes of 
works of reference, subscribers to which included 
librarians from all over the United Kingdom, Canada, 
France, Germany, and the United States. 


gtotlanfc. 

[from our own correspondent.] 

Glasgow University.— The final examinations now 
completed have not terminated to the unqualified satis¬ 
faction of candidates. Among many causes for 
grumbling on the part of students is in the outset the 
multiplicity of examiners Usu\lly there are four in 
surgery, and in medicine this year no less than six 
different eiaminers, each of whom it is reported has 
little points to which he is specin lly partial, and which 
may be classed under the term “ fads,” but he neverthe¬ 
less expects the unfortunate candidate to know all about 
them. Should a ca didate e*press to examiner A. the 
method of B. in performing an operation which does not 
tally with A.’s fad for the same operation and vice 
versa, the danger to the said candidate is self-evident. 
By this unfoitunate state of matters, many good and 
hard-working students have come down and been referred 
bark, especially in surgery. 

Queen Margaret College.— At the recent final 
examinations the women students have come out well, 
and in every branch pressing the males very hard. Among 
Queen Margaret students a scheme has been recently 
brought to their notice which is being organised by a 
committee of medical women practising in Scotland, 
and which proposes to establish a fund in commemora¬ 
tion of the efforts of Dr. Sophia Lea Blacke, who is now 
retiring, and to whose work the satisfactory position of 
women in the profession iB largely due. If funds are 
forthcoming, the present idea is to offer periodically a 
post-graduate scholarship or something of that nature. 

Horse-Play at the Edinburgh Royal Infirmary.— 
The resident physicians and surgeons have recently 
been making themselves "lightly ridiculous. “ Ragging ” 
of bedrooms and other more or less elaborate practical 
jokes are an old tradition, and, as a rule, no harm comes 
of it. This summer, unfortunately, the fooling has not 
been taken as it was meant, or, say the victims, was carried 
to an undue extreme. Be this as it may, the friction 
became so excessive that certain members of the resi¬ 
dency thought right to lay the matter before the autho¬ 
rities a few dayB ago, ana a thorough inquiry is being 
instituted. It seems to us that, in itself, such practical 
joking—even if it does reduce a man to vacating his 
room for a night or two—is of little consequence, but 
what the residents do not realise is the amount of harm 
to which the publicity of their actions—harmless 
enough in themselves - may give rise. The credit of an 
hospital, in more ways than one, depends on their beha¬ 
viour ; it is with them that the public come most fre¬ 
quently and directly in contact, and (though it is not for 
one moment suggested that the patients can or do Buffer 
in any way on account of rows in the residency) surely a 
very little common sense might tell the men that to act 
in such a way as periodically to yield “ copy ” to the news¬ 
papers is neither seemly nor calculated to inspire the 
public with confidence. 


©bituartj. 

DR. CAHILL, OF BALLYNACARGY. 

The above well-known and respected member of the 
medical profession died at his residence, Ballynacargy, 
on Sunday, the 18th inst., at the age of 75 years. Dr. 
Cahill commenced professional life in the district more 
than half a century ago, and for many yearB had a lucra¬ 
tive and extensive practice in the counties of Westmeath 
and Longford. He was an honorary surgeon to the 
county infirmary, and as well as being a magistrate for 
the co. W estmeath, was for a time member of the Council 
of the Irish Medical Association. 

Of a retiring and unobtrusive manner, there were few 
physicians in rulral practice in Ireland who so fully pos¬ 
sessed the confidence of the community as a well- 
informed and conscientious practitioner; kind, urbane, 
and genial to all, he passed away mourned, beloved, 
and respected by those among whom he lived and 
laboured so long. 


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682 The Medical Press. 


MEDICAL NEWS. 


June 28, 1890. 


DE. WILLIAM McGILL, OF GLASGOW. 

Dr. McGill, who died on the 17th inst., was for over 
forty years medical officer to the police force in Glasgow, 
which post he held and discharged its dnties until 1896, 
when he ceased from active duty, and was allowed a 
retiring allowance. He was a Licentiate of the Faculty 
of Physicians and Surgeons, Glasgow, 1848, and of the 
College ef Physicians, Edinburgh, 1869, and M.D. of 
Glasgow University, 1867. Dr. McGill was of an exceed¬ 
ingly kindly disposition, discharging his duties during 
his long term of service with satisfaction both to the 
members of the force and to the authorities. At the 
time of his death he had reached the ripe age of eighty- 
two years. 


(tarfcepmtOettcc, 

We do not hold ourselves responsible for the opinions of our 
correspondent*. 


NOEDEACH AND FALKENSTEIN. 

To the Editor of The Medical Pbbsb and Cibculab. 

Sib,— In the Medical Press and Circular for May 
31st appears an editorial article entitled, “The Eival 
Systems for the Senatorial Cure of Phthisis. 1 ' 

The writer refers in the first place to “ the wordy war¬ 
fare waged between the apostles and their disciples of 
the two schools, viz., Falkenstein and Nordrach ; Falken- 
stein with its apostle Dettweiler, and Nordrach boasting 
Walther as its prophet.” 

In reference to this I would merely remark that Dr. 
Dettweiler has never written a word against Nordrach, 
mor has Dr. W alther ever published a single line, either 
about his own sanatorium or any other, except once, to 
contradict a sapient visitor who declared that there were 
no windows in his institution. On the contrary, I have 
never heard Dr. W alther speak of Dr. Dettweiler except 
in terms of admiration; and I know he regards the defi- 
ciences of Falkenstein as being due to deviations from 
the original spirit and intention of Dettweiler himself. 

This article is, however, more understandable when 
one remembers that visitors to Nordrach seem to con¬ 
sider a twenty minutes' stay in the place sufficient 
ground for writing an authoritative criticism upon Dr. 
Walt heir's system of treatment; so much so that they 
are ironically called by patients “ the twenty minutes’ 
doctors.” 

To quote again from the Medical Press and Cir¬ 
cular article. Beferring to a Nordrach patient, the 
writer says :—“ If unwilling to sleep with a wide-open 
window, the window is removed.” 

With regard to this statement, I may observe that I 
have lived a year and a half at N ordrach, and can abso¬ 
lutely deny that such a thiDg is ever done. 

Again, the writer says that “The Nordrach system 
aims at individual medical control, and limits the 
number of inmates; but even this has a drawback, for 
it is seldom possible to install a resident expert laryngo¬ 
logist because of the expense; and even the Nordrach 
treatment requires, it appears, some local assistance in 
laryngeal cases. It is extremely difficult to find out the 
truth as to laryngeal cases of consumption in sana¬ 
toria." 

Dr. Walther has never attempted to install a resident 
laryngologist, for the very good reason that he was him- 
telf an expert laryngologist in Frankfort before the 
illness of a consumptive relative decided him to give up 
his practice and undertake the treatment of con¬ 
sumption. 

The writer goes on to eay, "We believe that such 
patients— i.e., laryngeal cases are not pertonw gratee at 
Nordrach.” 

I am in a position to state that Dr. Walther usually 
knows nothing about his patients until they arrive at 
Nordrach, that there is no selection of cases such as 
obtains in most of the other German sanatoria, that 
numbers of laryngeal cases are treated at Nordrach, and 
that there are people now in England who, having 
suffered from laryngeal tuberculosis, have been cured 
at Nordrach, remain well, and are even able to sing. 


But the most astonishing statement yet remains to be 
cited. The writer, in speaking of the methods of sana¬ 
toria of the Falkenstein type as compared with Nordrach, 
says, “ There is no doubt that both are right in so far as 
they are severally adapted for various different types of 
patients; one type of patient is benefited by the milder 
regime (i.e., Falkenstein). injured by the harsher, and 
vice versa.” Very plausible, but not correct. Has the 
writer a single tittle of evidence to support this state¬ 
ment? I trow not. Now I have treated patients, both 
English and German, under Dr. Walther, at Nordrach, 
patients coming from other German sanatoria conducted 
on the same lines as Falkenstein, and I can refer the 
writer to people in Frankfort if he likes, who, after 
trying the sanatorium treatment inculcated by Dett¬ 
weiler for many months, failed to make progress; nay, 
were fast pursuing the downward path and who were 
cured at Nordrach, and now follow their ordinary avo¬ 
cations in good health. 

Can the writer of the article adduce a solitary 
in which a Nordrach patient, failing to improve there, hat 
gone to some other sanatorium and made a recovery ? I 
know he cannot, and I know that the Nordrach treat¬ 
ment is the best system ever devised for bringing 
about the arrest of pulmonary tuberculosis, and that if 
that system fails there is then no other means known to 
us at present which has the slightest chance of bringing 
about the desired result. * 

I think it would be well if would-be critics of Dr. 
Walther and his system would first take the trouble to 
verify their facts. 

I am. Sir, yours truly, 

(Signed) E. Mander Smith, M.D,Lond. 

[No better evidence could be afforded of the exports 
views of an adherent to one of the systems referred to 
than by Dr. Mander Smith’s letter. No one, forsooth, 
has ever been tenefitted by any other system after 
having failed to respond to his own special pat! We 
know personally of several cases. Nor are Nordrach and 
Falkenstein the only institutions, though they may be 
the earlieft and most famous in which the systems are 
carried out. As Dettweiter is still the consulting 
physician at Falkenstein, and constantly visiting the 
sanatorium, it is to be presumed that any change in the 
routine there has hiB sanction and approval. Dr. Smith 
“ knows ” that the Nordrach system “ is the best.” Just 
so, that is the point we were complaining of.—E d.] 




Messrs. Burroughs, Wellcome, and Go. 

Have during the past few days opened new chemical 
research laboratories at King Street, Snow Hill, with Dr. 
F. B. Power as director of a large ►taff of scientific 
workers. The increasing demand for the serums of this 
firm has also necessitated increased accommodation for 
their manufacture, to insure which they have acquired 
the Brockwell Hall estate at Herne Hill, where the fine 
old mansion is in course of reconstruction in order 
to adapt it to purposes foreign to its original 
designer, whilst the extensive paddock will form 
a valuable adjunct for rearing and keeping the «.nima.lc 
necessary for serum culture. But whilst keeping pace 
with the exigencies of business they have not neglected 
the health and enjoyment of their workpeople. Were it 
not for the fact that the principal—Mr. Wellcome—hae 
not yet reached middle age, one might not inaptly des¬ 
cribe him as Pat rim pictatie imago, inasmuch as on 
Saturday last he presented a large park, with club and 
institute, to his employee!, who now number more than 
800 of both sexeB (including a large number of profes¬ 
sional scientific workers), in order to promote harmony 
and social intercourse amongst them, to encourage mental 
and physical recreation by means of musical, literary, 
and other entertainments, educational classes and leo- 


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Junk 28, 1899. 


MEDICAL NEWS. 


The Medical Press. 683 


tores on scientific and technical subjects, and 
by providing the space and opportunity for indulgence 
in athletics, field sports, and games. The club and grounds 
are close to the factory at Dartford, and on Saturday 
the donor generously gave hospitality to about 1,000 
people, including guests, among whom were several 
members of the learned professions. The day was 
devoted to sports and recreation of every conceivable 
kind, finishing up with the presentation of prizes by 
Mrs. A. Chune Fletcher, the illumination of grounds, 
lake, and river, and a brilliant pyrotechnic display. 

Abscess, or Aneurysm ? 

An interesting action was tried at the Sunderland 
County Court last week, when one Smith, a labourer, 
claimed damages from Mr. Robert John Bums, a Poor- 
law medical officer, for having opened an aneurysm, 
which he had mistaken for an abscess, in spite of the 
protests of the plaintiff. It transpired that the plaintiff 
nad been an in-patient at the Infirmary for this very 
aneurysm, but had left of his own free will. Hethen 
obtained an order, and Mr. Bums attended him in conse- 

3 uence. The plaintiff does not appear to have told the 
efendant the nature of the lesion as diagnosed at the 
infirmary, and without due reflection Mr. Bums made an 
incision, but promptly discovered his mistake, and after 
some delay steps were taken to arrest the haemorrhage. 
The allegations of inebriety made by the plaintiff against 
the doctor were shown to be devoid of foundation, and 
after it had been explained to the jury how easy it was 
to mistake an aneurysm for an abscess, an error for 
which there are numerous illustrious precedents, they 
returned a verdict in favour of the defendant. 


Death From Tetanus. 

A death from tetanus was the subject of an inquest in 
East London last week, the victim being a blacksmith, 
set. 51. The symptoms had developed some days after 
an injury caused by a fall from a cart, and it was only 
on the tenth day that he was sent to the hospital, where 
he shortly after died. 

Carbolic Acid Poisoning. 

In reply to Sir John Leng, the Home Secretary 
admitted the frequency with which death occurred from 
the accidental and intentional ingestion of carbolic acid, 
adding that when some years ago the Pharmaceutical 
Society petitioned the Privy Council to comprise the 
acid in the schedule of poisons it was considered that 
the gain to the public would not be commensurate with 
the inconveniences of such restrictions. He admitted 
that it was scheduled as a poison in Ireland, but that 
was by a special Act. He concluded by stating that 
the Privy Council were prepared to consider the desira¬ 
bility of dealing with the subject, but con'd only do so 
on representations from the Pharmaceutical Society. 
As these representations will presumably be forthcoming 
it may be that we are within reach of this much needed 
step, though in view of the procrastinating policy of the 
Privy Council on this point in the past we dare not 
express too sanguine a view. 

Death Under Chloroform. 

Another death under the so-called “open ’ method 
of chloroform administration is reported from Edin¬ 
burgh, where a labouring man died shoitly after the 
performance of an operation for which the anaesthetic 
had been given. 

Association of British Postal Medical Officers. 

The annual dinner of this association took place at 
the Whitehall Rooms, Hotel Metropole, on Thursday 
last, Dr. W. Dougan, President, in the chair, supported 
by a large number of members and distinguished guests. 
The toast list was unusually comprehensive, but its 
length was compensated by the choice of orators, among 
whom we may mention Sir Walter Foster, who responded 
to the toast for the “ Houses of Parliament; ” Sir Hugh 
Gilzean Reid, who proposed that of the “ Post Office 
Service;” Sir James Crichton Browne, to whom was 
entrusted the toast for the “ Education and other State 
Departments,” this toast being responded to by Sir 
George Kekewich; Professor Coifield, who spoke on 
behalf of “ Municipal Institutions; ’ and Professor Sims 
Woodhead, who proposed, and Dr. Glover who acknow¬ 


ledged, the toast of the “ General Medical Council.” 

I he toast ef the “ Medical Press ” was proposed by Dr. 
J. Tatham, and was responded to by Mr. Wakley, jun., 
for the Lanc» f , and by Dr. Gubb on behalf of the 
Medical Press and Circclab. Mr. Wakley pointed 
out that the association was evidently one without 
grievances, inasmuch as the medical press bad not so 
far been cognizant of its existence, an ideal position 
for an association of medical men. A very agreeable if 
protracted evening was spent, the intervals between the 
toasts being filled by appropriate musical selections ren¬ 
dered by musical volunteers. 

The Midwives Bill 

This Bill has now been definitely dropped so far as 
the present session is concerned, but we have no doubt 
that more will be heard of the scheme on a future occa¬ 
sion. The aspirmt midwife affects the pertinacity of 
the importunate widow. 

Thb Queen has intimated her intention to open the 
new wing of the National Hospital for Consumption at 
Ventnor during the stay of the Court at Osborne. The 
wing now in course of erection is named after the late 
Prince Henry of Battenberg, and the foundation-stone 
was laid last year by Princess Henry. 

Boyal College of Burgeons, Ireland. 

Fellowship Examinations.— The following gentle¬ 
men, having passed the necessary examination, have 
been admitted Fellows of the College:—Mr A. A. Doyle, 

L. R.C.P.I., and L.R.C.S.I., and Mr J. P. Frengley, M.D., 
and B.Ch., Royal University. 

Society of Apothecaries of London. 

At the June examination", the following candidates 
passed in:— 

Surgery.—F. W. Chesnnve (Section II.), S. E. Dunkin, H. H. J. 
Edwards (Sections I. and II.), W. M. Hocken.D. V. Lowndes (Sec¬ 
tion II.), V. S. Partridge (Section II.), D. O. Williams, W. P. 
W'illiauison. 

Medicine.—S. J. H. Eastwiek Field, H. H. J. Edwards (Section 

II ), T. H. Fox, J. B. Hal) (Section I.), G. C. Hobbs (Section II.), A. 
Killick (Sections I. nnd II.), W. M. McLoughlin, A. Ornie (Section 
II.), G. E. Seville. W. C. Stunham. 

Forensic Medicine.—S. J. H. Eastwiek Field, T. H. Fox, F. Gold- 
ing-Bml, J. B. Hall, A. Kil.ick, W. M. McLoughlin, G. E.. Seville, 
W. C. S anhain. 

Midwifery.—J. R. Bentley, H. S. A. Davies, J. C. S. Dunn, S. J. 
H. Eastwiek Field, T. H. Fox, L. Lehmann, F. Marriott, G. G. 
Meuibeiy-.A. Ornie. G. E. Seville. 

The diploma of the Society was granted to the following candi¬ 
dates, entitling them to practise medicine, surgery, and midwifery: 
—F. W. Clie8uuye, S. E. Dunkin, H. H. J. Edwards, F. Golding- 
Bird. W. M Hocken.G. C. Hobbs, A. Killick. D. V. Lowndes, W. 

M. McLoughlin, W. P. 'Williamson, and D. O. Williams. 

Univemlty of Glasgow. 

At the recent final examination for M.B., Ch.B, the 
following candidates attained distinction in the subjects 
indicated (S. surgery and Clinical Suigery; P., 
Practice of Medicine and Clinical Medicine; M., Mid¬ 
wifery.) 

James Robert Chalmers (P., M.); John Craig 'P.); Hugh Camb 
bell Ferguson (S.. M.) ; George Gardner (M. ; John Gardenr (9., 
P., M. 1 ; Jessie Downie Granger (P., M.) ; Jessie Sophia Beatrix 
Hunter (M.); Hugh Miller iM.) ; Norman M'Leod Miller (M.); 
Ebenezer Mitchell, M.A. iP.,M.); James Hogg MacDonald tP., 
M.); Peter M‘Fadyeu M.); William Alexander Riddell (M.); 
Arthur Robin (M.); Alfred George Stewart (P.) ; Wil'iam Brown 
Thomson (P.): Edythe Marjorie Stewart Walker (P.) : Alexander 
Laurie Watson, M.A. S., P., M.); Alexander Simpsou Wells, M.A. 
(S., P.) 

The following have passed the Fourth (Final) Pro¬ 
fessional Examination:— 

For the M.B., C.M.— George Henry Beck Harvie, Alexander 
Page Robertson, Alexander Waugh. 

For the M.B., Ch.B.—James Napier Baxter, Auguste Boyes, 
William Bioad. undrew Brownlie, James Robert Chalmers, David 
Maclure Cowan, John Craig, George Morris Crawford, William 
Crerar, John Lullen, Charles Cheveu dimming, Sarah Davidson, 
John Lithgow Davie, James A ust in Dickie, Hugh Campbell Ferguson, 
James Fulton Find ay, G. Gardner, John Gardner, Hyam Goodman, 
M.A.; Jessie Downie Granger, James Garden Green, Andrew Kerr, 
Andiew Love, Ramsay Millar, Hugh Miller, Norman M’LeodMiUer, 
Ebenezer Mitchell, M.A.; James Hogg MacDonald. John M’Gil- 
christ, Norman Forbes MacLeod, W'il iam Johnston Maclure, John 
M'Millan, Iua Lochhead M'Neill, John Pattou, Thomas Stephens 
PickeD, John Reid (Lma>k', William Alexander Riddell, Arthur 
Robin, Catherine Love Smith, Dnvid James Smith, William Stewart 
Stalker, Alfred George Stewart, Frederic Richardson Stewart, M.A,; 
Charles Pinkerton Thomson, William Brown Thomson, Henry 
Niabet Turner, Edythe Marjorie Stewart Walker, Alexander 
Laurie Watson, M.A.: Alexander Simpson Wells, M.A.; Sara 
Whiteford, Robert Orr Whyte, M.A.; William Wright, John Doctor 
Young. 


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684 The Medical Press NOTICES TO CORRESPONDENTS. June 28, 1899. 


Notices to 

(Eorreeponbenie, Short liters, ■&£. 

0*r Correspondents requiring a reply in this column are par¬ 
ticularly requested to make use of a distinctive signature or 
nitiale, and avoid the practice of signing themselves “ Reader,” 
■’Subscriber,” “Old Subscriber,” Ac. Much confusion will be 
spared by attention to this rule. 

Beading Cases.—C loth board cases, gilt lettered, containing 
twenty-six strings for holding the numbers of The Medical Pbess 
akd Circular, may now be had at either office of this journal, 
price 2s. 6d. These cases will be found very useful to keep each 
weekly number intact, clean, and flat after it has passed through 
the post. 

Reprints. -Authors of papers requiring reprints in pamphlet 
form after they have appeared in these columns can have them, at 
half the usual cost, on application to the printers before the type is 
broken up. 

BACTERIOLOGY IN EXCEL8IS. 

A woman here dearly loves big words, and she does not always 
use them correctly. The other day a neighbour complained of in¬ 
cessant pain in her back, whereupon the user of big words said : “ I 
would consult Dr. Pellets for pains in the back. He’s the finest 
bacteriologist that I know ot."—PitUburg Chronicle. 

Mb. Horn.—W e will look into the matter and inform you of 
result in due course. 

A Candidate fob the Hioheb Exam, will find all he requires in 
Stewart's “ Manual of Physiology.” 

THE MEDICAL SICKNESS 80CIETY. 

Dr. Barbt, Ballyduff, co. Waterford, will be glad to hear the 
views of the Irish members of the Medical Sickness Society, 
London, as to the desirability of holding a meeting of medical men 
in reference to the working of above Society in so far as it concerns 
Ireland, and to arrange for a meeting to be held in Dublin or 
elsewhere at an early date. The meeting is being organised by Mr. 
R. A. Williams, of Queen's Square, Fermoy, a member of the 
Society. 

J. H. S.—The Imperial Accident Insurance Company (17 Pall 
Mall, London) issues, we believe, a special policy for the insurance 
of doctors' carriages. 

Dr. W. R. Debmott’s “ Monistic Physiology ” is marked for 
early insertion. 

THE SYMBOL OF FAITH. 

The ideal symbol of faith, observes an American exchange, is not 
the traditional maiden clinging to the Rock of Ages, but the bald- 
headed man confidently consulting the bald-headed specialist, and 
looking forward with enthusiasm to a great growth. 

Mr. H. F. C.—Regret we must decline your communication; it is 
more suitable fora chemist’s journal than for this. 

Miss Gilbert.—W e do not undertake to give medical advice. 
You had better consult your usual medical attendant who, no 
doubt, will have no difficulty in gratifying your curiosity as to the 
cause of your trouble. 

" THOSE CUB8ES OF HUMAN LIFE.” 

We are in receipt of a letter headed “ Lucas Hospital, Woking¬ 
ham,” and signed “ J. Stratton," which contains the following pas¬ 
sage:—“We have no sympathy with papers which support the 
cowardly pests and curses of human life • the vivisectors, who, if 
they had their deserts, would be hung up on the nearest trees.” We 
are unable to find the institution referred to in the “ Medical Direc¬ 
tory,” and the same remark applies to the signatory of the letter, a 
fact which may explain the writer’s hysterical eloquence on a sub- 

J ect on which, probably, he knows little and feels strongly. Where 
he reason is weak the prejudice is at ong! 

Ex-Student.— We cannot hold out any hope that the General 
Medical Council will provide facilities for the qualification of impe¬ 
cunious or backward students, past or present. If, for pecuniary 
reasons, the medical career is closed to yon, you had better seek 
some other sphere of activity. We are not cognisant of any fund 
on which you could draw to defray the expenses of a medical educa¬ 
tion, though, of course, there are plenty of scholarships open to 
the exceptionally gifted. 


DaoutricB. 

Berrywood Asylum, Northampton.—Assistant Medical Officer for 
five yea is, unmarried. Salary £150, increasing to £200, with 
board, lodging, washing, and attendance. 

Bethlem Hospital, Bridewell, London.— Two Resident House 
Physicians for six months. Apartments, complete board, and 
washing provided. Honorarium at the rate of £12 12s. each 
per quarter will be paid. (See Advt.) 

Burton-upon-Trent.—Medical Officer of Health for the District of 
the Borough. Salary at the rate of £350 per annum, exclusive 
of authorised disbursements.—Applications to the Town Clerk, 
Burton-upon-Trent. 

Bradford Poor-Law Union.— Two Resident Assistant Medical 
Officers for the Hospitals and Workhouseof the Union. Salary 
of 8enior £125. of Junior £100, with rations, apartments, and 
washing.—Applications to the Clerk to the Guardians, Brad¬ 
ford. 

County Asylum, Gloucester.—Third Assistant Medical Officer, un¬ 


married. 8alary £105 per annum, with board (no Btimulants), 
lodgings, and washing. 

County Asylum. Prestwich, Manchester. - Junior Assistant Medical 
Officer. Salary commencing at £125 per annum, with apart¬ 
ments, board, attendance, and washing. 

County Asylum, Whittingham, Lancashire. — Locum Tenene for 
about four or five months. Salary two guineas a week, with 
board, Ac. 

Glasgow University. Assistant Examinersbip in Medicine, with 
special qualification to examine in zoology.—Applications with 
testimonials must be sent to A. E. Clapperton, Esq., 91 West 
Regent Street, Glasgow. (See Advt.) 

Gort Union.—Analyst to the Union. - Immediate applications. (See 
Advt.) 

Manchester Royal Infirmary.—Resident Surgical Officer for twelve 
months, unmarried. Salary £100 per annum, with board and 
residence. 

Mason University College, Birmingham (with Queen’s Faculty of 
Medicine).—Professorship of Physiology. 

Owens College, Manchester.—Senior Demonstrator in Physiology. 
8tipend £150 per annum, rising to £200. 

Royal Cornwall Infirmary, Truro.—House Surgeon. Salary £120, 
with furnished apartments and ittendance. 

Seamen’s Hospital Society, Greenwich, S.E.—Physician to the In- 

S .tients and a Physician to the Out-patients at the Branch 
capital in the Royal Victoria and Albert Docks, E.—Particu¬ 
lars of the Secretary. 

Staffordshire General Infirmary, Stafford. - House Surgeon. Salary 
£100 per annum, with board, lodging, and washing. Also 
Assistant House Surgeon. Salary £50 per annum, with board, 
lodging, and washing. 

Stockton and Thomaby Hospital, Stockton-on-Tees.—House Sur¬ 
geon, non-resident. Salary £200 per annum. 

Thomastown Union. Locum Tenens for one month from July 15th. 
Remuneration £3 3s. per week. Candidates must possess legal 
qualifications. (See Advt.) 


ointments. 

Boa»e, B. D., L.R.C.P.Lond., M R.C.S., Medical Officer by the 
Penzance Fort Sanitary Authority. 

Boteb, L., M.B., Ch.B.Edin., Assistant Medical Officer at the 
Infirmary of the Parish of Birmingham. 

Davies, W. N., M.D., M.Ch.Irel., Medical Officer for the Llan- 
harran Sanitary District. 

Drew, Douglas, M.D., B.S., F.R.C.S.Eng., Surgeon to the North- 
Eastern Hospital for Children, Hackney. 

Hesbet, J. D., L.R.C.P.Lond., M.B.C.S., Medical Officer for the 
Cottage Homes of the Hastings Union. 

Hollings, C. E., L.B.C.P , L.R.C.S.Edin., L.F.P.S.Glasg., Medical 
Officer for the Weaverthorpe Sanitary District of the Driffield 
Union. 

Knight, Henry Ernest, M.D.Lond., M.B.C.S, L.R.C.P.Lond., 
Honorary Surgeon to the Rotherham Hospital and Dispensary. 

Lansdown, C. E., L.R.C.P.Lond.. M.R.C.S., Deputy Medical Officer 
by the Cheltenham Board of Guardians. 

Lawrence, A. G., M.D.St. And., M.B.C.S., Medical Officer for the 
Shirenewton Sanitary District of the Chepstow Union. 

Montgoherv, W. P., M.A.Oxon., B.S. and M.B.Lond., F.B.C.S. 
Eng., Visiting Surgeon to the Manchester Workhouse Infir¬ 
mary. 

Morrison, J. T. J., M.A., M.B.Cantab., F.R.C.S., Professor of 
Forensic Medicine in the Mason University College, Bir¬ 
mingham. 

ORR, Vivian B., M.B., B.S.Melb., Assistant House Surgeon to the 
Cancer Hospital (Free), Brompton, London. 

Reid, Arthur G., B.Sc.Lond., M.B., C M.Edin., Honorary Surgeon 
to the Rotherham Hospital. 

Wheatley, A. J., M.D. C.M.Edin., Me Heal Officer for the Seventh 
Sanitary District of Bradford (Yorks) Union. 

Whitehxad, A. L., M.B., B.S.Lond., Assistant Surgeon to the Eye 
and Ear Department of the General Infirmary, Leeds. 

Wilson, J. H„ M.D., B.S.Durh., Medical Officer of Health for the 
Wigan Rural Sanitary District. 


girths. 

Wa 80 n. —On June 25th, at fit Burgovne Rood. Harringay, N., the 
wife of Richard L. Wason, M.K C.S., L.B.C.P., of a son. 


Carriages. 

Dickson—Cookbon.— On June 22nd, at St. Stephen’s Church, 
Ealing, Walter Dickson, M.B., C.M., of Hungerford, son of the 
late Dr. W. G. Dickson, to Muriel Chorley, daughter of the late 
Thos. Chorley Cookson, M.A. 

Gonin Willett. —On June22nd, at St. Mark’s Church, Brighton, 
Edmund Henri Gonin, M.D., of Towceater. Northamptonshire, 
eldest son of the late Rev. Pasteur Gomn, of Worthing, to 
Mildred Theyre Willett, younger daughter of George Walter 
Willett, J.P., D.L., of West House, Brighton. 

Manning—Davis.— On June I7th, at the Parish Church, Rugby, 
Robert Harris Manning, L.D.S.Eng., youngest son of Willhun 
Woodward Manning, J.P., to Mary Anne (Minnie), elder 
daugnter of the Rev. W. Smith Davis, late Rector of Steeple 
Gidaing, Hunts. 

Oliver 8trawson.— On June 22nd, at All Saints’ Church, Penarth, 
John Percy Oliver, M.B.C.S., L.D.8., L.R.C.P.Lond.. of Havens- 
worth. Penarth, to Frances Sarah Josephine, eldest daughter of 
Jamea Young Strawson, Oak wood, Penarth. 


gcaihs. 

Harrison.— On June 24th, at Chester Street, Wrexham, Edwin 
Harrison, M.B.C.8., L.S.A., aged 75. 


Digitized by 




rm 


Old 8eeies, Vol. CXVIII. | N 8138 WEDNESDAY, JUNE 28, 1899. 
New 8bkim, Vol. LXVTI. ) 


SUMMARY OP CONTENT# 


The Eradication of Tnbercu 
losts. By George Fleming. 




PASTEUR, HYDROPHOBIA, 8ER0-THERAPY 


County v. City in Asylum 

™g*t- 8 Sa ThW^entBoard * 

rfl SID, and the St. Olaves Vestry.. 677 


A New Method of ventilating 
Sewers. By Sir Charles 
A. Cameron, C.B., M.D., 
F.R.C.P., F.R.C.S.I., D.P.H. 

Camb.. ■ • • •••••• • ; 062 

General Disorders, Originat¬ 
ing In Disease of the Female 
Pelvic Organa By Dr. 

MendesdeLeon .. .... •• «» 
British Gynecological Society 667 
British Orthopradic Society .. ee« 
The British Balneological 


London : John Bale, 8ons and DardelMOT, Ltd^Oxford House, 
88-89 Great Titchfield 8treet, Oxford Street, W._ 


F R A n c R. — Creosote and 
Phthisis; Cacodyllc Acid, 

Hemorrhoids. 670 

GERMANY.—Neurotic Insuffi¬ 
ciency of the Cardiac Muscle; 

The Diagnosis and Treat¬ 
ment of Primary Tubercu- __ 

lous Ulcer of the Stomach; | p i en t Tuberculosis. hEN&Y T. BUTLIH. F.R.G.8., 

Leucaemia and Leucocytosls 670 Bicycling in Diabetes. .WORD MAT JON ANT 

Austria -Symblepharon Fol- The Union Drug Analyst .... 680 rpHE OPERATIVE SURGERY Of MALLOW AN A 

lowing Pemphigus Conjunc- Tlie Late Mr. Lawson Talt I DIgSAgB> 8vo, 14a Containing an 

K? H»Rf7elli. or and the Antl-VlvlsectlonUts 680 ^ mnw* ^ ^ which may b. obtained In different 

Multiple Hemorrhages In One Shilling a Week for the Tissues and Organs of the Body. 

Typhoid ; Clinical Ferro- ^ Epidemic' at Hull 680 SARCOMA and CARCINOMA. 8vO, with 4 RatM, 

THE Operating Theatres.- The Practice of Medicine lo MaltoantDiseaae of the Tsj^a Tongua ffiwphagus, 

Operation for Ruptured Bto- iuly . .v 680 TonsLL Erasmus Wilson Lectures, R.C.8., 1W0-188I. 

n “ Ch ’ editorial. . 672 A liM d ..“ eso MALIGNANT DISEASE of the LARYNX. 8vo. with 

OoviaNOTM *^mSc^' Stotton # .Engravt^s^ur^, 7 Great Marlboro ugh Street, W 

ublic Baths at Home and Sootland . Third Edition. 

ab T p tioh •••••••* ™ gS5SK«»-::«::::^ m adapted to the new BRITISH fhabmacopceia, u«. 

ISSfliaStorSlander 676 Index to &l. cxvm. ^ ^OXt g 00 k Of PhaTHiaCOlOgy, 

--Therapeutics, and Materia Medica. 

IONTINENTAL HEALTH RKRORTR, HOTELA, PP ^ T TjAirMB brohto*. M.D., D.Sc., F.R.B., 

^WaUAM H. BENNETT. r.R.o.s _ 

TU3T PUBLISHED, 8vo, price 3a fld. With 12 Hlustratlons ADAPTED TO THE UNITED 8TATE8 PHARMAWP®IA BY 

ir A-RlX.lt. Causes and Treatment, with especial A y H WILLIAMS, M.D., BOSTON, MASS. 

"reference to THBOMBOBIB- „ u ilmply a mlne 0 f wealth both for student* *ud prartJUonen. 

London: Lono-M-Sj C °' Kwll* 

rMS* ^.dl.»„ot^h, i ,.t r , , ng. P o 1 »t in U» 


A New Form of Milk Adultera- la, post free la 2d- 

Th«°S.l'e of" ijiiick Medicine. 671 THE MODERN DOCTBINE of BAOTEBIOLOGT 

Tuberculosis and Climate - - 677 Or GERM THEORY of 1DI8EABB. 

A Malarial Investigation Ex- B y OEO ROE GRANVILLE BANTOCK, M.D., F.E.C.8 Ed, 

CoSm "and " Post I Mortem Bale, Sons & Danielson, Ltd., 83, 86, 87,89 Oreat^ ltchfleldSt^ 

Th?sSwK*Cnre:"::::: «S NOW READY. Second Edition, much Enlarged, with 57 Illustrations, 
The Perils of Patent Medicine ’ _ _ W tt\ w i PTPY 

Trading ..... A SHORT PRACTICE OF MIDWIFERY, 

d 

Joint Stock Doctoring . .. . • • 679 a by w. J. SMYLY, M.D., late' Master of the Rotunda 

Medical Organisation at En- Hospital, Dublin. 

. , fl . e i d ; Hon ' in • Inci- London : J. ft A. Churchill, 7 Great Marlborough Street._ 


£d 669 li^HU of Patent Medicine ^ 

r A N C R. — Creosote and A|) oygter-Typholil Tragedy.. 679 
Phthisis; Cacodyllc Acid, The Thirteenth International 
Hemorrhoids.. • 670 c<mKr ess of Medicine-6/9 


Auto - Auscultation In Inci- 

pient Tuberculosis. 

Bicycling in Diabetes ...680 

The Union Drug Analyst ... - 680 
The Late Mr. Lawson Tait 


EDITORIAL. 

Thk aord Poor and Local 
Government Board In- 

8PEOTION . 673 

PCBLIC BATHS AT HOME AND 

ABROAD . 674 

THR ELIMINATION OF THK 

Unfit. 675 

Cerebrospinal Fever ........ 676 

A Medical Action for Slander 676 


Annual Meeting of the Irish 

Medical Association .68} 

PERSONAL . 

SCOTLAND . 

OBITUARY .6SJ 

CORRESPONDENCE.......... • • 

Medical News and Pass Lists 682 
Notices to Correspondent*— ow 

index to vol. cxvm. 


(NTS see page ii. 


CONTINENTAL HEALTH KEEOETE, HOTELE, PP- xxii-xxlii. ^ T Tiln n« R Brunton, M.D., D.Sc., F.R.S., 

WILLIAM H. BENNETT. F.B.0.S 

■' a^-°saaa? 

TUST PUBLISHED, 8vo, price 3s. 6d. With 12 Hlustratlons ADAPTED TO THE UNITED STATES PHARMAWP® 

TTAMX «it* Causes and Treatment, with especial A F H wn-LlAMS, M.D., boston, mass. 

reftrOT^to THR OMBOMB- „ It u glmply a mine of wealth both for studenU and nM 

London: Lo.o^ «**”'* C °' SlSfc'SlSjSMSSfu.’taiw" 

Also, price 2s. cloth. “L'Jrt’^loh marks a dUtinot epoch, a turaing-poli 

By the same Author. 8vo. price 8s. 6d. BT tot SAME AUTHOR. 

CUMIOAL LEcnmEB ro ABDoi tmAL hhuoa. tociu k Disorders of Digestion: 

8,0 ^ S K.J,i E o" 0 o.°«. E1K Their Consequences and Treatment. 

Londo”,' tt L„»0«.»». «.«.» 

^oot, 2nd Edition, W6 PP-. with lU n,t™Uon.. »» ' 

diseases or ^ E f^f D ;- A Telt - Book - 

Professor in CJtolcal Smgery In the New York Post Graduate School. London Mtdioal M ^ mllUn 4 ^ _ Ltd f London, 

London :BaUllere, Tindall, A Cox. 

Registered for Home and Foreign Transmission, 


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Rumman) of 


BOOKS & PUBLICATIONS. 
Ballllere, Tindall, A'Cox 

Allingham, W. and H. W.— 

Works bv. 3 

Klnhorn, M.—Diseases of the 

Stomach . 1 

Field, 0. P.—Diseases of the 

Ear. 3 

Jessett, F. B. Works by.. .. 4 

Bale & Co., Ltd. 

Bantock, 0. G.— Bacteriology 1 
Lutuad, Dr. A.—Pasteur, Hy¬ 
drophobia, Sero-Therapy.. 1 

Cassell & Co- :— 

Bryant, T.—Diseases of the 


HEALTH RESORTS,'Ac. (contd.) 

Shaftesbury House. It) 

The Retreat Private Asylum .. 19 

Aix-les-Bains (Savoie). 23 

„ Grand Hotel d'Aix 23 
Brides & Salins-Moutiers . 23 
Interlaken. — Bernese-Ober- 

land Health Resort9 23 
,, Rugen Hotel, Jung- 

fraublick.23 

Kaiser Friedrich Quelle 

(Mineral Spring) . 28 

Lyons — Society Lyonnaise— 

Grand CaM . 22 

Neuenahr—Alcaline Therm il 

Springs . 22 

Source Larbaud-St.-Yorre 21 
Uriage - les - Bains— Saline- 

Sulphurous Spring 23 


MINERAL WATERS, BEERS 
WINES. COCOAS,Ac.(continued. 
Lamb A Watt — Crown Meat 

and Malt Wine . 

Lazenby, E. & Son — Soup 

Squares. 15 

Me Master, Hodgson <t Co.— 

Sweet Essence of Rennet_ 16 

Nelson Dale.G. & Co.—"Hipi." 16 

Nestle's 8wiss Milk . 17 

Poths, H. A Co. — Improved 

Meat Solution. 8 

Riddle, A. A Co. — StowePs 

Lime Juice ..21 

Royat - les - Bains Chocolaterte 22 
Saxlehner, A.—Hunyadl Janos 21 

Tibbies, Dr.—Vl-Cocoa. 2 

Waltham Bros.—Stout. 8 

Wheatley— “ Old Style ” Ginger 


BOOKS, Ac. (continued). 
Medical Publishing Co.:- 
Bennett. W.H.—Appendicitis 1 
Bryant, T.—Villous Growths 3 
Wright & Co.:— 

The Medical Annual, 1899 .. 4 


CHEMICAL AND MEDICAL 
PREPARATIONS, FOODS,fcc. 
Abbott, G. Vau, A Sons— 

Diabetic Foods. 8 

Allen A Hanburys — Bynin. 

Amara . 9 

Benger A Co.—Benger s Food 10 
Boileau A Boyd — Wholesale 

Druggists, Ac. 18 

Brin’s Oxygen Co., Ltd.—Oxygen 16 
Bullock, J. L.—Pepsina Porct.. 7 
Burroughs, Wellcome A Co. — 

Saxin, Emol-Keleet, Ac. 11 

British Somatose Co., Ltd.— 

Somatose . 7 

Collis Browne's Chlorodyne.... 1 * 
Hamilton, Long A Co.—Liquor 

Pepsinss ..16 

Maw Son A Thompson— 

Listerlne . 13 

Nicolny A Co. — Hommels 

Hsemotogen. 7 

Richards, J. M.—Antlkamnia . 6 
Roberts A Co. — Bromldla 8 
The Bayer Co.. Ltd.— Pharma¬ 
ceutical Products . 12 

The Distillers Co., Limited.— 

“ D.C.L.” Malt Extract . 17 

Vinolia Co., Ltd.—Vinolia Pre- 


Breast. 


Churchill, J. & A. 

Bryant, T.—Works by. 3 

Butlin, H. T.—Works by.... 1 
Harrison, R.—Disorders of the 

Urinary Organs . 4 

Jellett, H.—Midwifery. 1 

Laugdon-Down, J.—Mental 

Affections. .. 4 

Squire—Companion to the 
British Pharmacopoeia 3 

Fannin & Co. (Dub.) 

Meldon, A.—Works by. 3 

Ormsby, L. H.— Works by.. 4 

Kegan Paul, Trench & Co. 
Taylor—Diseases of the Eye 3 

Longmans & Co. 

Althaus, J.—Value of Elec¬ 
trical Treatment. 3 

Althaus, J.—Works by. 3 

Bennett—Works by 1 

Cabot, R. C.—Serum Diagno¬ 
sis of Disease. 3 

Macmillan & Co 
Brunton, Lauder—Works by 1 


VACANCIES 
Army Medical Service .. 

Castlerea Union. 

Coleraine Union .... .. 

Indian Medical Service 
Medical Locum Tenens 
Mitchelstown Union.... 

Tliomastown Union_ 

University of Glasgow . 


MISCELLANEOUS. 
Graham—Celebrated Hats ... 18 
Hearns, Ltd.—Poison Bottle .. 18 
Imperial Accident, Live Stock, 

A General Insuranoe Co. 19 

IsaacACo.—Dispensing Bottb s 18 
Lozier Manf. Co.—The World's 

Best Bicycle. 18 

Medical Practice, Wanted to 

Purchase . 19 

Working Class Practice for Sale 20 


EDUCATIONAL. 

Bethlem Royal Hospital. 20 

Institute Verneuil, France ... 20 


MINERAL WATERS, 
BEERS, WINES, COCOAS, Ac. 

Apollinaries—Apenta .24 

Bewley A Draper—Ginger Wine 14 
CantrellACochrane—Club Soda 16 
Chemists' Aerated Mineral 

Water Assoc., Ltd. 21 

Contrexeville Pavilion. 20 

Ellis A Sons.—Table Waters .. 21 
Ingram A Royle— Vichy Water 19 
Ingram ARoyle—Carlsbad Nat- 
uralMlneralWaters,Salts,Ac. 22 


SURGICAL INSTRUMENTS 
AND APPLIANCES, &c. 

Burgoyne—Brit. Calf Vaccine 19 

Dr. Renner’s Calf Vaccine_ 19 

Fannin A Co. — Clinical Ther¬ 
mometers, &c. 14 

KrohneA Sesemann—Martin's 

Rubber Bandages . 18 

M ather, W., Ltd. — Plalsterg.. 4 

Pope A Plant—Elastic Stocking!, 18 
Salmon's Abdominal Belts_ * 


parations 


HEALTH RESORTS. 
HOTELS, HOMES, & ASYLUMS, 

Bloomfield Residence .. 18 

Church Stretton Asylum. 19 

Dalrymple Home. 19 

Hampstead Gent's Private Hosp 19 
Hlghfleld Ladies' Private Hosp. 19 


MEDICAL MAGAZINE. 


LANCET. 


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June 28, 1899 


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JUST PUBLISHED. Royal Svo, price 7a. 6d- 

THE SERUM DIAGNOSIS OF DISEASE. 

By RICHARD C. CABOT, M.D., 

Physician to Out-Patients, Massachusetts General Hnepital. With 9 Illustrations. 

London : LON OMAN H, GREEN St Co - 


NOW READY, Third Edition, prioe 8s. 6d. 

THE VALUE OF ELECTRICAL TREATMENT. 


By Dr. JULIUS ALTHAUS, 

Consulting Physician to the Hospital for Epilepsy and Paralysis, Regent’s Park. 

With which is incorporated a Chapter on “ ELECTRICITY IN GYNECOLOGY,” written specially for| the 

present edition by Dr. APOSTOLI, of PARIS. 

London: LONGMANS, GREEN & CO., 39 Paternoster Row; New York and Bombay._ 


sixth Edition. Now Rbady. Price 12s. 6d. 

DISEASES of the RECTUM. 

By WM. ALLINGHAM, F.R.O.S., 

AND 

HERBERT W. ALLINGHAM, F.R.O.S., 

Surgeon to the Household of H R.H. the Prince of Wales ; Sura-eon to 
the Great Northern Hospital; Assistant Surgeon to St. George's 
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Also by Wu. H. W. allinohah, F.R.C.S. Price e*. 

COLOTOMY, 

INGUINAL, LUMBAR, and TRANSVERSE for 

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With Stricture of the Large Intestine. 

London : Ballllere, Tindall, A Cox, King William 8treet, Strand. 

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“Forms an excellent guide for the practitioner or the Student."— 
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London; Ballllere, Tindall, A Cox, King William Street, Strand. 


BY DR. JULIUS ALTHAUS, 

Consulting Physician to the Hospital for Epilepsy and Paralysis 
Regent's Park. 

Now Ready, Fifth Edition, enlarged, coloured plate and engravings 
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ON FAILURE OF BRAIN POWER: ITS NATURE 

AND TREATMENT. 

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Works by AUSTIN MELDON, D.L.J.F. 

Ex-President Royal College of Surgeons, 8enlor Surgeon to Jervis Street 
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Goat and Rheumatic Gout. Tenth Edition, poet 8vo, 

2s. ed. 

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Thousand, 8vo, 2s. 6d. 

An Address on Surgery. Delivered as President of 

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Hospital. Is. Od. 

Intravenous Injections of Milk, is. oa. 

London : Ballllere, Tindall, A Cox, King William Street, Strand 
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NOW READY, with Photograph and numerous Illustrations. Third 
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ON DISEASES OF THE E7E. 

By CHARLES BELL TAYLOR, F.R.C.8., and M.D.Bdln., 

Fellow Medical Society, London, late President of the Parisian Medical 
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London: Keg&n, Paul, Trench, and Co., Paternoster Square^ 


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Seventeenth Year, 8vo, Cloth, about 900 pp. Price 7/6 net, post free 

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IS NOW READY. 


A Work of Reference for Medical Practitioners. 

Comprising A DICTIONARY OF NEW REMEDIES, A DICTIONARY OF NEW TREATMENT, 
Various Special Articles, and much General Information. 

Large 8vo. 574 pages. Strongly bound. Reduced to 12/6 net. 

This Book is now brought within the reach of every Student, the publishers reserving their right to 

revert to the original charge of 21/- at any time. 

A TEXT-BOOK of HISTOLOGY: 

Descriptive and Practical. 

WITH 174 BEAUTIFULLY COLOURED ORIGINAL PLATES, and other Illustrations. 

By ARTHUR CLARKSON, M.B., C.M.Edin. 

11 The author's plan of procedure Is one that is l>est calculated to give the user of the look a good practical knowledge of the science. 

. . . The feature of the volume is the beauty of the illustrations . . the finest »eries that we remember to have seen in any text- 

liook . . . they have just that amount of diagrammatic character which it is advisable to infuse Into a teaching manual. . . . We 
congratulate the author on having provided us with a most important addition to students' text books."—Bril. Med. Joum, 


BRISTOL: JOHN WRIGHT & CO. LONDON: SIMPKIN & CO., Ltd. 

—— — mi m m — n a^ecag a ■ i. i ... - m naan^———— 


NOW READY. Price 5s., Illustrated. 

SELECTED PAPERS on STONE, PROSTATE, and 
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By REGINALD HARRISON, K.R.C.S., Surgeon to St. Peter's Hospital 
CoNTKNTS : Vesical Stone and Prostatlc Disorders : A Further Con¬ 
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Enlarged Prostate by Vasectomy. Albuminuria and Keni-Puncture, 
and other Articles on Allied subjects. 

J. A A. Churchill, Loudon. 


Works by F. BOWREMAN JE8SETT, F.R.O.S., 

* Burgeon to the Cancer Hoapltal, Brompton. 

Lectures on Cancer of the Uterus with Cases. 

Just out price 8*. 0d. 

Cancer of the Month, Tongne, and (Esophagus. 

Illustrated, price fla. ! 

Surgical Diseases and Injuries of the Stomach i 

and INTESTINES. With 07 niustratious, price 7s. 8d. 

London: Baillifere, Tindall, A Cox, King William 8treet, Strand. 

Works by LAMBERT HEPENSTAL 0RM8BY, I 

M.D.. F.R.C.B., 

Lecturer on Clinical and Operative Surgery, and 8urgeon to the Me.th | 
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late Member of the Court of Examiners, Royal College of Surgeon*. 

Varicose Veins: their Cause, Symptoms, and Cure, i 

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Osteotomy for Genu Valgum. Price 1*. 

The Causes, Symptoms, and Treatment of Phi-! 

mosis and Paraphimosis, with a description of the Ancient Rite of . 
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The Radical Treatment of Piles and Prolapsus Recti 

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An Operation Chart, giving the Instruments in 

detail used In all the Major and Minor Operations in 8urgery, 
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Dublin: Fannin A Co. London : Bailliere. Tindall. A Co.x. 


O N SOME of the MENTAL AFFECTIONS of CHILD¬ 
HOOD and YOUTH; being the Lettsomian Lecture* delivered 
before the Medical Society of London in 1887; together with other 
Papers. By J. LANGDON-DOWN, M.D., F.B.C.P., Consulting Phy¬ 
sician to the London Hospital. Post 8vo, Os. 

“ Dr. Down shows a happy talent for presenting the main facta and 
avoiding immaterial details. —London Medioal Record. 

"A series of essays which will henceforth occupy a place of the first 
Importance in the literature of the subject."— The Practitioner. 
London: J. A A. Churchill, 7 Great Marlborough Street, W. 


WILLIAM MATHER, Limited, 

MANUFACTURERS OF ' 

India Rubber, Medicinal. Adhesive, Porous, Bunion, 
Corn, Court, Kid, Leather, Mustard, Boll, Spread, 
Pharmaceutical and Surgical 


of every description, In the most approved form. 

Quality First Importance. Every Article Warranted. 
8AMPLKS AND PRICKS ON APPLICATION. 

MARKING FLUID for LINENNIGRINE.” 

No Warm Iron or Heating required. 

TRU BBEa ALL BJMDB. 

WILLIAM MATHER, Ltd., Dyer St, Holme, Manchester. 

London, Wholesale and Export Agents— 

Messrs. MACE A HALDANE, M Milton Street, E.C. 


SALMON’S ABDOMINAL BELT. 



For use before and after accouchement, and for all case* of abdomi¬ 
nal weakness, afford* a more complete lifting support than any hither¬ 
to made, as it effectually raises 
the lower part of the abdomen. 
Air pads are fitted to it for 
casea of hernia prolapan* and 
moreable kidney when required. 
Price* from 26*. to 60*. Ladles 
can ad dree* to Mr*. 8almon. 

HENRY R. SALMON, 

42 BEAUMONT ST., UPPER WIMPOLX 8T 
London, W. '* 

(Established 1881 


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VINOLIA 

VIOLET 

POWDER 


PREMIER 

VINOLIA 

SHAVING 

STICK 


PREMIER 

VINOLIA 

SOAP 


IViNOLlM^ 

KoONSNEVn 0 ^ 


WLET PCWnEB 


Specially prepared for 
Toilet &. Nursery Use. 


Causes no blotches under 
the Chin. 


Keeps the Complex 
ion Beautiful ar.d 
Clear. 


2-ox. Packet, 3d. 
1-lb. Tin or Packet, 6d. 


i VinoliaC-L** u*«• 


&5l 


Yields a splendid lather. 


EXTRACtf* 1 * 

LONDON mw 


Also supplied in 1-lb tins 


1 /- per box of 3 
Tablets. 


In Gold-blocked Card¬ 
board Case, 6d. 


VINOLIA 


VINOLIA 

POWDER 


VINOLIA 

SHAVING 

CREAM. 


PERFUMES. 


CONCENTRATED, 

DELICATE, 

PURE. 


For Redness, 
Roughness, 
Toilet, &c. 


For use without Brush 
and Water. 


In White, Pink, 
and Cream 
Tints. 


White Rose, Violet, and all 
Popular Odours. 


^0 RYlAMOWdt LONDON. 


,VlNOLI*el" 

' iw'*/ 


6d. per Bottle and upwards. 


'YjKoliaG ?!. 1 


LONDONXI 


VINOLIA CREAM. 


VINOLIA 


In Collapsible Tube, 9d. 


PREMIER 
VINOLIA 
DENTI- 
1 FRICE 


For Itching, 
Face Spots, 
Eczema, and 
the Skin in 
health and 
disease. 


COLOGNE 


PREMIE?, 


FRAGRANT 


REFRESHING. 


Keeps the Teeth 
Ivory White, 
•Healthy and 
Beautiful. 

In Metal Box and 
Glass Bottle, 

4d. and 8d. 


As tine as can possibly be made. 


1/1*, 1/9, 3/6, 
and 6 /- per box. 


VINOLIA 

LAVENDER 

WATER 


PREMIER 

VINOLIA 

POMADE. 


VINOLIA 

LIQUID 

DENTIFRICE 


NATURAL AND VERY 
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Natural to the Hair 
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Imparts a floe Silkiness 
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C Keeps the Gums healthy 
strong, and of a good colour. 


Contains the finest Essen¬ 
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therefore the most Econo¬ 
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^Pomade 

VTnolisC’L’ 

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mou A yi 


The Draper «’ Record reports; 

“ Vinolia Liquid Dentifrice 
is an astringent and tonic for 
the gums.” 


6d. per bottle. 


In 1-oz., 2-oz., 4-oz., & S-oz. 
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6d., II; »/-, and 3/6. 


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Inexhaustible Lavender 

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These Smellings Salts are of 
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6d. and 9d. per bottle. 

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An exquisite 
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coralline emollient for Dry. Rough, Cracked 
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Vmou&csts 

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VINOLIA 00., LTD., MALDEN ORESCENT, LONDON, N.VT. 


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Ufro- 

Ovarian 

Pain. 







9 If the pain is over the lower border of the 
i Liver, or lower part of the Stomach, or, in short, 
a pain of any description caused by suppressed or 
£ irregular menstruation : it will yield to two 5 gr. 
£ tablets of Antikamnia. Repeal dose in hour or 
/ two, if necessary. Crush tablets, and swallow 
9 with a little wine, diluted whisky or toddy. 






Does not depress the heart: no drug habit induced 


in t he 

T reatment 

of melancholia with vaso-motor disturbances, anemic headaches, emo¬ 
tional distress, in relieving the persistent headache which accompanies 
nervousness, 

“In neurasthenia, in mild hysteroid affections, and in the various 
neuralgias, particularly ovarian, in the nervous tremor so often seen in 
confirmed drunkards; and 

“ In angina pec'oris this drug has a beneficial action.” 

Analgesic — Antipyretic — Anodyne. 


Ant ikamnia powder and tablets (5-gr. and 3-gr.) i-oz. packages, price to the profession, 3/10 post free. 
Antikamnia Chem. Co. (St. Louis, U.S.A.). British Depot : 46 llolborn Viaduct, E.C. 


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The Medical Press and Circular Advertiser. 


SOMATOSE 

THE BRITISH SOMATOSE 00., Ltd., has been formed 
for putting before the public in a prominent manner 
the recently discovered invalid food—SOMATOSE—a 
NUTRIENT MEAT POWDE R—almost tasteless and 
odourless. It can and does put life and strength into 
the weakest invalids and those whose condition pre¬ 
cludes the use of ordinary foods. It is not a Patent 
Medicine or a drug, but a food in a form never before 
obtainable. 

SOLD BY ALL CHEMISTS. 

THE BRITISH SOMATOSE CO., Ltd., 

165 Queen Victoria St., LONDON, E.C. 


Superior to Cod Liver Oil, Tincture of Iron, or Peptone 

H O M M EL’S H/EMATOG E N. 

Haemoglobinum ooncentratum et Glycerinum purissimum [English Patent, No. 12,504, A.D. 1894], agreeably flavoured.) 

Entirely free from Antiseptic Chemicals. 

A BLOOD-FORMING TONIC, OF THE UTM08T VALUE 
In General Debility, Anaemia, Chlorosis, Neurasthenia, Rickets, 
Scrofula, Weak Heart, Wasting Diseases of Children, Chronic Catarrh 
of the Stomach and Bowels, Loss of Appetite, 8low Convalescence 
after Fevers, and Over-Rapid Growth In Young Persons. 

Kept in Stock by all Pharmaceutical Chemists. Price of Original 9 ounce Bottle 4s. 

Dow for yonng Infants, Half a Tea-spoonful, or one Tea-spoonful, twice a clny in Milk, of the proper Heat for Drinking. For Children, 
One or two Dessert-spoonfuls, either pure, or mixed with any convenient liquid. For Adults, One Table-spoonful twice a day before 
food, so as to secure the full benefit of Its powerful appetising effect. 

NICOLA Y& CO.. 36 & 36a St. Andrew’s Hill , London , E.C. 

BULLOCK’S PEPSINA PORCI. 

_ DOSE-2 to 4 GRAINS. _ 

ACID GLYCERINE OF PEPSINE 

DOSE—I to 2 DRMS. btolook). 

In thia preparation advantage has been taken of the solnbilityof Pepsine in Glycerine to produce a convenient and desir¬ 
able liquid form of this valuable medicine; whilst the preservative qualities of the menstruum confer upon the Aoid 
Glyoenne of Pepsine the property of keeping for any length of time. 

May be prescribed with most subsl.tcsa compatible with Acids. in 4 ox., 6 oz., and 16 ox. Bottles, and In Balk. 

Tne published experiments of G. F. Dowdbswtcll, Esq., M.A. Cantab., F.C.S., F.L.8., &o., Dr. Pavt, Professor 
Tusow, the l*te Professor Garrod, Dr. Arnold Lkrs, and others, conclusively demonstrate the excellenoe, high digestive 

power, and medicinal valne of the above preparations. 

J. L. BULL0CI^&C0.,3, Hanover St., Hanover Sq., London, W. 


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DIABETES. 


VAN ABBOTT’S GLUTEN BREAD, BISCUITS, AND FLOUB. 
VAN ABBOTT’S SOTA BBEAD, BISCUITS, AND FLOUB. 


And various other Biscuit* and Bread from Bran, Almond Nat, and Heat Floor. 


GK VAST ABBOTT & BON a3, tM WIOMOBE STREET CAVENDISH SQUARE, LONDON W. 
Purveyors to H.M. Naval, Military, and Principal London, Provincial, and Colonial Hoi pi tala. Established 1869. Agent* f- r 

DublinRetail—W. H. Bowies * Co., Great Bruniwick Street. Wholesale— Hcht A Co., 17 Weitland Bow. 



"Easily digestible. . . decidedly superior to a clear extract." — LANCET. 

LEUBE-ROSENTHAL’S 

IMPROVED 

MEAT SOLUTION 

Present* In the moat readily assimilable form all the best properties of 
the meat, unaltered by heat, and constitutes a strong, safe, and palatable 
diet of special nutritive value for the sick or convalescent. Being uon- 
lrrltant and of relishing flavour, is acceptable to, and retained by, the 
weakest stomach, and Is particularly rich in peptones. Is not an 
“ extract," but the meat itself; and does not constipate, but aids and 
Improve* digestion. 

Approved by scientific Experts both at home and abroad, and Recoin• 
mended by Physicians. A nalysis on application, 

Prlc* 2/- per Tin of mil Oho mists. 

Wholesale of H. POTHS & CO., 4,5, & 6 Bury Court, 
St. Mary Axe, London, E.C. 


MEAT & MALT WINE 

CONTAINS 

Good Alto Douro Port, Mosquerah Beef Jelly, 
and Extract of Malt. 

Prices: Hslf-bottle, 2s. ; Bottle, Ss. «d. 

| HIGHLY RECOMMENDED by the MEDICAL PROFESSION 

j A Hslf-bottle sent on application to any Medical Gentleman from 
I our nearest Agent free of charge. 

Prepared by LAMB & WATT, St. Anne Street, 

LIVERPOOL. 


Always Trustworthy. 

has been proven by clinical tests that Bromidia is the b«-si 
Sr and safest hypnotic yet known to the profession. 

It is always of the same strength, and lienee can always 
be relied upon, to produce the same results under the same 
conditions. 

It is so well known and so well liked by the profession 
everywhere, that it can be obtained in almost every drug store 
in every country in the world. 

Avoid substitution. The doctor should always take special care 
to get the genuine, which is only made by Battle & Co. 

Dose: —One-half to one fluid drachm, repeated as indicated. 

A Sample Bottle of BROMIDIA and Pamphlet will be forwarded free of charge 

to Medical Men on application to 

ROBERTS & CO., 76 New Bond St., London, 

GENERAL DEPdT FOR GREAT BRITAIN. 

BATTLE A GO., St. Louii, Mo., U.S.A. 


Digitized by 


Google 


























Jane 28, 1890 


The Medical Press and Circular Advertiser. 


PTO Pre PTO _PTO PTO PTO 


‘Saxin 


‘Emol-Keleet’ 


Has been aptly termed the 
“Sweetest thing on earth.” 
It is about 600 times sweeter 
than sugar and more delicate 
in flavour. ‘Saxin’ undergoes 
no change in the system, and 
may be safely prescribed in 
all cases where sugar is 
harmful. 

toxin.' 1/4 gr., la aupplled In bottlaa of 100 and 200, 
at 7d. and la. Id. par bottla. 


Is a natural powder, contain¬ 
ing a large proportion of native 
silicates. It has proved 
successful for drying weeping 
surfaces when all other pow¬ 
ders have failed. Its soft, silky 
texture, soothing influence 
and other physical qualities 
enhance its healing action. 

“£mol-Keleet la auppllad In neat metal boxeo, 
at Od. per box. 


Burroughs Wellcome and Co., London and Sydney. 


fOOPVftlOMT) 


TRADE ^ 

MARK 


Soloid’ 


Lead Subacetate 

<g||^ gr- «o [ 0.648 gm.] 

- THE MOST CONVENIENT MEANS OF PREPAR 

/ 1NG OR PRESCRIBING GOULARD WATER. 

dissolved in five ounces of distilled water, yields a solution 
containing about the same quantity of Lead Subacetate as 
an equal volume of Liq. Plumbi Subacetatis DiL BJ*. 

'Soloid' Lead Subacetate is extremely portable and promptly soluble. 

At bottiee of 25, at Od. per bottle. 


Burroughs Wellcome and Co., 

London and Sydney. 




[ecmiMT] 


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xli 


The Medical Press and Circular Advertiser. 


June 28, 1899 


BAYER’S 

PHARMACEUTICAL SPECIALITIES. 


An ideal astringent in infantile 
diarrhoea, colic enteritis, dysen¬ 
tery, etc. An acetic derivative of 
tannin without taste or smell. 
Insoluble in water or dilute acids, 
but easily soluble in the presence 
of alkalis. 


An ideal substitute for the Salicy¬ 
lates, having no irritating effect on 
the stomach, through which it 
passes unchanged, decomposing 
only in the alkaline intestinal 
fluid. It is free from the un¬ 
pleasant after effects so frequently 
attending the use of Salicylic 
Acid and its salts. 

An excellent substitute for 
Codeine. In doses of 1-12th of 
a grain. Heroin has given most 
excellent results in cases of 
Bronchitis, Pharyngitis, Catarrh 
of the Lungs, and in Asthma 
Bronchiale. In the latter two 
cases the dose may be increased 
to l-6th of a grain. 


TANNIGEN 

(Triacetyl of Tannin). 


ASPIRIN 

(Acetic Ether of Sali¬ 
cylic Acid.) 


HEROIN 

(Di-acetic Ether of 
Morphine). 


May be prescribed in all cases 
where it is desired to produce~an 
astringent action on the intestinal 
mucus. Benders especially valu¬ 
able sendee in acute and chronic 
colic, and is a specific in summer 
diarrhoea of children. 

Dose : Children 2 to 5 grains ; 
Adults, 8 to 12 grains 4 or 6 
times a day. 

It has an agreeable, slightlyjacid 
taste, favourably contrasting with 
the repugnant sweet taste of the 
Salicylates. Extensive clinical 
trials have proved the value of 
Aspirin as a perfect substitute for 
Salicylic Acid and its salts. 

Dose : 16 grains, 3 or 4 times 
a day. 

Heroin does not cause constipa¬ 
tion, and may be administered to 
patients with a weak heart who 
cannot tolerate Morphine. 

Hydrochloride of Heroin. A 

neutral Heroin salt, easily soluble 
in water, and suitable for subcu¬ 
taneous injection. 

Dose, subcutaneously, 1-2Oth 
to l-6th of a grain. 


Trional, Tannigen, Salophen, Lycetol, Creosotal, Duotal, Heroin, Aristol, Tetronal, 
Analgen, Losophan, Somatose, Iron Somatose, Milk Somatose, Phenacetine- 
Bayer, Sulfonal-Bayer, Piperazine-Bayer, Salol-Bayer. 


Samples and Literature may be had on application to the Wholesale Depot for all Bayer’s Pharmaceutical Specialitiee. 

THE BAYER CO., Ltd., 19 ST. DUNSTAN’S HILL, LONDON, E.C. 

Also at MANCHBSTBF, GLASGOW, and BRADFORD^ 


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June 28, 1899 


The Medioal Press and Circular Advertiser. 


xiii 


LISTERINE. 

THE STANDARD ANTISEPTIC. 

LISTERINE is a non-toxic, non-irritating and non-escharotic antiseptic, composed 
of ozoniferous essences, vegetable antiseptics and benzo-boracic acid. 

LISTERINE is sufficiently powerful to make and maintain surgical cleanliness in 
the antiseptic and prophylactic treatment and care of all parts of the human 
body. 

LISTERINE has ever proven a thoroughly trustworthy antiseptic dressing for 
operative or accidental wounds. 

LISTERINE is invaluable in obstetrics and gynecology as a general cleansing 
prophylactic, or antiseptic agent, and is an effective remedy in the treatment 
of catarrhal conditions of every locality. 

LISTERINE is useful in the treatment of the infectious maladies which are 
attended by inflammation of accessible surfaces—as diphtheria, scarlet fever 
and pertussis. 

LISTERINE diluted with water or glycerine speedily relieves certain fermentative 
forms of indigestion. 

LISTERINE is indispensable for the preservation of the teeth, and for maintaining 
the mucous membrane of the mouth in a healthy condition. 

LISTERINE employed in the sick-room by means of a spray, or saturated cloths 
hung about, is actively ozonifying and rapidly oxidizing in its effects upon 
organic matter afloat in the atmosphere. 

LISTERINE is of accurately determined and uniform antiseptic power, and of 
positive originality. 

LISTERINE is kept in stock by all worthy pharmacists everywhere. 

FOR DESCRIPTIVE LITERATURE, ADDRESS 

S MAW, SON & THOMPSON, 7 to 12 Aldersgate Street, LONDON, E.C. 

British Agents for the Products of LAMBERT PHARMAOAL CO., St. Louis, U SA. 


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xlV 


The Medloal Press and Circular AHv««*tig*p. 


June 28, 1969 


BEWLEY & DRAPER’S 

GINGER WINE 

May be obtained of all Grocers and Wine Merchants. 

Manufacturers, BEWLEY & PRATES. Limited, DUBLIN. 


FANNIN & Co.’s Clinical Ther mometers. 

Hospital Clinical Thermometers, Plain or Lens Front . £0 16 

A. —Fannin & Co.’s Clinical Thermometers, any length, with indestructible Index, 2i, 

3, 3A, and 4 inches, in Metal Cases . 0 2 0 

D.—Fannin & Co.’s Clinical Thermometer, with flat back . 0 3 6 

B. —Fannin & Co.’s Half-Minute Clinical Thermometer . 0 3 6 

F.—Fannin & Co.’s Clinical Thermometer, with Lens Front Magnifying Index ... 0 3 6 

H.—Fannin & Co.’s Half-Minute Clinical Thermometer, with Lens front Magnifying index 0 5 6 

Immisch’s Patent Metallic Clinical Thermometers. 0 15 O 

Veterinary Thermometers, in various lengths, enclosed in protecting Tubes ... 5/6 to 0 10 6 

Special Quotation for Qusbntltiea. 

Certificate* of Correction* determined by comparison with the Standard Instrument* at Kew Observatory supplied with each Thermometer 

tor 1*. 6<L extra. 

FANNIN & CO. guarantee every Thermometer bearing their name to be of standard precision. 

BREAKAGE of CLINICAL THERMOMETERS.— From the nature of their construction, Clinical Thermometers are exceedingly fragile, 
and there is considerable risk of breakage In their transmission either through the post or by any other mode of conveyance. We use every 
precaution in packing, bnt do not guarantee safe delivery, and can only supply them at the risk of purchasers 

FANNIN & CO, LTD., .Manufacturers of gurgual instruments anb Jlpp lianas. 

Makers of Artificial Limbs and Orthopcedic Apparatus. 

41 GRAFTON ST., DUBLIN. 38 WELLINGTON PLACE, BELFAST. 

Telephone No.‘i98. Telephone No. 1269. 


DR. J. COLLIS BROWNE’S 

CHLORODYNE 

THE ORIGINAL AND ONLY GENUINE. 


From Symes & Co., Chemists, Medical Hall, Simla, January 5, 1880. 

To J. T. Davenport, Esq., 33 Great Bussell Street, Bloomsbury, London. 

Dear Sir, —Have the goodness to furnish us with your best quotations for Dr. J. Collis Browne’s 
Chlorodyne as being large buyers, we would much prefer doing business with you direct than through the 
wholesale houses. We embrace this opportunity of congratulating you upon the widespread reputation 
this justly esteemed medicine has earned for itself, not only in Hindostan, bnt all over the East. As a 
remedy of general utility, we much question whether a better is imported into the country, and we shall be 
glad to hear of its finding a place in every Anglo-Indian home. The other brands, we are happy to say, 
are now relegated to the native bazaars, and judging from their sale, we fancy their sojourn tnere will 
be but evanescent. We could multiply instances ad infinitum of the extraordinary efficacy of Dr. Collis 
Browne’s Chlorodyne in Diarrhoea and Dysentery, Spasms, Cramps, Neuralgia, the Vomiting of Preg¬ 
nancy, and 86 general sedative, that have occurred under our personal observation daring many years. 
In Choleraic Diarrhoea, and even in the more terrible forms of Cholera itself, we have witnessed its 
surprisingly controlling power. We have never used any other form of this medicine than Collis 
Browne’s, from a firm conviction that it is decidedly the best, and also from a sense of duty we owe to 
the profession and the public, as we are of opinion that the substitution of any other than Collu 
Browne’s is a deliberate breach of faith on the part of the chemist to prescriber and patient alike. 

We are Sir, faithfully yours, SYMES & CO., 

Hi* Excellency the Viceroy’s Chemists. 

Sole Manufacturer, J. T. DAVENPORT. 

37 GREAT RUSSELL STREET, BLOOMSBURY SQUARE, LONDON. 


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June 28, 1899 the Medical Press and Circular Advertiser. xvii 



The Richest m Cream. 


PERCENTAGE of BUTTER-FAT. 

Six samples of NESTLE’S MILK bought at random at six 
different shops, and analyzed by Mr. OTTO 
HEHNER, late President of the Society of Public 
Analysts, contained AN AVERAGE OF 

13.13 per cent of BUTTER-Fi^T. 

Sample Tin sent free, to the Medical Profession on application to HENRI NESTLE, 
48 , Cannon Street, London, E.C. 



Extinct. 


which vu shewn at the 

BRITISH MEDICAL ASSOCIATION 

Meeting held in Edinburgh this year, Is guaranteed to be a perfectly 
pure Extract made from Malted Barley only. The grain used is \ 
chosen with the greatest possible care; and as The Distillers Co, 
Ltd., purchased over 400,000 quarters during last year, it must ! 
be apparent that their knowledge is exceptional. Malting is conduc¬ 
ted entirely on their own premises, the machinery employed Is of the 
most perfect description, and every lot made is carefully tested before* 
being bottled. 

The “D.C.L ” MALT EXTRACT can be obtained combined with 
Cod Liver Oil. Medical Men can have Samples sent free on application, 
and are respectfully urged to prescribe "D.C.L" to their patients, 
otherwise very inferior makes may be supplied. 

There are several older makes of Malt Extract now before the public 
which are valueless in Dyspepsia, as they are utterly Innocent of 
Diastase and are artificially thickened with Dextrine. 1 

"D.C.L" MALT EXTRACT is reliable in every particular. 

SoleMaken: THE DISTILLERS 00., Ltd., Edinburgh. 

Manufacturer s of the Celebrated" D.C.L.” Yeait. 


WHEATLEY’S 

©lb St^le 

BREWED 

GINGER BEER. 


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_ The Medical Press and Uiroular Advertiser. _ June 28 , 1899 

Established 1700. 

BOILEAU & BOYD, Limited, 

Wholesale Druggists, Manufacturing Chemists, 

ST. BRIDE’S LABORATORY, TDTJZBIaHST. 


Sped*] attention to all Requirements of Medical Practitioners. 


Ask for Quarterly Price List. 


TpOR Varicose Veins & Weakness 

* SURGICAL ELASTIC STOCKINGS, 

and KNEE-CAPS, pervious, light in texture, and 
INEXPENSIVE, yielding an efficient and unvarying 
support, under any temperature, without the trouble 
of Lacing or Bandaging. Likewise a strong low-priced 
article for Hospitals and the Working Classes. 

ABDOMINAL SUPPORTING BELTS, those for 
ladies' use, before and after accouchement, are 
admirably adapted for giving adequate support with 
extkkks LIGHTNESS—a point hitherto little attended 
to. 

Instructions for Measurements and prices on ap- 

e I cation, and the articles sent by post from the 
anufacturers 

POPE & PLANTE, 

Hosiers by appointment to the Queen. 

Removed to 39b OLD BOND ST., LONDON, W. 

The Profession, Trade, and Hospitals are supplied. 



The World's Best Bicycle. 

Ubvei&wb 



£10 10s.; 12s. 12s.; £18 18s. 

CL EVELAN D PREMIER, 

WHAT IS FRICTION? 

It in one of the natural laws which prevents an old 
style ball-touoh-ball bearings from revolving at a higher 
rate of speed than 18,000 revolutions a minute. It is also 
a natural law that admits of the new “ Cleveland” ball and 
roller beariDgs revolving 35,000 revolutions a minute with¬ 
out heating. “ Twice as Easy ” well describes the running 
of the “ Cleveland ” Cycle fitted with these bearings. 


THE LOZIER 
MANUFACTURING 

COMPANY, 

24-27 ORCHARD ST., 
OXFORD STREET, 

LONDON, W. 


BLOOMFIELD, MOREHAMPTON ROAD, 

DUBLIN. 

(A Home for the Insane}. 

THIS PLEA8ANTLY - SITUATED RESIDENCE, with extensive 
gardens and grounds, for the reception of ]>ersons suffering from 
Mental Disorders, is carried on under the care of a Committee of 
Members of the Society of Friends. 

Consulting Physician—Sir JOHN THOMAS BANKS, K.C.B , M.D., 
F.R.C.P.I., 46 Merrion 8quare, East. HENRY T. BEWLEY, M.D., 

K. R.C.P.I., 28 Liwcr Baggot Street, Medical Attendant. 

For terms and other particulars, application to be made to the 
Superintendent at the Institution, or to the Hon. Sec., JOHN EVANS, 

L. R.C.S.I. 49 Dawaon Street. 



MR. MARTIN’S PURE RUBBER BANDAGES 

(REGISTERED TRADE MARK.) 

For the radical Cure of ULCERS and other Diseases of the Legs, are 
far superior to any of the numerous imitations. 

No. 8A 6 ft. by 21 in., No. 24 wire gauge, price 8s. 6d. 

No. IB 10} ft. by 8 in., No 28 wire gauge, „ 6s. fld. 

No. 8 14 ft. by 8 in., Ho 28 wire gauge, „ 7s. 8d. 

No. 93 21 ft. by 8 in., No 28 wire gauge, „ 10a. 8d. 

No. 1A 10} ft. by 8 in. Nr. 24 wire gauge, „ ’ 7s. 8d. 

No. 7 14 ft. by 8 in No. 24 wire gauze, ,, 9s. 6d. 

No. 9A 21 ft. by 3 in., Ho 24 wire gauge, „ 18s. fld. 

CAUTION.—Please Order the Genuine Martin's Bandages, each 
being stamped with Dr. Hkhry A. Martin's 
S ignature. All others are spurious imitations. 

Complete Price List, also Dr. H. A. 
Martin s Pampnlet, poet free from the Sole 
A ' European Agents, 

U KROHNE ft 8B8EKAHV, 

Surgical Instrument M ken, 

Duke St., Manchester 8q., W. <fe 241 Whitechapel Road, Loudon* 




DISPENSING BOTTLES. 
SPECIAL NOTICE. REDUCED PRICES. 

8 and 4 ounce, plain or graduated, 8s. per gross. 

8 and 8 „ „ „ 9s. „ 

The above can be had Washed and Corked ready for use Is. per 
gross extra. They are the improved shape with rounded edges. 

WHITE MOULDED PHIALS. 

Plain or graduated, teaspoons, best quality 
} ounce, 8s. 4d. per gross. I 1} ounoe, 4s. 8d, pel gross 

1 8s. 6d. „ 2 „ 6s. Od. .7 


GLASS BOTTLE MANUFACTURERS. 

106 Midland Road, St. Pancras, LONDON, N.W. 

Bankers—L ondon & Wksthihstkr Bank. Established 60 Years 


NEW POISON REGULATIONS. 


STEPHENSON’S 

PATENT 

POISON BOTTLE 



PRICE LIST. 


PLAIN. 

8T0PPBRBD. 

} oz. Deep 

Blue 

Glass 6/6 

24/- per grow 

1 oz. 


7/0 

26/- 

1 } oz. 

II 

8/6 

28/6 

2 oz. 

II 

9/6 

30/- 

3 oz 

>1 

11/- 

34/- „ 

4 oz. 

II 

12/0 

36/- 

6 oz. 

II 

16/- 

40/- 

8 oz. 

•» 

16/6 

42/- 

10 oz. 

II 

21/- 

«>/- 

56/- 

1* oz. 

II 

24/- 

16 oz. 

II 

30/- 

62/0 

20 oz. 

>1 

34/- 

OS'- .. 

3! oz. 

II 

60/- 

75/- 

40 oz. 


00/- 

88/- 


Samples on application to any of the Wholesa 
• or Druggists Sundry Houses. 


Drug 


See opinions of the Press, Truth, Daily News, Pall Mall Gazette, &c. Ac. 
«0LB MANUKACTURKRS: 

IsIMITBD, 

Eclipse Glass Works, Lea Bridge, London, N.E. 

Manufacturen of every description of Glass Bottles, Plain or Stoppered. 
Special Laliels Tor this bottlo may ho obtained from Mr. II. Silveblock, *2 
11 lark friars Hoad. London, S.E. 


B (CELEBRATED HATS). 

WEST END HAT WAREHOUSE, 

4 GRAFTON STREET, DUBLIN. 

Several Specialities of Hate and Caps made to Medical Order affording 
much relief to Invalids suffering from Nervous or Head Affections. 


Digitized by v^ooQle 






June 28, 1809 


The Medical Press and Clroular Advertiser. 


NATURAL MINERAL WATERS 


(STATE SPRINGS) 


VICHY 


DB* 61 .-For Disease* of (he Kidney*, Grave], Gout, Rheumatum, Diabetes, etc. 

1 O- XC Z Xa Zi Z1 .-For Difeases of the Inver and Biliary Organs, etc. 

i - — For 8tomach Complaints. 


VICHY-ETAT PA8TILLE8. 

or 3 Pastilles after each ni 2 &l facilitate digestion. 


VlCHY-ETAT COM PRIMES. 

For instantaneously producing an effervescing alkaline water 


Samples and Pamphlets free to Members of the Medical Profession on application. 

OAIITION.- Each bottle from the STATE SPRINGS bears a neck label with the words “VICHY-ETAT” and the name of the 

SOLE AGENTS:- 

INGRAM & ROYLE, Ltd., East Paul’s Wharf, 26 Upper Thames Street, E.O. 

And at Liverpool, and Bristol. 


BRITISH CALF VACCINE n™™- 


1 D II MMiT^urif a? iZ L L HIGHFIELD, DRUMCONDRA, for LADIES 
1 Russell villas, Willoughby Road, Twiokennam, near Dublin. 


RICHMOND BRIDGE. 

Director—w m. FAULKNER, M.R.C.8. 

® GLYCERINATED CALF LYHPH 
aranteed of exceptionally pure 
quality. 

Put up In tin oases, oontalnlng 1 large 
Tube (2-4 Vaodnations) .. per case 1/ 
Put up in tin oaeee, oontalnlng 6 large 
Tube* (1-4 each) .. peroaae 6/ 

Sent post free on receipt of Postal Order or 
Stamp*. 

U N8ATOTACTORY Tons MXCHAX8KD nn 

or chabok. 

Specially packed for Export at same 
prfcee. Postage extra. 

Bole Wholesale Depot 

BURGOYNE, BURBIDGES, & CO., 
COLEMAN STREET, LONDON E.C. 

Telegraphic Address ’’Cyrtaa. London." 

DR. RENNER'S ESTABLISHMENT 

FOR 

VACCINATION with CALF LYMPH, 

186 MARYLEBONE RD., LONDON, N.W. 

The Oldest Original Calf Vaccine Institution In this Country. 
Pricks or Calt Lymph.—(Glyokriratkd). 

Large ... 2s. each or 8 for 6e. 

T h I Small .. Is. each or 8 for 2s. 6d. 

) „ .. sufficient for one Vaodnation only; 2 for Is. or 8 

' for 2s. 6d. 

Squares .. .. 2s. 6d. each. 

Registered telegraphic address—" Vaccine,” London. 

Sent on receipt of remittance addressed to the Manager of the 
establishment or the appointed agents 

CARRIAGES INSURED 
AGAINST ACCIDENTS 

BY THK 

IMPERIAL ACCIDENT. LIVE STOCK & GENERAL 

INSURANCE COMPANY, LIMITED. 

, Established 1878. 

Head Offices: 17 PALL MALL EAST, London, S.W. 

Carriages and other Vehicles Insured against Damage caused by 
Collision, Falling, Bolting or Kicking of the Horses, or being Run Into by 
other Vehicles. Carriages Insured for the Year or Season only.-- 
Prospectuses, Ac., Post Free. 

«GENTS WANTED. B. S. ESSEX, Manager. 

OORT UNION. 

The Board of Guardians of this Union will, at their Meeting on 
SATURDAY, the 1st day of JULY, 1899, receive applications for tire 
position of ANALYST for the Union. The gentleman appointed must 
satisfy the Local Government Board as to nls qualifications and pre¬ 
vious experience. (By Order), MYLES J. BURKE, 


17th June, 1899. 


Clerk of Union. 


Telephone No. 1032. 

Licensed under the Government Inspector*' Supervision. 

As Hospitals for the Medical Care and Treatment of Patients of the 
Upper and Middle Classes suffering from 
MENTAL AND NERVOUS DI8EASE8 
Voluntary Patients admitted without Medical Certificate. 

Relatives of Patients who desire to reside with Patients can do so. 
There are cottages for special cases on the demesne (154 acres). 
Further information can be obtained from Ithe Resident Medical 
Superintendent, Hr. MARCUS EUSTACE, M.D., any time at the 
above addresses, or at his office, 41 Grafton Street, Dublin, 
on MONDAYS, ■) 

WEDNESDAYS, 5- 2-3 p.m. 

FRIDAYS, ) 

THE RETREAT PRIVATE ASYLUM, 

Near Armagh. 

(Established 1824,) 

Licensed for the reception of ladiee and gentlemen of the upper 
and middle clawed suffering from 

MENTAL AND NERVOUS DISEASES. 
(Voluntary Hoarders and Inebriates admitted). This establish¬ 
ment has lately undergone many structural alterations and Improve¬ 
ments, and the walks and grounds are extensive and picturesque. 

Great care and attention are bestowed upon the patients; outdoor 
and indoor games, and regular carriage exercise being provided. 
Golf-links have been recently addea. 

For further information, apply to the Medical Superintendent, 
Dr. J. Gower Allbh, J.P„ or Mr. Jomph Adler, Otonallen, 
Armagh._ 

SHAFTESBURY HOUSE, FORMBY-BY- 

THE-SEA, near LIVERPOOL. 

Recently erected with all the latest Improvements, upon place 
approved by the Commissioners in Lunacy, and lioenaed for ladies 
and gentlemen mentally afflicted. Each Sitting-room, Dormitory, 
and Corridor is warmed and ventilated by special means, besides the 
ordinary fireplace. The building la surrounded by ten acres of 
ornamentally laid out pleasure grounds. Lawn tennis, cricket, and 
carriage exercise. Private «uitea of rooma if required. Terma moderate 
_ Apply to STANLEY A. GILL. B.A.. M.D. M.R.C.P.Lond- 

TREATMENT OF INEBRIETY. 

DALRYMPLE HOME, 

RICKMANSWORTH, HERTS. 

For Gentlemen under the Act and privately. Terma—2 to 6 guineas. 
Apply to the Medical Superintendent 

STRETTON HOUSE, CHURCH STRETTON, 

SALOP. 

. A Home for Insane Gentlemen.—Established 1853. 

Church Stretton lain the Shropshire Highlanda, 000 feet above sea 
level, and this establishment has the great advantages of bracing air, 
and beautiful hill scenery : also a farm, workshops, and extensive 
grounds for occupation and recreation. 

Express trains from London (4) hours) and other parts. 

For further Information see Medical Directory, p. 1948, or ap ply for 
fully Illustrated prospectus to RESIDENT MED ICAL OFFICER. 
Telegrams— Campbell Hyslop. Church Stretton. 

MEDICAL PRACTICE OR PARTNERSHIP 

Required in Ireland. Advertiser .has ample means, would accept 
Locum Fees.—Apply to the Manager, Medical Press, 10 Llucoln 
Place, Dublin. 


Digitized by v^ooQle 







the Medioal Press and Circular Advertiser. 


.tune 28, 18&9 


CONTREXEVILLE. 


Most Effective in the 
Treatment of 


GOUT, GRAVEL, ARTHRITISM. 


OHM 


... ,w,f " (Diuretic,Tonic, Digestible) 


Samples free to Alembert of the Medical Profession on application to INGRAM & ROYLE, Eat t Paul's Wharf, 26, Upp. Thames st. London, E. C. 


UNIVEBSITY OF GLASGOW. BETHLEM HOSPITAL. 


ASSISTANT EXAMINER. 

The University Court of the University of Glasgow will shortly pro¬ 
ceed to appoint an EXAMINER for Degrees in Medicine, with special 
Qualifications to examine in Zoology. The appointment will he from 
date of appointment till Hist December. 1901. The Annual Salary 


Qualifications to examine in Zoology. The appointment will he from 
date.of appointment till Hist December, 1901. The Annual Salary 
attached to the Examinership is £30. Candidates should lodge twenty 
copies of their Application and Testimonials with the undersigned on 
or before 8th July next. 

ALAN E. CLAPPERTON, 

91 West Regent Street, Glasgow. Secretary of the Court. 


INSTITUTE VERNEUIL. 

LA BAULB-EBOOUBLAC, near Bt. NAZAIRK, FRANCE. 


AN INSTITUTION FOR THE EDUCATION AND TREATMENT 
OF DELICATE CHILDREN for whom prolonged treatment and the 
Seaside is recommended (Anssmia and Struma). 

Under the patronage of eminent French Physicians and Surgeons. 
Inclusive terms 200 franca a month, no extras. 

Apply to DlRBCTECK, 


4 RUE DU GENERAL FOY, PARIS. 


ARMY MEDICAL SERVICE 

A N EXAMINATION of CANDIDATES for 

21 TWENTY-EIGHT COMMISSIONS In the ROYAL ARMY 
MEDICAL CORPS will be held at the Examination Hall, Victoria 
Embankment, W.C., on 28th July, 1S99, and following days. 

Applications to compete should be made not later than the 17th 
July, on which date the list will be closed. 

The following is the scale of pay, stated in annual amounts 


Lieutenants and Captains 

Major* . 

Lieut.-Colonels 

Colonels . 

Surgeon-Generals .. 


£200 to £273 16s. Od. a year. 
£366 to £410 12 b. Od. 

£456 to £601 16s. Od. „ 

£730 .. 

£1,008 16s.. 


Surgeon-Generals. £1,008 16s.. 

Exclusive of quarters, fuel, servants. Ac., or allowances In lieu. 
GRATUITIES AND PENSIONS. 

After 10 years' sei vice.gratuity of £1,250 

„ 16 „ „ . „ £1,801 

„ 18 „ „ . „ £2,500 

„ 20 ,, „ .. .. annual pension of £366 

26 „ „ .. „ £410 to £600 

Colonels, after 8 years' service as such about £640 

Surg.-Generals , ., , .... „ £730 

The necessary forms, together with regulations and all further In¬ 
formation, can be obtained from the Director-General, Army Medical 
Service, 18 Victoria Street, S.W. 

War Office, (Signed), J. JAMESON, 

10th May, 1899 Director-General. 


INDIAN MEDIOAL SERVICE. 

INDIA OFFICE, 31st May, 1899. 

A N EXAMINATION FOR TWENTY- 

three APPOINTMENTS TO HER MAJESTY'S INDIAN 
MEDICAL "ERVICB will be held in London on 28th July, 1899, aud 
following days. 

Copies of Regulations for the Examination, with Information regard¬ 
ing the Pay ana Retiring Allowances, Ac., of Indian Medical Officers, 
may be obtained from the Military Secretary, India Office, London, 
8.W., to whom applications for admission to the Examination, with the 
necessary certificates, should l>e sent so as to reach him not later than 
17th July, 1899. 

E. STEDMAN, Major-General, 

Military Secretary. 


MIDLAND ENGLISH COUNTY. — A GOOD 

WORKING CLASS PRACTICE of £800 per annum, can be easily In¬ 
creased, In a rapidly growing district, Including Parish and Club 
Appointments, with introduction of three or six months, opposition 
slight, suitable residence, stabling for two horses. No assistant, cen¬ 
tral position, rent £30. Vendor will dispose of Fittings, Stock, and 
Furniture, If requisite. Held by incumbent overtwelve years.—Apply 
In the first place, E. A. Paine Solicitor, Hanley, Staffs. 


THOMASTOWN UNION. 


LOCUM TENENS REQUIRED. 


Wanted, TWO RESIDENT HOUSE PHY8ICIAN8 recently qualified 
In Medicine and Surgery- 

The term of residence is for six months from June 1st, apartment*, 
complete board, and washing being provided, and an honorarium at 
the rate of £12 i2a. each per quarter will be paid. They will be under 
the direction of the Resident Physician, and are required to present 
themselves to him previous to the date of election. 

Applications, with testimonials, are to be forwarded to the Treasurer. 
Bridewell Hospital. New Bridge Street, London, EC., endorsed 
“ House Physicians.'' 

Candidates must attend at Bethlem Hospital, Lambeth Road, S.E., 
on Wednesday, at 11.30 a m , when the Sub committee will make the 
appointments. 

JOHN BREWER, Clerk, Ac. 

Bridewell Hospital, New Bridge Street, E.C., 

June, 1899. 


MITCHELSTOWN UNION. 


TRAINED NIGHT NURSE WANTED. 

The Board .of Guardians of above Union will, at their meeting 
on THURSDAY, the 6th JULY, 1699, proceed to appoint a TRAINED 
NIGHT NURSE for the Workhouse Infirmary, at a Salary of £30 per 
annum, with first-class rations and apartment. 

The term “ Trained Night Nurse," by letter of the Local Govern¬ 
ment Board, dated 12 th January , 18W, shall mean any person who has 
resided for not less than two years iu a Clinical or other Hospital 
recognised by th« Co cal Government Board, and who, after examina¬ 
tion, has obtained from such Hospital a certificate of proficiency in 
Nursing. 

Applications in Candidate's own handwriting, stating age, accom¬ 
panied hy diplomas, certificates, and testimonials as to character and 
competency, will be received by me up to 1 o'clock on Thursday, 6th 
July, 1899. 

Personal attendance desirable, but not absolutely necessary. 

(By Order), RICHARD F1TZGIBBON, Clerk of Union. 

Boardroom, Mltchelstown, 

15th June, 1899. 


COLERAINE UNION. 


TRAINED NURSE WANTED. 

The Board of Ouardians of the above named Union will, at their 


with Apartments, Rations, Fuel, and Light. 

Candidates must possess a Certificate of proficiency In Nursing from 
a recognised Hospital or other Examining Body, which must be pro¬ 
duced at the time of election. 

Applications, accompanied by testimonial aa to character and com¬ 
petency, and containing the names of two Solvent Sureties willing t» 
join applicant in a bona for £10 for the due performance of the duties 
of the office, will be received by me up to 11 o'clock, a.m., on the 8th 
proximo. (By Order), WILLIAM HENRY, 

Boardroom, Coleraine Union, Clerk of Union. 

24th June, 1899. 


CASTLEREA UNION. 


NOTICE. —NIGHT NURSE WANTED. 

The Board of Guardians of Castlerca Union will, at their Meeting t" 
be held on SATURDAY, the 8th day of JULY, 1899, appoint a Duly 
Qualified person to act as NIGHT NURSEln the Workhouse Iuflnnary 
at a Salary of £40 a year, with the usual rations and apartments. 

The peison appointed must be always prepared to undertake alter¬ 
nate day duty, to attend to Midwifery cases, and to render such other 
necessary assistance as may be required, when so directed by tbe 
Medical Officer. 

Applications, accompanied by testimonials from parish clergymen 
with Certificate of Traoilng, must be lodged with the Clerk of the 
Union before 12 o'clock, noon, on the day above named. 

Tile term “ Trained Nurse ” shall mean any person who has resided 
for not less than two years in a Clinical or other Hospital recognised 
by the Local Government Board, and who, after examination, has 
obtained from such Hospital a certlflcate-of proficiency In Nursing. 

(By Order), M. FLANAGAN, Clerk of the Union 

Boardroom, 17th day of July, 1899. 


CASTLEREA UNION. 

CASTLEREA DISPENSARY DISTRICT. 
MIDWIFE WANTED. 

The Board of Ouardians of Castlerea Union will, at their Meeting t*> 


the 6th JULY next, consider applications from gentlemen willing Qualified MIDWIFE for the District, at a Salary of £30 a year. 


to act for one month for Dr. Waishi of Graiguc, from the 16th July. 
The Guardians allow Three Guineas per week. 


Applications, accompanied by testimonials from parish 
with Certificate of Training, must be lodged In the Board 


The gentleman appointed must have the Qualifications prescribed by 12 o'clock, noon, on the day above nun... 
le Local Government Board and must reside in the District. The person appointed must reside in the village of Ballenlough. 

(By Order), L. BARRY, Clerk of Union. i (By Order), M. FLANAGAN, Clerk of the Unk> 


sh clergymen, 
rdroom la-fore 


(By Order), M. FLANAGAN, Clerk of th« Union. 
Boardroom, 17th June, 1899. 


;ed by G00gk 


24th June 1899. 













June 28, 1809 


Th e Medioal Press and Circular Advertiser. 

“THE BEST IN THE WORLD.” 




k. •Pir.T. Tw An soar, xtut iiin , ar. waie«. im. 

_ . . , I W. Best A Sons, 22 Henrietta Street, W.; 

Londim Agent*: . , D Wheatley A Sons, 24 8outh Audley Street, Vi. 

Medicinal preparation* and Phynciant' prencriptum* in Aerated Water*, in Bottle* or Syphon*, accurately and promptly pnpand 


STOWERS 

NO MUSTY FLAVOUR. LIME JUICE 


BEST. STRONGEST. PU REST. 

Supplied to Her Majesty, both Houses of Parliament, all the leading Hospitals, and the principal Ooean Linen. 
Sample post-ftec on application to the Sole Proprietor* & Manufacture., 

A. RIDDLE & CO., 36 and 38 COMMERCIAL STREET, LO NDON . 




JtCDlCAL OriWO IV7f 


PURITY. 

QUALITY. 

CHEAPNESS. 

CONVENIENCE 

ELEGANCE. 

VARIETY. 


The Medioal Profession are requested to specify C.A.M.W.A.L. 
TABLE WATERS. Every"label distinctly states the quantity of 
active ingredient Jin each half-pint of the \\ aters. Hundreds of 
Medical Men have sent written testimony in favour of C. A.M.W .A.L. 
Table Waters. 

Lists of nearest A«ents on reoeipt of post-card to the Secretary 
45 Gifford Street, London, N. 

O.A-M.W.A.L. supplies Chemists and Hospitals only ; over 4,000 
Chemists have joined hands in this business, and this number is 
steadily increasing. 

London, Manchester. Birmingham, Bristol, Harrogate & Mitcham. 


ptmga&i Smtos 

BEST AND SAFEST ^NATURAL APERIENT. 

25 YEARS’ SUCCESS IN THE UNITED KINGDOM. 

Recommended and Prescribed by Medical Men Everywhere. 

“ HUNTADI JANOS has established itself in favour with leading physicians and 
therapeutists of every country, whose testimonies bear witness to its action as a speedy, 
sure, and gentle Aperient for ordinary use; it is remarkably and exoept : onally uniform in 
its composition, and free from defects incidental to many other Hungarian Bitter 
Waters .”—British Medical Journal , August 80th, 1884. 

PROFESSOR VIROHOW, the celebrated Berlin Physician, says that “HUNTADI 
JANOS ” has always given him prompt and satisfactory results, and be considers it to be “ one 
of the most valuable of the Ourative Agents at our disposal.” 

CA XJTION.—Every Bottle heart the Signature of the Proprietor AN DEE AS 8AXLE HNEE. 

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xxii 


The Medical Press and Giroular Advertiser. 


June 28, 1890 


Royat-les-Bains. — MAISON-du-GBANDE MONDE. — France. 

GHOCOLATERIE-de-ROY^T. 

I "7i‘o KI "' CHOCOLATalaMODE. Write for Price Lists “ 











GRAND 


J^Mjctesn/ JfytoXj 


RUGEN-HOTEL, JUNGFRAUBLICK. 

First-Class in every respect. Electric Lighting. Telephones. Lift. Tennis. 
Unrivalled Views over Lakes, Glaciers, Valleys, and Alps. 

Choicest and healthiest situation; not too elevated for comfort in May and 
June, yet with deliciously cool breezes from the SUberhom Glaciers in July 
and August. 

Reduced Terms for June. 

Mr. and Mrs. OESCH MULLER, Proprietors. 


AIX-LES-BAINS 


19 hours fW)m London. 
9 hours from Paris. 


(SAVOIE.) 

THE MOST POPULAR AND FASHIONABLE WATERING-PLACE IN FRANCE. 
SULPHUR and ALUM HOT-SPRINGS. (1,125,000 gallons per day.) 

Large Bath Establishment, enlarged and completely renewed in 189S. 
Successfully treated at Aix-les-Balns :-Rheumatism Sciatica, Gout, Nodosity of Joint*, Catarrhs, 
Feminine Diseases, Chronic Catarrhal affections ot the Digestive, Uterine, and Urinary passages, 
THE MOST DESIRABLE HEALTH RESORT OF EUROPE. 


AIX-LES-BAINS. 

Tblkcirapii Address : 

“GRAND HOTEL, AIX-LES-BAINS. 


G** nD 

d’Aix. 


HIGH-CLASS RESIDENTIAL HOTEL. 
LIFT. ELECTRIC LIGHT THROUGHOUT 

GUI BERT. Proprietor. 


NS. 

(ISERE, FRANCE.) 

8 EA 8 ON from May 25th to October 15th. 

SALINE, PURGATIVE!, and 8ULPHUROU8 WATERS. 
Treatment of DISEASES of the SKIM. 

Lymphatlsm, Rheumatism, Byphilia, Eto. 

Baths, Douches, Pulverisations, Hydro-Therapeutlos, Mnd 

HEALTH RESORT. 

Apply to the DIRECTOR Of the ETABLISSEMENT at URIAGE. 


Season—April to October.] 

INTERLAKEN. 


[Altitude 1,893 feet above the Sea. 
The most renowned HEALTH RESORT in the BERNESE- 
OBERLAND, Switzerland. 

Specially recommended for Chronic CATARRHAL Affections of the Larynx. Bronchial. 
Membrane, Stomach and Intestines. 

Also for Dyspepsia, Neuralgia, Rheumatism, Amentia, and NERVOUS DERANGE- 
MENTS CASINO, GARDENS, PROMENADES, and HOTELS brilliantly 
lighted by ELECTRICITY. 

Splendid Mountain Excursions. Charming Walks in Pine-Woods. Superb Scenery. 


June 28, 1899 The Medical Press and Circular Advertiser. _ 

CONTINENTAL HEALTH RESORTS AND HOTELS. 


Altitude 1,800 feet 

BRIDES AND SAUNS-MOUTIERS. wvV&Sfo*. 

(Nfear AIX-les-BAINS, SAVOY, FRANCE.) 

nninre ( For Maladies of the Intestines, Kidneys, Liver, (Indian Liver), Constipation, 
DnlUE.0 \ Diabetes, Corpulence, Gout, Dyspepsia, etc. 

•'TAI INC MHIITirDC / For Anaemia, Rickets, Lyinphatism, Chlorosis, Feminine 
uIhLIIqu - hIUU I 11.110 Troubles, Infantile Maladies, Rheumatism. 

These two adjacent HEALTH STATIONS conjointly offer SPECIFIC ADVANTAGES 
FjjJ NOT to be ELSEWHERE FOUND TOGETHER. 

Mountain Excursions Unsurpassed. English Church. Casino. Theatre. Concerts. 

HOTEL-des-THERMES.- Lift. Electric Lighting. Every Modern Luxury. 


Lift. Electric Lighting. Every Modern Luxury. 


Digitized by V 


KAISER FRIEDRICH 
QUELLE 

(A Mineral Spring containing 
Soda and Lithia.) 

OFFENBACH A/M MAIN. 


Observations made In the Hospital of the University of Gottingen 
have proved that when the water of the Kaiser Friedrich Quelle is 
taken the urine becomes more capable of retaining uric acid in 
solution. The use of the water to the extent required to bring about 
this result may he continued for a long time without producing any 
ill effects. It is therefore an excellent table beverage for all those 
who either have a tendency to the uric acid diathesis or suffer from its 
consequences, such as sandy deposit in the urine, gout, and 
formation of concretions. Special terms to Medical Men. Samples 
supplied gratis by all Wholesale Dealers in Mineral Waters, qr 
forwarded direct from the Spring at Offenbach a/m Main, 


The most Perfect Natural Mineral Water of the Vichy Basin . 

The Coldest and the Least Changeable 


by Transport. 


(DISCOV ERED IN 1853). 

Sovereign Remedy in Diseases of the liver 

the stomach and kidneys, diabetes, gravel and gout. 

PRICE-20 fr. per case of 50 litres, at VICHY. Depot at all CHEMISTS and DEALERS in MINERAL WATER! 






















XXIV 


The Medioal Press and Ciroular Advertiser. 


Jape 88. 1899 


*• The predominance of Magnesium Sulphate and the 
“ presence of Lithium in APENTA WATER having been 
“ recently pointed out by Professor Pouchet, I determined 
“ to ascertain for myself the properties of this water, and 
“ for this purpose I prescribed it to a large number of my 
“ patients. 

“ My observations have proved that APENTA WATER 

“ is an excellent, very active purgative, and of strictly 
“ constant composition. Its action is mild and reliable, 
“ and a wineglassful or half a glass acts as an aperient 
‘ without producing either griping or discomfort. It 
“ is the Water specially suited for the treatment of habitual 
“ constipation. Moreover, by its special and constant 
“ composition this Water appears to me to merit a place 
“ by itself in the therapeutics of Mineral Waters.” 

Paris, 4th February, 1899 

Dr. E. Lancereaux, 

Profeaaeur d la Facvlte de Medecine, Paris; Medecin honoraire des Hupitauar. ; 

Membre de VAcademic de Medecine. 


“APENTA” 

THE BEST NATURAL APERIENT WATER. 


Sole Importers: THE APOLLIHARIS COMPANY, Ltd., LONDON. 

Stated tor the Proprietor and Published every Wednesday morning by Albert Alfred Tindall, King William street Strand. London 

Dublin : A. H. Jacob, 10 Lincoln Plano. 


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